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1.
BMJ Open ; 10(10): e042392, 2020 10 31.
Artigo em Inglês | MEDLINE | ID: mdl-33130573

RESUMO

OBJECTIVES: The suspension of elective surgery during the COVID-19 pandemic is unprecedented and has resulted in record volumes of patients waiting for operations. Novel approaches that maximise capacity and efficiency of surgical care are urgently required. This study applies Markov multiscale community detection (MMCD), an unsupervised graph-based clustering framework, to identify new surgical care models based on pooled waiting-lists delivered across an expanded network of surgical providers. DESIGN: Retrospective observational study using Hospital Episode Statistics. SETTING: Public and private hospitals providing surgical care to National Health Service (NHS) patients in England. PARTICIPANTS: All adult patients resident in England undergoing NHS-funded planned surgical procedures between 1 April 2017 and 31 March 2018. MAIN OUTCOME MEASURES: The identification of the most common planned surgical procedures in England (high-volume procedures (HVP)) and proportion of low, medium and high-risk patients undergoing each HVP. The mapping of hospitals providing surgical care onto optimised groupings based on patient usage data. RESULTS: A total of 7 811 891 planned operations were identified in 4 284 925 adults during the 1-year period of our study. The 28 most common surgical procedures accounted for a combined 3 907 474 operations (50.0% of the total). 2 412 613 (61.7%) of these most common procedures involved 'low risk' patients. Patients travelled an average of 11.3 km for these procedures. Based on the data, MMCD partitioned England into 45, 16 and 7 mutually exclusive and collectively exhaustive natural surgical communities of increasing coarseness. The coarser partitions into 16 and seven surgical communities were shown to be associated with balanced supply and demand for surgical care within communities. CONCLUSIONS: Pooled waiting-lists for low-risk elective procedures and patients across integrated, expanded natural surgical community networks have the potential to increase efficiency by innovatively flexing existing supply to better match demand.


Assuntos
Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Cadeias de Markov , Modelos Organizacionais , Pandemias , Medicina Estatal/organização & administração , Listas de Espera , Adulto , Betacoronavirus , Redes Comunitárias/organização & administração , Infecções por Coronavirus/epidemiologia , Eficiência Organizacional , Procedimentos Cirúrgicos Eletivos/classificação , Inglaterra/epidemiologia , Acesso aos Serviços de Saúde , Humanos , Colaboração Intersetorial , Pneumonia Viral/epidemiologia , Estudos Retrospectivos , Medição de Risco , Medicina Estatal/estatística & dados numéricos
2.
Pain Physician ; 23(4S): S183-204, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32942785

RESUMO

BACKGROUND: The COVID-19 pandemic has worsened the pain and suffering of chronic pain patients due to stoppage of "elective" interventional pain management and office visits across the United States. The reopening of America and restarting of interventional techniques and elective surgical procedures has started. Unfortunately, with resurgence in some states, restrictions are once again being imposed. In addition, even during the Phase II and III of reopening, chronic pain patients and interventional pain physicians have faced difficulties because of the priority selection of elective surgical procedures.Chronic pain patients require high intensity care, specifically during a pandemic such as COVID-19. Consequently, it has become necessary to provide guidance for triaging interventional pain procedures, or related elective surgery restrictions during a pandemic. OBJECTIVES: The aim of these guidelines is to provide education and guidance for physicians, healthcare administrators, the public and patients during the COVID-19 pandemic. Our goal is to restore the opportunity to receive appropriate care for our patients who may benefit from interventional techniques. METHODS: The American Society of Interventional Pain Physicians (ASIPP) has created the COVID-19 Task Force in order to provide guidance for triaging interventional pain procedures or related elective surgery restrictions to provide appropriate access to interventional pain management (IPM) procedures in par with other elective surgical procedures. In developing the guidance, trustworthy standards and appropriate disclosures of conflicts of interest were applied with a section of a panel of experts from various regions, specialties, types of practices (private practice, community hospital and academic institutes) and groups. The literature pertaining to all aspects of COVID-19, specifically related to epidemiology, risk factors, complications, morbidity and mortality, and literature related to risk mitigation and stratification was reviewed. The evidence -- informed with the incorporation of the best available research and practice knowledge was utilized, instead of a simplified evidence-based approach. Consequently, these guidelines are considered evidence-informed with the incorporation of the best available research and practice knowledge. RESULTS: The Task Force defined the medical urgency of a case and developed an IPM acuity scale for elective IPM procedures with 3 tiers. These included urgent, emergency, and elective procedures. Examples of urgent and emergency procedures included new onset or exacerbation of complex regional pain syndrome (CRPS), acute trauma or acute exacerbation of degenerative or neurological disease resulting in impaired mobility and inability to perform activities of daily living. Examples include painful rib fractures affecting oxygenation and post-dural puncture headaches limiting the ability to sit upright, stand and walk. In addition, emergency procedures include procedures to treat any severe or debilitating disease that prevents the patient from carrying out activities of daily living. Elective procedures were considered as any condition that is stable and can be safely managed with alternatives. LIMITATIONS: COVID-19 continues to be an ongoing pandemic. When these recommendations were developed, different stages of reopening based on geographical regulations were in process. The pandemic continues to be dynamic creating every changing evidence-based guidance. Consequently, we provided evidence-informed guidance. CONCLUSION: The COVID-19 pandemic has created unprecedented challenges in IPM creating needless suffering for pain patients. Many IPM procedures cannot be indefinitely postponed without adverse consequences. Chronic pain exacerbations are associated with marked functional declines and risks with alternative treatment modalities. They must be treated with the concern that they deserve. Clinicians must assess patients, local healthcare resources, and weigh the risks and benefits of a procedure against the risks of suffering from disabling pain and exposure to the COVID-19 virus.


