Error Traps and Culture of Safety in Abdominal Wall Defects
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Key Takeaways
- Spring-loaded silos in gastroschisis work well but can cause bowel necrosis and perforation—recognize this error trap.
- Prenatal ultrasound findings may indicate need for premature delivery in gastroschisis; don't assume term delivery is always safe.
- Gastroschisis and omphalocele require distinct safety approaches—separate your management protocols for each condition.
- Culture of safety in abdominal wall defects spans prenatal diagnosis through long-term follow-up—address risks at every stage.
- Error traps are interventions that succeed most of the time but fail in specific nuances—identify and mitigate these scenarios.
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Transcript
The June issue of Seminars and Pediatric Surgery focused on a topic that's important to every pediatric surgeon: improving the healthcare we deliver to children around the world. Follow along with our latest video series as we highlight articles that help enhance the culture of safety from various pediatric surgical subspecialties. And you might recognize a few well-known faces and names along the way. Here's a quick summary of error traps and culture of safety in abdominal wall defects with guest video reviewer, Dr. Sherif Emil. Now, a culture of safety is a deliberate way of doing things to avoid complications. And error traps are things that work well most of the time, but can have certain nuances where sometimes they do not work well. For example, in the care of gastroschisis cases, the spring loaded silo works quite well for the majority of patients, but can also lead to very significant complications such as bowel wall necrosis and perforation. So this is an example. In writing this article, I looked at all the literature, really that has been published so far on safety issues in the treatment of abdominal wall defects as well as complications. Because gastroschisis cases and omphalocele have really very different issues, I separated the two. And for each topic, I started from the prenatal factors that could be involved. For example, in gastroschisis cases, one of the error traps is to assume that there would be no reason to do a premature delivery. But in fact, there can be findings on ultrasound that should alert us to closing gastroschisis cases or other complications where a premature delivery may be needed. And so on and so forth for omphalocele as well, and I go through all of the steps in the care of abdominal wall defect patients from the prenatal diagnosis to the immediate post-natal care, even going into long-term follow up. I think you'll find this article very useful and I think you'll find it helpful in managing abdominal wall defect patients in a safe manner and avoiding error traps. Thank you so much and I encourage you to read the article.