There are a myriad of risk factors for surgical mortality, intraoperative and postoperative complications, and prolonged length of stay. Effectively identifying possible risk factors in the preoperative patient profiles that may impact the outcome of elective open intestinal resection has significant implications on the quality of care, the safe delivery of surgical care, and the speedy recovery of patients undergoing elective open intestinal resection. Few studies specifically focused on the construction of individual preoperative patient risk profile used only preoperative patient profiles in elective open intestinal resection. A retrospective cohort predictive study was conducted to assess the impact of preoperative patient profiles on surgical outcomes in patients undergoing elective open intestinal resection using 2009-2011 Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) databases. This study aimed to identify independent predictors in the preoperative patient profiles for the development of preoperative patient risk profiling tool for the construction of an individual preoperative patient risk profile for risk stratification, surgical planning, and care coordination for patients undergoing elective open intestinal resection. The results of this study showed that independent predictors in the preoperative patient profiles could predict the risks of increased adverse surgical outcomes in terms of in-hospital mortality, in-hospital complications, and prolonged length of stay in patients undergoing elective open intestinal resection. Independent predictors of increased adverse surgical outcomes were identified in the personal domain, the social history domain, and the comorbidity domain of preoperative patient profiles. In the personal domain profile, advanced age was an independent predictor of increased in-hospital mortality, prolonged length of stay (LOS), and six of the eight categories of in-hospital complications studied, except mechanical wound complications and infection complications. The 18 to 39 age group was more likely to develop the latter two complications. Male gender was an independent predictor of in-hospital mortality, prolonged LOS, and six of the eight in-hospital complications except intraoperative complication and systemic complications. Asian/Pacific Islanders were more likely to have intraoperative bleeding complication while black patients were more likely to have gastrointestinal complications and prolonged LOS compared to white patients. In the social history domain profile, patients with alcohol abuse were more likely to suffer pulmonary complications and have prolonged LOS. Patients with illicit drug abuse were more likely to have prolonged LOS as well. Four comorbidities, fluid and electrolyte disorders, weight loss, coagulopathy, and congestive heart failure, were identified as the strongest independent predictors of increased adverse surgical outcomes overall, except in the cardiovascular complications. Pulmonary circulation disorders were the strongest independent predictors of cardiovascular complications. Other comorbidities that were statistically significant and unique predictors of adverse outcomes were also identified. Patients without comorbidity were less likely to have increased in-hospital mortality, prolonged LOS, and in-hospital complications. These findings have significant implications in developing preoperative patient risk profiling tools for the construction of an individual preoperative patient risk profile for risk stratification, surgical planning, and care coordination in patients undergoing elective open intestinal resection.

Background: Cesarean delivery rates have been increasing since 1996, and Cesarean delivery is now the most common major operative procedure performed in the United States. Identifying risk factors for wound complications following Cesarean delivery is necessary to prevent unnecessary maternal morbidity. Methods: A case-control study was carried out and data was collected via a medical record review for patients undergoing a Cesarean delivery at the UIHC between 10/1/2011 and 12/31/2012. Results: Several modifiable risk factors were identified, and models based on patient and surgical factors performed better than the current standard NHSN risk index model. Conclusion: More robust prediction models can be created using patient and surgical factors.

Current state: Using tools to identify and analyse risks is presently very important in nursing to minimise the risk of harm to patients that can be prevented. The FMEA (Failure Mode and Effect Analysis) is a very efficient tool to address the failure issue. It is an important preventive method determining possible failures and proposing preventive measures to minimise the risk of errors. The RCA (Root Cause Analysis) is another important tool to handle failures. Objectives of the work: The objective of the research was to determine processes with the highest risks in nursing and to find out the most common risks associated with the nurse profession. Another objective is to describe the undesirable events reporting methods and to find out the utilisation of all risk analysis methods by nurses. And the final objective was to describe the intervention fall prevention programmes.Methodology: A qualitative research method was used to prepare the empirical part of the thesis. Data were collected using in-depth interviews. Qualitative data were coded using the pencil and paper technique; data were then categorised and respective subcategories were determined and shown in the SmartArt application. Research participants: Interviews were conducted with the head nurse, quality manager, senior nursing officer and departmental sister from the department of internal medicine, department of neurology and aftercare department. The first research was conducted in Nemocnice Jindřichův Hradec, a.s., the second in Nemocnice Tábor, a.s. and the final one in Nemocnice Písek, a.s. Results: It was found out from the results of the qualitative research that the most risky processes included medication in form of pills when, for example, generics drugs are given incorrectly or drugs of wrong strength are administered. The second risk process is the preparation of drugs from concentrated solutions of kalium, heparin or insulin. Administering intravenous drugs and infusion solutions is the third risky process. Too many activities of a nurse at one time is often the cause. Non-cooperation, poor communication of the patient and his/her family also lead to risky situations.Another serious group of risky processes includes patient transfer, moving the patient from a stretcher to a bed or going to the toilet. Further, it was found out that the most common risks are nosocomial infections, falls and decubital ulcers. Too much workload of nurses and new staff undergoing training are also mentioned as a risk. They include in particular medical assistants. Prescribing drugs through a computer system where the doctor relies on the nurse that she will alert when wrong drugs are prescribed although it is not her obligation to do so is also considered a common risk. Closing the infectious department in a hospital is the next risk. Patients who have a suspicion for certain diseases are then examined in a department. Nurses working there are afraid of getting infected from the ill person. And quite often, a disease is really found in the patients. Respondents gave different answers to the procedure of reporting undesirable events. The answers were different from one hospital to another. Nevertheless, all the reporting go to the hospital management that evaluates it. Nurses in the inquired hospitals do not use any risk analysis method. Not even nurses in management positions do not work with the methods and do not know the FMEA method. A direct analysis is addressed by the quality manager who most often uses the RCA analysis. Its results are discussed at meetings of nurses in the department, meetings of senior nursing officers or meetings of chief physicians. As for preventive programmes reducing the risk of falls it was found out that in all hospitals the screening of the risk of falls is standardly performed in all patients upon admission, except hospitalisations shorter than 3 days.

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