Skip header and navigation

Refine By

7 records – page 1 of 1.

An internist's role in perioperative medicine: a survey of surgeons' opinions.

https://arctichealth.org/en/permalink/ahliterature159268
Source
BMC Fam Pract. 2008;9:4
Publication Type
Article
Date
2008
Author
Lisa Pausjenssen
Heather A Ward
Sharon E Card
Author Affiliation
Department of Internal Medicine, University of Saskatchewan, Saskatoon, Canada. lisa.pj@usask.ca
Source
BMC Fam Pract. 2008;9:4
Date
2008
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Cooperative Behavior
General Surgery - statistics & numerical data
Health Care Surveys
Heart Diseases - surgery
Humans
Internal Medicine - standards
Interprofessional Relations
Perioperative Care - methods - standards
Physician's Role
Physician-Patient Relations
Preoperative Care - methods - standards
Questionnaires
Referral and Consultation - standards
Saskatchewan
Surgery Department, Hospital - manpower
Abstract
Literature exists regarding the perioperative role of internists. Internists rely on this literature assuming it meets the needs of surgeons without actually knowing their perspective. We sought to understand why surgeons ask for preoperative consultations and their view on the internist's role in perioperative medicine.
Survey of surgeons in Saskatoon, Saskatchewan, Canada regarding an internist's potential role in perioperative care.
Fifty-nine percent responded. The majority request a preoperative consultation for a difficult case (83%) or specific problem (81%). While almost half feel that a preoperative consultation is to "clear" a patient for surgery, 33% disagree with this statement. The majority believe the internist should discuss risk with the patient. Aspects of the preoperative consultation deemed most important are cardiac medication optimization (93%), cardiac risk stratification (83%), addition of beta-blockers (76%), and diabetes management (74%).
Surgeons perceive the most important roles for the internist as cardiac risk stratification and medication management. Areas of controversy identified amongst the surgeons included who should inform the patient of their operative risk, and whether the internist should follow the patient daily postoperatively. Unclear expectations have the potential to impact on patient safety and informed consent unless acknowledged and acted on by all. We recommend that internists performing perioperative consults communicate directly with the consulting physician to ensure that all parties are in accordance as to each others duties. We also recommend that the teaching of perioperative consults emphasizes the interdisciplinary communication needed to ensure that patient needs are not neglected when one specialty assumes the other will perform a function.
Notes
Cites: Neth J Med. 2000 Jan;56(1):7-1110667035
Cites: Arch Intern Med. 2007 Feb 12;167(3):271-517296883
Cites: Med Clin North Am. 2003 Jan;87(1):1-612575881
Cites: Chest. 1981 Jan;79(1):16-227449500
Cites: J Med Educ. 1983 Feb;58(2):149-516822987
Cites: Am J Med. 1983 May;74(5):870-66837610
Cites: Arch Intern Med. 1983 Apr;143(4):743-46838296
Cites: Arch Intern Med. 1983 Sep;143(9):1753-56615097
Cites: Am J Med. 1986 Sep;81(3):508-143752150
Cites: J Gen Intern Med. 1986 Jul-Aug;1(4):211-93772593
Cites: Arch Intern Med. 1986 Nov;146(11):2131-43778043
Cites: Circulation. 1996 Mar 15;93(6):1278-3178653858
Cites: Ann Intern Med. 1997 Aug 15;127(4):309-129265433
Cites: Anesth Analg. 1998 Oct;87(4):830-69768778
Cites: Circulation. 1999 Sep 7;100(10):1043-910477528
Cites: Can J Anaesth. 2005 Aug-Sep;52(7):697-70216103381
Cites: J Gen Intern Med. 2002 Dec;17(12):933-612472929
PubMed ID
18208614 View in PubMed
Less detail

Impact of the World Health Organization's Surgical Safety Checklist on safety culture in the operating theatre: a controlled intervention study.

