scholarly journals 905 How to prioritise patients and safely resume elective surgery during the Covid-19 pandemic

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
H Subbiah Ponniah ◽  
M Ahmed ◽  
T Edwards ◽  
J Cobb ◽  
E Dean ◽  
...  
Keyword(s):  
Patient Safety ◽  
High Risk ◽  
Orthopaedic Surgery ◽  
Elective Surgery ◽  
Paediatric Patients ◽  
Level 3 ◽  
Level 1 ◽  
Surgical Unit

Abstract Introduction There are now over 2.5 million NHS patients awaiting elective surgery, with the most in orthopaedics. We present an algorithm and results for safely and equitably restarting surgery at COVID-light sites. Method An MDT applied the COVID-19 Algorithm for Resuming Elective Surgery (CARES) on 1169 patients awaiting elective orthopaedic surgery. It assessed safety, procedural efficacy, and biopsychosocial factors, to prioritise patients. They were assigned to five categories and underwent surgery at one of three COVID-light sites (1. access to HDU/ITU/Paediatrics/specialist equipment, 2. an NHS elective surgical unit and 3. a private elective surgical unit). Results 21 ‘Urgent’ patients received expedited care; 118 were Level 1/2; 222 were Level 3; 808 were Level 4. In 6 weeks, 355 surgeries were performed, with Urgent and Level 1/2 cases performed soonest (mean 18 days, p < 0.001). 33 high-risk/complex/paediatric patients had surgery at Site 1 and the rest at Sites 2 and 3. No patients contracted COVID-19 within 2 weeks of surgery. Conclusions We validated a widely generalisable model to facilitate resumption of elective surgery in COVID-light sites. It enabled surgery for patients in most suffering, undergoing the most efficacious procedures and/or at highest risk of deterioration, without compromising patient-safety.

scholarly journals V7 Project Restart’; Safe resumption of elective orthopaedic surgery following the Covid-19 pandemic

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Marriam Ahmed ◽  
Hariharan Subbiah Ponniah ◽  
Thomas Edwards ◽  
Alexander Liddle ◽  
Justin Cobb ◽  
...  
Keyword(s):  
Healthcare Workers ◽  
Elective Surgery ◽  
Holistic Approach ◽  
Evidence Based ◽  
Short Stay ◽  
Rt Pcr ◽  
Level 3 ◽  
Level 1 ◽  
The Uk ◽  
Surgical Unit

Abstract Introduction The Covid-19 pandemic resulted in nearly 2 million patients being put on waiting lists for elective procedures in the UK. We aim to describe how the COVID-19 Algorithm for Resuming Elective Surgery (CARES) was used to allocate patients to elective theatre lists while factoring in patient safety, risk to healthcare workers and, protection of resources. Methodology A multidisciplinary team was employed with the task of using CARES to allocate theatre slots to 1169 patients on the waiting list. CARES was used in conjunction with an evidence-based scale for procedural urgency (Levels 1-4) to stratify patients and list them for surgery at one of three ‘COVID-light’ sites i.e. 1. With HDU/ITU access, specialist staff, and equipment, 2. An NHS short-stay surgical unit, 3. A private surgical unit. Incidence of post-operative Covid-19 infection was assessed by looking at positive Covid-19 RT-PCR or CT Chest with characteristic findings performed within 2 weeks of the surgery. Results 118 cases were deemed to be Priority 1/2, 222 were Level 3, and 808 were Level 4. In 6 weeks, 355 surgeries were performed, with Urgent and Level 1/2 cases performed soonest (mean 18 days, p < 0.001). 33 high-risk/complex/paediatric patients had surgery at Site 1 and the rest at Sites 2 and 3. No patients contracted COVID-19 within 2 weeks of surgery. Conclusion CARES’ holistic approach enabled equitable and safe resumption of arthroplasty during the pandemic, by stratification and creation of COVID-light sites. It could be applied internationally and across sub-specialties. Introduction The Covid-19 pandemic resulted in nearly 2 million patients being put on waiting lists for elective procedures in the UK. We aim to describe how the COVID-19 Algorithm for Resuming Elective Surgery (CARES) was used to allocate patients to elective theatre lists while factoring in patient safety, risk to healthcare workers and, protection of resources. Methodology A multidisciplinary team was employed with the task of using CARES to allocate theatre slots to 1169 patients on the waiting list. CARES was used in conjunction with an evidence-based scale for procedural urgency (Levels 1-4) to stratify patients and list them for surgery at one of three ‘COVID-light’ sites i.e. 1. With HDU/ITU access, specialist staff, and equipment, 2. An NHS short-stay surgical unit, 3. A private surgical unit. Incidence of post-operative Covid-19 infection was assessed by looking at positive Covid-19 RT-PCR or CT Chest with characteristic findings performed within 2 weeks of the surgery. Results 118 cases were deemed to be Priority 1/2, 222 were Level 3, and 808 were Level 4. In 6 weeks, 355 surgeries were performed, with Urgent and Level 1/2 cases performed soonest (mean 18 days, p < 0.001). 33 high-risk/complex/paediatric patients had surgery at Site 1 and the rest at Sites 2 and 3. No patients contracted COVID-19 within 2 weeks of surgery. Conclusion CARES’ holistic approach enabled equitable and safe resumption of arthroplasty during the pandemic, by stratification and creation of COVID-light sites. It could be applied internationally and across sub-specialties.

