PONE-D-22-33805We are submitting the manuscript entitled “Impact of the implementation of Identification-Situation-Background-Assesment-Recommendation (ISBAR) tool as improving quality and safety measure in a lithotripsy and endourological Unit”.PLOS ONE

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Academic Editor

PLOS ONE

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Additional Editor Comments (if provided):

interesting paper, perform the revisions required .

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Reviewers' comments:

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Comments to the Author

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Reviewer #1: Yes

Reviewer #2: No

Reviewer #3: Partly

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: No

Reviewer #3: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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Reviewer #1: Yes

Reviewer #2: No

Reviewer #3: Yes

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5. Review Comments to the Author

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Reviewer #1: I read with great interest the manuscript by Gadea-Company et al. on the implementation of ISBAR tool to improve quality and safety measures. The paper is relevant and sound. However, I have some minor issues to be addressed.

Title. Please modify into "IMPACT OF THE IMPLEMENTATION OF IDENTIFICATION-SITUATION-BACKGROUND-ASSESSMENT-RECOMMENDATION (ISBAR) TOOL TO IMPROVE QUALITY AND SAFETY MEASURE IN A LITHOTRIPSY AND

ENDOUROLOGICAL UNIT"

Introduction.

- Acronyms should be written in full the first time they appear in text. Please modify into: "The mnemonic tool Identification-Situation-Background-Assessment-Recommendation (ISBAR) was established to improve..."

- You should mention the surgical technique in use for percutaneous nephrolithotomy (doi: 10.1007/s00345-017-2001-0) and state that it could be performed under general (doi: 10.4111/kju.2013.54.3.172) and spinal anesthesia (doi: 10.23736/S0375-9393.22.16969-5). Please briefly discuss and add these 3 references.

Results.

- Please specify the acronym NPR in Table 5.

Discussion.

- Simulation for surgical training is also a valid and well known tool to increase patient safety and quality of surgical procedures (doi: 10.1016/j.nec.2014.11.002 - doi: 10.1136/qshc.2010.042424). Please discuss.

Reviewer #2: Aim of this manuscript is to assess the impact of introduction of surgical safety checklist on perioperative outcomes of endourology procedures in a large referral center. Topic is relevant and efforts of Authors are praiseworthy; however, the manuscript shows several inherent flaws.

-Firstly, the retrospective nature of the study impacts on the overall reliability of results. Moreover, the Authors only included patients treated with "high-risk" endoscopic procedures (PCNL) due to the increase likelihood of periop complications and also they excluded patients with high surgical risks. These arbitrary selections negatively impact on the reliability of results.

-The Authors concluded that the introduction of surgical safety checklist reduced rate of sepsis and that also influenced lenght of hospital stay. However, difference in terms of sepsis rates between the two study groups was not statistically significant. Therefore, these conclusions cannot be drawn.

-Preoperative and postoperative features should be reported as median (IQR) rather than mean (SD).

Reviewer #3: 1-Why do you compared two non-equal numbers of patients?

2-As long as it is in urological unite why should not include all the types od surgery, some time easy cases have miss-conduction.

3-Bleeding was included in the complication!

4-There are some minor differences in your outcomes, but they are non-significant enough to support your conclusion.

5-How you reached the conclusion: effective safety tool.

6-Who secure the anonymity of the participants?

7-How both groups are comparable, and data shows female 173 Group A and 46 Group B, meanwhile the 173 is not 50.7% of 357 patients.

8-Both DM 1 and 2 are more frequent and significant. Do you think this may affect the outcomes?

9-Sepsis has many predisposing factors: Do you think it has been reduced by ISBAR only?

10- Postoperative hospital stay will be prolonged also due to leakage and bleeding not only sepsis.

11- Reference 7 and 17need correction.

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: No

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Impact of the implementation of Identification-Situation-Background-Assesment-Recommendation (ISBAR) tool to improve quality and safety measure in a lithotripsy and endourological Unit.

PONE-D-22-33805R1

Dear Dr. GADEA-COMPANY,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Antonino Maniaci

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: