Health care and socioeconomic impact of falls in the elderly.

Background: Elderly falls are associated with long hospital stays, major morbidity, and mortality. We sought to examine the fate of patients ≥75 years of age admitted after falls.

Methods: We reviewed all fall admissions in 2008.

Antiplatelet agents, warfarin, and epidemic intracranial hemorrhage.

Background: Atrial fibrillation prophylaxis with warfarin and strong antiplatelet agent use in cardiovascular diseases has increased the incidence of anticoagulation in the elderly. We studied traumatic intracranial hemorrhage (TICH) in patients ≥55 years of age on anticoagulation and antiplatelet agents in a stable population.

Methods: We used a Level 1 Trauma Center registry study comparing TICH in patients on anticoagulation drugs during the index periods 1999 to 2000 (T1) and 2007 to 2008 (T2).

Improving the patient, family, and clinician experience after harmful events: the "when things go wrong" curriculum.

The emotional toll of medical error is high for both patients and clinicians, who are often unsure with whom-and whether-they can discuss what happened. Although institutions are increasingly adopting full disclosure policies, trainees frequently do not disclose mistakes, and faculty physicians are underprepared to teach communication skills related to disclosure and apology. The authors developed an interactive educational program for trainees and faculty physicians that assesses experiences, attitudes, and perceptions about error, explores the human impact of error through filmed patient and family narratives, develops communication skills, and offers a strategy to facilitate bedside disclosures.

Diagnostic, surgical judgment, and systems issues leading to reoperation: mining administrative databases.

Background: Underreporting of surgical adverse events limits the ability to identify quality and safety issues. Automated screening of the clinical information system (CIS) can improve case capture and reduce dependency on self-reporting. We compared screening of a CIS to self-reporting for identifying unplanned reoperation and also examined the relationship between causality and probability of reporting.

The obesity paradox: body mass index and outcomes in patients undergoing nonbariatric general surgery.

Objective: We sought to examine the effect of body mass index (BMI) on 30-day morbidity and mortality in a large cohort of patients undergoing nonbariatric general surgery.

Summary Background Data: Obesity has long been considered a risk factor for poor outcomes from a variety of surgical procedures, yet recent studies of critically and chronically ill patients suggest that overweight and obese patients may paradoxically have better outcomes than "normal" weight patients.

Methods: A prospective, multi-institutional, risk-adjusted cohort study of 118,707 patients undergoing nonbariatric general surgery who were included in the National Surgical Quality Improvement Program Participant Use database in 2005 and 2006 was performed.

Design and impact of an intraoperative pathway: a new operating room model for team-based practice.

Background: The concept of a team-based model for delivery of care has been critical at our institution for improving efficiency and safety. Despite these measures, difficulties continue to occur during lengthy operating room procedures. Using a novel team-based practice model, a multidisciplinary team was organized to improve efficiency in microsurgical breast reconstruction.

Building better teams in surgery.

This manuscript represents an overview of a presentation at the SSAT 49th annual meeting which describes the evolution of the author's work within surgery to build and advance teamwork into processes of care.

Impact of body mass index on perioperative outcomes in patients undergoing major intra-abdominal cancer surgery.

Background: Obesity is an increasingly common serious chronic health condition. We sought to determine the impact of body mass index (BMI) on perioperative outcomes in patients undergoing major intra-abdominal cancer surgery.

Methods: A prospective, multi-institutional, risk-adjusted cohort study of patients undergoing major intra-abdominal cancer surgery was performed from the 14 university hospitals participating in the Patient Safety in Surgery Study of the National Surgical Quality Improvement Program (NSQIP).

Simulated laparoscopic operating room crisis: An approach to enhance the surgical team performance.

Objective: Diminishing human error and improving patient outcomes is the goal of task training and simulation experience. The fundamentals of laparoscopic surgery (FLS) is a validated tool to assess technical laparoscopic skills. We hypothesize that performance in a crisis depends on technical skills and team performance.

On the quest for Six Sigma.

A review of patient safety from a surgical perspective with emphasis on erosion of hierarchy, human factors, and an institutional implementation of multidisciplinary team training to create highly effective dynamic teams. Suggestions include further opportunities to enhance patient safety in surgical patients.

A mesothelial cyst of the round ligament presenting as an inguinal hernia after gonadotropin stimulation for in vitro fertilization.

Objective: To report the case of a round ligament cyst which, as the result of gonadotropin stimulation for IVF, simulated an incarcerated inguinal hernia.

Design: Case report.

Setting: A private infertility center and a university hospital.