Implementing mobile health in your surgical practice: Results of a multidisciplinary convening.

The perioperative journey remains complex and difficult to navigate for patients and caregivers. Poor communication and lack of care coordination lead to diminished patient satisfaction, outcomes, and system performance. Mobile health platforms have the potential to overcome some of these issues by improving care delivery through timely individualized assessments, improved patient education, and care coordination. Yet mobile health implementation in surgical practice remains limited. Based on a convening of experts using human-centered design techniques, an implementation guide for the integration of mobile health in perioperative care was created to assist with (1) identification of the use of mobile health within a specific surgical practice, (2) identification of the pathway to mobile health implementation, and (3) measurement of successful implementation including patient and surgical system impact. This article reviews those recommendations and provides references to additional literature, including the full implementation guide, to aid those seeking to implement mobile health in a surgical practice or system.

Integration of smartphone-based mobile health technology into perioperative care-the patient's perspective.

Although numerous use cases demonstrate the value of mobile health technology, there is limited knowledge regarding patient perceptions of such technology, which may explain the lack of broader implementation of mobile health technology. Achieving meaningful, sustained, and equitable use of mobile health technology in surgery necessitates a human-centered design approach with consideration given to end users. This review article draws on evidence from prior qualitative studies of both surgeons and patients to make recommendations that may assist health care systems in realizing the full potential of mobile health technology for delivering high-quality, patient-centered surgical care.

Primary Tissue Repair for Inguinal Hernias: The Shouldice Repair Technique and Patient Selection.

It is estimated that approximately one in four men and one in 20 women will develop an inguinal hernia over the course of their lifetime. A non-mesh inguinal hernia repair via the Shouldice technique is a unique approach that necessitates dissection of the entire groin region as well as careful assessment for any secondary hernias. Subsequently, a pure tissue laminated closure allows the repair to be performed without tension. Herein, the authors describe a brief overview of inguinal hernias and discuss the relevant patient evaluation, operative steps of the Shouldice procedure, and postoperative considerations.

Development of a Machine Learning-Based Prescriptive Tool to Address Racial Disparities in Access to Care After Penetrating Trauma.

Importance: The use of artificial intelligence (AI) in clinical medicine risks perpetuating existing bias in care, such as disparities in access to postinjury rehabilitation services. Objective: To leverage a novel, interpretable AI-based technology to uncover racial disparities in access to postinjury rehabilitation care and create an AI-based prescriptive tool to address these disparities. Design, Setting, and Participants: This cohort study used data from the 2010-2016 American College of Surgeons Trauma Quality Improvement Program database for Black and White patients with a penetrating mechanism of injury. An interpretable AI methodology called optimal classification trees (OCTs) was applied in an 80:20 derivation/validation split to predict discharge disposition (home vs postacute care [PAC]). The interpretable nature of OCTs allowed for examination of the AI logic to identify racial disparities. A prescriptive mixed-integer optimization model using age, injury, and gender data was allowed to "fairness-flip" the recommended discharge destination for a subset of patients while minimizing the ratio of imbalance between Black and White patients. Three OCTs were developed to predict discharge disposition: the first 2 trees used unadjusted data (one without and one with the race variable), and the third tree used fairness-adjusted data. Main Outcomes and Measures: Disparities and the discriminative performance (C statistic) were compared among fairness-adjusted and unadjusted OCTs. Results: A total of 52 468 patients were included; the median (IQR) age was 29 (22-40) years, 46 189 patients (88.0%) were male, 31 470 (60.0%) were Black, and 20 998 (40.0%) were White. A total of 3800 Black patients (12.1%) were discharged to PAC, compared with 4504 White patients (21.5%; P < .001). Examining the AI logic uncovered significant disparities in PAC discharge destination access, with race playing the second most important role. The prescriptive fairness adjustment recommended flipping the discharge destination of 4.5% of the patients, with the performance of the adjusted model increasing from a C statistic of 0.79 to 0.87. After fairness adjustment, disparities disappeared, and a similar percentage of Black and White patients (15.8% vs 15.8%; P = .87) had a recommended discharge to PAC. Conclusions and Relevance: In this study, we developed an accurate, machine learning-based, fairness-adjusted model that can identify barriers to discharge to postacute care. Instead of accidentally encoding bias, interpretable AI methodologies are powerful tools to diagnose and remedy system-related bias in care, such as disparities in access to postinjury rehabilitation care.

