A novel framework for human factors analysis and classification system for medical errors (HFACS-MES)-A Delphi study and causality analysis.

The healthcare system (HCS) is one of the most crucial and essential systems for humanity. Currently, supplying the patients' safety and preventing the medical adverse events (MAEs) in HCS is a global issue. Human and organizational factors (HOFs) are the primary causes of MAEs. However, there are limited analytical methods to investigate the role of these factors in medical errors (MEs). The aim of present study was to introduce a new and applicable framework for the causation of MAEs based on the original HFACS. In this descriptive-analytical study, HOFs related to MEs were initially extracted through a comprehensive literature review. Subsequently, a Delphi study was employed to develop a new human factors analysis and classification system for medical errors (HFACS-MEs) framework. To validate this framework in the causation and analysis of MEs, 180 MAEs were analyzed by using HFACS-MEs. The results showed that the new HFACS-MEs model comprised 5 causal levels and 25 causal categories. The most significant changes in HFACS-MEs compared to the original HFACS included adding a fifth causal level, named "extra-organizational issues", adding the causal categories "management of change" (MOC) and "patient safety culture" (PSC) to fourth causal level", adding "patient-related factors (PRF)" and "task elements" to second causal level and finally, appending "situational violations" to first causal level. Causality analyses among categories in the HFACS-MEs framework showed that the new added causal level (extra-organizational issues) have statistically significant relationships with causal factors of lower levels (Φc≤0.41, p-value≤0.038). Other new causal category including MOC, PSC, PRF and situational violations significantly influenced by the causal categories of higher levels and had an statistically significant effect on the lower-level causal categories (Φc>0.2, p-value<0.05). The framework developed in this study serves as a valuable tool in identifying the causes and causal pathways of MAEs, facilitating a comprehensive analysis of the human factors that significantly impact patient safety within HCS.

Leveraging a Safety Event Management System to Improve Organizational Learning and Safety Culture.

BACKGROUND AND OBJECTIVES: Safety event management systems (SEMS) are rich sources of patient safety information, which can be used to improve organizational safety culture. An ideal SEMS can accomplish this when the system is improved with the intention of increasing learning and engagement across the organization. To support a global aim of improving overall patient safety and becoming a highly reliable learning health system, focus was directed toward increasing event review and follow-up completion and using this information to drive resource allocation and improvement efforts. METHODS: A new integrated SEMS was customized, tested, and implemented based on identified organizational need. Revised policies were developed to define expectations for event review and follow-up. The new SEMS incorporated a closed-loop communication process which ensured information from events was shared with the event submitters and facilitated shared learning. The expected impacts, improved event reporting, and follow-up were studied and guided ongoing improvements. RESULTS: After transitioning to a new SEMS, we experienced increased overall reporting by 8.6% and improved event follow-up, demonstrated by documentation on specified system forms, by 53.7%. CONCLUSIONS: By implementing a new, efficient, and standardized SEMS, which decentralized event management processes, the organization saw increased reporting and better engagement with patient safety event review and follow-up. Overall, these results demonstrated a stronger reporting culture, which allowed for local problem solving and improved learning from every event reported. A robust reporting culture positively impacted the overall organizational culture of safety.

Safety culture and incident learning systems in radiation oncology: Staff perceptions across Australia and New Zealand.

INTRODUCTION: Radiation therapy has a highly complex pathway and uses detailed quality assurance protocols and incident learning systems (ILSs) to mitigate risk; however, errors can still occur. The safety culture (SC) in a department influences its commitment and effectiveness in maintaining patient safety. METHODS: Perceptions of SC and knowledge and understanding of ILSs and their use were evaluated for radiation oncology staff across Australia and New Zealand (ANZ). A validated healthcare survey tool (the Hospital Survey on Patient Safety Culture) was used, with additional specialty-focussed supporting questions. A total of 220 radiation oncologists, radiation therapists and radiation oncology medical physicists participated. RESULTS: An overall positive SC was indicated, with strength in teamwork (83.7%), supervisor/manager/leader support (83.3%) and reporting events (77.1%). The weakest areas related to communication about error (63.9%), hospital-level management support (60.5%) and handovers and information exchange (58.0%). Barriers to ILS use included 'it takes too long' and that many respondents must use multiple reporting systems, including mandatory hospital-level systems. These are generally not optimal for specific radiation oncology needs. Varied understanding was indicated of what and when to report. CONCLUSION: The findings report the ANZ perspective on ILS and SC, highlighting weaknesses, barriers and areas for further investigation. Differences observed in some areas suggest that a unified state, national or bi-national ILS specific to radiation oncology might eliminate multiple reporting systems and reduce reporting time. It could also provide more consistent and robust approaches to incident reporting, information sharing and analysis.