Assuntos
Dor Crônica/cirurgia , Infecções por Coronavirus , Manejo da Dor/métodos , Pandemias , Pneumonia Viral , Triagem/métodos , Betacoronavirus , Dor Crônica/classificação , Procedimentos Cirúrgicos Eletivos/classificação , Humanos , Estados Unidos
3.
Anesth Analg ; 131(4): 1249-1259, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32925346

RESUMO

BACKGROUND: Extended-release (ER) opioids are indicated for the management of persistent moderate to severe pain in patients requiring around-the-clock opioid analgesics for an extended period of time. Concerns have been raised regarding safety of ER opioids due to its potential for abuse and dependence. However, little is known about perioperative prescribing practices of ER opioids. This study assessed perioperative prescribing practices of ER opioids in noncancer surgical patients stratified by type of opioid exposure prior to admission and examined predictors of postoperative opioid administration in oral morphine equivalents (OME). METHODS: This was a retrospective cohort study using the University of California San Francisco Medical Center electronic health record data. This study included 25,396 adult noncancer patients undergoing elective surgery under general anesthesia in the period 2015-2018. The primary study outcome was predictors of postoperative administration of opioids in hospitalized surgical patients. Secondary outcomes included patients discontinued and initiated on ER opioids during their hospital stay. RESULTS: substance use disorder diagnosis and use of opioids, surgery type, and postoperative administration of nonopioid analgesics were associated with postoperative administration of opioids (P < .0001). The estimated adjusted mean (95% confidence interval [CI]) of postoperative administration of OME prior to admission in ER opioid users (170.08 mg; 147.08-196.67) was twice the amount for opioid-naïve patients (81.36 mg; 70.7-93.63; P < .0001). One in 5 prior to admission ER opioid users were weaned off ER opioids while hospitalized without adversely affecting their postoperative pain or hospital length of stay (LOS). Four of 5 patients who used ER opioids prior to admission also received ER opioids after surgery, whereas, 1 in 100 opioid-naïve patients received ER opioids during their hospital stay. CONCLUSIONS: We found significant variability in the perioperative prescribing practices of ER opioids in hospitalized noncancer surgical patients by use of opioids prior to admission and surgery type. Pain medicine practitioners and surgeons may play a significant role tackling the surgery-related risk of exposure to ER opioids and decreasing opioid-related complications.


Assuntos
Analgésicos Opioides , Prescrições de Medicamentos/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Período Perioperatório/estatística & dados numéricos , Padrões de Prática Médica , Adulto , Idoso , Analgésicos não Entorpecentes/uso terapêutico , Anestesia Geral , Estudos de Coortes , Preparações de Ação Retardada , Procedimentos Cirúrgicos Eletivos/classificação , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados com Narcóticos/epidemiologia , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/epidemiologia , Período Pós-Operatório , Fatores de Risco , Resultado do Tratamento
4.
Health Care Manag Sci ; 22(1): 85-105, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29177993

RESUMO

Rising admissions from emergency departments (EDs) to hospitals are a primary concern for many healthcare systems. The issue of how to differentiate urgent admissions from non-urgent or even elective admissions is crucial. We aim to develop a model for classifying inpatient admissions based on a patient's primary diagnosis as either emergency care or elective care and predicting urgency as a numerical value. We use supervised machine learning techniques and train the model with physician-expert judgments. Our model is accurate (96%) and has a high area under the ROC curve (>.99). We provide the first comprehensive classification and urgency categorization for inpatient emergency and elective care. This model assigns urgency values to every relevant diagnosis in the ICD catalog, and these values are easily applicable to existing hospital data. Our findings may provide a basis for policy makers to create incentives for hospitals to reduce the number of inappropriate ED admissions.


