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Salam A, Wireko AA, Jiffry R, Ng JC, Patel H, Zahid MJ, Mehta A, Huang H, Abdul-Rahman T, Isik A. The impact of natural disasters on healthcare and surgical services in low- and middle-income countries. Ann Med Surg (Lond) 2023; 85:3774-3777. [PMID: 37554857 PMCID: PMC10406090 DOI: 10.1097/ms9.0000000000001041] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 06/29/2023] [Indexed: 08/10/2023] Open
Affiliation(s)
- Abdus Salam
- Department of Surgery, Khyber Teaching Hospital
| | | | - Riaz Jiffry
- Faculty of Medicine and Health Sciences, University of Putra Malaysia, Serdang, Malaysia
| | - Jyi C. Ng
- Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - Heli Patel
- Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Florida, USA
| | - Muhammad J. Zahid
- Department of Surgery, Hayatabad Medical Complex, Peshawar, Pakistan
| | - Aashna Mehta
- Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Helen Huang
- Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | | | - Arda Isik
- Department of General Surgery, Istanbul Medeniyet University, Istanbul, Turkey
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Turcotte JJ, Gelfand JM, Jones CM, Jackson RS. Development of a Low-Resource Operating Room and a Wide-Awake Orthopedic Surgery Program During the COVID-19 Pandemic. Surg Innov 2021; 28:183-188. [PMID: 33780646 DOI: 10.1177/15533506211003530] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction. The COVID-19 pandemic resulted in significant medication, supply and equipment, and provider shortages, limiting the resources available for provision of surgical care. In response to mandates restricting surgery to high-acuity procedures during this period, our institution developed a multidisciplinary Low-Resource Operating Room (LROR) Taskforce in April 2020. This study describes our institutional experience developing an LROR to maintain access to urgent surgical procedures during the peak of the COVID-19 pandemic. Methods. A delineation of available resources and resource replacement strategies was conducted, and a final institution-wide plan for operationalizing the LROR was formed. Specialty-specific subgroups then convened to determine best practices and opportunities for LROR utilization. Orthopedic surgery performed in the LROR using wide-awake local anesthesia no tourniquet (WALANT) is presented as a use case. Results. Overall, 19 limited resources were identified, spanning across the domains of physical space, drugs, devices and equipment, and personnel. Based on the assessment, the decision to proceed with creation of an LROR was made. Sixteen urgent orthopedic surgeries were successfully performed using WALANT without conversion to general anesthesia. Conclusion. In response to the COVID-19 pandemic, a LROR was successfully designed and operationalized. The process for development of a LROR and recommended strategies for operating in a resource-constrained environment may serve as a model for other institutions and facilitate rapid implementation of this care model should the need arise in future pandemic or disaster situations.
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Affiliation(s)
- Justin J Turcotte
- Department of Orthopedics, Anne Arundel Medical Center, Annapolis, MD, USA
| | - Jeffrey M Gelfand
- Department of Orthopedics, Anne Arundel Medical Center, Annapolis, MD, USA
| | | | - Rubie S Jackson
- Department of Surgery, Fortney Breast Center, Anne Arundel Medical Center, Annapolis, MD, USA
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Shah N, Mathew S, Pereira A, Nakaima A, Sridharan S. The role of evaluation in iterative learning and implementation of quality of care interventions. Glob Health Action 2021; 14:1882182. [PMID: 34148508 PMCID: PMC8216261 DOI: 10.1080/16549716.2021.1882182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 12/22/2020] [Indexed: 11/01/2022] Open
Abstract
Background: The Lancet Global Health Commission (LGHC) has argued that quality of care (QoC) is an emergent property that requires an iterative process to learn and implement. Such iterations are required given that health systems are complex adaptive systems.Objective: This paper explores the multiple roles that evaluations need to play in order to help with iterative learning and implementation. We argue evaluation needs to shift from a summative focus toward an approach that promotes learning in complex systems. A framework is presented to help guide the iterative learning, and includes the dimensions of clinical care, person-centered care, continuum of care, and 'more than medicine. Multiple roles of evaluation corresponding to each of the dimensions are discussed.Methods: This paper is informed by reviews of the literature on QoC and the roles of evaluation in complex systems. The proposed framework synthesizes the multiple views of QoC. The recommendations of the roles of evaluation are informed both by review and experience in evaluating multiple QoC initiatives.Results: The specific roles of different evaluation approaches, including summative, realist, developmental, and participatory, are identified in relationship to the dimensions in our proposed framework. In order to achieve the potential of LGHC, there is a need to discuss how different evaluation approaches can be combined in a coherent way to promote iterative learning and implementation of QoC initiatives.Conclusion: One of the implications of the QoC framework discussed in the paper is that time needs to be spent upfront in recognizing areas in which knowledge of a specific intervention is not complete at the outset. This, of course, implies taking stock of areas of incompleteness in knowledge of context, theory of change, support structures needed in order for the program to succeed in specific settings. The role of evaluation should not be limited to only providing an external assessment, but an important goal in building evaluation capacity should be to promote adaptive management among planners and practitioners. Such iterative learning and adaptive management are needed to achieve the goals of sustainable development goals.