Evaluating incident learning systems and safety culture in two radiation oncology departments.

INTRODUCTION: Radiation oncology patient pathways are complex. This complexity creates risk and potential for error to occur. Comprehensive safety and quality management programmes have been developed alongside the use of incident learning systems (ILSs) to mitigate risks and errors reaching patients. Robust ILSs rely on the safety culture (SC) within a department. The aim of this study was to assess perceptions and understanding of SC and ILSs in two closely linked radiation oncology departments and to use the results to consider possible quality improvement (QI) of department ILSs and SC. METHODS: A survey to assess perceptions of SC and the currently used ILSs was distributed to radiation oncologists, radiation therapists and radiation oncology medical physicists in the two departments. The responses of 95 staff were evaluated (63% of staff). The findings were used to determine any areas for improvement in SC and local ILSs. RESULTS: Differences were shown between the professional cohorts. Barriers to current ILS use were indicated by 67% of respondents. Positive SC was shown in each area assessed: 69% indicated the departments practised a no-blame culture. Barriers identified in one department prompted a QI project to develop a new reporting system and process, improve departmental learning and modify the overall ILS. CONCLUSION: An understanding of SC and attitudes to ILSs has been established and used to improve ILS reporting, feedback on incidents, departmental learning and the QA program. This can be used for future comparisons as the systems develop.

Six Sigma in surgery: how to create a safer culture in the operating theatre using innovative technology.

Safe delivery of patient care in the operating theatre is complex and co-dependent of many individual, organisational, and environmental factors, including patient, task and technology, individual, and human factors. The Six Sigma approach aims to implement a data-driven strategy to reduce variability and consequently improve safety. Analytical data platforms such as a Black Box ought to be embraced to support process optimisation and ultimately create a higher level of Six Sigma safety performance of the operating theatre team.

Fire safety and emergency evacuation guidelines for intensive care units and operating theatres: for use in the event of fire, flood, power cut, oxygen supply failure, noxious gas, structural collapse or other critical incidents: Guidelines from the Association of Anaesthetists and the Intensive Care Society.

The need to evacuate an ICU or operating theatre complex during a fire or other emergency is a rare event but one potentially fraught with difficulty: Not only is there a risk that patients may come to harm but also that staff may be injured and unable to work. Designing newly-built or refurbished ICUs and operating theatre suites is an opportunity to incorporate mandatory fire safety features and improve the management and outcomes of such emergencies: These include well-marked manual fire call points and oxygen shut off valves (area valve service units); the ability to isolate individual zones; multiple clear exit routes; small bays or side rooms; preference for ground floor ICU location and interconnecting routes with operating theatres; separate clinical and non-clinical areas. ICUs and operating theatre suites should have a bespoke emergency evacuation plan and route map that is readily available. Staff should receive practical fire and evacuation training in their clinical area of work on induction and annually as part of mandatory training, including 'walk-through practice' or simulation training and location of manual fire call points and fire extinguishers, evacuation routes and location and operation of area valve service units. The staff member in charge of each shift should be able to select and operate fire extinguishers and lead an evacuation. Following an emergency evacuation, a network-wide response should be activated, including retrieval and transport of patients to other ICUs if needed. A full investigation should take place and ongoing support and follow-up of staff provided.

X-ray management in electrophysiology: a survey of the Italian Association of Arrhythmology and Cardiac Pacing (AIAC).

AIMS: Radiation use in medicine has significantly increased over the last decade, and cardiologists are among the specialists most responsible for X-ray exposure. The present study investigates a broad range of aspects, from specific European Union directives to general practical principles, related to radiation management among a national cohort of cardiologists. METHODS AND RESULTS: A voluntary 31-question survey was run on the Italian Arrhythmology and Pacing Society (AIAC) website. From June 2019 to January 2020, 125 cardiologists, routinely performing interventional electrophysiology, participated in the survey. Eighty-seven (70.2%) participants are aware of the recent European Directive (Euratom 2013/59), although only 35 (28.2%) declare to have read the document in detail. Ninety-six (77.4%) participants register the dose delivered to the patient in each procedure, in 66.1% of the cases both as fluoroscopy time and dose area product. Years of exposition (P = 0.009) and working in centers performing pediatric procedures (P = 0.021) related to greater degree of X-ray equipment optimization. The majority of participants (72, 58.1%) did not recently attend radioprotection courses. The latter is related to increased awareness of techniques to reduce radiation exposure (96% vs. 81%, P = 0.022), registration of the delivered dose in each procedure (92% vs. 67%, P = 0.009), and X-ray equipment optimization (50% vs. 36%, P = 0.006). CONCLUSION: Italian interventional cardiologists show an acceptable level of radiation awareness and knowledge of updated European directives. However, there is clear space for improvement. Comparison to other health professionals, both at national and international levels, is needed to pursue proper X-ray management and protect public health.