Assuntos
Procedimentos Cirúrgicos Eletivos/classificação , Serviços Médicos de Emergência/classificação , Aprendizado de Máquina , Admissão do Paciente/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Criança , Pré-Escolar , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Serviços Médicos de Emergência/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Pessoa de Meia-Idade , Adulto Jovem
5.
ANZ J Surg ; 88(6): 621-625, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28643856

RESUMO

BACKGROUND: Coding inaccuracies in surgery misrepresent the productivity of hospitals and outcome data of surgeons. The aim of this study was to audit the extent of coding inaccuracies in hepato-pancreato-biliary (HPB) surgery and assess the financial impact of introducing a coding proforma. METHODS: Coding of patients who underwent elective HPB surgery over a 3-month period was audited. Codes were based on International Classification of Diseases 10 and Office of Population and Census Surveys-4 codes. A coding proforma was introduced and assessed. New human resource group codes were re-assigned and new tariffs calculated. A cost analysis was also performed. RESULTS: Prior to the introduction of the coding proforma, 42.0% of patients had the incorrect diagnosis and 48.5% had missing co-morbidities. In addition, 14.5% of primary procedures were incorrect and 37.6% had additional procedures that were not coded for at all. Following the introduction of the coding proforma, there was a 27.5% improvement in the accuracy of primary diagnosis (P < 0.001) and 21% improvement in co-morbidities (P = 0.002). There was a 7.2% improvement in the accuracy of coding primary procedures (P = not significant) and a 21% improvement in the accuracy of coding of additional procedures (P < 0.001). Financial loss as a result of coding inaccuracy over our 3-month study period was £56 073 with an estimated annual loss of £228 292. CONCLUSION: Coding in HPB surgery is prone to coding inaccuracies due to the complex nature of HPB surgery and the patient case-mix. A specialized coding proforma completed 'in theatre' significantly improves the accuracy of coding and prevents loss of income.


Assuntos
Procedimentos Cirúrgicos do Sistema Biliar/normas , Codificação Clínica/normas , Procedimentos Cirúrgicos Eletivos/classificação , Custos Hospitalares , Pancreatectomia/normas , Procedimentos Cirúrgicos do Sistema Biliar/economia , Codificação Clínica/economia , Estudos de Coortes , Redução de Custos , Procedimentos Cirúrgicos Eletivos/economia , Feminino , Humanos , Masculino , Pancreatectomia/economia , Medição de Risco , Reino Unido
6.
Ir J Med Sci ; 187(3): 747-754, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29234971

RESUMO

BACKGROUND: In the year to July 2017, surgical disciplines accounted for 73% of the total national inpatient and day case waiting list and, of these, day cases accounted for 72%. Their proper classification is therefore important so that patients can be managed and treated in the most suitable and efficient setting. AIMS: We set out to sub-classify the different elective surgical day cases treated in Irish public hospitals in order to assess their need to be managed as day cases and the consistency of practice between hospitals. METHODS: We analysed all elective day cases that came under the care of surgeons between January 2014 and December 2016 and sub-classified them into those that were (A) true day case surgical procedures; (B) minor surgery or outpatient procedures; (C) gastrointestinal endoscopies; (D) day case, non-surgical interventions and (E) unclassified or having no primary procedure identified. RESULTS: Of 813,236 day case surgical interventions performed over 3 years, 26% were adjudged to accord with group A, 41% with B, 23% with C, 5% with D and 5% with E. The ratio of A to B procedures did not vary significantly across the range of hospital types. However, there were some notable variations in coding and practices between hospitals. CONCLUSION: Our findings show that many day cases should have been performed as outpatient procedures and that there were variations in coding and practices between hospitals that could not be easily explained. Outpatient procedure coding and a better, more consistent, classification of day cases are both required to better manage this group of patients.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/classificação , Codificação Clínica/classificação , Procedimentos Cirúrgicos Eletivos/classificação , Procedimentos Cirúrgicos Ambulatórios/métodos , Codificação Clínica/métodos , Procedimentos Cirúrgicos Eletivos/métodos , Feminino , Humanos , Irlanda , Masculino
7.
BMJ Open ; 6(12): e012210, 2016 12 13.
Artigo em Inglês | MEDLINE | ID: mdl-27965248

