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1 – 10 of 122Bita A. Kash, Kayla M. Cline, Stephen Timmons, Rahil Roopani and Thomas R. Miller
Health care institutions in many Western countries have developed preoperative testing and assessment guidelines to improve surgical outcomes and reduce cost of surgical care. The…
Abstract
Purpose
Health care institutions in many Western countries have developed preoperative testing and assessment guidelines to improve surgical outcomes and reduce cost of surgical care. The aims of this chapter are to (1) summarize the literature on the effect of preoperative testing on clinical outcomes, efficiency, and cost; and (2) to compare preoperative testing guidelines developed in the United States, the United Kingdom, and Canada.
Design/methodology/approach
We reviewed the literature from 1975 to 2014 for studies and preoperative testing guidelines.
Findings
We identified 29 empirical studies and 8 country-specific guidelines for review. Most studies indicate that preoperative testing is overused and comes at a high cost. Guidelines are tied to payment only in one country studied. This is the most recent review of the literature on preoperative testing and assessment with a focus on quality of care, efficiency, and cost outcomes. In addition, this chapter provides an international comparison of preoperative guidelines.
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C.U. Dussa, K. Durve and K. Singhal
The purpose of this paper is to find the incidence and medical reasons for cancellations of elective orthopaedic cases following admission for an operation in a district general…
Abstract
Purpose
The purpose of this paper is to find the incidence and medical reasons for cancellations of elective orthopaedic cases following admission for an operation in a district general hospital. The paper also aims to determine the deficiencies in the local preoperative assessment protocol.
Design/methodology/approach
This is a retrospective study. The elective orthopaedic surgeries cancelled following their admission into the hospital due to medical reasons between January 2003 and December 2004, were identified. These cases were reviewed using the preoperative assessment charts and case notes. The NHS Modernisation Agency's guidelines, National Good Practice Guidance on Preoperative Assessment for Inpatient Surgery, are taken as the benchmark for comparison.
Findings
The paper finds that 44 elective orthopaedic cases were cancelled due to medical reasons. Of these patients, 64 per cent did not have a pre‐operative assessment prior to the admission for the planned surgery; 6 per cent had inadequate documentation of relevant past medical history; and 30 per cent (patients with significant medical problems) were not referred to the anaesthetist for advice although these problems were identified during the pre‐operative assessment.
Research limitations/implications
It is possible to stimulate good medical practice through audit.
Practical implications
Cancellation of an elective operation is not uncommon in hospital practice. This paper aims to highlight the possible avoidable causes for such cancellations. The paper identifies such deficiencies in the local preoperative assessment protocol and suggests remedies to improve the quality of care. These improvements and close adherence to the guidelines are important as preoperative assessment by nurse‐led clinics are being increasingly practised through out the UK.
Originality/value
The paper fulfils its aims of identifying the medical causes for cancellation of an operation and also the existing deficiencies in the preoperative assessment practice. The paper values the importance of adherence to NHS Modernising Agency's guidelines in preoperative assessment. It is useful not only to the Orthopaedic department but also to the department managers.
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Asgar Aghaei Hashjin, Bahram Delgoshaei, Dionne S Kringos, Seyed Jamaladin Tabibi, Jila Manouchehri and Niek S Klazinga
– The purpose of this paper is to provide an overview of applied hospital quality assurance (QA) policies in Iran.
Abstract
Purpose
The purpose of this paper is to provide an overview of applied hospital quality assurance (QA) policies in Iran.
Design/methodology/approach
A mixed method (quantitative data and qualitative document analysis) study was carried out between 1996 and 2010.
Findings
The QA policy cycle forms a tight monitoring system to assure hospital quality by combining mandatory and voluntary methods in Iran. The licensing, annual evaluation and grading, and regulatory inspections statutorily implemented by the government as a national package to assure and improve hospital care quality, while implementing quality management systems (QMS) was voluntary for hospitals. The government’s strong QA policy legislation role and support has been an important factor for successful QA implementation in Iran, though it may affected QA assessment independency and validity. Increased hospital evaluation independency and repositioning, updating standards, professional involvement and effectiveness studies could increase QA policy impact and maturity.
Practical implications
The study highlights the current QA policy implementation cycle in Iranian hospitals. It provides a basis for further quality strategy development in Iranian hospitals and elsewhere. It also raises attention about finding the optimal balance between different QA policies, which is topical for many countries.
Originality/value
This paper describes experiences when implementing a unique approach, combining mandatory and voluntary QA policies simultaneously in a developing country, which has invested considerably over time to improve hospital quality. The experiences with a mixed obligatory/voluntary approach and comprehensive policies in Iran may contain lessons for policy makers in developing and developed countries.
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Kunal Karamchandani, Kyle Barden and Jansie Prozesky
The purpose of this paper is to review surgical antimicrobial prophylaxis administration practices in a small cohort and assess compliance with national guidelines.
Abstract
Purpose
The purpose of this paper is to review surgical antimicrobial prophylaxis administration practices in a small cohort and assess compliance with national guidelines.
