The American surgeon
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The American surgeon · Aug 2012
Breakdown of the consent process at a quaternary medical center: our full disclosure.
Circumstances may arise in the intensive care unit (ICU) when the physician is unable to obtain informed consent. We undertook this study to determine the variations in the consent process. An anonymous survey was distributed to all critical care nurses (RN), resident physicians (RES), advanced practitioners (AP), and attending physicians (ATT). ⋯ However, many physicians (34% ATT and 27% RES) denied having informed consent discussions with 50 per cent or more of their patients. This study has exposed a wide variation in consent practices. Future efforts to standardize consent processes are needed to protect patients and physicians.
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The American surgeon · Aug 2012
Initial suction evacuation of traumatic hemothoraces: a novel approach to decreasing chest tube duration and complications.
Between 2 and 4.4 per cent of all patients with trauma chest tubes develop retained hemothoraces. Retained hemothoraces prolong chest tube duration and hospital length of stay, and increase infectious complications like empyema. Early surgical drainage of retained hemothoraces has been shown to decrease complications and reduce hospital length of stay. ⋯ Compared with propensity matched controls, patients that underwent initial suction evacuation experienced significantly shorter chest tube duration (4.2 ± 1.9 vs 5.8 ± 2.3 days, P = 0.04). Also, in this population, there was an 8.2 per cent decrease in the number of patients that developed empyema or required additional drainage. Our study suggests that initial suction evacuation of traumatic hemothoraces is an effective and relatively easy intervention that reduces the duration of chest tube therapy, empyema formation, and the need for additional surgical intervention.