Audit of emergent and urgent surgery for acutely ill pediatric patients: is access timely?

Chan, Grace; Butterworth, Sonia A.

doi:10.1016/j.jpedsurg.2016.02.033

Cited by 4 publications

(6 citation statements)

References 15 publications

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“…Institutional factors occasionally determine whether a surgical procedure or treatment plan could be provided to their patients or not, based on the availability of specific surgical tools and expertise. 3 , 6 , 23 – 25 Surgeons working at academic hospitals of the University of Toronto found that occasionally they would receive referrals from non-academic hospitals due to the unavailability of specific surgical equipment and/or expertise. Although surgeons felt that their institution provided many resources regarding surgical equipment, they expressed a concern that there was still room for improvement.…”

Section: Discussionmentioning

confidence: 99%

Factors Affecting Surgical Decisionmaking—A Qualitative Study

Gunaratnam¹,

Bernstein²

2018

Rambam Maimonides Med J

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BackgroundGuidelines and Class 1 evidence are strong factors that help guide surgeons’ decision-making, but dilemmas exist in selecting the best surgical option, usually without the benefit of guidelines or Class 1 evidence. A few studies have discussed the variability of surgical treatment options that are currently available, but no study has examined surgeons’ views on the influential factors that encourage them to choose one surgical treatment over another. This study examines the influential factors and the thought process that encourage surgeons to make these decisions in such circumstances.MethodsSemi-structured face-to-face interviews were conducted with 32 senior consultant surgeons, surgical fellows, and senior surgical residents at the University of Toronto teaching hospitals. An e-mail was sent out for volunteers, and interviews were audio-recorded, transcribed verbatim, and subjected to thematic analysis using open and axial coding.ResultsBroadly speaking there are five groups of factors affecting surgeons’ decision-making: medical condition, information, institutional, patient, and surgeon factors. When information factors such as guidelines and Class 1 evidence are lacking, the other four groups of factors—medical condition, institutional, patient, and surgeon factors (the last-mentioned likely being the most powerful)—play a significant role in guiding surgical decision-making.ConclusionsThis study is the first qualitative study on surgeons’ perspectives on the influential factors that help them choose one surgical treatment option over another for their patients.

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Section: Discussionmentioning

confidence: 99%

Factors Affecting Surgical Decisionmaking—A Qualitative Study

Gunaratnam¹,

Bernstein²

2018

Rambam Maimonides Med J

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“…Patients in high-and low-resource settings experience delays in emergency surgical care and thus suffer increased morbidity and mortality. [2][3][4][5][6][7][8][9][10][11] There are three primary phases of delay: pre-hospital, inter-facility, and in-hospital. 1,2 Pre-hospital delay, or a delay in seeking care, can stem from financial or geographic restrictions, cultural beliefs, lack of education, historic disconnection from formal health systems, and lack of awareness or confidence in formal health structures.…”

Section: Introductionmentioning

confidence: 99%

“…[2][3][4][5][6][7][8][9][10][11] There are three primary phases of delay: pre-hospital, inter-facility, and in-hospital. 1,2 Pre-hospital delay, or a delay in seeking care, can stem from financial or geographic restrictions, cultural beliefs, lack of education, historic disconnection from formal health systems, and lack of awareness or confidence in formal health structures. Inter-facility, or delay in reaching a healthcare facility with the capability of providing definitive care after initial healthcare presentation, is related to the lack of access to hospitals with surgical capacity and lack of access to reliable and affordable transportation and geographical barriers.…”

Section: Introductionmentioning

confidence: 99%

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Reasons for in-hospital delays to emergency surgical care in a resource-limited setting: Surgery versus anesthesiology perspective

Robinson

Purcell

Reiss³

et al. 2022

Trop Doct

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Patients experience delays in emergency surgical care. Our 3-month mixed-methods observational prospective study examined the duration of in-hospital delays (IHDs) to emergency surgery at a tertiary hospital in Malawi and perceived reasons for such delay, assessing the correlation between surgery and anesthesia. Delays over two hours occurred in the majority, and almost 20% waited over twelve hours. However, we found no correlation between surgeons and anaesthetists in the perceived reasons for In-hospital delays to emergency surgical care.

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“…Delays in surgical intervention for emergency conditions increase mortality. The three primary sources of delay to surgical care for patients in limited‐resource settings include: delay in seeking care (pre‐hospital), delay in transferring to a facility equipped to perform the procedure (interfacility), and delay from presentation at a hospital able to provide definitive care to the start of the operative intervention (in‐hospital delays; IHDs).…”

Section: Introductionmentioning

confidence: 99%

Effect of in‐hospital delays on surgical mortality for emergency general surgery conditions at a tertiary hospital in Malawi

et al. 2019

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Background In sub‐Saharan Africa, surgical access is limited by an inadequate surgical workforce, lack of infrastructure and decreased care‐seeking by patients. Delays in treatment can result from delayed presentation (pre‐hospital), delays in transfer (intrafacility) or after arrival at the treating centre (in‐hospital delay; IHD). This study evaluated the effect of IHD on mortality among patients undergoing emergency general surgery and identified factors associated with IHD. Methods Utilizing Malawi's Kamuzu Central Hospital Emergency General Surgery database, data were collected prospectively from September 2013 to November 2017. Included patients had a diagnosis considered to warrant urgent or emergency intervention for surgery. Bivariable analysis and Poisson regression modelling was done to determine the effect of IHD (more than 24 h) on mortality, and identify factors associated with IHD. Results Of 764 included patients, 281 (36·8 per cent) had IHDs. After adjustment, IHD (relative risk (RR) 1·68, 95 per cent c.i. 1·01 to 2·78; P = 0·045), generalized peritonitis (RR 4·49, 1·69 to 11·95; P = 0·005) and gastrointestinal perforation (RR 3·73, 1·25 to 11·08; P = 0·018) were associated with a higher risk of mortality. Female sex (RR 1·33, 1·08 to 1·64; P = 0·007), obtaining any laboratory results (RR 1·58, 1·29 to 1·94; P < 0·001) and night‐time admission (RR 1·59, 1·32 to 1·90; P < 0·001) were associated with an increased risk of IHD after adjustment. Conclusion IHDs were associated with increased mortality. Increased staffing levels and operating room availability at tertiary hospitals, especially at night, are needed.

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Audit of emergent and urgent surgery for acutely ill pediatric patients: is access timely?

Cited by 4 publications

References 15 publications

Factors Affecting Surgical Decisionmaking—A Qualitative Study

Factors Affecting Surgical Decisionmaking—A Qualitative Study

Reasons for in-hospital delays to emergency surgical care in a resource-limited setting: Surgery versus anesthesiology perspective

Effect of in‐hospital delays on surgical mortality for emergency general surgery conditions at a tertiary hospital in Malawi

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