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Showing results for tags 'Surgery - General'.
Found 485 results
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Content ArticleMaintaining safe elective surgical activity during the global coronavirus disease 2019 (COVID‐19) pandemic is challenging and it is not clear how COVID‐19 may impact peri‐operative morbidity and mortality in this population. Therefore, adaptations to normal care pathways are required. Here, Kane et al. establish if implementation of a bespoke peri‐operative care bundle for urgent elective surgery during a pandemic surge period can deliver a low COVID‐19‐associated complication profile. Kane et al. present a single‐centre retrospective cohort study from a tertiary care hospital of patients planned for urgent elective surgery during the initial COVID‐19 surge in the UK between 29 March and 12 June 2020.
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Content ArticleIn this Anaesthesia editorial, Simoes and Bhangu, on behalf of the CovidSurg Collaborative, outline why and how elective surgery must restart. "COVID‐19‐free pathways will be crucial for patient safety during the COVID‐19 pandemic, as they seem to lead to low rates of SARS‐CoV‐2 infection rates and complications. Further preventive measures and patient level risk assessment will allow surgery to safely restart and continue during this, and future, crises." This editorial accompanies an article by Kane et al. Anaesthesia 2020; 75: 1596–1604.
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Content ArticleThe onset of COVID-19 caused some patients throughout the United States to delay their surgeries as many hospital systems postponed nonemergent procedures. This led to a potentially large backlog of case volume. In a recent McKinsey survey of health system leaders, hospital executives said they may struggle to address this backlog given workforce availability, enhanced sanitation protocols, and reserved inpatient capacity. Without healthcare systems recalibrating demand and capacity, patients could face long backlogs for procedures, and potentially experience higher morbidity and mortality rates. Solutions may include 1) reducing the unnecessary deferral of care, 2) effectively addressing new throughput challenges, 3) using advanced analytics to better forecast demand and manage capacity in real time, and 4) reimagining operating room operations to increase long-term capacity. Berlin et al. explore these solutions further in this article.
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Content ArticleThe 2008 Second Global Patient Safety Challenge sponsored by the World Health Organization articulated 10 “essential objectives for safe surgery”. One of these is to “establish routine surveillance of surgical capacity, volume, and results” at the hospital level. There can be little doubt that this recommendation was made in the expectation that longitudinal surveillance and analysis of surgical results could lead to quality improvements in care and improved patient outcomes. In this linked study, Duclos and colleagues investigated a surveillance system the central feature of which was the use of Shewhart control charts. Originally developed to monitor industrial processes, control charts track variability in key process indicators over time and provide visual feedback on both positive and negative trends. This allows evaluation of the impact of process changes or, in the case of a negative trend, it triggers investigation into the causes and the formulation of appropriate responses. They found that the implementation of control charts with feedback on indicators to surgical teams was associated with concomitant reductions in major adverse events in patients. Understanding variations in surgical outcomes and how to provide safe surgery is imperative for improvements.
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Content ArticleSurgical instruments are essential for the delivery of modern healthcare. Their use is so widespread that they are easily taken for granted. The supplier base for instruments is diverse, including small, family owned businesses, and large multinational corporations. What they have in common are complex manufacturing processes, global supply chains, broad product ranges to suit varying clinical needs and product development with the capacity to innovate as required.
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Content ArticlePatient safety is an activity to mitigate preventable patient harm that may occur during the delivery of medical care. The European Board of Anaesthesiology (EBA)/European Union of Medical Specialists had previously published safety recommendations on minimal monitoring and postanaesthesia care, but with the growing public and professional interest it was decided to produce a much more encompassing document. The EBA and the European Society of Anaesthesiology (ESA) published a consensus on what needs to be done/achieved for improvement of peri-operative patient safety. During the Euroanaesthesia meeting in Helsinki/Finland in 2010, this vision was presented to anaesthesiologists, patients, industry and others involved in health care as the ‘Helsinki Declaration on Patient Safety in Anaesthesiology’. Authors of this article, published in the European Journal of Anaesthesiology, hope to further stimulate implementation of the Helsinki Declaration on Patient Safety in Anaesthesiology, as well as initiating relevant research in the future.
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Content ArticleOperating theatre fires remain an uncommon but real safety risk for patients undergoing nearly all types of procedures, and despite ongoing safety initiatives, occur more commonly than wrong-site surgeries. One of the most compelling cases for safety improvement in the surgical setting is within this area. Combining the simple steps of operating theatre team education; improving lines of communication between surgeons, anaesthetists, and operating theatre nurses or practitioners; and the deliberate separation of the elements of the fire triangle can almost completely eliminate the incidence of surgical fires. In this brief review, Cowles Jr and Culp Jr hope that readers will be able to reduce the risk of surgical fires effectively by the application of the safety principles described.
