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Showing results for tags 'Surgery - General'.
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Content ArticleThis narrative review in the journal Anaesthesia reviews the background to overlapping surgery, an approach in which a single senior surgeon operates across two parallel operating theatres. Anaesthesia is induced and surgery commenced by junior surgeons in the second operating theatre while the lead surgeon completes the operation in the first. The authors assessed whether there is any theoretical basis to expect increased productivity in terms of number of operations completed. A review of observational studies found that while there is a perception of increased surgical output for one surgeon, there is no evidence of increased productivity compared with two surgeons working in parallel. There is potential for overlapping surgery to have some positive impact in situations where turnover times between cases are long, operations are short and where ‘critical portions’ of surgery constitute about half of the total operation time. However, any advantages must be balanced against safety, ethical and training concerns.
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Content ArticleIn the UK, surgical care is responsible for the equivalent of about 5.7 million tonnes of carbon dioxide emissions each year – equivalent to that from heat, electricity, transport and waste of 700,000 UK homes. Reducing the emissions produced during surgery would be a significant step towards the NHS achieving its aim to be net zero by 2045. The report shows that solutions are available and in many cases could result in better options for patients while at the same time costing the NHS less. Reducing and reusing products used in surgery, shutdown checklists for operating rooms to save energy when they are not in use, switching to less harmful anaesthetics, and surgeons and patients working together to optimise their treatment are all highlighted as ways in which carbon emissions could be reduced. This landmark report highlights a number of successful initiatives that have already been implemented. For example, a team at Imperial College Healthcare NHS Trust successfully reduced both carbon dioxide emissions and cost by switching from general to local anaesthesia for some procedures, and from disposable to reusable surgical gowns. The report, which involved collaboration across multiple organisations involved in different aspects of surgical care, was produced by the UK Health Alliance on Climate Change, Brighton and Sussex Medical School and the Centre for Sustainable Healthcare.
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Content ArticleElective recovery plans in part rely on the strengths of Surgical Hubs (SH) and Community Diagnostic Centres (CDC) to provide additional support. This report by the Medical Technology Group (MTG) considers how well these new tools are working for the NHS. It raises questions about how SHs and CDCs have been established and the decision making processes within these services.
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Content ArticleSince the Covid-19 pandemic, there has been a significant increase in telehealth use for patient evaluations. The US Veteran Health Administration (VHA) has tripled phone and video visits across several specialties. Although there are hesitations in phone-call-based communication for procedural subspecialties, phone calls to veterans have proven safe and efficacious after general surgery procedures. Telehealth has additional benefits, including reducing transportation barriers, improving access to care and reducing delays in medical care. This article in the journal Surgery aimed to evaluate clinic access after the establishment of routine telehealth use through phone calls by the surgeon.
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Content ArticleThis study in The American Journal of Surgery aimed to assess the impact of gender on imposter syndrome among surgical trainees. An online national survey was distributed to surgical subspecialty residents between March and September 2022 which included demographics, validated Clance Imposter Scale and a short questionnaire evaluating depression and anxiety. The study found that Women surgical trainees were found to be more affected by imposter syndrome, particularly frequent and intense imposterism. Risk factors found were being single, having no dependents, working in obstetrics and gynaecology and being a foreign medical graduate. The authors identified a need for residency programs to develop wellness curriculum to address imposter syndrome among all surgical trainees.
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Content Article
Latest issue of the Operating Theatre Journal
Patient Safety Learning posted an article in Surgery
A monthly journal for all operating theatre staff covering surgical and anaesthesia news. -
Content ArticleIncreasing interest in general surgery from students who are Under-Represented in Medicine (URiM) is vital to advancing diversity, equity and inclusion efforts. This study in The American Journal of Surgery examined medical student third year surgery clerkship evaluations quantitatively and qualitatively to understand the experiences of URiM and non-URiM learners. The authors found that URiM students are less likely than non-URiM students to see surgical residents and faculty as positive role models. They highlight that integrating medical students into the team, taking time to teach and allowing students to feel valued in their roles improves the clerkship experience for trainees and can contribute to recruitment efforts.