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Affiliation(s)
- Nikhil Shah
- The Evaluation Centre for Complex Health Interventions, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Sharon Mathew
- The Evaluation Centre for Complex Health Interventions, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Amanda Pereira
- The Evaluation Centre for Complex Health Interventions, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - April Nakaima
- The Evaluation Centre for Complex Health Interventions, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Pyda J, Patterson RH, Caddell L, Wurdeman T, Koch R, Polatty D, Card B, Meara JG, Corlew DS. Towards resilient health systems: opportunities to align surgical and disaster planning. BMJ Glob Health 2019; 4:e001493. [PMID: 31275620 PMCID: PMC6577360 DOI: 10.1136/bmjgh-2019-001493] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 05/08/2019] [Accepted: 05/11/2019] [Indexed: 11/10/2022] Open
Abstract
Natural disasters significantly contribute to human death and suffering. Moreover, they exacerbate pre-existing health inequalities by imposing an additional burden on the most vulnerable populations. Robust local health systems can greatly mitigate this burden by absorbing the extraordinary patient volume and case complexity immediately after a disaster. This resilience is largely determined by the predisaster local surgical capacity, with trauma, neurosurgical, obstetrical and anaesthesia care of particular importance. Nevertheless, the disaster management and global surgery communities have not coordinated the development of surgical systems in low/middle-income countries (LMIC) with disaster resilience in mind. Herein, we argue that an appropriate peridisaster response requires coordinated surgical and disaster policy, as only local surgical systems can provide adequate disaster care in LMICs. We highlight three opportunities to help guide this policy collaboration. First, the Lancet Commission on Global Surgery and the Sendai Framework for Disaster Risk Reduction set forth independent roadmaps for global surgical care and disaster risk reduction; however, ultimately both advocate for health system strengthening in LMICs. Second, the integration of surgical and disaster planning is necessary. Disaster risk reduction plans could recognise the role of surgical systems in disaster preparedness more explicitly and pre-emptively identify deficiencies in surgical systems. Based on these insights, National Surgical, Obstetric, and Anesthesia Plans, in turn, can better address deficiencies in systems and ensure increased disaster resilience. Lastly, the recent momentum for national surgical planning in LMICs represents a political window for the integration of surgical policy and disaster risk reduction strategies.
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Affiliation(s)
- Jordan Pyda
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA.,Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Rolvix H Patterson
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA.,Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Luke Caddell
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA.,University of Miami School of Medicine, Miami, Florida, USA
| | - Taylor Wurdeman
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA.,University of Miami School of Medicine, Miami, Florida, USA
| | - Rachel Koch
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA.,Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - David Polatty
- Humanitarian Response Program, US Naval War College, Newport, Rhode Island, USA
| | - Brittany Card
- Humanitarian Response Program, US Naval War College, Newport, Rhode Island, USA
| | - John G Meara
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA.,Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Daniel Scott Corlew
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
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