Time Out: The Impact of Physician Burnout on Patient Care Quality and Safety in Perioperative Medicine.

Perioperative care delivery is a patient-centered, multidisciplinary process. It relies heavily on synchronized teamwork from a well-coordinated team. Perioperative physicians-surgeons and anesthesiologists-face enormous challenges in surgical care delivery due to changing work environments, post-COVID consequences, shift work disorder, value conflict, escalating demands, regulatory complexity, and financial uncertainties. Physician burnout in this working environment has become increasingly prevalent. It is not only harmful to physicians' health and well-being, but it also affects the quality and safety of patient care. Additionally, the economic costs associated with physician burnout are untenable due to the high turnover rate, high recruitment expenses, and potential early permanent exit from medical practice. In this deteriorating environment of unbalanced physician supply/demand, recognizing, managing, and preventing physician burnout may help preserve the system's most valuable asset and contribute to higher quality and safety of patient care. Leaders in government agencies, health care systems, and organizations must work together to re-engineer the health care system for better physicians and patient care.

Global perioperative surgery research: A call to Latin America / Investigación global sobre el perioperatorio quirúrgico: un llamado a América Latina

Every year, around 300 million surgical procedures are performed worldwide 1,2, with an estimated 4% early postoperative mortality rate. 3,4 However, little is known about global quality of surgery, specifically in middle-income countries. Colombia, similar to other Latin American countries, has an interesting diversity of healthcare needs. In urban settings, the healthcare offered is among the best in Latin America, with top-quality hospitals and educational programs comparable to those in the USA or Europe. In contrast, in most rural areas of Latin America, including some of the most remote locations in the world (like the Pacific Coast or the Amazon forest), a frail and fragmented healthcare system prevails, similar to the conditions in very low-income countries. At least 7.1 million people (15.1% of the population) lack hospital access within a 2-hour drive, and despite these characteristics, the early reported postoperative mortality is low - 0.74%.

Cada año se realizan alrededor de 300 millones de intervenciones quirúrgicas en todo el mundo 1,2, con una tasa estimada de mortalidad postoperatoria temprana del 4%. 3,4 Sin embargo, poco se sabe sobre la calidad global de la cirugía, específicamente en los países de ingresos medios. Colombia, al igual que otros países latinoamericanos, presenta una interesante diversidad de necesidades de atención médica. En los entornos urbanos, la oferta sanitaria se encuentra entre las mejores de América Latina, con hospitales de primera calidad y programas educativos comparables a los de Estados Unidos o Europa. En cambio, en la mayoría de las zonas rurales de América Latina, incluidas algunas de las localidades más remotas del mundo (como la costa del Pacífico o la selva amazónica), prevalece un sistema sanitario frágil y fragmentado, similar a las condiciones de los países de muy bajos ingresos. Al menos 7,1 millones de personas (el 15,1% de la población) carecen de acceso a un hospital a menos de 2 horas de viaje, y a pesar de estas características, la mortalidad postoperatoria temprana reportada es baja: 0,74%.

Obstructive sleep apnoea and perioperative medicine: a growing concern.

Obstructive sleep apnoea represents a sizable public health and economic burden. Owing to rising obesity rates, the prevalence of obstructive sleep apnoea is increasing, and it is a condition that is significantly underdiagnosed. Exacerbated by the COVID-19 pandemic, the backlog of elective surgeries is also sizable and growing. A combination of these factors means that many patients due to have surgery will have obstructive sleep apnoea, either diagnosed or otherwise. Patients with obstructive sleep apnoea have a significantly increased risk of operative complications, but the evidence base for optimum perioperative management of these patients is limited. This article reviews sleep apnoea, its prevalence and its impact on operative management and perioperative outcomes for patients. The evidence base for screening and treating undiagnosed obstructive sleep apnoea is also comprehensively assessed. Finally, a pathway to manage patients with possible undiagnosed obstructive sleep apnoea is proposed, and areas for further research identified.

