1) Great Ormond Street Hospital for Children (GOSH) benchmarked its handoff process from cardiac surgery to intensive care against the pit stop techniques of Formula One racing teams.
2) Process improvements resulting from this benchmarking included increased standardization, role definition, coordination, and checklists, which led to increased patient safety and decreased error rates.
3) While some aspects like teamwork and choreography were directly transferable, other Formula One techniques like extensive rehearsal and contingency planning were not feasible for GOSH due to limitations of resources, flexibility needs, and the complexity of living patients compared to race cars.
CURRICULUM ON RESIDENCY PROGRAM FOR FCPS MOLECULAR PATHOLOGYJibran Mohsin
CURRICULUM ON RESIDENCY PROGRAM FOR FCPS MOLECULAR PATHOLOGY (Advanced Level Course on Curriculum Development in Health Professions Education, Department for Educational Development, The Aga Khan University)
This presentation focusses on the importance of diagnostic biomarkers for Alzheimer's disease. MRI, amyloid PET and CSF biomarkers are discussed in detail.
Treacher Collins Syndrome is a rare genetic disorder that affects the development of the facial structures. It is caused by mutations in genes that play roles in facial development. The syndrome is characterized by hypoplasia of the zygomatic bones, mandible, and other facial structures derived from the first and second branchial arches. Treatment involves a series of reconstructive surgeries throughout childhood to correct functional issues and reconstruct the facial structures. Surgical techniques discussed include mandibular distraction, zygomaticomaxillary bone grafting and distraction, and coloboma repair. Later orthognathic procedures may also be considered in selected adult patients.
What does “climate-resilient health systems” and “GREEN and SMART healthcare ...Changgyo Yoon
Given the important role of climate resilient health systems in the Pacific countries where the health impact of climate change is inevitable, this presentation discusses how to contextualize the concept of climate resilience in assessing and strengthening health care facilities in the Pacific.
Artificial intelligence has various applications in oral and maxillofacial surgery including robotics, navigation surgery, virtual reality, and augmented reality. AI-based systems use machine learning and neural networks to aid in clinical decision making, diagnosis, treatment planning, and predicting outcomes. Recent advances in AI, virtual reality, augmented reality, and surgical navigation have improved precision and simplified complex procedures in oral and maxillofacial surgery. However, more data and training is still needed for AI to reach its full potential.
CURRICULUM ON RESIDENCY PROGRAM FOR FCPS MOLECULAR PATHOLOGYJibran Mohsin
CURRICULUM ON RESIDENCY PROGRAM FOR FCPS MOLECULAR PATHOLOGY (Advanced Level Course on Curriculum Development in Health Professions Education, Department for Educational Development, The Aga Khan University)
This presentation focusses on the importance of diagnostic biomarkers for Alzheimer's disease. MRI, amyloid PET and CSF biomarkers are discussed in detail.
Treacher Collins Syndrome is a rare genetic disorder that affects the development of the facial structures. It is caused by mutations in genes that play roles in facial development. The syndrome is characterized by hypoplasia of the zygomatic bones, mandible, and other facial structures derived from the first and second branchial arches. Treatment involves a series of reconstructive surgeries throughout childhood to correct functional issues and reconstruct the facial structures. Surgical techniques discussed include mandibular distraction, zygomaticomaxillary bone grafting and distraction, and coloboma repair. Later orthognathic procedures may also be considered in selected adult patients.
What does “climate-resilient health systems” and “GREEN and SMART healthcare ...Changgyo Yoon
Given the important role of climate resilient health systems in the Pacific countries where the health impact of climate change is inevitable, this presentation discusses how to contextualize the concept of climate resilience in assessing and strengthening health care facilities in the Pacific.
Artificial intelligence has various applications in oral and maxillofacial surgery including robotics, navigation surgery, virtual reality, and augmented reality. AI-based systems use machine learning and neural networks to aid in clinical decision making, diagnosis, treatment planning, and predicting outcomes. Recent advances in AI, virtual reality, augmented reality, and surgical navigation have improved precision and simplified complex procedures in oral and maxillofacial surgery. However, more data and training is still needed for AI to reach its full potential.
Prof. Mridul Panditrao's Peri-operative Management of Jehovah's Witness Patient Prof. Mridul Panditrao
This document describes the peri-operative management of a Jehovah's Witness patient requiring an emergency exploratory laparotomy who refused blood transfusion. It presents a case report of a 65-year-old male who underwent surgery under general anesthesia. Special consent was obtained for no blood transfusion. Intraoperatively, blood loss was replaced with crystalloids and the colloid Tetrastarch (Voluven) to maintain cardiovascular stability given the patient's anemia. The patient had an uneventful recovery without blood transfusion, demonstrating that surgery can be safely performed in Jehovah's Witness patients refusing transfusion through careful pre-operative optimization and use of alternatives to blood loss replacement like collo
Building a world class surgical program requires assuring an efficient and effective peri-operative process. This includes standardizing cardiac clearance as part of pre-admission testing, developing preference cards to reduce variation in practice, and creating an efficiency index to maximize the use of space, time, staff, and patient safety. The goal is an efficient operating room workflow from patient arrival to recovery.
Prof. Mridul Panditrao's Peri-operative MANAGEMENT OF Patients for LaparoscopyProf. Mridul Panditrao
Prof. Panditrao takes you in the detailed discussion about the historical aspects, problems, altered physiology, preparation of and Anesthetic/ peri-operative management of the patients for various laparoscopic surgical procedures
This document provides information on various minor surgical procedures including extraction, incision and drainage, biopsy, cyst removal, and root resection. It describes the indications, contraindications, techniques, and postoperative care for each procedure. Extraction involves removing a tooth while minimizing trauma to surrounding tissues. Incision and drainage treats localized swelling by incising and draining the fluctuant mass. Biopsies and cyst removals involve excising portions of or entire lesions for examination. Root resection, or apicoectomy, treats apical pathology by resecting and removing infected root portions. Proper techniques and care are outlined to perform each procedure safely and effectively.
