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1.
J Surg Res ; 259: 465-472, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33616077

RESUMO

BACKGROUND: Within the operating rooms (ORs), distractions occur on a regular basis, which affect the surgical workflow and results in the interruption of urgent tasks. This study aimed to observe the occurrence of intraoperative distractions in Tunisian ORs and evaluate associations among distractions, teamwork, workload, and stress. METHODS: This observational cross-sectional study was conducted in four different ORs (orthopedic, urology, emergency, and digestive surgery) of Sahloul University Hospital for a period of 3 mo in 2018. Distractions and teamwork were recorded and rated in real time during the intraoperative phase of each case using validated observation sheets. Besides, at the end of each operation, stress and workload of team members were measured. RESULTS: Altogether, 50 cases were observed and 160 participants were included. Distractions happened in 100% of the included operations. Overall, we recorded 933 distractions that occurred once every 3 min, with a mean frequency of M = 18.66 (standard deviation [SD] = 8.24) per case. It is particularly noticeable that procedural distractions occurred significantly higher during teaching cases compared with nonteaching cases (M = 3.85, M = 0.60, respectively, P < 0.001). The mean global teamwork score was M = 3.85 (SD = 0.67), the mean workload score was M = 58.60 (SD = 24.27), and the mean stress score was M = 15.29 (SD = 4.00). Furthermore, a higher stress level among surgeons was associated with distractions related to equipment failures and people entering or exiting the OR (r = 0.206, P < 0.01 and r = 0.137, P < 0.01, respectively). Similarly, nurses reported a higher workload in the presence of distractions related to the work environment in the OR (r = 0.313, P < 0.05). CONCLUSIONS: This study highlighted a serious problem, which often team members seem to ignore or underestimate. Taking our findings into consideration, we recommend the implementation of the Surgical Checklist and preoperative briefings to reduce the number of surgical distractions. Also, a continuous teamwork training should be adopted to ensure that OR staff can avoid or handle distractions when they happen.


Assuntos
Estresse Ocupacional/epidemiologia , Salas Cirúrgicas/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Cirurgiões/organização & administração , Análise e Desempenho de Tarefas , Comunicação , Estudos Transversais , Feminino , Humanos , Masculino , Estresse Ocupacional/etiologia , Estresse Ocupacional/prevenção & controle , Estresse Ocupacional/psicologia , Salas Cirúrgicas/estatística & dados numéricos , Duração da Cirurgia , Equipe de Assistência ao Paciente/estatística & dados numéricos , Cirurgiões/psicologia , Cirurgiões/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios/educação , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Fluxo de Trabalho , Carga de Trabalho/psicologia , Carga de Trabalho/estatística & dados numéricos
2.
J Surg Res ; 261: 39-42, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33412507

RESUMO

The Center for Basic and Translational Science was formed to address the unique challenges faced by surgeon-scientists. Shortly after its inception, COVID-19 upended research workflows at our institution. We discuss how the collaborative Center for Basic and Translational Science framework was adapted to support laboratories during the pandemic by assisting with ramp-down, promoting mentorship and community building, and maintaining research productivity.


Assuntos
/prevenção & controle , Colaboração Intersetorial , Pesquisadores/organização & administração , Cirurgiões/organização & administração , Pesquisa Médica Translacional/organização & administração , /epidemiologia , Eficiência , Humanos , Mentores , Michigan/epidemiologia , Pandemias
4.
Eur J Vasc Endovasc Surg ; 60(5): 764-771, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33039296