Practice-Changing Updates in Perioperative Medicine Literature 2020-2021: A Systematic Review.

Recent literature published in a variety of multidisciplinary journals has significantly influenced perioperative patient care. Distilling and synthesizing the clinically important literature can be challenging. This review summarizes practice-changing articles in perioperative medicine from the years 2020 and 2021. Embase, Ovid, and EBM reviews databases were queried from January 2020 to December 2021. Inclusion criteria were original research, systematic review, meta-analysis, and important guidelines. Exclusion criteria were conference abstracts, case reports, letters, protocols, pediatric and obstetric articles, and cardiac surgery literature. Two authors reviewed each reference using the Distiller SR systematic review software (Evidence Partners Inc., Ottawa, Ont., Canada). A modified Delphi technique was used to identify 9 practice-changing articles. We identified another 13 articles for tabular summaries, as they were relevant to an internist's perioperative evaluation of a patient. Articles were selected to highlight the clinical implications of new evidence in each field. We have also pointed out limitations of each study and clinical populations where they are not applicable.

Towards integrated perioperative medicine: a survey of general practitioners' attitudes, beliefs and behaviours regarding perioperative medicine for older people.

BACKGROUND: Perioperative optimisation can improve outcomes for older people having surgery. Integration with primary care could improve quality and reduce variability in access to preoperative optimisation. AIM: Our aim was to explore attitudes, beliefs and behaviours of general practitioners (GPs) regarding the perioperative pathway, and evaluate enablers and barriers to GP-led preoperative optimisation. METHODS: Stakeholder interviews (n=38) informed survey development. A purposive sampling frame was used to target delivery of online and paper surveys. Results were analysed using descriptive statistics. RESULTS: We had 231 responses (response rate 32.7%). Enablers included belief among GPs that optimisation improves postoperative outcomes (86%) and that they have a role discussing modifiable risk factors with patients (85%). Barriers included low frequency exposure to older surgical patients, minimal training in perioperative medicine and rare interaction with perioperative services. CONCLUSION: This survey illustrates the importance of interprofessional education, cross-sector training opportunities and collaboration to deliver integrated preoperative optimisation for older people undergoing surgery.

Developing a virtual geriatric perioperative medicine clinic: a mixed methods healthcare improvement study.

BACKGROUND: the Geriatric Perioperative Care clinic at North Bristol NHS Trust was suspended in March 2020 during the COVID-19 pandemic. A virtual clinic was piloted to deliver preoperative health optimisation and shared decision-making for patients undergoing critical elective surgery. No literature existed on virtual preoperative clinics for older people to support the development. OBJECTIVE: this healthcare improvement study describes the setup and delivery of the virtual clinic as its primary aim. Secondary aims included: assessing older people's access to technology and their digital literacy for virtual consultation; to describe barriers and facilitators for consultations, as well as evaluation of patient and clinician satisfaction with the consultations' mode of delivery and outcomes. METHODS: a mixed methods healthcare improvement study was undertaken through plan-do-study-act cycles, semi-structure interviews, and quantitative service benchmarking. RESULTS: the pilot evaluated 67 preoperative consultations (43.3% video, 56.7% telephone, mean age 75) with a mix of surgical pathology (vascular 88.1%, colorectal 10.4%, urological 1.5%). Patient feedback demonstrated improved understanding of conditions (90.6%), and adequate opportunity to express opinions and questions (96.2%). Clinicians preferred video consultations (adequate to deliver services: 89.7% video; 68.4% telephone). The greatest barriers to engagement, none of which were exclusions to participation, included cognitive impairment, sensory impairment, or needing technical assistance setting up video consultations (52.2%). CONCLUSIONS: delivering a virtual preoperative medical optimisation and shared decision clinic for older people is feasible. This study will aid other units in developing their own virtual preoperative clinics. Future work should evaluate perioperative outcomes of delivering a face-to-face versus virtual clinic.