scholarly journals The (non) use of prioritisation protocols by surgeons

2020 ◽  
Author(s):  
Kevin Dew ◽  
M Stubbe ◽  
L Macdonald ◽  
A Dowell ◽  
E Plumridge
Keyword(s):  
Elective Surgery ◽  
Good News ◽  
Consultation Process ◽  
Policy Goals ◽  
Dominant Feature ◽  
Treatment Plans ◽  
Video And Audio ◽  
Sociology Of Health ◽  
Priority Assessment ◽  
Clinician Behaviour

Priority setting and rationing is a dominant feature of contemporary health policy. In New Zealand, clinical priority assessment criteria (CPAC) tools have been developed to make access to elective surgery more equitable and efficient. Research was undertaken to identify how surgeons used these tools in the consultation. Forty-seven consultations with 15 different surgeons have to date been video- and audio-recorded. There were no instances where CPAC tools were explicitly used in the consultation. Drawing on the methodology of conversation analysis and the concept of news delivery as developed by Maynard, this paper argues that the delivery of diagnoses and treatment plans can usefully be seen in part as the delivery of bad or good news. Using three case studies to illustrate the argument, it is suggested that the interactional work required in the delivery of such news challenges the ability of clinicians to use protocols such as CPAC. The analysis sheds light on important consultation processes that need to be more carefully considered when designing interventions to influence clinician behaviour. In order to influence the behaviour of clinicians to achieve policy goals, greater attention needs to be paid to the interactional demands of the consultation process. © 2010 The Authors. Journal compilation © 2010 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd.

scholarly journals The (non) use of prioritisation protocols by surgeons

2020 ◽  
Author(s):  
Kevin Dew ◽  
M Stubbe ◽  
L Macdonald ◽  
A Dowell ◽  
E Plumridge
Keyword(s):  
Elective Surgery ◽  
Good News ◽  
Consultation Process ◽  
Policy Goals ◽  
Dominant Feature ◽  
Treatment Plans ◽  
Video And Audio ◽  
Sociology Of Health ◽  
Priority Assessment ◽  
Clinician Behaviour

Priority setting and rationing is a dominant feature of contemporary health policy. In New Zealand, clinical priority assessment criteria (CPAC) tools have been developed to make access to elective surgery more equitable and efficient. Research was undertaken to identify how surgeons used these tools in the consultation. Forty-seven consultations with 15 different surgeons have to date been video- and audio-recorded. There were no instances where CPAC tools were explicitly used in the consultation. Drawing on the methodology of conversation analysis and the concept of news delivery as developed by Maynard, this paper argues that the delivery of diagnoses and treatment plans can usefully be seen in part as the delivery of bad or good news. Using three case studies to illustrate the argument, it is suggested that the interactional work required in the delivery of such news challenges the ability of clinicians to use protocols such as CPAC. The analysis sheds light on important consultation processes that need to be more carefully considered when designing interventions to influence clinician behaviour. In order to influence the behaviour of clinicians to achieve policy goals, greater attention needs to be paid to the interactional demands of the consultation process. © 2010 The Authors. Journal compilation © 2010 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd.

Evaluation of explicit prioritisation for elective surgery: A prospective study

2002 ◽  
Vol 7 (1_suppl) ◽  
pp. 14-22 ◽  
Author(s):  
Sarah Derrett ◽  
Charlotte Paul ◽  
Peter Herbison ◽  
Helen Williams
Keyword(s):  
Health Status ◽  
Elective Surgery ◽  
Treatment Preferences ◽  
Risks And Benefits ◽  
Highly Correlated ◽  
Priority Assessment ◽  
A Prospective Study ◽  
The Impact ◽  
Access To Surgery ◽  
Specific Health

Objectives To evaluate whether the Clinical Priority Assessment Criteria (CPAC), used to prioritise access to elective surgery, was associated with: (a) patients’ access to surgery in practice; (b) patients’ level of need; and (c) patients’ ability to benefit from surgery. Patients’ perceptions of the ‘booking system’ for surgery were also explored. Methods Prospective cohort study in New Zealand. Consecutive patients assessed for cataract (n= 101), prostate (n=103) or hip or knee joint replacement (n=137) surgery were interviewed close to the time of their CPAC prioritisation, and then six and 12 months later. Results CPAC scores were associated with access to surgery. There were weak-to-moderate correlations between CPAC scores and disease-specific health status before surgery (need) but almost no correlations with improvement in health status following surgery (ability to benefit). Change in health status was highly correlated with pre-surgery health status. Many patients supported prioritisation according to need, although the impersonal nature of the scoring system and the changing thresholds for surgery distressed some. Conclusions While prioritisation systems for surgery have potential value the CPAC criteria investigated need modification. Ability to benefit should receive increased weight. The impact of an explicit prioritisation system upon the doctor-patient relationship needs to be explored as there is some evidence that it may impede the discussion of the risks and benefits of surgery, and of the treatment preferences of patients.

