Undergoing an amputation can be a life altering procedure for many patients. Despite this, we know relatively little about how best to support these patients to help ensure their psychologically prepared for what is to come. The pre-operative period is often compressed, with the need for surgery to be conducted urgently This presents a challenge for clinical staff in how best to help patients with preparing for what is to come. Our team at De Montfort University recently completed a four-year study to explore the psychological preparation of amputation patients. The study- ‘PreAmp’- aimed to understand more about how preparation work is currently conducted, to explore the barriers and facilitators to psychological preparation of patients, and then to work with patients and clinical staff to co-design resources to help support preparation. We conducted an extensive range of research activities, including a survey of healthcare staff, interviews with existing amputees, ethnographic observations of preparation work in vascular wards as well as interviews with healthcare professionals and patients in those wards.

We found that both patients and healthcare professionals feel that preparation is very important, but at present this often does not happen in the ways that both patients and staff would like it to. Good psychological preparation for amputation requires the provision of clear information, staff need to include patients in conversations about their care and patients need time and space to work through any questions they have. Preparation is very much a multidisciplinary activity and teams working together- with the patient as a central part of the team- is a key way of ensuring effective preparation. There is a need to include people who work outside of hospitals, such as social workers/ social care services in preparing patients, though often that does not happen and delays in discharge are often as a result of this. Vascular wards are very busy, with staff under significant pressures, and as a result there is often not a lot of time to spend on the preparation of patients. Vascular services cannot routinely access psychological services for their patients, yet this is a major need for patients who experience anxiety and distress as a result of the need for amputation. Often it is allied health professionals who have to attempt to counsel patients despite it not being their area of expertise. Patients would also like to be able to talk to existing amputees as part of their preparation, those with lived experience of amputation are seen as helpful to people about to have an amputation. From this research we then created resources to help with preparation for having amputations. We co-designed these resources with amputees and healthcare professionals to make sure they were fit for purpose. The resources we developed are:

We are proud to present the BJS Prize session from 49th ASiT Annual Surgical Conference held at the ICC Belfast from 7-9 March 2025. The BJS Prize winner was Hashem Malkawi: "Open repair vs endovascular repair in connective tissue disease patients with thoracoabdominal aortic pathologies - a systematic review & meta-analysis".

Leinweber ME, Rahmaditya FS, Hinchliffe RJ

Br J Surg 2025; 112: znaf051.

Correspondence to: Ranjith Kumaran Ramu (e-mail: ranjithkumaran2009@gmail.com)

Senior Resident

Department of General Surgery

Correspondence to: Simon Lundström (e-mail: Simon.Lundstrom@med.lu.se)

Department of Surgery

Skåne University Hospital

Despite an increasing emphasis on patient safety, modern surgical practice is still plagued by the occurrence of serious Adverse Events (AEs). A large proportion of these AEs are caused not by technical errors, but short comings in non-technical skills (NTS) or non-technical errors.1 NTS are the cognitive and interpersonal components of surgical professionalism including communication, decision-making, situational awareness and leadership.2 Few studies have attempted to quantify the significance of non-technical errors leading to patient harm. Those that have, only include small, non-representative cohorts, or have assessed for NTS shortcomings using heterogeneous, non-standardised, and non-comprehensive assessment methods.3-6 As a result, the true impact of non-technical errors, and information about how, when, and why these errors occur are poorly understood. Evidence to guide NTS improvement is lacking.

This study7 aimed to investigate the incidence of non-technical errors linked to patient death in a large representative Australian cohort, investigate factors associated with fatal non-technical errors, and whether the incidence of non-technical errors had changed over time. To achieve this, an 8-year retrospective audit using surgical mortality cases was conducted. Data were derived from the Australian and New Zealand Audit of Surgical Mortality (ANZASM) a mandatory, national surgical mortality audit overseen by the Royal Australasian College of Surgeons. In Australia, every surgical death is reported to ANZASM for external peer review for the purpose of identifying clinical management issues (CMI’s) that could be improved in future. CMI’s are rated on a three-tiered system with ‘area of concern’ or ‘Adverse Event’ representing the two most serious. All surgical deaths between 2012-2019 (excluding New South Wales), flagged with an area of concern or AE were included with no further exclusions. Each case was assessed using the System for Identification and Categorization of Non-technical Errors in Surgical Settings (SICNESS), a validated tool, developed by the study authors.8 The SICNESS enabled assessors to identify if a non-technical error linked to patient death had occurred, and if so, to which NTS domain it belonged.

There were 30,971 surgical deaths reported to ANZASM during the study. Of these, 3829 were flagged with an AE or Area of concern. Some 134 had insufficient information for assessment, leaving 3695 cases for review. A non-technical error linked to patient death was identified in 2354 cases (63.7%). Of the cases with non-technical errors, 1375 (58.4%) had decision making errors, 1328 (56.4%) had situational awareness errors, 357 (15.2%) had communication/teamwork errors, and 128 (5.44%) had leadership errors.