Please Note: It was not considered unethical not to make the responses to the questionnaire anonymous because this choice was made only with the intention of monitoring that all the staff expressed at least one feedback and, in any case, the statistical data were then subsequently processed as relative percentage value, also and above all for the purpose of making any decisions on the continuation of the research project (for example: see question 8) and always, without any qualitative indication or judgmental interpretation, adopting appropriate Likert scales for transmutation of opinions, to avoid any analytical bias [2-5].

Question 3

The third question involved assessing the validity of the idea of using a multi-function trolley as an emergency trolley, in a specialised operating unit. The staff expressed itself as following: 68,4 % of the staff STRONGLY AGREE with the idea, 26,3 % AGREE, while only 5,3 % DISAGREE (1 answer).

Question 4

The fourth question asked the nursing staff to carry out a self-assessment of their level of training in the use of the device at the end of the six-month trial period. The staff expressed itself in this direction: only 10.5% of nurses considered themselves VERY prepared to use the device; the majority of the staff (73.7%) self-assessed itself as ENOUGH trained; finally, 15.8% of nurses considered themselves UNDERTRAINED.

Question 5

The fifth question asked the staff feedback on the adequacy of the external and internal contents of the device, both to carry out the specialist procedures typical of thoracic surgery and to treat any emergency linked or not to these procedures which require a specific clinical and/or surgical expertise. According to the staff, 36.8 % of nurses considered these contents VERY adequate, 57.9 % QUITE adequate and the remaining 5.3 % NOT MUCH adequate (1 answer) [6-7].

Question 6

The sixth question asked the staff to identify and list the main critical issues related to the being analysed device. What emerges from the nurses’ answers is that, in fact, the main problems would be related to the ergonomic design of the device: one of the staff nurses considered it not adequate to perform multifunctionality, having regard to the reduced capacity of the drawers and the qualitative- quantitative abundance of the materials within them. Moreover, many nurses have expressed themselves on the excessive quantity of materials inside it; therefore, it has been tried in the subsequent reworkings of the checklist to reduce these quantities to the bare minimum. From a qualitative point of view, however, some nurses considered part of the material (for example, that for the positioning of PICC, CICC and/or FICC central lines) to be little essential and/or superfluous, despite the rational of the need of a multifunction monitor for their insertion. Another problem that emerged was that relating to the seal of the garrison: since the same is equipped with a closing band that allows to seal only the first drawer (containing life-saving drugs) leaving the others open anyway, it was difficult for the staff to ensure the integrity of the other non-lockable drawers, despite the daily compilation of the checklist, either because the staff considered prohibitive in some shifts to compile the above referenced checklist, both because the procurement of various materials from drawers that remained open was also improperly done for reasons of non-urgency or without using the cart in any specialized procedure. Therefore, considering the small number of procedures/urgencies actually managed by using the multifunction trolley during the first six months of its testing, it was decided to lock laterally the entire garrison and to place the key in the closing seal affixed to the first drawer, in such a way that those who must use it were forced to break the seal in full to access even the other drawers apart from the first one, clearly with all the medical and legal implications of the case. Hence, the preference to switch to a weekly control of the full checklist, rather than a daily check. Finally, the new nursing coordinator, although she did not fill in the questionnaire for the survey of opinions on the new garrison since she had recently taken office, still considered it appropriate to move the portable oxygen cylinder in the adjacent business premises, for the alleged explosive risk due to the presence of cables and wires of the monitors on the trolley, although this recommendation had not emerged from the results of the systematic review conducted for the development of the original thesis product [8].

