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Fertility and Pregnancy Outcomes in Female Physicians in Procedural Specialties: A Large National Survey
Vol. 223, No. 4S1, October 2016
support, or those who are reluctant to seek care early to decrease rates of perforation. Fertility and Pregnancy Outcomes in Female Physicians in Procedural Specialties: A Large National Survey Rebecca Scully, MD, Nelya Melnitchouk, MD, Jennifer S Davids, MD Brigham and Women’s Hospital Boston, MA, University of Massachusetts Medical School, Worcester, MA INTRODUCTION: Concern exists that female physicians in procedural specialties may have higher risk of pregnancy complications and decreased fertility than women in non-procedural specialties. We hypothesized that women in procedural specialties face greater self-reported challenges with fertility and pregnancy complications, leading to increased time out of work. METHODS: Data from 1,559 US attending female physicians was gathered via an anonymous, IRB-approved online survey. Univariate analysis was performed using Chi-squared and Student’s Ttest. A multivariable model was constructed to determine impact of procedural status on use of in-vitro fertilization (IVF) and pregnancy complications. RESULTS: Proceduralists (n¼400, 25%) were more likely to report older age at first pregnancy than non-proceduralists (>30 years old: 75.0 % vs 67.7%, p¼0.006). Controlling for age at first pregnancy, there was no difference between proceduralists and non-proceduralists in IVF use (OR 1.13, 95% CI 0.85-1.49, p¼0.40) or delayed conception (>1 year: OR 0.89, 95% CI 0.67-1.19, p¼0.44). While overall 28.5% of respondents reported missing work during pregnancy, there was no difference between proceduralists and non-proceduralists (29.5% vs 25.5%, p¼0.13). Controlling for age, proceduralists were less likely to be placed on bedrest (OR 0.62, 95% CI 0.42-0.92, p¼0.02) and there was no difference between groups in the frequency of missed work due to preterm labor, preeclampsia, or hyperemesis gravidarum. CONCLUSIONS: Although proceduralists were more likely to delay pregnancy, they had lower rates of bedrest and comparable rates of reproductive assistance and missed work due to pregnancy-related complications. Data from this large-scale national survey suggest that pregnancy outcomes are not worse for proceduralists.
Scientific Forum Abstracts
S109
Commission (JC) Error Taxonomy is used to classify such events in real patients. We hypothesized that JC taxonomy classification of errors identified in repeated, in situ simulations after trauma center relocation would demonstrate fewer errors over time. METHODS: After a mature trauma center was relocated to a different hospital (February 2015), weekly or bimonthly multidisciplinary in situ simulations were conducted in the trauma bay, operating room, post-anesthesia care unit, surgical ward, or ICU. With IRB approval, 23 simulations (FebruaryeSeptember) were reviewed and identified 167 errors/adverse events that were classified into the 4 spheres of the JC taxonomy. Number of events (Median [IQR]) identified per simulation are reported for each of 3 time periods. The Kruskall Wallis test with post-hoc subgroup Bonferroni correction was used for analysis. RESULTS: Most events were seen early after the trauma center relocation. Less severe impact events decreased significantly after the first period (Table) but more severe harm events remained rare throughout (5 [1-7] to 3.5 [1-5] events/simulation). Event types related to patient management decreased but not significantly while those related to communication remained stable. Provider domain remained unchanged for both nurses and physicians, many of whom had transferred from the old hospital. Organizational system causes were significantly less frequent in both later time periods (Table). Table.
