Surgery

NHS England concludes review of children heart surgery at Leeds Hospitals – NHS England – 28 October 2014

Posted on October 29, 2014. Filed under: Cardiol / Cardiothor Surg, Child Health / Paediatrics, Patient Safety, Surgery | Tags: |

NHS England concludes review of children heart surgery at Leeds Hospitals – NHS England – 28 October 2014

“The review into children’s heart surgery at Leeds Teaching Hospitals Trust concluded today (28 October) with the publication of the final two reports, undertaken by an independent investigation agency Verita.

NHS England’s deputy medical director, Dr Mike Bewick, paid tribute to all those who have contributed to the process, which was begun following the voluntary, temporary suspension of surgery at Leeds Teaching Hospitals Trust in March 2013.”

… continues

Independent review into concerns about paediatric cardiac surgery (the 14 cases) at Leeds Teaching Hospitals NHS Trust – Verita – October 2014

Leeds Teaching Hospitals NHS Trust: Overarching report about paediatric cardiac surgery – Verita – October 2014

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Good Surgical Practice – Royal College of Surgeons – 29 August 2014

Posted on September 2, 2014. Filed under: Surgery | Tags: |

Good Surgical Practice – Royal College of Surgeons – 29 August 2014

News release – New Good Surgical Practice, published by RCS – 29 August 2014

“Standards for surgical practice and achieving high-quality care outlined in new Good Surgical Practice published by RCS

The Royal College of Surgeons of England today launched Good Surgical Practice outlining clear standards expected of all surgeons. The guide outlines the skills, values and attitudes that underpin the profession and has been developed with surgeons and patient groups. Good Surgical Practice has been updated following the recent release of the General Medical Council’s re-working of Good Medical Practice and addresses some of the key challenges facing the profession today.

Collaborative working and patient safety shines through as a core message in the guide. In light of the launch of revalidation for all doctors at the beginning of this year, the publication of the Francis Inquiry report in 2013 and increasing focus on quality of care, transparency and professionalism, the guide recommends surgeons should ensure they are effectively working in multidisciplinary teams to improve communication with patients and the decision making process. Surgical leadership and teamwork are crucial for achieving high-quality patient care and this guide provides surgeons with a model that they should aspire to in day to day practice.

Good Surgical Practice provides guidance around 4 core areas which reflect the four domains of the GMC’s Good Medical Practice:

Knowledge, skills and performance
Safety and Quality
Communication, partnership, teamwork
Maintaining trust”

… continues on the site

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Is Access to Surgery A Postcode Lottery? – Royal College of Surgeons of England – 15 July 2014

Posted on July 22, 2014. Filed under: Surgery | Tags: |

Is Access to Surgery A Postcode Lottery? – Royal College of Surgeons of England – 15 July 2014

News release: Many CCGs are ignoring clinical evidence in their surgical commissioning policies

“The report: Is Access to Surgery A Postcode Lottery? is one of the first investigations of its kind and analyses information obtained under the Freedom of Information Act gathered in April. It reveals that 73% of the CCGs reviewed do not follow NICE and clinical guidance on referral for hip replacements, or have no policy in place for this procedure. Over a third of CCGs (44%) require patients to be in various degrees of pain and immobility (with no consistency applied across the country) or to lose weight before surgery. The report states that this is unacceptable.

The study investigated commissioning policies relating to four common surgical procedures carried out on the NHS and compared those policies to evidence-based guidance published by The Royal College of Surgeons, the surgical specialty associations and NICE.”

 

 

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Emergency general surgery (acute abdominal pain), Commissioning guide 2014 – Royal College of Surgeons – April 2014

Posted on April 29, 2014. Filed under: Surgery | Tags: |

Emergency general surgery (acute abdominal pain), Commissioning guide 2014 – Royal College of Surgeons – April 2014

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From innovation to adoption: Successfully spreading surgical innovation – Royal College of Surgeons – 14 April 2014

Posted on April 15, 2014. Filed under: Surgery | Tags: , |

From innovation to adoption: Successfully spreading surgical innovation – Royal College of Surgeons – 14 April 2014

News release: Patients must reap the benefits of the latest surgical innovations, warns new report

“Failure to adopt new surgical techniques quickly into everyday clinical practice means NHS patients are missing out on ground-breaking new procedures, warns a new report from the Royal College of Surgeons.

The report, entitled From innovation to adoption: Successfully spreading surgical innovation, sets out for the first time the factors that have helped and hindered the adoption of new surgical techniques in England.”

… continues on the site

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National Hip Fracture Database: Anaesthesia Sprint Audit of Practice (ASAP) – Royal College of Physicians – 31 March 2014

Posted on April 4, 2014. Filed under: Anaesthesiology, Orthopaedics, Surgery | Tags: |

National Hip Fracture Database: Anaesthesia Sprint Audit of Practice (ASAP) – Royal College of Physicians – 31 March 2014

Media release: Professionals are divided over best care for hip fracture patients, latest audit results show

“The latest report from the Falls and Fragility Fracture Programme (FFFAP) National Hip Fracture Database (NHFD) shows that just over half of patients are receiving pain relieving anaesthetic (known as a ‘nerve block’) as part of their care for hip fracture.

The National Hip Fracture Database Anaesthesia Sprint Audit of Practice (ASAP) (PDF 2MB) results, published today, show that 56% of hip fracture patients receive a peri-operative nerve block for pain relief and 44% of patients do not. The audit recommends that this type of pain relieving anaesthetic should be offered to all hospital patients who suffer hip fracture.

The Anaesthetic Sprint Audit of Practice (ASAP) was commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit programme. ASAP marks a successful collaboration between several professional organisations. The NHS Hip Fracture Perioperative Network (HipPen), British Orthopaedic Association (BOA), British Geriatrics Society (BGS), Royal College of Physicians (RCP) and Association of Anaesthetists of Great Britain and Ireland (AAGBI) have worked together to explore anaesthesia within hip fracture care using data collected by members of the HipPen.”

.. continues on the site

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Building a Culture of Candour – Royal College of Surgeons – 6 March 2014

Posted on March 10, 2014. Filed under: Patient Safety, Surgery | Tags: |

Building a Culture of Candour – Royal College of Surgeons – 6 March 2014

Press release: Building a culture of candour review published

“Healthcare organisations, including hospitals and GP practices, must usher in a new culture of candour so that patients and their families are told honestly about any harm that has been caused and what will be done to put it right, an independent review has concluded.

Following the Government’s response to the Mid Staffs Public Inquiry, Health Secretary Jeremy Hunt asked Professor Norman Williams, President of the Royal College of Surgeons, and Sir David Dalton, Chief Executive at Salford Royal NHS Foundation Trust, to undertake a review on how to enhance candour in the NHS.

The group was asked to examine the threshold at which a new statutory duty of candour should apply to organisations, and how they can be incentivised to be more open and honest.

The central recommendation is that the old days where errors were not disclosed must give way to an environment that allows staff to be trained and supported in admitting errors, reporting them and learning fully from mistakes.”

… continues on the site

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Standardise, educate, harmonise: Commissioning the conditions for safer surgery Report of the NHS England Never Events Taskforce – 27 February 2014

Posted on February 28, 2014. Filed under: Patient Safety, Surgery |

Standardise, educate, harmonise: Commissioning the conditions for safer surgery Report of the NHS England Never Events Taskforce – 27 February 2014

“The main recommendations of the report cover three themes:

Standardise – The development of high-level national standards of operating department practice that will support all providers of NHS-funded care to develop and maintain their own more detailed standardised local procedures. The report also recommends the establishment of an Independent Surgical Investigation Panel to externally review selected serious incidents;

Educate – Consistency in training and education of all staff in the operating theatres, development of a range of multimedia tools to support implementation of standards and support for surgical safety training including human factors; and

Harmonise – Consistency in reporting and publishing of data on serious incidents, dissemination of learning from serious incidents and concordance with local and national standards taken into account through regulation.

In order to respond appropriately to the report’s recommendations, NHS England will engage and collaborate with a range of organisations to ensure the initiatives we develop are accessible, achievable and manageable; and also ensure that we develop the right kind of standard practice across NHS perioperative care, education, training and regulation.”

