Background: A gap exists between the best evidence and practice with regards to surgical site infection (SSI) prevention. Awareness of evidence is the first step in knowledge translation. Methods: A web-based survey was distributed to 59 general surgeons and 68 residents at University of Toronto teaching hospitals. Five domains pertaining ...

Hospitals in the Midwest and South activated their disaster plans in early March to deal with a phalanx of powerful tornadoes that leveled several small towns and killed at least two dozen people. Some hospitals had to activate plans for both internal and external disasters as their own facilities were ...

BACKGROUND: There are few established metrics to define surgical capacity in resource-limited settings. Previous work hypothesizes that the relative frequency of cesarean sections (CS) at a hospital, expressed as a proportion of total operative procedures (%CS), may serve as a proxy measure of surgical capacity. We attempted to evaluate this ...

Objective. To efficiently validate the accuracy of surgical site infection (SSI) data reported to the National Healthcare Safety Network (NHSN) by New York State (NYS) hospitals. Design. Validation study. Setting. 176 NYS hospitals. Methods. NYS Department of Health staff validated the data reported to NHSN by review of a stratified sample of medical records ...

BACKGROUND: Approximately 30% of patients undergoing elective general surgery smoke cigarettes. The association between smoking status and hospital costs in general surgery patients is unknown. The objectives of this study were to compare total inpatient costs in current smokers, former smokers, and never smokers undergoing general surgical procedures in Veterans ...

BACKGROUND: A first step toward improving surgical care in many low and middle income countries is to document the need. To facilitate the collection and analysis of surgical capacity data and measure changes over time, Surgeons OverSeas (SOS) developed a tool and index based on personnel, infrastructure, procedures, equipment, and ...

A study evaluated the impact of physicians on hospital finances in four basic areas of physician care: primary care, medical specialties, surgical specialties, and other specialties. The study highlighted inherent differences in the activity and revenue-generating patterns of physicians to provide insight into the financial implications of the clinical enterprise. ...

One hospital targeted surgical-site infections, another MRSA, a third CLAUTI, a fourth CLABSI. The results are all remarkable.

Leonard Lindon was the first neurosurgeon on the staff of the Royal Adelaide Hospital, and headed this hospital's neurosurgical service from 1931 to 1951, with an interruption from war service. Like other early neurosurgeons, Lindon began as a general surgeon. In 1929, when he was well established in his surgical ...

IntroductionMore than half of in-hospital adverse events can be attributed to a surgical discipline. Checklists can effectively decrease errors and adverse events. However, the mechanisms by which checklists lead to increased safety are unclear. This study aimed to assess the number, nature and timing of incidents intercepted by use of ...

BACKGROUND: There are large disparities in access to surgical services due to a multitude of factors, including insufficient health human resources, infrastructure, medicines, equipment, financing, logistics, and information reporting. This study aimed to assess these important factors in Uganda's government hospitals as part of a larger study examining surgical and ...

Anesthesiology groups, particularly academic departments, are increasingly dependent on hospital support for financial viability. Economic stresses are driven by higher patient acuity, by multiple subspecialty service and call demands, by high-risk obstetric services, and by long case durations attributable to both case complexity and time for teaching. An unfavorable payer ...

Benefits derived from the Council for Health Services Accreditation South Africa (COHSASA) accreditation of the Universitas Academic Hospital (UAH) in Bloemfontein are illustrated. Accreditation assessments were performed between 2001 and 2007, and full compliance with the COHSASA standards for Academic Hospitals was achieved. An initiative to develop thoracic surgery in ...

In the developing world, neglected clubfoot often results in a permanent and disabling deformity with subsequent social implications. Data from the four organizations that manage clubfoot in Zambia were collected using clinic and operating room registries and analyzed using Fisher exact test. In the central hospitals in the capital city ...

Control charts are used in industry to monitor performance and are being used increasingly in hospitals as a quality improvement tool. The authors' objective was to determine if control charts using surgical site infection (SSI) rates predict changes in outlier status for risk-adjusted SSI rates using data from a surgical ...

A national sample of physician assistants (PAs) responded to a survey about their perceptions of specialty certification. Fewer than one-third planned to certify. Of three factors, advantage of specialization was most related to awareness, plans to certify, and demographics. Respondents were unsure whether certification would increase PA salaries. Many felt ...

