Article Commentary: Retained Intra-abdominal Surgical Instruments: Time to Use Nascent Technology?

2007 ◽  
Vol 73 (11) ◽  
pp. 1083-1085 ◽  
Author(s):  
Seth Berkowitz ◽  
Harry Marshall ◽  
Anthony Charles
Keyword(s):  
Healthcare System ◽  
Foreign Bodies ◽  
Surgical Care ◽  
Surgical Instruments ◽  
Individual Surgeon ◽  
The Individual ◽  
Complication Of Surgery

Retention of surgical instruments is a possible complication of surgery; moreover, its occurrence has typically been used to denote poor surgical care on the part of the individual surgeon and the healthcare system. In the literature, it is not surprising that instances of retained foreign bodies are underreported to minimize exposure to possible litigation.

scholarly journals Shared care in surgery: Practical considerations for surgical leaders

2020 ◽  
pp. 084047042095248
Author(s):  
Morgann Reid ◽  
Alex Lee ◽  
David R. Urbach ◽  
Craig Kuziemsky ◽  
Morad Hameed ◽  
...  
Keyword(s):  
Clinical Care ◽  
Surgical Care ◽  
Shared Care ◽  
Clinical Integration ◽  
Integration Model ◽  
Surgical Access ◽  
Disease Site ◽  
Individual Surgeon ◽  
Professional Isolation ◽  
The Individual

The recent COVID-19 pandemic has highlighted limitations in current healthcare systems and needed strategies to increase surgical access. This article presents a team-based integration model that embraces intra-disciplinary collaboration in shared clinical care, professional development, and administrative processes to address this surge in demand for surgical care. Implementing this model will require communicating the rationale for and benefits of shared care, while shifting patient trust to a team of providers. For the individual surgeon, advantages of clinical integration through shared care include decreased burnout and professional isolation, and more efficient transitions into and out of practice. Advantages to the system include greater surgeon availability, streamlined disease site wait lists, and promotion of system efficiency through a centralized distribution of clinical resources. We present a framework to stimulate national dialogue around shared care that will ultimately help overcome system bottlenecks for surgical patients and provide support for health professionals.

scholarly journals Outcomes of COVID-19 Negative Hip Fracture Patients During the Acute and Subacute Pandemic

2021 ◽  
Vol 12 ◽  
pp. 215145932110066
Author(s):  
Naoko Onizuka ◽  
Lauren N. Topor ◽  
Lisa K. Schroder ◽  
Julie A. Switzer
Keyword(s):  
Hip Fracture ◽  
Length Of Stay ◽  
Healthcare System ◽  
Perioperative Complications ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Surgical Care ◽  
Admission Rate ◽  
System Response ◽  
Fragility Hip Fracture

Objectives: To better elucidate how the COVID-19 pandemic has affected the operatively treated geriatric hip fracture population and how the health care system adapted to pandemic dictated procedures. Design: Retrospective cohort study. Setting: A community hospital. Participants: Individuals ≥65 years of age presented with a proximal femoral fracture from a low-energy mechanism undergoing operative treatment from January 17, 2020 to July 2, 2020 (N = 125). Measurements: We defined 3 phases of healthcare system response: pre-COVID-19, acute phase, and subacute phase. Thirty-day mortality, time to operating room (OR), length of stay, time to start physical therapy, perioperative complications, delirium rate, hospice admission rate, discharge dispositions, readmission rate, and the reason of surgery delay were assessed. Results: The number of hip fractures has remained constant during the pandemic. The 30-day mortality rate, time to OR, and length of stay were higher in the pandemic compared to the pre-pandemic. Those who had a longer wait time to OR (≥ 24 hours) had more complications and increased 30-day mortality rates. Some of the surgery delays were related to OR unavailability as a consequence of the COVID-19 pandemic. Surgery was delayed in 3 patients who were on direct oral anticoagulants (DOACs) in pandemic but none for pre-pandemic period. Conclusion: This is the first study to compare the effect of the acute and subacute phases of the pandemic on uninfected hip fracture patients. In the age of COVID-19, to provide the best care for the vulnerable geriatric orthopedic populations, the healthcare system must adopt new protocols. We should still aim to promote prompt surgical care when indicated. It is important to ensure adequate resource availability, such as OR time and staff so that hip fracture patients may continue to receive rapid access to surgery. A multidisciplinary approach remains the key to the management of fragility hip fracture patients during the pandemic.

