Safer Surgery
Knowledge and Library Services Evidence Update
Part of the Barts Health Education Academy
Hello and welcome to this edition of Barts Health Knowledge and Library Services’ monthly Safer Surgery Evidence Update.

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News and Opinion

Guidance and Institutional Publications
Latest Research Articles

Library COVID Update
New on our Website
Our Other Recent Updates

News and Opinion

Making the NHS safer: learning from case reports and investigations
"The NHS in England has what can be termed a patient-safety-policy development, guidance-implementation roundabout. Successive governments have brought in many commendable patient safety policies and guidance publications. Some of these, however, can be seen to have fallen on fallow ground in parts of the NHS. In some places there is a stubborn and persistent reluctance to change healthcare practices, even in the light of adverse patient safety events occurring..."
Examining the new NHS National Patient Safety Syllabus
"The author introduces the recently published NHS National Patient Safety Syllabus and some recent patient safety reports. Education and training are fundamental prerequisites to the development of any patient safety culture in any healthcare system. Healthcare staff must be given time to learn and reflect on the causes of adverse healthcare events that have resulted in patient harm..."

Guidance and Institutional Publications

Patient Safety Syllabus
"Health Education England has published the first NHS-wide Patient Safety Syllabus which applies to all NHS employees and will result in all NHS employees receiving enhanced patient safety training... Written by the Academy of Medical Royal Colleges and commissioned by HEE the new National Patient Safety Syllabus outlines a new approach to patient safety emphasising a proactive approach to identifying risks to safe care while also including systems thinking and human factors... Level one and two learning materials will be available on the E Learning for Health platform for staff to access and complete from August and September 2021..."

Latest Research Articles

WALANT Protocol: Stop before you block
"The use of Wide Awake Local Anaesthetic No Tourniquet (WALANT) amongst Plastic and Orthopaedic Hand Surgeons has been accelerated by the impact of the COVID-19 pandemic and associated risks of general anaesthesia. Benefits of WALANT include a bloodless field, improved recovery, on-table testing, as well as cost and time savings. Whilst more clinical trials are underway to fully elucidate safety-profile and outcomes, there is a lack of consensus and clarity over contraindications to WALANT. A survey of trainees identified that only one-in-five were aware of the appropriate reversal agent in the event of inadequate perfusion. We feel that a WALANT checklist should be developed and implemented for use immediately prior to administration of local anaesthetic with adrenaline to an extremity, building on the successes of the World Health Organisation (WHO) and the Royal College of Anaesthetists checklists. Such a checklist should include contraindications to WALANT and make the operator aware of the availability, dose and location of Phentolamine as a reversal agent. Introducing this checklist will help to facilitate safer and more effective use of WALANT within Hand Surgery..."
Perioperative management for gynecologic minimally invasive surgery during the COVID-19 pandemic
"Perioperative management for surgical patients should be modified to promote the safety and wellbeing of patients and caregivers amidst the COVID-19 pandemic. COVID-19 testing should be performed preoperatively with subsequent preprocedure quarantine. Nonemergent or nonlife-threatening surgery should be postponed for COVID-19 positive patients. The consensus of surgical societies is to use a laparoscopic surgical approach for COVID-19 positive patients when appropriate and to avoid port venting at the end of procedures. For COVID-19 positive patients requiring an emergent procedure, the use of personal protective equipment is strongly recommended..."
Outcomes of a multicomponent safe surgery intervention in Tanzania’s Lake Zone: a prospective, longitudinal study
"We conducted a prospective, longitudinal study in 10 intervention and 10 control facilities in Tanzania’s Lake Zone, across a 3-month pre-intervention period in 2018 and 3-month post-intervention period in 2019. SS2020 is a multicomponent intervention to support four surgical quality areas: (i) leadership and teamwork, (ii) evidence-based surgery, anesthesia and equipment sterilization practices, (iii) data completeness and (iv) infrastructure. Surgical team members received training and mentorship, and each facility received up to a $10 000 infrastructure grant. Inpatients undergoing major surgery and postpartum women were followed during their stay up to 30 days. We assessed adherence to 14 safety and teamwork and communication measures through direct observation in the operating room..."
"The LocSSIP checklist was successfully developed and approved for implementation. Pre-procedure and sign-out sections were created to allow safety checks before and after the procedures whilst allowing for efficiency and effective use. All questions were tailored to haematology such as bone marrow biopsies, lumbar punctures, and line insertions. Additionally, key safety questions for conscious sedation were created in line with local Trust and NICE guidance. Compliance of haematology LocSSIPs was 93.5% involving 31 procedures..."
Robotic surgery can be safely performed for patients and healthcare workers during COVID-19 pandemic
"We performed a retrospective single-centre cohort study of patients undergoing robotic surgery in initial period of COVID-19 pandemic. Patients and healthcare workers COVID-19 infection status was assessed by structured telephone follow-up and/or repeated nasopharyngeal swabs... After 61 robotic surgeries (93,5% cancer surgery), one patient (1.6%) had COVID-19 infection. Sixty healthcare workers cumulatively exposed to 1187 h of robotic surgery had no infection. One patient with postoperative proof of SARS-CoV-2 had complete recovery. After this potentially contagious robotic surgery, eight healthcare workers had no COVID-19 infection after follow-up with each three nasopharyngeal swabs..."
Safety and feasibility of resuming bariatric surgery under the cloud of COVID-19
"Because of the COVID-19 pandemic, numerous bariatric surgical units globally have halted weight loss surgery. Obesity itself has been shown to be a predictor of poor outcome in people infected with the virus. The aim of this study was to report our experience as a high-volume bariatric institution resuming elective weight loss surgery safely amidst emergency admissions of COVID-19-positive patients... A standard operating procedure based on national guidance and altered to accommodate local considerations was initiated across the hospital. Data were collected prospectively for 50 consecutive patients undergoing bariatric surgery following recommencement of elective surgery after the first national lockdown in the UK..."
Adapting an emergency general surgery service in response to the COVID-19 pandemic
"In response to the COVID-19 pandemic, our emergency general surgery (EGS) service underwent significant restructuring, including establishing an enhanced ambulatory service and undertaking nonoperative management of selected pathologies. The aim of this study was to compare the activity of our EGS service before and after these changes... Patients referred by the emergency department were identified prospectively over a 4-week period beginning from the date our EGS service was reconfigured (COVID) and compared with patients identified retrospectively from the same period the previous year (Pre-COVID), and followed up for 30 days. Data were extracted from handover documents and electronic care records. The primary outcomes were the rate of admission, ambulation and discharge..."
Thoracic Surgery in the COVID-19 Pandemic: A Novel Approach to Reach Guideline Consensus
"We derived recommendations from 14 thoracic societies to address key questions on the topic of COVID-19 in the field of thoracic surgery. Respective recommendations were extracted and the degree of consensus among different organizations was calculated. A high degree of consensus was found to temporarily suspend non-critical elective procedures or procedures for benign conditions and to prioritize patients with symptomatic or advanced cancer. Prior to hospitalization, patients should be screened for respiratory symptoms indicating possible COVID-19 infection and most societies recommended to screen all patients for COVID-19 prior to admission. There was a weak consensus on the usage of serology tests and CT scans for COVID-19 diagnostics. Nearly all societies suggested to postpone elective procedures in patients with suspected or confirmed COVID-19 and recommended constant reevaluation of these patients. Additionally, we summarized recommendations focusing on precautions in the theater and the management of chest drains. This study provides a novel approach to informed guidance for thoracic surgeons during the COVID-19 pandemic in the absence of scientific evidence-based data..."
[Letter] Managing elective surgery without preoperative testing during COVID-19 pandemic
"Testing upon admission was introduced to limit the spread of new coronavirus. However, the reliability of testing is limited by the fact that some patients with negative test may be in the incubation period and may start spreading the virus just after admission... In this correspondence we describe a successful approach to control the entry of COVID-19 in a specialized surgical hospital throughout the pandemic..."
Exploring the impact of the COVID-19 pandemic on cardiac surgical services: A scoping review
"Reallocation of resources, conversion of surgical intensive care units and wards to COVID-19 facilities, increased risk of nosocomial transmission to cardiac surgery patients, lead to reduced accessibility, quality, and affordability of health care facilities to cardiac surgery patients. Increasing the mortality and morbidity rate among such patients. Cardiac patients are at an increased risk to develop a severe illness if infected by COVID-19 and are associated with a high mortality rate. Therefore, measures had to be taken to reduce the spread of the virus. Various approaches such as the hubs and the spokes centers, or parallel system were enforced. Elective surgeries were postponed while urgent surgeries were prioritized. Use of personal protective equipments and surgeries performed by only senior surgeons became necessary..."