This document defines and describes common surgical procedures including herniorrhaphy to correct hernias, amputation to remove limbs, turp to resect the prostate, gastrectomy to remove part of the stomach, thoracostomy to access the thoracic cavity, tonsillectomy to remove the tonsils, colostomy to create a stoma in the colon, hemorrhoidectomy to remove hemorrhoids, dilatation and curettage of the uterus, hysterectomy to remove the uterus and ovaries, pulmonary lobectomy to remove a lung lobe, pneumonectomy to remove an entire lung, and more. It provides indications for each procedure and relevant definitions.
The document describes several common minor surgical procedures, including incision and drainage, central venous pressure monitoring, tracheostomy, thoracentesis, pericardiocentesis, and paracentesis abdominis. For each procedure, the document discusses indications, relevant anatomy, equipment needed, and basic techniques. Minor surgical procedures allow for drainage, monitoring, airway management, fluid removal, and diagnostic sampling in a minimally invasive manner.
1. Fetal surgery is increasingly being used to treat conditions diagnosed before birth. Both endoscopic and open fetal surgeries are performed, though indications differ between the two methods.
2. While fetal surgery was pioneered in the US, Europe has more widely embraced fetoscopic interventions due to trials like Eurofoetus. However, uptake of open fetal surgery has been lower in Europe compared to the US.
3. The increasing use of fetal surgery has benefits but also limitations due to the rarity of suitable indications and the need for specialized multidisciplinary teams. Standards aim to ensure fetal surgery is primarily performed within clinical trials.
International Innovation RAFT_188_Research_Media_01margochanning
The Restoration of Appearance and Function Trust (RAFT) is a UK-based charity that conducts medical research to improve quality of life for patients dealing with diseases, injuries, or birth defects. Over its 27 years:
1) RAFT research has led to over 100 innovations used in hospitals worldwide to restore appearance and function for patients, helping them regain independence and dignity.
2) RAFT aims to train plastic surgeons in research to establish a new generation with strong research skills. 15% of UK plastic surgeons have a background with RAFT.
3) As a charity, RAFT has no public funding and must raise all funds itself, but continues to produce successful research recognized internationally despite financial
- The document discusses centralizing the intensive care units (ICUs) of Singapore Hospital to better handle major disasters and improve daily operations. The hospital's ICUs were previously spread across eight blocks according to specialty.
- Using simulation models, the feasibility of centralizing the ICUs was analyzed considering space constraints, costs, and staffing needs. The optimal number of centralized ICUs was determined to meet patient demand while fitting in the proposed centralized space.
- Centralizing ICUs can reduce patient transit times and improve survival chances, but faces challenges around costs, space limitations, and needing to retrain staff for a consolidated ICU model. Simulation results can help hospitals optimize intensive care processes.
Critical Care Summit 2015 -ECMO Milestones in EgyptDr.Mahmoud Abbas
1. The Critical Care Department at Cairo University introduced extracorporeal membrane oxygenation (ECMO) as a new technique after a male patient with avian influenza developed acute respiratory distress syndrome and required ECMO support.
2. A scientific day was held to introduce ECMO and its applications, convincing the department chief to build an ECMO center of excellence.
3. The Critical Care Department has since become the first and leading center for critical care in Egypt, treating over 6 ECMO cases with a mortality rate of 50% in their initial learning curve.
Element descriptionthe problem ofdescribe the problemaffectRAHUL126667
Massachusetts General Hospital's Pre-Admission Testing Area (PATA) was struggling with long patient wait times and inefficiencies. PATA was responsible for completing pre-operative work-ups for outpatient surgical patients, but faced challenges including limited capacity, lack of clear prioritization guidelines for surgeons, and shared ownership between departments. This resulted in patients spending hours in the clinic with minimal face time with providers, delays in surgeries, and overworked staff. A task force was formed to address these challenges, and brought on an MBA intern to conduct an assessment of PATA's processes.
1. The document describes the introduction and establishment of extracorporeal life support (ECLS) at the Critical Care Department of Cairo University Hospitals in Egypt.
2. An ECLS team was formed, physicians were trained abroad, and equipment was acquired to begin treating patients using ECLS.
3. The first few ECLS cases involved treating acute respiratory distress syndrome and had successful outcomes, demonstrating the viability of the new program in Egypt.
This document summarizes a hospital training report submitted by Jatin Sharma at the Clara Swain Mission Hospital in Bareilly, India. It provides background on the hospital's founding in the 1870s and its expansion in recent years. The report describes departments visited including OPD, emergency ward, ICU, and laboratories. It also covers procedures observed like IV insertions and ECG exams. The conclusion expresses that the training was helpful for learning patient care and healthcare systems.
Surgical orthodontics, also known as orthognathic surgery, aims to correct dentofacial deformities through a combination of orthodontic treatment and corrective jaw surgery. It seeks to improve both facial and dental aesthetics as well as create a functional bite. Key developments over time have improved surgical outcomes and patient comfort. Common indications for orthognathic surgery include severe class II or III malocclusions, facial asymmetries, and craniofacial anomalies. Careful examination, investigations, planning and multidisciplinary treatment are required to achieve optimal results.
An overview of the John Theurer Cancer Center at Hackensack University Medical Center - a top-50 U.S. News & World Report Best Hospitals for Cancer – the only cancer center in New Jersey with this prestigious designation.
To request printed copies of this brochure, please contact aleahing@p4strategy.com.
PHEM - Pre Hospital Emergency Medicine Guidelines for TrainersEmergency Live
This Guide describes the curriculum, training and assessment processes for Pre-hospital Emergency
Medicine (PHEM) sub-specialty training. It reflects the General Medical Council (GMC) standards and the
uK wide regulations for specialty training (the Gold Guide).1,2 Where there are differences between the four
uK national agencies, the parts of the Gold Guide applicable to these agencies should be regarded as the
definitive guidance.
The correct application of the safety check steps in our routine theatre operations and procedures will greatly reduce surgically related mortality and morbidity.
ABSTRACT
Objective: To evaluate the role of age as a moderator of bone regeneration patterns and
symphysis remodeling after genioplasty.