Surgical never events taskforce

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Benefits and Harms of Routine Preoperative Testing: Comparative Effectiveness – Agency for Healthcare Research and Quality – 29 January 2014

Posted on February 5, 2014. Filed under: Anaesthesiology, Comparative Effectiveness Research, Surgery | Tags: |

Benefits and Harms of Routine Preoperative Testing: Comparative Effectiveness – Agency for Healthcare Research and Quality – 29 January 2014

Balk EM, Earley A, Hadar N, Shah N, Trikalinos TA. Benefits and Harms of Routine Preoperative Testing: Comparative Effectiveness. Comparative Effectiveness Review No. 130. (Prepared by Brown Evidence-based Practice Center under Contract No. 290-2012-0012-I.) AHRQ Publication No. 14-EHC009-EF. Rockville, MD: Agency for Healthcare Research and Quality; January 2014.

“Structured Abstract

Objectives. Preoperative testing is used to guide the action plan for patients undergoing surgical and other procedures that require anesthesia and to predict potential postoperative complications.There is uncertainty whether routine or per-protocol testing in the absence of a specific indication prevents complications and improves outcomes, or whether it causes unnecessary delays, costs, and harms due to false-positive results.

Data sources. We searched MEDLINE® and Ovid Healthstar® (from inception to July 22, 2013), as well as Cochrane Central Trials Registry and Cochrane Database of Systematic Reviews.

Review methods. We included comparative and cohortstudies of both adults and children undergoing surgical and other procedures requiring either anesthesia or sedation (excluding local anesthesia). We included all preoperative tests that were likely to be conducted routinely (in all patients) or on a per-protocol basis(in selected patients). For comparative studies, the comparator of interest was either no testing or ad hoc testing done at the discretion of the clinician. We also looked for studies that compared routine and per-protocol testing. The outcomes of interest were mortality, perioperative events, complications, patient satisfaction, resource utilization, and harms related to testing.

Results. Fifty-seven studies (14 comparative and 43 cohort) met inclusion criteria for the review. Well-conducted randomized controlled trials (RCTs) of cataract surgeries suggested that routine testing with electrocardiography, complete blood count, and/or a basic metabolic panel did not affect procedure cancellations (2 RCTs, relative risks [RRs] of 1.00 or 0.97), and there was no clinically important difference for total complications (3 RCTs, RR = 0.99; 95% confidence interval, 0.86 to 1.14). Two RCTs and six nonrandomized comparative studies of general elective surgeries in adults varied greatly in the surgeries and patients included, along with the routine or per-protocol tests used. They also mostly had high risk of bias due to lack of adjustment for patient and clinician factors, making their results unreliable. Therefore, they yielded insufficient evidence regarding the effect of routine or per-protocol testing on complications and other outcomes. There was also insufficient evidence for patients undergoing other procedures. No studies reported on quality of life, patient satisfaction, or harms related to testing.

Conclusions. There is high strength of evidence that, for patients scheduled for cataract surgery, routine preoperative testing has no effect on total perioperative complications or procedure cancellation. There is insufficient evidence for all other procedures and insufficient evidence comparing routine and per-protocol testing. There is no evidence regarding quality of life or satisfaction, resource utilization, or harms of testing and no evidence regarding other factors that may affect the balance of benefits and harms. The findings of the cataract surgery studies are not reliably applicable to other patients undergoing other higher risk procedures. Except arguably for cataract surgery, numerous future adequately powered RCTs or well-conducted and analyzed observational comparative studies are needed to evaluate the benefits and harms of routine preoperative testing in specific groups of patients with different risk factors for surgical and anesthetic complications undergoing specific types of procedures and types of anesthesia.”

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NHS waiting times for elective care in England – National Audit Office – 23 January 2014

Posted on January 23, 2014. Filed under: Surgery | Tags: , , , |

NHS waiting times for elective care in England – National Audit Office – 23 January 2014

“The National Audit Office has highlighted the increasing challenge to the NHS of sustaining the 18-week waiting time standard for elective care and the importance for trusts of having reliable performance information and shared good practice. Today’s report to Parliament concludes that value for money is being undermined by the problems with the completeness, consistency and accuracy of patient waiting time data; and by inconsistencies in the way that patient referrals to hospitals are managed.”

Press release

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Variations in outcome and costs among NHS providers for common surgical procedures: econometric analyses of routinely collected data – Health Services and Delivery Research – January 2014

Posted on January 10, 2014. Filed under: Health Economics, Orthopaedics, Surgery | Tags: |

Variations in outcome and costs among NHS providers for common surgical procedures: econometric analyses of routinely collected data – Health Services and Delivery Research – January 2014

DOI 10.3310/hsdr02010 NHS National Institute for Health Research

Street A, Gutacker N, Bojke C, Devlin N, Daidone S. Variations in outcome and costs among NHS providers for common surgical procedures: econometric analyses of routinely collected data. Health Serv Deliv Res 2014;2(1)

“Background: It is important that NHS resources are used to their full extent, but efforts to reduce costs may have an adverse effect on patient outcomes. Our research is designed to provide a better understanding of the inter-relationship between costs and health outcomes among NHS providers (hospitals) for common surgical procedures.

Objectives: In England, patient-reported outcomes measures (PROMs) are collected from patients undergoing one of four elective procedures: unilateral hip replacement, unilateral knee replacement, groin hernia repair and varicose vein surgery. We identify variation in patient-reported outcomes (PROs) across hospitals, assess the relationship between the cost and outcomes among NHS hospitals for these procedures, and determine the extent to which variations in outcomes and costs are due to differences in hospital performance.

Data sources: We link Hospital Episode Statistics (HES) data with reference cost data and PROM data for patients having the four treatments between April 2009 and March 2010.

Methods: The first part of the empirical analysis focuses on variation in different dimensions of self-reported health status. We argue that each of the EuroQol-5D questionnaire (EQ-5D; European Quality of Life-5 Dimensions) dimensions should be assessed separately. Our graphical summary of the differential impact that hospitals have on PROs indicates the probability of reporting a given health outcome and shows how these probabilities vary across EQ–5D dimensions and hospitals. The second part of the empirical analysis focuses on the performance of hospitals and the inter-relationship between PROs and resource use.

Results: We find that poorer post-treatment health status is associated with lower initial health status, higher weighted Charlson score, more diagnoses and lower socioeconomic status. We find significantly unexplained variation among hospitals in outcomes for patients undergoing hip replacement, knee replacement or varicose vein surgery, but not for hernia patients. For all four treatments we find significant unexplained variation in resource use among hospitals, whether measured by cost of treatment or length of stay. This suggests that hospitals can improve their utilisation of resources.

Limitations: Our analyses are based on the HES. If data are missing from the medical record, or extracted and coded inaccurately, HES will contain errors. Hospitals should minimise these errors. Our study suffers from a large number of missing data, mainly because some hospitals were better than others at administering the baseline survey.”

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Australian hospital statistics 2012-13: elective surgery waiting times – AIHW – 4 October 2013

Posted on October 4, 2013. Filed under: Surgery | Tags: , |

Australian hospital statistics 2012-13: elective surgery waiting times – AIHW – 4 October 2013

“In 2012-13:- about 673,000 patients were admitted to Australian public hospitals from elective surgery waiting lists- 50% of patients were admitted for their surgery within 36 days of being placed on the waiting list and 90% were admitted within 265 days.

ISSN 1036-613X; ISBN 978-1-74249-503-3; Cat. no. HSE 140; 63pp”

Media release: Elective surgery admissions rise, waiting times unchanged

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National definitions for elective surgery urgency categories – AIHW – 31 July 2013

Posted on August 1, 2013. Filed under: Health Informatics, Surgery | Tags: , |

National definitions for elective surgery urgency categories – AIHW – 31 July 2013

proposal for the Standing Council on Health

“In 2012, the Australian Institute of Health and Welfare and the Royal Australasian College of Surgeons worked together to develop national definitions for elective surgery urgency categories, at the request of the Standing Council on Health. The development of the national definitions resulted in a package of six integrated components proposed for adoption. This report presents the proposed definitions and components.”

ISBN 978-1-74249-465-4; Cat. no. HSE 138; 77pp.

Media release: Consistent definitions for elective surgery urgency categories released in new report

 

 

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Consultant treatment outcomes now published online – NHS England

Posted on July 25, 2013. Filed under: Clin Governance / Risk Mgmt / Quality, Surgery | Tags: , |

Consultant treatment outcomes now published online – NHS England

“NHS England is committed to making more information available about how services and professionals are performing. The aim is to drive up the quality of care in the NHS and help people choose the treatment that suits them best.

