‘Overnight, things changed. Suddenly, we were in it’: A qualitative study exploring how surgical teams mitigated risks of COVID-19

Daisy Elliott*, Cynthia Ochieng, Marcus Jepson, Natalie S. Blencowe, Kerry N.L. Avery, Sangeetha Paramasivan, Sian Cousins, Anni Skilton, Peter Hutchinson, David Jayne, Martin Birchall, Jane M. Blazeby, Jenny L. Donovan, Leila Rooshenas

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

4 Citations (Scopus)
56 Downloads (Pure)

Abstract

Objectives: COVID-19 presents a risk of infection and transmission for operating theatre teams. Guidelines to protect patients and staff emerged and changed rapidly based on expert opinion and limited evidence. This paper presents the experiences and innovations developed by international surgical teams during the early stages of the pandemic to attempt to mitigate risk.
Design: In-depth, semi-structured interviews were audio-recorded, transcribed and analysed thematically using methods of constant comparison.
Participants: 43 participants, including surgeons from a range of specialities (primarily general surgery, otolaryngology, neurosurgery, cardiothoracic and ophthalmology), anaesthetists and those in nursing roles.
Setting: The UK, Italy, Spain, USA, China and New Zealand between March and May 2020.
Results: Surgical teams sought to mitigate COVID-19 risks by modifying their current practice with an abundance of strategies and innovations. Communication and teamwork played an integral role in how teams adapted, although participants reflected on the challenges of having to improvise in real time. Uncertainties remained about optimal surgical practice and there were significant tensions where teams were forced to balance what was best for patients whilst contemplating their own safety.
Conclusions: The perceptions of risks during a pandemic such as COVID-19 can be complex and context dependent. Management of these risks in surgery must be driven by evidence‐based practice resulting from a pragmatic and novel approach to collation of global evidence.
The context of surgery has changed dramatically, and surgical teams have developed a plethora of innovations. There is an urgent need for high-quality evidence to inform surgical practice that optimises the safety of both patients and healthcare professionals as the COVID-19 pandemic unfolds.
Original languageEnglish
Article numbere046662
Number of pages11
JournalBMJ Open
Volume11
Issue number6
DOIs
Publication statusPublished - 16 Jun 2021

Bibliographical note

Funding Information:
Funding This study was funded by the Royal College of Surgeons (RCS Covid Research Group) and Rosetrees Trust, with support from the National Institute for Health Research (NIHR) Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol and NIHR Advanced Surgical Technologies Incubator. JD and JB are NIHR senior investigators. NSB is an MRC clinician scientist.

Funding Information:
This study was funded by the Royal College of Surgeons (RCS Covid Research Group) and Rosetrees Trust, with support from the National Institute for Health Research (NIHR) Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol and NIHR Advanced Surgical Technologies Incubator. JD and JB are NIHR senior investigators. NSB is an MRC clinician scientist.

Funding Information:
Acknowledgements We would like to thank Rosetrees Trust for funding this study, and each participant for taking the time to share their experiences with us. We are also grateful to Murat Akkulak, Steven Beech, Becky Carthy, Jenny Russe, Jane Collingwood, Chris Pawsey and Tom Steart-Feilding for providing help and support for the study.

Publisher Copyright:
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.

Structured keywords

  • Covid19

Keywords

  • COVID-19
  • qualitative research
  • surgery

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