Improved Comorbidity Capture Using a Standardized 1-Step Quality Improvement Documentation Tool

2018 ◽  
Vol 159 (1) ◽  
pp. 143-148 ◽  
Author(s):  
Robert J. Morrison ◽  
Kelly M. Malloy ◽  
Rishi R. Bakshi
Keyword(s):  
Head And Neck ◽  
Neck Surgery ◽  
The United States ◽  
Head And Neck Surgery ◽  
Clinical Severity ◽  
Quality Outcomes ◽  
Query Process ◽  
Implementation Period ◽  
Query System ◽  
The Impact

Objective To assess the impact of implementation of a “1-step” documentation query system on comorbidity capture and quality outcomes within the Department of Otolaryngology–Head and Neck Surgery. Methods Implementation of the 1-step documentation query system was instituted for all otolaryngology–head and neck surgery faculty at a single institution. Individual query responses and impact metrics were analyzed. Departmental case-mix index (CMI), risk of mortality (ROM), and severity of illness (SOI) were collated over a 14-month implementation period and compared to a 12-month preimplementation period. Results A total of 226 documentation queries occurred during the program pilot period, with an 86.7% response rate. Of queries with a response, 91.0% resulted in a significant impact for the hospitalization diagnoses-related group, ROM, or SOI. Departmental CMI increased from 2.73 to 2.91 over the implementation period, and observed/expected mortality ratio decreased from 0.50 to 0.42 pre- to postimplementation. Discussion With increasing emphasis on quality metrics outcomes within the United States health care system, there is a need for institutions to accurately capture the complexity and acuity of the patients they care for. There was a positive change in quality outcomes metrics, including ROM, SOI, and CMI over the first year of deployment of the 1-step documentation query process. Implications for Practice Clinical severity metrics are becoming increasingly important to otolaryngologists, as insurers move to severity-adjusted profiles. The 1-step documentation query process provides a reproducible and effective way for clinical documentation specialists and physicians to collaborate on improving departmental clinical severity metrics.

A National Survey of Robotic Surgery Training Among Otolaryngology—Head and Neck Surgery Residents

2021 ◽  
pp. 000348942199696
Author(s):  
Hilary C. McCrary ◽  
Sierra R. McLean ◽  
Abigail Luman ◽  
Patricia O’Sullivan ◽  
Brigitte Smith ◽  
...  
Keyword(s):  
Robotic Surgery ◽  
Head And Neck ◽  
National Survey ◽  
Neck Surgery ◽  
The United States ◽  
Head And Neck Surgery ◽  
Residency Programs ◽  
Surgery Training ◽  
Robotic Surgery Training ◽  
Operative Experience

Objective: The aim of this study is to describe the current state of robotic surgery training among Otolaryngology—Head and Neck Surgery (OHNS) residency programs in the United States. Methods: This is a national survey study among OHNS residents. All OHNS residency programs were identified via the Accreditation Council for Graduate Medical Education website. A total of 64/127 (50.3%) of OHNS programs were selected based on a random number generator. The main outcome measure was the number of OHNS residents with access to robotic surgery training and assessment of operative experience in robotic surgery among those residents. Results: A total of 140 OHNS residents participated in the survey, of which 59.3% (n = 83) were male. Response rate was 40.2%. Respondents came from middle 50.0% (n = 70), southern 17.8% (n = 25), western 17.8% (n = 25), and eastern sections 14.3% (n = 20). Most respondents (94.3%, n = 132) reported that their institution utilized a robot for head and neck surgery. Resident experience at the bedside increased in the junior years of training and console experience increased across the years particularly for more senior residents. However, 63.4% of residents reported no operative experience at the console. Only 11.4% of programs have a structured robotics training program. Conclusion: This survey indicated that nearly all OHNS residencies utilize robotic surgery in their clinical practice with residents receiving little formal education in robotics or experience at the console. OHNS residencies should aim to increase access to training opportunities in order to increase resident competency. Level of Evidence: IV

scholarly journals The Impact of the COVID-19 Pandemic on Head and Neck Surgery Training: A Brazilian National Survey

