Consensus-based perioperative protocols during the COVID-19 pandemic
| Autor: | Sarah B Doernberg, Marshall L. Stoller, Valli P Mummaneni, Vaikom S. Mahadevan, Adrienne Green, Sheila Antrum, Julie Ann Sosa, Maureen P. Kohi, Mitchel S. Berger, S. Andrew Josephson, John F. Burke, Andrew K Chan, Michael A. Gropper, John P. Roberts, Errol Lobo, Thomas P. Vail, Sandra Wienholz, Steven W. Hetts, Philip V. Theodosopoulos, C. Benjamin Ma, Sirisha Narayana, Sigurd Berven, Andrew H. Murr, Michael S. Conte, Annette M. Molinaro, Praveen V. Mummaneni, Andrew N. Goldberg, Christopher P. Hess |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
perioperative care
Clinical Sciences Delphi method surgical triage law.invention Officer 03 medical and health sciences 0302 clinical medicine Multidisciplinary approach law Clinical Research Pandemic Medicine Infection control coronavirus disease 19 business.industry Neurosciences COVID-19 General Medicine Perioperative medicine.disease Intensive care unit infection Good Health and Well Being Orthopedics 030220 oncology & carcinogenesis Medical emergency business 030217 neurology & neurosurgery Statistician |
| Zdroj: | Journal of neurosurgery. Spine, vol 34, iss 1 |
| ISSN: | 1547-5646 |
| Popis: | OBJECTIVEDuring the COVID-19 pandemic, quaternary-care facilities continue to provide care for patients in need of urgent and emergent invasive procedures. Perioperative protocols are needed to streamline care for these patients notwithstanding capacity and resource constraints.METHODSA multidisciplinary panel was assembled at the University of California, San Francisco, with 26 leaders across 10 academic departments, including 7 department chairpersons, the chief medical officer, the chief operating officer, infection control officers, nursing leaders, and resident house staff champions. An epidemiologist, an ethicist, and a statistician were also consulted. A modified two-round, blinded Delphi method based on 18 agree/disagree statements was used to build consensus. Significant disagreement for each statement was tested using a one-sided exact binomial test against an expected outcome of 95% consensus using a significance threshold of p < 0.05. Final triage protocols were developed with unblinded group-level discussion.RESULTSOverall, 15 of 18 statements achieved consensus in the first round of the Delphi method; the 3 statements with significant disagreement (p < 0.01) were modified and iteratively resubmitted to the expert panel to achieve consensus. Consensus-based protocols were developed using unblinded multidisciplinary panel discussions. The final algorithms 1) quantified outbreak level, 2) triaged patients based on acuity, 3) provided a checklist for urgent/emergent invasive procedures, and 4) created a novel scoring system for the allocation of personal protective equipment. In particular, the authors modified the American College of Surgeons three-tiered triage system to incorporate more urgent cases, as are often encountered in neurosurgery and spine surgery.CONCLUSIONSUrgent and emergent invasive procedures need to be performed during the COVID-19 pandemic. The consensus-based protocols in this study may assist healthcare providers to optimize perioperative care during the pandemic. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|