Design/methodology/approach
Patients that developed surgical site infections (SSI) in a tertiary care academic medical center over a two-year period were identified. Their electronic medical records were reviewed for compliance with national guidelines with respect to surgical antibiotic prophylaxis.
Findings
Over a two-year period, 283 SSI patients were identified. An appropriate antibiotic was chosen in 80 percent, an appropriate dose was administered in 45 percent and timing complied in 89 percent. The antibiotics were appropriately re-dosed in only 9.2 percent in whom the requirement was met. The prescribing guidelines were adhered to in entirety in only 54 patients (23.8 percent).
Practical implications
Timely and appropriate antibiotic administration prior to surgery is essential to prevent SSI. Proper diligence is required to accomplish this task effectively.
Originality/value
Based on the findings, it appears that merely, “checking a box” for antibiotic administration during surgery is not enough, and a multidisciplinary approach should be followed to ensure “appropriate” antibiotic administration.
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Mats Lundström, Peter Barry, Lucia Brocato, Carol Fitzpatrick, Ype Henry, Paul Rosen and Ulf Stenevi
A project aimed at creating a multi-national database for cataract and refractive surgery was initiated in 2008. The database was intended for learning and clinical improvement…
Abstract
Purpose
A project aimed at creating a multi-national database for cataract and refractive surgery was initiated in 2008. The database was intended for learning and clinical improvement, not supervision. The project was co-funded by the European Union, under the Executive Agency for Health and Consumers and the European Society of Cataract and Refractive Surgeons (ESCRS) and supported by 11 national societies for cataract and refractive surgery. The purpose of this article is to describe the setup of the database and the ensuing achievements within cataract surgery after four years.
Design/methodology/approach
A web-based system was created for input and output of data, with a software interface to two databases, one for cataract surgery and one for refractive surgery. Data can be put in either manually through web forms or by transfer of data from existing national registries or large electronic medical record systems. Output of reports from the system or export of one's own data is available on the web. The data are anonymous to all users, with the sole exception that reporting surgeons and clinics have access to their own data. The system does not include any patient identification.
Findings
After four years, data from 16 countries have been entered into the system, including reports of more than 900,000 cataract extractions. The database has been used by individual clinics for benchmarking and clinical improvement work, and has also served as the basis for new clinical guidelines for cataract surgery. The ESCRS has guaranteed the sustainability of the database after the project period.
Originality/value
A European quality registry with data input from surgeons and clinics in 16 European countries has been established. Close to one million surgeries have been entered into the system during the first four years. Evidence-based guidelines have been published based on data in the registry. The system is used for benchmarking by both experienced surgeons and trainees.
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Melissa De Regge, Paul Gemmel and Bert Meijboom
Process management approaches all pursue standardization, of which evidence-based medicine (EBM) is the most common form in healthcare. While EBM addresses improvement in clinical…
Abstract
Purpose
Process management approaches all pursue standardization, of which evidence-based medicine (EBM) is the most common form in healthcare. While EBM addresses improvement in clinical performance, it is unclear whether EBM also enhances operational performance. Conversely, operational process standardization (OPS) does not necessarily yield better clinical performance. The authors have therefore looked at the relationship between clinical practise standardization (CPS) and OPS and the way in which they jointly affect operational performance. The paper aims to discuss this issue.
Design/methodology/approach
The authors conducted a comparative case study analysis of a cataract surgery treatment at five Belgium hospital sites. Data collection involved 218 h of observations of 274 cataract surgeries. Both qualitative and quantitative methods were used.
Findings
Findings suggest that CPS does not automatically lead to improved resource or throughput efficiency. This can be explained by the low level of OPS across the five units, notwithstanding CPS. The results indicate that a wide range of variables on different levels (patient, physician and organization) affect OPS.
Research limitations/implications
Considering one type of care treatment in which clinical outcome variations are small complicates translating the findings to unstructured and complex care treatments.
Originality/value
With the introduction of OPS as a complementary view of CPS, the study clearly shows the potential of OPS to support CPS in practice. Operations matters in healthcare standardization, but only when it is managed in a deliberate way on a hospital and policy level.
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Diana Popescu, Dan Laptoiu, Rodica Marinescu and Iozefina Botezatu
This paper aims to fill a research gap by presenting design and 3D printing guidelines and considerations which apply to the development process of patient-specific osteotomy…
Abstract
Purpose
This paper aims to fill a research gap by presenting design and 3D printing guidelines and considerations which apply to the development process of patient-specific osteotomy guides for orthopaedic surgery.
Design/methodology/approach
Analysis of specific constraints related to patient-specific surgical guides design and 3D printing, lessons learned during the development process of osteotomy guides for orthopaedic surgery, literature review of recent studies in the field and data gathered from questioning a group of surgeons for capturing their preferences in terms of surgical guides design corresponding to precise functionality (materializing cutting trajectories, ensuring unique positioning and stable fixation during surgery), were all used to extract design recommendations.