2021 ◽  
Author(s):  
Ana Kober Leite ◽  
Leandro Luongo Matos ◽  
Claudio R. Cernea ◽  
Luiz Paulo Kowalski
Keyword(s):  
Head And Neck ◽  
Surgical Training ◽  
Online Survey ◽  
Negative Impact ◽  
Neck Surgery ◽  
Head And Neck Surgery ◽  
Educational Activities ◽  
Residency Programs ◽  
Surgery Training ◽  
The Impact

Abstract Introduction The COVID-19 pandemic has had a high impact on surgical training around the world due to required measures regarding the suspension of elective procedures and the dismissal of nonessential personnel. Objectives To understand the impact the pandemic had on head and neck surgery training in Brazil. Methods We conducted a 29-question online survey with head and neck surgery residents in Brazil, assessing the impact the pandemic had on their training. Results Forty-six residents responded to the survey, and 91.3% of them reported that their residency was affected by the pandemic, but most residents were not assigned to work directly with patients infected with the new coronavirus (71.4%). All residents reported decrease in clinic visits and in surgical procedures, mostly an important reduction of ∼ 75%. A total of 56.5% of the residents described that the pandemic has had a negative impact on their mental, health and only 4 (8.7%) do not have any symptoms of burnout. The majority (78.3%) of the residents reported that educational activities were successfully adapted to online platforms, and 37% were personally infected with the virus. Conclusion Most surgical residencies were greatly affected by the pandemic, and residents had an important decrease in surgical training. Educational activities were successfully adapted to online modalities, but the residency programs should search for ways of trying to compensate for the loss of practical activities.

Implementation of duty hour standards in otolaryngology-head and neck surgery residency training

2005 ◽  
Vol 132 (6) ◽  
pp. 819-822 ◽  
Author(s):  
Todd A. Kupferman ◽  
Tim S. Lian
Keyword(s):  
Head And Neck ◽  
Residency Training ◽  
Training Programs ◽  
Neck Surgery ◽  
Program Directors ◽  
The United States ◽  
Head And Neck Surgery ◽  
Training Experience ◽  
Duty Hours ◽  
Resident Duty

OBJECTIVE: To determine what impact, if any, of the recently implemented duty hour standards have had on otolaryngology-head and neck surgery residency programs from the perspective of program directors. We hypothesized that the implementation of resident duty hour limitations have caused changes in otolaryngology training programs in the United States. STUDY DESIGN AND SETTING: Information was collected via survey in a prospective, blinded fashion from program directors of otolaryngology-head and neck residency training programs in the United States. RESULTS: Overall, limitation of resident duty hours is not an improvement in otolaryngology-head and neck residency training according to 77% of the respondents. The limitations on duty hours have caused changes in the resident work schedules in 71% of the programs responding. Approximately half of the residents have a favorable impression of the work hour changes. Thirty-two percent of the respondents indicate that changes to otolaryngology support staff were required, and of those many hired physician assistants. Eighty-four percent of the respondents did not believe that the limitations on resident duty hours improved patient care, and 81% believed that it has negatively impacted resident training experience. Forty-five percent of the program directors felt that otolaryngology-head and neck faculty were forced to increase their work loads to accommodate the decrease in the time that residents were allowed to be involved in clinical activities. Fifty-four percent of the programs changed from in-hospital to home call to accommodate the duty hour restrictions. CONCLUSIONS: According to the majority of otolaryngology-head and neck surgery program directors who responded to the survey, the limitations on resident duty hours imposed by the ACGME are not an improvement in residency training, do not improve patient care, and have decreased the training experience of residents. SIGNIFICANCE: This study demonstrates that multiple changes have been made to otolaryngology-head and neck surgery training programs because of work hour limitations set forth by the ACGME.

scholarly journals Impact of economic crisis on indications for general versus local anaesthesia in head and neck surgery: a single centre analysis