https://arctichealth.org/en/permalink/ahliterature116358
Source
Br J Anaesth. 2013 May;110(5):807-15
Publication Type
Article
Date
May-2013
Author
A S Haugen
E. Søfteland
G E Eide
N. Sevdalis
C A Vincent
M W Nortvedt
S. Harthug
Author Affiliation
Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Jonas Liesvei 65, 5021 Bergen, Norway. arvid.haugen@helse-bergen.no
Source
Br J Anaesth. 2013 May;110(5):807-15
Date
May-2013
Language
English
Publication Type
Article
Keywords
Checklist - utilization
Female
Guideline Adherence - statistics & numerical data
Humans
Male
Norway
Operating Rooms - standards
Organizational Culture
Patient Safety - standards
Perioperative Care - methods - standards
Prospective Studies
Safety Management - methods
World Health Organization
Abstract
Positive changes in safety culture have been hypothesized to be one of the mechanisms behind the reduction in mortality and morbidity after the introduction of the World Health Organization's Surgical Safety Checklist (SSC). We aimed to study the checklist effects on safety culture perceptions in operating theatre personnel using a prospective controlled intervention design at a single Norwegian university hospital.
We conducted a study with pre- and post-intervention surveys using the intervention and control groups. The primary outcome was the effects of the Norwegian version of the SSC on safety culture perceptions. Safety culture was measured using the validated Norwegian version of the Hospital Survey on Patient Safety Culture. Descriptive characteristics of operating theatre personnel and checklist compliance data were also recorded. A mixed linear regression model was used to assess changes in safety culture.
The response rate was 61% (349/575) at baseline and 51% (292/569) post-intervention. Checklist compliance ranged from 77% to 85%. We found significant positive changes in the checklist intervention group for the culture factors 'frequency of events reported' and 'adequate staffing' with regression coefficients at -0.25 [95% confidence interval (CI), -0.47 to -0.07] and 0.21 (95% CI, 0.07-0.35), respectively. Overall, the intervention group reported significantly more positive culture scores-including at baseline.
Implementation of the SSC had rather limited impact on the safety culture within this hospital.
Notes
Cites: BMJ Qual Saf. 2011 Aug;20(8):711-721676948
Cites: Best Pract Res Clin Anaesthesiol. 2011 Jun;25(2):161-821550541
Cites: Acta Anaesthesiol Scand. 2011 Nov;55(10):1206-1422092125
Cites: Ann Surg. 2012 Jan;255(1):44-922123159
Cites: Acta Anaesthesiol Scand. 2012 Mar;56(3):332-822188135
Cites: Aviat Space Environ Med. 2012 Apr;83(4):441-422462374
Cites: BMJ Qual Saf. 2012 Jun;21(6):503-822447822
Cites: Br J Anaesth. 2012 Jul;109(1):47-5422649183
Cites: Qual Saf Health Care. 2003 Dec;12 Suppl 2:ii17-2314645891
Cites: BMJ Qual Saf. 2011 Sep;20(9):818-2221693466
Cites: Br J Anaesth. 2012 Dec;109 Suppl 1:i3-i1623242749
Cites: Qual Saf Health Care. 2006 Apr;15(2):109-1516585110
Cites: BMC Health Serv Res. 2006;6:4416584553
Cites: BMC Med Res Methodol. 2006;6:5417092344
Cites: Arch Surg. 2008 Jan;143(1):12-7; discussion 1818209148
Cites: Qual Saf Health Care. 2008 Jun;17(3):216-2318519629
Cites: Lancet. 2008 Jul 12;372(9633):139-4418582931
Cites: Br J Anaesth. 2008 Sep;101(3):332-718556692
Cites: Acta Anaesthesiol Scand. 2009 Feb;53(2):143-5119032571
Cites: N Engl J Med. 2009 Jan 29;360(5):491-919144931
Cites: Lancet. 2009 Aug 8;374(9688):444-519681190
Cites: BMJ. 2010;340:b543320071413
Cites: J Health Serv Res Policy. 2010 Jan;15 Suppl 1:11-620075122
Cites: Accid Anal Prev. 2010 Sep;42(5):1498-50620538106
Cites: BMC Health Serv Res. 2010;10:19920615247
Cites: BMC Health Serv Res. 2010;10:27920860787
Cites: Qual Saf Health Care. 2010 Oct;19 Suppl 3:i75-920959323
Cites: N Engl J Med. 2010 Nov 11;363(20):1928-3721067384
Cites: BMJ Qual Saf. 2011 Jan;20(1):102-721228082
Comment In: AORN J. 2013 Dec;98(6):663-824396941
PubMed ID
23404986 View in PubMed
Less detail

