Human factors
Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS), with a view to rolling out to all surgical specialties through the Presidential Forum of the Federation of Surgical Specialties Association (FSSA), the umbrella organisation for surgical specialty societies.
Understanding the core problems There is still much work to be done in applying our principles and understanding of current processes to the development of a functional and healthy system that effectively addresses real stresses and issues. The steps outlined here represent the first
stage of this process, and it is my intention and vision to develop innovative processes that can improve overall health, enhance stress management, and lead to better outcomes for all within this evolving environment.
COMMENT with WILLIAM LEIVA
Reducing risk of surgical complications
CSJ
Implementing effective temperature management is key to reducing the risk of surgical complications, says William Leiva, MPH, 3M Senior Medical Science Liaison. There’s a wealth of evidence around the importance of keeping patient core temperature within normal parameters and preventing the temperature from dropping below 36°C. Failing to prevent this may lead to increased blood loss, potentially requiring a blood transfusion and increasing the chances of complications such as surgical site infection, as well as longer recovery time. Although patient temperature management is thoroughly implemented during intra- and post-operative steps of the surgical journey, the adoption of pre-warming protocols to prevent a rapid heat loss due to temperature redistribution remains a challenge. The pre-operative phase differs in many ways as hospitals have different facilities, lay outs and workflows. For the former, different infrastructures may lead to reduced space to implement heating units. For the latter, workflows may be significantly different, enhancing the time the patient waits in the preoperative area or being transported to the operation theatre. Unfortunately, lack of adherence to the patient temperature management at this stage may enhance the heat loss distribution, leading to a rapid heat loss after induction. As evidence increases, we know more about risks but also about the technologies
available to help prevent temperature drop in the pre-operative phase. Building a robust approach to patient temperature management by using a holistic approach perioperatively may provide clinical as well as economic benefits. However, there’s a third element that must be considered: patient satisfaction and well-being during their surgical journey. When exploring new healthcare technologies, the benefit analysis portion consists of
About the author
Dr. Richard Sherry is a consultant chartered clinical psychologist, clinical neuropsychologist, psychoanalytic psychotherapist, and BPS aviation and aerospace psychologist. He is a full member for the BPS Division of Occupational Psychology (DOP), and is a specialist in psychological clinical traumatology (ESTSS Certificate and an EMDR consultant) who works with individuals and organisations. He has run the Clinical Psychology Section for the US Military Inpatient’s Service for more than 7 years as an external consultant and has a specialist post graduate training in Medical Ethics and Philosophy (DPMSA), specialising in Disaster Ethics. Dr. Sherry is also on the Specialist Register for Clinical Neuropsychology (SRCN) (which is the highest gold standard of Clinical Neuropsychology in the UK). https://www.
psychologicalsystems.org
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a plethora of aspects, which must be carefully assessed. For the clinical benefit side, the most obvious is the maintenance of a patient’s core temperature through their surgical journey; however, further assessment can include the clinical benefits of maintaining such temperature, which may include reduction in myocardial ischaemia and cardiac disturbance, and incidence of surgical site infections and other post-operative complications. Regarding the financial aspects, the immediate assessment often includes the cost of the implementation of a new technology per patient, paired with the potential for savings brought by maintaining normothermia with such a solution, which may include reduced length of stay. The use of 3M Bair Hugger Temperature Management solutions, implemented with clinical protocols, will help healthcare facilities deliver positive experiences and results. Clinical protocols are always subject to improvement and, as such, reviewing current
protocols with new technologies is a good starting point. However, the implementation of successful and sustainable clinical protocols requires a holistic approach, including assessment, implementation and sustaining the protocol and its benefits. The assessment will allow better understanding of the current workflow in preparation for the implementation of new technology, which is done through close collaboration between the clinicians and the solution manufacturer. It is essential that all users and key stakeholders are made aware of any new or revised protocol, to promote a successful implementation of any new technology being considered. During the implementation, follow-up activities should include the assessment of compliance with the new protocol and address any shortcomings in both education and training. Sustaining the benefits requires a combination of adequate implementation, supervision, monitoring of patients’ outcomes and quality indicators, which will support the facility’s successful and sustained adoption. Ultimately, stakeholder involvement helps increase likelihood of success. Implementing
new technologies without providing the rationale to clinicians, the potential benefits to clinical practice and patient care, will likely lead to a failed implementation, leading to a missed opportunity to realise benefits for both patients and facilities. Leveraging a close partnership with the new solution’s manufacturer will help enable an effective implementation by benefiting from external resources to facilitate the implementation.
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