Method: Fifty-four patients who underwent genioplasty at the end of their orthodontic treatment
were divided into three age groups: younger than 15 years at the time of surgery (group 1), 15 to
19 years (group 2), and 20 years or older (group 3). Twenty-three patients who did not accept
genioplasty and had a follow-up radiograph 2 years after the end of their orthodontic treatment
were used as a control group. Patients were evaluated at three time points: immediate preoperative
(T1), immediate postoperative (T2,) and 2 years postsurgery (T3).
Results: The mean genial advancement at surgery was similar for the three age groups, but the
extent of remodeling around the repositioned chin was greater in group 1, less in group 2, and still
less in group 3. Symphysis thickness increased significantly during the 2-year postsurgery interval
for the three groups, and this increase was significantly greater in group 1 than in group 3.
Remodeling above and behind the repositioned chin also was greater in the younger patients. This
was related to greater vertical growth of the dentoalveolar process in the younger patients. There
was no evidence of a deleterious effect on mandibular growth.
Conclusion: The outcomes of forward-upward genioplasty include increased symphysis
thickness, bone apposition above B point, and remodeling at the inferior border. When indications
for this type of genioplasty are recognized, early surgical correction (before age 15) produces a
better outcome in terms of bone remodeling. (Angle Orthod. 0000;00:000–000.)
Risk Management Plan-Response to an adverse eventDaniel Akins
This document contains a risk management plan analyzing a case where two patients, Jonesky and Jones, received the wrong surgical procedures due to misidentification. A root cause analysis found that the error occurred due to a language barrier, fatigue of overworked staff, and a lack of verification during the pre-operation process. The risk management plan recommends establishing a diverse investigation team and timeline to analyze adverse events, improving identification procedures, and defining staff responsibilities to prevent future errors and improve patient safety.
The document discusses guidelines for day surgery. It notes that day surgery has expanded significantly due to advances in surgical and anesthetic techniques. National and international guidelines on patient care, admission/discharge processes, and running day surgery units have helped the growth of day surgery. The latest joint guidelines from 2019 provide recommendations such as thorough pre-assessment, determining fitness based on function rather than physical status, undertaking most surgeries as day cases, and trained multidisciplinary teams. Day surgery provides benefits to both patients, such as early mobility, and hospitals by freeing beds and reducing costs. A wide range of procedures are now suitable as day cases.
Prof. Mridul Panditrao's Peri-operative Management of Jehovah's Witness Patient Prof. Mridul Panditrao
This document describes the peri-operative management of a Jehovah's Witness patient requiring an emergency exploratory laparotomy who refused blood transfusion. It presents a case report of a 65-year-old male who underwent surgery under general anesthesia. Special consent was obtained for no blood transfusion. Intraoperatively, blood loss was replaced with crystalloids and the colloid Tetrastarch (Voluven) to maintain cardiovascular stability given the patient's anemia. The patient had an uneventful recovery without blood transfusion, demonstrating that surgery can be safely performed in Jehovah's Witness patients refusing transfusion through careful pre-operative optimization and use of alternatives to blood loss replacement like collo
Building a world class surgical program requires assuring an efficient and effective peri-operative process. This includes standardizing cardiac clearance as part of pre-admission testing, developing preference cards to reduce variation in practice, and creating an efficiency index to maximize the use of space, time, staff, and patient safety. The goal is an efficient operating room workflow from patient arrival to recovery.
Prof. Mridul Panditrao's Peri-operative MANAGEMENT OF Patients for LaparoscopyProf. Mridul Panditrao
Prof. Panditrao takes you in the detailed discussion about the historical aspects, problems, altered physiology, preparation of and Anesthetic/ peri-operative management of the patients for various laparoscopic surgical procedures
This document provides information on various minor surgical procedures including extraction, incision and drainage, biopsy, cyst removal, and root resection. It describes the indications, contraindications, techniques, and postoperative care for each procedure. Extraction involves removing a tooth while minimizing trauma to surrounding tissues. Incision and drainage treats localized swelling by incising and draining the fluctuant mass. Biopsies and cyst removals involve excising portions of or entire lesions for examination. Root resection, or apicoectomy, treats apical pathology by resecting and removing infected root portions. Proper techniques and care are outlined to perform each procedure safely and effectively.
This document defines and describes common surgical procedures including herniorrhaphy to correct hernias, amputation to remove limbs, turp to resect the prostate, gastrectomy to remove part of the stomach, thoracostomy to access the thoracic cavity, tonsillectomy to remove the tonsils, colostomy to create a stoma in the colon, hemorrhoidectomy to remove hemorrhoids, dilatation and curettage of the uterus, hysterectomy to remove the uterus and ovaries, pulmonary lobectomy to remove a lung lobe, pneumonectomy to remove an entire lung, and more. It provides indications for each procedure and relevant definitions.
The document describes several common minor surgical procedures, including incision and drainage, central venous pressure monitoring, tracheostomy, thoracentesis, pericardiocentesis, and paracentesis abdominis. For each procedure, the document discusses indications, relevant anatomy, equipment needed, and basic techniques. Minor surgical procedures allow for drainage, monitoring, airway management, fluid removal, and diagnostic sampling in a minimally invasive manner.
1. Fetal surgery is increasingly being used to treat conditions diagnosed before birth. Both endoscopic and open fetal surgeries are performed, though indications differ between the two methods.
2. While fetal surgery was pioneered in the US, Europe has more widely embraced fetoscopic interventions due to trials like Eurofoetus. However, uptake of open fetal surgery has been lower in Europe compared to the US.
3. The increasing use of fetal surgery has benefits but also limitations due to the rarity of suitable indications and the need for specialized multidisciplinary teams. Standards aim to ensure fetal surgery is primarily performed within clinical trials.
International Innovation RAFT_188_Research_Media_01margochanning
The Restoration of Appearance and Function Trust (RAFT) is a UK-based charity that conducts medical research to improve quality of life for patients dealing with diseases, injuries, or birth defects. Over its 27 years:
1) RAFT research has led to over 100 innovations used in hospitals worldwide to restore appearance and function for patients, helping them regain independence and dignity.
2) RAFT aims to train plastic surgeons in research to establish a new generation with strong research skills. 15% of UK plastic surgeons have a background with RAFT.
