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Ara Ko, Lia Aquino, Nicolas Melo, Rodrigo F Alban
BACKGROUND: The relationship between failure-to-rescue (FTR) after colectomy is not well understood, particularly in teaching institutions. We sought to examine this relationship using a large national database. METHODS: Patients undergoing colectomy from 2010 to 2012 were identified in the Nationwide Inpatient Sample database. FTR events were defined as deaths following deep vein thrombosis or pulmonary embolism, sepsis, gastrointestinal bleed, acute myocardial infarction, acute kidney injury, pneumonia, respiratory failure, shock...
September 30, 2016: American Journal of Surgery
Cheryl K Zogg, Fernando Payró Chew, John W Scott, Lindsey L Wolf, Thomas C Tsai, Peter Najjar, Olubode A Olufajo, Eric B Schneider, Elliott R Haut, Adil H Haider, Joseph K Canner
Importance: Trauma is the leading cause of death and disability among young adults, who are also among the most likely to be uninsured. Efforts to increase insurance coverage, including passage of the Patient Protection and Affordable Care Act (ACA), were intended to improve access to care and promote improvements in outcomes. However, despite reported gains in coverage, the ACA's success in promoting use of high-quality care and enacting changes in clinical end points remains unclear...
October 19, 2016: JAMA Surgery
Adele Callaghan, Leigh Kinsman, Simon Cooper, Natalie Radomski
OBJECTIVES: Junior doctors are frequently the first doctor to be called by a nurse to review patients whose clinical status has declined in hospital wards, yet little is known about how well prepared they are to deal with this situation. This paper aims to identify the factors that influence junior doctors' early recognition and management of patient deterioration in an acute ward settings. METHOD: Integrative review methodology was used to allow for the inclusion of broad research designs, summarising current knowledge from existing research and identify gaps in the literature...
October 7, 2016: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
Angela Jones, Megan-Jane Johnstone
BACKGROUND: Failure to identify and respond to clinical deterioration is an important measure of patient safety, hospital performance and quality of care. Although studies have identified the role of patient, system and human factors in failure to rescue events, the role of 'inattentional blindness' as a possible contributing factor has been overlooked. OBJECTIVES: To explore the nature and possible patient safety implications of inattentional blindness in critical care, emergency and perioperative nursing contexts...
October 5, 2016: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
Jason C Pradarelli, Mark A Healy, Nicholas H Osborne, Amir A Ghaferi, Justin B Dimick, Hari Nathan
Importance: Treating surgical complications presents a major challenge for hospitals striving to deliver high-quality care while reducing costs. Costs associated with rescuing patients from perioperative complications are poorly characterized. Objective: To evaluate differences across hospitals in the costs of care for patients surviving perioperative complications after major inpatient surgery. Design, Setting, and Participants: Retrospective cohort study using claims data from the Medicare Provider Analysis and Review files...
October 5, 2016: JAMA Surgery
Emily Earl-Royal, Elinore J Kaufman, Jesse Y Hsu, Douglas J Wiebe, Patrick M Reilly, Daniel N Holena
BACKGROUND: Failure to rescue (FTR: the conditional probability of death after complication) has been studied in trauma cohorts, but the impact of age and preexisting conditions (PECs) on risk of FTR is not well known. We assessed the relationship between age and PECs on the risk of experiencing serious adverse events (SAEs) subsequent FTR in trauma patients with the hypothesis that increased comorbidity burden and age would be associated with increased FTR. MATERIALS AND METHODS: We performed a retrospective cohort analysis at an urban level 1 trauma center in Pennsylvania...
October 2016: Journal of Surgical Research
Michael P Hurley, Lena Schoemaker, John M Morton, Sherry M Wren, William B Vogt, Sachiko Watanabe, Aki Yoshikawa, Jay Bhattacharya
OBJECTIVES: Unwarranted geographic variation in spending has received intense scrutiny in the United States. However, few studies have compared variation in spending and surgical outcomes between the United States healthcare system and those of other nations. In this study, we compare the geographic variation in postsurgical outcomes and cost between the United States and Japan. STUDY DESIGN: This retrospective cohort study uses Medicare Part A data from the United States (2010-2011) and similar inpatient data from Japan (2012)...
