The second of two articles. To outside observers, Mary Jones, RN, lived a charmed life: She was married to a bank owner, had 3 lovely children, and lived in a beautiful home overlooking a park. Colleagues in the OR where she worked enjoyed working with her. But Mary was hiding…

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Pay-for-performance—it's a term you'll hear more about. Medicare officials think pay-for-performance (P4P) could encourage hospitals to improve quality while bringing costs down—a priority given that the hospital trust fund is projected to run out of money in 11 years. Congress has asked Medicare to come up with a plan that…

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A new push is on to reduce hospital-acquired infections—the target is zero. As of Oct 1, 2008, Medicare will not pay hospitals for additional costs associated with 3 types of infections deemed preventable: catheter-associated urinary tract infections central line catheter-associated bloodstream infections mediastinitis—a deep sternal incisional infection following coronary artery…

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First article in a series. Elements of performance management Job description Initial competencies Orientation Goal setting/performance planning Competency assessment Coaching, mentoring, and recognition Performance evaluation Self-evaluation Peer evaluation Performance enhancement plan. Performance appraisal: Do these 2 words bring a feeling of dread when you hear them? Do you put most…

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Will there be enough general surgeons to meet the needs of an aging population? How will the supply affect hospital ORs? Findings from a new study suggest the nation could be facing a shortage. The number of general surgeons per 100,000 Americans has fallen by more than 25% over the…

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Medicare has proposed more steps to link hospital quality with payment for the 2009 fiscal year and beyond. Nine preventable conditions would be added to the list of those Medicare would no longer pay for at a higher rate. And more than 40 quality indicators would be added to those…

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A structured OR team briefing before a case can dramatically reduce communication failures, a new study from Canada finds. In the study surgeons, nurses, and anesthesia providers held a short briefing guided by a checklist. Researchers documented communication problems before and after the briefings were implemented. Results showed communication failures…

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Strong leadership, meticulous auditing, and close followup are some factors that have kept Baptist Hospital of Miami, Florida, in the top 10% of performers in the Hospital Quality Incentive Demonstration. The demonstration, conducted by the Centers for Medicare and Medicaid Services and Premier, pays hospitals a little more for meeting…

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A 44-year-old man has a knee arth-roscopy under local anesthesia and sedation. He remains conscious and alert during the procedure. He is able to eat and walk before he is allowed to leave. His friend doesn't show up to drive him home. While driving himself home, he has an accident…

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MH crisis management For live help, call the MH hotline: 1-800-MH-HYPER (1-800-644-9737)in US and Canada Other resources available: Emergency therapy poster Anesthetic choices for MH-susceptible patients Frequently asked questions, and more. Contact Malignant Hyperthermia Association of the United States. www.mhaus.org Suddenly, the word is out that surgery centers and other…

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AORN has updated 7 recommended practices (RPs) for 2008. Highlights were covered at the AORN Congress March 30 to April 4 in Anaheim. Here are selected highlights, which were presented by members of the Recommended Practices Committee. For the complete text, see AORN's 2008 Perioperative Standards and Recommended Practices. Each…

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