Surge capacity and capability of intensive care units across a large healthcare system: An operational blueprint for regional integration

2021 ◽  
Vol 16 (3) ◽  
pp. 179-192
Author(s):  
Abhijit Duggal, MD, MPH, MSc ◽  
Erica Orsini, MD ◽  
Eduardo Mireles-Cabodevila, MD ◽  
Sudhir Krishnan, MD ◽  
Prabalini Rajendram, MD ◽  
...  
Keyword(s):  
Resource Allocation ◽  
Intensive Care ◽  
Healthcare System ◽  
Regional Integration ◽  
Medical Center ◽  
Academic Medical Center ◽  
Healthcare Services ◽  
Surge Capacity ◽  
Hospital System ◽  
The Individual

Objective: Many hospitals were unprepared for the surge of patients associated with the spread of coronavirus disease 2019 (COVID-19) pandemic. We describe the processes to develop and implement a surge plan framework for resource allocation, staffing, and standardized management in response to the COVID-19 pandemic across a large integrated regional healthcare system.Setting: A large academic medical center in the Cleveland metropolitan area, with a network of 10 regional hospitals throughout Northeastern Ohio with a daily capacity of more than 500 intensive care unit (ICU) beds.Results: At the beginning of the pandemic, an equitable delivery of healthcare services across the healthcare system was developed. This distribution of resources was implemented with the potential needs and resources of the individual ICUs in mind, and epidemiologic predictions of virus transmissibility. We describe the processes to develop and implement a surge plan framework for resource allocation, staffing, and standardized management in response to the COVID-19 pandemic across a large integrated regional healthcare system. We also describe an additional level of surge capacity, which is available to well-integrated institutions called “extension of capacity.” This refers to the ability to immediately have access to the beds and resources within a hospital system with minimal administrative burden.Conclusions: Large integrated hospital systems may have an advantage over individual hospitals because they can shift supplies among regional partners, which may lead to faster mobilization of resources, rather than depending on local and national governments. The pandemic response of our healthcare system highlights these benefits.

scholarly journals EVOLUTION OF VIEWS ON THE DEVELOPMENT AND IMPLEMENTATION OF MODERN SURGICAL MAGNETIC INSTRUMENTS ON THE CASE OF INFLAMMATORY PENETRATING INJURIES OF THE BREAST

2020 ◽  
pp. 113-118
Author(s):  
Yu. V. Bunin ◽  
P. M. Zamyatin ◽  
R. M. Mihаylusov ◽  
V. V. Negoduyko ◽  
S. O. Beresnyev ◽  
...  
Keyword(s):  
Foreign Bodies ◽  
Pleural Cavity ◽  
Gunshot Wounds ◽  
Surgical Instruments ◽  
Internal Organs ◽  
Surgical Interventions ◽  
Magnetic Nozzle ◽  
Endoscopic Laser ◽  
Laser Visualization ◽  
Magnetic Instrument

Summary. The arms — to analyze the evolution of the development of modern surgical instruments in gunshot wounds chest. Materials and methods. 80 cases of using a modern magnetic surgical instrument for penetrating gunshot wounds of the chest were analyzed. Intraoperatively used: a magnetic multifunctional tool for the diagnosis and removal of metallic ferromagnetic foreign bodies, a flexible device for removing ferromagnetic foreign bodies, a magnetic tool for endovideoscopic diagnosis and removal of metallic ferromagnetic foreign bodies from the abdominal and pleural cavities, a magnetic nozzle for video endoscopic surgical interventions. When removing metal foreign bodies, the following methods were used: a method for preliminary determination of the material and properties of a foreign body, a method for video endoscopic laser visualization of the internal organs of the abdominal and pleural cavities. Results. Foreign bodies of the pleural cavity were diagnosed in 80 (100 %) wounded according to СT. Ferromagnetic metal foreign bodies of a gunshot origin of the pleural cavity were removed both during thoracotomy or minithoracotomy, and during thoracoscopic surgical interventions using the method of video endoscopic laser visualization of the internal organs of the abdominal and pleural cavities. The most convenient tool was the endoscopic magnetic tool for removing foreign bodies from the pleural or abdominal cavities. A magnetic nozzle for video endoscopic surgical interventions allows navigation both in the pleural cavity and along the wound channel. Conclusions. 1. The development of a surgical magnetic instrument was phased and began with the improvement of a surgical magnetic instrument to remove ferromagnetic foreign bodies of soft tissues. 2. The improvement of the tool took place as the restrictions on the use of the existing tool were established, which was a prerequisite for the development of a new tool. 3. It is advisable to create a special set of surgical magnetic instruments for video endoscopic surgery.

