Surgery
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With liberal use of computed tomography in the diagnostic management of trauma patients, incidental findings are common and represent a major patient-care and medical-legal concern. Consequently, we began an initiative to capture, notify, and documentadequately incidental finding events with a dedicated incidental finding coordinator. We hypothesized a dedicated incidental finding coordinator would increase incidental finding capture and promote notification, follow-up, and documentation of incidental finding events. ⋯ The implementation of a dedicated incidental finding coordinator resulted in more than a 2.5-fold higher capture of incidental findings. Dedicated attention to incidental findings resulted in a near complete initiation of patient notification, follow-up, and hospital record documentation of incidental finding events. Inadequate patient notification and follow-up would delay appropriate care and potentially would result in morbidity or even mortality. A dedicated incidental finding coordinator represents a potential solution to this patient-care and medical-legal dilemma.
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Our previous investigation demonstrated that despite routine chemoprophylaxis, thrombelastography, which is a comprehensive test measuring the viscoelastic properties of blood, identified a hypercoagulable state in a cohort of critically ill surgical patients that was associated with thromboemobolic events. Furthermore, because thrombelastography allows for the comprehensive assessment of coagulation status, this work suggested that platelet hyperactivity is a component of the hypercoagulable state. We hypothesized that progressive postinjury thrombocytosis contributes to a hypercoagulable state that is associated with thrombelastography. ⋯ Persistent thrombocytosis in critically injured patients receiving routine chemoprophylaxis is associated with thrombotic complications. Subsequent investigation is warranted to differentiate enzymatic from platelet hypercoagulability to ascertain the role of antiplatelet therapy for prevention of TE.
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Dedicated skills courses may help to prepare 4th-year medical students for surgical internships. The purpose of this study was to analyze the factors that influence the preparedness of 4th-year medical students planning a surgical career, and the role that our skills course plays in that preparedness. ⋯ Completion of an accelerated skills course results in comparable levels of student performance postcourse across a variety of preclinical backgrounds and clerkship experiences.
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The development of anastomotic leaks and/or strictures can be associated with considerable morbidity and impairment of quality of life. In the current study, we evaluated the outcomes of patients who developed anastomotic complications after esophagectomy to elucidate the impact of these events on morbidity, mortality, and subsequent need for dilation. ⋯ Anastomotic integrity after esophagectomy has a substantial impact on perioperative course and long-term swallowing. A more formal radiographic and endoscopic leak classification system seems justified.
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The dichotomy between clinical and hospital revenue generation for trauma care is well established. Many trauma programs require hospital support for fiscal survival. We evaluated the impact of standardized clinical documentation to the hospital's bottom line at our trauma center. ⋯ An effective standardized documentation strategy for trauma care results in significant fiscal gains in hospital reimbursement.