This initiative is a central part of NHS England’s ambition to ensure every patient gets high quality care, and to build improved services for the future.

On NHS Choices you’ll find links to information about individual consultants in a number of clinical areas. You can look at their results for a range of operations and treatments to help you make decisions about your care.

Prof Sir Bruce Keogh, National Medical Director of NHS England, said: ‘This is a major breakthrough in NHS transparency.

‘We know from our experience with heart surgery that putting this information into the public domain can help drive up standards. That means more patients surviving operations and there is no greater prize than that.’

The reporting of the data was led by Prof Ben Bridgewater from the Healthcare Quality Improvement Partnership (HQIP). Prof Bridgewater is a practising heart surgeon who leads the successful cardiac consultant-level reporting which paved the way for this work.”

… continues on the site

Everyone counts: Publication of Consultant clinical outcomes: Frequently Asked Questions

Your choices: consultant choice – the data

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Managing operating theatre efficiency for elective surgery – Audit Office of New South Wales – 17 July 2013

Posted on July 24, 2013. Filed under: Surgery | Tags: , |

Managing operating theatre efficiency for elective surgery – Audit Office of New South Wales – 17 July 2013

Auditor-General’s Report: Performance Audit

 

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Improving SAS appraisal: a guide for employers [specialty and associate specialist] – NHS Employers – June 2013

Posted on June 19, 2013. Filed under: Medicine, Surgery | Tags: , |

Improving SAS appraisal: a guide for employers [specialty and associate specialist] – NHS Employers – June 2013

Extract from the Introduction

“Effective annual appraisal is the cornerstone of medical revalidation. Doctors need to be able to discuss and reflect on their practice and performance during their appraisal to demonstrate that they are keeping up to date and are fit to practise. This is key for patient safety-improved appraisal makes good doctors better, and leads to improved patient care.

The England Organisational Readiness Self Assessment (ORSA) return in March 2012 indicated that only 53.5 per cent of specialty and associate specialist (SAS) and staff grade doctors had been appraised in 2011 – 2012. This was an improvement from the March 2011 ORSA return, which indicated that only 35.6 per cent of this group of doctors had been appraised in 2010 – 2011. Appraisal rates for trust doctors are similarly low.

These results suggested that there may have been unidentified barriers to appraisal for SAS and trust doctors.”

… continues on the site

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Review of the Regulation of Cosmetic Interventions – Department of Health [England] – 24 April 2013

Posted on April 26, 2013. Filed under: Patient Safety, Surgery | Tags: , |

Review of the Regulation of Cosmetic Interventions – Department of Health [England] – 24 April 2013

“The report outlines the need for better regulation to bring the cosmetic surgery industry into line with those in other countries and align it with comparable public health and consumer practice in this country.

Its recommendations focus on three important areas: high quality care with safe products, skilled practitioners and responsible providers; an informed public to ensure people get accurate advice and that the vulnerable are protected; accessible redress and resolution in case things go wrong.”

Recommendations to protect people who choose cosmetic surgery – 24 April 2013

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Australian hospital statistics: national emergency access and elective surgery targets 2012 – AIHW – 28 February 2013

Posted on February 28, 2013. Filed under: Emergency Medicine, Surgery | Tags: , , |

Australian hospital statistics: national emergency access and elective surgery targets 2012 – AIHW – 28 February 2013

“This report presents 2012 data for performance indicators in the National Partnership Agreement on Improving Public Hospital Services. Included are measures of the extent to which states and territories met targets for emergency department lengths of stay of 4 hours or less and for lengths of time spent waiting for elective surgery.

ISSN 1036-613X; ISBN 978-1-74249-405-0; Cat. no. HSE 131; 20pp”

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Acting on Concerns: Your Professional Responsibility – Royal College of Surgeons of England – 19 February 2013

Posted on February 26, 2013. Filed under: Clin Governance / Risk Mgmt / Quality, Surgery, Workforce | Tags: |

Acting on Concerns: Your Professional Responsibility – Royal College of Surgeons of England – 19 February 2013

“The Royal College of Surgeons (RCS) is today publishing a comprehensive manual that advises clinicians on how to act if they consider patients are receiving poor care. Acting on Concerns: Your Professional Responsibility guides surgeons on how best to collaborate with colleagues to monitor performance and quality of care, deal with problems, raise concerns and support others to do the same.

Real excellence in surgery comes from managing past failures and future risks well, with teams supporting each other through difficulties and responding to problems in a timely and constructive way. It is vital that surgeons make every effort to foster a culture where the quality of patient care provided by each individual member of the team is everyone’s concern.

This publication provides practical advice on how to develop an open culture where there is a willingness to address issues. It urges individuals not to wait for things to go wrong before personally attending to the quality of clinical governance in a team or department.”

… continues

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Reshaping surgical services: principles for change – Royal College of Surgeons – January 2013

Posted on January 21, 2013. Filed under: Patient Participation, Surgery | Tags: |

Reshaping surgical services: principles for change – Royal College of Surgeons – January 2013

King’s Fund blog on this

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Hospital Episode Statistics and Revalidation: Creating the evidence to support revalidation – Royal College of Surgeons of England, funded by the Academy of Medical Royal Colleges – 9 January 2013

Posted on January 15, 2013. Filed under: Surgery, Workforce | Tags: , , , |

Hospital Episode Statistics and Revalidation: Creating the evidence to support revalidation – Royal College of Surgeons of England, funded by the Academy of Medical Royal Colleges – 9 January 2013

Extract:

“Background
This report outlines the results of a project which started in September 2009. The project’s aim was to assess the strengths and weaknesses of using administrative data for revalidation in the areas of ischaemic heart disease, urological malignancies, and peripheral vascular disease. We distinguished between procedure-specific indicators and disease-specific indicators as well as between hospital-specific and consultant-specific outcomes.”

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Improving the Measurement of Surgical Site Infection Risk Stratification/Outcome Detection – The Agency for Healthcare Research and Quality [US] – August 2012

Posted on October 22, 2012. Filed under: Infection Control, Surgery | Tags: |

Improving the Measurement of Surgical Site Infection Risk Stratification/Outcome Detection – The Agency for Healthcare Research and Quality [US] – August 2012

Final Contract Report

“The Agency for Healthcare Research and Quality, in cooperation with the United States Centers for Disease Control and Prevention, commissioned a study in 2009 with the objective of developing techniques to improve the identification and surveillance of likely cases of surgical site infection using data on four common procedures (hernia repair, coronary artery bypass grafts, and hip and knee arthroplasty). A major focus of the project was to test the usefulness of computer algorithms that could alert infection control specialists to patients likely to have surgical site infections on the basis of retrospective analysis of electronic medical records, laboratory test results, and patient demographics.

Prepared for the Agency for Healthcare Research and Quality under contract HHSA 290-2006-00-20.”

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Surgery in Australian hospitals 2010–11 – AIHW – 5 July 2012

Posted on July 5, 2012. Filed under: Surgery | Tags: |

Surgery in Australian hospitals 2010–11 – AIHW – 5 July 2012

“In 2010–11, over a quarter of the 8.9 million hospitalisations (separations) in Australia’s public and private hospitals included a visit to an operating room for surgery. This bulletin provides an overview of these 2.4 million hospitalisations involving surgery.

This information was sourced from the AIHW’s National Hospital Morbidity Database and National Elective Surgery Waiting Times Data Collection.”

… continues

Media release: More than 1 in 4 hospital admissions need surgery

“More than a quarter of Australia’s 8.9 million hospitalisations in 2010–11 included a visit to an operating room for surgery, according to a new surgery snapshot released today by the Australian Institute of Health and Welfare (AIHW).

The snapshot bulletin, Surgery in Australian Hospitals 2010–11, provides an overview of Australia’s 2.4 million annual hospitalisations for surgery, based on data first published by the AIHW in April.

Around 1.0 million surgery hospitalisations occurred in public hospitals and 1.4 million in private hospitals.

In the five years to 2011, admissions involving surgery have been rising 2.4% a year in public hospitals and 4.1% a year in private hospitals. But in the last year, annual growth in surgery admissions in public hospitals has outstripped annual growth in private hospitals 2.7% to 2.1%.”