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News Article
London hospital cuts waiting lists with innovative system
Patient Safety Learning posted a news article in News
Surgeons at one London hospital are performing an entire week’s operations in a single day as part of a ground-breaking initiative that could help tackle the record waiting lists in the NHS. Guy’s and St Thomas’ NHS Foundation Trust has already slashed its own elective backlog in certain specialities by running monthly HIT (High Intensity Theatre) lists at weekends. Under the innovative model, two operating theatres run side by side and as soon as one procedure is finished the next patient is already under anaesthetic and ready to be wheeled in. Nurses are on standby to sterilise the operating theatre and instead of taking 40 minutes between cases it takes less than two, the only delay is the 30 second it takes for the anti-bacterial cleaning fluid to work. Kariem El-Boghdadly, the consultant anaesthetist who designed the programme with his colleague Imran Ahmad, compares it to a Formula One pit stop. “They’ve got one person doing the rear right wheel, one person doing the front left wheel. It’s the same thing. The operating theatre is effectively like that.” Read full story (paywalled) Source: The Times, 10 December 2023 -
Content ArticleThis investigation explores the patient safety risk of unintended retention of surgical swabs after surgery. Surgical swabs are sterile pieces of gauze which are used to absorb bodily fluids, such as blood, during a surgical procedure. The investigation will: explore the factors associated with unintentional retained surgical swab events identify alternative safety controls to reduce the likelihood of foreign objects being unintentionally retained. The interim report analyses the findings of 31 NHS trust serious incident reports.
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News Article
Hospital staff failed man living with HIV by unnecessarily delaying surgery
Patient Safety Learning posted a news article in News
A hospital that unnecessarily delayed a man’s surgery at the last minute because he had HIV failed in their care, according to England’s Health Ombudsman. The 48-year-old from Walsall, who does not want to be named, had been due to have prostate surgery at Walsall Manor Hospital on 10 March 2020. His surgery was scheduled to be the first of the morning. As he was about to enter the operating room, he was told that due to his HIV status his surgery would now be moved to last on the operating list that afternoon. The hospital claimed that this was due to the level of cleaning and infection control that would need to take place following his surgery to reduce the risk to others. However, the Parliamentary and Health Service Ombudsman (PHSO), found that Walsall Healthcare NHS Trust acted inappropriately and failed the man. This is because the universal precautions that apply to all patients having surgery are enough to protect and prevent infections from spreading among patients and staff. Therefore, no additional cleaning should have been necessary. The policy of placing a patient at the end of an operating list usually relates to patients with a high-risk bacterial infection. It should not be applied to a person who has HIV and is receiving treatment. The Ombudsman also found that although the Trust had made some changes since this happened, they had not done enough to make sure the same mistake did not reoccur. PHSO recommended the Trust apologise to the man and create an action plan to stop this happening again. The Trust has complied with these recommendations. Read full story Source: Parliamentary and Health Service Ombudsman, 1 December 2023 -
News Article
Police investigate 105 cases of alleged negligence in Brighton hospital
Patient Safety Learning posted a news article in News
Police are investigating 105 cases of alleged medical negligence at the Royal Sussex County Hospital in Brighton amid claims of a cover-up. Specialist officers from the National Crime Agency and Sussex police are looking into cases of harm, which include at least 40 deaths, in the general surgery and neurosurgery departments between 2015 and 2021. An email from Sussex police, released to The Times after a court application, revealed the huge investigation is looking into 84 cases connected to neurology and 21 related to gastroenterology. Most of the families are yet to be told that their case is among them. Officers were called in by the senior coroner after she heard of allegations made by two consultant surgeons at University Hospitals Sussex NHS Foundation Trust, one of the largest NHS organisations with 20,000 staff. The trust has been accused of bullying the whistleblowers and attempting to cover up the circumstances of the deaths. Mansoor Foroughi, a consultant neurosurgeon, was sacked for “acting in bad faith” in December 2021 after raising concerns about 19 deaths and 23 cases of serious patient harm. Another whistleblower, Krishna Singh, a consultant general surgeon, claimed that he lost his post as clinical director because he said the trust promoted insufficiently competent surgeons, introduced an unsafe rota and had cut costs too quickly. Read full story (paywalled) Source: The Times, 27 November 2023 -
Content ArticleThis study in the American Journal of Surgery aimed to understand the impact of operating room temperature and humidity on surgical site infection (SSI). The authors found that large deviations in operating theatre temperature and humidity do not increase the risk of SSI.
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Content ArticleThe harsh reality of surgery often involves grappling with the distressing and emotionally taxing aspects of human suffering that many people outside of healthcare never witness. When complications occur, surgeons feel the weight of their responsibility and are often alone to ruminate with negative thoughts of self-doubt, sometimes leading to anxiety and depression. This article in The American Journal of Surgery examines existing literature on Second Victim Syndrome (SVS) specifically focusing on prevalence among surgeons and factors related to different responses. The authors identify women and junior surgeons at particularly high risk of SVS and peer support as a preferred method of coping but an overall lack of institutional support highlighting the need for ongoing, open conversations about the topic of surgeon well-being.