Artificial intelligence versus surgeon gestalt in predicting risk of emergency general surgery.

BACKGROUND: Artificial intelligence (AI) risk prediction algorithms such as the smartphone-available Predictive OpTimal Trees in Emergency Surgery Risk (POTTER) for emergency general surgery (EGS) are superior to traditional risk calculators because they account for complex nonlinear interactions between variables, but how they compare to surgeons' gestalt remains unknown. Herein, we sought to: (1) compare POTTER to surgeons' surgical risk estimation and (2) assess how POTTER influences surgeons' risk estimation. STUDY DESIGN: A total of 150 patients who underwent EGS at a large quaternary care center between May 2018 and May 2019 were prospectively followed up for 30-day postoperative outcomes (mortality, septic shock, ventilator dependence, bleeding requiring transfusion, pneumonia), and clinical cases were systematically created representing their initial presentation. POTTER's outcome predictions for each case were also recorded. Thirty acute care surgeons with diverse practice settings and levels of experience were then randomized into two groups: 15 surgeons (SURG) were asked to predict the outcomes without access to POTTER's predictions while the remaining 15 (SURG-POTTER) were asked to predict the same outcomes after interacting with POTTER. Comparing to actual patient outcomes, the area under the curve (AUC) methodology was used to assess the predictive performance of (1) POTTER versus SURG, and (2) SURG versus SURG-POTTER. RESULTS: POTTER outperformed SURG in predicting all outcomes (mortality-AUC: 0.880 vs. 0.841; ventilator dependence-AUC: 0.928 vs. 0.833; bleeding-AUC: 0.832 vs. 0.735; pneumonia-AUC: 0.837 vs. 0.753) except septic shock (AUC: 0.816 vs. 0.820). SURG-POTTER outperformed SURG in predicting mortality (AUC: 0.870 vs. 0.841), bleeding (AUC: 0.811 vs. 0.735), pneumonia (AUC: 0.803 vs. 0.753) but not septic shock (AUC: 0.712 vs. 0.820) or ventilator dependence (AUC: 0.834 vs. 0.833). CONCLUSION: The AI risk calculator POTTER outperformed surgeons' gestalt in predicting the postoperative mortality and outcomes of EGS patients, and when used, improved the individual surgeons' risk prediction. Artificial intelligence algorithms, such as POTTER, could prove useful as a bedside adjunct to surgeons when preoperatively counseling patients. LEVEL OF EVIDENCE: Prognostic and Epidemiological; Level II.

The Big Sibling program: Impact of a medical student-resident mentorship program during the surgery clerkship.

BACKGROUND: We created a Big Sibling mentorship program for medical students and studied the program effects. METHODS: Between July 2019 to December 2020, students completing their surgery clerkship were paired with a Big Sibling surgical research resident. Participation in and perceptions of the program were assessed by survey. RESULTS: 81 medical students and 25 residents participated with a 79% and 95% survey response rate, respectively. The most valuable topics discussed included ward skills, personal development and career advising. Students who interacted >2 times with their Big Sibling were more likely to perceive the operating room as a positive learning environment, view attendings as role models, and receive mentoring and feedback from residents and attendings (p = 0.03, 0.02, 0.01 respectively). 78% of residents thought the program was a positive experience and no residents found it burdensome. CONCLUSION: The Big Siblings program enhances the surgery clerkship learning environment. Students who engaged with their Big Sibling had a more positive view of the clerkship and the mentorship provided by residents and attendings.

Impact of hospital characteristics on best-practice adherence for gallstone pancreatitis: a nationwide analysis.

