The Surgical Nosology In Primary-care Settings (SNIPS): a simple bridging classification for the interface between primary and specialist care (original) (raw)
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The demand for surgery: an analysis of referrals from Australian general practitioners
ANZ Journal of Surgery, 2004
Background: Optimal planning for surgical training and the surgical workforce requires knowledge of the need and demand for surgical care in the community. This has previously relied on indirect indicators, such as hospital throughput. We aimed to describe referrals from general practitioners (GPs) to surgeons in Australia using a classification of surgical disorders developed especially for primary care settings. Methods: Terms in the International Classification of Primary Care Version 2-Plus were reclassified into categories delineated by specialist surgeons, resulting in the Surgical Nosology In Primary-care Settings (SNIPS). Referrals to surgeons were analysed using data on 303 000 patient encounters by a random sample of 3030 GPs involved in the Bettering the Evaluation and Care of Health (BEACH) study. Results: Thirty-two per cent ) of all problems were classified as potential surgical problems, of which 9.5% (13 570) were referred to surgeons at an overall rate of 44.8 referrals per 1000 GP encounters. Patients with surgical problems were significantly older than the overall general practice patient population. Women and patients with health care cards were significantly less likely than men and patients without health care cards to be referred when a surgical problem was managed by the GP. Forty-two per cent of all surgical referrals were accounted for by the following categories: skin lesions, skin infection/injury, upper gastrointestinal, breast lumps/cancer, spine, knee arthritis/pain, knee injury/instability, infective and non-infective ear disorders. Many commonly referred problems are usually managed as outpatients.
Health services research in surgery—definitions, approaches and methods
Langenbeck's Archives of Surgery, 2008
Background and aims Health services research (HSR) investigates the translation of clinical studies into the practice of health care in relation to quality and efficiency from the individual and socioeconomic perspective. Given the fact that HSR has become increasingly popular during the last decade, this article aims at providing an overview of the significance and benefit of HSR in general and especially in the field of surgery. Results The first part of the overview provides various definitions that apply to the field, gives a brief historical overview of the development in Germany in contrast to the USA and Great Britain, and describes relevant theoretical frameworks and methods. In the second part it deals with gaps in patient care, patient-related outcomes, registry research, the integration of clinical and ambulatory surgery, and research on implementation of guidelines into practice. Conclusions This overview shows that HSR is by now regarded as an essential field, at least in developed countries, and that we are just at the beginning to understand why demonstrated effective strategies in the clinical context do not or rarely translate into routine patient's care.
New Zealand general practitioners' non-urgent referrals to surgeons: who and why?
The New Zealand medical journal, 2008
To describe the clinical and demographic characteristics of patients referred by general practitioners (GPs) to both public and private sectors for non-urgent surgical assessment. During 2004, a cohort of 1420 adult patients with the potential to benefit from elective surgery was recruited into the study by their GPs. GPs recorded patient demographics and reasons for referral. 345 out of 828 eligible GPs (42%) agreed to participate in the study and submitted data on 1603 referrals, 2.4 referrals per reporting week. After excluding ACC cases, data on 1420 referrals were analysed. Forty-two percent of those referred were male and 69% were European New Zealanders. The mean age was 55 years. The largest number of referrals were made to general surgery (37%), followed by orthopaedics (19%), gynaecology (12%), and plastic surgery (10%). The modal level of urgency was "routine" and in 24% of cases cancer was a possibility. The GP felt surgery was needed in 47% of cases, while in ...
The international classification of primary care--an update
The Journal of family practice, 1989
The International Classification of Primary Care (ICPC) has become a standard all over the world. It became a standard tool to classify the important elements in the Electronic Patient Record (EPR) of the GP: reasons for encounter (RFE) reflecting the patient's view, process of care (decision, action, intervention or plans) reflecting the care process, and the assessment (diagnosis or health issue) reflecting the doctor's view. ICPC-2 is fully compatible with structuring data in the episode of care model and it's reflecting the essential elements of each patient/provider encounter. To implement ICPC-2 in the EPR a Thesaurus has been developed in Belgium with double encoded clinical labels. The implementation is now mandatory for labeled EPR systems in Belgium. The use of ICPC 2 may improve the accessibility and use of on-line Expert systems and Guidelines.
Health service reconfigurations may result in increasing numbers of minor surgical procedures migrating from secondary care in hospitals to primary care in the community. Procedures may be performed by General Practitioners with a specialist interest in Surgery, or secondary care Surgeons who are sub-contracted to perform procedures in the community. Surgical training in such procedures, which are currently hospital based, may therefore be adversely affected unless surgical training also takes advantage of these opportunities. There is potential for surgical trainees to benefit from training in the community setting. ASiT supports the development of formal surgical training in the community setting for junior surgical trainees, providing high standards of patient care and training provision are ensured. Anticipated problems relating to the migration of surgical services to the community relate to the availability and quality assurance of training opportunities in primary care, its funding, including exposure to issues of indemnity cover for trainees, and also the release of surgical trainees from hospital duties in order to attend these training opportunities. These consensus recommendations set out a framework through which both patient care and training remain at the forefront of these continued service reconfigurations.
