Joint GSI-Anesthesia Operative Conference-1996

Joint GSI-Anesthesia Operative Conference

January, 1999

Content

Start of Joint GSI-Anesthesia Operative Conference (Januar 13, 1999)

Memorandum of Agreement

Implementing Guidelines and Evaluating Strategies

Start of Joint GSI-Anesthesia Operative Conference (Januar 13, 1999)

Division of Head and Neck, Breast, Esophagus, and Soft Tissue Surgery
Department of Surgery
Philippine General Hospital

January 6, 1999

Professor Benigno M. Sulit, Jr., MD
Department of Anesthesia
Philippine General Hospital

Dear Prof.. Sulit:

Thank you for attending our GS I Preop and Postop Conference on January 6, 1999. Your presence indeed promoted a better working relationship between our two units. As heads of our respective units, we have agreed to a joint GSI-Anesthesia Operative Conference to formally start on January 13, 1999 and every Wednesday thereafter, from 3 to 4 pm.

Both of us agreed that this formally expressed cooperation is a nice way to start the new year. We also hope that this joint meeting will continue on to the next millenium and beyond for the benefit of our patients in the Philippine General Hospital.

To formalize as well as institutionalize this historic joint GSI-Anesthesia Operative Conference, I put into writing what we agreed upon on January 6, 1999 and prepared a memo of agreement. Please go over the memo. If you don't have any corrections, let us both sign it and then get the approval signatures of our department chairmen.

May our joint conference stir the other units in our departments to follow suit in the name of quality patient care.

Thank you once again.

Reynaldo O. Joson, MD, MHA, MHPEd, MS Surg
Chief, GSI Division

cc: Chairs, Department of Surgery and Anesthesia

Start of Joint GSI-Anesthesia Operative Conference (Januar 13, 1999)
Memorandum of Agreement
Implementing Guidelines and Evaluating Strategies

Memorandum of Agreement

GSI-Anesthesia Operative Conference
Philippine General Hosppital

WHEREAS, the management of surgical patients needs the expertise of both the surgeons and the anesthesiologists;

WHEREAS, the outcome of management of surgical patients rely heavily on the precise teamwork of the surgeons and the anesthesiologists;

WHEREAS, the preoperative preparations, intraoperative maneuvers, and postoperative care need coordination between the surgeons and the anesthesiologists; and

WHEREAS, preoperative planning is the first and a crucial phase of management where surgeons and anesthesiologists must come together to openly discuss and consensually decide on a concerted and coordinated operative treatment strategy;

WE RESOLVE, therefore, that a formal joint GSI-Anesthesia Operative Conference be held for the benefit of the patients to be managed by both specialties, starting January 13, 1999, and every week thereafter, all year round.

WE ALSO RESOLVE that implementing guidelines and evaluating strategies be set up for the GSI-Anesthesia Preoperative Conference.

Signed on January 13, 1999, Philippine General Hospital, Metro Manila.

Reynaldo O. Joson, MD
Chief, GSI Division

Benigno M. Sulit, Jr., MD
Chief, GS Anesthesia Service

Romeo R. Gutierrez, MD
Chair, Department of Surgery

Virgilio T. Genuino, MD
Chair, Department of Anesthesia

Start of Joint GSI-Anesthesia Operative Conference (Januar 13, 1999)
Memorandum of Agreement
Implementing Guidelines and Evaluating Strategies

Implementing Guidelines and Evaluating Strategies

GSI-Anesthesia Operative Conference
Philippine General Hosppital

Objectives of GSI-Anesthesia Operative Conference
Persons Responsible for the Conference
Types of Persons Who Must be Present for the Conference to be a Joint Conference
Preconference Preparations
Format of the Conference
Evaluating Strategies
Data Bases Needed
Reports
Improvement and Revision of Implementing Guidelines and Evaluation Strategies

Objectives of GSI-Anesthesia Operative Conference

To provide opportunities for surgeons and anesthesiologists to openly discuss and to consensually decide on a concerted and coordinated operative treatment plan for all GSI patients so as to produce quality surgical-anesthetic care.
To provide opportunities for surgeons and anesthesiologists to openly evaluate course and outcome of operations previously performed by both parties so as to constantly and continuously improve the quality of surgical-anesthetic care.

Persons Responsible for the Conference

GSI Senior Resident under the supervision of the Chief of GSI Division of the Department of Surgery
Senior Anesthesia Resident assigned to GSI Patients under the supervision of Chief of the GS Anesthesia Service of the Department of Anesthesia

Types of Persons Who Must be Present for the Conference to be a Joint Conference

At least one GSI consultant
At least one Anesthesia consultant
GSI Residents
Anesthesia residents assigned to GSI patients

Venue: GSI Conference Room

Time: Every Wednesday, 3-4 pm

Preconference Preparations

Both the GSI Senior Resident and the Senior Anesthesia Resident assigned to GSI should coordinate in the preparation of presentation in the conference.
They should have evaluated all GSI patients, both preop and postop, to be presented in the conference.
They should consensually decide which patients should receive priority in the presentation so that the conference finishes on time.
They should consensually decide on the presence or absence of anticipated surgical and anesthetic difficulties in preop patients.

They should analyze and be ready to discuss the surgical and anesthetic problems encountered in operated patients.

Format of the Conference

For Postop Patients

1. GSI Resident presents case for discussion.

Age/Sex
Diagnosis
Surgical procedure done
Statement on problems encountered

For surgical problems, GSI resident describes, presents analysis of causes and recommendations for improvement and avoidance
For anesthetic problems, Anesthesia resident describes, presents analysis of causes and recommendations for improvement and avoidance

2. Discussion

Focus on problem identification, causes, and improvement.

