Actions of a regulatory nurse in the management of surgical waiting lists

ABSTRACT Objectives: to describe the actions of the regulatory nurse in the management of waiting lines for elective surgeries in a public hospital. Methods: this is an experience report about the actions of the regulatory nurse in the management of waiting lines for elective surgeries. Results: the results of this initiative were: diminution in waiting times; elimination of discrepancies that led to access inequality; promotion of safer treatments; actions of the nurse as a manager, conducting and mediating situations between services; autonomy from the high management of the hospital with regard to the manager of waiting lists; and effective communication due to a constant feedback with the medical teams. Final Considerations: the management of the surgical waiting lists must be continuous and systematic, and it must be broader, to include teams that are not involved yet. This initiative can be replicated and improved in other health organizations.

People’s Responsibility towards Organ Donation an Unanswered Appeal

People easily agree with the principle of organ donation; nevertheless, when a person dies, their relatives often refuse to honour this agreement. Because of this persistent social conduct, organ shortage is responsible for the rising mortality of patients on organ waiting lists. This sad reality continues despite the ongoing education effort with the enduring slogan: “Organ donation is a gift of life”.

Modelling the recovery of elective waiting lists following COVID-19: scenario projections for England

Background: A significant indirect impact of COVID-19 has been the increasing elective waiting times observed in many countries. In England's National Health Service, the waiting list has grown from 4.4 million in February 2020 to 5.7m by August 2021. Aims: The objective of this study was to estimate the trajectory of future waiting list size and waiting times to December 2025. Methods: A scenario analysis was performed using computer simulation and publicly available data as of November 2021. Future demand assumed a phased return of various proportions (0, 25, 50 and 75%) of the estimated 7.1 million referrals 'missed' during the pandemic. Future capacity assumed 90, 100 and 110% of that provided in the 12 months immediately before the pandemic. Results: As a worst case, the waiting list would reach 13.6m (95% CI: 12.4m to 15.6m) by Autumn 2022, if 75% of missed referrals returned and only 90% of pre pandemic capacity could be achieved. Under this scenario, the proportion of patients waiting under 18 weeks would reduce from 67.6% in August 2021 to 42.2% (37.4% to 46.2%) with the number waiting over 52 weeks reaching 1.6m (0.8m to 3.1m) by Summer 2023. At this time, 29.0% (21.3% to 36.8%) of patients would be leaving the waiting list before treatment. Waiting lists would remain pressured under even the most optimistic of scenarios considered, with 18-week performance struggling to maintain 60% (against the 92% constitutional target). Conclusions: This study reveals the long-term challenge for the NHS in recovering elective waiting lists as well as potential implications for patient outcomes and experience.

Visualizing the Invisible: Invisible Waste in Diagnostic Imaging

There is extensive waste in diagnostic imaging, at the same time as there are long waiting lists. While the problem of waste in diagnostics has been known for a long time, the problem persists. Accordingly, the objective of this study is to investigate various types of waste in imaging and why they are so pervasive and persistent in today’s health services. After a short overview of different conceptions and types of waste in diagnostic imaging (in radiology), we identify two reasons why these types of waste are so difficult to address: (1) they are invisible in the healthcare system and (2) wasteful imaging is driven by strong external forces and internal drivers. Lastly, we present specific measures to address wasteful imaging. Visualizing and identifying the waste in diagnostic imaging and its ingrained drivers is one important way to improve the quality and efficiency of healthcare services.

