Dataset Information

Surgery during the COVID-19 pandemic: operating room suggestions from an international Delphi process.

ABSTRACT:

Background

Operating room (OR) practice during the COVID-19 pandemic is driven by basic principles, shared experience and nascent literature. This study aimed to identify the knowledge needs of the global OR workforce, and characterize supportive evidence to establish consensus.

Methods

A rapid, modified Delphi exercise was performed, open to all stakeholders, informed via an online international collaborative evaluation.

Results

The consensus exercise was completed by 339 individuals from 41 countries (64·3 per cent UK). Consensus was reached on 71 of 100 statements, predominantly standardization of OR pathways, OR staffing and preoperative screening or diagnosis. The highest levels of consensus were observed in statements relating to appropriate personal protective equipment (PPE) and risk distribution (96-99 per cent), clear consent processes (96 per cent), multidisciplinary decision-making and working (97 per cent). Statements yielding equivocal responses predominantly related to technical and procedure choices, including: decontamination (40-68 per cent), laminar flow systems (13-61 per cent), PPE reuse (58 per cent), risk stratification of patients (21-48 per cent), open versus laparoscopic surgery (63 per cent), preferential cholecystostomy in biliary disease (48 per cent), and definition of aerosol-generating procedures (19 per cent).

Conclusion

High levels of consensus existed for many statements within each domain, supporting much of the initial guidance issued by professional bodies. However, there were several contentious areas, which represent urgent targets for investigation to delineate safe COVID-19-related OR practice.

SUBMITTER: Welsh Surgical Research Initiative (WSRI) Collaborative

PROVIDER: S-EPMC7273074 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

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Publications

Surgery during the COVID-19 pandemic: operating room suggestions from an international Delphi process.

The British journal of surgery 20200627 11

<h4>Background</h4>Operating room (OR) practice during the COVID-19 pandemic is driven by basic principles, shared experience and nascent literature. This study aimed to identify the knowledge needs of the global OR workforce, and characterize supportive evidence to establish consensus.<h4>Methods</h4>A rapid, modified Delphi exercise was performed, open to all stakeholders, informed via an online international collaborative evaluation.<h4>Results</h4>The consensus exercise was completed by 339 ...[more]

PMID: 32395829

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Project description:BACKGROUND:Although the surgical pause or time-out is a required part of most hospitals' standard operating procedures, little is known about the quality of execution of the time-out in routine clinical practice. An interactive electronic time-out was implemented to increase surgical team compliance with the time-out procedure and to improve communication among team members in the operating room. We sought to identify nonroutine events that occur during the time-out procedure in the operating room, including distractions and interruptions, deviations from protocol, and the problem-solving strategies used by operating room team members to mitigate them. METHODS:Direct observations of surgical time-outs were performed on 166 nonemergent surgeries in 2016. For each time-out, the observers recorded compliance with each step, any nonroutine events that may have occurred, and whether any operating room team members were distracted. RESULTS:The time-out procedure was performed before the first incision in 100% of cases. An announcement was made to indicate the start of the time-out procedure in 163 of 166 observed surgeries. Most observed time-outs were completed in <1 minute. Most time-outs were completed without interruption (92.8%). The most common reason for an interruption was to verify patient information. Ten time-out procedures were stopped due to a safety concern. At least 1 member of the operating room team was actively distracted in 10.2% of the time-out procedures observed. CONCLUSIONS:Compliance with preincision time-outs is high at our institution, and nonroutine events are a rare occurrence. It is common for ?1 member of the operating room team to be actively distracted during time-out procedures, even though most time-outs are completed in under 1 minute. Despite distractions, there were no wrong-site or wrong-person surgeries reported at our hospital during the study period. We conclude that the simple act of performing a preprocedure checklist may be completed quickly, but that distractions are common.

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Dataset Information

Surgery during the COVID-19 pandemic: operating room suggestions from an international Delphi process.

Background

Methods

Results

Conclusion

Publications

Surgery during the COVID-19 pandemic: operating room suggestions from an international Delphi process.

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