scholarly journals UK Health Care Workers' Experiences of Major System Change in Elective Surgery during the COVID-19 Pandemic: Reflections on Rapid Service Adaptation

2021 ◽  
Author(s):  
Georgina Singleton ◽  
Anna Dowrick ◽  
Louisa Manby ◽  
Harrison Fillmore ◽  
Aron Syversen ◽  
...  
Keyword(s):  
Decision Making ◽  
Elective Surgery ◽  
Rapid Change ◽  
Surgical Care ◽  
Systems Change ◽  
System Level ◽  
Framework Analysis ◽  
Surgical Services ◽  
The Uk ◽  
Service Adaptation

Background The COVID-19 pandemic disrupted the delivery of elective surgery in the UK. The majority of planned surgery was cancelled or postponed in March 2020 for the duration of the first wave of the pandemic. We investigated the experiences of staff responsible for delivering rapid changes to surgical services during the first wave of the pandemic in the UK, with the aim of developing lessons for future major systems change. Methods Using a rapid qualitative study design, we conducted 25 interviews with frontline surgical staff during the first wave of the pandemic. We also carried out a policy review of the guidance developed for those delivering surgical services in pandemic conditions. We used framework analysis to organise and interpret findings. Results Staff discussed positive and negative experiences of rapid service organisation. Clinician-led decision making, the flexibility of individual staff and teams, and the opportunity to innovate service design were all seen as positive contributors to success in service adaptation. The negative aspects of rapid change were inconsistent guidance from national government and medical bodies, top-down decisions about when to cancel and restart surgery, the challenges of delivering emergency surgical care safely and the complexity of prioritising surgical cases when services re-started. Conclusion Success in the rapid reorganisation of elective surgical services can be attributed to the flexibility and adaptability of staff. However, there was an absence of involvement of staff in wider system-level pandemic decision-making and competing guidance from national bodies. Involving staff in decisions about the organisation and delivery of major systems change is essential for the sustainability of change processes.

scholarly journals UK Healthcare Workers’ Experiences of Major System Change in Elective Surgery During the COVID-19 Pandemic: Reflections on Rapid Service Adaptation

2021 ◽  
Author(s):  
Georgina Singleton ◽  
Anna Dowrick ◽  
Louisa Manby ◽  
Harrison Fillmore ◽  
Aron Syverson ◽  
...  
Keyword(s):  
Decision Making ◽  
United Kingdom ◽  
Elective Surgery ◽  
Rapid Change ◽  
Surgical Care ◽  
System Level ◽  
Framework Analysis ◽  
Surgical Services ◽  
The United Kingdom ◽  
Service Adaptation

Background: The coronavirus disease 2019 (COVID-19) pandemic disrupted the delivery of elective surgery in the United Kingdom. The majority of planned surgery was cancelled or postponed in March 2020 for the duration of the first wave of the pandemic. We investigated the experiences of staff responsible for delivering rapid changes to surgical services during the first wave of the pandemic in the United Kingdom, with the aim of developing lessons for future major systems change (MSC). Methods: Using a rapid qualitative study design, we conducted 25 interviews with frontline surgical staff during the first wave of the pandemic. Framework analysis was used to organise and interpret findings. Results: Staff discussed positive and negative experiences of rapid service organisation. Clinician-led decision-making, the flexibility of individual staff and teams, and the opportunity to innovate service design were all seen as positive contributors to success in service adaptation. The negative aspects of rapid change were inconsistent guidance from national government and medical bodies, top-down decisions about when to cancel and restart surgery, the challenges of delivering emergency surgical care safely and the complexity of prioritising surgical cases when services re-started. Conclusion: Success in the rapid reorganisation of elective surgical services can be attributed to the flexibility and adaptability of staff. However, there was an absence of involvement of staff in wider system-level pandemic decision-making and competing guidance from national bodies. Involving staff in decisions about the organisation and delivery of MSC is essential for the sustainability of change processes.

scholarly journals Making a decision about surgery for female urinary incontinence: a qualitative study of women’s views

