European Journal of Molecular & Clinical Medicine

Background and Aims: Perioperative management of functional adrenal tumours is resource intensive. Due to the covid 19 pandemic, there has been sizeable delay in preparing and conducting these time sensitive surgeries.Quality of care andresource utilisation may worsen. This retrospective review was aimed at finding if care quality deteriorated due to covid 19 related restrictions, from anaesthetic perspective.
Methods:Three cases of hormone-secreting adrenal tumours operated during a two year period in a tertiary cancer centre in India were retrospectively reviewed.Summary of the demographic profile, tumour characteristics, and the perioperative care were described using tables and analysed in the discussion.
Results: Out of the three cases operated for adrenal gland tumour, pheochromocytoma tumour type with distant metastasis had prolonged hospital stay. One patient developed covid 19 infection in hospital. Cases were adequately managed during the perioperative period and the covid 19 related constraints didn’t affect the quality of care.
Conclusion:As in any other major surgery, adhering to a unique checklist, multidisciplinary approach, clear communication, knowledge sharing and establishing a care pathway helps to maintainquality care in high risk cases and at times of crisis.
 

Hospital is one of the strategic elements to improve the public health status.
Therefore, a hospital needs a design or strategy to carry out a sustainable service
process. One such care model is case management. This study aims atevaluating the
implementation ofcase management programs at Central Public HospitalHaji Adam
Malik Medan. This type of research is mixed-method research with a sequential
explanatory design approach. The instruments used at the quantitative stage were
demographic data, perception questionnaires of room nurses about the implementation
of case management programs, and observation sheets for the implementation of case
management programs. Meanwhile, at the qualitative stage, the focus group discussion
(FGD) interview guides were used. This research had been conducted within two
months.The samples were 46 nurses consisting of heads of rooms and team leaders.
For the qualitative stage, there were 9 participants. The results based on the perception
questionnaires showedthat respondents’major characteristics were educated with
Nurse Profession Certificate (95.7%), female (100%), positioned as team
leaders(69.6%), and had worked for 17—22 years (60.9%). Characteristics based on
the observation sheets were educational background with NurseProfession Certificate
(66.7%),gender of female (100%), and work experienceof 17—22 years (66.7%). The
results of the questionnairesalso revealed that nurses’perceptions about the
implementation of case management programswere good (87%). The results of the
observations showed that the implementation of case management had been carried
out well (100%). However, the activities were carried out orally, were not structured,
and were not documented according to standards. The results of FGD obtained 4
themes, namely: 1) case management programs that have been carried out in hospitals,
2) obstacles in implementing the case management programs, 3) supporting factors for
the implementation of case management programs, 4) future expectations for case
managers.