Objective. To describe the epidemiology of surgical-site infections (SSIs) in community hospitals and to explore the impact of depth of SSI, healthcare location at the time of diagnosis, and variations in surveillance practices on the overall rate of SSI. Design. Retrospective cohort study. Setting. Thirty-seven community hospitals in the southeastern United States. Patients. Consecutive ...

OBJECTIVE: /st>To devise an adverse event (AE) detection system and assess its validity and utility. DESIGN: /st>Observational, retrospective study. SETTING: /st>Six public hospitals in Northern Italy including a Teaching Hospital. PARTICIPANTS: /st>Eligible cases were all patients with at least one admission to a surgical ward, over a 3-month period. INTERVENTIONS: ...

Rural hospitals rethink their strategies for recruiting physicians, including offering unique incentives.

Although uncertainty around reform continues, hospitals can plan on these influential trends.

In the past decade, there has been a trend from doing procedures in the hospital operating room and the ambulatory treatment center to performing procedures in the doctor's office. This trend is becoming more prevalent as doctors have recognized that they have more control over their practices by working in ...

Hospitals across the United States are more involved in disaster/rapid response planning than ever. This collaboration is often driven by continuing federal and state preparedness and all-hazards planning efforts that provide cooperative agreement and/or grant support. These efforts currently include programs administered by the US assistant secretary for preparedness and ...

Retiring physicians have much to think about for estate planning purposes. The authors stand ready to help physicians sell or close their medical practice, navigate the 2010 Tax Act, take advantage of current planning opportunities, and prepare appropriate estate planning documents. Every estate is unique, so it is important to ...

KEY FINDINGS: Hospital outpatient department visits attended only by physician assistants (PAs) or advance practice nurses (APNs) increased by 50% from 2000-2001 (10%) through 2008-2009 (15%). The more urban the hospital location, the lower the percentage of visits seen only by PAs or APNs; decreasing from 36% in nonmetropolitan areas ...

Cancellation of elective surgical operations is recognized as a major cause of emotional trauma to patients as well as their families. This study was carried out to assess the incidence, causes and pattern of cancellation of elective surgical operations in our setting and to find the appropriate solutions for better ...

The author leaves a rural clinic in Fort Morgan, CO, to briefly join a medical relief team responding to the Haitian January 2010 earthquake. While transporting an ill newborn, he reflects on similarities between the Haitians' displacement and resulting vulnerability and that of his patients back home. "Jeff! Jeff! Get ...

Abstract Introduction. The availability of ambulances to respond to emergency calls is related to their ability to return to service from the hospital. Extended hospital turnaround times decrease the number of available unit hours ambulances are deployed, which in turn can increase coverage costs or sacrifice coverage. Objective. To determine ...

Abstract Background. Cardiac arrest center (CAC) criteria are not well defined, nor is their potential impact on current emergency medical services (EMS) transportation practices for post-cardiac arrest (PCA) patients. In addition to the availability of emergent cardiac catheterization (CATH) and therapeutic hypothermia (TH), high-volume centers and those with PCA protocols ...

BACKGROUND AND PURPOSE: Acute stroke management requires minimization of prehospital time. This study addresses the value of helicopter transport compared with other means of transportation to a stroke unit and compares their rates of thrombolysis on a nationwide basis. METHODS: Prospective data collection and prespecified evaluation of data from 32 ...

INTRODUCTION: Some major trauma patients in metropolitan Perth (area 5000km(2)) are initially transported to a secondary hospital (non-trauma centre), rather than directly to a tertiary hospital (trauma centre). They are subsequently transferred to a tertiary hospital. We compared outcomes from these different systems of care. METHODS: Major trauma (Injury Severity ...

Abstract Introduction. Helicopter and ground emergency medical services (EMS) units are frequently called to transport patients from winter resorts to area trauma centers. Objective. The purpose of this study was to examine helicopter EMS (HEMS) utilization for such patients, and to investigate out-of-hospital clinical variables that might help providers determine ...

OBJECTIVE: To describe the current practice of pediatric airway management at referring hospitals and the associated adverse events compared to a receiving tertiary pediatric ICU. METHOD: Retrospective chart and transport record review of all emergency critical care transports to our Pediatric ICU over 3 years. Data regarding tracheal intubation procedure, ...

To canvass the experience of a group of New Zealand rural hospital doctors of transfers from their hospitals. Ten rural hospital doctors were required to write an assignment on patient transfer as part of their assessment for a postgraduate diploma. The information from the completed assignments was grouped into themes ...

