Surgery
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The observed to expected (O:E) mortality based on Injury Severity Scores (ISS) has been used to assess quality of trauma center (TC) care. Injuries in the elderly have increased, and these patients often have advanced directives, on occasion limiting aggressive care even for potentially survivable injuries; unfortunately, there are few data on the impact of these demographic changes on mortality. Additionally, many patients arrive moribund and care provided is likely to be futile. We sought to examine the impact of these situations on TC mortality. ⋯ There has been a major shift in the demographics of the injured with a high proportion of elderly and head injured and/or those who have little likelihood of survival. Crude mortality or O:E based on ISS overestimates preventable deaths. Societal factors, presence of advanced directives, and WOC decisions must be considered when assessing TC performance. Although our crude mortality rate was 6.4%, it was only 2.4% in patients we were actually permitted to treat. We suggest a WOC factor should be added to TC data to characterize mortality rates more accurately.
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This study was conducted to determine if team training using a federally sponsored team training program improves operating room (OR) performance and culture. ⋯ These data confirm that team training improves OR performance, but continued team training is required to provide sustained improved OR culture.
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To assess differences in hospital costs for inpatients with Clostridium difficile (CD) colitis based on hospital size, rural or urban hospital setting, and hospital designation as a teaching institution. ⋯ Costs for inpatient CD colitis in Pennsylvania have been increasing. Teaching and urban hospitals treat the group of patients with CD colitis with the greatest comorbidity, accounting for their greater cost of care. The cost of treating CD colitis is comparable among different sizes of teaching hospitals, which may reflect a more standardized approach toward treatment choices.