Journal of perioperative practice
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Current provision of trauma services in the United Kingdom is insufficient, resulting in a high mortality of trauma patients. Multiple studies proved that regionalisation of the trauma care can significantly reduce mortality and morbidity by avoiding unnecessary transfer and reducing delay in delivering definitive surgery. This evidence led to changes in delivering trauma care in London which showed a significant reduction in mortality from severe injuries.
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Enhanced recovery after surgery (ERAS) workshop: effect on attitudes of the perioperative care team.
Enhanced recovery after surgery (ERAS) or 'fast track' surgery is heavily based on a multidisciplinary focused perioperative care model with all players being equally important for successful implementation. Several institutions run an ERAS course but few data are available on their effect on attitudes and perceptions to perioperative care principles. ⋯ There appears to be a high rate of evidence agreement with some interventions but not others amongst perioperative staff. Attending a multidisciplinary ERAS workshop seems to align opinion with evidence.
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The NHS Management Executive recommends that hospitals should aim to use 90% of planned theatre time and that theatre utilisation should be used as a key performance indicator. This study aims to investigate the impact of late-starts and overruns on theatre utilisation rates. Data were retrieved from a prospectively updated theatre database for all elective plastic surgical main theatre operating sessions carried out over a one year period. ⋯ In contrast, overrunning lists demonstrated much higher utilisation rates than those that finished before the end of the session (96.7% versus 76.6% respectively, p < 0.001). The study shows that late-starts and overruns represent obvious sources of theatre inefficiency yet their impact on utilisation is misleading: overruns exaggerate theatre usage and late-starts have little impact upon it. We conclude that the use of utilisation as a marker of theatre performance requires caution.
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Over 40 million surgical procedures are performed per annum in the USA and Europe, including several million patients who are considered to be high risk (Bennett-Guerrero et al 2003). Overall, the risk of death or major complications after surgery in the general surgical patient population is low, with a post-operative mortality rate of less than1% during the same hospital admission (Niskanen et al 2001).
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Surgical smoke is produced when tissues are dissected or cauterised by heat generating devices. Perioperative personnel and patients are routinely exposed to this smoke, and the use of smoke evacuation devices in operating theatres is not mandatory. This review will examine the most recent literature relating to surgical smoke in an attempt to discover guidelines for best practice and thereby provide recommendations for future practice.