Development and content validation of the Safe Surgery Organizational Readiness Tool: A quality improvement study.

BACKGROUND: Recent efforts to increase access to safe and high-quality surgical care in low- and middle-income countries have proven successful. However, multiple facilities implementing the same safety and quality improvement interventions may not all achieve successful outcomes. This heterogeneity could be explained, in part, by pre-intervention organizational characteristics and lack of readiness of surgical facilities. In this study, we describe the process of developing and content validating the Safe Surgery Organizational Readiness Tool. MATERIALS AND METHODS: The new tool was developed in two stages. First, qualitative results from a Safe Surgery 2020 intervention were combined with findings from a literature review of organizational readiness and change. Second, through iterative discussions and expert review, the Safe Surgery Organizational Readiness Tool was content validated. RESULTS: The Safe Surgery Organizational Readiness Tool includes 14 domains and 56 items measuring the readiness of surgical facilities in low- and middle-income countries to implement surgical safety and quality improvement interventions. This multi-dimensional and multi-level tool offers insights into facility members' beliefs and attitudes at the individual, team, and facility levels. A panel review affirmed the content validity of the Safe Surgery Organizational Readiness Tool. CONCLUSION: The Safe Surgery Organizational Readiness Tool is a theory- and evidence-based tool that can be used by change agents and facility leaders in low- and middle-income countries to assess the baseline readiness of surgical facilities to implement surgical safety and quality improvement interventions. Next steps include assessing the reliability and validity of the Safe Surgery Organizational Readiness Tool, likely resulting in refinements.

Laser dentistry in daily practice during the COVID-19 pandemic: Benefits, risks and recommendations for safe treatments.

The COVID-19 pandemic forced dental professionals to cope with an unexpected challenge and caused an abrupt cessation of conventional care practices. The high degree of contagiousness as well as the diffusion of the virus through the air and droplets via respiratory transmission placed dental professionals at top-level risk of contracting and spreading the disease. General recommendations were announced in different countries, including patient distancing, air ventilation, surface and instrument sanitization, and the wearing of suitable masks and shields. However, many dental treatments are performed using lasers, and some specific precautions must be added to conventional procedures to ensure the advantages of this technology to patients because of the particular tissue­matter interaction effects of laser wavelengths. Based on the literature, the authors evaluated all of using laser wavelengths to analyze the risk and the benefits of using lasers in daily dental practice, and to provide safety recommendations during pandemic. An unrestricted search of indexed databases was performed. Laser use effects were categorized into: 1) explosive processes that produce tissue ablation and aerosol formation; 2) thermal actions that create vaporization and smoke plume; 3) photobiomodulation of the cells; and 4) enhanced chemical activity. Knowledge of the device functions and choice of adequate parameters will reduce aerosol and plume formation, and the application of suction systems with high flow volume and good filtration close to the surgical site will avoid virus dissemination during laser use. In the categories that involve low energy, the beneficial effects of lasers are available and sometimes preferable during this pandemic because only conventional precautions are required. Lasers maintain the potential to add benefits to dental practice even in the COVID-19 era, but it is necessary to know how lasers work to utilize these advantages. The great potential of laser light, with undiscovered limits, may provide a different path to face the severe health challenges of this pandemic.