BACKGROUND: Current guidelines recommend cholecystectomy during the index admission for gallstone pancreatitis, and a growing body of evidence indicates that patients benefit from cholecystectomy within the first 48 h of admission. We examined the impact of hospital characteristics on adherence to these data-driven practices. METHODS: We queried the National Inpatient Sample for patients admitted for gallstone pancreatitis between October 2015 and December 2018. Patients who underwent same-admission cholecystectomy were identified by procedure codes. Cholecystectomies within the first two days were classified as early cholecystectomies. Multivariable logistic regression was used to determine the association between hospital characteristics and adherence to these practices. RESULTS: Of 163,390 admissions for gallstone pancreatitis, only 90,790 (55.6%) underwent cholecystectomy before discharge. Mean time from admission to cholecystectomy was 2.9 days; 27.0% of patients (44,005) underwent early cholecystectomy. Odds of same-admission cholecystectomy were highest in large hospitals (OR 1.21, 95% CI 1.13-1.28), urban teaching centers (OR 1.33, 95% CI 1.21-1.46), and the South (OR 1.70, 95% CI 1.57-1.83). Odds of early cholecystectomy did not vary with hospital size, urban-rural status, or teaching status but were highest in the West (OR 1.98, 95% CI 1.80-2.18). CONCLUSION: Best-practice adherence for cholecystectomy in gallstone pancreatitis remains low despite an abundance of evidence and clinical practice guidelines. Active interventions are needed to improve delivery of surgical care for this patient population. Implementation efforts should focus on small hospitals, rural areas, and health systems in the Northeast region.

Perceptions of Mobile Health Technology in Elective Surgery: A Qualitative Study of North American Surgeons.

OBJECTIVES: To explore the surgeon-perceived added value of mobile health technologies (mHealth), and determine facilitators of and barriers to implementing mHealth. BACKGROUND: Despite the growing popularity of mHealth and evidence of meaningful use of patient-generated health data in surgery, implementation remains limited. METHODS: This was an exploratory qualitative study following the Consolidated Criteria for Reporting Qualitative Research. Purposive sampling was used to identify surgeons across the United States and Canada. The Consolidated Framework for Implementation Research informed development of a semistructured interview guide. Video-based interviews were conducted (September-November 2020) and interview transcripts were thematically analyzed. RESULTS: Thirty surgeons from 8 specialties and 6 North American regions were interviewed. Surgeons identified opportunities to integrate mHealth data pre- operatively (eg, expectation-setting, decision-making) and during recovery (eg, remote monitoring, earlier detection of adverse events) among higher risk patients. Perceived advantages of mHealth data compared with surgical and patient-reported outcomes included easier data collection, higher interpretability and objectivity of mHealth data, and the potential to develop more patientcentered and functional measures of health. Surgeons identified a variety of implementation facilitators and barriers around surgeon- and patient buy-in, integration with electronic medical records, regulatory/reimbursement concerns, and personnel responsible for mHealth data. Surgeons described similar considerations regarding perceptions of mHealth among patients, including the potential to address or worsen existing disparities in surgical care. CONCLUSIONS: These findings have the potential to inform the effective and equitable implementation of mHealth for the purposes of supporting patients and surgical care teams throughout the delivery of surgical care.

Impact of Rater Training on Residents Technical Skill Assessments: A Randomized Trial.