… continues

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Poly implant Prothese (PiP) breast implants: Final report of the Expert Group [NHS] – 18 June 2012

Posted on June 19, 2012. Filed under: Surgery |

Poly implant Prothese (PiP) breast implants: Final report of the Expert Group [NHS] – 18 June 2012

News
http://www.dh.gov.uk/health/2012/06/pip-report/
http://mediacentre.dh.gov.uk/2012/06/18/final-expert-report-on-pip-breast-implants-published/

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Fulfilling the potential – A better journey for patients and a better deal for the NHS – NHS Improvement – April 2012

Posted on May 4, 2012. Filed under: Patient Participation, Surgery | Tags: |

Fulfilling the potential – A better journey for patients and a better deal for the NHS – NHS Improvement – April 2012

Enhanced Recovery Partnership

What is Enhanced Recovery?

“Enhanced Recovery is a novel approach to elective surgery based on the following principles:

patients are in the optimal condition for treatment
patients have different care during their operation
patients experience optimal post-operative rehabilitation.

Enhanced Recovery may be referred to as Rapid, Accelerated Recovery or Fast Track surgery and was originally pioneered in Denmark.

Enhanced Recovery involves the whole health community.

Enhanced Recovery has a compelling clinical evidence base and should be the norm for best practice elective care pathways.”

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Report: PIP breast implants and regulation of cosmetic interventions – House of Commons Select Health Committee – 28 March 2012

Posted on March 28, 2012. Filed under: Health Technology Assessment, Patient Safety, Surgery | Tags: , |

PIP breast implants and regulation of cosmetic interventions – House of Commons Select Health Committee – 28 March 2012

“The Health Committee welcomes the Government’s decision to commission two reviews following public concern about breast implant surgery, following the decision of the French authorities to recommend removal of implants sourced from PIP.

Report: PIP breast implants and regulation of cosmetic interventions
Inquiry: PIP breast implants and regulation of cosmetic interventions
Health Committee

The two reviews have different terms of reference:

The first, led by Sir Bruce Keogh, is tasked with assessing the regulation of cosmetic interventions in general. Sir Bruce’s expert group will also continue to analyse the scientific evidence of risk arising from PIP implants.

The second, led by Earl Howe, is tasked with analysing the policy reaction, in particular by MHRA and DoH, to the announcement by the French authorities in March 2010 that PIP products did not comply with the requirements of their CE registration.
Conclusions

Following a brief inquiry into the background to these events the Committee concludes:”

… continues on the site

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Outcomes after Elective Repair of Infra-renal Abdominal Aortic Aneurysm – Vascular Society of Great Britain and Ireland – 28 February 2012

Posted on March 1, 2012. Filed under: Clin Governance / Risk Mgmt / Quality, Patient Safety, Surgery | Tags: |

Outcomes after Elective Repair of Infra-renal Abdominal Aortic Aneurysm – Vascular Society of Great Britain and Ireland – 28 February 2012

“This report which demonstrates a dramatic reduction in mortality for Abdominal Aortic Aneurysm Surgery over a relatively short period of time demonstrates how collecting, analysing and reflecting on clinical outcomes can result in significant improvements.”

Guardian media report on this

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Analysing hospital variation in health outcome at the level of EQ-5D dimensions – Centre for Health Economics, University of York – January 2012

Posted on February 13, 2012. Filed under: Clin Governance / Risk Mgmt / Quality, Health Economics, Surgery | Tags: |

Analysing hospital variation in health outcome at the level of EQ-5D dimensions – Centre for Health Economics, University of York – January 2012

by Nils Gutacker, Chris Bojke, Silvio Daidone, Nancy Devlin, Andrew Street

Abstract

“The English Department of Health has introduced routine collection of patient-reported health outcome data for selected surgical procedures (hip and knee replacement, hernia repair, varicose vein surgery) to facilitate patient choice and increase provider accountability. The EQ-5D has been chosen as the preferred generic instrument and the current risk-adjustment methodology is based on the EQ-5D index score to measure variation across hospital providers.

There are two potential problems with this. First, using a population value set to generate the index score may not be appropriate for purposes of provider performance assessment because it introduces an exogenous source of variation and assumes identical preferences for health dimensions among patients. Second, the multimodal distribution of the index score creates statistical problems that are not yet resolved. Analysing variation for each dimension of the EQ-5D dimensions (mobility, self care, usual activities, pain/discomfort, anxiety/depression) seems therefore more appropriate and promising.

For hip replacement surgery, we explore a) the impact of treatment on each EQ-5D dimension b) the extent to which treatment impact varies across providers c) the extent to which treatment impact across EQ-5D dimensions is correlated within providers.

We combine information on pre- and post-operative EQ-5D outcomes with Hospital Episode Statistics for the financial year 2009/10. The overall sample consists of 25k patients with complete pre- and post-operative responses.

We employ multilevel ordered probit models that recognise the hierarchical nature of the data (measurement points nested in patients, which themselves are nested in hospital providers) and the response distributions. The treatment impact is modelled as a random coefficient that varies at hospital-level. We obtain provider-specific Empirical Bayes (EB) estimates of this coefficient. We estimate separate models for each of the five EQ-5D dimensions and analyse correlations of the EB estimates across dimensions.

Our analysis suggests that hospital treatment is indeed associated with improvements in health and that variability in treatment impact is generally more pronounced on the dimensions mobility, usual activity and pain/discomfort than on others. The pairwise correlation between the provider EB estimates is substantial, suggesting a) that certain providers are better in improving health across multiple EQ-5D dimensions than others and b) multivariate models are appropriate and should be further investigated.”

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Poly Implant Prothèse (PIP) breast implants: Joint surgical statement on clinical guidance for patients, GPs and surgeons – 17 January 2012

Posted on January 19, 2012. Filed under: Patient Safety, Surgery |

Poly Implant Prothèse (PIP) breast implants: Joint surgical statement on clinical guidance for patients, GPs and surgeons – 17 January 2012

by The Association of Breast Surgery, the British Association of Plastic and Reconstructive Aesthetic Surgeons, the British Association of Aesthetic Plastic Surgeons, the Federation of Surgical Speciality Associations and the Royal College of Surgeons

Media release
“Authoritative new professional and patient guidance for all women who have received a PIP breast implant has been released today (Tuesday, 17 Jan 2012) by the professional bodies representing surgeons. The new guidance provides patients with practical advice on what to expect and their rights, indicates to GPs where to refer different groups of patient and advises surgeons on treatment. The guidance goes beyond current government advice aimed at patients with symptoms to give additional practical advice for the majority of patients who do not. Key points include:”

… continues on the site

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Value Based Clinical Commissioning of Elective Surgical Care. Emerging Views of Commissioners & Surgeons and Production of High Value Care Pathways – NHS Right Care – November 2011

Posted on January 16, 2012. Filed under: Surgery | Tags: |

Value Based Clinical Commissioning of Elective Surgical Care. Emerging Views of Commissioners & Surgeons and Production of High Value Care Pathways – NHS Right Care – November 2011

QIPP Right Care Team: Muir Gray, Simon Swift, Mehrunisha Suleman East Midlands SHA: Nigel Beasley, Donna Hakes and Malcolm Qualie London SHA: Andy Mitchell, Sue Dutch
Edited by:Edited by: Mehrunisha Suleman

Executive Summary

“The aim of this report has been to make recommendations for consideration by the NHS Operations Board with regard to effective commissioning of elective surgical procedures. The work was commissioned by Professor Sir Bruce Keogh, NHS Medical Director, following widespread expressions of concern from professional bodies that approaches based on lists of procedures deemed to be of ‘limited effectiveness’, ‘lowvalue’ or requiring a ‘threshold’ result in inequitable patterns of service delivery. The evidence base for such approaches are not thought to be sufficiently robust, and in many cases procedures with well‐established evidence of effectiveness, such as cataracts or arthroplasty, have been included.

The paper draws on discussions held between clinicians and commissioners in two SHAs (London and East Midlands). It establishes principles of  ommissioning which support fully informed shared‐decision making that takes into consideration patients individual circumstances, and ensures that they receive appropriate interventions by suitably skilled individuals in line with widely agreed, nationally endorsed pathways of care. It emphasizes the importance of the care pathways rather than individual procedures, and the requirement for audit of points on the pathway against set standards.”

