Metrics of efficient use of operating rooms during the SARS-CoV-2 (COVID-19) pandemic

Introduction: the COVID-19 pandemic has induced a transformation in the way hospitals function, causing a decrease in the time and efforts dedicated to surgical activity, which in turn has caused delays in the surgery schedule of most hospitals. This represents a major public health problem, significantly compromising the principle of equity that inspires public health systems throughout the world. To address this problem, it would be of the utmost importance to put in place initiatives to measure and improve surgical efficiency. Objective: evaluate indicators of efficiency in the use of operating rooms during the COVID-19 pandemic. Material and methods: a descriptive, longitudinal retrospective study was conducted on 3554 patients scheduled for surgery during a one-year period of the COVID-19 pandemic. Indicators of efficiency in they use of operating rooms were measured. The data was processed using SPSS v-25.0. Results: a total of 3,554 surgeries were scheduled, 1,309 of them emergency surgeries, 1,979 elective surgeries, and 266 deferred surgeries. The following parameters were estimated: Starting time of the procedure (42.32 ± 37.04 min);opportunity for emergency surgeries (104.69 ± 102.55 min);starting time of anesthesia (10.11 ± 9.85 min);starting time of surgery (40.03 ± 24.68 min);time of admission to post-anesthesia care unit/intensive care unit (PACU/ICU) (15.35 ± 29.94 min);turnover or replacement time (177.97 ± 174.33 min);active surgery time (27.70%). Conclusions: the COVID-19 pandemic negatively impacted the indicators of efficient use of operating rooms, posing new challenges for the management and organization of surgical work. (English) [ FROM AUTHOR] Introducción: la pandemia por COVID-19 ha emplazado una transformación hospitalaria, esto acarreó un decremento de la actividad quirúrgica e implicó un aplazamiento en la programación, lo que representó un problema, ya que comprometió sensiblemente el principio de equidad que inspira a los sistemas sanitarios. Así, resultó imperativa la implementación de iniciativas para medir y mejorar la eficiencia quirúrgica. Objetivo: medir los indicadores de uso eficiente del quirófano durante la pandemia por COVID-19. Material y métodos: se realizó un análisis descriptivo, longitudinal y retrospectivo en 3,554 pacientes programados para cirugía, durante la pandemia en un período de un año, además se midieron los indicadores de uso eficiente del quirófano. Los datos fueron procesados en SPSS v-25.0. Resultados: se programaron 3,554 cirugías, 1,309 urgencias, 1,979 electivas, 266 diferidas. Se estimó un tiempo de inicio del procedimiento 42.32 ± 37.04 min, oportunidad para urgencias quirúrgicas 104.69 ± 102.55 min, tiempo de inicio de anestesia 10.11 ± 9.85 min, tiempo de inicio de cirugía 40.03 ± 24.68 min, tiempo para la admisión en la unidad de cuidados postanestésicos/unidad de terapia intensiva (UCPA/UTI) 15.35 ± 29.94 min, tiempo de rotación o recambio 177.97 ± 174.33 min y tiempo quirúrgico activo 27.70%. Conclusiones: la pandemia por COVID-19 impactó negativamente en los indicadores de uso eficiente del quirófano, lo que implicará nuevos retos en la gestión y organización de la jornada quirúrgica para su mejora. (Spanish) [ FROM AUTHOR] Copyright of Revista Mexicana de Anestesiologia is the property of Colegio Mexicano de Anestesiologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Electronic consultation (e-consultation) between primary care and the neurology department: One-year experience in a healthcare district in Andalusia, Spain

