Hybrid Surgical Hot Clinic (HSHC): Evaluation of Surgical Hot Clinic Services during COVID-19 Lockdown

Hybrid Clinics: A New Model for Ambulatory Care to Reduce Infection Risk

Objectives: To assess the viability of a hybrid clinic model combining in-person examination with video-based consultation to minimize viral transmission risk. Methods: Data were collected prospectively in a pediatric urology clinic for in-person visits from January to April 2018 ("classic") and hybrid visits from October to December 2020 of the COVID-19 pandemic ("hybrid"). Variables included provider, diagnosis, patient type, time of day, prior surgery, postoperative status, and decision-making for surgery. The primary outcome was "room time" or time in-person. The secondary outcome was "total time" or visit duration. Proportion of visits involving close contact (room time ≥15 min) was assessed. Univariate analyses were performed using the Wilcoxon rank-sum test and Fisher's exact test. Mixed models were fitted for visit approach and other covariates as fixed effects and provider as random effect. Results: Data were collected for 346 visits (256 classic, 90 hybrid). Hybrid visits were associated with less room time (median 3 min vs. 10 min, p < 0.001) but greater total time (median 13.5 min vs. 10 min, p = 0.001) as compared with classic visits. On multivariate analysis, hybrid visits were associated with 3 min less room time (95% confidence intervals [CIs]: -5.3 to -1.7, p < 0.001) but 3.8 min more total time (95% CI: 1.5-6.1, p = 0.001). Close contact occurred in 6.7% of hybrid visits, as compared with 34.8% of classic visits (p < 0.001). Conclusions: Hybrid clinic visits reduce room time as compared with classic visits. This approach overcomes the examination limitations of telemedicine while minimizing viral transmission, and represents a viable model for ambulatory care whenever close contact carries infection risk.

Leadership: an effective human factor during COVID-19

Background

A hybrid leader is an individual with a professional background who takes on managerial roles. For surgeons, leadership is a non-technical skill within a domain of a human factor and a diverse role that makes them an effective hybrid leader.

Objectives

We hypothesised that a surgical leader acts as a link between different departments in an organisation to influence performance at the workplace to bring positive changes in healthcare and patient safety.

Methods

We followed the nine-dimension Healthcare Leadership Model (HLM) and reflected on the leadership roles within our surgical department at the Princess Alexandra Hospital NHS Trust, United Kingdom.

Results

Changes were quickly adopted and monitored while leadership learned adaptability to function quickly. Hierarchical decision making was removed while levelling up communication. Telemedicine was quickly adopted at both elective and ambulatory emergency settings. The local survey also showed trust and co-operation among team members.

Conclusions

Hybrid surgical leadership is a complex but divergent role that acts as a bridge between the surgical team and others in administrative roles that promotes safer patient outcomes and better well-being for the organisations’ members

Preoperative assessment and optimisation: the key to good outcomes after the pandemic

Complications following surgery are common, predictable and often preventable. New preoperative assessment and optimisation guidance recommends clear pathways with triggers for interventions, patient involvement, shared decision making and team education, to help both patients and service efficiency.