RESUMO

OBJECTIVE: Vascular surgeons can be useful in non-vascular surgery cases, especially in oncology where complete resection is important. Such activity has been quantified at least locally, but maybe not adequately reported in a systematic manner, or studied prospectively. This study aimed to describe the roles of vascular surgeons in oncovascular surgery (OVS) and non-vascular surgery (NVS), and to analyse the yearly trends of consult surgery, early mortality and morbidity and risk factors for poor outcomes. METHODS: This study was a five year retrospective review of the role of vascular surgeons in various settings at a tertiary hospital. Electronic medical records and images were reviewed retrospectively. Between January 2014 and December 2018, the vascular surgery registry data of Seoul National University Hospital were reviewed for OVS or NVS assisted by vascular surgeons and operations primarily done by vascular surgeons. Demographic data, clinical characteristics, operative data, vascular related data and operative outcomes were collected. The operations were classified into primary surgery or consult surgery. Consult procedures were divided into planned or unplanned surgery. RESULTS: Of 564 cases, vascular surgeons performed 74 OVS as primary surgery, and retroperitoneal tumour was the most frequent diagnosis (n = 34). There were 490 intra-operative requests for a vascular surgeon's assistance, of which 109 were emergency calls. Total intra-operative consultations increased by 115.9% over five years, and the proportion of unplanned operations also increased. Unplanned assistance was most commonly requested for bleeding, whereas node dissection was the most common reason for planned surgery. The mortality rate was not different between the planned and unplanned surgery groups, but the latter showed worse outcomes in total operating time, length of hospital stay, post-operative consultations, and post-operative vascular related complications. CONCLUSION: Vascular surgeons have an essential role to play in the modern practice of cancer surgery. Oncovascular surgery enables gross resection of a tumour even in the presence of major vessel invasion. Emergency unplanned surgery had worse outcomes; therefore, pre-operative vascular consultation and multidisciplinary management are highly recommended for better patient outcomes.


Assuntos
Comunicação Interdisciplinar , Neoplasias/cirurgia , Papel Profissional , Encaminhamento e Consulta/organização & administração , Cirurgiões/organização & administração , Adulto , Idoso , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Neoplasias/irrigação sanguínea , Duração da Cirurgia , Equipe de Assistência ao Paciente/organização & administração , Estudos Retrospectivos , Fatores de Risco , Seul , Centros de Atenção Terciária , Fatores de Tempo , Resultado do Tratamento
6.
Am Surg ; 86(7): 762-765, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32916069

RESUMO

The response of the American College of Surgeons (ACS) to the COVID-19 pandemic was vigorous and effective because it had mature programs in surgical quality and health policy and advocacy, the legacy of decades of work by its officers and leaders and its current executive director, David Hoyt. Hoyt had the foresight to institute a digital communications platform upon which the College collected data for its clinical programs and conducted many of its meetings. Through internet portals, online communities, and social media it broadcasted news and information to the membership. When the global COVID-19 pandemic struck, the College was able to quickly mobilize its leaders and scientific experts to disseminate credible information, recommend protocols to maintain patient and provider safety in operating room environments, provide a rational scheme of prioritization of urgent surgical operations, and a sensible means of resumption of normal surgical practice. As the financial impact of the outbreak on surgical practice became apparent, the ACS represented the interests of surgeons in the White House, Capitol, federal agencies, and governors' mansions and statehouses. In an interview by Steven Wexner, a member of the ACS Board of Regents, Hoyt described the response of the ACS to an unprecedented threat to the surgical care of patients in the country and the world. His story demonstrates the legacy of credibility and professionalism built by decades of principled leadership of generations of officers and Regents of the College, and his own example of effective leadership in crisis.


Assuntos
Infecções por Coronavirus/prevenção & controle , Liderança , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Sociedades Médicas/organização & administração , Cirurgiões/organização & administração , Gestão da Qualidade Total , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Humanos , Controle de Infecções/organização & administração , Disseminação de Informação , Masculino , Inovação Organizacional , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Profissionalismo , Estados Unidos
7.
Am Surg ; 86(7): 757-761, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32916074

RESUMO

From the onset of the COVID-19 global pandemic of 2020, the American College of Surgeons (ACS) has been a leader in disseminating credible information on the clinical and scientific aspects of the disease. As governmental regulations enforced the closure of hospitals and operating rooms to elective surgical cases as part of its "shelter-in-place" public lockdown policies, the ACS brought specialty societies together to create guidelines to protect patients and preserve surgical quality. Federal agencies made available financial aid programs to mitigate the economic impact of the outbreak. The division of advocacy and health policy of the ACS made certain that the interests of surgeons and their patients were served. Steven Wexner, member of the Board of Regents of the ACS interviewed the medical directors of the division, Frank Opelka in quality and health policy, and Patrick Bailey in advocacy, for their stories of how the College responded to the many health and public policy issues that came before Congress and governmental agencies during the pandemic.