Library COVID Update

All staff are now required to sign-in, and wash their hands with the gel provided, when entering our libraries.

St Bart’s Hospital Library has moved back to its original space in the department of diagnostic imaging, on the ground floor of the KGV Building. It will be staffed from 10am-4pm, Monday to Friday, and available to staff 24/7. The phone no. there is 020 3465 5467.

At Whipps Cross and Newham Hospitals we offer comfortable seats and computer access, with tea and coffee, from 10am-4pm. Please check local notices for details. Staff can continue to access our 24/7 knowledge hubs (computer rooms) on each site.

Our Library Hub at the Royal London continues to be available to staff 24/7.

Please see our new website and our Digital Library WeShare page for more information.

New on Our Website

Browse the resource collections within our COVID-19 pages; plus further services, resources, and NHS discounts have been added to our Wellbeing pages.

Our  Leadership and Management subject guide collects all our services and resources on the topic, and signposts to external help.

You can now search the entirety of our collection from the website homepage below via the Discovery search bar too...

Visit Green at Barts Health's new website, hosted and maintained by Knowledge and Library Services:


Our Other Recent Updates

Read our latest COVID-19 and TB Update (published 5/7/21) here.
Read our round-up of research published by Barts Health authors in the month of June 2021 (published 2/7/21) here.
Read our latest monthly Leadership Update (published 1/7/21) here.
Read our latest Inclusion and Diversity Update (published 30/6/21) here.
Read our latest COVID-19 Update (published 29/6/21) here.
Read our latest Health Services Management Update (published 18/6/21) here.
Read our previous Safer Surgery Update (published 11/6/21) here.
Read our latest monthly Delirium in ICU Evidence Alert (published 17/5/21) here.
Read our latest Staff Wellbeing Update (published 13/5/21) here.

Catch up with all our archived updates on our Digital Library Weshare page.

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