Feasibility of quality indicators on prehospital advanced airway management in a physician-staffed emergency medical service: survey-based assessment of the provider point of view.

OBJECTIVE: We aimed to determine the feasibility of quality indicators (QIs) for prehospital advanced airway management (PAAM) from a provider point of view. DESIGN: The study is a survey based feasibility assessment following field testing of QIs for PAAM. SETTING: The study was performed in two physician staffed emergency medical services in Switzerland. PARTICIPANTS: 42 of the 44 emergency physicians who completed at least one case report form (CRF) dedicated to the collection of the QIs on PAAM between 1 January 2019 and 31 December 2021 participated in the study. INTERVENTION: The data required to calculate the 17 QIs was systematically collected through a dedicated electronic CRF. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcomes were provider-related feasibility criteria: relevance and acceptance of the QIs, as well as reliability of the data collection. Secondary outcomes were effort to collect specific data and to complete the CRF. RESULTS: Over the study period, 470 CRFs were completed, with a median of 11 per physician (IQR 4-17; range 1-48). The median time to complete the CRF was 7 min (IQR 3-16) and was considered reasonable by 95% of the physicians. Overall, 75% of the physicians assessed the set of QIs to be relevant, and 74% accepted that the set of QIs assessed the quality of PAAM. The reliability of data collection was rated as good or excellent for each of the 17 QIs, with the lowest rated for the following 3 QIs: duration of preoxygenation, duration of laryngoscopy and occurrence of desaturation during laryngoscopy. CONCLUSIONS: Collection of QIs on PAAM appears feasible. Electronic medical records and technological solutions facilitating automatic collection of vital parameters and timing during the procedure could improve the reliability of data collection for some QIs. Studies in other services are needed to determine the external validity of our results.

ERAS® protocol improves survival after radical cystectomy: A single-center cohort study.

INTRODUCTION: To evaluate Enhanced recovery after surgery (ERAS®) protocol on oncological outcomes for patients treated with radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB). METHODS: A prospectively maintained single-institutional database comprising 160 consecutive UCB patients who underwent open RC from 2012 to 2020 was analyzed. Patients receiving chemotherapy and those with a urinary diversion other than ileal conduit were excluded. Patients were divided into two groups according to the perioperative management (ERAS® and pre-ERAS®). The study aimed to evaluate the impact of the ERAS® protocol on survival at five years after surgery using a Kaplan-Meier log-rank test. A multivariable Cox proportional hazards model was used to identify prognostic factors for cancer-specific (CSS) and overall survival (OS). RESULTS: Of the 107 patients considered for the final analysis, 74 (69%) were included in the ERAS® group. Median follow-up for patients alive at last follow-up was 28 months (interquartile range [IQR] 12-48). Five-years CSS rate was 74% for ERAS® patients, compared to 48% for the control population (P = 0.02), while 5-years OS was 31% higher in the ERAS® (67% vs. 36%, P = .003). In the multivariable analysis, ERAS® protocol and tumor stage were independent factors of CSS, while ERAS®, tumor stage so as total blood loss were independent factors for OS. DISCUSSION: A dedicated ERAS® protocol for UCB patients treated with RC has a significant impact on survival. Reduction of stress after a major surgery and its potential improvement of perioperative patient's immunity may explain these data.

[Mass-gathering medical care: what is at stake? The example of the 2019 Fête des Vignerons]. / Dispositif sanitaire lors de grandes manifestations : quels enjeux ? - L'exemple de la Fête des Vignerons 2019.

During an event, the organizer is responsible for ensuring compliance with all standards, including in the medical and health field. It is therefore up to them to set up a display capable of handling potential patients. The planning of this display requires a preliminary risk assessment, including an estimate of the probability of occurrence and the potential severity in the event of occurrence. There are few decision-making tools available to plan such a device; the impact of major events, particularly on the surrounding care structures, or the sizing of such devices remains a poorly studied field. This article provides an update on recommendations and trends in this area, illustrated by the experience of the 2019 Fête des Vignerons.

Lors d'une manifestation, l'organisateur est responsable de s'assurer du respect de toutes les normes, y compris dans le domaine médico-sanitaire. Il lui incombe donc de mettre en place un dispositif à même de prendre en charge d'éventuels patients. La planification de ce dispositif nécessite une évaluation préalable des risques, intégrant une estimation de la probabilité d'occurrence et de la gravité potentielle en cas de survenue. Il existe peu d'outils d'aide à la décision permettant de planifier un tel dispositif ; l'impact des grands événements, en particulier sur les structures de soins environnantes, ou le dimensionnement de ces dispositifs restant un domaine peu étudié. Cet article propose une mise au point sur les recommandations et tendances dans ce domaine, en l'illustrant par l'expérience de la Fête des Vignerons 2019.

[Transforming operating rooms into an intensive care unit to manage the COVID-19 outbreak]. / Transformation du bloc opératoire en unité de soins intensifs pour gérer la pandémie de Covid-19.

This article is a descriptive analysis of the organizational steps undertaken to transform eight OR (operating rooms) of the University Hospital Lausanne CHUV into a dedicated ICU (intensive care unit) during the COVID-19 pandemic. An efficient response of our institution was mandatory to timely increase the number of ICU beds. The transformation of an entire floor of a functioning operating ward was deemed the most appropriate solution to provide rapidly a significant number of beds. The newly created ICU was the first additional ICU to open and admitted its first patient 48 hours after the beginning of the transformation.

Cet article résume les étapes organisationnelles entreprises pour transformer huit salles d'opération en une unité de soins intensifs pendant la pandémie de Covid-19. Une réponse efficace de notre institution était obligatoire pour augmenter en temps opportun le nombre de lits en soins intensifs. La transformation d'un étage entier d'un bloc opératoire fonctionnel a été jugée la solution la plus appropriée pour offrir le plus rapidement possible un nombre de lits conséquent. La nouvelle unité de soins intensifs adultes (SIA) a été la première unité de soins intensifs supplémentaire à ouvrir et a admis son premier patient 48 heures après le début des transformations.