PRIORITIZING PATIENTS FOR ELECTIVE SURGERY

2003 ◽  
Vol 19 (1) ◽  
pp. 91-105 ◽  
Author(s):  
Sarah Derrett ◽  
Nancy Devlin ◽  
Paul Hansen ◽  
Peter Herbison
Keyword(s):  
New Zealand ◽  
Health Status ◽  
Elective Surgery ◽  
Current Method ◽  
Strongly Correlated ◽  
Gold Standard Method ◽  
Clinical Patient ◽  
Before And After ◽  
Priority Assessment ◽  
Health Status Measures

Objectives: Many hospitals in New Zealand have been using clinical priority assessment criteria (CPAC) to select and prioritize patients for access to publicly funded elective surgery. CPAC usually consist of clinical, patient-experienced, and social measures. The objective of this study was to determine how robust patient rankings were and the extent to which the patients selected were those who benefited the most from surgery.Methods: Patients prioritized for cataract (n = 101), prostate (n = 103), and hip or knee joint replacement (n = 137) surgery according to CPAC were assessed using the EQ-5D, SF-12, and condition-related patient-experienced health status measures before and after treatment. Correlations between the rankings of patients on the CPACs and the alternative instruments were explored.Results: For each surgery group, the CPAC ranking of patients was not strongly correlated with rankings obtained using their before-treatment EQ-5D (valued) profiles or the SF-12, although there was some correlation with rankings according to the condition-related measures. Improvements in the health status of patients who were operated on, as measured by the change in their EQ-5D values, were poorly correlated with equivalent changes on the SF-12 and condition-related measures. Patients' baseline health status according to the CPAC, the EQ-5D, and the SF-12 patient-experienced measures was only slightly related to the magnitude of benefit following surgery. The strongest predictors of improvement in health status were the baseline condition-related measures.Conclusions: The current method of prioritizing patients in New Zealand requires reconsideration, although a gold standard method for prioritization is not immediately apparent from these results.

Use of, and attitudes to, clinical priority assessment criteria in elective surgery in New Zealand

2004 ◽  
Vol 9 (2) ◽  
pp. 91-99 ◽  
Author(s):  
Deborah McLeod ◽  
Sonya Morgan ◽  
Eileen McKinlay ◽  
Kevin Dew ◽  
Jackie Cumming ◽  
...  
Keyword(s):  
New Zealand ◽  
Elective Surgery ◽  
Assessment Criteria ◽  
Priority Assessment

Clinicians' reported use of clinical priority assessment criteria and their attitudes to prioritization for elective surgery: a cross-sectional survey

2004 ◽  
Vol 74 (11) ◽  
pp. 1003-1009 ◽  
Author(s):  
Deborah McLeod ◽  
Sonya Morgan ◽  
Eileen McKinlay ◽  
Kevin Dew ◽  
Jackie Cumming ◽  
...  
Keyword(s):  
Elective Surgery ◽  
Assessment Criteria ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Priority Assessment

Outreach Opportunities Using the Instructional SEM at Iowa State University

1996 ◽  
Vol 54 ◽  
pp. 412-413
Author(s):  
L. S. Chumbley ◽  
M. Meyer ◽  
K. Fredrickson ◽  
F.C. Laabs
Keyword(s):  
Materials Science ◽  
State University ◽  
Digital Cameras ◽  
Audio Signals ◽  
Iowa State University ◽  
Cornell University ◽  
Sem Image ◽  
Local Schools ◽  
Materials Science And Engineering ◽  
Video And Audio

The development of a scanning electron microscope (SEM) suitable for instructional purposes has created a large number of outreach opportunities for the Materials Science and Engineering (MSE) Department at Iowa State University. Several collaborative efforts are presently underway with local schools and the Department of Curriculum and Instruction (C&I) at ISU to bring SEM technology into the classroom in a near live-time, interactive manner. The SEM laboratory is shown in Figure 1.Interactions between the laboratory and the classroom use inexpensive digital cameras and shareware called CU-SeeMe, Figure 2. Developed by Cornell University and available over the internet, CUSeeMe provides inexpensive video conferencing capabilities. The software allows video and audio signals from Quikcam™ cameras to be sent and received between computers. A reflector site has been established in the MSE department that allows eight different computers to be interconnected simultaneously. This arrangement allows us to demonstrate SEM principles in the classroom. An Apple Macintosh has been configured to allow the SEM image to be seen using CU-SeeMe.

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