Cancellation of Surgeries: Integrative Review Al Talalwah, Narmeen; McIltrot, Kimberly H.
Journal of perianesthesia nursing,
February 2019, 2019-Feb, 2019-02-00, 20190201, Volume:
34, Issue:
1
Journal Article
Peer reviewed
To analyze cancellations of surgeries and identify evidence-based interventions to address this issue.
Integrative literature review.
An integrative literature search was conducted in four databases: ...CINAHL, PubMed, Embase, and Cochrane and included literature sources dated January 2011 to January 2016. The complete list of search terms consisted of the following: ambulatory surgery, day surgery center, elective surgical procedure, elective operation, elective surgery, schedule, access to care, surgery cancellation, operation cancellation, and surgery delay.
Twenty-three literature sources were identified. Evidence included one randomized controlled trial and multiple studies. Causes of cancellations were classified into three categories: hospital-related reasons, patient-related reasons, and surgeon-related reasons. Evidence confirmed most cancellations were avoidable.
Cancellation of scheduled surgeries has a significant impact on patients' health, resources, cost, and quality of care. It is difficult to devise a solution without understanding the cause of cancellations.
To survey the literature to gain insight into nursing facilitators of and barriers to implementation of positioning/turning strategies to prevent hospital-acquired pressure injuries (PIs) in adult ...critical care patients.
This integrative review surveyed literature across databases including PubMed, CINAHL, Embase, and Cochrane Library, and through hand searching.
Key terms included "pressure ulcer" OR "pressure sore*" OR "pressure injur*" AND "patient positioning" OR "turn" OR "turning" OR "patient repositioning" AND "critical care" OR "intensive care unit*" OR "inpatient*" AND "prevent*." Peer reviewed, English language articles published within the past 10 years were included. Inclusion and exclusion criteria narrowed the database yield to 432 articles. After title/abstract and full text review, 11 articles were included.
Articles were appraised using the PRISMA flow diagram and the Johns Hopkins Nursing Evidence-Based Practice appraisal tool. Data was extracted and major themes were identified.
The identified themes were synthesized into factors that facilitated or impeded the nursing implementation of turning/repositioning strategies to prevent hospital-acquired PIs. Facilitators were the use of verbal cues and alerts to improve compliance and nursing education on PI prevention. Barriers to successful implementation were increased nursing workload or burden, lack of staff, and perceived hemodynamic instability in ICU patients.
Future interventions can be tailored to mitigate barriers and reinforce facilitators to improve nursing compliance with repositioning/turning strategies. Increased compliance with these measures could aid in PI prevention in adult ICU patients.
Background Extensive literature has proved that the Nuss procedure leads to permanent remodeling of the chest wall in pediatric patients with pectus excavatum (PE). However, limited long-term ...follow-up data are available for adults. Herein, we report a single-institution experience in the management of adult PE with the Nuss procedure, evaluating long-term outcomes and overall patient satisfaction after bar removal. Methods Adult patients who underwent PE repair with a modified Nuss procedure between January 1998 and June 2011 were retrospectively identified. Outcomes of interest were postoperative pain, recurrence, and patient satisfaction. A modified single-step Nuss questionnaire was administered to evaluate patient satisfaction and quality-of-life improvement after PE repair. Results Ninety-eight patients with a median age of 30.9 years (range, 21.8 to 55.1 years) at the time of repair were identified. One bar was placed in most patients (89.7%). Four patients (4.1%) required reoperation for bar displacement. Results after bar removal were overall satisfactory in 94.4% of patients; 2 patients required reoperation for recurrence. Thirty-nine patients participated in the survey. Satisfaction with chest appearance was reported by 89.7% of responders. Seven patients reported dissatisfaction with the overall results; the most common complaints were severe postoperative chest pain and dissatisfaction with surgical scars. Conclusions Favorable long-term results can be achieved with the Nuss procedure in adults. However, postoperative pain may require a more aggressive analgesic regimen, and it may be the overriding factor in the patient’s perception of the quality of the postoperative course.
Cancellation of elective surgery negatively affects patient outcomes and the efficiency of the work environment. The purpose of this project was to analyze the cancellation of elective surgeries and ...identify the best evidence-based interventions to address cancellations in a tertiary hospital in the Middle East.
A quality improvement study design.
A retrospective review of cancellations conducted over two 3-month periods in 2016 and 2017.
In both phases of the audit, patient-related reasons were the leading cause of cancellations. Conducting a preoperative call 2 days before surgery and doing a weekly review of the surgery schedule reduced cancellations from 3.8% to 3.5%. Cancellations because of patient-related reasons reduced from 81% to 79.7% whereas cancellations because of hospital-related reasons reduced from 17.5% to 15.9%.
Cancellation of surgeries is a worldwide health care issue and without understanding the causes of cancellations, it is difficult to devise an effective intervention to address this issue.
