Hot Topics in Surgical Patient Safety brought together a panel of surgeons to discuss high-interest issues such as protocols for operating room (OR) attire during the COVID-19 pandemic on Monday afternoon, October 5, at the virtual Clinical Congress 2020.
This and other educational sessions will be available for on-demand viewing through the virtual meeting platform through December 31.
Heather L. Evans, MD, MS, FACS, vice-chair of clinical research and applied informatics, Medical University of South Carolina (MUSC), Charleston, was part of a team that developed a protocol and instructional materials for donning and doffing sterile personal protective equipment (PPE) for surgical teams aimed at protection against exposure to the SARS-CoV-2 virus that causes COVID-19.
“There was a lack of guidance, as no one was an expert in the coronavirus at the time,” Dr. Evans said, “and the standards for using PPE were difficult to meet once we actually did decide on what those should be due to the supply chain challenges that we experienced throughout the U.S.”
The guide for PPE in the OR instituted at MUSC Health, the university’s clinical health system, was adapted from National Emerging Special Pathogen Training and Education Center (NETEC) protocols for use outside of the sterile OR and was later made available online and published in Surgical Infections in July.
In addressing another key topic in surgical patient safety, Nicole M. Saur, MD, FACS, FASCRS, assistant professor of surgery, University of Pennsylvania, Philadelphia, suggested perioperative care of geriatric patients can be improved through universal frailty screening, multidisciplinary optimization based on the patient’s risk factors, optimal perioperative care, and a multidisciplinary approach to postoperative care.
“Prehabilitation is just once piece of this very complex puzzle to treat these patients,” Dr. Saur said. “Hopefully, we can start to fine tune the entire multimodality pathway so that we can fill in more of the puzzle pieces.”
Another speaker, Syed Husain, MBBS, FACS, FASCRS, associate professor, division of colon and rectal surgery, Wexner Medical Center, Ohio State University, Columbus, spoke about strategies to prevent surgical site infections (SSIs).
He said 2 to 5 percent of surgical patients experience an SSI, adding up to an estimated 500,000 such infections each year, and resulting in about $10 billion in annual health care expenditures. Smoking cessation, weight reduction, nutritional optimization, glycemic control, bowel prep, antibiotics, and skin prep are all preoperative interventions that contribute to lowering the risk of these infections, Dr. Husain explained.
Panelist Douglas S. Smink, MD, MPH, FACS, program director for general surgery residency and associate chair of education, department of surgery, Brigham and Women’s Hospital, Boston, MA, and associate professor of surgery, Harvard Medical School, Cambridge, MA, spoke about training surgeons and surgical teams in nontechnical skills such as situational awareness, leadership, communication, and teamwork.
“I would argue that as surgeons, we almost never, if ever, practice with our team, and that we rarely talk with them about the work we do together,” Dr. Smink said. “I think those are two things that we should change.”
Failure to rescue, or death following a major complication after surgery, was another hot topic addressed by the panel. “One can try to avoid any complications through preventative measures, or [by pursuing] something that hasn’t been explored as much—trying to stop this cascade of events once a complication has occurred and being able to effectively rescue that patient once they’ve developed that complication, said Amir A. Ghaferi, MD, MS, FACS, vice-chair for strategy and finance, associate professor of surgery and business, health system director for ambulatory surgery, University of Michigan, and director, Michigan Bariatric Surgery Collective, Ann Arbor.
The final speaker, Elizabeth C. Wick, MD, FACS, professor of surgery, vice-chair of quality and safety, University of California, San Francisco, discussed how to make sense of hospital rankings, for which she leveled some criticism. She finds them incomplete, in part because they rely on limited publicly available data and because they often are based on information that is a few years old and may not reflect recent changes and turnover at an institution.
While patients must be a surgeon’s “north star,” guiding their actions, Dr. Wick said it is beneficial to know how an institution’s surgical quality program can enhance performance rankings.