Assuntos
Infecções por Coronavirus/prevenção & controle , Controle de Infecções/organização & administração , Pandemias/prevenção & controle , Defesa do Paciente , Pneumonia Viral/prevenção & controle , Política Pública , Cirurgiões/organização & administração , Comitês Consultivos , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Masculino , Inovação Organizacional , Avaliação de Resultados em Cuidados de Saúde , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Sociedades Médicas/organização & administração , Estados Unidos
8.
Eur J Cardiothorac Surg ; 58(5): 875-880, 2020 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-32964930

RESUMO

OBJECTIVES: Coronavirus disease 2019 is a new contagious disease that has spread rapidly across the world. It is associated with high mortality in those who develop respiratory complications and require admission to intensive care. Extracorporeal membrane oxygenation (ECMO) is a supportive therapy option for selected severely ill patients who deteriorate despite the best supportive care. During the coronavirus disease 2019 pandemic, extra demand led to staff reorganization; hence, cardiac surgery consultants joined the ECMO retrieval team. This article describes how we increased service provisions to adapt to the changes in activity and staffing. METHODS: The data were collected from 16 March 2020 to 8 May 2020. The patients were referred through a dedicated Web-based referral portal to cope with increasing demand. The retrieval team attended the referring hospital, reviewed the patients and made the final decision to proceed with ECMO. RESULTS: We reported 41 ECMO retrieval runs during this study period. Apart from staffing changes, other retrieval protocols were maintained. The preferred cannulation method for veno-venous ECMO was drainage via the femoral vein and return to the right internal jugular vein. There were no complications reported during cannulation or transport. CONCLUSIONS: Staff reorganization in a crisis is of paramount importance. For those with precise transferrable skills, experience can be gained quickly with appropriate supervision. Therefore, the team members were selected based on skill mix rather than on roles that are more traditional. We have demonstrated that an ECMO retrieval service can be reorganized swiftly and successfully to cope with the sudden increase in demand by spending cardiac surgeons services to supplement the anaesthetic-intensivist roles.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Cuidados Críticos/organização & administração , Oxigenação por Membrana Extracorpórea , Acesso aos Serviços de Saúde/organização & administração , Admissão e Escalonamento de Pessoal/organização & administração , Pneumonia Viral/terapia , Cirurgiões/organização & administração , Adulto , Idoso , Cardiologia/organização & administração , Cuidados Críticos/métodos , Estado Terminal , Oxigenação por Membrana Extracorpórea/métodos , Feminino , Necessidades e Demandas de Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Equipe de Assistência ao Paciente/organização & administração , Reino Unido
10.
Plast Reconstr Surg ; 146(2): 447-454, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740604

RESUMO

Plastic surgeons have the unique perspective of working with all types of patients and care teams from almost all specialties in surgery and medicine, which creates unique challenges in times of distress. As the initial epicenter of coronavirus disease 2019 cases in the United States, the University of Washington program was required to rapidly develop strategies to deal with the escalating crisis. All aspects of the program were affected, including the need to triage the urgency of plastic surgery care, safe staffing of plastic surgery teams, and the role of plastic surgery in the greater hospital community. In addition, as a residency training program, limiting the impact of resident education and maintaining a sense of community and connection among members of the program developed into important considerations. The authors hope that the narrative of their experience will provide insight into the decisions made in the University of Washington health care system but also remind others that they are not alone in dealing with the challenges of this pandemic.