Event
All significant Period 2 p values Period 3 Apr/May Period 1 between Jun/Sept (n¼8), (n¼8), Feb/Mar (n¼7), time periods Median [IQR] Median [IQR] Median [IQR]
IMPACT: all less severe harm 5 [3-8]
2.5 [2-4]
3[2.5-4]
1 vs 2, p¼0.01
IMPACT: minimal temporary harm 4 [2-5]
1 [1-1.5]
2[1-3]
1 vs 2, p¼0.003
TYPE: Patient communication
2 [1-2]
1 [0-1.5]
2[1-3]
All NS
TYPE: Patient management
7 [3-10]
2.5 [0.5-4.5]
2.5[1-3]
All NS
DOMAIN: Physician
3 [1-4]
1.5 [1-3.5]
3.5[2.5-4.5]
All NS
DOMAIN: Nurse
1 [1-3]
1 [0.5-1.5]
1[0-1.5]
All NS
2.5 [0.5-3]
3[2-3]
1 vs 2, p¼0.004 1 vs 3, p¼0.01
0.5 [0-1]
1[0-1]
1 vs 2, p¼0.006 1 vs 3, p¼0.02
CAUSE: Total Systems -organizational
5 [4-7]
CAUSE: Systems- organizational- culture 2 [1-3]
CONCLUSIONS: Using the JC taxonomy to classify adverse events discovered during repeated In situ simulations is an excellent method to track system processes and demonstrate changes in provider care.
Gauging Trauma Center Quality Improvement by Classifying Adverse Events from Recurring in Situ Simulations Using the JC Taxonomy Kinza Akhunzada, Daniel N Holena, MD, FACS, Patricia Abel-Baker, Gregory Motuk, Janet Mcmaster, Patrick K Kim, MD, FACS, Mook M Megan, Sara Holland, Brian P Smith, MD, Jose L Pascual, MD, FACS, FCCM Perelman School of Medicne at the University of Pennsylvania, Philadelphia, PA
Identifying Quality Markers of a Safe Surgical Ward: An Interview Study of Patients, Clinical Staff and Administrators Yasmin AM Hassen, MBBS, Pritam Singh, MBBS, PhD, Philip H Pucher, MD, Maximilian J Johnston, MBBCh, PhD, Ara W Darzi, MB BCH, FACS(Hon) Imperial College, London, UK
INTRODUCTION: In situ simulations are used in healthcare to identify errors, adverse events, and latent threats. The Joint
INTRODUCTION: Patient safety within the operating theatre has been examined extensively. However, errors in the perioperative
support, or those who are reluctant to seek care early to decrease rates of perforation. Fertility and Pregnancy Outcomes in Female Physicians in Procedural Specialties: A Large National Survey Rebecca Scully, MD, Nelya Melnitchouk, MD, Jennifer S Davids, MD Brigham and Women’s Hospital Boston, MA, University of Massachusetts Medical School, Worcester, MA INTRODUCTION: Concern exists that female physicians in procedural specialties may have higher risk of pregnancy complications and decreased fertility than women in non-procedural specialties. We hypothesized that women in procedural specialties face greater self-reported challenges with fertility and pregnancy complications, leading to increased time out of work. METHODS: Data from 1,559 US attending female physicians was gathered via an anonymous, IRB-approved online survey. Univariate analysis was performed using Chi-squared and Student’s Ttest. A multivariable model was constructed to determine impact of procedural status on use of in-vitro fertilization (IVF) and pregnancy complications. RESULTS: Proceduralists (n¼400, 25%) were more likely to report older age at first pregnancy than non-proceduralists (>30 years old: 75.0 % vs 67.7%, p¼0.006). Controlling for age at first pregnancy, there was no difference between proceduralists and non-proceduralists in IVF use (OR 1.13, 95% CI 0.85-1.49, p¼0.40) or delayed conception (>1 year: OR 0.89, 95% CI 0.67-1.19, p¼0.44). While overall 28.5% of respondents reported missing work during pregnancy, there was no difference between proceduralists and non-proceduralists (29.5% vs 25.5%, p¼0.13). Controlling for age, proceduralists were less likely to be placed on bedrest (OR 0.62, 95% CI 0.42-0.92, p¼0.02) and there was no difference between groups in the frequency of missed work due to preterm labor, preeclampsia, or hyperemesis gravidarum. CONCLUSIONS: Although proceduralists were more likely to delay pregnancy, they had lower rates of bedrest and comparable rates of reproductive assistance and missed work due to pregnancy-related complications. Data from this large-scale national survey suggest that pregnancy outcomes are not worse for proceduralists.