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Content ArticleA surgical fire is potentially devastating for a patient. Fire has been recognised as a potential complication of surgery for many years. Surgical fires continue to happen with alarming frequency. Yardley and Donaldson present a review of the literature and an examination of possible solutions to this problem.
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Content Article
Tim Stephens is a researcher at Queen Mary University of London and Barts Health NHS Trust and a qualified intensive care nurse. He is currently working with a large team of clinicians, patients and scientists to investigate how older people make decisions about having major surgery. In this blog, Tim talks about shared decision-making, individual impact and the need for better data to help clinicians quantify risk.- Posted
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Content ArticleThis Royal College of Nursing (RCN) publication highlights the specific needs of children and young people undergoing day surgery, outlining pre- and post-operative aspects of care and preparation, parental involvement and facilitating discharge.
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Content ArticleThe latest ECRI and the Institute for Safe Medication Practices PSO Deep Dive explores one of the areas that accounts for a large portion of healthcare volume: surgical care. Annually, surgery accounts for 7 million inpatient hospital stays and 36 million procedures in the outpatient setting. Although surgical safety has been the subject of guidelines, patient safety and quality improvement projects, and attention in the literature, adverse events continue to occur with relative frequency, putting patients at risk.
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Content Article"Cancel everything” has trended as a hashtag during the coronavirus disease 2019 (COVID-19) pandemic, and for good reason. The pandemic has touched virtually every aspect of society, substantially altering, and at its onset halting, the very ways nearly every person in the United States works, learns, lives, and maintains health. The practice of surgery has not been immune, with emergency declarations by many states to suspend elective procedures and office visits in mid-March. While only temporary, this abrupt cessation of surgery has had far-reaching implications that can inform future approaches in the context of both crisis and uncertainty as Meredith et al. reflect on in this JAMA article.
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Perioperative care – The ‘Holy Grail of healthcare’
Patient Safety Learning posted an article in Surgery
The Centre for Perioperative Care (CPOC) has now published, perhaps for the first time on this scale, comprehensive evidence that the perioperative pathway is associated with higher quality clinical outcomes, reduced financial cost and better satisfaction for surgical patients. This triad is the holy grail of healthcare. Dr David Selwyn, Director of the Centre for Perioperative Care, and Mr Mark Weiss, Head of Policy and Public Affairs, Royal College of Anaesthetists have written this blog in line with CPOC's own rapid research review that highlights the impact of perioperative care and their pioneering new evidence. "Now is the time to ensure that every surgical patient’s journey is delivered along a single, coordinated care pathway, supported by an appropriate multi-professional team. Now is the time to deliver seamless communication and collaboration between primary, secondary and community care. Now is the time to review our patient flows and how we counsel and prepare patients for surgery. And now is the time to empower patients through shared decision-making and personalised care, and to change the postoperative course with emphasis on enhanced recovery. " -
Content ArticleThis review explores the benefits of multidisciplinary team working to support people having surgery and the factors that may help and hinder its development and sustainability. Perioperative care is the integrated multidisciplinary care of patients from the moment surgery is contemplated through to full recovery. Multidisciplinary working, whereby professionals from different specialties and sectors work together to support someone along their journey, is a foundation of perioperative care. The Centre for Perioperative Care (CPOC) wanted to explore the benefits of, and barriers and enabler to, multidisciplinary team working. The rapid review summarises learning from 236 UK and international studies about this. About 13% of the studies were from the UK. To identify relevant research, 14 bibliographic databases were searched and screened more than 18,000 articles available as of June 2020.
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Content ArticleThe Health and Social Care Committee is calling for urgent action to assess and tackle a backlog of appointments and an unknown patient demand for all health services, specifically across cancer treatments, mental health services, dentistry services, GP services and elective surgery. MPs say a compelling case has been made for the nationwide routine testing of all NHS staff and they are yet to understand why it cannot be introduced.
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Content ArticleIn October 2004 the World Health Organization (WHO) launched the World Alliance for Patient Safety. The Alliance raises awareness and political commitment to improve the safety of care and supports Member States to develop patient safety policy and practice. Each year the Alliance organises programmes covering systemic and technical aspects for improving patient safety around the world. A core element of the work of the Alliance is the formulation of Global Patient Safety Challenges. Every two years a Challenge is formulated to galvanise global commitment and action on a patient safety issue which addresses a significant area of risk for all WHO Member States. The first Challenge focused on health care-associated infection, while safe surgery has been chosen as the topic for the second Global Patient Safety Challenge.