Long-term mortality following peptic ulcer perforation in the PULP trial. A nationwide follow-up study.

https://arctichealth.org/en/permalink/ahliterature118387
Source
Scand J Gastroenterol. 2013 Feb;48(2):168-75
Publication Type
Article
Date
Feb-2013
Author
Morten Hylander Møller
Morten Vester-Andersen
Reimar Wernich Thomsen
Author Affiliation
Department of Anaesthesiology and Intensive Care Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark. mortenhylander@gmail.com
Source
Scand J Gastroenterol. 2013 Feb;48(2):168-75
Date
Feb-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Denmark
Female
Follow-Up Studies
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Peptic Ulcer Perforation - mortality - surgery
Perioperative Care - methods - standards
Postoperative Complications - diagnosis - prevention & control - therapy
Practice Guidelines as Topic
Prospective Studies
Sepsis - diagnosis - etiology - prevention & control - therapy
Treatment Outcome
Young Adult
Abstract
Morbidity and mortality following perforated peptic ulcer (PPU) remain substantial. In the recently published PULP trial, 30-day mortality in patients surgically treated for PPU decreased from 27% to 17% following the implementation of a perioperative care protocol based on The Surviving Sepsis Guidelines. The objective of the present study was to evaluate long-term mortality in the PULP trial intervention and control cohort.
nationwide follow-up study of a multicenter, non-randomized, clinical trial with external controls.
Danish patients surgically treated for PPU between 1 January 2008 and 31 December 2009.
117 patients in the intervention group and 512 in the control group.
a perioperative care protocol based on The Surviving Sepsis Guidelines.
60-day, 90-day, 180-day, 1-year, and 2-year mortality rates.
survival statistics.
Baseline characteristics, clinical, and perioperative data were in general, similar in the intervention and control group. Sixty days postoperatively, the originally observed difference in 30-day mortality had diminished (25% vs. 30%, p = 0.268). After 180 days, the mortality difference was reduced additionally (31% vs. 33%, p = 0.645), and one year postoperatively, a mortality difference was no longer present (36% in both groups, p = 0.993). Two years postoperatively, the mortality rate in the intervention group was 44%, as compared to 40% in the control group (p = 0.472).
The survival benefit associated with a perioperative care protocol in patients treated for PPU decreases progressively after 30 days and is no longer present after one year.
NCT00624169 ( http://www.clinicaltrials.gov ).
PubMed ID
23215900 View in PubMed
Less detail

Perioperative care of patients with obstructive sleep apnea - a survey of Canadian anesthesiologists.

https://arctichealth.org/en/permalink/ahliterature170328
Source
Can J Anaesth. 2006 Mar;53(3):299-304
Publication Type
Article
Date
Mar-2006
Author
Kim Turner
Elizabeth VanDenkerkhof
Miu Lam
William Mackillop
Author Affiliation
Department of Anesthesiology, Kingston General Hospital, Ontario, Canada. turnerk@kgh.kari.net
Source
Can J Anaesth. 2006 Mar;53(3):299-304
Date
Mar-2006
Language
English
Publication Type
Article
Keywords
Anesthesiology - methods - standards
Canada
Female
Health Care Surveys
Humans
Male
Perioperative Care - methods - standards
Physician's Practice Patterns - statistics & numerical data
Practice Guidelines as Topic
Questionnaires
Sleep Apnea, Obstructive - therapy
Abstract
At present, there are no guidelines and insufficient evidence to guide the decision-making of anesthesiologists in the perioperative care of patients with obstructive sleep apnea (OSA). The purpose of this study was to examine the current perioperative care provided, and to obtain opinions from anesthesiologists regarding evidence/consensus based guidelines to assist them in providing care to patients with OSA.
Canadian anesthesiologists were sent a postal questionnaire examining their opinions and perioperative care of patients with OSA. Respondents were asked to indicate the postoperative monitoring they would most likely select for two clinical scenarios, representing administration of a general and regional anesthetic, which was altered to reflect: treatment of OSA; use of postoperative opioids; presence of morbid obesity; and increased severity of OSA.
The survey had a response rate of 70% (746/1,063). Sixty-seven percent of respondents provided perioperative care to one to five patients with OSA per month, and 72% reported not having departmental policies for care of OSA patients. Ninety-two percent reported asking patients about OSA preoperatively. There was >or= 75% respondent agreement in two of the five alterations of the general anesthesia case scenario and in none of the alterations of the regional anesthesia case scenario. Eighty-two percent reported that guidelines would assist them in caring for patients with OSA.
This study demonstrates a variation amongst anesthesiologists in their postoperative monitoring of patients with OSA. The majority surveyed do not have departmental policies, and believed that guidelines would assist them in providing care to patients with OSA.
PubMed ID
16527797 View in PubMed
Less detail

