QRB. Quality review bulletin
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Administrators at Mercy Hospital in Springfield, Massachusetts, studied the effects of daily patient number and arrival rate on waiting time in the Emergency Unit. These two factors were found to have a smaller impact on waiting times than might be expected. Several issues relating to staffing and to patients' illnesses were addressed to reduce visit lengths (ie, inadequate number of admitting registrars, inefficient use of staff, insufficient locations for the rapid treatment of patients requiring suturing, and large numbers of ancillary services requested on a stat basis). Subsequent studies showed that changes instituted as a result of the initial study had reduced overall emergency waiting time by 12%, even though average daily census had increased by 17%.
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Human error and mechanical failure in anesthesia frequently cause incidents which, if not detected and corrected in time, could lead to increased patient morbidity or mortality. A study was conducted to analyze the human and technical factors that contribute to such incidents. The data thus obtained proved useful in reducing preventable anesthesia mishaps in specific institutions and generated recommendations for improving anesthesia practice in general.
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Because small hospitals tend to have few members on their anesthesia services, perform less complicated and less extensive surgical procedures, use relatively straightforward anesthesia regimes, and have low anesthesia complication rates, foci for review may be difficult to identify. A review of intraoperative and postoperative mortality can be a productive approach, however. The authors provide criteria to help small hospitals identify problem areas in the delivery of anesthesia care through mortality review.