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Development of a  Standard Operating Procedure (SOP) for  Laparoscopic Roux-en-Y Gastric Bypass Abeezar Sarela, Krishna Mo...
 
Standard Operating Procedure <ul><li>Effective catalyst to drive performance-improvement and improve organizational result...
 
Safety in Bariatric Surgery <ul><li>WHO: Safe Surgery Saves Lives </li></ul><ul><li>National Patient Safety Agency </li></...
Aims <ul><li>To develop a prototype Standard Operating Procedure (SOP) for laparoscopic Roux-en-Y Gastric Bypass  </li></u...
Creation of a  Standard Operating Procedure <ul><li>Working Group </li></ul><ul><li>Consultation </li></ul><ul><li>Consens...
Consultation Outcome: Safety Domains for Bariatric Surgery <ul><li>Wrong procedure-Wrong patient </li></ul><ul><li>Equipme...
Consensus Building: Process Categories in Bariatric Surgery <ul><li>Processes supported by strong evidence to improve safe...
Consensus-Building: Process Categories in Bariatric Surgery <ul><li>Processes supported by strong evidence to improve safe...
Consensus-Building: Process Categories in Bariatric Surgery <ul><li>Processes supported by strong evidence to improve safe...
Assessment <ul><li>Examination of  </li></ul><ul><li>case-notes just before discharge of patient from hospital </li></ul>
Variability <ul><li>Between two centres: 10%-90% </li></ul><ul><ul><li>Pre-list briefing </li></ul></ul><ul><ul><li>Safety...
Summary <ul><li>Collaborative, multi-disciplinary approach was effective to generate a prototype SOP for laparoscopic gast...
Conclusion <ul><li>Generic SOP template </li></ul><ul><li>Centre-specific population of template </li></ul><ul><li>Wide as...
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Sop for rygb

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Sop for rygb

  1. 1. Development of a Standard Operating Procedure (SOP) for Laparoscopic Roux-en-Y Gastric Bypass Abeezar Sarela, Krishna Moorthy 1 , Andrea Fox-Hiley, Joanne Johnston, Simon Dexter, Michael McMahon St James’s University Hospital & Nuffield Hospital, Leeds 1 Imperial College School of Medicine
  2. 3. Standard Operating Procedure <ul><li>Effective catalyst to drive performance-improvement and improve organizational results </li></ul><ul><li>Elimination of variation because of different levels of: </li></ul><ul><ul><li>Knowledge </li></ul></ul><ul><ul><li>Experience </li></ul></ul><ul><ul><li>Skill </li></ul></ul>
  3. 5. Safety in Bariatric Surgery <ul><li>WHO: Safe Surgery Saves Lives </li></ul><ul><li>National Patient Safety Agency </li></ul><ul><ul><li>Briefing : facilitate information transfer </li></ul></ul><ul><ul><li>Checklist : minimize memory recall </li></ul></ul><ul><li>Standard Operating Procedure (SOP) </li></ul><ul><ul><li>Live, inter-active document </li></ul></ul><ul><ul><li>Text and audio-visual details of current best methods </li></ul></ul><ul><ul><li>Ensures quality, cost, delivery and safety targets </li></ul></ul>
  4. 6. Aims <ul><li>To develop a prototype Standard Operating Procedure (SOP) for laparoscopic Roux-en-Y Gastric Bypass </li></ul><ul><li>Preliminary assessment of variability in the application of the SOP </li></ul>
  5. 7. Creation of a Standard Operating Procedure <ul><li>Working Group </li></ul><ul><li>Consultation </li></ul><ul><li>Consensus-Building </li></ul>
  6. 8. Consultation Outcome: Safety Domains for Bariatric Surgery <ul><li>Wrong procedure-Wrong patient </li></ul><ul><li>Equipment-related problems </li></ul><ul><li>Venous thromboembolism prophylaxis </li></ul><ul><li>Surgical technique </li></ul><ul><li>Strategies for post-operative care </li></ul>
  7. 9. Consensus Building: Process Categories in Bariatric Surgery <ul><li>Processes supported by strong evidence to improve safety </li></ul><ul><li>Thromboembolism prophylaxis </li></ul><ul><ul><li>Timing in relation to surgery </li></ul></ul><ul><ul><li>Extended post-operative therapy </li></ul></ul><ul><li>Pre-operation briefing & checklists </li></ul><ul><li>Pre-operation risk stratification </li></ul>
  8. 10. Consensus-Building: Process Categories in Bariatric Surgery <ul><li>Processes supported by strong evidence to improve safety </li></ul><ul><li>Processes related to surgical technique </li></ul><ul><ul><li>Anastomotic leakage-test </li></ul></ul><ul><ul><li>Closure of mesenteric defects </li></ul></ul>
  9. 11. Consensus-Building: Process Categories in Bariatric Surgery <ul><li>Processes supported by strong evidence to improve safety </li></ul><ul><li>Processes related to surgical technique </li></ul><ul><li>Processes without common practise </li></ul><ul><ul><li>Discharge advice for diabetes medication </li></ul></ul>
  10. 12. Assessment <ul><li>Examination of </li></ul><ul><li>case-notes just before discharge of patient from hospital </li></ul>
  11. 13. Variability <ul><li>Between two centres: 10%-90% </li></ul><ul><ul><li>Pre-list briefing </li></ul></ul><ul><ul><li>Safety checklist </li></ul></ul><ul><ul><li>Closure of mesenteric & Peterson’s defects </li></ul></ul><ul><ul><li>Discharge advise on diabetes medication </li></ul></ul><ul><li>Amongst surgeons in the same centre: 5-10% </li></ul>
  12. 14. Summary <ul><li>Collaborative, multi-disciplinary approach was effective to generate a prototype SOP for laparoscopic gastric bypass </li></ul><ul><li>Substantial variation between centres </li></ul><ul><li>Minimal variation amongst surgeons in the same centre </li></ul>
  13. 15. Conclusion <ul><li>Generic SOP template </li></ul><ul><li>Centre-specific population of template </li></ul><ul><li>Wide assessment </li></ul><ul><li>Review </li></ul>

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