To identify variation in patient, event, and scene characteristics of out-of-hospital cardiac arrest (OOHCA) patients assessed by emergency medical services (EMS), and to investigate variation in transport practices in relation to documented prehospital return of spontaneous circulation (ROSC) within eight regional clinical centers participating in the Resuscitation Outcomes Consortium (ROC) ...

Objective: Analyze factors associated with clinical complications during intra-hospital transport of neonatal intensive care unit (NICU) patients. Methods: Prospective study of 641 infants submitted to 1197 intra-hospital transports at a public university NICU. Factors associated with clinical complications during intra-hospital transports were studied by multiple logistic regression analysis. Results: Included ...

A portable version of the Glostavent anaesthetic machine is described in which recent developments in draw-over technology are incorporated into a traditional draw-over anaesthetic system. The additional features include a more efficient reservoir and an improved vaporiser which have enhanced the performance and versatility. The portable Glostavent weighs less than ...

This study investigated the reasons for continued high rates of home births in rural Shanxi Province, northern China, despite a national programme designed to encourage hospital deliveries. We conducted semi-structured interviews with 30 home-birthing women in five rural counties and drew on hospital audit data, observations and interviews with local ...

A struggling hospital re-examines its values and turns employee and patint satisfaction around.

The inflammatory bowel diseases (IBDs) have been extensively studied with administrative databases. Ananthakrishnan et al. (this issue) used an administrative database to develop a risk score that predicted disease severity in hospitalized Crohn's disease patients. To understand the implication of this work, the concept of risk adjustment is reviewed and ...

The validity of administrative data may be vulnerable to how well physicians document medical charts. The objective of this study is to determine the relationship between chart documentation quality and the validity of administrative data. The charts for patients who underwent carotid endarterectomy were re-abstracted and rated for the quality ...

Pill-in-the-pocket treatment should be prescribed only if the administration of a loading oral dose of flecainide or propafenone has been proved safe in hospital, since major adverse effects have been reported in 5% of patients during in-hospital treatment. However, in emergency rooms, the oral administration of these drugs for the ...

Partial hospitalization programs represent a midpoint along the treatment intensity continuum between an inpatient and an outpatient service. Partial hospitalization programs can be used in place of an inpatient unit for patients who need crisis stabilization and amelioration of their acute symptoms, but who are not imminently homicidal or suicidal. ...

Long Island Health Network developed a provider-initiated pay-for-performance (PI-PFP) program beginning in 2004 and operated by 10 clinically integrated hospitals. The PI-PFP administrative processes, length of stay, patient satisfaction, and Hospital Quality Alliance measures are elaborated. PI-PFP has evolved over time and supports best practice sharing. We document how the ...

Uterine fibroid embolization (UFE) is a nonsurgical procedure performed by an interventional radiologist to treat uterine fibroids, the most common solid pelvic, benign tumors occurring in women and one of the most prevalent indications for hysterectomies. Most hospitals already have the resources in place to establish an effective UFE program ...

We validated the accuracy of case definitions for hypertension derived from administrative data across time periods (year 2001 versus 2004) and geographic regions using physician charts. Physician charts were randomly selected in rural and urban areas from Alberta and British Columbia, Canada, during years 2001 and 2004. Physician charts were ...

OBJECTIVE: Administrative databases of hospital admissions are increasingly being used, mostly without validation, for epidemiological and clinical outcomes studies. Although it has been difficult to assess the true accuracy of administrative databases, we have identified an opportunity to directly compare the State of Maryland administrative database against a prospectively maintained ...

Metabolic syndrome (MS) is most important because of its association with subsequent development of cardiovascular diseases. However, few studies about the prevalence of MS among hospital employees had been published.The aims of our study were to examine the prevalence of MS and associated factors. The up-to-date health examination data of ...

The purpose of this article is to provide intensivists with information and examples regarding cooling technology selection, cost assessment, adaptation, barriers, and presentation to hospital administrators. A review of medical and business literature was conducted using the following search terms: technology assessment, organizational innovation, intensive care, critical care, hospital administration, ...

The aim of this study was to determine the accuracy of dysphagia coding using the International Classification of Diseases version 9 (ICD-9) code 787.2. We used the administrative database of a tertiary hospital and sequential videofluorographic swallowing study (VFSS) reports for patients admitted to the same hospital from January to ...

OBJECTIVE: There has been a rapid increase in the number of pediatric hospitalist programs in the United States. As most pediatric hospitalist services are believed to be subsidized by hospitals, gaining a better understanding of the rationale for these subsidies is critical to the future success and existence of these ...