OBJECTIVE: The ACS/APDS Resident Skills Curriculum's Objective Structured Assessment of Technical Skills (OSATS) consists of task-specific checklists and a global rating scale (GRS) completed by raters. Prior work demonstrated a need for rater training. This study evaluates the impact of a rater-training curriculum on scoring discrimination, consistency, and validity for handsewn bowel anastomosis (HBA) and vascular anastomosis (VA). DESIGN/ METHODS: A rater training video model was developed, which included a GRS orientation and anchoring performances representing the range of potential scores. Faculty raters were randomized to rater training or no rater training and were asked to score videos of resident HBA/VA. Consensus scores were assigned to each video using a modified Delphi process (Gold Score). Trained and untrained scores were analyzed for discrimination and score spread and compared to the Gold Score for relative agreement. RESULTS: Eight general and eight vascular surgery faculty were randomized to score 24 HBA/VA videos. Rater training increased rater discrimination and decreased rating scale shrinkage for both VA (mean trained score: 2.83, variance 1.88; mean untrained score: 3.1, variance 1.14, p = 0.007) and HBA (mean trained score: 3.52, variance 1.44; mean untrained score: 3.42, variance 0.96, p = 0.033). On validity analyses, a comparison between each rater group vs Gold Score revealed a moderate training impact for VA, trained κ=0.65 vs untrained κ=0.57 and no impact for HBA, R1 κ = 0.71 vs R2 κ = 0.73. CONCLUSION: A rater-training curriculum improved raters' ability to differentiate performance levels and use a wider range of the scoring scale. However, despite rater training, there was persistent disagreement between faculty GRS scores with no groups reaching the agreement threshold for formative assessment. If technical skill exams are incorporated into high stakes assessments, consensus ratings via a standard setting process are likely a more valid option than individual faculty ratings.

Gaps in Practice Management Skills After Training: A Qualitative Needs Assessment of Early Career Surgeons.

PURPOSE: Shifts in American healthcare delivery mechanisms pose significant hurdles to new physicians. Surgeons are particularly susceptible to these changes, but surgical residency educational efforts primarily focus on technical and clinical training to the exclusion of business and management practices. This study conducted a needs assessment of perceived gaps in practice management skills among early career surgeons to guide future training curricula. METHODS: This study was an exploratory qualitative study following the Consolidated Criteria for Reporting Qualitative Research. Purposive sampling was used to identify early career (<5 years following fellowship completion) surgeons across the United States. A semi-structured interview guide was created from interviews with surgical administrators and physician administrative curricula. Transcripts were de-identified and analyzed using a constructivist grounded theory approach. RESULTS: Ten surgeons from 6 specialties and 6 institutions were interviewed along with 3 surgeon administrators. Three major domains of need were identified: (1) fundamentals of procedural coding, clinical billing, & compliance, (2) finding/building a practice, and (3) navigating organizational challenges. First, surgeons thought trainees would benefit from a better understanding of reimbursement schema and the basics of health policy. They also thought that more exposure to malpractice litigation, especially for handling case review or expert witness requests, would be helpful for discerning how to handle such issues early in their career. In addition, early career surgeons expressed a desire to have dedicated mentorship time, a primer on evaluating job offers with simulated contract negotiation, and guidance regarding administrative roles. Finally, surgeons requested training in change management techniques, care pathway construction, and the basics of staffing decisions. CONCLUSIONS: There are significant practice management gaps in surgical training which may be amenable to targeted educational efforts during a residency or fellowship program. Future research will test the generalizability of these findings as well as build curricula that adequately meet these needs.

POTTER-ICU: An artificial intelligence smartphone-accessible tool to predict the need for intensive care after emergency surgery.

BACKGROUND: Delays in admitting high-risk emergency surgery patients to the intensive care unit result in worse outcomes and increased health care costs. We aimed to use interpretable artificial intelligence technology to create a preoperative predictor for postoperative intensive care unit need in emergency surgery patients. METHODS: A novel, interpretable artificial intelligence technology called optimal classification trees was leveraged in an 80:20 train:test split of adult emergency surgery patients in the 2007-2017 American College of Surgeons National Surgical Quality Improvement Program database. Demographics, comorbidities, and laboratory values were used to develop, train, and then validate optimal classification tree algorithms to predict the need for postoperative intensive care unit admission. The latter was defined as postoperative death or the development of 1 or more postoperative complications warranting critical care (eg, unplanned intubation, ventilator requirement ≥48 hours, cardiac arrest requiring cardiopulmonary resuscitation, and septic shock). An interactive and user-friendly application was created. C statistics were used to measure performance. RESULTS: A total of 464,861 patients were included. The mean age was 55 years, 48% were male, and 11% developed severe postoperative complications warranting critical care. The Predictive OpTimal Trees in Emergency Surgery Risk Intensive Care Unit application was created as the user-friendly interface of the complex optimal classification tree algorithms. The number of questions (ie, tree depths) needed to predict intensive care unit admission ranged from 2 to 11. The Predictive OpTimal Trees in Emergency Surgery Risk Intensive Care Unit application had excellent discrimination for predicting the need for intensive care unit admission (C statistics: 0.89 train, 0.88 test). CONCLUSION: We recommend the Predictive OpTimal Trees in Emergency Surgery Risk Intensive Care Unit application as an accurate, artificial intelligence-based tool for predicting severe complications warranting intensive care unit admission after emergency surgery. The Predictive OpTimal Trees in Emergency Surgery Risk Intensive Care Unit application can prove useful to triage patients to the intensive care unit and to potentially decrease failure to rescue in emergency surgery patients.