scholarly journals Introducing an AKI predictive tool for patients undergoing orthopaedic surgery

2019 ◽  
Vol 8 (1) ◽  
pp. e000306 ◽  
Author(s):  
David Paul Baird ◽  
Fraser Rae ◽  
Christina Beecroft ◽  
Katherine Gallagher ◽  
Stephanie Sim ◽  
...  
Keyword(s):  
High Risk ◽  
Fluid Balance ◽  
Orthopaedic Surgery ◽  
Elective Surgery ◽  
Adverse Outcomes ◽  
Royal Infirmary ◽  
Predictive Tool ◽  
Electronic Tool ◽  
Increased Risk ◽  
Scoring Tool

Patients undergoing surgery are at increased risk of acute kidney injury (AKI). AKI is associated with adverse outcomes such as increased mortality and future risk of developing chronic kidney disease. We have developed a validated preoperative scoring tool to predict postoperative AKI in patients undergoing orthopaedic surgery using seven readily available parameters. The aim of this project was to establish the use of this scoring tool with a target compliance of 80% in patients undergoing orthopaedic surgery requiring an overnight stay at Perth Royal Infirmary, a district general hospital in NHS Tayside. We created an intervention bundle for patients at high risk of AKI, which we defined as greater than 10%. An electronic tool available on smartphones and desktop computers was developed that can be used to calculate the score. The interventions were incorporated into the electronic tool and posters outlining the intervention were placed in clinical areas. Patients undergoing elective procedures were scored in the preassessment clinic while emergency patients were scored by the admitting doctors. The score was introduced using four PDSA cycles. This confirmed that the scoring tool functioned well and was being used accurately. Compliance for patients undergoing elective surgery was reasonable at 19/24 (79%) in the third and fourth PDSA cycles but was poorer for emergency admissions with compliance of only 3/7 (43%). There was excellent compliance with the suggested medication changes and postoperative blood test monitoring as advised by our intervention bundle for those at high risk of AKI. Fluid balance monitoring was advised for all patients but the outcome was similar following our intervention at 27/41 (66%) compared with 23/37 (62%) in the baseline data collection. Compliance with fluid balance monitoring was higher in patients at high risk of AKI (9/12, 75%).

scholarly journals How to prioritize patients and redesign care to safely resume planned surgery during the COVID-19 pandemic

