INTRODUCTION: The surgical debrief is a standardized checklist performed near the conclusion of a surgery, similar to the pre-procedure “Time Out.” This surgeon lead debrief confirms correct procedures and specimens, addresses anesthesia concerns, patient disposition, and allows all team members to participate in discussions regarding case efficiency. It has been studied in several surgical fields and shown to improve operating room safety and communication, increase efficiency, and decrease morbidity. It also provides opportunities for educational feedback in academic institutions. The surgical debrief has not been studied in gynecologic surgery. This study evaluates the implementation of a standardized surgical debrief at a teaching hospital. METHODS: This is a quality improvement study using PDSA (plan-do-study-act) cycles to implement surgical debriefs in all gynecologic surgeries performed at this hospital. All OR team members took pre/post implementation surveys regarding OR safety and communication and received surgeon lead education regarding implementation protocols. IRB approval was obtained. RESULTS: In PDSA cycle 1, 59% (33/56) of eligible gynecologic surgeries completed debriefs. In PDSA cycle 2, debriefs were completed in 70% (40/57) of eligible gynecologic surgeries. Immediate resident feedback occurred in 46% of the cases that completed debriefs. CONCLUSION: The surgical debrief was successfully implemented into gynecologic surgery. Anonymous survey results by the vast majority of OR personnel felt the debrief enhanced OR safety, improved communication, and prompted immediate resident feedback in such a positive way, that it has been adopted routinely for all cases, amongst all surgical specialties at this institution.
Faculty Advisor: Arthur Ollendorff, MD PURPOSE: To increase surgical evaluations by implementing a post-procedure Time Out for teaching. BACKGROUND: Compliance with intra-operative resident feedback and use of myTIPreport evaluations is poor. Feedback with completed evaluations is vital to improving surgical competence and compliance with ACGME milestones. METHODS: Post procedure Time Out for Teaching was implemented after gynecologic surgery to remind faculty to complete evaluations. A paper myTIPreport evaluation was provided in each operating room. Compliance goal was 80%. Evaluations were completed prior to leaving the operating room. PDSA cycles were used to introduce and evaluate this process. Using T-test, we compared completion rates prior to implementation of the Time Out. We removed the paper evaluations and continued PDSA cycles with the Time Out and electronic evaluations only. We compared completion rates of Time Out with paper evaluations to those with electronic evaluations. RESULTS: Implementing the Time Out with paper evaluations significantly improved compliance from 6/101 (5.9%) to 74/90 (82%, P<.01). When paper was removed, there was no significant difference in completed evaluations with Time Out alone (P=.14). Evaluation using chi squared and Fisher's exact tests showed completion rates with paper to be 11.36 times higher than with electronic evaluations (P<.0001). DISCUSSION: Adding a Post-procedure Time Out to remind faculty to complete intra-operative evaluations did improve compliance. However, having a paper evaluation proved to increase compliance more than the Time Out with electronic evaluations. We plan to continue the Time Out for Teaching process, but will give faculty the option to complete evaluations on paper.
INTRODUCTION: Abnormal weight and its effects on health and fertility are poorly understood by patients. We aimed to evaluate differences in knowledge of abnormal weight and its effect on fertility between patients seen for infertility and general gynecology (GYN) at a rural, resident-run clinic. METHODS: Participation in this 12-question survey-based analysis of weight/fertility knowledge was offered to patients seen in our rural, resident-run clinic. Survey assessed knowledge of abnormal weight and its effect on fertility, yielding a “Fertility Knowledge Score” and “Physician Education Score.” Visit number, age, visit type, and body mass index (BMI) were collected via chart review. The mean correct scores of both groups of patients (infertility and GYN) were compared using 2 sample T-test and Chi-squared test. RESULTS: Surveys for 44 infertility patients and 51 GYN patients were included. Infertility patients had higher mean BMI (37.5) than gynecology patients (32.9), (p=0.0263); 91% of fertility patients and 80% of GYN patients were overweight/obese. Infertility patients (p=0.0239) and patients with higher BMI (p=0.0112) reported discussing weight/BMI with a physician more often. There was no difference in survey scores between new and established patients overall or when these scores were analyzed by patient weight. CONCLUSION: Both infertility and GYN patients have little insight into their own BMI, with no change over visits. BMI is higher among infertility patients. Though, infertility patients have high general knowledge of effects of abnormal weight on fertility. This suggests we are not effectively discussing individual implications of weight/BMI despite large numbers of overweight/obese patients under our care.
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