3) As a charity, RAFT has no public funding and must raise all funds itself, but continues to produce successful research recognized internationally despite financial
- The document discusses centralizing the intensive care units (ICUs) of Singapore Hospital to better handle major disasters and improve daily operations. The hospital's ICUs were previously spread across eight blocks according to specialty.
- Using simulation models, the feasibility of centralizing the ICUs was analyzed considering space constraints, costs, and staffing needs. The optimal number of centralized ICUs was determined to meet patient demand while fitting in the proposed centralized space.
- Centralizing ICUs can reduce patient transit times and improve survival chances, but faces challenges around costs, space limitations, and needing to retrain staff for a consolidated ICU model. Simulation results can help hospitals optimize intensive care processes.
Critical Care Summit 2015 -ECMO Milestones in EgyptDr.Mahmoud Abbas
1. The Critical Care Department at Cairo University introduced extracorporeal membrane oxygenation (ECMO) as a new technique after a male patient with avian influenza developed acute respiratory distress syndrome and required ECMO support.
2. A scientific day was held to introduce ECMO and its applications, convincing the department chief to build an ECMO center of excellence.
3. The Critical Care Department has since become the first and leading center for critical care in Egypt, treating over 6 ECMO cases with a mortality rate of 50% in their initial learning curve.
Element descriptionthe problem ofdescribe the problemaffectRAHUL126667
Massachusetts General Hospital's Pre-Admission Testing Area (PATA) was struggling with long patient wait times and inefficiencies. PATA was responsible for completing pre-operative work-ups for outpatient surgical patients, but faced challenges including limited capacity, lack of clear prioritization guidelines for surgeons, and shared ownership between departments. This resulted in patients spending hours in the clinic with minimal face time with providers, delays in surgeries, and overworked staff. A task force was formed to address these challenges, and brought on an MBA intern to conduct an assessment of PATA's processes.
1. The document describes the introduction and establishment of extracorporeal life support (ECLS) at the Critical Care Department of Cairo University Hospitals in Egypt.
2. An ECLS team was formed, physicians were trained abroad, and equipment was acquired to begin treating patients using ECLS.
3. The first few ECLS cases involved treating acute respiratory distress syndrome and had successful outcomes, demonstrating the viability of the new program in Egypt.
This document summarizes a hospital training report submitted by Jatin Sharma at the Clara Swain Mission Hospital in Bareilly, India. It provides background on the hospital's founding in the 1870s and its expansion in recent years. The report describes departments visited including OPD, emergency ward, ICU, and laboratories. It also covers procedures observed like IV insertions and ECG exams. The conclusion expresses that the training was helpful for learning patient care and healthcare systems.
Surgical orthodontics, also known as orthognathic surgery, aims to correct dentofacial deformities through a combination of orthodontic treatment and corrective jaw surgery. It seeks to improve both facial and dental aesthetics as well as create a functional bite. Key developments over time have improved surgical outcomes and patient comfort. Common indications for orthognathic surgery include severe class II or III malocclusions, facial asymmetries, and craniofacial anomalies. Careful examination, investigations, planning and multidisciplinary treatment are required to achieve optimal results.
An overview of the John Theurer Cancer Center at Hackensack University Medical Center - a top-50 U.S. News & World Report Best Hospitals for Cancer – the only cancer center in New Jersey with this prestigious designation.
To request printed copies of this brochure, please contact aleahing@p4strategy.com.
PHEM - Pre Hospital Emergency Medicine Guidelines for TrainersEmergency Live
This Guide describes the curriculum, training and assessment processes for Pre-hospital Emergency
Medicine (PHEM) sub-specialty training. It reflects the General Medical Council (GMC) standards and the
uK wide regulations for specialty training (the Gold Guide).1,2 Where there are differences between the four
uK national agencies, the parts of the Gold Guide applicable to these agencies should be regarded as the
definitive guidance.
The correct application of the safety check steps in our routine theatre operations and procedures will greatly reduce surgically related mortality and morbidity.
ABSTRACT
Objective: To evaluate the role of age as a moderator of bone regeneration patterns and
symphysis remodeling after genioplasty.
Method: Fifty-four patients who underwent genioplasty at the end of their orthodontic treatment
were divided into three age groups: younger than 15 years at the time of surgery (group 1), 15 to
19 years (group 2), and 20 years or older (group 3). Twenty-three patients who did not accept
genioplasty and had a follow-up radiograph 2 years after the end of their orthodontic treatment
were used as a control group. Patients were evaluated at three time points: immediate preoperative
(T1), immediate postoperative (T2,) and 2 years postsurgery (T3).
Results: The mean genial advancement at surgery was similar for the three age groups, but the
extent of remodeling around the repositioned chin was greater in group 1, less in group 2, and still
less in group 3. Symphysis thickness increased significantly during the 2-year postsurgery interval
for the three groups, and this increase was significantly greater in group 1 than in group 3.
Remodeling above and behind the repositioned chin also was greater in the younger patients. This
was related to greater vertical growth of the dentoalveolar process in the younger patients. There
was no evidence of a deleterious effect on mandibular growth.
Conclusion: The outcomes of forward-upward genioplasty include increased symphysis
thickness, bone apposition above B point, and remodeling at the inferior border. When indications
for this type of genioplasty are recognized, early surgical correction (before age 15) produces a
better outcome in terms of bone remodeling. (Angle Orthod. 0000;00:000–000.)
Risk Management Plan-Response to an adverse eventDaniel Akins
This document contains a risk management plan analyzing a case where two patients, Jonesky and Jones, received the wrong surgical procedures due to misidentification. A root cause analysis found that the error occurred due to a language barrier, fatigue of overworked staff, and a lack of verification during the pre-operation process. The risk management plan recommends establishing a diverse investigation team and timeline to analyze adverse events, improving identification procedures, and defining staff responsibilities to prevent future errors and improve patient safety.
The document discusses guidelines for day surgery. It notes that day surgery has expanded significantly due to advances in surgical and anesthetic techniques. National and international guidelines on patient care, admission/discharge processes, and running day surgery units have helped the growth of day surgery. The latest joint guidelines from 2019 provide recommendations such as thorough pre-assessment, determining fitness based on function rather than physical status, undertaking most surgeries as day cases, and trained multidisciplinary teams. Day surgery provides benefits to both patients, such as early mobility, and hospitals by freeing beds and reducing costs. A wide range of procedures are now suitable as day cases.
