Malignant hyperthermia (MH) is a rare but life-threatening surgical complication that seems to turn the effects of general anesthesia upside down. Instead of relaxing, muscles become rigid, releasing large amounts of acid and potassium into the blood. Instead of a normal slowing of breathing, respirations quicken, and end-tidal CO2 rises.…
A care transition poses a danger point for patients—failing to “hand off” needed information from one clinician to another can lead to significant morbidity and mortality. The Joint Commission was so concerned about handoffs that in 2017 it issued a sentinel event alert on the topic. “Handoffs are a safety…
In 2017, the Joint Commission issued a Sentinel Alert Event on the problem of inadequate handoff communication, focusing attention on this vital aspect of care. (See related story, p 22.) Clinicians and leaders agree that handoffs are important, but implementing them effectively can be challenging, particularly in the fast-paced perioperative…
Enhanced Recovery After Surgery The implementation of Enhanced Recovery After Surgery (ERAS) is based on the concept of organizing care around the patient, addressing medical condition needs to optimize readiness for surgery and reducing the likelihood of postoperative complications. Efficacy is measured by how well we perform according to these…
Editor's Note Though patient and personnel factors affect the order of case induction, induction time is most dependent on patient factors, this study finds. Of 15,823 cases analyzed, predictors of later patient induction included add-on case, ASA class 3 or more, neuraxial anesthesia, and CRNA staffing. In 11,093 (70.1%) cases,…
Editor's Note In this study, the most important data-use practice associated with successful implementation of enhanced recovery pathways (ERPs) was data feedback to frontline providers of process and outcome measures. Of 140 hospitals analyzed, 52% reported previous ERP implementation, with wide variations in data-use practices. Feedback of process and outcome…
At Virginia Commonwealth University System (VCU Health) in Richmond, we are using quality standards to establish operational definitions for elements of Enhanced Recovery After Surgery (ERAS). This article describes what those standards are and how they are implemented. Previous articles in this series appeared in the October 2019 and November…
Editor's Note Compared to the historical mean (HM) scheduling approach, the data-driven regression modeling (RM) method improves multiple measures of operative suite efficiency and personnel satisfaction without adversely affecting clinical outcomes, this study finds. The HM approach included case duration of the most recent 4 years, and the RM system…
Editor's Note Ambulatory surgery center (ASC) outpatient procedures were more efficiently performed than those performed at a hospital outpatient department (HOP) in this study. Of 220 procedures included in the study (114 ASC, 106 HOP): mean turnover time was 29.8 minutes for HOP vs 24.5 for ASC ancillary time was…
Editor's Note Incorporating medical scribes into surgical practices to reduce time surgeons spend on patient documentation and managing electronic health records increases the number of patients seen by surgeons and residents in outpatient clinics, finds this study presented October 29 at the American College of Surgeons Clinical Congress 2019 in…
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