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Organ and Tissue Authority Donation and Transplantation Performance Report 2011 – DonateLife – released 16 January 2012

Posted on January 16, 2012. Filed under: Surgery | Tags: , |

Organ and Tissue Authority Donation and Transplantation Performance Report 2011 – DonateLife – released 16 January 2012

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Poly implant prostheses (PIP) breast implants: interim report of the Expert Group, Sir Bruce Keogh, NHS Medical Director – 6 January 2012

Posted on January 10, 2012. Filed under: Health Technology Assessment, Patient Safety, Surgery | Tags: , |

Poly implant prostheses (PIP) breast implants: interim report of the Expert Group, Sir Bruce Keogh, NHS Medical Director – 6 January 2012

Media release

Department of Health [England] statement on breast implants and response to expert group report – 6 January 2012

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Delivering major breast surgery safely as a day case or one night stay (excluding reconstruction) – NHS Improvement – December 2011

Posted on January 6, 2012. Filed under: Oncology, Surgery | Tags: |

Delivering major breast surgery safely as a day case or one night stay (excluding reconstruction) – NHS Improvement – December 2011

“Why should major breast surgery be an inpatient procedure?

• It’s a relatively short operation
• Low post operative pain
• Patients can mobilise, eat anddrink early
• Rare post operative events
• Patients want to return to normal life as quickly as possible.

In 2007, NHS Improvement Transforming Inpatient Care Programme as part of the Cancer Reform Strategy (2007) and recently the Improving Cancer Outcomes Strategy (2011) redesigned the breast care surgical pathway (excluding reconstruction) with the working hypothesis that:
“Streamlining of the breast surgical pathway could reduce length of stay by 50% and release 25% of unnecessary bed days for 80% of major breast surgery (excluding reconstruction).” ”

… continues

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Australian hospital statistics 2010-2011: emergency department care and elective surgery waiting times – AIHW – 30 November 2011

Posted on November 30, 2011. Filed under: Emergency Medicine, Surgery | Tags: |

Australian hospital statistics 2010-2011: emergency department care and elective surgery waiting times – AIHW – 30 November 2011

‘Australian hospital statistics 2010-11: emergency department care and elective surgery waiting times’ presents information relating to emergency department care in major public hospitals and public hospital elective surgery waiting times for the period 1 July 2010 to 30 June 2011. In 2010-11: over 6.2 million emergency department presentations were provided by major public hospitals, with 70% of patients receiving treatment within an appropriate time for their urgency (triage category); about 621,000 patients were admitted to Australian public hospitals from waiting lists for elective surgery, with 50% of patients admitted within 36 days.

ISSN 1036-613X; ISBN 978-1-74249-262-9; Cat. no. HSE 115; 88pp.

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Optimizing your Perioperative Supply Chain: A Guide to Improvement Projects – Ontario Hospital Association

Posted on November 28, 2011. Filed under: Surgery |

Optimizing your Perioperative Supply Chain: A Guide to Improvement Projects – Ontario Hospital Association

“Informed by hospitals undertaking improvement projects and written by a committee of subject matter experts, this guide is designed to help executives and a cross-disciplinary team of hospital staff successfully complete their own perioperative supply chain improvement project.

Since first being identified as a key best practice for surgical efficiency, perioperative supply chain improvements have become a growing area of interest. While participating in a pilot program, 14 Ontario hospitals that undertook improvement projects reported significant decreases in supply costs, greater staff efficiencies and an overall more collaborative work environment. 

Their experiences, which serve to inform this guide, found savings from a series of foundational projects, mostly focusing on refining inventory data, managing procedure card systems, optimizing surgical inventory and storage, and standardizing product.

The clinical and non-clinical leaders of these projects, supported by a network of subject matter experts, worked together to develop the guide. Divided into five chapters, each examines one of four foundational projects: Procedure Card Management; Data Optimization; OR Inventory Optimization and Product Selection and Standardization, with a fifth chapter serving as a refresher on Project Management.”

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National Thoracic Surgery Activity & Outcomes Report 2011 – Royal College of Surgeons – 3 November 2011

Posted on November 14, 2011. Filed under: Oncology, Respiratory Medicine, Surgery |

National Thoracic Surgery Activity & Outcomes Report 2011 – Royal College of Surgeons – 3 November 2011

“The number of lung cancer patients benefiting from life-saving surgery has shot up by 60 per cent while the operative mortality rate has halved in recent years as a new generation of specialist lung surgeons start to come through into the NHS. In the last year alone the number of lung cancer operations has increased by more than 17 per cent. These are among the findings of a comprehensive new audit from the Society for Cardiothoracic surgery (SCTS). The study also finds that new scanning technology has led to more accurate decisions on which patients could benefit from an operation; but points to the need for more training in minimally-invasive techniques.

The report, the National Thoracic Surgery Activity & Outcomes Report 2011, tracks the results of more than 400,000 operations from 1980 to 2010 and includes hospital-specific data for the past three years. Among the findings are:”

… continues on the site

The report in full text

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Surgery in Children: Are We There Yet? A review of organisational and clinical aspects of children’s surgery- National Confidential Enquiry into Perioperative Deaths (NCEPOD) – 2011

Posted on October 31, 2011. Filed under: Child Health / Paediatrics, Patient Safety, Surgery | Tags: |

Surgery in Children: Are We There Yet? A review of organisational and clinical aspects of children’s surgery- National Confidential Enquiry into Perioperative Deaths (NCEPOD)  – 2011

“This NCEPOD report highlights the process of care of children less than 18 years of age, including neonates who died within 30 days of emergency or elective surgery on the same admission. The report takes a critical look at areas where the care of patients might have been improved. Remediable factors have also been identified in the clinical and the organisational care of these patients.”

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Patient Outcomes in Surgery. A report comparing Independent Sector Treatment Centres and NHS providers – Royal College of Surgery – 20 October 2011

Posted on October 24, 2011. Filed under: Surgery | Tags: |

Patient Outcomes in Surgery. A report comparing Independent Sector Treatment Centres and NHS providers – Royal College of Surgery – 20 October 2011

Extract from the media release:
“NHS patients undergoing elective operations in dedicated independent sector units report better outcomes than those seen by NHS Hospitals treating emergency and elective patients, according to a major new study released today (Wednesday, 19 Oct 2011) by the Royal College of Surgeons [RCS] and London School of Hygiene & Tropical Medicine. But researchers also found these differences reflect that those patients seen by independent sector treatment centres [ISTCs] tend to be younger, in better health before their operation and from more affluent areas than those seen by NHS Hospitals.”

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The Higher Risk General Surgical Patient: towards improved care for a forgotten group – The Royal College of Surgeons of England – 29 September 2011

Posted on September 30, 2011. Filed under: Health Mgmt Policy Planning, Health Systems Improvement, Patient Safety, Surgery |

The Higher Risk General Surgical Patient: towards improved care for a forgotten group – The Royal College of Surgeons of England – 29 September 2011

“The NHS must address the significant variations in care experienced by the 170,000 patients who have major emergency abdominal surgery each year, says a new report published by the Royal College of Surgeons. Poorly designed hospital services, particularly access to emergency operating theatres and radiology treatment, are among the problems highlighted. This results in patients missing out on early diagnosis and rapid life-saving care. In addition, there is a general lack of appreciation of the level of risk in emergency surgical patients – where death rates of 15 to 20 per cent are typical, and can be as high as 40 per cent in the most elderly patients. Surgeons say this imminent risk of death is not being reflected in the priority given to these patients whose chances of survival can more than double, depending on which NHS hospital they are treated in.

The report, The Higher Risk General Surgical Patient: Towards Improved Care for a Forgotten Group makes nine detailed recommendations. If implemented within two years, they will reduce complications and deaths, as well as reduce the cost of treating a group of patients who account for almost 90 per cent of post-operative general surgical deaths. Among the recommendations are:”

… continues on the site

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Adult emergency services: Acute medicine and emergency general surgery – LondonHealth Programmes – September 2011 reports

Posted on September 22, 2011. Filed under: Emergency Medicine, Health Mgmt Policy Planning, Surgery | Tags: |

Adult emergency services: Acute medicine and emergency general surgery – LondonHealth Programmes – September 2011 reports
 
Adult emergency services: Case for change 
 
Adult emergency services: Case for change summary 
 
Adult emergency services: Commissioning standards 
 
Adult emergency services: Survey of current arrangements 
 
Media commentary:
 
BBC London hospitals: Hundreds die ‘due to weekend staffing’  – 21 Sept 2011
“Stark” differences in consultant hours at weekends were identified Hundreds of people die every year in London due to a lack of hospital consultants available at weekends, according to NHS London.