Practice patterns after implementation of a selective spinal immobilization protocol in a regional trauma system.

BACKGROUND: Universal spinal immobilization has been the standard of prehospital trauma care since the 1960s. Selective immobilization has been shown to be safe and effective for emergency medical services use, but it is unclear whether such protocols reduce unnecessary and potentially harmful immobilization practices. This study evaluated the impact of a selective spinal immobilization protocol on practice patterns in a regional trauma system. METHODS: All encounters for traumatic injury in the Tidewater Emergency Medical Services region from 2010 to 2016 were extracted from the Virginia Pre-Hospital Information Bridge. An interrupted time series analysis was used to assess practice change after system-wide protocol implementation in 2013. Intravenous access was used as a nonequivalent outcome measure in the absence of an appropriate control group. RESULTS: A total of 63,981 encounters were analyzed. At baseline, 16.7% of patients underwent full immobilization. The preprotocol slope was slightly positive (0.2% per month; 95% confidence interval, 0.1-0.2%). Slope and level changes after protocol implementation did not differ from those observed for intravenous access (-0.4% vs. -0.4% per month [ p = 0.4917] and -1.6% vs. -1.1% [ p = 0.1202], respectively). Cervical spinal immobilization became more common over the postimplementation period (0.1% per month; 95% confidence interval, 0.1-0.1%). Rates of immobilization for isolated penetrating trauma remained unchanged. CONCLUSION: Implementation of a selective spinal immobilization protocol did not reduce prehospital immobilization rates in a regional trauma system. Given the entrenched nature of immobilization practices, more intensive education and training strategies are needed. Efforts should prioritize eliminating immobilization for isolated penetrating trauma given its association with increased mortality. LEVEL OF EVIDENCE: Therapeutic/Care Management; Level IV.

Lower Mortality with Cryoprecipitate During Massive Transfusion in Penetrating but Not Blunt Trauma.

BACKGROUND: Balanced blood product transfusion improves the outcomes of trauma patients with exsanguinating hemorrhage, but it remains unclear whether administering cryoprecipitate improves mortality. We aimed to examine the impact of early cryoprecipitate transfusion on the outcomes of the trauma patients needing massive transfusion (MT). METHODS: All MT patients 18 years or older in the 2017 Trauma Quality Improvement Program (TQIP) were retrospectively reviewed. MT was defined as the transfusion of ≥10 units of blood within 24 hours. Propensity score analysis (PSA) was used to 1:1 match then compare patients who received and those who did not receive cryoprecipitate in the first 4 hours after injury. Outcomes included in-hospital mortality, 1-day mortality, in-hospital complications and transfusion needs at 24 hours. RESULTS: Of 1,004,440 trauma patients, 1,454 MT patients received cryoprecipitate and 2,920 did not. After PSA, 877 patients receiving cryoprecipitate were matched to 877 patients who did not. In-hospital mortality was lower among patients who received cryoprecipitate (49.4% v. 54.9%, P = 0.022), as was 1-day mortality. Sub-analyses showed that mortality was lower with cryoprecipitate in patients with penetrating (37.5% versus. 48%, adjusted P = 0.008), but not blunt trauma (58.5% versus. 59.8%, adjusted P = 1.000). In penetrating trauma, the cryoprecipitate group also had lower 1-day mortality (21.8% versus. 38.6%, P <0.001) and a higher rate of hemorrhage control surgeries performed within 24 hours (71.4% versus. 63.3%, P = 0.018). CONCLUSIONS: Cryoprecipitate in MT is associated with improved survival in penetrating, but not blunt, trauma. Randomized trials are needed to better define the role of cryoprecipitate in MT.

