A before and after study at the University of Vermont Medical Center found that a 24-item operating room checklist did not significantly reduce the incidence of any of nine postoperative adverse outcomes. More than 12,000 cases were studied, and outcomes included: mortality, death among surgical inpatients with serious treatable complications, sepsis, respiratory failure, wound dehiscence, postoperative venous thromboembolic events (VTE), postoperative hemorrhage or hematoma, transfusion reaction and retained ...

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Dr. Pronovost is a leading figure in the patient safety movement, and is someone I greatly admire.  His work with surgical checklists is touted by Dr. Atul Gawande as having saved more lives than any researcher in the past decade.  However, I disagree with his latest initiative: to get hospitals who perform certain procedures at very low rates to stop performing them altogether. On the surface, it seems like a ...

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According to the Residency Review Committee for Surgery, "A resident may be considered the surgeon only when he or she can document a significant role in the following aspects of management: determination or confirmation of the diagnosis, provision of preoperative care, selection, and accomplishment of the appropriate operative procedure, and direction of the postoperative care." In nearly all instances, resident "determination or confirmation of the diagnosis, provision of preoperative ...

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Her voice cracked with strain. I could imagine the woman at the other end of the line shaking, overcome with remorse about the hospital where her husband had had esophageal surgery. Might he still be alive, she asked me, if they had chosen a different hospital? The couple had initially planned to have the procedure done at a well-known medical center, but when she went online to do her homework, she ...

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american society of anesthesiologistsA guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. The possibility of anesthetic neurotoxicity in infants and children -- the supposition that anesthesia may alter normal activity in the nervous system - was first suggested more than 15 years ago with findings of increased neuronal cell death in the developing brains of rodents ...

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I had a familiar conversation the other day with yet another female medical student. “I really loved surgery!” she said, “but I was concerned about the lifestyle, so I decided on ______.” Lifestyle — it turns out — almost always seems to be code for having a family. Maybe it’s just the kind of students who seek me out. I have yet to encounter someone concerned that a surgical career will hamper their ...

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I am forced to write anonymously because of gross neglect by my residency program regarding standard ACGME duty-hour rules. If my name were published, it would identify my program. As a PGY-2, I worked 100+ hours per week on average last year while taking primary call for my urology department. (Admittedly, the PGY-2 is the historic “worst year” for any urology resident.) On a quarterly basis (depending on manpower), we take ...

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It was Thanksgiving morning. My wife was standing in the living room when she received a text message from her father. Her face went pale, and her expression turned to one of anger and disbelief. She cursed. She cried. Her mother had complained of chest pain and stroke-like symptoms and was being rushed to the hospital by ambulance. Many hours went by with few answers and endless speculation. We had moved ...

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A popular meme is that the U.S. spends more on health care than other developed nations but has nothing to show for that spending. This is different from saying that the U.S. spends more, but achieves something, but the something it achieves is so little that it isn’t worth the public purse. The latter is difficult to assert because the asserter must then say how little is too little in ...

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The wrong body was cremated by the county coroner’s office in Los Angeles. Jorge Hernandez died of an overdose, and the body of another Jorge Hernandez, an indigent patient, scheduled for cremation, was also present in the morgue. The distraught family of overdose victim Jorge Hernandez had planned a funeral with a viewing and were shocked when they were told his body had been cremated by mistake because a morgue attendant ...

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