The Journal of surgical research
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The purpose of this article was to conduct a gap analysis of important team constructs that may be absent in widely used team assessments. ⋯ Despite continued evidence of validity and reliability, there were several behavioral constructs that were not represented when using the NOTSS and Cannon-Bowers scales. Critical team errors, individual team member contributions, task performance, and overall team performance appear important in our ability to understand teams and teamwork.
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Emphasis on the provision of high quality, cost-effective healthcare has meant increasing efforts at reducing postoperative length of stay while reducing 30-d readmission rates. The aim of this study was to identify factors associated with early discharge (ED) and to evaluate the effectof ED on readmission after colorectal resection. ⋯ In the appropriate patient population, ED after colorectal surgery may be implemented without any adverse effect on readmission rates.
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The architecture of medical care facilities ca affect the safety of a patient, but it is unknown if the architecture affects outcomes. We hypothesized that patients in rooms who are more visible from the central nursing station would experience better outcomes than those patients in less visible rooms. ⋯ Trauma patient room placement within the ICU does not relate to mortality rate significantly when corrected for patient acuity. Instead, variables such as age, ISS, and CCI are associated with mortality. A policy of placing more critically ill patients in HVRs may prevent increased mortality in high-acuity patients.
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The University HealthSystem Consortium Clinical Database-Resource Manager (UHC CD-RM) is an administrative database increasingly queried for both research and administrative purposes, but it has not been comprehensively validated. To address this knowledge gap, we compared the UHC CD-RM with an institutional dataset to determine its validity and accuracy. ⋯ Most of the clinically significant patient- and intervention-specific variables within the UHC CD-RM are reliably reported. With recognition of its limitations, the UHC CD-RM is a reliable surrogate for institutional medical records and should be considered a valuable research tool for health service researchers.
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Meta Analysis
Risk factors for retained surgical items: a meta-analysis and proposed risk stratification system.
Retained surgical items (RSI) are designated as completely preventable "never events". Despite numerous case reports, clinical series, and expert opinions few studies provide quantitative insight into RSI risk factors and their relative contributions to the overall RSI risk profile. Existing case-control studies lack the ability to reliably detect clinically important differences within the long list of proposed risks. This meta-analysis examines the best available data for RSI risk factors, seeking to provide a clinically relevant risk stratification system. ⋯ Among the "common risk factors" reported by all three case-control studies, seven synergistically show elevated RSI risk across the pooled data. Based on these results, we propose a risk stratification scheme and issue a call to arms for large, prospective, and multicenter studies evaluating effects of specific changes at the institutional level (i.e., universal surgical counts, radiographic verification of the absence of RSI, and radiofrequency labeling of surgical instruments and sponges) on the risk of RSI. Overall, our findings provide a meaningful foundation for future patient safety initiatives and clinical studies of RSI occurrence and prevention.