Structures, processes and models of care for emergency general surgery in Ontario: a cross-sectional survey

Skelhorne‐Gross, Graham; Nenshi, Rahima; Jerath, Angela; Gomez, David

doi:10.9778/cmajo.20200306

Cited by 4 publications

(10 citation statements)

References 39 publications

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“… 27 The practice patterns were variable, with differences noted across different sociodemographic cohorts and different types of hospitals and regions of the country. It is possible that academic institutions have greater access to advanced endoscopic procedures 28 to palliate symptoms and therefore use radiation less often, although the regional differences could represent different levels of clinician and patient enthusiasm for radiation as a palliative approach in different parts of the country. Alternatively, this could reflect differences in prevalence of obstructive symptoms at presentation or nutritional reserve.…”

Section: Discussionmentioning

confidence: 99%

Utilization and Outcomes of Radiation in Stage IV Esophageal Cancer

Zhan¹,

Canavan²,

Ermer³

et al. 2022

JTO Clinical and Research Reports

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Section: Discussionmentioning

confidence: 99%

Utilization and Outcomes of Radiation in Stage IV Esophageal Cancer

Zhan¹,

Canavan²,

Ermer³

et al. 2022

JTO Clinical and Research Reports

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“…Furthermore, population with access was measured at the census block centroid, which may over or underestimate access in some areas. Services offered by Ornge, the sole provincial critical care transport and air ambulance service in Ontario [ 27 ], were not included. Air ambulances are critical in reaching rural and remote patients, and this may have unaccounted consequences for this group.…”

Section: Discussionmentioning

confidence: 99%

“…Hospital information was derived from a survey assessing structures, processes, and models of care across hospitals in Ontario in 2020 [ 27 ]. The authors identified that 114 of the 147 hospitals within Ontario offered urgent general surgical care: non-elective general surgery within 24–48 h of presentation, which we define here as EGS care [ 28 ].…”

Section: Methodsmentioning

confidence: 99%

“…All 114 institutions were considered capable of providing EGS care based on publicly available information for the 5 non-respondents. We used survey data to further classify these institutions by whether they offered 24-h, any day (24/7) emergency department (ED) care ( n = 100), or 24/7 operating room (OR) availability ( n = 77), corresponding to critical aspects of EGS services [ 27 ]. Although some centers with 24/7 EDs did not have 24/7 ORs, all those with a 24/7 OR had around-the-clock EDs, making OR availability the most restrictive factor.…”

Section: Methodsmentioning

confidence: 99%

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Potential Access to Emergency General Surgical Care in Ontario

Nantais

Larsen

Skelhorne‐Gross

et al. 2022

IJERPH

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Limited access to timely emergency general surgery (EGS) care is a probable driver of increased mortality and morbidity. Our objective was to estimate the portion of the Ontario population with potential access to 24/7 EGS care. Geographic information system-based network-analysis was used to model 15-, 30-, 45-, 60-, and 90-min land transport catchment areas for hospitals providing EGS care, 24/7 emergency department (ED) access, and/or 24/7 operating room (OR) access. The capabilities of hospitals to provide each service were derived from a prior survey. Population counts were based on 2016 census blocks, and the 2019 road network for Ontario was used to determine speed limits and driving restrictions. Ninety-six percent of the Ontario population (n = 12,933,892) lived within 30-min’s driving time to a hospital that provides any EGS care. The availability of 24/7 EDs was somewhat more limited, with 95% (n = 12,821,747) having potential access at 30-min. Potential access to all factors, including 24/7 ORs, was only possible for 93% (n = 12,471,908) of people at 30-min. Populations with potential access were tightly clustered around metropolitan centers. Supplementation of 24/7 OR capabilities, particularly in centers with existing 24/7 ED infrastructure, is most likely to improve access without the need for new hospitals.

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“…One study identified a group of processes involved in carotid endarterectomy 34. Other studies have investigated processes of care within palliative care surgery35 or emergency general surgery 36. However, there is limited data regarding what set of processes of care are essential to delivering high quality intraoperative care for patients undergoing GI cancer surgery 37.…”

Section: Introductionmentioning

confidence: 99%

Role of intraoperative processes of care during major upper gastrointestinal oncological resection in postoperative outcomes: a scoping review protocol

et al. 2023

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IntroductionOptimal delivery and organisation of care is critical for surgical outcomes and healthcare systems efficiency. Anaesthesia volumes have been recently associated with improved postoperative recovery outcomes; however, the mechanism is unclear. Understanding the individual processes of care (interventions received by the patient) is important to design effective systems that leverage the volume-outcome association to improve patient care. The primary objective of this scoping review is to systematically map the evidence regarding intraoperative processes of care for upper gastrointestinal cancer surgery. We aim to synthesise the quantity, type, and scope of studies on intraoperative processes of care in adults who undergo major upper gastrointestinal cancer surgeries (oesophagectomy, hepatectomy, pancreaticoduodenectomy, and gastrectomy) to better understand the volume-outcome relationship for anaesthesiology care.Methods and analysisThis scoping review will follow the Arksey and O’Malley framework and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension framework for scoping reviews. We will systematically search MEDLINE, Embase and Cochrane databases for original research articles published after 2010 examining postoperative outcomes in adult patients undergoing either: oesophagectomy, hepatectomy, pancreaticoduodenectomy, or gastrectomy, which report at least one intraoperative processes of care (intervention or framework) applied by anaesthesia or surgery. The data from included studies will be extracted, charted, and summarised both quantitatively and qualitatively through descriptive statistics and narrative synthesis.Ethics and disseminationNo ethics approval is required for this scoping review. Results will be disseminated through publication targeted at relevant stakeholders in anaesthesiology and cancer surgery.Trial registration number10.17605/OSF.IO/392UG;https://archive.org/details/osf-registrations-392ug-v1.

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Structures, processes and models of care for emergency general surgery in Ontario: a cross-sectional survey

Cited by 4 publications

References 39 publications

Utilization and Outcomes of Radiation in Stage IV Esophageal Cancer

Utilization and Outcomes of Radiation in Stage IV Esophageal Cancer

Potential Access to Emergency General Surgical Care in Ontario

Role of intraoperative processes of care during major upper gastrointestinal oncological resection in postoperative outcomes: a scoping review protocol

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