Analgesia Use in Children with Acute Long Bone Fractures in the Pediatric Emergency Department.

Background: Practice variation exists in pain management of children with long bone fractures (LBFs).

Objective: The objectives of this study were to describe current pain management in children with LBFs and the factors associated with the undertreatment of pain.

Methods: We retrospectively studied children (aged 0-18 years) with a diagnosis of LBF in a pediatric emergency department (PED) from November 2015 through August 2016.

Long-Term Sustainability of a Quality Initiative Program on Transfusion Rates in Total Joint Arthroplasty: A Follow-Up Study.

Background: There are significant variations in transfusion rates among institutions performing total joint arthroplasty. We previously demonstrated that implementation of an educational program to increase awareness of the American Association of Blood Banks' transfusion guidelines led to an immediate decrease in transfusion rates at our facilities. It remained unclear how this initiative would endure over time.

Walk a Mile in the Leadership's Shoes: Why Focus on Quality Improvement?

Quality Improvement (QI) throughout health care in the United States continues to be of growing importance to both patients and providers. Leaders in health care including physicians, nurses, hospital administrators, and payors are all responsible for ensuring the continuation and growth of QI initiatives. This article will discuss various ways that healthcare leaders, with specific regard to orthopedic surgery, have utilized QI measures to provide better, more efficient, care to patients.

How Do Preoperative Medications Influence Outcomes After Total Joint Arthroplasty?

Background: Recent health care policy changes require hospitals and physicians to demonstrate improved quality. In 2012, a prospective database was formed with the Blue Cross and Blue Shield of Michigan to improve quality of care. The purpose of this study was to analyze patient preoperative medication as predictors of outcomes after total joint arthroplasty.

The Effect of Comorbidities on Discharge Disposition and Readmission for Total Joint Arthroplasty Patients.

Background: As the annual demand and number of total joint arthroplasty cases increase, so do concerns of outcomes of patient with specific comorbidities relative to outcomes and costs of care.

Methods: The study cohort included 2009 primary total knee arthroplasty (TKA) patients and 905 total hip arthroplasty patients. Discharge disposition was classified as discharge to any facility or home.

The Evaluation of Comorbidities Relative to Length of Stay for Total Joint Arthroplasty Patients.

Background: The ability to identify those at risk for longer inpatient stay helps providers with postoperative planning and patient expectations. Decreasing length of stay (LOS) in the future will be determined by appropriate patient selection, risk stratification, and preoperative patient optimization. The purpose of this study was to identify factors that place patients at risk for extended postoperative LOSs.

Application of Circumferential Compression Device (Binder) in Pelvic Injuries: Room for Improvement.

Introduction: The use of a noninvasive pelvic circumferential compression device (PCCD) to achieve pelvic stabilization by both decreasing pelvic volume and limiting inter-fragmentary motion has become commonplace, and is a well-established component of Advanced Trauma Life Support (ATLS) protocol in the treatment of pelvic ring injuries. The purpose of this study was to evaluate the following: 1) how consistently a PCCD was placed on patients who arrived at our hospital with unstable pelvic ring injuries; 2) if they were placed in a timely manner; and 3) if hemodynamic instability influenced their use.

Methods: We performed an institutional review board-approved retrospective study on 112 consecutive unstable pelvic ring injuries, managed over a two-year period at our Level I trauma center.

Preoperative and Postoperative Opiate Use by the Arthroplasty Patient.

Background: As opioid use increases nationally, the arthroplasty surgeon is likely to see more patients taking opioid analgesics on initial presentation. The purpose of this study was to investigate the use of opiate medication in the preoperative and postoperative patient undergoing primary total joint arthroplasty.

Methods: From October 2010 to November 2011, data on 367 consecutive patients who underwent primary total joint arthroplasty were reviewed.