Bulletin of the Hospital for Joint Disease (2013)
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Bull Hosp Jt Dis (2013) · Mar 2015
Multicenter Study Comparative StudyCan We Improve Workflows in the OR? A Comparison of Quality Perceptions and Preoperative Efficiency across Institutions in Spine Surgery.
Cost containment and surgical inefficiencies are major concerns for hospitals in this era of declining resources. The primary aim of this investigation was to understand subjective perceptions of perioperative spine surgical quality across three practice settings and to identify potential factors contributing to these perceptions. Subsequently, we objectively evaluated factors that influence the duration of time in which the patient is in the operating room (OR) prior to the surgical incision and assessed the influence of fluoroscopy technician expertise on radiation dose and imaging efficiency. ⋯ Large private and university hospitals had higher surgeon ratings. The university setting was associated with larger and less consistent surgical teams and lower nurse ratings. Surgical staff awareness of the procedure and attention to preoperative tasks specific to the procedure reduced pre-operative time spent in the OR as well as fluoroscopy radiation. These data suggest that nurses and support staff make substantial contributions to overall quality of care, and that leadership and interpersonal coordination are especially important within large teams at teaching hospitals.
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Bull Hosp Jt Dis (2013) · Mar 2015
Comparative StudyThe Effect of Adductor-Canal-Blockade on Outcome after Medial Unicondylar Knee Arthroplasty A Preliminary Study.
Unicondylar knee arthroplasty (UKA) offers decreased morbidity, faster recovery, better functional outcomes, and equivalent survivorship compared to TKA for certain patients. To fully capture these benefits, regional anesthesia techniques must facilitate rather than compromise patients ability for early postoperative mobilization and safe discharge following UKA. The purpose of this study was to determine whether the predominantly sensory adductor canal blockade (ACB) shortens hospital stay after medial UKA (mUKA). Secondary endpoints were narcotic consumption, steps walked during PT sessions, and total PT sessions required prior to discharge. ⋯ Data from our study suggests that ACB may permit earlier hospital discharge and better participation in PT without compromising the quality of perioperative analgesia. Thus, ACB may represent a promising option for patients undergoing mUKA in terms of improved clinical outcomes, decreased postoperative morbidity, and cost-effectiveness.
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Bull Hosp Jt Dis (2013) · Mar 2015
Randomized Controlled Trial Comparative StudyThe Impact of Popliteal Block on Postoperative Medication Administration and Time to Discharge from the Post-Anesthesia Care Unit.
Previous studies have demonstrated the efficacy of popliteal block anesthesia in decreasing post - operative narcotic administration, nausea, and length of stay in patients undergoing foot and ankle surgeries. The purpose of this study was to compare the amount of narcotic medication administered, the need for anti-emetic medication, PACU length of stay, and discharge status in patients treated surgically for ankle fractures who received popliteal blocks with those who received general anesthesia alone. ⋯ While previous studies have demonstrated the efficacy of popliteal block in decreasing anti-emetic and pain medication administration in the PACU, we found no difference in the amount of medication administered. We found that popliteal block patients were no more likely to be discharged to home than those who received general anesthesia.