Guardian
Don’t go to A&E this weekend; you may die. The Patient from hell reads a report, which claims that 520 emergency patients die in London every year due to understaffed out-of-hours care

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National Partnership Agreement on the Elective Surgery Waiting List Reduction Plan: Period 3 assessment report – COAG Reform Council – released 6 September 2011

Posted on September 6, 2011. Filed under: Surgery | Tags: , |

National Partnership Agreement on the Elective Surgery Waiting List Reduction Plan: Period 3 assessment report – COAG Reform Council – released 6 September 2011

“Under the National Partnership on the Elective Surgery Waiting List Reduction Plan, each State and Territory has agreed targets for the number of elective surgery volume admissions over three reporting periods.

States and Territories are eligible for reward payments made by the Commonwealth if they meet their targets. The council’s role is to provide the Commonwealth with an independent assessment of the achievement of the agreed targets.

This is the council’s third and final report on the National Partnership on the Elective Surgery Waiting List Reduction Plan.

This report was submitted to COAG on 8 August 2011, and publicly released on 6 September 2011.”

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RAND/UCLA Quality-of-Care Measures for Carpal Tunnel Syndrome. Tools for Assessing Quality of Care and Appropriateness of Surgery – RAND – 2011

Posted on August 23, 2011. Filed under: Clin Governance / Risk Mgmt / Quality, Surgery | Tags: |

RAND/UCLA Quality-of-Care Measures for Carpal Tunnel Syndrome. Tools for Assessing Quality of Care and Appropriateness of Surgery – RAND – 2011
by Teryl K. Nuckols et al

“Claims relating to carpal tunnel syndrome (CTS) are common in workers’ compensation systems. Given that the human and economic costs related to CTS are considerable, healthcare organizations must be able to offer high-quality care to people affected by this condition. The study on which this report is based is a step toward improving care for CTS. It has produced two unique tools for institutions to use, one for assessing the quality of care received by a population of patients who have or may have CTS, and the other for identifying the appropriateness of surgery for individual patients. Tools that assist in measuring quality of care are fundamental to efforts to improve healthcare quality. Tools that assess the appropriateness of surgery ensure that people who need surgery receive it and, conversely, that people are not subjected to inappropriate operations. Applied in this way, these two tools are likely to improve clinical circumstances and economic outcomes for people with CTS. Together, they can be useful to provider organizations, medical groups, medical certification boards, and other associated decisionmakers attempting to assess, monitor, and provide appropriate care for people with CTS.”

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Transferring children to and from theatre. RCN position statement and guidance for good practice – Royal College of Nursing – 21 July 2011

Posted on August 10, 2011. Filed under: Child Health / Paediatrics, Surgery | Tags: |

Transferring children to and from theatre. RCN position statement and guidance for good practice – Royal College of Nursing – 21 July 2011
ISBN: 978-1-906633-77-6

“Abstract:
Undergoing surgery can be a very stressful time for a child and their family. It is well recognised that family involvement reduces anxiety, for example, a family member accompanying the child to the anaesthetic room and being in the recovery area when the child wakes up. The results of a study by the RCN Children’s Surgical Nursing Forum highlighted an absence of standards for the transfer of children to and from the operating theatre. This publication aims to support health care staff to develop locally agreed guidelines for the assessment and management of children and young people being transferred between hospital departments, ensuring they are safely transferred to and from theatre.”

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Expert Panel Review of Elective Surgery and Emergency Access Targets under the National Partnership Agreement on Improving Public Hospital Services

Posted on August 4, 2011. Filed under: Nat Hlth & Hosps Reform Comm, Surgery |

Expert Panel Review of Elective Surgery and Emergency Access Targets under the National Partnership Agreement on Improving Public Hospital Services
Professor Chris Baggoley
Chair, Expert Panel

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Enhancing Surgical Care in BC: Improving Perioperative Quality, Efficiency, and Access – A Policy Paper by BC’s Physicians – June 2011

Posted on July 7, 2011. Filed under: Health Systems Improvement, Surgery |

Enhancing Surgical Care in BC: Improving Perioperative Quality, Efficiency, and Access – A Policy Paper by BC’s Physicians – June 2011

British Columbia Medical Association
Extract from the executive summary.

“In this policy paper, the BC Medical Association (BCMA) proposes that a coordinated initiative to improve the quality, efficiency, and access to surgical care needs to be implemented across British Columbia. There are over 400,000 hospital-based surgical procedures performed each year in the province. The increasing demand for surgical care, a growing emphasis on the quality and safety of care, and the rising costs of delivering health services are driving the need for the health care system to improve the level and quality of surgical care while keeping health care expenditures in check.

The operating room (OR) and the processes that support the OR make up the perioperative system. A considerable amount of planning, preparation, and coordination within the perioperative system is required to ensure that patients receive quality surgical care that is safe and timely. However, quality and efficiency issues can cause surgical delays, cancellations, adverse events, and suboptimal care for surgical patients. These issues affect the experience and outcomes of  surgical patients, the satisfaction of perioperative personnel, and the financial budgets of hospitals.

To address these issues, hospitals across Canada and in other countries have turned to concepts such as process improvement and system redesign initiatives to enhance the quality and efficiency of the surgical system. Perioperative personnel are being directly engaged. Surgeons, anesthesiologists, nurses, OR coordinators, and others can systematically examine where problems exist and develop solutions to reduce surgical delays and cancellations, eliminate adverse events, and improve the system for patients.

Individual hospitals in BC are beginning to apply process improvement methods to surgical care and other areas of the health care system with some promising results. The BCMA proposes that a provincial framework centered on the principle of continuous process improvement should be developed to support individual hospitals and surgical personnel to implement this initiative. In the spirit of process improvement, this needs to be an undertaking that engages perioperative personnel, is supported by senior management, and is ongoing and measurable—with institutions  learning from each other’s challenges and success.”

The BCMA offers 12 recommendations on the design, implementation, and evaluation of performance improvement in surgical care in BC. The following is a working summary, which synthesizes some of the recommendations into six concepts:

… continues

 

 

 

 

 

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Locum surgeons: Principles and Standards – Royal College of Surgeons – 19 May 2011

Posted on May 23, 2011. Filed under: Surgery, Workforce | Tags: |

Locum surgeons: Principles and Standards – Royal College of Surgeons – 19 May 2011

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Variations in health care: The good, the bad and the inexplicable – King’s Fund – 14 April 2011

Posted on April 14, 2011. Filed under: Clin Governance / Risk Mgmt / Quality, Evidence Based Practice, Surgery | Tags: |

Variations in health care: The good, the bad and the inexplicable – King’s Fund – 14 April 2011

press release

“A new report from The King’s Fund has found persistent and widespread variations across England in patients’ chances of undergoing surgery for common medical conditions.” 

“The report Variations in health care: The good, the bad and the inexplicable, outlines differences in admission rates for several routine interventions by analysing the geographical variation in health care provision in the NHS in England. Thirty-six different procedures were selected for analysis because they were either:

generally recognised to be clinically effective, or
there is uncertainty regarding their intervention, and/or
there are cost-effective alternatives available for conducting surgery – for example, treatment as a day case, rather than being admitted as an inpatient.

Evidence suggests that medical opinion and/or doctor preferences and attitudes have a substantial influence over which treatment patients will receive and are a major source of variation. Studies have also found that patients, if fully informed about their options, will often choose differently from their doctors and are less likely to elect for surgery than control groups.”