Near miss na atenção primária à saúde e a segurança do paciente: revisão integrativa / Near miss in primary care for patient health and safety: integrative review / Near miss en atención primaria de salud y seguridad del paciente: revisión integrativa

Objetivo: Identificar as evidências sobre os incidentes near miss em serviços de atenção primária à saúde. Método: Revisão integrativa de literatura a partir de artigos primários publicados em sete bases de dados. Utilizou-se os descritores "near miss", "atenção primária à saúde" e "gestão da segurança" sem limitações quanto ao ano de publicação e idiomas. Resultados: Os tipos de incidentes near miss notificados com maior frequência estavam relacionados a erros de medicação, com variação entre 6,2% e 96%, e o processo de prescrição foi o mais recorrente. Os profissionais de saúde foram os responsáveis por interceptar entre 66% a 83% dos incidentes. Conclusão: A notificação de incidentes near miss deve ser incentivada e incorporada nas práticas gerenciais. Conhecer precocemente os erros e seu potencial de dano possibilita ações de melhorias para segurança do paciente.(AU)

Objective: To identify the evidence about near miss incidents in primary health care services. Method: Integrative literature review based on primary articles published in seven databases. The descriptors "near miss", "primary health care" and "safety management" were used without limitations regarding the year of publication and languages. Results: The types of near miss incidents most frequently reported were related to medication errors, ranging from 6.2% to 96%, and the prescription process was the most recurrent. Health professionals were responsible for intercepting between 66% to 83% of incidents. Conclusion: Reporting of near miss incidents should be encouraged and incorporated into management practices. Knowing the errors early and their potential for damage enables improvement actions for patient safety.(AU)

Objetivo: identificar la evidencia sobre incidentes near miss en los servicios de atención primaria de salud. Método: revisión bibliográfica basada en artículos primarios publicados en siete bases de datos. Los descriptores "near miss salud", "atención primaria de salud" y "gestión de seguridad" se utilizaron sin limitaciones con respecto al año de publicación y los idiomas. Resultados: los tipos de incidentes cercanos a fallas más frecuentes se relacionaron con errores de medicación, que oscilaron entre 6.2% y 96%, y el proceso de prescripción fue el más recurrente. Los profesionales de la salud fueron responsables de interceptar entre el 66% y el 83% de los incidentes. Conclusión: Se debe alentar e incorporar a las prácticas de gestión la notificación de incidentes cercanos. Conocer los errores temprano y su potencial de daño permite acciones de mejora para la seguridad del paciente.(AU)

Processes to Create a Culture of Surgical Patient Safety.

This article discusses the processes, interventions, and methods by which health care systems can change the culture of their workplace to promote safety. The importance of this culture shift is discussed, as well as an organizational approach, highlighting the importance of investment of time and resources to the cause. Efforts must include an educational focus on patient safety where a culture of patient safety is emphasized. This attitude along with several specific key interventions, including, measurement, teamwork, briefings, checklists, and developmental infrastructure, are discussed.

Cultura de segurança do paciente: perspectiva de trabalhadores da saúde e apoio / Cultura de seguridad del paciente: perspectiva de trabajadores de la salud y de apoyo / Patient safety culture: perspective of health and support workers

Resumo Objetivo Analisar a cultura de segurança do paciente na perspectiva dos trabalhadores que atuam direta ou indiretamente no cuidado ao paciente hospitalizado. Métodos Estudo transversal, com 2.634 trabalhadores do serviço hospitalar de sete instituições do Rio Grande do Sul, Brasil. Utilizou-se a versão brasileira do Safety Attitudes Questionnaire. Realizaram-se análises descritiva e inferencial, considerando cultura positiva escore ≥ 75 pontos. Resultados Evidenciou-se avaliação positiva da cultura de segurança nos domínios Clima de trabalho em equipe (mediana 75) e Satisfação no Trabalho (mediana 90). Os fisioterapeutas, dentistas e trabalhadores da manutenção avaliaram de forma positiva a cultura de segurança (p<0,05). Psicólogos, profissionais da nutrição/dietética e vigilantes/porteiros tiveram maiores percentuais para cultura negativa (p<0,05). Conclusão A cultura de segurança obteve escores predominantemente negativos, mais expressivos no domínio percepção da gerência do hospital. Quando comparadas as categorias da saúde e apoio, identificou-se pouca variabilidade nos escores dos domínios do instrumento. No entanto, os profissionais do apoio tenderam a pontuações mais baixas. Avaliar as dimensões da cultura de segurança fornece um diagnóstico situacional da organização ou unidade de trabalho e pode subsidiar estratégias gerenciais com vistas ao aprimoramento da qualidade da assistência prestada ao paciente.