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Content Article
Yvette Greenway-Mansfield experienced complications relating to the vaginal mesh that was used to treat a uterine prolapse. Those complications were not listed on the consent form she signed. Fortunately, she kept her copy and was able to prove this. Yvette has recently been awarded £1 million because it was found that her form had been doctored after she had signed it. Her successful medical negligence claim was also based on the fact that alternative treatment options were not considered when they should have been. These alternatives came with fewer risks, and it was agreed that they would actually have been more suitable in her case. In this blog, I reflect on the levels of harm caused to the patient and how digital consent forms could help protect others. -
News Article
NHS failing to prioritise those in most need, says departing ICB chief
Patient Safety Learning posted a news article in News
The NHS should better track patients with the greatest clinical need so they can move to the front of the queue for treatment, a former government waiting list tsar has said. Anthony “Mac” McKeever told HSJ the health service could improve how it works through its elective backlog by using a system introduced during the covid pandemic to prioritise the most pressing cases. He said a “large chunk” of cases were still not given a code to say how long they are considered to be able to wait for surgery, which is at the heart of this process. Mr McKeever retired as Mid and South Essex Integrated Care Board chief executive this month following nearly five decades in the health service, including as a trust leader. Although Mr McKeever said he only knew the regional situation for the East of England, he would be “very surprised” if the national picture was any different. Waiting list expert Rob Findlay agreed this was a reasonable assumption. Read full story (paywalled) Source: HSJ, 17 November 2023 -
Content ArticlePotentially serious complications occurred in 1 in 18 procedures under the care of an anaesthetist in UK hospitals, according to a national audit by the Royal College of Anaesthetists (RCA). Risks were found to be highest in babies, males, patients with frailty, people with comorbidities, and patients with obesity. Risks were also associated with the urgency and extent of surgery and procedures taking place at night and/or at weekends. The survey, published in Anaesthesia, was the RCA's seventh national audit project (NAP7) and included more than 20,000 procedures at over 350 hospital sites. NAPs study rare but potentially serious complications related to anaesthesia, and are intended to drive improvements in practice. Each focuses on a different topic and NAP7 examined perioperative cardiac arrest. Dr Andrew Kane, consultant in anaesthesia at James Cook University Hospital in Middlesbrough and a fellow at the RCA's Health Services Research Centre in London, said the new data presented "the first estimates for the rates of potentially serious complications and critical incidents observed during modern anaesthetic practice". The data confirmed that individual complications are uncommon during elective practice, but highlight the relatively higher rate of complications in emergency settings.
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News ArticleNHS staff are carrying out the equivalent of one 'never-event' every day, figures show. This is despite the Government ordering a crackdown on the mistakes, which cost hospitals an estimated £800million in compensation each year. Experts today demanded further action on 'unacceptable' levels of never-events, blaming inadequate staffing levels and a lack of investment in the NHS. A MailOnline audit of a decade's worth of NHS data found a colossal 4,328 never-events have occurred in England since 2013. This equates to roughly eight a week. Shocking incidents uncovered include women getting parts of their reproductive anatomy cut out instead of an appendix, men getting unwanted circumcisions and laser procedures to the wrong eye. The Royal College of Surgeons said the level of never-events was 'unacceptable' and blamed NHS staffing levels for increasing the risk to patients. "Surgeons will be working hard to do their best for patients, but they do so in difficult circumstances," a spokesperson said. "The NHS is overstretched, with staff shortages, a workforce suffering from burn-out and pressure to get record waiting times down. "This increases the risk of mistakes happening." Read full story Source: MailOnline, 10 October 2023
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Content ArticleThis report published by the National Confidential Enquiry into Patient Outcome and Death, is a review of the care provided to patients aged 16 and over with a diagnosis of, and who underwent surgery for, Crohn’s disease. In summary, the report says that surgery for patients with drug resistant Crohn’s disease surgery should be considered earlier in the treatment pathway for patients, instead of surgery being perceived as a failure of medical care. Once a decision to perform surgery has been made it should be undertaken within a month to prevent patients on elective waiting lists deteriorating and requiring emergency surgery. Furthermore, closer working between all members of the multidisciplinary team would benefit patients, to reduce delays as well as providing all the holistic care that patients with Crohn’s disease need. Read the full list of recommendations and the report via the link below.