2020 ◽  
Vol 32 (1) ◽  
pp. 127-133 ◽  
Author(s):  
Rebecca Lynch ◽  
Philip Toozs-Hobson ◽  
Jonathan Duckett ◽  
Douglas Tincello ◽  
Simon Cohn
Keyword(s):  
Decision Making ◽  
Urinary Incontinence ◽  
Shared Decision Making ◽  
Medical Information ◽  
Elective Surgery ◽  
Comparative Method ◽  
Shared Decision ◽  
Qualitative Interview Study ◽  
Personal Accounts ◽  
The Uk

Abstract Introduction and hypothesis This qualitative interview study explores aspects women with urinary incontinence(UI) reflect upon when considering whether or not to have surgery. Conducted prior to the recent mesh pause in the UK, the article provides insights for current and future approaches to shared decision-making. Methods Qualitative in-depth interviews of 28 patients referred to secondary care for stress and mixed UI who were considering UI surgery. Participants were recruited from four urogynaecology clinics in the Midlands and South England, UK. Interviews were conducted in clinics, in patient homes, and by telephone. Data analysis was based on the constant comparative method. Results Participants’ accounts comprised three key concerns: their experience of symptoms, the extent to which these impacted a variety of social roles and demands, and overcoming embarrassment. Accounts drew on individual circumstances, values, and concerns rather than objective or measurable criteria. In combination, these dimensions constituted a personal assessment of the severity of their UI and hence framed the extent to which women prioritized addressing their condition. Conclusions Acknowledging women’s personal accounts of UI shifts the concept of ‘severity’ beyond a medical definition to include what is important to patients themselves. Decision-making around elective surgery must endeavour to link medical information with women’s own experiences and personal criteria, which often change in priority over time. We propose that this research provides insight into how the controversy around the use of mesh in the UK emerged. This study also suggests ways in which facilitating shared decision-making should be conducted in future.

scholarly journals A multi-centre analysis of cardiac surgery referral patterns and resource allocation during the COVID-19 pandemic

2021 ◽  
Author(s):  
Damian Balmforth ◽  
Ana Lopez-Marco ◽  
Martin Yates ◽  
Benjamin Adams ◽  
Alex Cale ◽  
...  
Keyword(s):  
Resource Allocation ◽  
Cardiac Surgery ◽  
Emergency Surgery ◽  
Clinical Decision Making ◽  
Elective Surgery ◽  
Treatment Strategies ◽  
Referral Patterns ◽  
Surgical Services ◽  
Bed Capacity ◽  
The Uk

Background and aims: The COVID-19 pandemic caused a dramatic shift in the provision of cardiac surgical services in the United Kingdom (UK) with all elective surgery suspended. We sought to explore referral patterns, changes in clinical decision making and resource allocation to adult cardiac surgical services in the UK during the first wave of the pandemic. Methods: Data from 11 UK centres on referrals and available health resources (operating theatre and bed capacity) for urgent or emergency adult cardiac surgery between the 1st March 2020 and the 1st August 2020 was collated, and securely transferred to the lead centre for analysis. Results: 1113 patients were referred for cardiac surgery over the study period. Following UK lockdown in March 2020 the number of referrals initially fell to 39% of pre-lockdown levels before recovering to 211% of that seen prior to the pandemic. A change in treatment strategies was observed with a trend towards deferring surgery entirely or favouring less invasive, non-surgical treatments. At the peak of the pandemic in April 2020, theatre availability and bed capacity fell to 26% and 54% of pre-lockdown levels, respectively. Provision for emergency surgery was maintained throughout at 1 to 2 emergency lists per unit weekly. Conclusion: During the first wave of the UK COVID-19 pandemic cardiac surgical operative activity dropped acutely before increasing over the next four months. Despite this drop, provision for emergency surgery was retained throughout. In the event of further waves of COVID-19 pandemic, maintaining essential cardiac surgical services should be prioritised.

scholarly journals P-BN45 The Impact of Covid-19 on Benign Upper GI Operations in England During 2020

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Laura Sandland-Taylor ◽  
Barbara Jenkins ◽  
Ian Beckingham
Keyword(s):  
Bile Duct ◽  
Elective Surgery ◽  
Demographic Data ◽  
National Level ◽  
Emergency Operations ◽  
Surgical Services ◽  
Upper Gi ◽  
Level Data ◽  
The Uk ◽  
The Impact