Resumen Objetivo Analizar la cultura de seguridad del paciente desde la perspectiva de los trabajadores que actúan directa o indirectamente en el cuidado al paciente hospitalizado. Métodos Estudio transversal con 2.634 trabajadores del servicio hospitalario de siete instituciones del estado de Rio Grande do Sul, Brasil. Se utilizó la versión brasileña del Safety Attitudes Questionnaire. Se realizó un análisis descriptivo e inferencial y se consideró como cultura positiva la puntuación ≥ 75. Resultados Se observó una evaluación positiva de la cultura de seguridad en los dominios Clima de trabajo en equipo (mediana 75) y Satisfacción en el trabajo (mediana 90). Los fisioterapeutas, dentistas y trabajadores de mantenimiento evaluaron de forma positiva la cultura de seguridad (p<0,05). Los psicólogos, profesionales de nutrición/dietética y vigilantes/porteros tuvieron porcentajes mayores de cultura negativa (p<0,05). Conclusión La cultura de seguridad obtuvo puntuaciones predominantemente negativas, más significativas en el dominio Percepción de la gerencia del hospital. Al comparar las categorías de salud y de apoyo, se identificó poca variabilidad en las puntuaciones de los dominios del instrumento. Sin embargo, los profesionales de apoyo tuvieron una tendencia de puntajes más bajos. Evaluar las dimensiones de seguridad ofrece un diagnóstico situacional de la organización o unidad de trabajo y puede respaldar estrategias gerenciales con el fin de mejorar la calidad de la atención prestada al paciente.

Abstract Objective To analyze the culture of patient safety from the perspective of workers working directly or indirectly in the care of hospitalized patients. Methods Cross-sectional study of 2,634 hospital service workers from seven institutions in Rio Grande do Sul, Brazil. The Brazilian version of the Safety Attitudes Questionnaire was used. Descriptive and inferential analyzes were performed, considering scores ≥ 75 points as positive culture. Results A positive evaluation of the safety culture was evidenced in the Teamwork climate (median 75) and Job Satisfaction (median 90) domains. Physiotherapists, dentists and maintenance workers evaluated the safety culture positively (p<0.05). Psychologists, nutrition/dietetics professionals and security guards/doormen achieved higher percentages for negative culture (p<0.05). Conclusion The safety culture obtained predominantly negative scores, more expressive in the Perception of hospital management domain. When comparing the health and support categories, little variability was identified in scores of the instrument domains, although support professionals tended to score lower. Assessing the dimensions of the safety culture provides a situational diagnosis of the organization or work unit and can support management strategies aimed at improving the quality of patient care.

Construção e validação do sistema informatizado de notificação voluntária de incidentes (SINVI): uma tecnologia para vigilância de incidentes relacionados à prestação do cuidado / Construction and validation of the computerized system of voluntary notification of incidents (SINVI): a technology for surveillance of incidents related to provision of care

Introdução: a gestão de risco nos serviços de saúde tem o papel de aplicar, de forma sistemática e contínua, as políticas, os procedimentos, as condutas e os recursos na identificação, análise, avaliação, comunicação e controle de riscos e eventos adversos que afetam a segurança, a saúde humana, a integridade profissional, o meio ambiente e a imagem institucional. A identificação dos eventos adversos que acontecem nos serviços de saúde é de extrema importância para o planejamento de ações de mitigação das falhas durante a assistência à saúde. Os sistemas de notificações voluntárias são o alicerce para um programa de segurança do paciente, ajudando a identificar melhorias no desenvolvimento de uma cultura de segurança, e funcionam como uma estratégia para garantir a qualidade. Objetivos: construir um protótipo de Sistema Informatizado de Notificação Voluntária de Incidentes Informatizado (SINVI); identificar os principais incidentes relacionados à prestação dos cuidados em banco de dados e discuti-los frente à literatura; validar um protótipo de um sistema informatizado de notificação voluntária de incidentes. Método: estudo metodológico desenvolvido em três etapas: identificação dos principais incidentes relacionados à prestação de cuidados; construção do protótipo de um Sistema Informatizado de Notificação Voluntária de Incidentes (SINVI); validação de conteúdo e usabilidade do protótipo do Sistema Informatizado de Notificação Voluntária de Incidentes (SINVI). Para a validação de conteúdo, foram utilizados o Coeficiente de Validação de Conteúdo (CVC), a Taxa de Concordância (TC) e o coeficiente de Kappa. Para a validação de usabilidade, foi utilizado o escore de System Usability Scale (SUS). Este estudo foi aprovado pelo Comitê de Ética em Pesquisa (CEP) com o número do Parecer: 3.674.180. Resultados: foram produzidos três produtos: dois estruturados em forma de artigo e o terceiro, em produto acadêmico. O primeiro identificou os principais eventos adversos notificados no país no período de 2014 a 2018; o segundo produto consiste na construção e validação do protótipo do SINVI e o terceiro é a apresentação do produto acadêmico, a produção técnica do protótipo do software do SINVI, localizado no estrado T1 na categorização da CAPES. Conclusão: os três produtos deste relatório de dissertação contribuem para a segurança do paciente nos serviços de saúde na medida em que fornecem subsídios para a gestão de risco e o núcleo de segurança do paciente na captação de dados agregados das notificações a partir do uso de um Sistema Informatizado de Notificação Voluntária de Incidentes (SINVI)