Reliability of Med-El Cochlear Implants in children. The Romania Experience.IJERA Editor
Introduction: Early detection of hearing loss significantly lowered the age of cochlear implantation. A failed CI
is a very problematic issue for the child and family and seems to be, for the moment, inevitable. This is a
retrospective review aimed to evaluate the reliability of Med-El devices implanted in children in Romania.
Materials and Methods: We designed a questionnaire to assess the incidence, the time elapsed and the reason
of total device failure. Medical-surgical data were collected from children who received Med-El cochlear
implants since the start of the National Cochlear Implant Program in 2001.
Results: There were 256 patients included. Failure Rate (6,64%) and Cumulative Survival Rate (95,31%) at 5
years were calculated. The majority of the hard and soft failures were encountered in Pulsar devices. Flap
necrosis was the most frequent medical/surgical reason for re-plantation. There was only one case of
posttraumatic device failure. Time elapsed to device failure was short – 22 months on average.
Conclusion: Cochlear implant reliability data should be considered during the choice of an implant for each
individual patient. This study confirms the safety and efficacy of Med-El cochlear implants in children for both
ceramic and non-ceramic devices.
Masjid Nabawi is the dream destination for any believer. The document includes prayers and blessings for Prophet Muhammad. It emphasizes visiting the mosque and sending prayers and blessings to the Prophet with each step. The vision is to provide the right care for every person every time through various strategies to lower the rate of bile duct injuries during laparoscopic cholecystectomy.
This proposal outlines a study on the experience of laparoscopic cholecystectomy (gallbladder removal surgery) at St. Paul's Hospital Millennium Medical College in Addis Ababa, Ethiopia. The study will retrospectively review medical records from 2015-2020 to evaluate postoperative complications, conversion rates from laparoscopic to open surgery, and factors associated with complications. The objectives are to assess complication patterns, determine factors linked to complications, and calculate conversion rates and reasons. The proposal describes the background, literature review, methods, work plan, and budget for the study.
The document is a newsletter from Southampton Hospital that covers various topics. It includes:
1) An announcement that the hospital's dialysis center received an award for exemplary patient safety from its accrediting body.
2) An article about bariatric surgery and how it can cure type 2 diabetes by causing significant weight loss. Support group meetings and informational seminars are offered.
3) A description of wellness programs and services offered at the hospital's Ed and Phyllis Davis Wellness Institute, including fitness classes, massage, workshops, and consultations with a physician specializing in functional and anti-aging medicine.
History of critical care center cairo universityDr.Mahmoud Abbas
The story of critical care medicine in Egypt began in 1982 with the inauguration of the Critical Care Center at Cairo University Hospitals. At that time, critical care medicine was a new field without established standards or a clear definition. The center helped establish critical care medicine as an independent specialty in Egypt, saving thousands of lives over the years through advances in areas like ventilation, diagnostics, and interventional cardiology. However, questions remain regarding overlaps with related fields like anesthesiology, emergency medicine, and cardiology, as well as the need for further specialization and mutual training between specialties.
Similar to Great Ormond Street Hospital Ferrari Formula One Handovers (20)
1) Mercy Medical Center implemented lean process improvements in their emergency department to address slipping patient satisfaction scores.
2) A cross-functional team conducted a value stream map of the emergency department which identified non-value added steps. This led to a series of lean initiatives including fast track service to treat less acute patients within one hour.
3) The results were dramatic - patient satisfaction scores rose to the 95th percentile, length of stay decreased, and the department saw a 6% increase in patient volume while maintaining quality of care.
Barnes-Jewish Hospital implemented an organization-wide lean curriculum to teach lean methodology to all employees. This was done to address the issue of improving processes across the entire hospital rather than just in isolated areas or departments. The curriculum combines an education program for all employees with focused process improvements in specific value streams. As a result of the hospital's lean transformation, it has seen improved operating margins, lower employee turnover rates, and higher patient satisfaction scores. Barnes-Jewish Hospital was also named a finalist for the 2009-2010 International Team Excellence Award for its lean process improvements.
The Akron Children's Hospital radiology department was facing long wait times for MRI exams of up to 8 weeks. A Lean Six Sigma project was conducted using a multidisciplinary team in a 2-day kaizen event. They identified issues with the scheduling process and insurance authorization delays. Countermeasures included modifying the scheduling to better meet demand and allowing authorization during scheduling. This reduced wait times significantly to same-day for many exams. It also increased exam volumes and generated over $1 million in additional annual revenue while improving patient access.
Seven core factors are key to counteracting the frequently encountered pitfalls to change management. These include: clarity of purpose and direction; engagement of stakeholders; allocation of necessary resources; alignment of systems and processes; leadership commitment at all levels; effective two-way communication; and tracking of goals and progress. Addressing these factors helps ensure change initiatives stay on track.
The document outlines Lean Six Sigma training courses for various roles, including:
- Executive Introduction to Lean Six Sigma for senior leaders
- Lean Six Sigma Champion training for those selecting and tracking projects
- Lean Six Sigma Black Belt training, a comprehensive 25-day course teaching the DMAIC methodology
- Lean Six Sigma Green Belt training, a shorter 6-day course also covering DMAIC
It provides details on the objectives, contents, and duration of each course. The goal is to equip individuals across an organization with the skills needed to successfully implement continuous improvement through Lean Six Sigma.
The document discusses the application of lean six sigma tools in healthcare settings, specifically within the UK's National Health Service (NHS). It notes that while terms like "six sigma" are viewed negatively, tools focused on continuous improvement, reducing waste, and improving processes are accepted. Popular tools used include control charts in Minitab to monitor performance at ward and business levels, as well as cause-and-effect diagrams, process mapping, and A3 reports in Quality Companion. Sensitivities within the NHS require terminology to focus on patients and the future rather than defects. Large continuous improvement programs in the NHS aim to reduce wait times and increase resources for direct patient care.
