There is increasing recognition that organisations need to look beyond their boundaries for new innovations. However, the introduction and implementation of best practice that has been developed externally may need different processes of implementation if a successful change process is going to be achieved. Using an enhanced recovery programme as an example, we report a case study that combines...

Ten years ago, Canada trailed internationally on access to health services, with “long waiting times for the type of care needed” specifically identified. In 2004, first ministers responded to the issue in the 10-Year Plan to Strengthen Health Care and agreed to reduce wait times for five priority areas: cancer, heart, diagnostic imaging, joint replacement and sight restoration. In the plan, th...

When a patient who has been taking warfarin long-term needs to undergo surgery, how to manage his or her anticoagulation is controversial. We believe most patients should stop taking warfarin 5 days before elective surgery, and most do not need to receive heparin in the perioperative period as a bridge to surgery.

OBJECTIVE To examine the association of mortality by day of the week for emergency and elective patients. DESIGN Retrospective observational study using the international dataset from the Global Comparators (GC) project consisting of hospital administrative data. SETTING 28 hospitals from England, Australia, USA and the Netherlands during 2009-2012. PARTICIPANTS Emergency and surgical-ele...

A total of 155 consecutive anaesthetics in three public Malaysian hospitals were prospectively studied to assess preoxygenation practices by their anaesthesia providers. Preoxygenation was practised in 96.1% of patients. Specialist and non-specialist anaesthesiologist did not preoxygenate 8.8% and 2.3% of their patients, respectively. Overall incidence of arterial oxygen desaturation during ind...

BACKGROUND Precise estimates of final operating room demand can only be made 1 or 2 days before the day of surgery, when it is harder to adjust staffing to match demand. The authors hypothesized that the accumulating elective schedule contains useful information for predicting final case demand sufficiently in advance to readily adjust staffing. METHODS The accumulated number of cases booked ...

OBJECTIVES The aim of this study is to examine the hypothesis that mode of delivery at birth may be associated with metabolic disorders in adult midlife. SETTING Population cohort study PARTICIPANTS The National Child Development Study consists of individuals born during 1 week in 1958 in Great Britain. Respondents with biomedical data on the metabolic syndrome at age 45 were included. OU...