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Best Practice in General Surgery

The Best Practice in General Surgery (BPIGS) initiative began in 2007 with the goal of standardizing care in the divisions of general surgery at the five University of Toronto teaching hospitals and the two affiliated hospitals based on best evidence.

We initially surveyed faculty and residents in the Division to ascertain issues of highest importance. The process have follow is to first audit practice at the participating hospitals; develop a guideline based on best evidence; circulate the guideline and reach consensus amongst the faculty as well as other key stake holders; then support implementation strategies at each of the hospitals. There are hospital champions for each hospital who work with the Steering Committee of BPIGS to implement the guidelines.

We are constantly gathering data and working on new guidelines. So check back soon to see what’s new!

 

Join the BPIGS/TASC listserv!

The Best Practice in General Surgery and Toronto Antimicrobial Stewardship Corridor have jointly completed a clinical practice guideline on the Management of Intra-Abdominal Infections. The guideline is available below. As part of the implementation strategy, we are planning to have a listserv discussion group where we will have a multidisciplinary discussion of five clinical scenarios which will highlight the various recommendations of the guideline. General surgeons, critical care and infectious disease specialists, interventional radiologists, pharmacists and residents and fellows from each discipline are invited to participate. Please click here for the invitation!

Guidelines:


Guideline #1: Surgical Site Infection Prevention Strategies which includes recommendations on:

  • Appropriate antibiotic use
  • Temperature regulation peri-operatively
  • Hair Removal
  • Hyperoxygenation


This guideline was developed under the direction of Drs Avery Nathens and Shawn Forbes

To view this evidence-based guideline in its entirety, please click here
To view the condensed recommendations, please click here

Guideline #2: Pre-operative Mechanical Bowel Preparation which includes recommendations on:

  • Mechanical bowel preparation
  • Use of enemas
  • Diet


This guideline was developed under the direction of Drs Cagla Eskicioglu, Darlene Fenech and Robin McLeod

To view this evidence-based guideline in its entirety, please click here
To view the condensed recommendations, please click here

Guideline #3: Thromboprophylaxis which includes recommendations for:

  • Patients having general surgical procedures
  • Patients admitted with acute abdominal conditions who are treated non-operatively


This guideline was developed under the direction of Drs Robin McLeod, Bill Geerts, and Darlene Fenech

To view this evidence-based guideline in its entirety, please click here
To view the condensed recommendations, please click here

NEW! Guideline #4: Management of Intra-Abdominal Infection which includes recommendations for:

  • Management of patients with perforated appendicitis and diverticulitis
  • Optimal antibiotic choice and duration for community acquired infections
  • Optimal antibiotic choice and duration for heath care associated infections
  • Management of patients with generalized peritonitis and systemic instability
  • Management of Biliary Tract Infections


This guideline was developed under the direction of Drs Jeffrey Doyle, Avery Nathens, Andrew Morris, Sandra Nelson, Robin McLeod


To view this evidence-based guideline in its entirety, please click here
To view the condensed recommendations, please click here

Checklist 1: Laparoscopic Cholecystectomy: Synoptic Report Checklist

To view the checklist, please click here

Future Projects:


We are currently working on guidelines for

  • Management of intra-abdominal sepsis
  • Enhanced Recovery after Surgery (ERAS)
  • Inguinal hernia synoptic OR reports  


Updates


The Best Practice in General Surgery provides staff surgeons, fellows and residents “updates” on our current research, click here to see past updates and check back often as we are constantly sending them out!

Update 1 - Overview of BPIGS
Update 2 - Normothermia Practical Tips
Update 3 - Update on all our studies
Update 4 - Where to find us
Update 5 - Surgical site infection prevention audit results
Update 6 - Thromboprophylaxis
Update 7 - Laparoscopic cholecystectomy audit results and checklist

If you would like to be added to our list, please email Emily Pearsall at epearsall@mtsinai.on.ca

Publications and Presentations

The BPIGS group has published numerous manuscripts on our various studies. Click here to check them out!

BPIGS has been invited to present our work all over North America, check out where we have presented and where we are presenting next!

Who we are


Steering Committee/Hospital Champions


For more information about Best Practice in General Surgery, please contact Emily Pearsall at epearsall@mtsinai.on.ca