Escalation of Commitment in the Surgical ICU.

Objectives: Escalation of commitment is a business term that describes the continued investment of resources into a project even after there is objective evidence of the project's impending failure. Escalation of commitment may be a contributor to high healthcare costs associated with critically ill patients as it has been shown that, despite almost certain futility, most ICU costs are incurred in the last week of life. Our objective was to determine if escalation of commitment occurs in healthcare settings, specifically in the surgical ICU.

Mandated self-reporting of ventilator-associated pneumonia bundle and catheter-related bloodstream infection bundle compliance and infection rates.

Importance: As quality measures increasingly become tied to payment, evaluating the most effective ways to provide high-quality care becomes more important.

Objectives: To determine whether mandated reporting for ventilator and catheter bundle compliance is correlated with decreased infection rates, and to determine whether labor-intensive audits are correlated with compliance.

Design, Setting, And Participants: Multiyear retrospective review of aggregated data from all patients admitted to 15 intensive care units in a Veterans Affairs hospital setting (the Veterans Integrated Service Network 16) from 2009 to 2011.

Identifying and Eliminating Deficiencies in the General Surgery Resident Core Competency Curriculum.

Importance: Although the Accreditation Council for Graduate Medical Education has defined 6 core competencies required of resident education, no consensus exists on best practices for reaching resident proficiency. Surgery programs must develop resourceful methods to incorporate learning. While patient care and medical knowledge are approached with formal didactics and traditional Halstedian educational formats, other core competencies are presumed to be learned on the job or emphasized in conferences.

Defining, measuring, and improving surgical quality: beyond teamwork and checklists to systems redesign and transformation.

Background: Surgical complications are multifactorial but often are attributable to deficiencies in the quality of care. This review examines how quality is defined in surgery, the modalities employed to measure quality, and the approaches to improving the quality of surgical care. Beyond developing a hospital environment supportive of organizational learning, the next generation of surgical performance improvement will include broader, more innovative approaches.

Improving antibiotic stewardship: order set implementation to improve prophylactic antimicrobial prescribing in the outpatient surgical setting.

In the landmark document Crossing the Quality Chasm, the Institute of Medicine lists 6 aims of healthcare, one of which is that healthcare has to be effective. One means of improving the effectiveness of healthcare includes the creation of evidence-based guidelines to help streamline processes, decrease variability in care, and improve outcomes. Postoperative infection constitutes one of the most common preventable complications for surgical patients.

Utility of the shock index in predicting mortality in traumatically injured patients.

Background: Currently, specific triage criteria, such as blood pressure, respiratory status, Glasgow Coma Scale, and mechanism of injury are used to categorize trauma patients and prioritize emergency department (ED) and trauma team responses. It has been demonstrated in previous literature that an abnormal shock index (SI = heart rate [HR]/systolic blood pressure, >0.9) portends a worse outcome in critically ill patients.

Survival Following Rectal Impalement through the Pelvic, Abdominal, and Thoracic Cavities: A Case Report.

Impalement injuries are a unique form of penetrating trauma and are typically associated with a fall onto the object (Steele, 2006). We present the case of a 45-year-old man who reportedly slipped in his bathtub and fell onto a broomstick. Radiographic examination revealed a slender mass extending from his rectum to the right side of his neck.