September 2016: American Journal of Managed Care
Robert H Hollis, Carla N Holcomb, Javier A Valle, Burke P Smith, Aerin J DeRussy, Laura A Graham, Joshua S Richman, Kamal M F Itani, Thomas M Maddox, Mary T Hawn
BACKGROUND: We evaluated coronary angiography use among patients with coronary stents suffering postoperative myocardial infarction (MI) and the association with mortality. METHODS: Patients with prior coronary stenting who underwent inpatient noncardiac surgery in Veterans Affairs hospitals between 2000 and 2012 and experienced postoperative MI were identified. Predictors of 30-day post-MI mortality were evaluated. RESULTS: Following 12,096 operations, 353 (2...
August 20, 2016: American Journal of Surgery
Ru-Hong Tu, Jian-Xian Lin, Chao-Hui Zheng, Ping Li, Jian-Wei Xie, Jia-Bin Wang, Jun Lu, Qi-Yue Chen, Long-Long Cao, Mi Lin, Chang-Ming Huang
BACKGROUND: To investigate the incidence of and factors associated with postoperative complications and failure to rescue following laparoscopic and open gastrectomy for gastric cancer. STUDY DESIGN: We analyzed the records of 4124 patients who underwent a laparoscopic or open gastrectomy for gastric cancer. One-to-one propensity score matching was performed to compare the difference between the two groups. RESULTS: A total of 4124 patients were included in the study, 627 of whom (15...
September 12, 2016: Surgical Endoscopy
James Waldie, Stephen Tee, Tina Day
AIM: This article proposes a radical new approach to the monitoring and governance of services, and the education and training of nurses to meet 'failure to rescue' requirements. BACKGROUND: Healthcare policy in the UK that seeks to ensure safe and effective services for the acutely ill has largely failed, resulting in adult patients dying unnecessarily. Despite grand rhetoric, UK governments have distanced themselves from implementation, resulting in patchy localised developments and creating inconsistent service responses...
September 8, 2016: British Journal of Nursing: BJN
Simon J Cooper, Leigh Kinsman, Catherine Chung, Robyn Cant, Jayne Boyle, Loretta Bull, Amanda Cameron, Cliff Connell, Jeong-Ah Kim, Denise McInnes, Angela McKay, Katrina Nankervis, Erika Penz, Thomas Rotter
BACKGROUND: There are international concerns in relation to the management of patient deterioration which has led to a body of evidence known as the 'failure to rescue' literature. Nursing staff are known to miss cues of deterioration and often fail to call for assistance. Medical Emergency Teams (Rapid Response Teams) do improve the management of acutely deteriorating patients, but first responders need the requisite skills to impact on patient safety. METHODS/DESIGN: In this study we aim to address these issues in a mixed methods interventional trial with the objective of measuring and comparing the cost and clinical impact of face-to-face and web-based simulation programs on the management of patient deterioration and related patient outcomes...
2016: BMC Health Services Research
Bellal Joseph, Herb Phelan, Ahmed Hassan, Tahereh Orouji Jokar, Terence O'Keeffe, Asad Azim, Lynn Gries, Narong Kulvatunyou, Rifat Latifi, Peter Rhee
INTRODUCTION: Failure-to-rescue (FTR) (defined as death from a major complication) is considered as an index of hospital quality in trauma patients. However, the role of frailty in FTR events remains unclear. We hypothesized that FTR rate is higher in elderly frail trauma patients. METHODS: We performed a prospective cohort study of all elderly (age ≥ 65 yrs.) trauma patients presenting at our level one trauma center. Patient's frailty status was calculated utilizing the Trauma Specific Frailty Index (TSFI) within 24 hours of admission...
September 16, 2016: Journal of Trauma and Acute Care Surgery
Mohammad Alyami, Peter Lundberg, Vahan Kepenekian, Diane Goéré, Jean-Marc Bereder, Simon Msika, Gérard Lorimier, François Quenet, Gwenaël Ferron, Emilie Thibaudeau, Karine Abboud, Réa Lo Dico, Delphine Delroeux, Cécile Brigand, Catherine Arvieux, Frédéric Marchal, Jean-Jacques Tuech, Jean-Marc Guilloit, Frédéric Guyon, Patrice Peyrat, Denis Pezet, Pablo Ortega-Deballon, Franck Zinzindohoue, Cécile de Chaisemartin, Reza Kianmanesh, Olivier Glehen, Guillaume Passot
OBJECTIVE: This study was designed to identify factors associated with morbidity and mortality in patients older than 70 years who underwent cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal carcinomatosis (PC). BACKGROUND: Major surgery is associated with higher morbidity and mortality in elderly patients. For PC, CRS and HIPEC is the only current potential curative therapy, but the risks inherent to this patient population have called its benefits into question...