2021 ◽  
Vol 2 (2) ◽  
pp. 134-140
Author(s):  
Kartik Logishetty ◽  
Thomas C. Edwards ◽  
Hariharan Subbiah Ponniah ◽  
Marriam Ahmed ◽  
Alexander D. Liddle ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Patient Safety ◽  
High Risk ◽  
Orthopaedic Surgery ◽  
Shared Decision ◽  
High Dependency Unit ◽  
High Dependency ◽  
Number Of Patients ◽  
Risk Patients ◽  
Complex Cases

Aims Restarting planned surgery during the COVID-19 pandemic is a clinical and societal priority, but it is unknown whether it can be done safely and include high-risk or complex cases. We developed a Surgical Prioritization and Allocation Guide (SPAG). Here, we validate its effectiveness and safety in COVID-free sites. Methods A multidisciplinary surgical prioritization committee developed the SPAG, incorporating procedural urgency, shared decision-making, patient safety, and biopsychosocial factors; and applied it to 1,142 adult patients awaiting orthopaedic surgery. Patients were stratified into four priority groups and underwent surgery at three COVID-free sites, including one with access to a high dependency unit (HDU) or intensive care unit (ICU) and specialist resources. Safety was assessed by the number of patients requiring inpatient postoperative HDU/ICU admission, contracting COVID-19 within 14 days postoperatively, and mortality within 30 days postoperatively. Results A total of 1,142 patients were included, 47 declined surgery, and 110 were deemed high-risk or requiring specialist resources. In the ten-week study period, 28 high-risk patients underwent surgery, during which 68% (13/19) of Priority 2 (P2, surgery within one month) patients underwent surgery, and 15% (3/20) of P3 (< three months) and 16% (11/71) of P4 (> three months) groups. Of the 1,032 low-risk patients, 322 patients underwent surgery. Overall, 21 P3 and P4 patients were expedited to ‘Urgent’ based on biopsychosocial factors identified by the SPAG. During the study period, 91% (19/21) of the Urgent group, 52% (49/95) of P2, 36% (70/196) of P3, and 26% (184/720) of P4 underwent surgery. No patients died or were admitted to HDU/ICU, or contracted COVID-19. Conclusion Our widely generalizable model enabled the restart of planned surgery during the COVID-19 pandemic, without compromising patient safety or excluding high-risk or complex cases. Patients classified as Urgent or P2 were most likely to undergo surgery, including those deemed high-risk. This model, which includes assessment of biopsychosocial factors alongside disease severity, can assist in equitably prioritizing the substantial list of patients now awaiting planned orthopaedic surgery worldwide. Cite this article: Bone Jt Open 2021;2(2):134–140.

scholarly journals SEGURANÇA DO PACIENTE: AVALIAÇÃO DO SISTEMA DE MEDICAÇÃO POR ENFERMEIROS UTILIZANDO ANÁLISE FOTOGRÁFICA

2016 ◽  
Vol 7 (1) ◽  
pp. 76-80 ◽  
Author(s):  
Camila Dannyelle Fernandes Dutra Pereira ◽  
Francis Solange Vieira Tourinho ◽  
Viviane Euzébia Pereira Santos
Keyword(s):  
Patient Safety ◽  
Safe Level ◽  
Analysis Methodology ◽  
Photographic Analysis ◽  
The Social ◽  
El Sistema ◽  
Level 3 ◽  
Level 1 ◽  
Inpatient Units ◽  
Level 2

