PREOPERATIVE INVESTIGATIONS IN ELECTIVE SURGERY: PRACTICES AND COSTS AT THE NATIONAL HOSPITAL OF SRI LANKA

During preoperative preparation patients undergo investigations to detect asymptomatic diseases. The probability of finding significant abnormalities on such “routine ” investigations is small, unnecessarily increasing costs of perioperative care. We evaluated current practices, compliance with guidelines and costs of preoperative investigations at the National Hospital of Sri Lanka (NHSL). Methods: Patients undergoing elective surgery at seven general surgical units of the NHSL from January-Februaary 2009 were included. NICE-UK guidelines on pre-operative investigation was the standard of assessment. Data on preoperative investigations were collected using an expert validated pre-tested interviewer administered questionnaire. A self-administered questionnaire was used to assess the ward practices and House Officers’(HOs) knowledge. Results: Sample size was 367. Mean age 45.7±15.8 years and males were 46.9%. Majority were ASA-I (68.7%) and surgical grade-II (56.7%). Urinalysis and arterial blood gases demonstrated good adherence (70%-100%) to guidelines. Electrocardiography, full blood count, renal functio

Preoperative testing in elective surgery: Is it really cost effective?

Hasil penelitian ini menujukkan bahwa variabel tingkat pendidikan dan kinerja pustakawan di Dinas Perpustakaan dan Kearsipan Provinsi Sulawesi Selatan termasuk dalam interval sangat baik. Hasil uji nilai korelasi person antara variabel pengaruh tingkat pendidikan dan kinerja pustakawan bernilai positif. Sedangkan berdasarkan hasil uji regresi ada pengaruh tingkat pendidikan terhadap kinerja pustakawan. Sedangkan hasil uji hipotesis menunjukkan bahwa t hitung variabel tingkat pendidikan sebesar 6.157 sementara t tabel sebesar 0.2108 yang artinya signifikan sehingga ha diterima yang menunjukkan bahwa ada pengaruh tingkat pendidikan terhadap kinerja pustakawan di Dinas Perpustakaan dan Kearsipan Provinsi Sulawesi Selatan

Trans-hiatal oesophagectomy in a AIDS patient

A 49-year-old man was diagnosed as HIV infected, with a CD4 count of 60 cells/µl. He was started on an antiretroviral treatment regimen comprising zidovudine, lamivudine and efavirenz. Following treatment, his CD4 count improved and the viral load was undetectable. He was subsequently found to have a moderately differentiated adenocarcinoma of the lower oesophagus

A learning health systems approach to improving the quality of care for patients in South Asia

Poor quality of care is a leading cause of excess morbidity and mortality in low- and middle- income countries (LMICs). Improving the quality of healthcare is complex, and requires an interdisciplinary team equipped with the skills to design, implement and analyse setting-relevant improvement interventions. Such capacity is limited in many LMICs. However, training for healthcare workers in quality improvement (QI) methodology without buy-in from multidisciplinary stakeholders and without identifying setting-specific priorities is unlikely to be successful. The Care Quality Improvement Network (CQIN) was established between Network for Improving Critical care Systems and Training (NICST) and University College London Centre for Perioperative Medicine, with the aim of building capacity for research and QI. A two-day international workshop, in collaboration with the College of Surgeons of Sri Lanka, was conducted to address the above deficits. Innovatively, the CQIN adopts a learning health systems (LHS) approach to improving care by leveraging information captured through the NICST electronic multi-centre acute and critical care surveillance platform. Fifty-two delegates from across the CQIN representing clinical, civic and academic healthcare stakeholders from six countries attended the workshop. Mapping of care processes enabled identification of barriers and drivers to the delivery of care and facilitated the selection of feasible QI methods and matrices. Six projects, reflecting key priorities for improving the delivery of acute care in Asia, were collaboratively developed: improving assessment of postoperative pain; optimising sedation in critical care; refining referral of deteriorating patients; reducing surgical site infection after caesarean section; reducing surgical site infection after elective general surgery; and improving provision of timely electrocardiogram recording for patients presenting with signs of acute myocardial infarction. Future project implementation and evaluation will be supported with resources and expertise from the CQIN partners. This LHS approach to building capacity for QI may be of interest to others seeing to improve care in LMICs

Addressing the information deficit in global health: lessons from a digital acute care platform in Sri Lanka