IOSR Journals , 2019
This hospital based study was conducted to determine the profile of patients coming to the general surgery outpatient department (OPD) of a tertiary care hospital. Demographic details, morbidity profile, investigations done, treatment rendered and the clinical outcomes of patients were evaluated. The difference in the rate of employment between male and female patients was statistically highly significant (X2=45.04, p<0.01). Abdominal pain was the main presenting symptom with 13 (11.82%) of the patients presenting with burning epigastric pain, 11 (10%) with hypochondriac pain while 5 (4.55%) presenting with right iliac fossa pain. An ultrasound of the abdomen and pelvis was the most common investigation ordered ie, for 36 (32.72%) patients. Gastritis was the commonest diagnosis ie, in 14 (12.72%) patients followed by hernia in 13 (11.71%) patients and cholelithiasis in 11 (10%) patients. 22 (20%) patients had diabetes followed by 9 (8.18%) who had hypertension. 46 (41.82%) patients developed complications after treatment which included surgical site infections, urinary tract infections and paralytic ileus. 22 (20%) patients had diabetes followed by 9 (8.18%) who had hypertension while 8 (7.27%) had both diabetes and hypertension. The difference in the rates of complications amongst those who have co-morbidities and amongst those who do not is statistically significant (X2=7.87, p=0.005).
Can guidelines improve referral to elective surgical specialties for adults? A systematic review
Quality & Safety in Health Care, 2010
AimTo assess effectiveness of guidelines for referral for elective surgical assessment.MethodSystematic review with descriptive synthesis.Data sourcesMedline, EMBASE, CINAHL and Cochrane database up to 2008. Hand searches of journals and websites.Selection of studiesStudies evaluated guidelines for referral from primary to secondary care, for elective surgical assessment for adults.Outcome measuresAppropriateness of referral (usually measured as guideline compliance) including clinical appropriateness, appropriateness of
Identification and characterisation of the high-risk surgical population in the United Kingdom
Critical Care, 2006
Introduction Little is known about mortality rates following general surgical procedures in the United Kingdom. Deaths are most common in the 'high-risk' surgical population consisting mainly of older patients, with coexisting medical disease, who undergo major surgery. Only limited data are presently available to describe this population. The aim of the present study was to estimate the size of the high-risk general surgical population and to describe the outcome and intensive care unit (ICU) resource use. Methods Data on inpatient general surgical procedures and ICU admissions in 94 National Health Service hospitals between January 1999 and October 2004 were extracted from the Intensive Care National Audit & Research Centre database and the CHKS database. High-risk surgical procedures were defined prospectively as those for which the mortality rate was 5% or greater. Results There were 4,117,727 surgical procedures; 2,893,432 were elective (12,704 deaths; 0.44%) and 1,224,295 were emergencies (65,674 deaths; 5.4%). A high-risk population of 513,924 patients was identified (63,340 deaths; 12.3%), which accounted for 83.8% of deaths but for only 12.5% of procedures. This population had a prolonged hospital stay (median, 16 days; interquartile range, 9-29 days). There were 59,424 ICU admissions (11,398 deaths; 19%). Among admissions directly to the ICU following surgery, there were 31,633 elective admissions with 3,199 deaths (10.1%) and 24,764 emergency admissions with 7,084 deaths (28.6%). The ICU stays were short (median, 1.6 days; interquartile range, 0.8-3.7 days) but hospital admissions for those admitted to the ICU were prolonged (median, 16 days; interquartile range, 10-30 days). Among the ICU population, 40.8% of deaths occurred after the initial discharge from the ICU. The highest mortality rate (39%) occurred in the population admitted to the ICU following initial postoperative care on a standard ward. Conclusion A large high-risk surgical population accounts for 12.5% of surgical procedures but for more than 80% of deaths. Despite high mortality rates, fewer than 15% of these patients are admitted to the ICU.
Elective ambulatory surgical care in Ireland-why it needs to be better coded, classified and managed
Irish journal of medical science, 2017
In the year to July 2017, surgical disciplines accounted for 73% of the total national inpatient and day case waiting list and, of these, day cases accounted for 72%. Their proper classification is therefore important so that patients can be managed and treated in the most suitable and efficient setting. We set out to sub-classify the different elective surgical day cases treated in Irish public hospitals in order to assess their need to be managed as day cases and the consistency of practice between hospitals. We analysed all elective day cases that came under the care of surgeons between January 2014 and December 2016 and sub-classified them into those that were (A) true day case surgical procedures; (B) minor surgery or outpatient procedures; (C) gastrointestinal endoscopies; (D) day case, non-surgical interventions and (E) unclassified or having no primary procedure identified. Of 813,236 day case surgical interventions performed over 3 years, 26% were adjudged to accord with gr...