Is After-Hours Orthopaedic Surgery Associated with Adverse Outcomes?

2009 ◽  
Vol 91 (9) ◽  
pp. 2067-2072 ◽  
Author(s):  
William M Ricci ◽  
Bethany Gallagher ◽  
Angel Brandt ◽  
John Schwappach ◽  
Michael Tucker ◽  
...  
Keyword(s):  
Orthopaedic Surgery ◽  
Adverse Outcomes ◽  
After Hours

scholarly journals Understanding Facilitators and Barriers in the Hospital Discharge Processes of Newly Prescribed Insulin: A Mixed-Methods Study

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A431-A432
Author(s):  
Cheong M Yu ◽  
Alice Lu ◽  
Emilie Touma ◽  
Pamela Wax ◽  
Amador Rosales ◽  
...  
Keyword(s):  
Comparative Method ◽  
Qualitative Interviews ◽  
Discharge Summary ◽  
Adverse Outcomes ◽  
Discharge Process ◽  
Low Health Literacy ◽  
Constant Comparative Method ◽  
Included Review ◽  
After Hours ◽  
Enterprise Data Warehouse

Abstract Patients, newly prescribed insulin, being discharged from the hospital are at high risk of adverse outcomes. An electronic enterprise data warehouse (EDW) algorithm was created and validated to identify these inpatients electronically. Qualitative interviews were also conducted to assess barriers in the discharge process. The EDW algorithm to identify inpatients (09/01/18-08/31/19), newly prescribed insulin at discharge, was created by identifying screening indicators (e.g., admission/discharge medication lists, discharge summary). Iterative adjustments to the algorithm were made after chart review and included review of medication reconciliation (med rec), admission/discharge orders, and insulin orders (types/delivery). The EDW list was compared to the list of patients who received insulin teaching from the Certified Diabetes Care and Education Specialist (CDCES), during the same period. Providers (N=8, 3 endocrine attending MDs, 2 fellow MDs, 3 resident MDs) were interviewed in key informant interviews (N=3) and focus groups (N=2); transcripts were independently coded by 2 coders, utilizing a constant comparative method to generate key themes. The EDW list (N=554) was audited by EHR review (n = 42, 8%); 83% (35/42) were correctly identified as newly discharged on insulin. Of the 7 incorrectly identified, 4 likely had incomplete med rec. The EDW algorithm was unable to correctly identify patients with inaccurate/incomplete med rec, patients transferring from outside hospitals or those without e-Rx at discharge (vouchers, call-in). The CDCES list (N=257) was audited (n=25, 10%), and of patients not meeting criteria (n=15), some had prior insulin prescribed (n=5), and most ended up not discharged on insulin after CDCES insulin teaching (n=9). Comparison of the EDW and CDCES lists had 177 patients (32% of EDW list) in common, with 377 on the EDW list with no CDCES consultation. An audit (n=21/377, 5%) of these EDW patients, who did not have CDCES or endocrinology consultation, revealed patients across service lines, with minimal formal documentation of insulin training/education. Key identified themes from interviews identified barriers including lack of availability of a CDCES after-hours and on weekends, low health literacy/numeracy, and lack of time during stay. In training MDs noted variability in discharge prescribing by supervising MDs and the need to assess “chart lore,” given cut and paste documentation in EHR. This study suggests that an EDW algorithm can be used to identify patients newly being discharged on insulin, for whom teaching by a CDCES is recommended. The data suggest the need for more targeted and increased CDCES capacity as only a portion of those eligible for insulin teaching were seen while others were seen but then not discharged on insulin. Additional resources for insulin teaching are needed and standardized training and documentation need to be developed.

scholarly journals An audit of consent for allograft use in elective orthopaedic surgery

2016 ◽  
Vol 98 (04) ◽  
pp. 254-257 ◽  
Author(s):  
CJ Mullan ◽  
R Pagoti ◽  
H Davison ◽  
MG McAlinden
Keyword(s):  
Informed Consent ◽  
Disease Transmission ◽  
Orthopaedic Surgery ◽  
High Volume ◽  
General Medical Council ◽  
Adverse Outcomes ◽  
Audit And Feedback ◽  
Medical Council ◽  
Patient Consent ◽  
Arthroplasty Surgery

Introduction Patients receiving musculoskeletal allografts may be at risk of postoperative infection. The General Medical Council guidelines on consent highlight the importance of providing patients with the information they want or need on any proposed investigation or treatment, including any potential adverse outcomes. With the increased cost of defending medicolegal claims, it is paramount that adequate, clear informed patient consent be documented. Methods We retrospectively examined the patterns of informed consent for allograft bone use during elective orthopaedic procedures in a large unit with an onsite bone bank. The initial audit included patients operated over the course of 1 year. Following a feedback session, a re-audit was performed to identify improvements in practice. Results The case mix of both studies was very similar. Revision hip arthroplasty surgery constituted the major subgroup requiring allograft (48%), followed by foot and ankle surgery (16.3%) and revision knee arthroplasty surgery (11.4%) .On the initial audit, 17/45 cases (38%) had either adequate preoperative documentation of the outpatient discussion or an appropriately completed consent form on the planned use of allograft. On the re-audit, 44/78 cases (56%) had adequate pre-operative documentation. There was little correlation between how frequently a surgeon used allograft and the adequacy of consent (Correlation coefficient -0.12). Conclusions Although the risk of disease transmission with allograft may be variable, informed consent for allograft should be a routine part of preoperative discussions in elective orthopaedic surgery. Regular audit and feedback sessions may further improve consent documentation, alongside the targeting of high volume/low compliance surgeons.