Great Ormond Street Hospital Ferrari Formula One Handovers
1. Making the Case for Quality
August 2008
Great Ormond Street Hospital for Children:
Ferrari’s Formula One Handovers and
Handovers From Surgery to Intensive Care
by Victor E. Sower, Jo Ann Duffy, and Gerald Kohers
Seldom does a hospital receive front page coverage in the Wall Street Journal, especially in an article about
At a Glance . . . Ferrari racing crews, and seldom are a hospital’s physicians invited to speak to boards of directors of multi-
million dollar corporations. Great Ormond Street Hospital for Children (GOSH), London, England, did both.
• Great Ormond Street Why? Because they had successfully benchmarked their handoff from cardiac surgery to the intensive care
Hospital for Children
unit (ICU) against pitstop techniques of the famous Ferrari Formula One race car team.
(GOSH) benchmarked
its handoff from cardiac
surgery to the intensive About the Hospital
care unit against pit
stop techniques of the GOSH has long been recognized for its care of children from throughout the world. Founded in 1852
Ferrari Formula One during a time of high infant mortality and malnutrition, GOSH was the first children’s hospital in the
race car team. English-speaking world. According to Sir Cyril Chantler, Chairman of GOSH Board of Directors,
• Process improvements “GOSH cannot be average.”1 This echoes the mission of the hospital:
resulted in increased
patient safety and To improve the health of children by being a leading centre of excellence in Europe for special
decreased error rates.
pediatric services and for research, evaluation, and education in the field of child health.2
• This case study is
excerpted from chapter The 335-bed hospital has 315 doctors, 900 registered nurses and healthcare assistants, and 135 allied
10 of Benchmarking for healthcare professionals, representing the widest range of children specialists under one roof in the
Hospitals: Achieving Best-
in-Class Performance
United Kingdom. GOSH is the largest pediatric epilepsy surgery center in the United Kingdom, the
Without Having to Reinvent second largest in Europe, the largest unit treating children’s brain tumors (over 100 per year), and the
the Wheel, by Victor E. largest pediatric intensive care unit in the United Kingdom (48 beds, plus eight high dependency beds
Sower, Jo Ann Duffy, and five transitional beds).
and Gerald Kohers.
The rating of excellent is the highest possible rating given by the independent Healthcare Commission.
Only six trusts out of 157 in the United Kingdom received this rating with GOSH being one. The rat-
ing is based on the level of care delivered to hospitalized children in five areas: access to child-specific
service, access to care near their homes, appropriate levels of trained staff, staff having child-specific
training, and opportunities for staff to maintain their skills.
Why Focus On the Handover?
External and internal drivers made GOSH aware of dangers in handover procedures. In the mid-1990s
in Bristol, England, there was very high mortality for surgery in congenital heart disease followed by
contentious public inquiry. One of the important findings of a subsequent study was that the journey
from the operating room to the intensive care unit (ICU) was high risk. This external environment
impetus to change was followed by an internal driver for change. Interest in human factors led staff
physician, Professor Marc de Leval to question whether staff-related factors, such as exhaustion, were
more important than patient-related factors, such as the position of the coronary arteries. De Leval
reviewed all the arterial switch procedures done in the United Kingdom over a two-year period with
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2. a psychologist watching the operation. Once again, the journey to Goldman and Elliott, while the development of a more formal
from the operating room to the ICU was demonstrated to be a protocol was led by human factors expert Ken Catchpole, MD,
high risk factor. This knowledge created a heightened awareness Senior PostDoctoral Scientist, Nuffield Department of Surgery,
of the danger. Staff came to accept that there was an element of John Radcliffe Hospital, Oxford, UK. What served to unite them
danger associated with what they were doing so they were recep- was a common interest in reducing error and improving quality.
tive to change. Benchmarking to improve handoffs also fit well with the mission
of the hospital. Moreover, it was supported by both the culture of
Moving From the Operating Room To the ICU the department and organizational structure of the hospital.
So many things can go wrong, and sometimes do, as the tiny What Was Learned From Benchmarking?
vulnerable person is transferred from the surgery to intensive
care. Moving the little body from one bed to another is only GOSH doctors visited and observed the pit crew handoff in
one part of the complex set of movements that must take place. Italy. While visiting the Formula One pit crew the GOSH doc-
Wires, equipment, people, and information move about in an tors became interested in the way they addressed possible failure.
intricate dance where a misstep can place the child in mor- The crew sat around a big table analyzing and reanalyzing, ask-
tal danger. Within 15 minutes all the technology and support ing, “What could go wrong?” and “What are we going to do if
systems, including ventilation, two to four monitoring lines, mul- it does go wrong?” and “How important is it if it goes wrong?”
tiple vasodilators, and inotropes, are transferred two times: going Everyone’s ideas were given equal weight until the group ranked
from operating theatre system to portable equipment to intensive them using the failure modes and effect analysis (FMEA).
care systems. Intimate knowledge of the patient gained during a
This anticipatory planning made the pit crew more prepared
procedure lasting up to eight hours must be transmitted from the
than the medical team whose strategy tended to be waiting until
surgical team to the intensive care unit team.
something went wrong to work out what they should have done.
How Was the Benchmark Selected? Observing the pit crew, the GOSH doctors noted the value of
process mapping, process description, and trying to work out
In the GOSH case, there was no survey or directed search what people’s tasks should be. They learned the keys to a suc-
for a benchmark to guide changes in the changeover cessful pit stop:
procedure. The proverbial light bulb went on as two tired
• The routine in the pit stop is taken seriously
doctors, Alan Goldman and Martin Elliott, sat down to relax
• What happens in the pit stop is predictable so problems can
after lengthy surgeries. Martin Elliott, MD, FRCS, Professor be anticipated and procedures can be standardized
of Cardiothoracic Surgery, University College London, and • Crews practice those procedures until they can perform
Chairman of Cardiothoracic Services, recalls: “I’d done a them perfectly
transplant, then an arterial switch in the morning and we were • Everyone knows their job, but one person is always in charge
both pretty knackered [exhausted]. The Formula One came on
TV just as we were sitting down . . . at the end of surgery, and Following the trip to Italy, the GOSH team videotaped the
we just realized that the pit stop where they changed tyres and handover in the surgery unit and sent it to be reviewed by the
topped up the fuel was pretty well identical in concept to what Formula One team. The GOSH research team and observers
we do in handover—so we phoned them up.” The two doctors from the Formula One team analyzed the film and noted a great
recognized the importance of teamwork in transforming the difference in the process map (flowchart). The handover process
highly risky pit stop operation into one that was both safe and of the pit crew was a very short process map compared to the
quick. They wondered: “If they can do it, why can’t we?” hospital’s process map.