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Emergency Surgery: Standards for unscheduled surgical care – Royal College of Surgeons – 7 April 2011

Posted on April 13, 2011. Filed under: Emergency Medicine, Surgery | Tags: |

Emergency Surgery: Standards for unscheduled surgical care – Royal College of Surgeons – 7 April 2011

“Emergency patients account for half the NHS surgical workload but mortality and complication rates vary widely; these are the problems identified in new standards for emergency surgery care published today by the Royal College of Surgeons [RCS]. The RCS estimates that the care of emergency surgery patients comprises 40-50 per cent of surgical work and in general surgery alone account for 14,000 admissions a year to intensive care in England and Wales, at a costs of at least £88m* and mortality rates of 25 per cent. The report demonstrates that there is a lack of detailed outcome measurement for emergency surgery patients – which is preventing hospitals from understanding how they can improve.

Surgeons believe that dedicated operating theatre time for emergency cases; better care for highrisk patients before and after surgery; and greater availability of consultants would save lives and shorten hospital stays for emergency patients.”

…continues on the site

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NICE backs use of new cardiac output monitoring device by the NHS – 29 March 2011

Posted on March 30, 2011. Filed under: Cardiol / Cardiothor Surg, Surgery | Tags: , |

NICE backs use of new cardiac output monitoring device by the NHS

“The National Institute for Health and Clinical Excellence (NICE) has today (Wednesday 30 March) published final guidance which supports the case for adoption of CardioQ-ODM in the NHS. Based on the best available evidence and expert advice, the Institute found this new device offers proven advantages for both patients and the NHS. It advises CardioQ-ODM should be considered for use in patients undergoing major or high-risk surgery, or for other surgical patients who may require invasive cardiovascular monitoring.”  …continues on the site

 CardioQ-ODM (oesophageal Doppler monitor)

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Maintaining patients’ trust: modern medical professionalism – Society for Cardiothoracic Surgeons in Great Britain and Ireland (SCTS) – 21 March 2011

Posted on March 24, 2011. Filed under: Cardiol / Cardiothor Surg, Patient Safety, Surgery |

Maintaining patients’ trust: modern medical professionalism – Society for Cardiothoracic Surgeons in Great Britain and Ireland (SCTS) – 21 March 2011
 
“The Society for Cardiothoracic Surgeons in Great Britain and Ireland (SCTS) has been collecting outcomes following surgery since 1977. In 2001 the adult cardiac surgery database was introduced and in 2005 SCTS published clinical outcomes through the Care Quality Commission website.
 
SCTS is launching its report ‘Maintaining patients’ trust: modern medical professionalism’ on Monday 21st March. This report includes submissions from a range of respected external organisations and opinion leaders. It describes SCTS’ work on:” … continues on the SCTS site

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NHS treated cancer patients receiving major surgical resections – March 2011

Posted on March 21, 2011. Filed under: Oncology, Surgery |

NHS treated cancer patients receiving major surgical resections – March 2011

“This initial report on major surgical resections in England presents the percentage of NHS treated cancer patients who received a major resection as part of their treatment. The report contains results for thirteen cancer sites and covers patients diagnosed during 2004-2006 who were followed up to 2007. Percentages are presented by sex, age, deprivation quintile and cancer network, with funnel plots depicting both percentages and indirectly age-standardised ratios by cancer network. Cancer networks have been assigned by the residence of patients at time of diagnosis. These data provide a basis to instigate further exploration of major surgical resections for cancer patients and to encourage improved recording and sharing of data to allow further analyses to be produced.”

A post on the Cancer Research UK Science Update Blog also discusses this work.

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Surgery Futures: A Plan for Greater Sydney – January 2011

Posted on February 25, 2011. Filed under: Health Mgmt Policy Planning, Surgery |

Surgery Futures: A Plan for Greater Sydney – January 2011

The Surgery Futures Project is a major project for the NSW Department of Health and the Surgical Services Taskforce for 2010.

“The Surgery Futures project will describe the delivery of surgical services over the next 5-10 years in the greater Sydney area in order that specialist surgeons and managers can capitalise on emerging surgical advances, make effective use of available resources and produce the best outcomes for the patients.”

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The Surgical Workforce Report 2010 – Royal College of Surgeons – 27 January 2011

Posted on February 7, 2011. Filed under: Surgery, Workforce | Tags: |

The Surgical Workforce Report 2010 – Royal College of Surgeons – 27 January 2011
Extract from the press release

“Almost three quarters of consultant surgeons who took part in a national survey work more than their contracted hours and seventy per cent report they are expected to undertake elective operations while they are supposed to be on call for emergencies. These are the headline statistics from the first ever comprehensive survey of the surgical workforce published today (Thursday 27th Jan) by the Royal College of Surgeons (RCS).

The Surgical Workforce Report 2010 is the first edition of what will become an annual survey of surgical consultants working practices and is intended to provide the NHS with accurate figures to inform long term planning of the numbers of surgeons required to serve the UK. The report breaks down figures for each of the nine surgical specialties and was produced in collaboration with each of their associations*:”  …continues

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Australian hospital statistics 2009-10: emergency department care and elective surgery waiting times – AIHW – 30 November 2010

Posted on January 25, 2011. Filed under: Emergency Medicine, Health Mgmt Policy Planning, Surgery | Tags: , |

Australian hospital statistics 2009-10: emergency department care and elective surgery waiting times – AIHW – 30 November 2010

“Australian hospital statistics 2009-10: emergency department care and elective surgery waiting times presents information relating to emergency department care in major public hospitals and public hospital elective surgery waiting times for the period 1 July 2009 to 30 June 2010. In 2009-10: almost 6 million emergency department presentations were provided by major public hospitals, with 70% of patients receiving treatment within an appropriate time for their urgency (triage category); about 610,000 patients were admitted to Australian public hospitals from waiting lists for elective surgery, with 50% of patients admitted within 36 days. *Please note: from 2009-10, the data for the Albury Base Hospital was reported by the Victorian Department of Health as part of the Albury Wodonga Health Service. The Albury Wodonga Health Service was formed by the integration of Wodonga Regional Health Service in Victoria and acute services at the Albury Base Hospital in New South Wales. Data for Albury Base Hospital are therefore now included in statistics for Victoria whereas they were formerly reported by, and included in statistics for New South Wales.”

Authored by AIHW.

Published 30 November 2010; ISSN 1036-613X; ISBN-13 978-1-74249-094-6; AIHW cat. no. HSE 93; 68pp

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Australia and New Zealand Audit of Surgical Mortality’s first national report – December 2010

Posted on January 11, 2011. Filed under: Patient Safety, Surgery | Tags: |

Australia and New Zealand Audit of Surgical Mortality’s first national report – December 2010

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On the face of it: a review of the organisational structures surrounding the practice of cosmetic surgery – A report by the National Confidential Enquiry into Patient Outcome and Death (2010)

Posted on September 28, 2010. Filed under: Patient Safety, Surgery |

On the face of it: a review of the organisational structures surrounding the practice of cosmetic surgery – A report by the National Confidential Enquiry into Patient Outcome and Death (2010)

… investigates policies surrounding advertising and consent; the structure and case-mix of teams providing cosmetic surgery, the number and types of procedures performed; the provision of post-operative follow-up; policies, facilities and protocols and policies for clinical audit.

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Shedding the pounds: obesity management, NICE guidance and bariatric surgery in England – Office of Health Economics – September 2010

Posted on September 10, 2010. Filed under: Health Status, Surgery | Tags: , |

Shedding the pounds: obesity management, NICE guidance and bariatric surgery in England – Office of Health Economics – September 2010

“This report details the results of an exercise undertaken by the Office of Health Economics (OHE) looking at trends in obesity, current provision of bariatric surgery in England with particular reference to the NICE clinical guideline for obesity, and potential economic benefits that could be achieved through adherence to the NICE guideline.”

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Delivering enhanced recovery: Helping patients to get better sooner after surgery – UK – 31 March 2010

Posted on May 6, 2010. Filed under: Health Systems Improvement, Surgery | Tags: |

Delivering enhanced recovery: Helping patients to get better sooner after surgery

Document type: Guidance
Author: Department of Health  (UK)
Published date: 31 March 2010
Pages: 34

“Enhanced recovery is transforming NHS elective and cancer care pathways by using a number of evidence based inteventions as a model of care enabling patients to recover sooner following surgery. This guide, developed using learning from centres across the UK, provides a starting point to support implementation of enhanced recovery.”