Lack of investment in low-income and middle-income countries (LMICs) in systems capturing continuous information regarding care of the acutely unwell patient is hindering global efforts to address inequalities, both at facility and national level. Furthermore, this of lack of data is disempowering frontline staff and those seeking to support them, from progressing setting-relevant research and quality improvement. In contrast to high-income country (HIC) settings, where electronic surveillance has boosted the capability of governments, clinicians and researchers to engage in service-wide healthcare evaluation, healthcare information in resource-limited settings remains almost exclusively paper based. In this practice paper, we describe the efforts of a collaboration of clinicians, administrators, researchers and healthcare informaticians working in South Asia, in addressing the inequality in access to patient information in acute care. Harnessing a clinician-led collaborative approach to design and evaluation, we have implemented a national acute care information platform in Sri Lanka that is tailored to priorities of frontline staff. Iterative adaptation has ensured the platform has the flexibility to integrate with legacy paper systems, support junior team members in advocating for acutely unwell patients and has made information captured accessible to diverse stakeholders to improve service delivery. The same platform is now empowering clinicians to participate in international research and drive forwards improvements in care. During this journey, we have also gained insights on how to overcome well-described barriers to implementation of digital information tools in LMIC. We anticipate that this north–south collaborative approach to addressing the challenges of health system implementation in acute care may provide learning and inspiration to other partnerships seeking to engage in similar work

A learning health systems approach to improving the quality of care for patients in South Asia

Poor quality of care is a leading cause of excess morbidity and mortality in low- and middle- income countries (LMICs). Improving the quality of healthcare is complex, and requires an interdisciplinary team equipped with the skills to design, implement and analyse setting-relevant improvement interventions. Such capacity is limited in many LMICs. However, training for healthcare workers in quality improvement (QI) methodology without buy-in from multidisciplinary stakeholders and without identifying setting-specific priorities is unlikely to be successful. The Care Quality Improvement Network (CQIN) was established between Network for Improving Critical care Systems and Training (NICST) and University College London Centre for Perioperative Medicine, with the aim of building capacity for research and QI. A two-day international workshop, in collaboration with the College of Surgeons of Sri Lanka, was conducted to address the above deficits. Innovatively, the CQIN adopts a learning health systems (LHS) approach to improving care by leveraging information captured through the NICST electronic multi-centre acute and critical care surveillance platform. Fifty-two delegates from across the CQIN representing clinical, civic and academic healthcare stakeholders from six countries attended the workshop. Mapping of care processes enabled identification of barriers and drivers to the delivery of care and facilitated the selection of feasible QI methods and matrices. Six projects, reflecting key priorities for improving the delivery of acute care in Asia, were collaboratively developed: improving assessment of postoperative pain; optimising sedation in critical care; refining referral of deteriorating patients; reducing surgical site infection after caesarean section; reducing surgical site infection after elective general surgery; and improving provision of timely electrocardiogram recording for patients presenting with signs of acute myocardial infarction. Future project implementation and evaluation will be supported with resources and expertise from the CQIN partners. This LHS approach to building capacity for QI may be of interest to others seeing to improve care in LMICs

CLINICAL INVESTIGATIONS COMPARISON OF THREE SKIN DISINFECTANT SOLUTIONS USED FOR SKIN PREPARATION PRIOR TO SPINAL AND EPIDURAL ANAESTHETIC PROCEDURES IN PARTURIENTS AT DE SOYZA MATERNITY HOSPITAL AND CASTLE STREET HOSPITAL FOR WOMEN.

Effective skin disinfection before spinal and epidural anaesthesia is essential to avoid bacterial infection. Three disinfectants, Betadine, Cetavlon and a combination of Chlorhexidine, Cetrimide and Isopropyl alcohol are used in hospitals as skin disinfectant solutions. We compared the ability of these disinfectant solutions to reduce the bacterial skin flora prior to anaesthetic procedures. Method 80 Pregnant women admitted to Castle Street Hospital for Women (CSHW) and De Soysa Maternity Hospital (DMH) who received epidural or spinal anaesthesia were studied. They were randomly assigned to receive skin preparation with Betadine, Cetavlon and the combined preparation. Two cultures were obtained from each subject; just prior to skin disinfection and immediately following disinfection. In-use test was performed to determine bacterial contamination of newly opened and multiple used bottles from each group. Results The reduction in bacterial colony forming units (CFU) following application of disinfectant in all three groups were significant (p <0.05). The reduction of bacterial CFU following ski