Archives of surgery (Chicago, Ill. : 1960)
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Comparative Study
Assessment of radiofrequency device sensitivity for the detection of retained surgical sponges in patients with morbid obesity.
Retained surgical sponges are serious medical errors that result in negative patient outcomes. A radiofrequency (RF) mat for the operating room bed has recently been introduced to detect the presence of a retained surgical sponge. The study objectives were to evaluate the sensitivity and specificity of the RF mat for the detection of surgical sponges through the torso of individuals with varying body habitus and to compare the sensitivity of the RF mat with that of the RF wand. We hypothesized that the sensitivity and specificity of the RF technology would be comparable to published findings of the manual sponge count by operating room personnel. ⋯ The sensitivity and specificity of RF device technology are much higher than those of surgical sponge counts or published findings on the use of intraoperative radiographs to identify retained surgical sponges. The RF wand is more sensitive than the RF mat in individuals with morbid obesity.
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The Surgical Care Improvement Project (SCIP) Inf-9 guideline promotes removal of indwelling urinary catheters (IUCs) within 48 hours of surgery. ⋯ Most UTIs occurred in patients deemed exempt from SCIP Inf-9. Although compliance rates remain high, practices are not actually improving. Surgical Care Improvement Project Inf-9 guidelines should be modified with fewer exemptions to facilitate earlier removal of IUCs.
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Venous thromboembolism is associated with substantial morbidity and mortality and is largely preventable. Despite this fact, appropriate prophylaxis is vastly underutilized. To improve compliance with best practice prophylaxis for VTE in hospitalized trauma patients, we implemented a mandatory computerized provider order entry-based clinical decision support tool. The system required completion of checklists of VTE risk factors and contraindications to pharmacologic prophylaxis. With this tool, we were able to determine a patient's risk stratification level and recommend appropriate prophylaxis. To evaluate the effect of our mandatory computerized provider order entry-based clinical decision support tool on compliance with prophylaxis guidelines for venous thromboembolism (VTE) and VTE outcomes among admitted adult trauma patients. ⋯ Implementation of a mandatory computerized provider order entry-based clinical decision support tool significantly improved compliance with VTE prophylaxis guidelines in hospitalized adult trauma patients. This improved compliance was associated with a significant decrease in the rate of preventable harm, which was defined as VTE events in patients not ordered appropriate prophylaxis.
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Multicenter Study
Clinical outcome in relation to timing of surgery in chronic pancreatitis: a nomogram to predict pain relief.
To evaluate the effect of timing of surgery on the long-term clinical outcome of surgery in chronic pancreatitis (CP). ⋯ The timing of surgery is an important risk factor for clinical outcome in CP. Surgery may need to be considered at an earlier phase than it is now, preferably within 3 years of symptomatic CP. Likelihood of postoperative pain relief can be calculated on an individual basis using the presented nomogram.