For Preop Patients

1. GSI Resident presents the case scheduled for operation.

Age/sex
Pretreatment diagnosis
Basis for diagnosis
Proposed surgical procedure
Rationale
Statement on the presence or absence of anticipated surgical difficulties

2. Discussion on

Diagnosis
Surgical Procedure

3. Anesthesia Resident presents anesthetic plan with a statement on presence or absence of anticipated anesthetic difficulties

4. Discussion on proposed anesthetic management

5. Consensual decision on preoperative plan, intraoperative maneuvers, and postoperative care

Evaluating Strategies

Objective-referenced evaluation parameters

Objectives

Parameters

Indicators/Target

Opportunites provided

Number of joint conferences held

No. of "joint" conferences
- 90% of total no. of conferences that can be possibly held in a year
(10x4 + 2x2 = 44)
[Feb-Nov x 4 + Jan+Dec x 2]

Mutually agreed plan

Number of consensual plan

No. of consensual plan
= no. of "joint" conferences held
Must be 90% of total no. of conferences that can be possibly held in a year

Quality patient care

Surgical morbidities/mortalities

Rate per year
Overall rate = 2 %

Anesthetic morbidities/mortalities

Rate per year
Overall rate = 2 %

Preoperative phase
Length of preop hospital stay

Average length
Overall average = 3 days

Intraoperative phase
Length of operative time

Average length
Overall average = 3 hours

Postoperative phase
Length of postop hospital stay

Average length
Overall average = 3 days

Note 1: Overall target rates and length are in consideration of types of operation being done in GSI - mastectomy, thyroidectomy, esophagectomy, soft tissue tumor extirpation, head and neck surgery

Note 2: Specifc target complication rates and length of treatment will also be used:

Length

Complication rate

Preop

Intraop

Postop

Thyroidectomy

1%

2 days

2 hours

1 day

Mastectomy

1%

2 days

2 hours

2 days

Soft Tissue Surgery

1%

2 days

2 hours

2 days

Head and Neck Surgery

2%

2 days

4 hours

2 days

Esophageal Surgery

5%

4 days

4 hours

7 days

Data Bases Needed

Persons Responsible

Number of joint conference held
Attendance

GSI consultants
Anesthesia consultants
GSI residents
Anesthesia residents

GSI / Anesthesia

Number of consensual preop plan

GSI/Anesthesia

Surgical morbidities

GSI

Surgical mortalities

GSI

Anesthetic morbidities

Anesthesia

Anesthetic mortalities

Anesthesia

Length of preop hospital stay

GSI/Anesthesia

Length of operation

GSI/Anesthesia

Length of postop hospital stay

GSI/Anesthesia

Reports

Monthly reports of evaluation parameters and targets
Annual reports of evaluation parameters and targets

Improvement and Revision of Implementing Guidelines and Evaluation Strategies

Yearly at least, may be quarterly (every 3 months)

Reynaldo O. Joson, MD
Chief, GSI Division

Benigno M. Sulit, Jr., MD
Chief, GS Anesthesia Service

Date of Accomplishment of Implementing Guidelines and Evaluation Strategies: January 13, 1999

Welcome to GSI

Reynaldo O. Joson, MD Chief, GSI Division	Benigno M. Sulit, Jr., MD Chief, GS Anesthesia Service
Romeo R. Gutierrez, MD Chair, Department of Surgery	Virgilio T. Genuino, MD Chair, Department of Anesthesia

For Preop Patients
1. GSI Resident presents the case scheduled for operation. Age/sex Pretreatment diagnosis Basis for diagnosis Proposed surgical procedure Rationale Statement on the presence or absence of anticipated surgical difficulties
2. Discussion on Diagnosis Surgical Procedure
3. Anesthesia Resident presents anesthetic plan with a statement on presence or absence of anticipated anesthetic difficulties
4. Discussion on proposed anesthetic management
5. Consensual decision on preoperative plan, intraoperative maneuvers, and postoperative care

Objective-referenced evaluation parameters
Objectives	Parameters	Indicators/Target
Opportunites provided	Number of joint conferences held	No. of "joint" conferences - 90% of total no. of conferences that can be possibly held in a year (10x4 + 2x2 = 44) [Feb-Nov x 4 + Jan+Dec x 2]
Mutually agreed plan	Number of consensual plan	No. of consensual plan = no. of "joint" conferences held Must be 90% of total no. of conferences that can be possibly held in a year
Quality patient care	Surgical morbidities/mortalities	Rate per year Overall rate = 2 %
	Anesthetic morbidities/mortalities	Rate per year Overall rate = 2 %
	Preoperative phase Length of preop hospital stay	Average length Overall average = 3 days
	Intraoperative phase Length of operative time	Average length Overall average = 3 hours
	Postoperative phase Length of postop hospital stay	Average length Overall average = 3 days

		Length
	Complication rate	Preop	Intraop	Postop
Thyroidectomy	1%	2 days	2 hours	1 day
Mastectomy	1%	2 days	2 hours	2 days
Soft Tissue Surgery	1%	2 days	2 hours	2 days
Head and Neck Surgery	2%	2 days	4 hours	2 days
Esophageal Surgery	5%	4 days	4 hours	7 days

	Persons Responsible
Number of joint conference held Attendance GSI consultants Anesthesia consultants GSI residents Anesthesia residents	GSI / Anesthesia
Number of consensual preop plan	GSI/Anesthesia
Surgical morbidities	GSI
Surgical mortalities	GSI
Anesthetic morbidities	Anesthesia
Anesthetic mortalities	Anesthesia
Length of preop hospital stay	GSI/Anesthesia
Length of operation	GSI/Anesthesia
Length of postop hospital stay	GSI/Anesthesia