scholarly journals A three-step model of stress management for health leaders

2018 ◽  
Vol 31 (3) ◽  
pp. 81-86
Author(s):  
Elizabeth Hartney
Keyword(s):  
Nervous System ◽  
Stress Management ◽  
Healthcare System ◽  
Stressful Environment ◽  
Step Model ◽  
System Functioning ◽  
Managing Stress ◽  
The Individual ◽  
The Impact ◽  
The Brain

The current healthcare system is often as highly stressful environment for patients, their families, and for the employees of the system. Health leaders also experience stress, which can have profound repercussions if not well managed. This article describes the impact of stress on the brain and nervous system functioning of health leaders, then, drawing on evidence from the literature, presents a three-step model for managing stress at the individual, team/organizational, and system levels.

Up Close and Personal: A Statewide Collaborative's Effort to Get Individual Surgeon Quality Improvement Data to the Practitioner

2016 ◽  
Vol 82 (3) ◽  
pp. 192-198
Author(s):  
Brian J. Daley ◽  
William Cecil ◽  
Joseph B. Cofer ◽  
P. Chris Clarke ◽  
Oscar Guillamondegui ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Best Practice ◽  
Quality Improvement Program ◽  
Surgical Morbidity ◽  
Improvement Program ◽  
Surgical Quality ◽  
Prolonged Intubation ◽  
Personal A ◽  
Individual Surgeon ◽  
The Individual

Ranking of surgeons and hospitals focuses on procedure volume and hospitality. The National Surgical Quality Improvement Program provides vetted outcomes of surgical quality and therefore can direct improvement. Our statewide collaborative's analysis creates personalized surgeon data to drive quality improvement. Statewide National Surgical Quality Improvement Program data generated specific measures from 103,656 general/vascular cases and identified individual surgeon's outcome of occurrences and length of procedure. We assumed a normal distribution and called the top 2.5 per cent as exemplars and the bottom 2.5 per cent as outliers. For length of operation, a standard duration was calculated, and identified outliers as longer than the 95th percentile of the upper confidence interval/procedure. Since 2009, sharing best practice reduced statewide mortality rate by 31.5 per cent and postoperative morbidity by 33.3 per cent. For length of surgery, long outliers have more complications (urinary tract infection, organ space/surgical site infection, sepsis, septic shock, prolonged intubation, pneumonia, deep venous thrombosis, deep incisional infection, and wound disruption). No significant trends in surgeon performance were seen over 24 months. A statewide collaborative has resulted in substantial risk-adjusted reductions in surgical morbidity and mortality. These results of the individual surgeon demonstrate best practices are shared, a proven tool for improvement in our collaborative.

The ageing population

2019 ◽  
Vol 12 (5) ◽  
pp. 239-242
Author(s):  
Zein Toukan
Keyword(s):  
Risk Factors ◽  
Older People ◽  
Healthcare System ◽  
Demographic Change ◽  
Morbidity And Mortality ◽  
Ageing Population ◽  
The Individual ◽  
The Uk

The UK is undergoing a significant demographic change, due to a steadily ageing population. By 2040 nearly one-in-four people will be aged 65 years or over. This will have several implications for the individual, society, the healthcare system and the economy. This article aims to highlight some of the risk factors that contribute to increased morbidity and mortality in older people and to outline strategies aimed at reducing ill health and disability.

scholarly journals Intravesical Tension-Free Vaginal Tape Removal: Is There a Single Solution?

ISRN Urology ◽  
2011 ◽  
Vol 2011 ◽  
pp. 1-4
Author(s):  
Rhana H. Zakri ◽  
Amit K. Patel ◽  
Babbin S. John ◽  
Nitin C. Shrotri
Keyword(s):  
Urinary Incontinence ◽  
Full Range ◽  
Common Interest ◽  
Optimal Management ◽  
Number Of Patients ◽  
Single Solution ◽  
Individual Surgeon ◽  
History Of ◽  
The Individual ◽  
The Ideal

Stress urinary incontinence (SUI) affects 10–20% of women in the general population. Surgery for stress incontinence has been performed on women for over a century, but with the advent of new urogynaecological sling procedures for its management, urological surgeons are having to deal with an increasing number of patients presenting with associated complications. With no clarity on the full range of possible complications or certain consensus on their optimal management, the ideal treatment remains a decision for the individual surgeon. In view of this, we felt it of common interest to review the literature for the history of sling procedures, present commonly arising complications, and seek to answer the question in the title.

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