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Factors
Patientfactors
Age
Comorbidities
Nutrition
Socioeconomicstatus
Preoperative
Diseasefactors
Stageorgradeofunderlyingpathology
Urgencyoftreatmentrequired
Healthsystem
Primarycare
Prehospitalcare
Delayinseekingcare
Delayinreachingcare
Delayinreceivingcare
Diseasefactors
Complexityofrequiredprocedure
Personnelfactors
Leveloftrainingofsurgical,anaesthetic,&
Intraoperative
nursingproviders
Teamfactors
Useofsafetychecklists
Non-technicalskills
Technologyfactors
M
Useofappropriateintraoperativemonitors
Robust,safetechnologyforanaesthetic
delivery
Abilitytorescue
Availabilityofappropriatediagnosticsand
Therapeulacstomanageintraoberanve
deterioration
Monitoring
Availabilityofmonitoredbeds
Frequencyofpostoperativenursingchecks
andvitalsigns
R
ostoperative
NursingCare
Nursetopatientratio
Leveloftrainingofnurses
Rapidresponsetodeterioration
Useofearlywarningscoresandprotocols
Timetointervention
Criticalcareresources
Outreachorrapidresponseteams
Criticalcarebedavailability
Availabilityoforgansupportmodalities(e.g.
mechanicalventilation,renalreplacement)
Perioperative mo!ality as a
meaningful indicator:…
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ReductionMeasures
Developarobustsystemofprimarycare
Addresscommunity-levelnutritionaldeficits
withapublichealthlens
Provideeducationtocommunityandlocal
healthcareprovidersonsurgicaldiseaseand
needforreferral
Provideevidence-basedscreeningforcommon
medicalandsurgicalillnesses
Worktowarduniversalhealthcoveragewhich
includesessentialsurgicalcare
Developasystemofprehospitalcareand
transportation
Ensurethathealthcentresarewell-staffedand
well-resourced(includingimaging,laboratory
services,andpathology)tomeetthelocal
burdenofsurgicaldisease
Providepreoperativeconsultationwith
perioperativemedicinespecialistsforpatients
withsignificantcomorbidities
Ensurethetimelyavailabilityofoperating
theatresforsurgicalemergencies
Ensurethatthehighestlevelofanaestheticand
surgicalprovidersareavailabletosupport,
supervise,orprovidecare
Adapt,implement,andmandateuseofthe
WHOsafesurgerychecklist
Providenon-technicalskillstrainingtoORteams
tofacilitateteamworkduringhigh-stakes
procedures
Ensurethatmonitoringtechnologyisup-to-
date,functional,anduniversallyapplied
Investinreliable,well-maintainedequipment
foranaestheticdelivery
Ensurerelevantdiagnostics(ECG,CXR,
laboratorytesting)arereadilyavailablewhen
requestedinOR
Ensurebloodandimportantdrugsareavailable
torescuepatientsintraoperatively
Ensurepatientsareadmittedtoawardwith
sufficientmonitoringcapabilities
postoperatively
Usetechnologytoprovidecontinuous
moniorinewherenecessary
Ensuresufficienttrainednursingstafftosafely
careforpostoperativepatients
• Developearlywarningsystemsandprotocolsto
rapidlyrecognizeandtreatdeterioration
Developafullspectrumofmodalitiestoaddress
complications,includingpercutaneous
interventions
Considerimplementingrapidresponseor
medicalemergencyteams
investincriticalcareresourcestomarch
hospitalneeds
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