Introduction The COVID-19 pandemic has prompted the implementation of telemedicine programmes to facilitate healthcare. In November 2020 we initiated an e-consultation programme between primary care and the neurology department, with asynchronous response, through a platform integrated into the corporate computer system of the Andalusian Public Health System. We present the results of the first year of operation. Methods We present a descriptive study of the e-consultations received in 2021 from a health area of approximately 300,000 inhabitants aged ≥14 years. The reasons for consultation were pre-established: "primary headache” (PH), "new-onset cognitive impairment” (CI), "complications of dementia” (DEM), and "epilepsy” (EPI). We defined inclusion criteria and the clinical information/tests that had to be provided. General practitioners could choose between e-consultation or face-to-face referral. Results A total of 1806 e-consultations were received (approximately 6/1000 population/year). By reasons for consultation: CI 34.3%, PH 32%, DEM 14.4%, EPI 11.7%, unspecified 7.6%. Responses were sent after an average of 2.25 days and were classified as: "refer for in-person consultation” (47.12%), "resolved” (39.98%), "criteria not met” (12.57%), or "follow-up by e-consultation” (0.33%). As expected, a high proportion of face-to-face referrals were required for CI (73.46%);the main value of the system for these patients was to prioritise appointments and select the most appropriate form of care. For the rest of the reasons for consultation, the proportion of "resolved” e-consultations reached 52.61%. Conclusions Asynchronous e-consultation between primary care and the neurology department is a useful tool in the indicated conditions, offering a rapid, "one-stop” response to a significant proportion of clinical or therapeutic uncertainties, as well as optimising face-to-face appointments. Resumen Introducción La pandemia por Covid-19 ha impulsado la implantación de programas de telemedicina para facilitar la asistencia sanitaria. En noviembre de 2020 iniciamos un programa de e-interconsulta entre Atención Primaria (AP)-Neurología, de respuesta asíncrona, a través de una plataforma integrada en la estación clínica corporativa del Sistema Sanitario Público de Andalucía. Presentamos los resultados de su primer año de funcionamiento. Métodos Estudio descriptivo de las e-interconsultas recibidas durante 2021 desde un área sanitaria de aproximadamente 300.000 habitantes ≥14 años. Se establecieron como motivos de consulta: "Cefalea primaria” (CEF), "Deterioro cognitivo de novo” (DC), "Complicaciones de la demencia” (DEM) y "Epilepsia” (EPI), definiéndose unos criterios preestablecidos y la información clínica/pruebas que se debían aportar. Los médicos/as de familia podían elegir entre e-interconsultar o derivar directamente para cita presencial. Resultados Se recibieron 1.806 e-interconsultas (≈6/1.000 hab./año). Por motivos de consulta: DC 34′3%, CEF 32%, DEM 14′4%, EPI 11′7%, no especificado 7′6%. Las respuestas se demoraron una media de 2′25 días y se clasificaron en: "precisa cita presencial” (47′12%), "alta” (39´98%), "no cumple criterios” (12′57%) o "seguimiento por e-interconsulta” (0′33%). Como era previsible, para el DC una alta proporción precisó cita presencial (73′46%);su mayor utilidad fue priorizar las citas y modalidad de asistencia. Para el resto de motivos, la proporción de "alta” alcanzó el 52′61%. Conclusiones La e-interconsulta asíncrona entre AP-Neurología es una herramienta útil en las condiciones indicadas, permitiendo resolver en un "acto único” y con escasa demora una significativa proporción de dudas clínicas o terapéuticas, así como optimizar las citas presenciales.

[Recommendations on the use of telemedicine as applied to nutritional pathology]. / Recomendaciones sobre el uso de la telemedicina aplicada a la patología nutricional.

Introduction: Introduction: telemedicine can improve the standards of clinical care and use of resources. The COVID-19 pandemic has required its implementation in routine practice. For this reason, a group of endocrinologists from Valencia, Murcia and the Balearic Islands created a committee for its development. Objectives: to establish recommendations in order to improve the quality of consultation in nutritional disorders, and to create indicators for its management. Methodology: the Delphi methodology was followed with the participation of 13 professionals in order to reach the widest consensus. A 16-item questionnaire was distributed within 3 rounds: in the first round, the degree of consensus was established; in the second round, the participants responded to the posed questions after having access to the first-round results. Agreement was considered if ≥ 75 % participants reached consensus, while strong agreement was considered if consensus was reached by ≥ 90 %. In addition, quality indicators were established. In a third round, these indicators were developed. Results: after 3 rounds and a revision 5 recommendations with strong agreement were established based on organizational aspects. Regarding administrative aspects, 6 recommendations with strong agreement were established while 4 recommendations reached the level of agreement. Eight quality indicators were selected and developed. Conclusions: this document compiles a list of recommendations about needs and requirements to be taken into account for a quality telematic consultation in patients with nutritional disorders. In addition, health care quality indicators have been created and developed.