Abstract Background Since the cancellation of elective surgery in early 2020 due to the threat of Covid-19, surgical provisions in England have continued to be affected by the Covid-19 pandemic. Elective surgery makes up the majority of surgical procedures performed in England and therefore   cancelled operation lists and increased demand for ITU beds has had a significant impact upon the surgical services delivered to patients through out 2020. The following research looks at the impact of Covid-19 on benign upper GI surgery in England and reviews the relationship between Covid-19 deaths and operations performed throughout England and analyses the data at a regional level.  Methods Data relating to operation numbers was taken from The Surgical Workload Outcomes Audit (SWORD) database. The SWORD database was interrogated for the years 2017 – 2020. A mean number of operations was calculated using the 2017-2019 data and compared to data from 2020. Operations performed and other demographic data  was analysed regionally and compared to Covid-19 deaths throughout England. Covid-19 data was obtained from the national government dashboards.  Results The results show that there is a correlation with increasing Covid deaths and lower rates of elective surgery. Furthermore, elective surgery was worse hit than emergency surgery with a slower recovery overall. Cholecystectomies were reduced by a total of 20817 (31.4%) for the year 2020 with a greater reduction seen in elective operations (35.6%). However, similar reductions were seen in both laparoscopic (31.4%) and open (37.5%) Similarly, bile duct explorations and elective splenectomy were reduced by 34.4% and 23.4% respectively. Comparatively, both paraumbilical and inguinal hernias also saw reductions of greater than 40% in 2020 when compared to the mean of the previous 3 years. Regional variances were seen between operation numbers performed and Covid-19 rates, however the overall trend remained the same for national level data.  Conclusions Overall, the Covid-19 pandemic has had a significant impact on operations, particularly on those deemed as benign and ‘less urgent’. Whilst a global impact across all benign operations was seen, greater reductions were seen in elective operations compared to emergency operations. Hernia operations and bile duct exploration saw greater overall reductions compared to cholecystectomies and splenectomies, which suggests that whilst operation numbers were reduced, efforts were made to prioritise operations with greater clinical need throughout the pandemic. On analysis of the data in relation to Covid-19 rates and deaths, variation was seen across the regions in the UK, however overall the trend remained the same. Centres and regions worse hit by Covid-19 performed less operations during 2020. However, further qualitative research to investigate why certain centres maintained higher levels of performance during the pandemic would be beneficial for planning for future waves and future pandemics. 

scholarly journals 743 Establishing COVID-Secure Surgery: Maintaining Urgent Elective Surgery During The COVID-19 Pandemic

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
L Phelan ◽  
H Digne-Malcolm ◽  
D Hassett ◽  
D N Naumann ◽  
M P Dilworth ◽  
...  
Keyword(s):  
Spinal Anaesthesia ◽  
Elective Surgery ◽  
Surgical Care ◽  
Healthcare Services ◽  
Major Surgery ◽  
Safe Delivery ◽  
Care Services ◽  
Anaesthetic Care ◽  
The Uk ◽  
Level 2

Abstract Introduction The COVID-19 pandemic continues to impose significant direct burdens on secondary healthcare services in the UK and around the world. Maintaining timely and safe delivery of major urgent elective surgery throughout the pandemic is essential if we are to continue to treat cancer and other time-critical surgical conditions. Our Trust established a COVID-secure hospital within the Trust to deliver urgent elective surgical care. Method Basic demographics, operative interventions and 30-day outcomes of consecutive patients undergoing major surgery at our COVID-secure site were collected between June-November 2020. Major surgery was defined as patients requiring admission to the Post Anaesthetic care unit (PACU). PACU provides Level 2 care for 23 hours before discharging patients to the ward. Results 279 consecutive patients were included. PACU admission >23 hours were associated with increased total length of stay (LOS) (p = 0.004), 30-day complications (p < 0.0001), higher rate of transfer to a ‘COVID-hot’ hospital (p = 0.01) and nosocomial COVID-19 infection (p = 0.051). Compared to spinal anaesthesia, epidural anaesthesia was associated with PACU admission breach (p = 0.02), increased total LOS (p = 0.01), increased transfer to the ‘hot’ sites (p = 0.03) and 30-day complications (p = 0.06). Conclusions Establishing a COVID-secure site enabled continuation of major urgent elective surgery within a viral pandemic. Level 2 support is essential to ensure safe delivery of complex surgery at ‘cold’ sites. This study has identified clinically relevant advantage with the use of adjuvant spinal anaesthesia in preference to epidural. Enhancing critical care services is essential to minimise patient transfer to ‘hot sites’ and limit nosocomial COVID infection.

