Journal of the American College of Surgeons
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Comparative Study Observational Study
Assessing the magnitude and costs of intraoperative inefficiencies attributable to surgical instrument trays.
Efficiency in the operating room has become a topic of great interest. This study aimed to quantify the percent use of instruments among common instrument trays across 4 busy surgical services: Otolaryngology, Plastic Surgery, Bariatric Surgery, and Neurosurgery. We further aimed to calculate the costs associated with tray and instrument sterilization, as well as the implications of missing or damaged instruments. ⋯ Our study demonstrates that the percent use of instruments across surgical specialties and multiple tray types is low. Attention to tray composition may result in immediate and significant cost savings.
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Multicenter Study Comparative Study
Using same-hospital readmission rates to estimate all-hospital readmission rates.
Since October of 2012, Medicare's Hospital Readmissions Reduction Program has fined 2,200 hospitals a total of $500 million. Although the program penalizes readmission to any hospital, many institutions can only track readmissions to their own hospitals. We sought to determine the extent to which same-hospital readmission rates can be used to estimate all-hospital readmission rates after major surgery. ⋯ In evaluating hospital profiling under Medicare's Hospital Readmissions Reduction Program, same-hospital rates provide unstable estimates of all-hospital readmission rates. To better anticipate penalties, hospitals require novel approaches for accurately tracking the totality of their postoperative readmissions.
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Multicenter Study Comparative Study
A health system-based critical care program with a novel tele-ICU: implementation, cost, and structure details.
Improving the efficiency of critical care service is needed as the shortfall of intensivists is increasing. Standardizing clinical practice, telemedicine, and organizing critical care service at a health system level improves outcomes. We developed a health system Critical Care Program based at an academic medical center. The main feature of our program is an intensivist who shares on-site and telemedicine clinical responsibilities. Tele-ICU facilitates the standardization of high-quality critical care across the system. A common electronic medical record made the communications among the ICUs feasible. Combining faculty from medical and surgical critical care divisions increased the productivity of intensivists. ⋯ We describe a novel health system level ICU program built using "off the shelf" technology based on a large University medical center and a tele-ICU with a full degree of treatment authority across the system.
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Multicenter Study
Entrustment of general surgery residents in the operating room: factors contributing to provision of resident autonomy.
Several challenges threaten the traditional premise of graduated independence in general surgery training, leading to a lack of readiness in graduating surgeons. The objective of this study was to determine the factors contributing to faculty decisions to grant residents autonomy in the operating room, the barriers to granting this autonomy, and the factors that facilitate entrustment. ⋯ This study identified several factors that attending surgeons report as significant limitations to transitioning autonomy to surgical residents in the operating room. These issues must be addressed in a direct manner if progressive graduated responsibility to independence is to occur in the next era of graduate surgical training.