Increased postoperative glucose variability is associated with adverse outcomes following orthopaedic surgery

2018 ◽  
Vol 100-B (8) ◽  
pp. 1125-1132 ◽  
Author(s):  
N. Shohat ◽  
C. Foltz ◽  
C. Restrepo ◽  
K. Goswami ◽  
T. Tan ◽  
...  
Keyword(s):  
Orthopaedic Surgery ◽  
Glucose Variability ◽  
Adverse Outcomes ◽  
Binary Outcomes ◽  
Diabetic Patients ◽  
Complication Rates ◽  
Glycaemic Variability ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
The Mean

Aims The aim of this study was to examine the association between postoperative glycaemic variability and adverse outcomes following orthopaedic surgery. Patients and Methods This retrospective study analyzed data on 12 978 patients (1361 with two operations) who underwent orthopaedic surgery at a single institution between 2001 and 2017. Patients with a minimum of either two postoperative measurements of blood glucose levels per day, or more than three measurements overall, were included in the study. Glycaemic variability was assessed using a coefficient of variation (CV). The length of stay (LOS), in-hospital complications, and 90-day readmission and mortality rates were examined. Data were analyzed with linear and generalized linear mixed models for linear and binary outcomes, adjusting for various covariates. Results The cohort included 14 339 admissions, of which 3302 (23.0%) involved diabetic patients. Patients with CV values in the upper tertile were twice as likely to have an in-hospital complication compared with patients in the lowest tertile (19.4% versus 9.0%, p < 0.001), and almost five times more likely to die compared with those in the lowest tertile (2.8% versus 0.6%, p < 0.001). Results of the adjusted analyses indicated that the mean LOS was 1.28 days longer in the highest versus the lowest CV tertile (p < 0.001), and the odds of an in-hospital complication and 90-day mortality in the highest CV tertile were respectively 1.91 (p < 0.001) and 2.10 (p = 0.001) times larger than the odds of these events in the lowest CV tertile. These associations were significant even for non-diabetic patients. After adjusting for hypoglycaemia, the relationships remained significant, except that the CV tertile no longer predicted mortality in diabetics. Conclusion These results indicate that higher glycaemic variability is associated with longer LOS and in-hospital complications. Glycaemic variability also predicted death, although that primarily held for non-diabetic patients in the highest CV tertile following orthopaedic surgery. Prospective studies should examine whether ensuring low postoperative glycaemic variability may reduce complication rates and mortality. Cite this article: Bone Joint J 2018;100-B:1125–32.

scholarly journals Introducing an AKI predictive tool for patients undergoing orthopaedic surgery

2019 ◽  
Vol 8 (1) ◽  
pp. e000306 ◽  
Author(s):  
David Paul Baird ◽  
Fraser Rae ◽  
Christina Beecroft ◽  
Katherine Gallagher ◽  
Stephanie Sim ◽  
...  
Keyword(s):  
High Risk ◽  
Fluid Balance ◽  
Orthopaedic Surgery ◽  
Elective Surgery ◽  
Adverse Outcomes ◽  
Royal Infirmary ◽  
Predictive Tool ◽  
Electronic Tool ◽  
Increased Risk ◽  
Scoring Tool

Patients undergoing surgery are at increased risk of acute kidney injury (AKI). AKI is associated with adverse outcomes such as increased mortality and future risk of developing chronic kidney disease. We have developed a validated preoperative scoring tool to predict postoperative AKI in patients undergoing orthopaedic surgery using seven readily available parameters. The aim of this project was to establish the use of this scoring tool with a target compliance of 80% in patients undergoing orthopaedic surgery requiring an overnight stay at Perth Royal Infirmary, a district general hospital in NHS Tayside. We created an intervention bundle for patients at high risk of AKI, which we defined as greater than 10%. An electronic tool available on smartphones and desktop computers was developed that can be used to calculate the score. The interventions were incorporated into the electronic tool and posters outlining the intervention were placed in clinical areas. Patients undergoing elective procedures were scored in the preassessment clinic while emergency patients were scored by the admitting doctors. The score was introduced using four PDSA cycles. This confirmed that the scoring tool functioned well and was being used accurately. Compliance for patients undergoing elective surgery was reasonable at 19/24 (79%) in the third and fourth PDSA cycles but was poorer for emergency admissions with compliance of only 3/7 (43%). There was excellent compliance with the suggested medication changes and postoperative blood test monitoring as advised by our intervention bundle for those at high risk of AKI. Fluid balance monitoring was advised for all patients but the outcome was similar following our intervention at 27/41 (66%) compared with 23/37 (62%) in the baseline data collection. Compliance with fluid balance monitoring was higher in patients at high risk of AKI (9/12, 75%).

Is Frailty Associated with Adverse Outcomes After Orthopaedic Surgery?

JBJS Reviews ◽  
2021 ◽  
Vol 9 (12) ◽  
Author(s):  
Jacie L. Lemos ◽  
Jessica M. Welch ◽  
Michelle Xiao ◽  
Lauren M. Shapiro ◽  
Ehsan Adeli ◽  
...  
Keyword(s):  
Orthopaedic Surgery ◽  
Adverse Outcomes
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