SP3.1.9 Building the ‘LIEGS’ way – The development and delivery of ambulatory surgical services in the busiest acute surgical unit in the UK

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Adam Peckham-Cooper ◽  
Andrea Giorga ◽  
Nasira Amtul ◽  
Aman Ahmad ◽  
Giles Toogood ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Surgical Care ◽  
Day Case ◽  
Emergency General Surgery ◽  
Alternative Pathways ◽  
Rapid Access ◽  
Acute Surgery ◽  
Patient Pathways ◽  
The Uk

Abstract Background Managing unplanned surgical care presents enormous challenges to trusts and continues to be resource intensive. Significant patient numbers can be managed in novel ways preventing admission with effective triage to alternative flow streams using outpatient/ambulatory models. Leeds Institute of Emergency General Surgery (LIEGS) reports its early experience. Methods Patients requiring assessment or admission from primary care are triaged directly by a consultant. GP’s are offered advice or patients are directed to appropriate assessment/triage pathways. A number of alternative pathways exist depending on pathology and patient demographics. Prospective data for all patients referred are captured and retrospective analysis of outcomes collected. We report our experience from October-November 2020. Results Consultant triage and early senior decision-making has streamlined patient pathways and flow. 51%(237) of all GP referrals(465) were assessed primarily in ASC, 8%(36) required advice only and 10%(44) were directed to other specialities. 30%(139) were seen on the Surgical Assessment Unit ward representing a reduction of 70% compared to the previous year. Outcomes from those patients seen in ASC were discharge after imaging (87,18.7%), discharge without imaging (74,15.9%), hospital admission (65,14%), acute operation (63,13.5%), referral to other specialty (64,13.8%) and Rapid Access Theatre for day case operation (32,6.9%). Conclusion 71.7% of all acute surgery primary care referrals were managed on in an ambulatory fashion providing an invaluable resource. Early senior decision making, a one-stop clinic for investigations and day case Rapid Access Theatre (RAT) lists can significantly improve the patient pathways and experience.

How multidisciplinary are multidisciplinary case reviews in cancer care? Feasibility analysis of a theory-driven team decision-making fidelity framework

2019 ◽  
Author(s):  
Tayana Soukup ◽  
Ged Murtagh ◽  
Ben W Lamb ◽  
James Green ◽  
Nick Sevdalis
Keyword(s):  
Decision Making ◽  
Cancer Care ◽  
Recent Decade ◽  
Individual Case ◽  
Multidisciplinary Teams ◽  
Final Decision ◽  
Political Climate ◽  
Implementation Framework ◽  
Feasibility Evaluation ◽  
The Uk

Background Multidisciplinary teams (MDTs) are a standard cancer care policy in many countries worldwide. Despite an increase in research in a recent decade on MDTs and their care planning meetings, the implementation of MDT-driven decision-making (fidelity) remains unstudied. We report a feasibility evaluation of a novel method for assessing cancer MDT decision-making fidelity. We used an observational protocol to assess (1) the degree to which MDTs adhere to the stages of group decision-making as per the ‘Orientation-Discussion-Decision-Implementation’ framework, and (2) the degree of multidisciplinarity underpinning individual case reviews in the meetings. MethodsThis is a prospective observational study. Breast, colorectal and gynaecological cancer MDTs in the Greater London and Derbyshire (United Kingdom) areas were video recorded over 12-weekly meetings encompassing 822 case reviews. Data were coded and analysed using frequency counts.Results Eight interaction formats during case reviews were identified. case reviews were not always multi-disciplinary: only 8% of overall reviews involved all five clinical disciplines present, and 38% included four of five. The majority of case reviews (i.e. 54%) took place between two (25%) or three (29%) disciplines only. Surgeons (83%) and oncologists (8%) most consistently engaged in all stages of decision-making. While all patients put forward for MDT review were actually reviewed, a small percentage of them (4%) either bypassed the orientation (case presentation) and went straight into discussing the patient, or they did not articulate the final decision to the entire team (8%). Conclusions Assessing fidelity of MDT decision-making at the point of their weekly meetings is feasible. We found that despite being a set policy, case reviews are not entirely MDT-driven. We discuss implications in relation to the current eco-political climate, and the quality and safety of care. Our findings are in line with the current national initiatives in the UK on streamlining MDT meetings, and could help decide how to re-organise them to be most efficient.