Perioperative use of beta-blockers remains low: experience of a single Canadian tertiary institution.

https://arctichealth.org/en/permalink/ahliterature178048
Source
Can J Anaesth. 2004 Oct;51(8):761-7
Publication Type
Article
Date
Oct-2004
Author
Ivan Rapchuk
Shannon Rabuka
Marcello Tonelli
Author Affiliation
Department of Anesthesia, Dalhousie University, Halifax, Nova Scotia.
Source
Can J Anaesth. 2004 Oct;51(8):761-7
Date
Oct-2004
Language
English
Publication Type
Article
Keywords
Adrenergic beta-Antagonists - therapeutic use
Aged
Canada
Drug Utilization - statistics & numerical data
Humans
Middle Aged
Perioperative Care - methods - standards
Practice Guidelines as Topic
Prospective Studies
Questionnaires
Retrospective Studies
Surgical Procedures, Operative - methods
Abstract
Perioperative beta-blockade appears to reduce morbidity and mortality in non-cardiac surgery, and is recommended by published guidelines. This study explores the frequency of perioperative beta-blockade and identifies factors limiting its use.
We conducted a prospective analysis of consecutive patients seen by anesthesiologists before major non-cardiac surgery in a single month. Because not all patients undergoing major surgery were seen preoperatively by anesthesiologists, we also performed a retrospective analysis of patients who recently underwent such surgery. Data were collected on demographic information, cardiovascular risk factors, beta-blocker use, and perceived contraindications/barriers to beta-blocker use, using a validated instrument.
The prospective phase studied 222 patients preoperatively, of whom 96 were suitable candidates for perioperative beta-blockade by the American College of Physician guidelines. The retrospective phase studied 200 patients, of whom 63 were suitable candidates, and assessed pre- and postoperative use of beta-blockade. 40.6% and 38.1% of suitable patients received preoperative beta-blockade in the two phases, respectively. Findings were similar in those undergoing vascular surgery, suggesting that perception of perioperative risk did not influence the decision to use beta-blockade. Beta-blockers were not prescribed preoperatively because of lack of knowledge about contraindications to beta-blockade, and anesthesiologist reluctance to prescribe oral medication to outpatients.
Use of preoperative beta-blockade among suitable candidates appears to be approximately 40%. Anesthesiologists started preoperative beta-blockers infrequently even in patients without contraindications. These findings suggest that educating anesthesiologists about the perioperative use of beta-blockade may increase the use of this potentially beneficial strategy.
Notes
Comment In: Can J Anaesth. 2004 Oct;51(8):749-5515470162
PubMed ID
15470164 View in PubMed
Less detail
Source
Ugeskr Laeger. 2008 Apr 28;170(18):1559-63
Publication Type
Article
Date
Apr-28-2008
Author
Rud Kirsten
Jakobsen Dorthe Hjort
Egerod Ingrid
Kehlet Henrik
Author Affiliation
Rigshospitalet, Enhed for Perioperativ Sygepleje, Universiteternes Center for Sygepleje, København Ø. krud@rh.dk
Source
Ugeskr Laeger. 2008 Apr 28;170(18):1559-63
Date
Apr-28-2008
Language
Danish
Publication Type
Article
Keywords
Aftercare - methods - standards
Denmark
Evidence-Based Medicine
Guideline Adherence
Humans
Length of Stay
Patient Care Planning - standards
Patient Discharge - standards
Patient Education as Topic - methods - standards
Perioperative Care - methods - standards
Physician's Practice Patterns
Practice Guidelines as Topic
Questionnaires
Recovery of Function
Surgical Procedures, Operative - methods - standards
Treatment Outcome
Abstract
INTRODUCTION: Evidence-based guidelines for perioperative care facilitate the recovery process and decrease morbidity and hospital stay. The aim of this study was to evaluate the availability and content of guidelines for perioperative care in all departments performing colonic resection, nephrectomy, ovarian cancer surgery, pulmonary resection and total knee replacement. MATERIALS AND METHODS: Based upon nationwide workshops and agreement on clinical guidelines for perioperative care a questionnaire was sent to all surgical departments which perform the five procedures. Where available, the guidelines were assessed for presence of written information at admission and discharge, expected hospital stay, plan for mobilisation, nutrition and pain control as well as information on care after discharge. RESULTS: Between 59% and 88% of the departments within each subspecialty had clinical guidelines for perioperative care. The content in the existing guidelines often lacked accurate information regarding preoperative information, objective pain assessment and well-defined discharge criteria. CONCLUSION: The number of clinical guidelines is increasing, but there is a need for further implementation of clinical guidelines for perioperative care in order to improve outcome.
PubMed ID
18454927 View in PubMed
Less detail