Assuntos
Infecções por Coronavirus/prevenção & controle , Controle de Infecções/normas , Internato e Residência/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Cirurgia Plástica/educação , Universidades/organização & administração , Centros Médicos Acadêmicos/organização & administração , Centros Médicos Acadêmicos/normas , Betacoronavirus/patogenicidade , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Feminino , Humanos , Internato e Residência/normas , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Procedimentos Cirúrgicos Reconstrutivos/educação , Cirurgiões/educação , Cirurgiões/organização & administração , Universidades/normas , Washington , Recursos Humanos/organização & administração , Recursos Humanos/normas
17.
Plast Reconstr Surg ; 146(5): 1197-1206, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32541534

RESUMO

The worldwide outbreak of coronavirus disease 2019 (COVID-19) has forced health care systems across the United States to undertake broad restructuring to address the ongoing crisis. The framework of crisis management can assist plastic surgeons navigate the dynamic environment of the COVID-19 pandemic. This article outlines crisis management tools at a number of different levels, from hospital-wide to plastic surgeon-specific, and it offers a practical discussion of the coronavirus situation as it affects plastic surgeons. Although there are innumerable ways that this virus is currently changing plastic surgeons' practices, it is crucial to remember that these changes are temporary, and they will be best met by being confronted head-on.


Assuntos
Infecções por Coronavirus , Pandemias , Pneumonia Viral , Administração da Prática Médica/organização & administração , Padrões de Prática Médica/organização & administração , Cirurgiões/organização & administração , Cirurgia Plástica/organização & administração , Alocação de Recursos para a Atenção à Saúde/organização & administração , Humanos , Liderança , Estados Unidos
18.
J Surg Res ; 255: 71-76, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32543381

RESUMO

BACKGROUND: Student-run free clinics (SRFCs) provide medical care to uninsured, and surgical issues are often outside the normal scope of care of these clinics. The Shade Tree Clinic (STC) is an SRFC serving 300 patients with complex medical conditions. This study describes the implementation and efficacy of a General Surgery Specialty Clinic in this setting. METHODS: This descriptive study examines the demographics and referral patterns of patients seen in two pilot Specialty Clinics and other patients evaluated for general surgical issues from December 2017 to January 2020. Providers were surveyed regarding their experience in clinic. RESULTS: Twenty patients were evaluated by six general surgeons during 22 separate encounters (n = 20). Nine patients were seen in two pilot Specialty Clinics for biliary colic, hernia, hemorrhoids, anal mass, toenail lesion, surgical weight loss, and venous insufficiency. Referrals from these clinics to affiliated Vanderbilt University Medical Center included six ultrasounds; referrals to vascular surgery and podiatry clinics; and referrals for laparoscopic cholecystectomy and anal mass excision. STC also directly referred eight patients for colonoscopies and five patients for major operations through primary care clinic. Hundred percent of care was cost-free to patients. Providers reported a median satisfaction score of five with the Specialty Clinics (Very Satisfied; [4, 5]). Hundred percent of providers felt that the concerns of patients were addressed. CONCLUSIONS: A surgery specialty clinic in the setting of an SRFC is an effective way to provide surgical care to underserved populations with the potential to reduce unplanned hospital utilization.


Assuntos
Cirurgia Geral/educação , Centros de Cuidados de Saúde Secundários/estatística & dados numéricos , Clínica Dirigida por Estudantes/organização & administração , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Feminino , Implementação de Plano de Saúde , Humanos , Masculino , Área Carente de Assistência Médica , Pessoas sem Cobertura de Seguro de Saúde , Pessoa de Meia-Idade , Avaliação de Programas e Projetos de Saúde , Encaminhamento e Consulta/economia , Encaminhamento e Consulta/organização & administração , Encaminhamento e Consulta/estatística & dados numéricos , Clínica Dirigida por Estudantes/economia , Clínica Dirigida por Estudantes/estatística & dados numéricos , Cirurgiões/educação , Cirurgiões/organização & administração , Procedimentos Cirúrgicos Operatórios/economia , Procedimentos Cirúrgicos Operatórios/educação
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