The Permanente journal
-
The Permanente journal · Jan 2012
Anesthesiology leadership rounding: identifying opportunities for improvement.
Rounding that includes participation of individuals with authority to implement changes has been advocated as important to the transformation of an institution into a high-quality and safe organization. We describe a Department of Anesthesiology's experience with leadership rounding. ⋯ A variety of organizations track specific measures across all phases of the patient experience to gauge quality of care. Chart auditing tools for detecting threats to safety are often used. These measures and tools missed opportunities for improvement that were discovered only through rounding. We conclude that the introduction of leadership rounding by an anesthesiology service can identify opportunities for improving quality that are not captured by conventional efforts.
-
The approach to and management of the athlete with concussion can be a challenging endeavor to physicians who care for athletes who have suffered a head injury--this group includes family physicians, pediatricians, internists, emergency medicine physicians, primary sports medicine physicians, orthopedic surgeons, neurologists, and neurosurgeons. Sometimes questions regarding the need for neurologic, psychological, or radiographic imaging can make the decision for return to play unclear. New legislation will undoubtedly increase physician visits for these athletes to return to play. Thus, the goal of this article is to review the latest guidelines regarding concussion management to help all physicians who care for athletes do so appropriately.
-
The Permanente journal · Jan 2012
Randomized Controlled TrialReductions in pain medication use associated with traditional Chinese medicine for chronic pain.
Participants in a randomized trial of traditional Chinese medicine (TCM) for temporomandibular joint dysfunction (TMD) had a linear decline in pain over 16 TCM visits. ⋯ Among the heaviest NSAID users, we observed a short-term reduction in NSAID use that was sustained as TCM visits became less frequent. There was no indication that pain reduction during TCM treatment was influenced by drug use.
-
The Permanente journal · Jan 2012
Comparative StudyAre there differences in access to care, treatment, and outcomes for children with appendicitis treated at county versus private hospitals?
We conducted a study to determine whether hospital type (county [ie, safety-net] vs private) affects health care access (appendiceal perforation [AP] rates), treatment (laparoscopic appendectomy [LA] rates), and outcomes in children with appendicitis. ⋯ Children with appendicitis treated at a county hospital were of lower socioeconomic background and had higher AP rates, longer LOH, and higher costs than their counterparts at private hospitals, but were more likely to undergo LA and require less abscess drainage. Within the county hospital, ethnic and socioeconomic disparities were not apparent; thus, these differences between institutions might have been caused by underlying disparities in ethnicity, income, and health care access.
-
The Permanente journal · Jan 2012
Predicting risk of death in general surgery patients on the basis of preoperative variables using American College of Surgeons National Surgical Quality Improvement Program data.
To use the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database to develop an accurate and clinically meaningful preoperative mortality predictor (PMP) for general surgery on the basis of objective information easily obtainable at the patient's bedside and to compare it with the preexisting NSQIP mortality predictor (NMP). ⋯ PMP score is an accurate and simple tool for predicting operative survival or death using only preoperative variables that are readily available at the bedside. This can serve as a performance assessment tool between hospitals and individual surgeons.