Hospital practice (1995)
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Hospital practice (1995) · Aug 2013
The surgical scorecard: a tool to close the loop on OR utilization.
Operating room (OR) suites are among the highest cost- and highest revenue-generating areas in most hospitals. A scorecard containing utilization and performance metrics for each surgical service and surgeon was designed by the OR leadership with results sent monthly to each surgical chief. Recent trends reveal an increased focus on optimizing utilization of OR resources as part of institutional cost-analysis efforts. Protected block time into which elective surgical and procedural cases can be booked must be used appropriately and booked fully to offset the fixed costs of staffing and running the OR. ⋯ The intent of the scorecard tool was to provide detailed information on utilization of protected block time for performance-improvement planning. First-case on-time start was also measured and reported so that block time at the start of the day was fully utilized. With the granular information on time-use performance of each surgeon, the surgical chiefs were able to make workflow changes to improve utilization of staffed prime-time block hours. The scorecard tool is used ultimately for communication, not calculation, of utilization metrics. MEASUREMENTS AND CONCLUSIONS: Block-time utilization was measured both before and after the implementation of the scorecard. The analysis of the period before and after implementation of the scorecard revealed an improvement in block-time utilization in all but 1 surgical service.
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Perioperative medicine is an increasing area of research focus that brings together internists, anesthesiologists, surgeons, and hospitalists. A medical team approach to ensure the best possible patient outcomes has fostered collaborative strategies across areas of patient care. We review 8 seminal articles in the field of perioperative medicine. Each article was published in either 2011 or 2012 and adds to care strategies in the areas of perioperative cardiac medicine, pulmonary care, blood transfusion decision making, and medication management.
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Stroke is one of the most common causes of morbidity and mortality in hospitalized patients in the United States. A proper understanding of stroke mechanisms helps to guide specific case management. ⋯ In this article, we provide an evidence-based review of the diagnostic approach for acute ischemic stroke, including recognizing common stroke mimics. We detail the initial medical management of acute stroke and the medical and surgical therapeutic interventions for patients who have sustained acute ischemic stroke.
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Hospital practice (1995) · Apr 2013
Comparative StudySex disparities in pre-hospital and hospital treatment of ST-segment elevation myocardial infarction.
To determine whether sex disparities exist in pre-hospital and hospital time to treatment in patients with ST-segment elevation myocardial infarction (STEMI). ⋯ Women with STEMI experienced significantly longer E2B and D2B times compared with men with STEMI, although these differences did not persist after adjustment for differences between sex groups at presentation. In addition to standard STEMI-care QI practices, sex-specific processes and interventions at the systems level may be needed to improve time to treatment for women with STEMI.
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Hospital practice (1995) · Apr 2013
Comparative StudyA comparative trial of anti-factor Xa levels versus the activated partial thromboplastin time for heparin monitoring.
To determine if laboratory monitoring of intravenous (IV) unfractionated heparin (UFH) using an anti–activated factor X (anti–factor Xa) assay, as opposed to the activated partial thromboplastin time (aPTT), would result in a higher percentage of results within the goal range, fewer monitoring tests, and fewer dose adjustments. ⋯ Use of an anti–factor Xa assay–based UFH-monitoring protocol resulted in a higher percentage of within-range blood plasma heparin monitoring tests, fewer monitoring tests for the patient to achieve blood plasma monitoring tests within goal range, and fewer dose adjustments compared with a protocol based on blood plasma monitoring using the aPTT.