Download Delivering enhanced recovery: Helping patients to get better sooner after surgery (PDF, 832K)

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NICE guideline on blood clot prevention – 27 January 2010

Posted on January 28, 2010. Filed under: Surgery | Tags: , , , |

2010/006 New NICE guideline on blood clot prevention will help save thousands of lives

“Thousands of lives could be saved with the help of a new guideline on preventing blood clots in hospital patients, published today (Wednesday 27 January) by the National Institute for Health and Clinical Excellence (NICE).  The guideline focuses on reducing the risk of deep vein thrombosis (blood clots blocking veins, also commonly known as DVT) in patients admitted to hospital.  If a blood clot breaks away it may travel to the lungs and cause a blockage – a potentially fatal pulmonary embolism.   Venous thromboembolism (VTE) covers both DVT and its possible consequence pulmonary embolism – the guideline sets out simple steps to help prevent VTE and therefore help save lives.

An estimated 25,000 people who are admitted to hospital die from preventable venous thromboembolism each year.  The NICE guideline, jointly developed with the National Clinical Guideline Centre for Acute and Chronic Conditions, recommends that all patients should be assessed for risk of developing blood clots on admission to hospital, and then given preventative treatment that suits their individual needs. Options include blood-thinning drugs such as heparin, anti-embolism stockings and foot impulse or pneumatic devices.  Importantly, this advice covers all patients admitted to hospital – including those having day-case procedures – and not just those patients having surgery.”

See the NICE VTE guideline

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United Hospital Center: Improving Surgical Care Through Evidence-Based Education and Standardization, The Commonwealth Fund, July 2009

Posted on July 6, 2009. Filed under: Health Systems Improvement, Surgery | Tags: |

S. Silow-Carroll, A. Lashbrook, United Hospital Center: Improving Surgical Care Through Evidence-Based Education and Standardization, The Commonwealth Fund, July 2009

“In just a few years, the United Hospital Center (UHC) rose from being one of the lower-performing U.S. hospitals on process-of-care measures to being one of the top performers. This case study focuses on UHC’s achievement in providing recommended treatment related to surgical care. UHC’s improvement can be attributed to hospital-wide strategies as well as policies and practices focused on the surgery department. Hospital-wide strategies include the creation of a subcommittee that reviews performance data and works across departments and disciplines to address performance gaps; careful data recording, assessment, and validation to gain the trust of physicians; engagement of the CEO, medical staff chairman, and medical staff; and communication of progress and challenges. Surgical care strategies include: emphasizing best-practice literature to bring surgeons on board; providing consistent data feedback, including to individual surgeons; using peer pressure when needed; and standardizing operating room procedures through standing orders, practice sets, and checklists.”

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Surgical Volume Trends, 2009 – Within and Beyond Wait Time Priority Areas – Canadian Institute for Health Information – 25 June 2009

Posted on June 30, 2009. Filed under: Health Systems Improvement, Surgery | Tags: , |

Surgical Volume Trends, 2009 – Within and Beyond Wait Time Priority Areas – Canadian Institute for Health Information
Date published: June 25, 2009        Pages: 52
ISBN 978-1-55465-553-3 (PDF)

“In this report, CIHI reports on trends in the number of people having surgeries within first ministers’ wait times priority areas (cancer, heart, joint replacement and sight restoration) as well as trends in the number of people who had surgery for other reasons (outside priority areas). This augments and updates information previously released in 2007 and 2008. This report addresses the following questions:

  • Has there been sustained growth in priority procedures?
  • Have there been repercussions in other parts of the health care system related to the focus on priority area surgery?
  • Has the increase in priority area surgery yielded benefits beyond reduced wait times?”

Full Report
Download Surgical Volume Trends, 2009 – Within and Beyond Wait Time Priority Areas (PDF) 1338 KB

Companion Products
Surgical Volume Trends, 2009 – Within and Beyond Wait Time Priority Areas PowerPoint Slides

Media Release
Rate of growth levels off for wait time priority procedures

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How can we improve waiting time for elective surgery in Australian public hospitals? – UQ Discussion paper March 2009

Posted on May 12, 2009. Filed under: Health Economics, Health Systems Improvement, Surgery | Tags: |

How can we improve waiting time for elective surgery in Australian public hospitals?
Merehau Cindy Mervin* and Sukhan Jackson, School of Economics Discussion Paper No. 387, March 2009, School of Economics, The University of Queensland. Australia.
Abstract
“This paper presents preliminary results from a study on waiting time for elective care in Australian public hospitals. It uses available data published in Australia to test the hypotheses that public beds and hospital staffing (specialist surgeons and enrolled nurses) influence waiting time for elective surgery in Australian public hospitals. We extracted data from the National Elective Surgery Waiting Times Data Collection (NESWTDC) and analyse waiting times for 8 specialty surgeries in Australian public hospitals. Hospital beds, nurses and specialist surgeons are used as proxies for the endogeneity of waiting times in a multiple regression analysis.”

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Report on the evaluation of the National Minimum Data Sets for Elective Surgery Waiting Times 22 April 2009 – AIHW

Posted on April 29, 2009. Filed under: Health Informatics, Surgery | Tags: |

Report on the evaluation of the National Minimum Data Sets for Elective Surgery Waiting Times

This evaluation found users of the national collections for Elective Surgery Waiting Times regarded the data as highly useful and highly important. It recommends collections continue, and coverage be improved to increase the proportion of public elective surgery episodes included in the collections. The report also recommends work to clarify what constitutes elective surgery and which types of surgery should be included.

Authored by Australian Institute of Health and Welfare.
Published 22 April 2009; ISBN-13 978 1 74024 921 8; AIHW cat. no. HSE 70; 122pp   Health services series no. 32

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The Productive Operating Theatre

Posted on April 16, 2009. Filed under: Health Systems Improvement, Surgery |

The Productive Operating Theatre

The NHS Institute is developing a new programme: The Productive Operating Theatre. This will be the next product in the productive series, and will be similar in approach to the productive ward, productive leader, and productive community hospital, where we have applied advanced improvement strategies, particularly lean thinking, to help staff achieve a step change in performance.

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Ontario Wait Times [for Emergency Room and for Surgery & Diagnostic Imaging]

Posted on April 9, 2009. Filed under: Diagnostics, Emergency Medicine, Pathology, Radiology, Surgery | Tags: , |

A wait times website from the Ontario Ministry of Health and Long-Term Care

From Canada’s Health Newsweekly – Health Edition Online

Ontario sets ER wait-time targets
February 20, 2009
Ontario is setting firm targets for ER wait times.

The clock starts ticking when a patient registers at the ER and stops when the patient is discharged home or admitted to a hospital bed.

….continues on the Health Edition website

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Institute for Healthcare Improvement – Improvement Map (US)

Posted on April 7, 2009. Filed under: Clin Governance / Risk Mgmt / Quality, Health Systems Improvement, Infection Control, Patient Safety, Surgery | Tags: |

The Improvement Map

The IHI Improvement Map is an initiative to help hospitals make sense of countless requirements and focus on high-leverage changes to transform care.  For details, download the Improvement Map overview.

The Improvement Map will cover the entire landscape of outstanding hospital care:

and now expanding the agenda with three new interventions:

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World Health Organization Surgical Safety Checklist 2008

Posted on April 7, 2009. Filed under: Patient Safety, Surgery |

WHO has undertaken a number of global and regional initiatives to address surgical safety. The Global Initiative for Emergency and Essential Surgical Care and the Guidelines for Essential Trauma Care focussed on access and quality. The Second Global Patient Safety Challenge: Safe Surgery Saves Lives addresses the safety of surgical care. The World Alliance for Patient Safety initiated work on the Challenge in January 2007.

The focus of the Challenge is the WHO Safe Surgery Checklist. The checklist identifies three phases of an operation, each corresponding to a specific period in the normal flow of work: Before the induction of anaesthesia (“sign in”), before the incision of the skin (“time out”) and before the patient leaves the operating room (“sign out”). In each phase, a checklist coordinator must confirm that the surgery team has completed the listed tasks before it proceeds with the operation.

The manual provides suggestions for implementing the checklist, understanding that different practice settings will adapt it to their own circumstances.

The implementation manual is designed to help ensure that surgical teams are able to implement the checklist consistently. By following a few critical steps, health care professionals can minimize the most common and avoidable risks endangering the lives and well-being of surgical patients.

The Safe Surgery Saves Lives initiative is also working to promote surgical improvement programs and collaboration by building a network of users. For more information on how to participate in this process, please visit the campaign page.

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