Benchmarking Risk Analysis Practice in the International Water Sector

2006 ◽  
Vol 1 (2) ◽  
Author(s):  
B.H. MacGillivray ◽  
P.D. Hamilton ◽  
S.E. Hrudey ◽  
L. Reekie ◽  
S.J.T Pollard
Keyword(s):  
Decision Making ◽  
Risk Analysis ◽  
Water Utilities ◽  
Water Sector ◽  
Water Utility ◽  
Analysis Techniques ◽  
The Usa ◽  
International Water ◽  
Practical Guidance ◽  
The Uk

Risk analysis in the water utility sector is fast becoming explicit. Here, we describe application of a capability model to benchmark the risk analysis maturity of a sub-sample of eight water utilities from the USA, the UK and Australia. Our analysis codifies risk analysis practice and offers practical guidance as to how utilities may more effectively employ their portfolio of risk analysis techniques for optimal, credible, and defensible decision making.

The Law & Politics of Brexit: Volume II

2020 ◽  
Keyword(s):  
Decision Making ◽  
European Union ◽  
Legal Framework ◽  
Comprehensive Analysis ◽  
The European Union ◽  
Trade Relations ◽  
The United Kingdom ◽  
The Uk ◽  
Financial Settlement ◽  
The Eu

This book provides the first comprehensive analysis of the withdrawal agreement concluded between the United Kingdom and the European Union to create the legal framework for Brexit. Building on a prior volume, it overviews the process of Brexit negotiations that took place between the UK and the EU from 2017 to 2019. It also examines the key provisions of the Brexit deal, including the protection of citizens’ rights, the Irish border, and the financial settlement. Moreover, the book assesses the governance provisions on transition, decision-making and adjudication, and the prospects for future EU–UK trade relations. Finally, it reflects on the longer-term challenges that the implementation of the 2016 Brexit referendum poses for the UK territorial system, for British–Irish relations, as well as for the future of the EU beyond Brexit.

scholarly journals Drivers of Broad-Spectrum Antibiotic Overuse across Diverse Hospital Contexts—A Qualitative Study of Prescribers in the UK, Sri Lanka and South Africa

Antibiotics ◽  
2021 ◽  
Vol 10 (1) ◽  
pp. 94
Author(s):  
Carolyn Tarrant ◽  
Andrew M. Colman ◽  
David R. Jenkins ◽  
Edmund Chattoe-Brown ◽  
Nelun Perera ◽  
...  
Keyword(s):  
South Africa ◽  
Sri Lanka ◽  
Antimicrobial Stewardship ◽  
Broad Spectrum ◽  
Low Income ◽  
System Level ◽  
Comparative Approach ◽  
Structured Interviews ◽  
Public And Private ◽  
The Uk

Antimicrobial stewardship programs focus on reducing overuse of broad-spectrum antibiotics (BSAs), primarily through interventions to change prescribing behavior. This study aims to identify multi-level influences on BSA overuse across diverse high and low income, and public and private, healthcare contexts. Semi-structured interviews were conducted with 46 prescribers from hospitals in the UK, Sri Lanka, and South Africa, including public and private providers. Interviews explored decision making about prescribing BSAs, drivers of the use of BSAs, and benefits of BSAs to various stakeholders, and were analyzed using a constant comparative approach. Analysis identified drivers of BSA overuse at the individual, social and structural levels. Structural drivers of overuse varied significantly across contexts and included: system-level factors generating tensions with stewardship goals; limited material resources within hospitals; and patient poverty, lack of infrastructure and resources in local communities. Antimicrobial stewardship needs to encompass efforts to reduce the reliance on BSAs as a solution to context-specific structural conditions.

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