Objetivo: identificar como enfermeiros avaliam a Segurança do Paciente no sistema de medicação através da análise fotográfica. Metodologia: estudo descritivo e quantitativo desenvolvido em um hospital de ensino, com amostra de 34 enfermeiros das unidades de internação. A coleta dos dados utilizou o método fotográfico. Abordou-se a avaliação da segurança em 10 fotografias através da escolha de um número entre 1 (muito inseguro) e 10 (muito seguro) e a análise dos dados foi realizado no Statistical Package for the Social Scienses versão 20.0. Resultados: adaptando os escores atribuídos à escala, foi possível identificar entre as fotografias: três Totalmente Inseguras (Grau 1), três Inseguras (Grau 2), três Seguras Parcialmente (Grau 3) e uma Segura (Grau 4). Conclusão: o estudo evidencia fragilidades no sistema de medicação, o que exige que a Enfermagem revise seu processo de trabalho para prevenir os erros, fundamentando o cuidado na Segurança do Paciente.Descritores: Enfermagem, Segurança do Paciente, Sistemas de Medicação.PATIENT SAFETY: NURSES’ EVALUATION OF THE MEDICATION SYSTEM THROUGH PHOTOGRAPHIC ANALYSISObjective: this study aimed to identify how nurses assess Patient Safety in the medication system through photographic analysis. Methodology: a descriptive and quantitative study conducted in a teaching hospital, with a sample of 34 nurses from inpatient units. Data collection used the photographic method. This study addressed the safety assessment in 10 photographs by choosing a number in a scale from 1 (very unsafe) to 10 (very safe) and data analysis was performed using the Statistical Package for Social Scienses version 20.0. Results: by adapting the scores attributed to the scale, we were able to identify among the photographs: three Totally Unsafe (Level 1), three Unsafe (Level 2), three Partially Safe (Level 3), and one Safe (Level 4). Conclusion: the study highlights the weaknesses in the medication system, which requires that nursing review its work process to prevent errors, basing the care on Patient Safety.Descriptors: Nursing, Patient Safety, Medication Systems.SEGURIDAD DEL PACIENTE: EVALUACIÓN DE LO SISTEMA DE MEDICAMENTOS PARA ENFERMEROS UTILIZANDO ANÁLISIS DE IMAGENObjetivo: tuvo como objetivo identificar cómo los enfermeros evalúan la seguridad del paciente en el sistema de medicamentos a través de análisis fotográfico. Metodología: estudio descriptivo y cuantitativo realizado en un hospital universitário, con una muestra de 34 enfermeros de las unidades de hospitalización. La recolección de datos utiliza el método fotográfico. Este estudio abordó la evaluación de la seguridad en 10 fotografías por la elección de un número entre 1 (muy inseguro) a 10 (muy seguro) y análisis de datos se realizó mediante el Statistical Package for Social Scienses version 20.0. Resultados: adaptación de las puntuaciones atribuidas a la escala pudo identificar entre las fotografías: tres Totalmente Inseguro (Grado 1) tres Inseguro (Grado 2), tres Parcialmente Seguro (Grado 3) y una Segura (Grado 4). Conclusión: el estudio pone de relieve las debilidades en el sistema de medicamentos, lo que requiere que la enfermería revisar su proceso de trabajo para evitar errores, basando la atención sobre la Seguridad del Paciente.Descriptores: Enfermería, Seguridad del Paciente, Sistemas de Medicación.

Anwendung des 10-Gruppenklassifikationssystems nach Robson für den Vergleich eines Perinatalzentrums Level 1 mit einem Level-3-Zentrum

2020 ◽  
Author(s):  
C Pulvermacher ◽  
P van de Vondel ◽  
L Gerzen ◽  
U Gembruch ◽  
W Merz
Keyword(s):  
Level 3 ◽  
Level 1

EVALUASI PELATIHAN DI PT. PUPUK KUJANG CIKAMPEK

2018 ◽  
Vol 3 (2) ◽  
Author(s):  
Lania Muharsih ◽  
Ratih Saraswati
Keyword(s):  
Training Evaluation ◽  
Work Productivity ◽  
Learning Behavior ◽  
Level 3 ◽  
Level 1 ◽  
Four Levels ◽  
A Company ◽  
Level 2 ◽  
Evaluation Sheet ◽  
Assessment Factor