Scientific Forum Abstracts
S109
Commission (JC) Error Taxonomy is used to classify such events in real patients. We hypothesized that JC taxonomy classification of errors identified in repeated, in situ simulations after trauma center relocation would demonstrate fewer errors over time. METHODS: After a mature trauma center was relocated to a different hospital (February 2015), weekly or bimonthly multidisciplinary in situ simulations were conducted in the trauma bay, operating room, post-anesthesia care unit, surgical ward, or ICU. With IRB approval, 23 simulations (FebruaryeSeptember) were reviewed and identified 167 errors/adverse events that were classified into the 4 spheres of the JC taxonomy. Number of events (Median [IQR]) identified per simulation are reported for each of 3 time periods. The Kruskall Wallis test with post-hoc subgroup Bonferroni correction was used for analysis. RESULTS: Most events were seen early after the trauma center relocation. Less severe impact events decreased significantly after the first period (Table) but more severe harm events remained rare throughout (5 [1-7] to 3.5 [1-5] events/simulation). Event types related to patient management decreased but not significantly while those related to communication remained stable. Provider domain remained unchanged for both nurses and physicians, many of whom had transferred from the old hospital. Organizational system causes were significantly less frequent in both later time periods (Table). Table.
Event
All significant Period 2 p values Period 3 Apr/May Period 1 between Jun/Sept (n¼8), (n¼8), Feb/Mar (n¼7), time periods Median [IQR] Median [IQR] Median [IQR]
IMPACT: all less severe harm 5 [3-8]
2.5 [2-4]
3[2.5-4]
1 vs 2, p¼0.01
IMPACT: minimal temporary harm 4 [2-5]
1 [1-1.5]
2[1-3]
1 vs 2, p¼0.003
TYPE: Patient communication
2 [1-2]
1 [0-1.5]
2[1-3]
All NS
TYPE: Patient management
7 [3-10]
2.5 [0.5-4.5]
2.5[1-3]
All NS
DOMAIN: Physician
3 [1-4]
1.5 [1-3.5]
3.5[2.5-4.5]
All NS
DOMAIN: Nurse
1 [1-3]
1 [0.5-1.5]
1[0-1.5]
All NS
2.5 [0.5-3]
3[2-3]
1 vs 2, p¼0.004 1 vs 3, p¼0.01
0.5 [0-1]
1[0-1]
1 vs 2, p¼0.006 1 vs 3, p¼0.02
CAUSE: Total Systems -organizational
5 [4-7]
CAUSE: Systems- organizational- culture 2 [1-3]
CONCLUSIONS: Using the JC taxonomy to classify adverse events discovered during repeated In situ simulations is an excellent method to track system processes and demonstrate changes in provider care.
Gauging Trauma Center Quality Improvement by Classifying Adverse Events from Recurring in Situ Simulations Using the JC Taxonomy Kinza Akhunzada, Daniel N Holena, MD, FACS, Patricia Abel-Baker, Gregory Motuk, Janet Mcmaster, Patrick K Kim, MD, FACS, Mook M Megan, Sara Holland, Brian P Smith, MD, Jose L Pascual, MD, FACS, FCCM Perelman School of Medicne at the University of Pennsylvania, Philadelphia, PA
Identifying Quality Markers of a Safe Surgical Ward: An Interview Study of Patients, Clinical Staff and Administrators Yasmin AM Hassen, MBBS, Pritam Singh, MBBS, PhD, Philip H Pucher, MD, Maximilian J Johnston, MBBCh, PhD, Ara W Darzi, MB BCH, FACS(Hon) Imperial College, London, UK
INTRODUCTION: In situ simulations are used in healthcare to identify errors, adverse events, and latent threats. The Joint
INTRODUCTION: Patient safety within the operating theatre has been examined extensively. However, errors in the perioperative