RESUMO

OBJECTIVES: A post hoc gender comparison of transfusion-related modifiable risk factors among patients undergoing elective surgery. SETTINGS: 23 Austrian centres randomly selected and stratified by region and level of care. PARTICIPANTS: We consecutively enrolled in total 6530 patients (3465 women and 3065 men); 1491 underwent coronary artery bypass graft (CABG) surgery, 2570 primary unilateral total hip replacement (THR) and 2469 primary unilateral total knee replacement (TKR). MAIN OUTCOME MEASURES: Primary outcome measures were the number of allogeneic and autologous red blood cell (RBC) units transfused (postoperative day 5 included) and differences in intraoperative and postoperative transfusion rate between men and women. Secondary outcomes included perioperative blood loss in transfused and non-transfused patients, volume of RBCs transfused, perioperative haemoglobin values and circulating red blood volume on postoperative day 5. RESULTS: In all surgical groups, the transfusion rate was significantly higher in women than in men (CABG 81 vs 49%, THR 46 vs 24% and TKR 37 vs 23%). In transfused patients, the absolute blood loss was higher among men in all surgical categories while the relative blood loss was higher among women in the CABG group (52.8 vs 47.8%) but comparable in orthopaedic surgery. The relative RBC volume transfused was significantly higher among women in all categories (CABG 40.0 vs 22.3; TKR 25.2 vs 20.2; THR 26.4 vs 20.8%). On postoperative day 5, the relative haemoglobin values and the relative circulating RBC volume were higher in women in all surgical categories. CONCLUSIONS: The higher transfusion rate and volume in women when compared with men in elective surgery can be explained by clinicians applying the same absolute transfusion thresholds irrespective of a patient's gender. This, together with the common use of a liberal transfusion strategy, leads to further overtransfusion in women.


Assuntos
Procedimentos Cirúrgicos Eletivos/classificação , Transfusão de Eritrócitos/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Fatores Sexuais , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril , Artroplastia do Joelho , Áustria , Perda Sanguínea Cirúrgica , Estudos de Coortes , Ponte de Artéria Coronária , Feminino , Hemoglobinas/análise , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Período Pós-Operatório , Fatores de Risco , Saúde da Mulher
10.
N Z Med J ; 121(1275): 57-64, 2008 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-18551154

RESUMO

AIM: To describe the clinical and demographic characteristics of patients referred by general practitioners (GPs) to both public and private sectors for non-urgent surgical assessment. METHOD: During 2004, a cohort of 1420 adult patients with the potential to benefit from elective surgery was recruited into the study by their GPs. GPs recorded patient demographics and reasons for referral. RESULTS: 345 out of 828 eligible GPs (42%) agreed to participate in the study and submitted data on 1603 referrals, 2.4 referrals per reporting week. After excluding ACC cases, data on 1420 referrals were analysed. Forty-two percent of those referred were male and 69% were European New Zealanders. The mean age was 55 years. The largest number of referrals were made to general surgery (37%), followed by orthopaedics (19%), gynaecology (12%), and plastic surgery (10%). The modal level of urgency was "routine" and in 24% of cases cancer was a possibility. The GP felt surgery was needed in 47% of cases, while in 73%, assistance with diagnosis and management was sought. In only 3% of eligible cases was no referral made. CONCLUSION: Elective surgical referral makes up a significant proportion of GP workload. In more than half of cases advice on diagnosis or management, rather than surgery, was sought, and in nearly two-thirds the patient was aged less than 65 years. Cancer control was a relatively frequent goal of referral. The very small number of cases where a desired referral was not made suggests that GP and patient expectations are adjusted to service capacity.


