Document Detail

Environmental impact of accelerated clinical care in a high-volume center.
MedLine Citation:
PMID:  17723885     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: "Fast-track" surgery, involving multimodal care, improves efficiency and short-term outcomes in patients undergoing bowel resection. The sustainability of the benefits and the "drag" effect on non-participating surgeons through changed nursing and resident practice is undetermined. METHODS: 297 consecutive elective colon resections (DRG149) within three study periods (pre-change, immediate post-change, long-term post-change) were retrospectively reviewed. Two surgeons began to "fast-track" their patients in 1999 independently from the other surgeons in the hospital. Surgeons were grouped into "fast-track surgeons," "high-volume surgeons," (>/=10 cases per year) and "low-volume surgeons," (<10 cases per year). Comparisons of duration of stay (DOS), readmission rates, and mortality were made for each of three time periods and surgeon groups. Trends were also compared with unrelated hospital non-colectomy control groups (uncomplicated craniotomy DRG 001 and pancreatic surgery DRG 192) and to a colectomy control group from a statewide database (DRG 149). RESULTS: Mean DOS for colon resection significantly decreased among the "fast-track" surgeons and among all the other surgeons in the hospital, from 6.3 +/- 0.3 days, down to 3.7 +/- 0.1 days. We found no significant difference in mortality or readmission rates between the study periods. 15% of the cases were performed laparoscopically, and the improvements in outcome were independent of surgical technique. Control group analyses demonstrated that the environmental impact on outcome was independent of hospital-wide or regional improvement efforts. CONCLUSIONS: Implementation of a new practice pattern in a shared environment leads to improved outcomes for patients of other surgeons within the same environment. Dissemination and cross-pollination of new methods through resident, nurse, and case manager practice pattern modification creates a favorable force for change and this impact is sustained over a 3-year period.
Elizabeth A Sailhamer; Suzanne M Sokal; Yuchiao Chang; David W Rattner; David L Berger
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Surgery     Volume:  142     ISSN:  0039-6060     ISO Abbreviation:  Surgery     Publication Date:  2007 Sep 
Date Detail:
Created Date:  2007-08-28     Completed Date:  2007-10-04     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0417347     Medline TA:  Surgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  343-9     Citation Subset:  AIM; IM    
Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.
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MeSH Terms
Digestive System Surgical Procedures / adverse effects,  methods,  trends*
Early Ambulation / adverse effects,  trends*
Hospitals / statistics & numerical data
Information Dissemination*
Interdisciplinary Communication*
Laparoscopy / adverse effects,  methods,  trends
Length of Stay / trends
Middle Aged
Outcome Assessment (Health Care)*
Patient Readmission / statistics & numerical data
Physician's Practice Patterns / statistics & numerical data,  trends*
Postoperative Complications / etiology
Regression Analysis
Retrospective Studies

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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