While many states adopted policies that allow for simulation or other experiences to replace direct clinical hours in pre-licensure nursing programmes during COVID-19 (National Council of State ...Boards of Nursing, 2020), AP nursing education regulations continue to require a minimum of 500 supervised direct patient clinical care hours for nurse practitioner (NP) students to meet graduation and certification requirements (National Organization of Nurse Practitioner Faculties NONPF, 2020). ...NP programmes must seek novel ways to maximize the use of available resources for students to earn supervised direct patient clinical care hours during this ongoing global health crisis. ...many AP clinical sites (66 of the 79) restricted student access for a variety of reasons, including a lack of personal protective equipment (PPE), increased workload of preceptors, staffing shortages and concerns about social distancing required for staff and student safety. Another opportunity allowed students to assist with a phone line at a local health centre where they spoke with low income, mostly uninsured patients about symptoms, emotional distress about community infections, and how to remain healthy during the pandemic. Other considerations for student learning include maintenance of privacy and standard of care in virtual visits, awareness of acceptable HIPAA-compliant platforms, how to educate patients on the use of technology and to join with preceptors as they also expand their learning of telehealth.
Abstract Background The safety and efficacy of minimally invasive pectus excavatum repair have been demonstrated over the last twenty years. However, technical details and perioperative management ...strategies continue to be debated. The aim of the present study is to review a large single-institution experience with the modified Nuss procedure. Methods A retrospective review was performed of patients who underwent primary pectus excavatum repair at a single tertiary hospital via a modified Nuss procedure that included: no thoracoscopy, retrosternal dissection achieved via a left-to-right thoracic approach, four-point stabilization of the bar, and no routine epidural analgesia. Data collected included demographics, preoperative symptoms, operative characteristics, hospital charges and postoperative outcomes. Results A total of 336 pediatric patients were identified. No cardiac perforations occurred and the rate of pericarditis was 0.6%. Contemporary rates of bar displacement have fallen to 1.2%. Routine use of chlorhexidine scrub reduced superficial site infections to 0.7%. Two patients (0.6%) with severe recurrence required reoperation. Bars were removed after an average period of 31.7(SD 13.2) months, with satisfactory cosmetic and functional results in 94.9% of cases. Conclusions We report here a single-institution large volume experience, including modifications to the Nuss procedure that make the technique simpler and safer, improve results, and minimize hospital charges.
Abstract Background Optimal management of recurrent pectus excavatum (PE) has not been established. Here, we review our institutional experience in managing recurrent PE to evaluate long-term ...outcomes and propose an anatomic classification of recurrences, and a decision-making algorithm. Methods Clinical records of patients undergoing repair of recurrent PE (1996–2011) were reviewed. Univariate and multivariate logistic regression analyses were employed to examine patient characteristics as potential predictors for re-recurrence. Results Eighty-five patients with recurrent PE were identified during the study period. The initial operation was a Ravitch procedure in 85% of cases. Revision procedures were most frequently Nuss repairs ( N = 73, 86%), with remaining cases managed via open approach. Overall cosmetic and functional results were satisfactory in 67 patients (91.8%) managed with Nuss and in 7 (58%) patients managed with other techniques. Seven (8%) patients required additional surgical revision. Multivariate analysis identified no statistically significant patient or procedural factors predictive of re-recurrence. Conclusion This study demonstrates that the Nuss procedure can be an effective intervention for recurrent pectus excavatum, regardless of the initial repair technique. However, open repair remains valuable when managing severe cases with abnormalities of the sternocostal junction and cartilage regrowth under the sternum.
Abstract
Purpose In this proof-of-concept pilot study, we aimed to increase nurse practitioner (NP) student knowledge of ophthalmology to prepare NPs for encounters in primary care settings. The ...Association of University Professors of Ophthalmology (AUPO) and the American Academy of Ophthalmology (AAO) endorse core knowledge that medical students should achieve. We assess the effectiveness of an innovative ophthalmologist-led curriculum based on these competencies tailored to issues NPs encounter in primary care.
Methods Johns Hopkins University NP students enrolled in a pre–post-cohort study and educational intervention. The didactic program was developed according to AUPO and AAO core ophthalmology content for medical students and was taught in-person by an ophthalmologist. Pre–post-assessments evaluated students' perceived readiness to encounter ophthalmic issues in the clinic and baseline knowledge of core competencies of ophthalmology.
Results A total of 42 NP students were included in the analysis. NP students improved in core knowledge and readiness to encounter ophthalmology issues. After the educational event, there was a statistically significant improvement in students' ratings of preparedness to obtain a focused history, exam, perform initial management and decide the urgency of a referral for acute painless vision loss (p < 0.001), chronic vision loss (p < 0.001), or a patient with a red/painful eye (p < 0.001). Students showed a statistically significant improvement in postdidactic event core ophthalmology knowledge assessment scores (p = 0.002).
Conclusion Primary care NPs are increasingly the initial point of contact for patients with ophthalmic complaints, and thus, high-quality and thorough education regarding ophthalmology triage and referral for NPs is necessary. NP student comfort with and knowledge of ophthalmic complaints and triage may be improved by a brief educational intervention taught by an ophthalmologist early in the NP curriculum.
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