Question 7

The seventh question asked the nursing staff for suggestions both for a better allocation of materials and for a better management of the garrison in full. In line with the findings of the criticality analysis, the main suggestions of the nursing staff were aimed at the reduction in the amount of materials collocated within the drawers and to the request to those in charge in the Corporate Health Management of another garrison with a different design, better and more capacious, in order to contain all the materials provided by the referenced checklist and avoid, in co-time, “makeshift” allocations (as in the case of the rcp table, which originally did not have a “dedicated” space but it was basically obtained in the context of the ergonomics of the cart). Alternatively, another solution proposed by the staff was to eliminate materials which, at present time, have a rare incidence of use in the management of emergencies, even if doing so would lead to lose markedly that multifunctionality characteristic that is an intrinsic and founding part of the project, according properly to the mission for which the garrison was born. Another main suggestion was that all drawers should be closed simultaneously with the first one, despite the absence of a definitive and simultaneous lateral closing band of all drawers. To respond to all these criticisms/suggestions, corrective actions have been taken and are still on running, as already mentioned in the body of the previous question and in the abstract of this document. Finally, another valuable piece of advice that emerged from the staff responses to the questionnaire was to seek greater involvement from the staff itself. This means that only a focal professional module constructed ad hoc for thoracic surgery could actually play the role of driving force and that - as we already said - it is enthusiastically proposed to constitute as the next phase of this research project.

Question 8

The eighth question asked the nursing staff to give its opinion on the frequency considered optimal for the compilation of the checklist in the reference operative unit, reiterating a priori the fundamental need to carry out the daily functional test in order to constantly ensure the proper functioning of the defibrillator in case of practice of CPR manoeuvres and, moreover, reaffirming the absolute need to restore the cart after each use, without leaving it out of stock until the next check. These are the results.

Therefore: the majority of the reference nursing population who expressed an opinion (57.9%) considered carrying out the weekly checklist sufficient; 21.1% believed it was sufficient to do it once a month. The remaining 21%, representing the minority, was divided quite evenly between the daily and bi-weekly execution of the operational checklist, expressing personal opinions however in line with the majority’s point of view and with what was stated above.

Therefore, from March 2023, the compilation of the checklist was planned on a weekly basis and, for reasons of internal organization of the operational unit’s work, Sunday was identified as the reference day, as a prerogative of the night shift.

Question 9

Question No. 9, by means of a special Likert transduction scale, required the healthcare personnel to define quantitatively and on a point scale from 0 to 5, its level of professional satisfaction in relation to the innovations carried by this new instrument introduced and brought into the reality of the reference operating unit . Most of the staff declared itself to be FAIRLY SATISFIED with the implementations made by the checklist (52.6%), while 36.8% expressed itself with the highest marks, as VERY SATISFIED.

Finally, the remaining 10.6% expressed itself simply as SATISFIED (1 operator) and LOW SATISFIED (1 operator).

Question 10

The penultimate question required nursing staff to evaluate the usefulness of building a specific “ad hoc” checklist modelled on the needs of a highly specialised working unit. The response was almost unanimous: 94.7 % of nurses considered the idea of a multifunctional emergency trolley to be valid and exportable. Only one operator (5.3%) voted negatively.

This, obviously, gives us hope to propose in the future, also in other multi-specialized operating units, the idea of a multi-functional trolley, standardized indeed, but also built on specific procedural needs, with the possibility of extending this pilot project to other working realities that share the same characteristics and vision within the company, increasingly promoting the personalization of the assistance that is so much talked about today, but that in addition to standardization as a safety tool should also offer additional safety through the specificity of the treatments to be provided, which must be performed with mastery, foreseeing all possible complications and proactively pushing to have all the necessary materials immediately available for their management and correction nearby; in other words, it is no longer possible to ignore the highly specific typology of patients who are currently treated in our work environments.

All this with a view to the rationalization of resources that makes the assistance increasingly cost-effective and time-effective for the patients.

Question 11

The last question, again by means of a special Likert Transduction Scale, required healthcare personnel to define quantitatively and in a numerical scale from 0 to 3, their motivation to be part of an inter- company working group (for example, the type of a vocational focal module) in order to promote the training of neophyte and student personnel through the sharing knowledge of various training tools, including and together with others, also the operative checklist for a multifunctional emergency trolley, making for this purpose the latter, in all respects, a real training tool, as well as a specialist health management tool.