Assuntos
Procedimentos Cirúrgicos Eletivos/classificação , Medicina de Família e Comunidade/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Adulto , Idoso , Feminino , Prioridades em Saúde , Humanos , Masculino , Medicina , Pessoa de Meia-Idade , Nova Zelândia , Especialização , Listas de Espera
12.
Acta pediatr. esp ; 65(5): 210-213, mayo 2007. tab
Artigo em Espanhol | IBECS | ID: ibc-055211

RESUMO

El calendario quirúrgico es una guía que intenta dar a conocer el momento más oportuno para la realización de la mayoría de las intervenciones quirúrgicas en el niño. Este calendario se modifica por el desarrollo de nuevas técnicas quirúrgicas. La elaboración de un calendario quirúrgico es beneficioso para obtener mejores resultados y ayuda al pediatra en la toma de decisiones


The surgical timetable is a practical guide that attempts to indicate the best moment for carrying out most of the surgical procedures to be performed in children. This timetable is modified depending on the introduction of new surgical techniques. The development of a surgical timetable improves results and helps the pediatrician in the decisionmaking process


Assuntos
Masculino , Feminino , Criança , Humanos , Agendamento de Consultas , Procedimentos Cirúrgicos Eletivos/classificação , Fatores Etários , Remissão Espontânea , Atenção Primária à Saúde/organização & administração
13.
BMC Health Serv Res ; 6: 78, 2006 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-16784523

RESUMO

BACKGROUND: The proportion of surgery performed as a day case varies greatly between countries. Low rates suggest a large growth potential in many countries. Measuring the potential development of one day surgery should be grounded on a comprehensive list of eligible procedures, based on a priori criteria, independent of local practices. We propose an algorithmic method, using only routinely available hospital data to identify surgical hospitalizations that could have been performed as one day treatment. METHODS: Moving inpatient surgery to one day surgery was considered feasible if at least one surgical intervention was eligible for one day surgery and if none of the following criteria were present: intervention or affection requiring an inpatient stay, patient transferred or died, and length of stay greater than four days. The eligibility of a procedure to be treated as a day case was mainly established on three a priori criteria: surgical access (endoscopic or not), the invasiveness of the procedure and the size of the operated organ. Few overrides of these criteria occurred when procedures were associated with risk of immediate complications, slow physiological recovery or pain treatment requiring hospital infrastructure. The algorithm was applied to a random sample of one million inpatient US stays and more than 600 thousand Swiss inpatient stays, in the year 2002. RESULTS: The validity of our method was demonstrated by the few discrepancies between the a priori criteria based list of eligible procedures, and a state list used for reimbursement purposes, the low proportion of hospitalizations eligible for one day care found in the US sample (4.9 versus 19.4% in the Swiss sample), and the distribution of the elective procedures found eligible in Swiss hospitals, well supported by the literature. There were large variations of the proportion of candidates for one day surgery among elective surgical hospitalizations between Swiss hospitals (3 to 45.3%). CONCLUSION: The proposed approach allows the monitoring of the proportion of inpatient stay candidates for one day surgery. It could be used for infrastructure planning, resources negotiation and the surveillance of appropriate resource utilization.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos/classificação , Definição da Elegibilidade/métodos , Pacientes Internados/classificação , Admissão do Paciente/estatística & dados numéricos , Seleção de Pacientes , Medição de Risco/métodos , Algoritmos , Procedimentos Cirúrgicos Ambulatórios/classificação , Procedimentos Cirúrgicos Ambulatórios/economia , Current Procedural Terminology , Procedimentos Cirúrgicos Eletivos/economia , Emergências , Endoscopia , Estudos de Viabilidade , Humanos , Tempo de Internação/estatística & dados numéricos , Procedimentos Cirúrgicos Minimamente Invasivos , Tamanho do Órgão , Transferência de Pacientes , Reembolso de Incentivo , Suíça , Resultado do Tratamento , Estados Unidos
14.
Health Serv Manage Res ; 17(3): 200-8, 2004 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-15285828

RESUMO

OBJECTIVE: To assess whether patients from non-white ethnic groups wait longer than white patients for elective in-patient admissions at St Mary's Hospital in London. METHODS: Patients who came off the waiting list for an elective inpatient admission between 1 April 2000 and 31 March 2001 were selected. A multivariable log linear model was developed to assess geometric mean waiting times for Black, Asian, Other and Missing ethnic groups compared to the White group, adjusted for age, sex, urgency and distance. RESULTS: Caution is needed in interpreting results, as a large number of patients had no usable ethnic code. There was no strong evidence that waiting times for ethnic groups were systematically different than for the White group. However, there was some evidence that white patients waited longer for a coronary arteriography than patients in other ethnic groups. This was partially explained by age, sex, clinical urgency and residential distance from St Mary's. CONCLUSIONS: The large proportion of patients with no usable ethnic code, lack of robust methods for case-mix adjustment and multiple ethnic categories makes analysis methodologically difficult. Regular and informative analysis of ethnic coded data is a necessary step in improving the accuracy and completeness of coding.