Introducción: Introducción: la telemedicina puede mejorar la calidad asistencial y el uso de recursos. La pandemia de COVID-19 ha hecho necesaria su implementación en la práctica habitual. Por ello, un grupo de endocrinólogos de la Comunidad Valenciana, Murcia y Baleares creó un comité para su desarrollo. Objetivos: establecer unas recomendaciones para mejorar la calidad de la consulta de patología nutricional y diseñar unos indicadores para su gestión. Metodología: se siguió la metodología Delphi con participación de 13 profesionales con el fin de alcanzar el mayor consenso. Para ello se circuló un cuestionario de 16 puntos en 3 rondas: en la primera se estableció el grado de consenso; en la segunda, los participantes tuvieron acceso a los resultados de la primera y respondieron a las cuestiones planteadas. Se consideró que había acuerdo si el consenso era ≥ 75 % de los participantes, y que existía acuerdo fuerte si este era ≥ 90 %. Además, se estableció la temática de los indicadores de calidad. En la tercera se desarrollaron dichos indicadores. Resultados: tras 3 rondas y una reunión de revisión se establecieron los sobre aspectos organizativos 5 recomendaciones con acuerdo fuerte; sobre los aspectos administrativos, 6 recomendaciones con acuerdo fuerte y 4 con acuerdo. Se seleccionaron 8 indicadores de calidad que se desarrollaron en formato de fichas. Conclusiones: este documento recopila una serie de recomendaciones sobre cuestiones, necesidades y requisitos a tener en cuenta para una consulta telemática de calidad al paciente con patología nutricional. Así mismo, se han desarrollado unos indicadores para mejorar la calidad asistencial.

Will neurological care change over the next 5 years due to the COVID-19 pandemic? Key informant consensus survey. / ¿Va a cambiar la neurología tras la pandemia de COVID-19 en los próximos 5 años? Estudio de enfoque mediante informadores clave.

INTRODUCTION: The COVID-19 pandemic will give rise to long-term changes in neurological care, which are not easily predictable. MATERIAL AND METHODS: A key informant survey was used to enquire about the changes expected in the specialty over the next 5 years. The survey was completed by heads of neurology departments with broad knowledge of the situation, having been active during the pandemic. RESULTS: Despite a low level of consensus between participants, there was strong (85%) and moderate consensus (70%) about certain subjects, mainly the increase in precautions to be taken, the use of telemedicine and teleconsultations, the reduction of care provided in in-person consultations to avoid the presence of large numbers of people in waiting rooms, the development of remote training solutions, and the changes in monitoring visits during clinical trials. There was consensus that there would be no changes to the indication of complementary testing or neurological examination. CONCLUSION: The key informant survey identified the foreseeable changes in neurological care after the pandemic.

Management of neurological care during the COVID-19 pandemic. / La gestión de la asistencia neurológica en tiempos de la pandemia de Covid-19.

INTRODUCTION: The COVID-19 epidemic has led to the need for unprecedented decisions to be made to maintain the provision of neurological care. This article addresses operational decision-making during the epidemic. DEVELOPMENT: We report the measures taken, including the preparation of a functional reorganisation plan, strategies for hospitalisation and emergency management, the use of telephone consultations to maintain neurological care, provision of care at a unit outside the hospital for priority patients, decisions about complementary testing and periodic in-hospital treatments, and the use of a specific telephone service to prioritise patients with epileptic seizures. CONCLUSION: Despite the situation of confinement, neurology departments must continue to provide patient care through different means of operation. Like all elements of management, these must be evaluated.