Challenges of virtual interviewing for surgical fellowships: a qualitative analysis of applicant experiences.

BACKGROUND: The COVID-19 pandemic forced surgical fellowship programs to transition from in-person to remote applicant interviews; the virtual interviewing format presented new and unique challenges. We sought to understand applicants' perceived challenges to virtual interviewing for a surgical fellowship program. METHOD: A grounded theory-based qualitative study was performed utilizing semi-structured interviews with fellowship applicants from the 2020 fellowship match. All Fellowship Council-registered applicants were eligible. We purposefully sampled participants to balance across gender, specialty-choice, and academic versus community-program affiliation. Interviews were inductively analyzed by two researchers for prominent themes. RESULTS: Fifteen interviews were conducted. Participants were 60% male (n = 9), with 33% (n = 5) from non-academic institutions. They applied for the following fellowships: Advanced Gastrointestinal/Minimal Invasive (55%), Bariatric (30%), Hepatopancreatobiliary (10%) and Surgical Oncology (5%). Four main themes emerged to describe virtual interview process challenges: (1) perceived data deficiency, (2) superficial personal connections, (3) magnification of non-professionalism, and (4) logistical frustrations. Applicants recommend program directors provide more information about the fellowship prior to interview day and offer informal independent interactions with current and previous fellows. CONCLUSIONS: According to fellowship applicants, virtual interviews resulted in a lack of information for rank-list decision making ultimately requiring them to rely on other information avenues to base their decisions. These applicants have offered advice to fellowship program directors and future applicants to better optimize this process.

Passing the Scalpel: Lessons on retirement planning from retired academic surgeons.

BACKGROUND: Almost half of practicing surgeons in the United States are currently older than 55, but guidelines on how to prepare for retirement are limited. We sought to identify possible facilitators for, and obstacles to, surgeons' preparations for retirement. METHODS: A qualitative study was conducted using semi-structured interviews with clinically inactive academic surgeons. Emergent themes were identified via a grounded theory approach. RESULTS: We interviewed 12 surgeons (83% male; median age 75 years). Major barriers to retirement from surgery included uncertainty about when to retire, limited identity outside of surgery, and perception of retirement as strictly individual/private. Facilitators of a successful retirement identified by the participants included early career financial planning, awareness of career trajectory, development of post-surgery goals, and utilization of collective knowledge. CONCLUSION: There are numerous barriers encountered by surgeons seeking to transition from clinical practice to retirement that could be overcome by dedicated departmental and institutional efforts.

Gauging the effects of COVID-related changes to the medical student surgical clerkship experience: a mixed-methods study.

Purpose: This study sought to understand the medical student experience on the restructured surgical clerkship during the COVID-era to provide guidance for future scenarios affecting student participation in clinical activities. Methods: Medical students completing an anonymous 70-question survey at the conclusion of their surgical clerkship from June 2019 to October 2020 were divided into 2 cohorts: students completing their clerkship prior to March 2020 and after June 2020. Quantitative assessment was performed to evaluate the clerkship performance and perceptions. Resulting findings were used to construct an interview guide and conduct semi-structured interviews. Results: Fifty-nine medical students rotated through the surgical clerkship prior to COVID and 23 during the COVID-era. No differences in perception of the surgical clerkship, participation in essential activities, or shelf examination scores were found. Students completing their clerkship during the COVID-era reported a lower perception of interaction and professional relationships with attending and resident surgeons (p = 0.03). Qualitatively, students completing their clerkship during the COVID-era struggled to balance clinical experiences with personal wellness and noted that building relationships with faculty was substantially more difficult. Conclusions: There does not appear to be a difference in the level of participation in essential clerkship activities nor a diminished perception of learning between students completing their surgical clerkship before or during the pandemic. However, there does appear to be a difference in the relationships formed between students and attending surgeons. Altered didactic structures and apprenticeship-type rotations may help mitigate such effects. Supplementary Information: The online version contains supplementary material available at 10.1007/s44186-022-00015-2.

