Checklist (for organizing short term surgical trips)

A successful voluntary surgical short-term trip requires planning for about a year to ensure that planning concerns are addressed in a timely manner, after several trips this time may become shorter. We develop this checklist for anesthesiologists to provide a concise guideline when organizing a short-term surgical trip.

Checklist:

  ✔ Set up a perioperative system.
Establish trip goals (Is the primary goal to provide direct medical service or educate local staff?). Define team size and composition and roles. Establish a team leader within each specialty. The team roles should be communicated to the entire team, knowing everyone role is extremely important because working with a multinational team, who is learning to use unfamiliar equipment and supplies can be challenging for practitioners.

  ✔ Obtain information from local people about patient population
It is important to know the Target population to plan for the team composition, supplies and allocation of resources. Ask the following questions: who are the patients? What types of surgery are anticipated? How the patients were gathered? Who is funding the patient travel? How will follow up occur? How far will patients have to travel? If required, are there resources for family members to stay the week of surgery? Have a clear understanding of the host’s expectations and the role that the host will play in the program. How many local practitioners are going to participate? Resistance may result if local practitioners believe the program disparages their stature within their own community, or leaves behind unsolicited responsibilities for follow-up.

  ✔ Obtain information about facilities and local resources. In person always better, plan for a visit!
This visit should occur far enough in advance to have plenty of time to address satisfactorily any issue. This visit should generate a written report for the organization to be share with the team leaders of each specialty.

Facilities:

Location, type/level of healthcare facility, number of operating rooms (OR) available, OR tables per room, space for the screening and recovery unit, number of recovery unit beds, number of inpatient beds for overnight observation and admissions. Appropriate laboratory facilities, ICU beds available, and contingency plans for complications.

Local Resources:

  1. Anesthesia delivering systems: Amount, type, quality and availability of technical support. If planning for inhalational agents use it is important to know the type of anesthesia machine and circuits. If planning for intravenous anesthesia techniques have a clear idea of the type and amount of pumps and pump sets available. If planning for regional anesthesia look for availability of neuroaxial needles, peripheral nerve block needles, peripheral nerve stimulators and ultrasound machines. Be prepared for multiple limitations and equipment that is different from one’s home country.
  2. Monitors: Amount, type, quality and technical support.
  3. Oxygen: Is there a central wall supply? Amount of cylinders available. Have a backup plan in case of need for more oxygen cylinders (Know where to buy more oxygen and how long will it take to have it available). It is useful to bring wrench and oxygen regulators.
  4. Controlled drugs, medications and IV fluids. Amount available donated and amount available to buy. A reliable local individual must be identified to serve as a liaison for obtaining these supplies prior and throughout the trip.
  5. Local hosts and liaison. This people/person will be in charge of helping with the organization with the pre- screening, communications and political interventions necessary when issues arise.
  6. Translators. Amount of translators available and how they will be distributed during the entire trip.

  ✔ Establish financial support and create a budget.
It is important to identify where the money is coming from and how this money will be use. Have a predictable financial support via academic institutions, professional or charitable organizations.

  ✔ Have a plan for evacuation in case of an emergency.
Most organizations do not have policies to cover individuals, provide information to the team members if you are planning to provide coverage in case of an emergency.

  ✔ Plan your documentation.
Common forms needed: Consent forms, standardized surgical and anesthesia screening forms, anesthesia records, surgical procedure documentation forms and postoperative follow up forms. Are you planning to use paper, electronic information, or both? It is important to have appropriate documentation during the preoperative evaluation about past medical history, new findings, plans and concerns. Adequate documentation will allow an appropriate follow up during the trip and in the future. Consider creating a database for follow-up and statistical purposes.

  ✔ Communicate with the team about local customs, available resources and how costs will be covered.
Team members need to be given realistic expectations about the site’s work environment and infrastructure, costs and expenses. Team members need to understand the limits of their own physical and mental endurance and that improvisation would be necessary.

  ✔ Shipment of supplies
Shipment of operating room (OR) surgical and anesthesia supplies requires substantial advanced planning in order to arrive intact and in a timely fashion. For materials that will not be hand carried, shipping arrangements should consider and be aware of possible delays. Any international health care equipment and supply requires a complete documentation for customs agents. Letters from government agencies or internationally recognized charities may facilitate transit through customs.
Do not ship materials or medications past their expiration dates because the discovery of even one may provoke confiscation of the entire shipment. Similarly, controlled substances should not be included without proper authorizations and documentation.

  ✔ Plan for an appropriate pre and in the ground communication.
Communication is always an important key for success. Plan for group and team meetings. Initial meeting with the entire group for everybody to meet and to talk about goals and planning. Daily team meetings throughout the trip are essential to air differences, provide updates, and discuss concerns.

  ✔ Have guidelines and communicate with the team. Establish guidelines if possible for screening, NPO and common preoperative concerns. Remember to be flexible and individualize management according to the circumstances, while keeping the patients safe.

Checklist for Anesthesiologist planning a surgical short term trip:
  ✔ Set up a perioperative system.
  ✔ Obtain information from local people about patient population
  ✔ Obtain information about facilities and local resources. In person always better, plan for a visit!
  ✔ Establish financial support and create a budget.
  ✔ Have a plan for evacuation in case of an emergency.
  ✔ Plan your documentation.
  ✔ Communicate with the team about local customs, available resources and how costs will be covered.
  ✔ Shipment of supplies
  ✔ Plan for an appropriate pre and in the ground communications.