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A day in the life of an Operating Department Practitioner
Patient Safety Learning posted an article in Surgery
There are three main aspects of the Operating Department Practitioner (ODP) role; namely, anaesthetics, surgery and post-anaesthetic care. There are some overarching qualities that are necessary for any ODP. These include excellent communication skills including verbal, non-verbal and written. Treating patients with dignity and respect, maintaining confidentiality throughout. -
Content Article
The role of the operating department practitioner
Patient Safety Learning posted an article in Surgery
The operating department practitioner (ODP) participates in the assessment of the patient prior to surgery and provides individualised care. The College of Operating Department Practitioners provides an overview of what an ODP does. -
Content Article
ECRI: Wrong-site surgery (14 December 2020)
Patient Safety Learning posted an article in Surgery
Wrong-site surgery is a broad, generic term that encompasses all surgical procedures performed on the wrong patient, the wrong body part, or the wrong side of the body; it can also describe performing the wrong procedure on, or performing on the wrong part of, a correctly identified anatomic site. This guidance from ECRI reviews the various types of wrong-site surgery; discusses the incidence, risk factors, and causes of wrong-site surgery; examines barriers to effective risk reduction; highlights Joint Commission’s elements of performance for the Universal Protocol and other accreditation and regulatory issues; and offers guidance for implementing strategies to prevent the occurrence of wrong-site surgery -
Content ArticleThe rise in antimicrobial resistance has highlighted the importance of surgical site infection (SSI) prevention with effective surveillance strategies playing a key role in improving patient safety. The aim of this study from Troughton et al. was to map national needs and priorities for SSI surveillance against current national surveillance activity. The authors found that current surveillance and future priorities were not associated with SSI rate, volume, or cost to hospitals. The two highest contributors of SSIs and related costs have no (caesarean section) or limited (LBS) coverage by national surveillance.
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Content ArticlePreventing surgical site infections requires knowledge of the sources of wound contamination. One possible source of wound contamination is bacteria aerosolised in diathermy plume (ie, surgical smoke). This study from Leonard Schultz used an experimental model of porcine tissue embedded with Serratia marcescens to determine the extent of viable bacteria present in surgical plume. The results showed that only blended current electrosurgery, not laser plume or coagulation electrosurgery, contains viable bacteria. Further, the study revealed that placing a suction device near the electrosurgical site reduced the number of aerosolised viable bacteria. Therefore, evacuating the electrosurgical plume may help reduce contamination of the surgical wound. Nurses may wish to advocate for the use of air suction devices as one way to protect patients from surgical site infections.
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Content ArticleSurgical site infections (SSIs) are one of the main sources of healthcare-associated infections (HAIs), which is a leading cause of preventable death in the U.S. While multiple causes of SSIs have been identified, one key source of wound contamination is surgical smoke, which can contain live viruses and bacteria as well as toxic chemicals, particulates and contaminated body fluid in the form of blood and dispersed vapor. Plume serves as a transfer vehicle for these pathogens. A team of bacteriology experts at Biotest Laboratories, Inc. in Brooklyn Park, Minnesota, undertook a project to discover if effective smoke capture and evacuation could limit local dispersal and aerosolization of bacteria. The researchers used porcine tissue embedded with viable bacteria (Serratia marcescens) to determine the extent of viable bacteria present in surgical plume. They developed protocols, performed experiments and tabulated results for three separate experiments. Their tests showed that plume from blended current electrosurgery contained viable bacteria and that placing a suction device near the electrosurgical site reduced the number of aerosolised viable bacteria. The study confirmed that effective smoke capture prevents bacteria in smoke from being aerosolised and significantly reduces contamination of a simulated surgical wound, in this case by as much as 50% to 60% compared to control.
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Content Article
Mölnlycke: SSI Risk Reduction Partnership
Patient Safety Learning posted an article in Surgery
Surgical Site Infections (SSIs) are a problem of increasing concern with major implications for both patients and the NHS. Between 2014 – 2019 SSIs, as a percentage of all healthcare associated infections, jumped from 16% 1 to 20%. It is a growing problem, in need of a solution. Mölnlycke has developed the Risk Reduction Partnership is a new initiative that has been specifically designed to combat the problem and potentially help reduce its incidence and impact. -
Content ArticlePresentation from Professor Benedetta Allegranzi, WHO's Infection Prevention & Control Global Unit, on the World Health Organization's guidelines on the prevention of surgical site infections.
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Content ArticleWorld Health Organization (WHO) presentation summarising the global guidelines and recommendation for the prevention of surgical site infections.
