Surgeon behaviour, chronic illness, stroke tests, and bariatric surgery in teens

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Health Report 28 min 2 speakers 8 chapters transcribed 6 days ago

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What is the overall focus of this health report episode?

Unknown 0:02

This is an ABC podcast.

James Bullen 0:06

Hello and welcome to this week's health report with me, James Bullen. Norman Swan's away for the next fortnight. Today, bariatric surgery for teens, controversial but effective, how Australia's hospitals are handling chronic illness, new findings in stroke research that could disrupt thousands of scientific papers, and what influence does a surgeon's bad behavior have on your outcomes as a patient? New research Research from the United States has found that surgeons who behave badly towards their colleagues could also be putting their patients' safety in jeopardy. The findings come amid concerns over the welfare of junior doctors in Australia, with several hospital units in New South Wales banned from training new juniors, including a surgical unit.

James Bullen 0:49

The paper's senior author was Professor Gerald Hickson, Senior Vice President of Quality, Safety and Risk Prevention. attention at Vanderbilt University Medical Center in Nashville, Tennessee.

Gerald Hickson 1:00

Our hypothesis going into the study was that if I am a surgeon and am disrespecting to other members of the team, their performance is likely to decline. And so therefore those patients who see me are more likely to experience what we now recognize are avoidable outcomes of care, including surgical infections and other kinds of problems that patients may experience in the OR.

James Bullen 1:26

And to work out if that was the case you needed particular pieces of information, one of those being reports from colleagues of surgeons' unprofessional behavior.

Gerald Hickson 1:36

So the study was dependent upon merging two large databases. One is a complaint database in which members of the medical team feel free to speak up when they observe behaviors or performance that they think are inconsistent with the core values of the organization or the profession. We linked a database with complaints about over two hundred surgeons with another database in which we've collected information about surgical outcomes, the complexity of care required, the characteristics of the patient, and most important, outcomes of the care in the first thirty days after the surgical procedure.

James Bullen 2:15

And so then you linked up the two data sets and you were able to sort surgeons by the number of reports of unprofessional behaviour they'd had in the past three years and organise them by that number of reports and then see if there was an association with the number of complications their patients received?

Gerald Hickson 2:33

So James, what we did is that we took thirteen thousand patients that were seen by the two hundred surgeons. And the question we ask is that if you are a patient, we want to look at whether or not your surgeon has had any one, two, three, four, or more complaints in the thirty six months prior to that surgical procedure. In addition, we wanted to see the kind of care you were requiring and then the outcomes of the care in question.

James Bullen 3:02

And what did you find?

Gerald Hickson 3:04

Overall, about eleven percent of the patients who had surgery experienced a complication, either a surgical complication or a medical kind of complication. If the surgeon had one, two, or three complaints of unprofessional, disrespectful behavior in the previous thirty six months. In that circumstance, the probability that you as that surgeon's patient would have an eighteen percent higher chance of having Вот вино армосли аводибал комплікація. We know that if the surgeon had four or more, the probability of having a complication was over thirty percent higher than that of those with no complaints at all.

James Bullen 3:48

That's a big figure. And and and what are the sorts of complications we are talking about? Because in some cases they could be life threatening.

Gerald Hickson 3:55

The infection's the most common thing we saw. And when you think about the need for team members to focus on what they're doing, focusing on the sterile field to protect that. If a nurse or anesthesiologist are not completely focused because they're worried about what I'm going to next be disrespectful, they may not apply such attention to detail. We also saw other complications uh related to the need to take the patient back to the intensive care unit to reintubate them to provide uh ventilatory support for uh pulmonary complications.