Estimating the incidence of suspected epidural hematoma and the hidden imaging cost of epidural catheterization: a retrospective review of 43,200 cases.

Background And Objectives: Hematoma associated with epidural catheterization is rare, but the diagnosis might be suspected relatively frequently. We sought to estimate the incidence of suspected epidural hematoma after epidural catheterization and to determine the associated cost of excluding or diagnosing an epidural hematoma through radiologic imaging.

Methods: We conducted an electronic retrospective chart review of 43,200 patient charts using 4 distinct search strategies and cost analysis, all from a single academic institution from 2001 through 2009.

Identifying meaningful outcome measures for the intensive care unit.

Despite important progress in measuring the safety of health care delivery in a variety of health care settings, a comprehensive set of metrics for benchmarking is still lacking, especially for patient outcomes. Even in high-risk settings where similar procedures are performed daily, such as hospital intensive care units (ICUs), these measures largely do not exist. Yet we cannot compare safety or quality across institutions or regions, nor can we track whether safety is improving over time.

Bar-code verification: reducing but not eliminating medication errors.

Using observation, eye tracking, and clinical simulation with embedded errors, we studied the impact of bar-code verification on error identification and recovery during medication administration. Data supported that bar-code verification may reduce but does not eliminate patient identification (ID) and medication errors during clinical simulation of medication administration.

Intermediate acting non-depolarizing neuromuscular blocking agents and risk of postoperative respiratory complications: prospective propensity score matched cohort study.

Objective: To determine whether use of intermediate acting neuromuscular blocking agents during general anesthesia increases the incidence of postoperative respiratory complications.

Design: Prospective, propensity score matched cohort study.

Setting: General teaching hospital in Boston, Massachusetts, United States, 2006-10.

Ongoing professional performance evaluation (OPPE) using automatically captured electronic anesthesia data.

Background: The Massachusetts General Hospital (Boston), a large academic center providing anesthesia services for more than 49,000 procedures each year, created an Ongoing Professional Practice Evaluation (OPPE) process that could use readily available, automatically captured electronic information from its vendor-provided anesthesia information management system.

Methods: The OPPE credentialing committee selected the following initial metrics: Blood pressure (BP) monitoring, end tidal CO2 monitoring, and timely documentation of compliance statements. Baseline data on the metrics were collected in an eight-month period (January 1, 2008-August 31, 2008).