This study aims to determine the training evaluation at PT. Kujang Fertilizer. PT. Pupuk Kujang is a company engaged in the field of petrochemicals. Evaluation sheet of PT. Fertilizer Kujang is made based on Kirkpatrick's theory which consists of four levels of evaluation, namely reaction, learning, behavior, and results. At level 1, namely reaction, in the evaluation sheet is in accordance with the theory of Kirkpatrick, at level 2 that is learning should be held pretest and posttest but only made scale. At level 3, behavior, according to theory, but on assessment factor number 3, quantity and work productivity should not need to be included because they are included in level 4. At level 4, that is the result, here is still lacking to get a picture of the results of the training that has been carried out because only based on answers from superiors without evidence of any documents.   Keywords: Training Evaluation, Kirkpatrick Theory.    Penelitian ini bertujuan mengetahui evaluasi training di PT. Pupuk Kujang. PT. Pupuk Kujang merupakan perusahaan yang bergerak di bidang petrokimia. Lembar evaluasi PT. Pupuk Kujang dibuat berdasarkan teori Kirkpatrick yang terdiri dari empat level evaluasi, yaitu reaksi, learning, behavior, dan hasil. Pada level 1 yaitu reaksi, di lembar evaluasi tersebut sudah sesuai dengan teori dari Kirkpatrick, pada level 2 yaitu learning seharusnya diadakan pretest dan posttest namun hanya dibuatkan skala. Pada level 3 yaitu behavior, sudah sesuai teori namun pada faktor penilaian nomor 3 kuantitas dan produktivitas kerja semestinya tidak perlu dimasukkan karena sudah termasuk ke dalam level 4. Pada level 4 yaitu hasil, disini masih sangat kurang untuk mendapatkan gambaran hasil dari pelatihan yang sudah dilaksanakan karena hanya berdasarkan dari jawaban atasan tanpa bukti dokumen apapun.   Kata kunci: Evaluasi Pelatihan, Teori Kirkpatrick.

scholarly journals Modified STOP-Bang for predicting perioperative adverse events in the Thai population

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lisa Sangkum ◽  
Chama Wathanavaha ◽  
Visasiri Tantrakul ◽  
Munthana Pothong ◽  
Cherdkiat Karnjanarachata
Keyword(s):  
High Risk ◽  
Adverse Events ◽  
Oxygen Therapy ◽  
Elective Surgery ◽  
Low Risk ◽  
Perioperative Outcomes ◽  
P Value ◽  
Icu Admission ◽  
Obstructive Sleep ◽  
Postanesthetic Care Unit

Abstract Background Undiagnosed obstructive sleep apnea (OSA) is associated with adverse perioperative outcomes. The STOP-Bang questionnaire is a validated screening tool for OSA. However, its precision may vary among different populations. This study determined the association between high-risk OSA based on the modified STOP-Bang questionnaire and perioperative adverse events. Methods This cross-sectional study included patients undergoing elective surgery from December 2018 to February 2019. The modified STOP-Bang questionnaire includes a history of Snoring, daytime Tiredness, Observed apnea, high blood Pressure, Body mass index > 30 kg/m2, Age > 50, Neck circumference > 40 cm, and male Gender. High risk for OSA was considered as a score ≥ 3. Results Overall, 400 patients were included, and 18.3% of patients experienced perioperative adverse events. On the basis of modified STOP-Bang, the incidence of perioperative adverse events was 23.2 and 13.8% in patients with high risk and low risk (P-value 0.016) (Original STOP-Bang: high risk 22.5% vs. low risk 14.7%, P-value 0.043). Neither modified nor original STOP-Bang was associated with perioperative adverse events (adjusted OR 1.91 (95% CI 0.99–3.66), P-value 0.055) vs. 1.69 (95%CI, 0.89–3.21), P-value 0.106). Modified STOP-Bang ≥3 could predict the incidence of difficult ventilation, laryngoscopic view ≥3, need for oxygen therapy during discharge from postanesthetic care unit and ICU admission. Conclusions Neither modified nor original STOP-Bang was significantly associated with perioperative adverse events. However, a modified STOP-Bang ≥3 can help identify patients at risk of difficult airway, need for oxygen therapy, and ICU admission. Trial registrations This study was registered on Thai Clinical Trials Registry, identifier TCTR20181129001, registered 23 November 2018 (Prospectively registered).

