Journal of the American College of Surgeons
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Comparative Study
Rural hospitals face a higher burden of ruptured abdominal aortic aneurysm and are more likely to transfer patients for emergent repair.
The influence of rural hospital location on abdominal aortic aneurysm (AAA) outcomes is unknown. We undertook a study to determine the difference in the risk of ruptured AAA presentation and outcomes after ruptured AAA between rural and urban areas. ⋯ Rural hospitals face a disproportionate burden of ruptured AAA and are more likely to transfer patients with ruptured AAA without performing repair, compared with urban hospitals. Solutions to rural disparity in ruptured AAA outcomes should focus on improving rural patients' access to vascular surgeons for elective and emergent AAA repair.
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Based on the goals of health care reform, growth in the demand for health care will continue to increase the demand for physicians and, as physician shortages widen, advanced practice nurses (APNs) and physician assistants (PAs) will play larger roles. Together with physicians they constitute a workforce of "advanced clinicians." The objective of this study was to assess the capacity of this combined workforce to meet the future demand for clinical services. ⋯ The nation faces a substantial shortfall in its combined supply of physicians, APNs, and PAs, even under aggressive training scenarios, and deeper shortages if these scenarios are not achieved. Efforts must be made to expand the output of clinicians in all 3 disciplines, while also strengthening the infrastructure of clinical practice and facilitating the delegation of tasks to a broadened spectrum of caregivers in new models of care.
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Evidence-based guidelines recommend cholecystectomy during initial hospitalization for complicated gallstone disease. Previous studies and quality initiative data from our institution demonstrated that only 40% to 75% of patients underwent cholecystectomy on index admission. ⋯ Implementation of a multidisciplinary critical pathway improved cholecystectomy rates on initial hospitalization and lowered costs by shortening length of stay and markedly decreasing readmission rates for gallstone-related problems. Broader implementation of similar pathways offers the potential to translate evidence-based guidelines into clinical practice and minimize the cost of medical care.
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Research suggests that surgical safety checklists can reduce mortality and other postoperative complications. The real world impact of surgical safety checklists on patient outcomes, however, depends on the effectiveness of hospitals' implementation processes. ⋯ The impact of surgical safety checklists on patient outcomes is likely to vary with the effectiveness of each hospital's implementation process. Further research is needed to confirm these findings and reveal additional factors supportive of checklist implementation.