Society for Perioperative Assessment and Quality Improvement (SPAQI) Consensus Statement on Perioperative Smoking Cessation.

Smokers are at increased risk for surgical complications. Despite the known benefits of smoking cessation, many perioperative health care providers do not routinely provide smoking cessation interventions. The variation in delivery of perioperative smoking cessation interventions may be due to limited high-level evidence for whether smoking cessation interventions used in the general population are effective and feasible in the surgical population, as well as the challenges and barriers to implementation of interventions. Yet smoking is a potentially modifiable risk factor for improving short- and long-term patient outcomes. The purpose of the Society for Perioperative Assessment and Quality Improvement (SPAQI) Consensus Statement on Perioperative Smoking Cessation is to present recommendations based on current scientific evidence in surgical patients. These statements address questions regarding the timing and intensity of interventions, roles of perioperative health care providers, and behavioral and pharmacological interventions. Barriers and strategies to overcome challenges surrounding implementation of interventions and future areas of research are identified. These statements are based on the current state of knowledge and its interpretation by a multidisciplinary group of experts at the time of publication.

Evaluation of a Pilot Perioperative Smoking Cessation Program: A Pre-Post Study.

BACKGROUND: Surgical clinic and perioperative settings are critical touchpoints for treating smoking, yet health care systems have not typically prioritized smoking cessation among surgical patients. We evaluated the implementation of a pilot smoking cessation intervention integrated into standard perioperative care. MATERIALS AND METHODS: English-speaking adult smokers undergoing elective surgery in Kaiser Permanente San Francisco before (2015) and after (2016-2017) the implementation of a smoking cessation intervention were included. Provider outcomes included counseling referrals, cessation medication orders (between surgery scheduling and surgery), and preoperative carbon monoxide testing. Patient outcomes included counseling and medication use, smoking status at surgery and 30 d after discharge, and surgical complications. Multivariable logistic regression analyses examined pre-to-post intervention changes in outcomes using electronic health record data and 30-d postdischarge telephone surveys. RESULTS: The sample included 276 patients (70% male; 59% non-Hispanic white; mean age = 50 y). There were significant pre-to-post increases in tobacco cessation counseling referrals (3% to 28%, adjusted odds ratio [AOR] = 11.12, 95% confidence interval [CI] = 3.78-32.71) and preoperative carbon monoxide testing (38% to 50%, AOR = 1.83, 95% CI = 1.10-3.06). At ∼30 d after discharge, patients in the postintervention period were more likely to report smoking abstinence in the previous 7 d (24% pre, 44% post; AOR = 2.39, 95% CI = 1.11-5.13) and since hospital discharge (18% pre, 39% post; AOR = 3.20, 95% CI = 1.42-7.23). Cessation medication orders and patient use of counseling and medications increased, whereas surgical complications decreased, but pre-to-post differences were not significant. CONCLUSIONS: A perioperative smoking cessation program integrated into standard care demonstrated positive smoking-related outcomes; however, larger studies are needed to evaluate the effectiveness of these programs.

Challenges of Capacity and Development for Health System Sustainability.

To achieve sustainability, remote and rural communities require health service models that are designed in and for these settings and are responsive to local population health needs. This paper draws on a panel discussion at the Rural and Indigenous Health Symposium held in Toronto, ON, on September 21, 2017. Active community participation is an important contributor to success in rural health system transformation, as well as health workforce recruitment and retention. Increasingly, communication technology is contributing to the quality and effectiveness of healthcare in remote rural community settings, particularly by ensuring that specialist expertise is accessible to and supportive of the local providers of care. Recent medical graduates bring life experiences and work expectations to rural primary care that are different from their senior colleagues. Successful recruitment and retention of the rural primary care workforce depend increasingly on offering a "turnkey" clinic work supported by a functioning electronic medical record. Rural health system sustainability occurs most frequently through ongoing collaboration and partnerships, partnerships, partnerships. It is through partnerships with communities, health services and healthcare providers that the Northern Ontario School of Medicine (NOSM) has been successful in producing medical graduates who provide care responsive to population health needs in previously underserved communities of northern Ontario. Sustainable healthcare in remote and rural communities is enhanced by active community participation and clustering these communities in local networks. An important key to success is shifting from hospital-centric to community-centric care.

Mothers with Physical Disabilities Caring for Young Children.

Seventy-one U.S. mothers with a physical disability who had a child aged 0 to 3 years responded to a survey about the system of care used for their child. Results indicated that mothers participated in all different types of care (physical, comforting, playing, limit setting, and taking the child outside the home). Partners and participants' mothers provided the most assistance with care. Mothers were generally satisfied with assistance received from others. This article explores how mothers remain central to their children with others assisting with the child's care and the impact of such assistance on mothers' relationships with partners and children.

How to integrate findings from simulation exercises to improve obstetrics care in the institution.

The opening of a new facility often brings teams from different backgrounds who have previously never worked together. Organizational goals of safety and high reliability from the first day of operations would be impossible to attain without testing. Simulation is now being used to test new services, departments, and entire facilities before opening. This has been accomplished by establishing a well-developed program of in situ simulation with strong physician and nursing educator co-leads and simulation teams. This article describes a process for testing through simulation and the systemic findings from testing existing and new facilities and services.

Persuasion: getting your points across.

Leaders have many options and resources open to them when they try to motivate their followers. These include forcing, ordering, manipulating, cajoling, threatening, and persuading. Of all these options, perhaps the most useful and powerful is persuasion. Every effective leader persuades, even when other options are open and available. Leaders persuade as a means to getting the maximum commitment from their followers, in pursuit of the objectives of the organization or for personal objectives. Force, threat, and manipulation too often lead to follower involvement ("I'm here, but that's all") but rarely to a personal commitment. Yet motivation experts suggest that the most productive behavior results when employees are committed to the organization, its clients, customers, and goals. It's been suggested that the difference between "commitment" and "involvement" is the difference between a ham-and-eggs breakfast: a chicken was involved in your meal, but a pig was committed to it. We persuade to raise our employee's involvement in their jobs to some greater level of commitment. This article will examine some of the latest persuasion research and how it applies to better management. In doing so, we'll frequently use the jargon of persuasion, referring to the persuaders as "sellers," and those being persuaded as "buyers."