2014 ◽  
Vol 3 (6) ◽  
pp. 92
Author(s):  
Tatjana Goranovic ◽  
Boris Simunjak ◽  
Dinko Tonkovic ◽  
Miran Martinac
Keyword(s):  
Cost Saving ◽  
Head And Neck ◽  
General Anaesthesia ◽  
Local Anaesthesia ◽  
Neck Surgery ◽  
Head And Neck Surgery ◽  
Significant Difference ◽  
Before And After ◽  
Saving Measure ◽  
The Impact

Objective: To analyze the impact of the hospital board’s cost saving measure on physicians’ decision to indicate head and neck surgery according to the type of anaesthesia (general versus local). Methods: Design: a retrospective analysis of medical charts on head and neck surgery and anaesthesia covering 2011-2012. Setting: department of otorhinolaryngology and head and neck surgery, university hospital, Croatia. Participants: patients undergoing head and neck surgery. Intervention(s): reduction of departmental financial fund for general anaesthesia for 10%. Main Outcome Measure(s): an overall of number of head and neck surgeries performed in general versus local anaesthesia before and after the implementation of the intervention measure. Results: There were a total of 984 head and neck surgeries in general anaesthesia in 2011 and 861 in 2012. There were a total of 460 head and neck surgeries in local anaesthesia in 2011 and 528 in 2012. The performance of head and neck surgeries in general anaesthesia was significantly reduced in a year after the implementation of the intervention (p = .01) There was no statistical significant difference in the performance of head and neck surgeries in local anaesthesia before and after the intervention. Conclusions: The reduction of departmental fund for general anaesthesia as a cost saving method resulted only in reducing the total performance of surgeries in general anaesthesia without any switch to performing surgeries in local anaesthesia. It seems that the hospital board’s cost saving measure did not have any impact on physicians’ decisions to indicate more surgeries in local anaesthesia. 

Use of standardized letters of recommendation for otolaryngology head and neck surgery residency and the impact of gender

2017 ◽  
Vol 127 (12) ◽  
pp. 2738-2745 ◽  
Author(s):  
Remy Friedman ◽  
Christina H. Fang ◽  
Johann Hasbun ◽  
Helen Han ◽  
Leila J. Mady ◽  
...  
Keyword(s):  
Head And Neck ◽  
Neck Surgery ◽  
Head And Neck Surgery ◽  
The Impact ◽  
Letters Of Recommendation

Commentary on “Otolaryngology–Head and Neck Surgery Physician Workforce Issues An Analysis for Future Specialty Planning” by Kim, Cooper, and Kennedy

2012 ◽  
Vol 146 (2) ◽  
pp. 203-205 ◽  
Author(s):  
Shannon P. Pryor ◽  
Linda Brodsky ◽  
Sujana S. Chandrasekhar ◽  
Lauren Zaretsky ◽  
Duane J. Taylor ◽  
...  
Keyword(s):  
Head And Neck ◽  
Neck Surgery ◽  
The United States ◽  
Head And Neck Surgery ◽  
Physician Workforce ◽  
Modeling Methods ◽  
The Us ◽  
Workforce Issues ◽  
Time Work ◽  
Part Time

An impending physician shortage has been projected. The article by Kim, Cooper, and Kennedy, titled “Otolaryngology–Head and Neck Surgery Physician Workforce Issues: An Analysis for Future Specialty Planning,” is an attempt to evaluate and address this potential shortage as it applies to otolaryngology. The authors of this comment have concerns about the article’s assumptions, design, and recommendations. Kim et al attempt to extrapolate data from other specialties and other countries to the US otolaryngology workforce, use that data in modeling methods without demonstrated validity, and based on their analysis, they recommend drastic changes to otolaryngologic training and practice in the United States. Particularly troublesome are (1) the emphasis placed on gender and part-time work and (2) the measurement of productivity defined as hours worked per week. Before redefining our specialty, more thorough and systematic data acquisition and review are necessary to meet the needs of our patients now and in the future.

