A systems approach to the management of acute surgical pain and reduction of opioid use: the approach of Oakville Trafalgar Memorial Hospital.

Surgeons are among the highest prescribers of opioids, accounting for 56% of new starts of opioids in Ontario in 2016. At times we may not have an appropriate systems-based approach to the management of acute pain, which may lead to suboptimal management or unintended long-term dependency issues. We present the newly developed integrated systems approach of our Department of Surgery (www.

Burnout, resilience and moral injury: How the wicked problems of health care defy solutions, yet require innovative strategies in the modern era.

Physician burnout is an increasingly concerning issue that affects patient care, costs and the sustainability of our health care system. Burnout is not solely related to personal resilience; it is important to recognize the major role of the institution of health care in creating this wicked problem. Only this way can we fully understand the shared responsibility required to develop local strategies to tilt the fulcrum in our favour.

Reducing catheter-associated urinary tract infections using a multimodal approach - the NSQIP experience of Oakville Trafalgar Memorial Hospital.

Catheter-associated urinary tract infections (CAUTI) cause significant morbidity and mortality in the surgical population as well as significant costs to health care. It can be surprisingly difficult to address this common complication without a multifaceted, multimodal team-based approach to the problem. We used our National Surgical Quality Improvement Program (NSQIP) data on the incidence of CAUTI in our "procedure targeted" and "essentials" general surgery and orthopedic surgery cases before and after the implementation of our reduction strategy and found a significant improvement.

Optimization of communication in the surgical program via instant messaging, Web-based surveys, newsletters, websites, smartphones and telemedicine: the experience of Oakville Trafalgar Memorial Hospital.

As our surgical program has rapidly expanded, new modalities are required for safe, effective and efficient communication. In this discussion we review how we have used Web-based survey tools, the Signal instant messaging app, a new departmental newsletter, personal surgeon office websites, a department of surgery website and encrypted video calls via the Ontario Telemedicine Network to address our evolving communication needs.