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Content ArticleThe Safe & Sound podcast by the Royal College of Surgeons in Ireland explores the world of human factors in healthcare and patient safety. Each episode, we will try to untangle different aspects of this complicated web of human factors in healthcare, through interviews with some extraordinary guests and faculty in Ireland, and across the world.
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News ArticleFormer BBC Technology correspondent Rory Cellan-Jones, now a writer and podcaster, has Parkinson's disease. Two weeks ago, after fracturing his elbow in a nasty fall, he found out just how difficult it can be to get answers from the NHS. "Getting information about one's treatment seems like an obstacle race where the system is always one step ahead. But communication between medical staff within and between hospitals also appears hopelessly inadequate, with the gulf between doctors and nurses particularly acute. "I also sense that, in some cases, new computer systems are slowing not speeding information through the system. On Saturday morning, as we waited in the surgical assessment unit, four nurses gathered around a computer screen while a fifth explained to them all the steps needed to check-in a patient and get them into a bed. It took about 20 minutes and appeared to be akin to mastering some complex video game beset with bear traps." Rory's latest experience as a customer of the health service has left him convinced that more money and more staff won't solve its problems without some fundamental changes in the way it communicates. Read full story Source: BBC News, 29 October 2023
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Content Article
The risks in perioperative care are well known. However, for patients having surgery in some African countries, the dangers are far more apparent. Staff are few and far between and many have not been able to access rationale for their practice or receive adequate training over the years. Friends of African Nursing (FoAN) is a small UK-based charity that has been providing education in several African countries to address this issue. More than 3,000 nurses and other healthcare workers have been trained face to face—and many more on-line—in patient safety, staff safety and infection prevention. FoAN's Chair of Trustees Kate Woodhead describes the challenges facing nurses working in perioperative care in many African countries. -
Content ArticleThe number of older people having surgery is increasing. However, older patients are more likely to have complications after surgery than younger patients as they often have multiple health conditions and age-related problems such as frailty and a decline in mental ability. These factors increase the risk of surgery and can hinder recovery. Surgical pre-assessment usually focuses on the patient’s physical fitness for surgery, not the broader range of health-related factors that are important to consider in older patients. The Perioperative care for Older People undergoing Surgery (POPS) model was developed to provide a holistic assessment of an older person’s medical, physiological and functional condition prior to surgery. The assessment is then used to inform interventions that can reduce the risk of complications. The POPS model is increasingly being implemented across the English and Welsh NHS, but there are often challenges in introducing these new ways of providing care that need to be better understood. This independent study, led by THIS Institute Fellow Professor Justin Waring, outlines the key activities and strategies that are needed for the POPS model to be successfully implemented and become part of routine practice in a hospital.
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Content ArticleIn this webinar, Chloe from the Getting It Right First Time (GIRFT) programme and Raj, a patient who had had surgery at a surgical hub an hour and half away from his home, talk about a project to improve the elective surgical hub programme based on patients' experiences and feedback. They were joined by the Patients Association project manager, Hannah. Elective hubs are surgical centres on existing hospital sites, separated from emergency services, which means the facilities can be kept free for patients waiting for planned operations, reducing the risk of short-notice cancellations. Raj speaks candidly of his experiences in the early days of the project, and Chloe explains how patient experiences have enabled the NHS to improve the service.
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News Article
Mum fears her son could die waiting for life changing surgery
Patient Safety Learning posted a news article in News
The mother of a four-year-old boy with complex needs said she fears he could die waiting for life-changing surgery. Collette Mullan made the claim to BBC Spotlight as it examined the scale of hospital waiting lists. Northern Ireland has the worst waiting times in the UK, with more than half a million cases queued for an outpatient or inpatient appointment. The Department of Health has described current waiting lists as "entirely unacceptable". Óisín, from County Londonderry, has a number of health conditions including cerebral palsy, and is currently waiting for two procedures. He is fed with a tube that carries his food through his nose into his stomach, but since it was inserted six months ago, his mum Collette said he has struggled to breathe. Óisín is now waiting to have the nasogastric tube removed and replaced by a different feeding system which goes directly to his stomach. Collette said she was told it could be a three-year wait for the procedure. She is concerned that Óisín's cerebral palsy puts him at a greater risk of complications, saying she had been warned there was a danger he could aspirate. "He could die. Anything going into his lung really, it could be very dangerous," she said. Read full story Source: BBC News, 3 October 2023 -
Content ArticleWatch this World Patient Safety Day webinar with Nigel Roberts on enhancing patient safety and surgical outcomes with the surgical safety checklist.
