Development of a Standard Operating Procedure (SOP) for Laparoscopic Roux-en-Y Gastric Bypass

Abeezar Sarela, Krishna Moorthy1, Andrea Fox-Hiley, Joanne Johnston, Simon Dexter, Michael McMahonSt James’s University Hospital & Nuffield Hospital,

Leeds1Imperial College School of Medicine

Standard Operating Procedure

• Effective catalyst to drive performance-improvement and improve organizational results

• Elimination of variation because of different levels of:

Knowledge

Experience

Skill

Safety in Bariatric Surgery• WHO: Safe Surgery Saves Lives• National Patient Safety Agency

– Briefing: facilitate information transfer– Checklist: minimize memory recall

• Standard Operating Procedure (SOP)– Live, inter-active document– Text and audio-visual details of current best

methods– Ensures quality, cost, delivery and safety

targets

Aims

• To develop a prototype Standard Operating Procedure (SOP) for laparoscopic Roux-en-Y Gastric Bypass

• Preliminary assessment of variability in the application of the SOP

Creation of a Standard Operating Procedure

• Working Group

• Consultation

• Consensus-Building

Consultation Outcome:Safety Domains for Bariatric Surgery

1. Wrong procedure-Wrong patient

2. Equipment-related problems

3. Venous thromboembolism prophylaxis

4. Surgical technique

5. Strategies for post-operative care

Consensus Building:Process Categories in Bariatric Surgery

1. Processes supported by strong evidence to improve safety

• Thromboembolism prophylaxis

– Timing in relation to surgery

– Extended post-operative therapy

• Pre-operation briefing & checklists

• Pre-operation risk stratification

Consensus-Building:Process Categories in Bariatric Surgery

1. Processes supported by strong evidence

to improve safety

2. Processes related to surgical technique

• Anastomotic leakage-test

• Closure of mesenteric defects

Consensus-Building:Process Categories in Bariatric Surgery

1. Processes supported by strong evidence to improve safety

2. Processes related to surgical technique

3. Processes without common practise

• Discharge advice for diabetes medication

Assessment

Examination of

case-notes just before discharge of patient from hospital

Variability

• Between two centres: 10%-90%– Pre-list briefing– Safety checklist– Closure of mesenteric & Peterson’s defects– Discharge advise on diabetes medication

• Amongst surgeons in the same centre: 5-10%

Summary

• Collaborative, multi-disciplinary approach

was effective to generate a prototype SOP

for laparoscopic gastric bypass

• Substantial variation between centres

• Minimal variation amongst surgeons in the

same centre

Conclusion

• Generic SOP template

• Centre-specific population of template

• Wide assessment

• Review