September 6, 2016: Annals of Surgical Oncology
Kathleen M Baldwin, Denice L Black, Lorrie K Normand, Patricia Bonds, Melissa Townley
PURPOSE: The project goal of was to decrease new graduate nurse (NGN) attrition during the first year of employment by improving communication skills and providing additional mentoring for NGNs employed in a community hospital located in a rural area. DESCRIPTION OF PROJECT: All NGNs participate in the Versant Residency Program. Even with this standardized residency program, exit interviews of NGNs who resigned during their first year of employment revealed 2 major issues: communication problems with patients and staff and perceived lack of support/mentoring from unit staff...
September 2016: Clinical Nurse Specialist CNS
Jack Chen, Lixin Ou, Arthas Flabouris, Ken Hillman, Rinaldo Bellomo, Michael Parr
AIM: To assess the impact of a standardized rapid response system (RRS) implemented across a large health care jurisdiction on reducing serious adverse events, hospital mortality and unexpected deaths. METHOD: We conducted an interrupted time series (2007-2013) population-based study in the state of New South Wales (NSW), Australia to evaluate the impact of introducing a statewide standardized RRS (the between-the-flags [BTF] system) which employed a five-component intervention strategy...
October 2016: Resuscitation
Andrew J Schoenfeld, Wei Jiang, Mitchel B Harris, Zara Cooper, Tracey Koehlmoos, Peter A Learn, Joel S Weissman, Adil H Haider
OBJECTIVE: To compare disparities in postoperative outcomes for African Americans after surgical intervention in the universally insured military system, versus the civilian setting in California. BACKGROUND: Health reform proponents cite the reduction of disparities for African Americans and minorities as an expected benefit. The impact of universal health insurance on reducing surgical disparities for African Americans has not previously been examined. METHODS: We used Department of Defense health insurance (Tricare) data (2006-2010) to measure outcomes for African Americans as compared with Whites after 12 major surgical procedures across multiple specialties...
August 5, 2016: Annals of Surgery
Matthew R Louis, Larry H Hollier
No abstract text is available yet for this article.
October 2016: Journal of Craniofacial Surgery
Alexander M Friedman, Cande V Ananth, Yongmei Huang, Mary E D'Alton, Jason D Wright
BACKGROUND: In the setting of persistently high risk for maternal mortality and severe obstetric morbidity, little is known about the relationship between hospital delivery volume and maternal outcomes. OBJECTIVE: The objectives of this analysis were (i) to determine maternal risk for severe morbidity during delivery hospitalizations by hospital delivery volume in the United States; and (ii) to characterize, by hospital volume, the risk for mortality in the setting of severe obstetrical morbidity - a concept known as failure to rescue...
July 22, 2016: American Journal of Obstetrics and Gynecology
Jeanna D Blitz, Samir M Kendale, Sudheer K Jain, Germaine E Cuff, Jung T Kim, Andrew D Rosenberg
BACKGROUND: As specialists in perioperative medicine, anesthesiologists are well equipped to design and oversee the preoperative patient preparation process; however, the impact of an anesthesiologist-led preoperative evaluation clinic (PEC) on clinical outcomes has yet to be fully elucidated. The authors compared the incidence of in-hospital postoperative mortality in patients who had been evaluated in their institution's PEC before elective surgery to the incidence in patients who had elective surgery without being seen in the PEC...
August 2016: Anesthesiology
Nader N Massarweh, Daniel A Anaya, Panagiotis Kougias, Faisal G Bakaeen, Samir S Awad, David H Berger
OBJECTIVE: To examine the extent to which multiple, sequential complications impacts variation in institutional postoperative mortality rates. BACKGROUND: Failure to rescue (FTR) has been proposed as an underlying factor in hospital variation in surgical mortality. However, little is currently known about hospital variation in FTR after multiple complications or the contribution of sequential complications to variation. METHODS: Retrospective cohort study of 266,101 patients within the Veterans Affairs Surgical Quality Improvement Program (2000-2014) who underwent a subset of high-mortality inpatient general, vascular, or thoracic procedures...
July 15, 2016: Annals of Surgery
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