In Formula One motor racing, the pit stop team completes the The process in the hospital was much, much longer because the
complex task of changing tires and fueling the car in about seven level of complexity of the medical process was much greater.
seconds. The doctors saw this as analogous to the team effort of From the analysis came a new 12-page handover protocol (a
surgeons, anesthetist, and ICU staff to transfer the patient, equip- short version, showing the four main stages of the new protocol,
ment, and information safely and quickly from the operating is shown in Figure 1). A copy of the protocol was laminated and
room to ICU. put by the bedside. If a staff member had not received training
in the new process or if someone needed a quick refresher, the
Initiating the Program posted protocol could be read through in five minutes, leading to
understanding of what needed to be done.
The GOSH benchmarking effort was not driven from the top
down nor can it be tied to an individual person or team. A Other aspects of the Formula One training process noted by the
number of individuals contributed to birthing this change initia- GOSH researchers were the repetition of filming from differ-
tive. Awareness of the need to look at human factors in cardiac ent angles and the multiple rehearsals of the handover. These
surgery was initiated by de Leval. The idea that a pit stop was a rehearsals ensured that each person knew their responsibilities
good parallel to what happened in a handover can be attributed down to the smallest details. The GOSH observers were struck
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3. Figure 1 Summary of the new handover protocol.3 awareness during the pit stop. In the old hospital handover there
was no one like the lollipop man so it was unclear who was in
Phase 0: The Patient Transfer Form is completed by the anesthetist and charge. Under the new handover process, the anesthetist was
Pre-Handover collected from theatres at least 30 minutes before the patient is
transferred to the ICU. given overall responsibility for coordinating the team until it was
The receiving nurse ensures the bed space is set up according to transferred to the intensivist at the termination of the handover.
the monitoring, ventilation, and other requirements specified on the
Patient Transfer Form.
These same two individuals were charged with the responsibil-
The receiving doctor ensures that all appropriate paperwork is ready. ity of periodically stepping back to look at the big picture and to
Phase 1: On arrival the team transfers the patient ventilation, monitoring make safety checks of the handover.
Equipment and and support from portable systems used during the transfer to the
Technology ICU systems.
Ferrari caused the hospital to view its own practice from a com-
Handover Monitor
pletely different perspective. Ferrari didn’t tell them exactly what
Ventilator needed to be changed or how to make the change. The hospital,
ODA however, was able to take what Ferrari did well and adapt it to
Consultant fit their situation.
Anesthetist
Power
Anesthetic
Registrar
What Wasn’t Transferable?
Pump Some aspects of the Formula One handover were not transfer-
CCC Reg/
Nurse
able to the medical handover process. When the consultant from
Drain Pump Formula One went to GOSH and looked at the whole handover
process, he said it would be best to engineer out parts and get
Nurse new equipment. He noted the complex technical problems with
the handover. In the operating room, the child is connected to
Nurse Urine Surgeon a lot of equipment and statically powered through an AC cord
with wires. There is a ventilator, which is a special anesthetic
ventilator, on the operating table, which is very stable. Moreover,
SAFETY CHECK: The anesthetist checks the equipment and that the there is equipment to control the baby’s temperature. So when
patient is appropriately ventilated and monitored and is stable. The
receiving nurse and doctor are identified and confirm their readiness. the infant needs to be moved from the operating table, all this
Phase 2: The anesthetist, then the surgeon, speak alone and uninterrupted, equipment must be disconnected and converted from AC to DC
Information providing the relevant information about the case, using the power. At that point there is no ventilator so the anesthetist must
Handover Information Transfer Aid Memoir.
SAFETY CHECK: The receiving nurse and doctor should use the use a bag to blow the lungs up and down. The child is moved to
Information Transfer Aid Memoir to check that all necessary a cold trolley, covered with a blanket, and wheeled down a cor-
information has been obtained, and ask appropriate questions.
ridor. Upon reaching the intensive care unit, everything has to be
Phase 3: The surgeon, anesthetist, and receiving team discuss the case as
Discussion a group. The receiving doctor manages the discussions, identifies once again dismantled and remantled and reconnected to other
and Plan anticipated problems, and anticipated recovery is discussed. monitors and a ventilator. The Formula One consultant asked,
The ICU Team now has responsibility for patient care and confirms the “Why don’t you just have one thing that does both and has its
plans for the patient.
own power supply and its own ventilator?” This was obviously
what needed to be done, but it turned out not to be feasible
by not only how fast, but also how quiet and disciplined the pit
since manufacturers were not interested in producing the needed
crew was. Every crew member knew the role and responsibili-
equipment. They were not interested because the market is
ties and kept out of the way of others as they fulfilled their roles.
very small (only children) and hospitals would never be able to
To help the medical team manage the same feat, a dance chore-
replace all its beds at the same time due to the exorbitant cost of
ographer was involved to help the team position themselves to
the proposed new equipment. While the Formula One crew can
stay out of the way of others. They also learned to recognize the
count on using technology to improve their handover process,
need for space around where they are standing. This meant that
the hospital team could not; they had to rely more on human
the movement around some of these events in handovers was beings and less on state-of-the-art technology.
modified. Working with the choreographer also introduced the
discipline of quietness and calm. Professor Elliott noted that the The lack of resources as well as inherent differences in the
handover team tended to talk a lot. After the new process was nature of the handover meant that the transferability of multiple
introduced the handover became one of the quietest activities in rehearsals and exhaustive contingency planning was not possible.
the hospital, especially during hand-off briefings.