scholarly journals The effects of a preoperative multidisciplinary conference on outcomes for high-risk patients with challenging surgical treatment options: a retrospective study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Masayoshi Koike ◽  
Mie Yoshimura ◽  
Yasushi Mio ◽  
Shoichi Uezono
Keyword(s):  
Patient Safety ◽  
Retrospective Study ◽  
High Risk ◽  
Treatment Plan ◽  
Treatment Options ◽  
High Risk Patients ◽  
Appropriate Treatment ◽  
Risk Patients ◽  
Treatment Plans ◽  
Multidisciplinary Conference

Abstract Background Surgical options for patients vary with age and comorbidities, advances in medical technology and patients’ wishes. This complexity can make it difficult for surgeons to determine appropriate treatment plans independently. At our institution, final decisions regarding treatment for patients are made at multidisciplinary meetings, termed High-Risk Conferences, led by the Patient Safety Committee. Methods In this retrospective study, we assessed the reasons for convening High-Risk Conferences, the final decisions made and treatment outcomes using conference records and patient medical records for conferences conducted at our institution from April 2010 to March 2018. Results A total of 410 High-Risk Conferences were conducted for 406 patients during the study period. The department with the most conferences was cardiovascular surgery (24%), and the reasons for convening conferences included the presence of severe comorbidities (51%), highly difficult surgeries (41%) and nonmedical/personal issues (8%). Treatment changes were made for 49 patients (12%), including surgical modifications for 20 patients and surgery cancellation for 29. The most common surgical modification was procedure reduction (16 patients); 4 deaths were reported. Follow-up was available for 21 patients for whom surgery was cancelled, with 11 deaths reported. Conclusions Given that some change to the treatment plan was made for 12% of the patients discussed at the High-Risk Conferences, we conclude that participants of these conferences did not always agree with the original surgical plan and that the multidisciplinary decision-making process of the conferences served to allow for modifications. Many of the modifications involved reductions in procedures to reflect a more conservative approach, which might have decreased perioperative mortality and the incidence of complications as well as unnecessary surgeries. High-risk patients have complex issues, and it is difficult to verify statistically whether outcomes are associated with changes in course of treatment. Nevertheless, these conferences might be useful from a patient safety perspective and minimize the potential for legal disputes.

scholarly journals An Atmospheric Visibility Grading Method Based on Ensemble Learning and Stochastic Weight Average

Atmosphere ◽  
2021 ◽  
Vol 12 (7) ◽  
pp. 869
Author(s):  
Xiuguo Zou ◽  
Jiahong Wu ◽  
Zhibin Cao ◽  
Yan Qian ◽  
Shixiu Zhang ◽  
...  
Keyword(s):  
Ensemble Learning ◽  
Traffic Accidents ◽  
Feature Sets ◽  
Atmospheric Visibility ◽  
Average Accuracy ◽  
Level 3 ◽  
Visual Characteristics ◽  
Level 1 ◽  
Grading Model ◽  
Level 2

In order to adequately characterize the visual characteristics of atmospheric visibility and overcome the disadvantages of the traditional atmospheric visibility measurement method with significant dependence on preset reference objects, high cost, and complicated steps, this paper proposed an ensemble learning method for atmospheric visibility grading based on deep neural network and stochastic weight averaging. An experiment was conducted using the scene of an expressway, and three visibility levels were set, i.e., Level 1, Level 2, and Level 3. Firstly, the EfficientNet was transferred to extract the abstract features of the images. Then, training and grading were performed on the feature sets through the SoftMax regression model. Subsequently, the feature sets were ensembled using the method of stochastic weight averaging to obtain the atmospheric visibility grading model. The obtained datasets were input into the grading model and tested. The grading model classified the results into three categories, with the grading accuracy being 95.00%, 89.45%, and 90.91%, respectively, and the average accuracy of 91.79%. The results obtained by the proposed method were compared with those obtained by the existing methods, and the proposed method showed better performance than those of other methods. This method can be used to classify the atmospheric visibility of traffic and reduce the incidence of traffic accidents caused by atmospheric visibility.

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