Findings
General design rules for patient-specific osteotomy guides were inferred from examining each step of the design process applied in several case studies in relation to how these guides should be designed to fulfill medical and manufacturing (fused deposition modelling process) constraints. Literature was also investigated for finding other information than the simple reference that the surgical guide is modelled as negative of the bone. It was noticed that literature is focussed more on presenting and discussing medical issues and on assessing surgical outcomes, but hardly at all on guides’ design and design for additive manufacturing aspects. Moreover, surgeons’ opinion was investigated to collect data on different design aspects, as well as interest and willingness to use such 3D-printed surgical guides in training and surgery.
Practical implications
The study contains useful rules and recommendations for engineers involved in designing and 3D printing patient-specific osteotomy guides.
Originality/value
A synergetic approach to identify general rules and recommendations for the patient-specific surgical guides design is presented. Specific constraints are identified and analysed using three case studies of wrist, femur and foot osteotomies. Recent literature is reviewed and surgeons’ opinion is investigated.
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Nicola Parfitt, Alison Smeatham, John Timperley, Matthew Hubble and Graham Gie
This paper aims to show the results from a pioneering primary care‐based extended scope physiotherapist (ESP) led service, which placed patients directly onto the surgical waiting…
Abstract
Purpose
This paper aims to show the results from a pioneering primary care‐based extended scope physiotherapist (ESP) led service, which placed patients directly onto the surgical waiting list of secondary care orthopaedic consultants over a two‐year period.
Design/methodology/approach
A retrospective data review was performed on all referrals from community‐based ESPs for direct listing at the secondary care hospital between 2 January 2008 and 31 December 2009.
Findings
A total of 130 referrals for direct listing were made by the ESP team during the two‐year period. Of these, 127 (98 per cent) went on to undergo a THR. Three patients (2 per cent) did not ultimately have a THR.
Research limitations/implications
This process has continued over the two years of the direct listing service, with ongoing evaluation and refinement of the pathway, so referral criteria and clinical/administrative pathways have been changed in the light of experience.
Practical implications
Patients who were directly listed did not require a hospital orthopaedic outpatient appointment until attendance at preoperative assessment clinic shortly before their surgery. In addition to the reduction in inconvenience and travelling costs incurred by patients, there was an approximate saving of £145 to the primary care trust per directly listed patient.
Originality/value
The authors believe that this service evaluation is the first publication to show that direct listing by primary care based ESPs is a safe and effective process for some patients requiring primary THR.
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Ida Papallo, Domenico Solari, Ilaria Onofrio, Lorenzo Ugga, Renato Cuocolo, Massimo Martorelli, Teresa Russo, Ilaria Bove, Luigi Maria Cavallo and Antonio Gloria
This study aims to integrate design methods and additive manufacturing with the use of a thermoplastic elastomer certified for medical use and reverse engineering towards a new…
Abstract
Purpose
This study aims to integrate design methods and additive manufacturing with the use of a thermoplastic elastomer certified for medical use and reverse engineering towards a new concept of a customized buttress model with optimized features for the reconstruction of the osteo-dural opening after endoscopic endonasal transtuberculum-transplanum approach.
Design/methodology/approach
Additive manufacturing allows making of cost-effective and useable devices with tailored properties for biomedical applications. The endoscopic endonasal approach to the suprasellar area enables the management of different intradural tumours, and the craniectomy at the skull base is generally wide and irregular. Defining an optimal strategy for osteodural defect closure at the preoperative stage represents a significant challenge.
Findings
Using the results obtained from a computed tomography analysis, skull base defects were designed to plan the surgical approach. Several concepts of customized buttress models were first built up, initially focusing on thin, flexible edges characterized by different thicknesses. Finite element analyses and design optimization allowed us to achieve the optimal design solution with improved compliance/flexibility for easy intranasal manoeuvrability, maintaining an adequate mechanical stability. As the thickness of the edges decreased, an increase of strain energy values was found (i.e. 1.2 mJ – Model A, 1.7 mJ – Model B, 2.3 mJ – Model C, 4.3 mJ – Model D). However, a further optimization (Model E) led to a significant increase of the compliance (strain energy of 14.1 mJ).
Originality/value
The results obtained from clinical evaluations demonstrated the feasibility of the proposed technical solutions, improving surgery effectiveness.
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Soo-Hoon Lee, Thomas W. Lee and Phillip H. Phan
Workplace voice is well-established and encompasses behaviors such as prosocial voice, informal complaints, grievance filing, and whistleblowing, and it focuses on interactions…
Abstract
Workplace voice is well-established and encompasses behaviors such as prosocial voice, informal complaints, grievance filing, and whistleblowing, and it focuses on interactions between the employee and supervisor or the employee and the organizational collective. In contrast, our chapter focuses on employee prosocial advocacy voice (PAV), which the authors define as prosocial voice behaviors aimed at preventing harm or promoting constructive changes by advocating on behalf of others. In the context of a healthcare organization, low quality and unsafe patient care are salient and objectionable states in which voice can motivate actions on behalf of the patient to improve information exchanges, governance, and outreach activities for safer outcomes. The authors draw from the theory and research on responsibility to intersect with theories on information processing, accountability, and stakeholders that operate through voice between the employee-patient, employee-coworker, and employee-profession, respectively, to propose a model of PAV in patient-centered healthcare. The authors complete the model by suggesting intervening influences and barriers to PAV that may affect patient-centered outcomes.
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