Introduction: risk management in health services has the role of applying, in a systematic and continuous manner, the policies, procedures, conducts and resources in the identification, analysis, evaluation, communication and control of risks and adverse events that affect safety, human health, professional integrity, the environment and the institutional image. The identification of adverse events that occur in health services is extremely important for the planning of actions to mitigate failures during health care. Voluntary reporting systems are the foundation of a patient safety program, helping to identify improvements in the development of a safety culture, and serve as a strategy to ensure quality. Objectives: build a prototype of a Computerized Voluntary Incident Notification System (SINVI); identify the main care-related incidents in a database and discuss them against the literature; validate a prototype of a computerized voluntary incident reporting system. Method: methodological study developed in three stages: identification of the main care-related incidents; construction of the prototype of a Computerized Voluntary Incident Notification System (SINVI); content and usability validation of the prototype of the Computerized Voluntary Incident Notification System (SINVI). For content validation, the Content Validation Coefficient (CVC), the Concordance Rate (CR), and the Kappa coefficient were used. For usability validation, the System Usability Scale (UHS) score was used. This study was approved by the Research Ethics Committee (REC) with Opinion number: 3.674.180. Results: Three products were produced: two structured as articles and the third as an academic product. The first identified the main adverse events reported in the country from 2014 to 2018; the second product consists of the construction and validation of the SINVI prototype and the third is the presentation of the academic product, the technical production of the SINVI software prototype, located on the T1 platform in the CAPES categorization. Conclusion: the three products of this dissertation report contribute to patient safety in health services in that they provide subsidies for risk management and the patient safety nucleus in capturing aggregate data from the notifications using a Computerized Voluntary Incident Notification System (SINVI)

Current understanding and future directions for an occupational infectious disease standard.

The coronavirus disease 2019 pandemic has demonstrated a need for an infectious disease standard that will promote a safe and healthy work environment and assure business continuity. The current pandemic has revealed gaps in workplace preparedness and employee protections to microbial exposures. Federal and state government agencies have responded by providing interim guidelines and stop-gap measures that continue to evolve and vary in approach and required controls. This interim and inconsistent approach has resulted in confusion on the part of businesses as they work toward reopening during the pandemic and uncertainty as to the efficacy of required or suggested controls. Moving forward, the US Occupational Safety and Health Administration, with guidance from the US National Institute for Occupational Safety and Health, should establish consistent and effective strategies through a nationwide standard to address the potential microbial exposures in the workplace. Such a standard will require effective worker protections from infectious diseases and assure business continuity.

Coronavirus Disease-19 and Rhinology/Facial Plastics.

This review summarizes the challenges and adaptations that have taken place in rhinology and facial plastics in response to the ongoing coronavirus disease-19 pandemic. In particular, the prolonged exposure and manipulation of the nasal and oral cavities portend a high risk of viral transmission. We discuss evidence-based recommendations to mitigate the risk of viral transmission through novel techniques and device implementation as well as increasing conservative management of certain pathologies.

Urgent safety considerations for dermatologic surgeons in the COVID-19 pandemic.

Dermatologic surgeons are at increased risk of contracting SARS-COV-2. At time of writing, there is no published standard for the role of pre-operative testing or the use of smoke evacuators, and personal protective equipment (PPE) in dermatologic surgery. Risks and safety measures in otolaryngology, plastic surgery, and ophthalmology are discussed. In Mohs surgery, cases involving nasal or oral mucosa are highest risk for SARS-COV-2 transmission; pre-operative testing and N95 masks should be urgently prioritized for these cases. Other key safety recommendations include strict control of patient droplets and expanded pre-clinic screening. Dermatologic surgeons are encouraged to advocate for appropriate pre-operative tests, smoke evacuators, and PPE. Future directions would include national consensus guidelines with continued refinement of safety protocols.