P-BN44 The impact of the COVID-19 pandemic on waiting lists for laparoscopic cholecystectomy and its effect on patient care and outcomes

Background It has been widely reported that the COVID-19 pandemic has had a detrimental impact on waiting lists for elective surgery in the NHS. Delays in laparoscopic cholecystectomy (LC) are likely to prolong suffering for symptomatic patients and risk increasing complications for patients which may then require emergency care and intervention. In this study we aim to quantify the impact of the COVID-19 pandemic on elective waiting lists and to assess what implications this might have on patient care and outcomes. Methods Electronic health records were retrospectively interrogated for patients undergoing LC in both March 2019 (prior to the COVID-19 pandemic) and March 2021. The following data was captured: age, gender, elective vs emergency operation, laparoscopic vs open, total vs subtotal cholecystectomy, use of drains, length of stay/daycase rates, the number of emergency presentations prior to operation and the number of days between being listed for surgery and their operation. The results were analysed using SPSS Statistics (IBM, New York). Results 111 patients were included in the study (25 male and 86 female). Of these, 60 had their LC in 2019, and 51 in 2021. The age and gender distribution of the patients in both time periods were similar. The median number of days on the waiting list was significantly higher (P < 0.001) for patients in 2021 at 379.5 days, compared with 153 days in 2019. There was a significant increase in the number of emergency presentations prior to LC in 2021 (P = 0.025) with an average of 0.7 presentations per patient compared with 0.45 in 2019. Additionally, there was a significant increase in the number of emergency LC performed in 2021 (P = 0.002), with 15 performed compared with 4 in 2019, representing 29.4% and 6.7% of all LC respectively. There was no significant change in rates of conversion to open, drains or subtotal cholecystectomy. There was no significant difference in daycase rates for elective patients in either period (55% vs 58%). Conclusions Whilst there has been no change in the operative outcomes for patients undergoing LC, there has been a stark increase in the length of time patients are on a waiting list prior to undergoing elective LC. This has resulted in a significant increase in the number of emergency presentations and the number of emergency LC performed. This study demonstrates the wider impact of increasing waiting list times beyond the prolonged suffering of symptomatic patients. A significant reduction in waiting list times would be beneficial to both patients and healthcare providers, with the aim of reducing the number of emergency presentations. A reduction in these would have a positive impact on acute services and on the associated cost implications.

Central European History in the Age of COVID-19

As COVID-19 began to spread across the globe in early 2020, few could have envisaged that it would so profoundly affect our personal and professional lives. In-class teaching soon had to be either replaced with online teaching or could only be carried out with great risk to staff and students. Working from home and a constant stream of video conferences became the norm instead of informal chats on departmental corridors. As if all of this were not bad enough, positions for junior academics, already scarce in the wake of the general financial crisis and the rise of the neoliberal university, were cut. Travel funding was slashed by many universities, and most countries closed their borders. Libraries were closed or could only be accessed with considerable difficulty. Archives were shut or, if they reopened, operated long waiting lists. In situ research, essential for historians of central Europe, became difficult, if not impossible.

Management of Men With Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia During and After COVID-19

The lower urinary tract (LUT), in particular the prostate, has been theoretically recognized as a target for SARS-CoV-2. Moreover, common pathophysiological mechanisms have been described for BPE/LUTS and COVID-19, including RAS dysregulation, androgen receptors, and MetS-related factors. These factors raise concerns about the possibility of worse urological outcomes due to BPE/LUTS progression in COVID-19 patients. The available results suggest a correlation between SARS-CoV-2 infection, exacerbation or new onset of LUTS, and semen impairment. BPE patients’ care and management have been deeply affected by COVID-19. In the midst of the pandemic, the main urological guidelines suggested postponement of BPH-related deferrable medical examinations and surgery. Telemedicine, therefore, gained attention and interest. Clinical evidence of impaired QoL or complications expedited surgical intervention. An informed consent covering the risk of COVID-19 and a negative molecular PCR within 72 hours of surgery were mandatory. A reduction in procedures under general anaesthesia was recommended. Long waiting lists accrued worldwide during the pandemic, leading to regular review of the BPE waiting lists and patients’ clinical status, encouraging the increase of minimally invasive office-based procedures, even in the post-COVID-19 era, and the improvement of telemedicine. Prospective studies are still needed to assess the course of LUTS/BPE patients after COVID-19.