Adequate time and money allowed motor car racing to have
While the main theme changes were more sophisticated pro- rehearsal after rehearsal after rehearsal. In healthcare those
cedures and better choreographed teamwork, another aspect resources are scarce, so one of the things GOSH had to do
of the Formula One handover process easily transferred to the was design a new process that was simple, easy to learn, and
hospital setting. The lollipop man is the one who waves the car didn’t need a lot of practice. The reason the motor car racing
in and coordinates the pit stop. He maintains overall situation team can do everything in such a short period of time is that
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4. everything is very carefully choreographed and each person is need to do anything more.” What they did say was, “This is
very well rehearsed in performing the small number of tasks great, but we can do even better.”
assigned. They complete their work very accurately in precisely
6.9 seconds. The GOSH handover takes somewhere between 8 Future Challenges
and 15 minutes because they are dealing with a living person,
not a piece of machinery. While the Formula One team could The real problem facing the GOSH cardiac unit in the future
identify all of the contingencies and practice how to deal with is keeping the new handover process in place. The European
them, this was not possible for the GOSH team. There are too Working Time Directive and normal staff turnover means new
many permutations of what could go wrong for the healthcare members are added to the team over time. Some of them are
team to practice every contingency. Although it was true the inexperienced and need training. Even the more experienced ones
GOSH team could emulate Formula One’s handover process in who come to GOSH from other hospitals need retraining because
some aspects, they could not address all possible contingencies handoffs are done differently in the cardiac unit at GOSH.
in their training program. The healthcare handover team had to Training is always time consuming and therein lies the challenge.
be far more flexible than the motor car racing team because of Another type of challenge is replicating the handover in other
the complexity of the surgical handoff. Benchmarking against areas of the hospital. There are more hand-offs now because of
changing working hours, changing staff rotation systems, and
the Formula One team pushed the hospital to anticipate problems
less-experienced junior staff due to shorter working hours.
rather than wait until something goes wrong to deal with it. The
GOSH researchers tried to build into the process the importance According to Professor Elliott, there is an ongoing challenge
of anticipating and being prepared to respond . . . even if they to “review our practice and see if we can do it any better and
didn’t know quite what would happen, even if they couldn’t institute new handoff procedures whenever we need them. . . .
rehearse every little detail. We will continue to monitor error. Our aim is to have error at
zero, or as close to zero as possible in every area we are capable
Gauging the Gains
of measuring it.” He continued, “You know how close we are
already? Miles away. You never get to zero, but just having it as
A number of broad categories were measured. Technical errors
an aspiration keeps it immersed in the culture.”
were monitored and scored. Information omissions were moni-
tored and scored, as was the duration of the handover. References
Team performance, leadership and teamwork, task management 1. Annual Report 2005/2006, Chairman’s Foreword, www.gosh.
work space and equipment, and situational awareness were all nhs.uk
observed and analyzed by psychologists. It is clear that gains
have been achieved; for example, error rates have continued to 2. www.ich.ucl.ac.uk/patients_fam/ppweb/didyouknow/index.
go down. In order to see whether improvements are being sus- html
tained there are plans to repeat the study.
3. Catchpole, K., M. De Leval, A. McEwan, N. J. Pigott, M. J.
The real gain for patients was safety. Results showed that the Elliott, A. McQuillan, C. MacDonald, and A. J. Goldman.
new handover procedure had broken the link between technical 2007. Patient Handover from Surgery to Intensive Care: Using
and informational errors. Formula 1 Pit-Stop and Aviation Models to Improve Safety
and Quality. Pediatric Anesthesia, 17(5), 470–478.
Before the new protocol was introduced, patients who had
experienced less than perfect equipment had a higher rate of For More Information
information omissions in the briefing. With the new protocol,
just because someone made a mistake with the equipment didn’t • This case study is excerpted from chapter 10 of
make it any more likely that somebody was going to forget to Benchmarking for Hospitals: Achieving Best-in-Class
relay an important piece of information to the ICU team. Performance Without Having to Reinvent the Wheel, by
Victor E. Sower, Jo Ann Duffy, and Gerald Kohers.
Before the new handover protocol, approximately 30 percent of the • Included in the book are additional details on organizational
patient errors occurred in both equipment and information; after- support, obstacles faced, and results at GOSH, plus four
ward, only 10 percent of the patient errors occurred in both areas. more benchmarking case studies.
Even though it was not perfect, the hospital did improve. Separating • The excerpted version offered here is provided for readers of
the time when the equipment was changed and the information ASQ’s Healthcare Update.
was exchanged into different stages in the protocol severed the link • To subscribe, visit www.asq.org/healthcare/update_info.html.
between errors in equipment handling and briefings.
About the Authors
Dr. Catchpole found the hospital’s reaction to the success of
the benchmarking effort interesting. People did not react to the Victor E. Sower (Ph.D., University of North Texas) is professor
improvement in handover by saying, “This is great, we don’t of operations management at Sam Houston State University. He
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5. is a Senior member of ASQ, a Certified Quality Engineer (CQE), Gerald Kohers (Ph.D., Virginia Tech) is professor of informa-
member of the Quality Management and Healthcare divisions of tion systems at Sam Houston State University, where he has been
ASQ, and member of the Health Care Management Division of the a faculty member since 1994. He has consulted with numerous
Academy of Management. He previously co-authored two books hospitals in quality assessment and improvement efforts and con-
and has published articles in journals such as Quality Management tributes in publishing the quarterly Hospital Quality Newsletter.
Journal, Health Care Management Review, Benchmarking for Kohers has also assisted in conducting quality control workshops.
Quality Management & Technology, and Quality Progress. He In addition to having more than 60 refereed proceedings/presen-
recently co-edited a special edition on benchmarking in services tations at regional and national academic conferences, he has
for Benchmarking: An International Journal. published numerous peer-reviewed articles in diverse areas such
as corporate finance and investments to healthcare, including one
Jo Ann Duffy (Ph.D., The University of Texas at Austin) is in Health Care Management Review.
professor of management and director of the Gibson D. Lewis
Center for Business and Economic Development at Sam Houston
State University. She is editor of the Journal of Business
Strategies and past president of the Southwest Academy of
Management. She has published articles on patient satisfaction,
service quality, and productivity in Health Care Management
Review, Benchmarking: An International Journal, Journal of
Operations Management, Journal of Service Marketing, Journal
of Aging Studies, and Journal of Gerontological Social Work.
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