Utilizing the physician assistant role: case study in an upper-extremity orthopedic surgical program.

https://arctichealth.org/en/permalink/ahliterature282225
Source
Can J Surg. 2017 Apr;60(2):115-121
Publication Type
Article
Date
Apr-2017
Author
Shelanne L Hepp
Esther Suter
Dwayne Nagy
Tanya Knorren
Joseph W Bergman
Source
Can J Surg. 2017 Apr;60(2):115-121
Date
Apr-2017
Language
English
Publication Type
Article
Keywords
Aftercare - methods - standards
Alberta
Humans
Organizational Case Studies
Orthopedic Procedures - methods - standards
Perioperative Care - methods - standards
Physician Assistants - organization & administration - standards
Professional Role
Upper Extremity - surgery
Abstract
Shortages with resources and inefficiencies with orthopedic services in Canada create opportunities for alternative staffing models and ways to use existing resources. Physician assistants (PAs) are a common provider used in specialty orthopedic services in the United States; however, Canada has limited experience with PAs. As part of a larger demonstration project, Alberta Health Services (AHS) implemented 1 PA position in an upper-extremity surgical program in Alberta, Canada, to demonstrate the role in 4 areas: preoperative, operative, postoperative and follow-up care.
A mixed-methods evaluation was conducted using semi-structured interviews (n = 38), health care provider (n = 28) and patient surveys (n = 47), and 2 years of clinic data on new patients. Data from a double operating room experiment detailed expected versus actual times for 3 phases of surgery (pre, during, post).
Preoperatively, the PA prioritizes patient referrals for surgery and redirects patients to alternative care. In the second year with the PA in place, there was an increase in total new patients seen (113%). Postoperatively, the PA attended rounds on 5 surgeons' patients and handled follow-up care activities. Health care providers and patients reported that the PA provided excellent care. Findings from the operating room showed that the preparation time was greater than expected (38.6%), whereas the surgeon time (20.6%) and postsurgery time (37.2%) was less than expected.
After 24 months the PA has become a valuable member of the health care team and works across the continuum of orthopedic care. The PA delivers quality care and improves system efficiencies.
Notes
Cites: J Bone Joint Surg Am. 2009 Aug;91(8):2028-3919651966
Cites: ANZ J Surg. 2007 Oct;77(10):892-817803558
Cites: Orthop Nurs. 2010 Nov-Dec;29(6):381-921099645
Cites: Ann R Coll Surg Engl. 2005 May;87(3):174-8015901377
Cites: Acad Med. 2010 Oct;85(10):1571-720881677
Cites: PLoS One. 2013 Jun 04;8(6):e6556023750266
Cites: BMJ Open. 2014 Jul 31;4(7):e00447225082417
Cites: Mil Med. 2012 Jun;177(6):740-422730852
Cites: J Allied Health. 2011 Winter;40(4):174-8022138871
Cites: J Bone Joint Surg Am. 2003 Sep;85-A(9):1710-512954829
Cites: Can J Surg. 2000 Dec;43(6):431-611129831
Cites: Health Care Manag Sci. 2011 Jun;14(2):135-4521152989
Cites: Public Health. 2005 Apr;119(4):290-315733689
Cites: Can J Surg. 2010 Apr;53(2):103-820334742
Cites: BMC Health Serv Res. 2009 Mar 31;9:5619335904
PubMed ID
28234216 View in PubMed
Less detail

7 records – page 1 of 1.