Trauma Bay Time Clocks: Influence on Emergency Department Length of Stay.

Background: To monitor the time elapsed since patient arrival in the emergency department, Trauma Services at the study institution installed a large digital stopwatch timer placed at the head of each trauma bay on June 5, 2017. This quality improvement endeavor became an essential component of performance evaluation.

Objective: The purpose of the study is to measure the impact of trauma bay time clocks on emergency department length of stay.

Using simulation to improve root cause analysis of adverse surgical outcomes.

Objective: The purpose of this study was to develop and test a simulation method of conducting investigation of the causality of adverse surgical outcomes.

Design: Six hundred and thirty-one closed claims of a major medical malpractice insurance company were reviewed. Each case had undergone conventional root cause analysis (RCA).

Damage control resuscitation in combination with damage control laparotomy: a survival advantage.

Background: Damage control laparotomy (DCL) improves outcomes when used in patients with severe hemorrhage. Correction of coagulopathy with close ratio resuscitation while limiting crystalloid forms a new methodology known as damage control resuscitation (DCR). We hypothesize a survival advantage in DCL patients managed with DCR when compared with DCL patients managed with conventional resuscitation efforts (CRE).

Linea alba fasciotomy: a novel alternative in trauma patients with secondary abdominal compartment syndrome.

Polytrauma patients needing aggressive resuscitation can develop intra-abdominal hypertension (IAH) with subsequent secondary abdominal compartment syndrome (SACS). After patients fail medical therapy, decompressive laparotomy is the surgical last resort. In patients with severe pancreatitis SACS, the use of linea alba fasciotomy (LAF) is an effective intervention to lower IAH without the morbidity of laparotomy.

Recurrent abdominal compartment syndrome: an inciting factor of the second hit phenomenon.

Intra-abdominal hypertension (IAH) after damage control laparotomy (DCL) is not unusual and because of this, patients are treated with open-abdomen techniques to prevent abdominal compartment syndrome (ACS). The occurrence of recurrent ACS (R-ACS) after abdominal wall closure under tension in patients managed with DCL can be a trigger factor for second hit syndrome. Outcomes in this subset have not been previously described.