Otolaryngology–Head and Neck Surgery Physician Work Force Issues

2012 ◽  
Vol 146 (2) ◽  
pp. 196-202 ◽  
Author(s):  
Jin Suk C. Kim ◽  
Richard A. Cooper ◽  
David W. Kennedy
Keyword(s):  
Head And Neck ◽  
Census Data ◽  
Supply And Demand ◽  
Insurance Coverage ◽  
Neck Surgery ◽  
The United States ◽  
Economic Modeling ◽  
Head And Neck Surgery ◽  
Population Census ◽  
Data Sets

Objective. To predict future trends in the otolaryngology workforce and propose solutions to correct the identified discrepancies between supply and demand. Study Design. Economic modeling and analysis. Setting. Data sets at national medical and economic organizations. Subjects and Methods. Based on current American Academy of Otolaryngology–Head and Neck Surgery, American Medical Association, and National Residency Matching Program data sets, population census data, and historical physician growth demand curves, the future otolaryngology workforce supply and demand were modeled. Adjustments were made for projected increases in mid-level providers, increased insurance coverage, and the potential effects of lifestyle preferences. Results. There are currently approximately 8600 otolaryngologists in the United States. Estimated demand by 2025 is 11,127 based on projected population growth and anticipated increase in insurance coverage. With an average retirement age of 65 years and no increase in PGY-1 positions for the specialty, the number of otolaryngologists in 2025 will be approximately 2500 short of projected demand. This shortfall will not be adequately compensated by mid-level providers performing less intensive services and may be increased by lifestyle preferences and changing demographics among medical students and residents. The current geographic maldistribution of otolaryngologists is likely to be exacerbated. Conclusion. The specialty needs to actively plan for the coming otolaryngologist shortage and train mid-level providers within the specialty. Failure to plan appropriately may result in a reduction in scope of practice of high-intensity services, which will likely remain a physician prerogative. Given the limited likelihood of a significant increase in residency slots, strong consideration should be given to shortening the base otolaryngology training program length.

Assessing the Practice Characteristics of Otolaryngology Same-Day Appointments in an Academic Center

2020 ◽  
pp. 019459982094249
Author(s):  
Katie Geelan-Hansen ◽  
Vega Were ◽  
Kleve Granger ◽  
Dwight Jones
Keyword(s):  
Access To Care ◽  
Head And Neck ◽  
Neck Surgery ◽  
Appointment Scheduling ◽  
Head And Neck Surgery ◽  
Urgent Care ◽  
Practice Characteristics ◽  
Academic Center ◽  
Day Clinic ◽  
The Impact

Objectives to Examine the practice characteristics of same-day clinic appointments and the use of same-day appointment scheduling to provide access to care in an otolaryngology–head and neck surgery clinic. Methods Retrospective chart review of same-day clinic appointments from January 1, 2016, to December 31, 2018, in patients aged >19 years at a single academic center. Demographic data, diagnoses, procedures completed, and operations completed were analyzed. Results There were 2696 visits by 2324 patients during the 3-year study period. More men than women (57% vs 43%) made same-day appointments. The mean age was 50.7 years (range, 19-99 years). Sinonasal and otologic diagnoses were the most frequently coded. A total of 1452 procedures were completed on the day of the visit, and 239 operations were completed as a result of the visit. Overall, a broad spectrum of otolaryngology care was delivered within the organizational new patient access goals. Discussion Access to otolaryngology–head and neck surgery care can be challenging. Many patients will seek care when they feel they need it, and patient conditions can change unexpectedly. Offering same-day scheduling can allow patients timely health care and appropriate care. Implications for Practice Same-day appointment scheduling can provide access to care and urgent care for patients. The department of otolaryngology–head and neck surgery has been able to maintain a high rate of providing new patient appointments within 10 days with this method. Further considerations for the impact of same-day scheduling on no-show rates and patient satisfaction can be evaluated.

Sign in / Sign up

Export Citation Format

Share Document