Interpersonal Violence and Social Determinants of Health.

Social determinants of health (SDOH) influence patient outcomes and risk assessment. This study focuses on interpersonal violence, trauma outcomes, and SDOH. We hypothesized patients with lower SDOH experience worse trauma outcomes and present from higher-risk communities.

The relationship between required physician letters of recommendation and decreasing diversity in osteopathic medical school admissions.

Context: Some racial and ethnic groups are underrepresented in the medical field because they face unique barriers to admission to medical school. One admission requirement that can present a barrier for applicants is the physician letter of recommendation (PLOR). Undergraduate students report confusion with the application process and lack of mentorship to be two of their biggest challenges to becoming a doctor.

Multi-modal Pain Control Protocol Decreases Narcotic Consumption in an Inpatient Trauma Population.

Introduction: Opioid use after surgery or trauma has been implicated as a contributing factor to opioid dependence. The Acute Care Surgery (ACS) service at our community-based trauma center instituted an opioid-minimizing, multi-modal pain control (MMPC) protocol. The classes of pain medication included a non-opioid analgesic, a non-steroidal anti-inflammatory drug, a gabapentinoid, a skeletal muscle relaxant, and a topical anesthetic.

Safety and Outcome of Intracranial Pressure Monitor Placement Performed by Trauma Critical Care Surgeons.

Introduction: The Brain Trauma Foundation advises intracranial pressure monitor placement (ICPM) following traumatic brain injury (TBI) with a Glasgow Coma Scale (GCS) score ≤8 and an abnormal head computed tomographic scan (CT) finding. Prior studies demonstrated that ICPMs could be placed by non-neurosurgeons. We hypothesized that ICPM placement by trauma critical care surgeons (TCCS) would increase appropriate utilization (AU), decrease time to placement (TTP), and have equivalent complications to those placed by neurosurgeons.

An assessment of the distance between the phrenic nerve and major intrathoracic structures.

Background: There is a lack of consensus in the literature regarding phrenic nerve proximity to thoracic structures at the level of the diaphragm. This study was undertaken to provide thoracic surgeons data on phrenic nerve location in order to reduce iatrogenic injury during invasive surgery.

Methods: Bilateral thoracic dissection was performed on 43 embalmed human cadavers (25 males; 18 females) and data was obtained from 33 left and 40 right phrenic nerves.

Blood Glucose Control in Noncritically Ill Patients Is Associated With a Decreased Length of Stay, Readmission Rate, and Hospital Mortality.

Purpose: Multiple studies have shown that hyperglycemia correlates with mortality and morbidity in critically ill patients. This has not been demonstrated in noncritically hospitalized patients. The primary objective of this study was to determine whether glycemic control shortens the length of stay (LOS).

Opportunities missed: improving the rate of contraceptive counseling or provision when prescribing reproductive-aged women potentially teratogenic medications in a family medicine resident clinic.

Background: Studies show poor documentation of contraceptive counseling when prescribing women teratogenic medications, suggesting a missed opportunity for contraceptive education.

Study Design: A retrospective chart review of selected Food and Drug Administration class D and X medications evaluated the office visit initiating this medication for documentation of either contraceptive counseling or provision. Following an educational intervention, another retrospective review was conducted to determine if the rate of counseling improved.

Using the electronic medical record to improve asthma severity documentation and treatment among family medicine residents.

Background And Objectives: Use of electronic medical records (EMRs) is being advocated to improve quality of care. The objectives of this study were (1) to determine the effect of EMR template use on family medicine residents' documentation of the severity classification of asthma and (2) to determine if documentation leads to appropriate treatment.

Methods: We reviewed the charts of patients with asthma seen by residents in the Center for Family Medicine (CFM) between July 1, 2007, and December 31, 2007.

Monitoring and feedback of hand hygiene compliance and the impact on facility-acquired methicillin-resistant Staphylococcus aureus.

In 2006, we began monitoring hand hygiene compliance by direct observation. In 2006, with no changes in the methicillin-resistant Staphylococcus aureus (MRSA) control program, a 38% reduction of facility-acquired rates for this organism was realized. These results indicate that focused monitoring of hand hygiene can reduce facility-acquired rates of MRSA.

Patient falls: acute care nurses' experiences.

Aim: To describe the findings from a qualitative study exploring acute care nurses' experiences with patient falls.

Background: Patient falls continue to be a problem in acute care settings for nurses at the point of care. Despite the growing body of knowledge related to risk factors and interventions for fall prevention, minimal attention has been given to nurses' perspectives of patient falls.

Managing the storm: an emergency department capacity strategy.

This article assesses the extent to which a team using quality improvement methods could improve the timeliness of the flow of admitted patients through the emergency department in one hospital. Using a structured approach, a multidisciplinary team redesigned the processes for admitting patients from the emergency department to the inpatient unit. Indicators of capacity limitations in the inpatient environment were also identified as triggers for a tiered institutional response to capacity constraints.

Spartanburg Fall Risk Assessment Tool: a simple three-step process.

The purpose of this study was to develop a valid, reliable, and user-friendly fall risk assessment tool that is a sensitive predictor for falls in the acute care population. Fall risk factors were determined from extensive review of evidence-based studies available from a PubMed search. Previous falls, medications, and gait were found to be the top three risk factors for predicting a true risk for falls in multiple health care settings.

Impact of implementing a method of feedback and accountability related to contact precautions compliance.

Background: In January 2002, Infection control professionals for Spartanburg Regional Healthcare System held a planning retreat focused on patient safety. The main challenge discussed was the control of antibiotic-resistant organisms. Rounds on the patient care units had revealed compliance issues with the current isolation procedures.