Performance improvement programs may help reduce the surgical backlog in South African hospitals
DOI:
https://doi.org/10.18203/2349-2902.isj20212300Keywords:
Surgical backlog, ERAS, Bundles of care, Care pathwayAbstract
The COVID-19 pandemic has presented an unprecedented dilemma to healthcare systems around the world, leaving many countries with the burden of massive surgical backlogs, caused by the postponement or cancellation of elective surgical procedures. Current ideas to reduce the consequential impact of this surgical backlog on patient morbidity and mortality is to increase surgical volumes, however in under-resourced countries such as South Africa this idea may be more difficult to implement due to a shortage of facilities and clinical staff. In addition, the current infrastructure, especially those in many public healthcare facilities are poor and this coupled with limited financial resources presents further challenges. Also, all hospitals both public and private alike, cannot function at full capacity due to COVID-19 protocols. Given these limitations, performance improvement strategies must be implemented with some urgency in order to limit further backlogs and disruptions to surgical outputs. Evidence-based, best practice strategies such as surgical bundles, care pathways and enhanced recovery after surgery programs have been shown to improve surgical outcomes and reduce hospital stay. Since the bottleneck to surgical volume lies in post-operative care and not theatre capacity, implementation of such programs may help to improve patient throughput, thereby increasing surgical volumes and could possibly be the answer towards reducing these overwhelming backlogs.
References
Corona virus cases. Available at: https://www.worldometers.info/coronavirus/country/south-africa/. Accessed on 20 February 2021.
Chu KM, Smith M, Steyn E, Goldberg P, Bougard H, Buccimazza I. Changes in surgical practice in 85 South African hospitals during COVID-19 hard lockdown. S Afr Med J. 2020;110(9):916-9.
CovidSurg Collaborative. Elective surgery cancellations due to the COVID-19 pandemic: global predictive modelling to inform surgical recovery plans. Br J Surg. 2020;107(11):1440-9.
Haraden C. Institute for healthcare improvement website: what is a bundle?. Available at: http://www.ihi.org/knowledge/Pages/ImprovementStories/WhatIsaBundle.aspx. Accessed October 14, 2013.
Resar R, Pronovost P, Haraden C, Simmonds T, Rainey T, Nolan T. Using a bundle approach to improve ventilator care processes and reduce ventilator-associated pneumonia. Jt Comm J Qual Patient Saf. 2005;31(5):243-8.
Resar R, Griffin FA, Haraden C, Nolan TW. Using care bundles to improve health care quality. IHI innovation series white paper. Available at: http://www.ihi.org/resources/Pages/IHIWhitePapers/UsingCareBundles.aspx. Accessed on 20 February 2021.
Wasserman S, Messina A. Guide to infection control in the healthcare setting. Available at: https://www.urotoday.com/images/catheters/pdf/IHIUsingCareBundlesWhitePaper2012.pdf. Accessed on 20 February 2021.
Bardram L, Funch-Jensen P, Jensen P, Crawford ME, Kehlet H. Recovery after laparoscopic colonic surgery with epidural analgesia, and early oral nutrition and mobilisation. Lancet. 1995;345:763-4.
Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth. 1997;78:606-17.
Kehlet H, Mogensen T. Hospital stay of 2 days after open sigmoidectomy with a multimodal rehabilitation programme. Br J Surg. 1999;86(2):227-30.
Ljungqvist O, Scott M , Fearon KC. Enhanced recovery after surgery: a review. JAMA Surg. 2017;152(3): 292-8.
Loughlin SM, Alvarez A, Falcão LFDR, Ljungqvist O. The History of ERAS (Enhanced Recovery After Surgery) Society and its development in Latin America. Rev Col Bras Cir. 2020;47:e20202525.
Kehlet H. Enhanced postoperative recovery: good from afar, but far from good? Anaesthesia. 2020;75(1):e54-61.
Guidelines. Available at: https://www.erassociety. org/. Accessed on 20 February 2021.
Loots E, Sartorius B, Paruk IM, Clarke DL. The Successful Implementation of a Modified Enhanced Recovery After Surgery (ERAS) Program for Bariatric Surgery in a South African Teaching Hospital. Surg Laparosc Endosc Percutan Tech. 2018; 28(1):26-9.
Oodit RL, Ljungqvist O, Moodley J. Can an Enhanced Recovery After Surgery(ERAS) programme improve colorectal cancer outcomes in South Africa? S Afr J Surg. 2018;56(1):8-11.
Napolitano LM. Standardization of perioperative management: clinical pathways. Surg Clin North Am. 2005;85(6):1321-7.
Berrios-Torres SI, Umscheid CA, Bratzler DW. Centers for disease control and prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg. 2017;152(8):784-91.
Global guidelines for the prevention of surgical site infection. Available at: https://www.who.int/gpsc/ssi-prevention-guidelines/en/. Accessed on 20 February 2021.
NICE guideline, surgical site infections: prevention and treatment.. Available at: https://www.nice.org. uk/guidance/ng125. Accessed on 20 February 2021.
Kawakita T, Iqbal SN, Landy HJ, Huang JC, Fries M. Reducing Cesarean Delivery Surgical Site Infections: A Resident-Driven Quality Initiative. Obstet Gynecol. 2019;133(2):282-8.
McCoy A, Das R. Reducing patient mortality, length of stay and readmissions through machine learning-based sepsis prediction in the emergency department, intensive care unit and hospital floor units. BMJ Open Qual. 2017;6(2):e000158.
Mayon-White RT, Ducel G, Kereselidze T, Tikomirov E. An international survey of the prevalence of hospital-acquired infection. J Hosp Infect. 1988;11:43-8.
Dell AJ, Navsaria PH, Gray S, Kloppers JC. Nosocomial infections: A further assault on patients in a high-volume urban trauma centre in South Africa. S Afr Med J. 2020;110(2):123-5.
Nair A, Steinberg WJ, Habib T, Saeed H, Raubenheimer JE. Prevalence of healthcare-associated infection at a tertiary hospital in the Northern Cape Province, South Africa. South African Family Pract 2018;60(5):162-7.
