Bariatric Times - June 2008 - (Page 42)

42 Surgical Perspective Bariatric Times • June 2008 Table 1. Minimum Operative Requirements for Certification by the American Board of Surgery Skin, soft tissue and breast . . . . . 25 Head and neck . . . . . . . . . . . . . . . 24 Alimentary tract . . . . . . . . . . . . . . 72 Abdominal . . . . . . . . . . . . . . . . . . 65 Liver . . . . . . . . . . . . . . . . . . . . . . 4 Pancreas . . . . . . . . . . . . . . . . . . . . 3 Vascular. . . . . . . . . . . . . . . . . . . . 44 Endocrine. . . . . . . . . . . . . . . . . . . . 8 sign in a bariatric surgical patient and who fails to notify the surgeon is as serious a problem as a failure in technique. The hospitalist who chooses a nasogastric tube to relieve a patient after a gastric bypass is another example of well-intentioned disaster. In short, the advantages of volume apply to the whole team as much as the surgeon. The entire team needs to be trained and the training reinforced frequently. Checklists and “time-out” protocols, similar to the procedures used in the airline industry, offer additional approaches that can turn a disparate set of workers into a functional team. the ASMBS BSCOE status, approval by Centers for Medicare and Medicaid Services (CMS) to perform transplantation, and cardiac scores of the Society for Thoracic Surgery (STS), provide surgical teams comparison not only with their own successes, but also with those of other centers. Differences can then be traced and problems corrected promptly and effectively. VOLUME MATTERS The validation that greater volumes produce better outcomes can no longer be ignored in bariatric surgery—indeed in all surgery. We have accumulated more than enough evidence that volume matters. It is high time that we respond at every level in our practices, our hospitals, our training programs, and our certification efforts. Educational processes from the 1900s no longer suffice. To be fair, the American Board of Surgery has already provided programs with flexibility, but that is not enough. Training programs need to rise to the challenge with experimental curricula that are rigorously tested with measures of outcomes during practice. Continuing surgical education programs must offer more than lectures in big auditoria so that our colleagues who have been in practice for 15 years have the same skills as recent graduates. How can we assure that the surgeon in Keenansville, North Carolina, who has provided demanding day and night care for a decade without a chance for hands-on renewal can compete with the new surgeon in Kinston, North Carolina, who just completed her fellowship? Yes, today volume matters. With vision, acceptance of new technologies, and a willingness to drop outmoded approaches, we can overcome the volume metric and, instead, be assured that a finishing resident will provide quality care on the first day after they receive their certificates. Just remember, any of us could be his or her first patient. ADDRESS FOR CORRESPONDENCE Walter J. Pories, MD, FACS Brody School of Medicine East Carolina University Greenville, NC 27834 Phone: (252) 744-3290 E-mail: pories@aol.com OPTIMAL CARE PATHS Thoracic. . . . . . . . . . . . . . . . . . . . 15 Pediatric . . . . . . . . . . . . . . . . . . . 20 Plastic . . . . . . . . . . . . . . . . . . . . . . 5 Trauma. . . . . . . . . . . . . . . . . . . . . 10 Trauma nonoperative . . . . . . . . . . 20 Endoscopy . . . . . . . . . . . . . . . . . 29 Laparoscopic, basic . . . . . . . . . . 60 Laparoscopic, complex . . . . . . . . 25 Total cases: 750, 150 of which must be done as Chief. One common trait of the most successful bariatric programs appears to be the routine application of care paths with which every patient is treated in a defined, stepwise manner with identical evaluations, preoperative preparations, anesthetic agents, and postoperative care— changed only if there are indications, such as allergies, to do so. Optimal care paths have proven to be the best way to assure smooth progress, early discharges, and good outcomes. Currently, care pathways are generally grounded in the demands of lead surgeons or the experience of successful programs. Soon SRC’s Bariatric Outcomes Longitudinal Database™ (BOLD™), the nationwide database program for the documentation of bariatric surgery in BSCOE Centers, will be able to provide even better information based on national experience. ADDRESS FOR CORRESPONDENCE Gary M. Pratt Surgical Review Corporation 4800 Falls of the Neuse Road Suite 160 Raleigh, NC 27609 Phone: (866) 790-4772 E-mail: Gary.pratt@surgicalreview.org TRAINING THE TEAM Bad outcomes are often not the fault of the surgeon. In a specialty where hours make a difference, failure to inform the surgeon immediately can spell disaster. Surgical care, like a chain, is only as strong as the weakest link. A novice anesthesiologist, a dietitian offering the wrong advice, and an inadequate mental health evaluation may be as much of a hindrance as an inexperienced surgeon. The recent nurse graduate who does not recognize that tachycardia is a serious danger EVALUATION OF OUTCOMES All teams do not win all of the time. Performance may vary for a number of reasons, but at least in sports, scores usually define individual and team success. The same approach is promising for the delivery of surgical care. Keeping score, as required to achieve and maintain BAD OUTCOMES ARE OFTEN NOT THE FAULT OF THE SURGEON SURGICAL CARE, LIKE A CHAIN, IS ONLY AS STRONG AS THE WEAKEST LINK.

Table of Contents Feed for the Digital Edition of Bariatric Times - June 2008

Bariatric Times - June 2008 Endoluminal Treatment Options for Morbid Obesity: Devices and Techniques for Natural Orifice Approaches The Multidisciplinary Approach to Weight Loss: Defining the Roles of the Necessary Providers Acute Bleeding after Gastric Bypass Editorial Message Contents ASMBS: 25 Years Editorial Board Surgical Site Infection In The Morbidly Obese Patient: A Review Consultant's Corner The Link Between Sleep Loss and Obesity: Understanding the Mechanisms Responsible for Weight Gain with Sleep Deprivation Volume Matters Journal Watch Advertiser Index

Bariatric Times - June 2008

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