Expected Versus Experienced Health-Related Quality of Life Among Patients Recovering From Cancer Surgery: A Prospective Cohort Study.

Patient expectations of the impact of surgery on postoperative health-related quality of life (HRQL) may reflect the effectiveness of patient-provider communication. We sought to compare expected versus experienced HRQL among patients undergoing cancer surgery. METHODS: Adults undergoing cancer surgery were eligible for inclusion (2017-2019). Preoperatively, patients completed a smartphone-based survey assessing expectations for HRQL 1 week and 1, 3, and 6 months postoperatively based on the 8 short-form 36 (SF36) domains (physical functioning, physical role limitations, pain, general health, vitality, social functioning, emotional role limitations, and mental health). Experienced HRQL was then assessed through smartphone-based SF36 surveys 1, 3, and 6 months postoperatively. Correlations between 1- and 6-month trends in expected versus experienced HRQL were determined. RESULTS: Among 101 consenting patients, 74 completed preoperative expectations and SF36 surveys (73%). The mean age was 54 years (SD 14), 49 (66%) were female, and the most common operations were for breast (34%) and abdominal (31%) tumors. Patients expected HRQL to worsen 1 week after surgery and improve toward minimal disability over 6 months. There was poor correlation (≤±0.4) between 1- and 6-month trends in expected versus experienced HRQL in all SF36 domains except for moderate correlation in physical functioning (0.50, 95% confidence interval [0.22-0.78], P < 0.001) and physical role limitations (0.41, 95% confidence interval [0.05-0.77], P = 0.024). Patients expected better HRQL than they experienced. CONCLUSIONS: Preoperative expectations of postoperative HRQL correlated poorly with lived experiences except in physical health domains. Surgeons should evaluate factors which inform expectations around physical and psychosocial health and use these data to enhance shared decision-making.

Redeployment of Health Care Workers in the COVID-19 Pandemic: A Qualitative Study of Health System Leaders' Strategies.

OBJECTIVES: This study aimed to determine the strategies used and critical considerations among an international sample of hospital leaders when mobilizing human resources in response to the clinical demands associated with the COVID-19 pandemic surge. METHODS: This was a cross-sectional, qualitative research study designed to investigate strategies used by health system leaders from around the world when mobilizing human resources in response to the global COVD-19 pandemic. Prospective interviewees were identified through nonprobability and purposive sampling methods from May to July 2020. The primary outcomes were the critical considerations, as perceived by health system leaders, when redeploying health care workers during the COVID-19 pandemic determined through thematic analysis of transcribed notes. Redeployment was defined as reassigning personnel to a different location or retraining personnel for a different task. RESULTS: Nine hospital leaders from 9 hospitals in 8 health systems located in 5 countries (United States, United Kingdom, New Zealand, Singapore, and South Korea) were interviewed. Six hospitals in 5 health systems experienced a surge of critically ill patients with COVID-19, and the remaining 3 hospitals anticipated, but did not experience, a similar surge. Seven of 8 hospitals redeployed their health care workforce, and 1 had a redeployment plan in place but did not need to use it. Thematic analysis of the interview notes identified 3 themes representing effective practices and lessons learned when preparing and executing workforce redeployment: process, leadership, and communication. Critical considerations within each theme were identified. Because of the various expertise of redeployed personnel, retraining had to be customized and a decentralized flexible strategy was implemented. There were 3 concerns regarding redeployed personnel. These included the fear of becoming infected, the concern over their skills and patient safety, and concerns regarding professional loss (such as loss of education opportunities in their chosen profession). Transparency via multiple different types of communications is important to prevent the development of doubt and rumors. CONCLUSIONS: Redeployment strategies should critically consider the process of redeploying and supporting the health care workforce, decentralized leadership that encourages and supports local implementation of system-wide plans, and communication that is transparent, regular, consistent, and informed by data.