Assuntos
Procedimentos Cirúrgicos Eletivos , Grupos Étnicos , Admissão do Paciente/estatística & dados numéricos , Listas de Espera , Procedimentos Cirúrgicos Eletivos/classificação , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Medicina Estatal , Reino Unido
16.
ANZ J Surg ; 73(10): 839-42, 2003 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-14525579

RESUMO

AIM: The aim of the present paper was to assess trends in clinician's utilization of urgency categories for elective surgery. METHODS: The present paper reviews the additions to the Victorian elective surgery waiting list for hip replacement and prostatectomy as recorded by the Elective Surgery Information System database. Review of general trends in utilization over two separate 12 month periods were undertaken. RESULTS: There is inconsistency in categorization of patients referred to the waiting list for hip joint replacement and prostatectomy. An increasing trend to categorize patients as semi-urgent (category 2) in preference to non-urgent (category 3) emerged over this period (category creep). Semi-urgent cases might be competing for access within the category 2 band with less urgent cases. CONCLUSIONS: There seems to be an increasing imbalance between demand for and availability of elective surgery for lower urgency elective surgical procedures. This imbalance, characterized by lengthening waiting times, means that not all patients will receive treatment within the clinically recommended waiting times. The variable approach to categorization of urgency suggests that the process lacks objectivity and consensus. Simple clinical tools to assist prioritization are currently being evaluated in Victoria (Australia) and other countries.


Assuntos
Artroplastia de Quadril , Procedimentos Cirúrgicos Eletivos/classificação , Prostatectomia , Listas de Espera , Humanos , Masculino , Vitória
18.
Transfus Med ; 12(6): 353-6, 2002 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-12473151

RESUMO

There is an increasing emphasis on reducing in-patient hospital stay for elective surgical procedures. As a result, pre-operative stay has shortened, with less time available for performing baseline investigations before surgery, including those required to ensure a supply of safe, compatible blood. We have estimated the frequency of failure to complete 'group and screen' (G&S) testing before surgery where indicated, so that neither group-compatible blood nor crossmatched blood could be provided promptly if an unexpected haemorrhage occurs. Retrospective data were obtained from elective surgical procedures performed over a 3-week period. Of the 309 procedures performed, 21 patients were exposed to the risk of failure to provide appropriately matched blood had an emergency arisen. (In 20, a G&S was required; in one, a crossmatch was required.) Late samples and lack of information on the request form regarding the date and time of surgery were the main causes. Procedures requiring G&S only as opposed to crossmatch posed the greatest risk. Urgent measures are needed to ensure that, where indicated, a pre-operative G&S result is available before surgery begins. Educating colleagues, redesigning request forms and improving out-of-hour laboratory services and hospital information systems are the main steps needed to reduce this latent risk.


Assuntos
Tipagem e Reações Cruzadas Sanguíneas/normas , Transfusão de Sangue/normas , Procedimentos Cirúrgicos Eletivos/normas , Hospitalização/tendências , Procedimentos Cirúrgicos Eletivos/classificação , Procedimentos Cirúrgicos Eletivos/tendências , Humanos , Erros Médicos/prevenção & controle , Cuidados Pré-Operatórios/normas , Cuidados Pré-Operatórios/tendências , Estudos Retrospectivos , Risco
19.
Aust Health Rev ; 25(4): 40-9, 2002.
Artigo em Inglês | MEDLINE | ID: mdl-12404965

RESUMO

In some countries, patients requiring elective surgery can access comparative waiting time information for various surgical units. What someone can deduce from this information will depend upon how the statistics are derived, and how waiting lists behave. However, empirical analyses of waiting list behaviour are scarce. This study analysed three years of waiting list data collected at one hospital in Sydney, Australia. The results highlight various issues that raise questions about using particular waiting time statistics to make inferences about patient waiting times. In particular, the results highlight the considerable variation in behaviour that can exist between surgeons in the same specialty, and that can occur over time.


Assuntos
Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Serviços de Informação/estatística & dados numéricos , Especialidades Cirúrgicas/estatística & dados numéricos , Listas de Espera , Censos , Estudos Transversais , Procedimentos Cirúrgicos Eletivos/classificação , Comportamentos Relacionados com a Saúde , Pesquisas sobre Serviços de Saúde , Pesquisa sobre Serviços de Saúde , Hospitais de Ensino/estatística & dados numéricos , Humanos , Internet , New South Wales , Triagem
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