Bile duct injury following laparoscopic cholecystectomy: a cause for continued concern.

Previous reports suggest that bile duct injuries sustained during laparoscopic cholecystectomy (lap chole) are frequently severe and related to cautery and high clip ligation. We performed a review of patients who sustained bile duct injury from lap chole since 1990 and assessed time to injury recognition, time to referral, Bismuth classification, initial and subsequent repairs, rate of recurrence, and length of follow-up. Seventy-four patients [median age 44 years, 58 of 74 female (78%)] were referred with a bile duct injury after lap chole.

Nursing orientation: a continuous quality improvement story.

THIS ARTICLE ADDRESSES an orientation process utilizing a collaborative, multidisciplinary approach and principles of continuous quality improvement (CQI). This process successfully transitioned 63 graduate nurses into three different practice specialties, decreased the vacancy rate, and eliminated the need for agency nurses at Georgia Baptist Medical Center in Atlanta, Georgia. CNSs, acting as educators, clinical experts, and consultants, played a key role in developing, implementing, and evaluating this comprehensive program.