Assessing Adherence to Posttraumatic Stress Disorder Screening in Young Stroke Survivors.

Background: Over 795 000 US people per year experience a stroke, and 10% are younger than 50 years. After a stroke, posttraumatic stress disorder (PTSD) affects 10% to 30% of those patients and may compromise a survivor's secondary prevention compliance. At an inner-city clinic in Maryland where up to 300 young adult stroke survivors are followed, zero patients were screened for PTSD.

Implementing primary care follow-up for high-risk vascular surgery patients.

Background: The Centers for Medicare and Medicaid Services consider the 30-day hospital readmission rate an outcome of care measure; a high rate is associated with high-cost and bed utilization.

Purpose: The Division of Vascular Surgery at a large academic medical center implemented a 15-week quality improvement project in the fall of 2022 to reduce readmissions among patients deemed high-risk for readmission and discharged to home.

Methods: The discharging provider utilized the "HOSPITAL Score for Readmission" tool to identify patients at high-risk for unplanned 30-day readmission to receive the intervention, which included follow-up with a primary care provider (PCP) within two weeks of hospital discharge to address non-surgical medical conditions that may have been exacerbated during the hospital stay.

Popliteal Vein Entrapment as a Rare Form of Popliteal Entrapment Syndrome.

Popliteal entrapment syndrome (PES) describes a cluster of symptoms related to the compression of the neurovascular bundle in the popliteal fossa, most commonly involving the popliteal artery. In approximately 10-15% of the cases of popliteal entrapment syndrome, the popliteal vein is compressed. Symptoms of popliteal vein entrapment can mimic venous insufficiency or deep venous thrombosis, causing the diagnosis to be missed or delayed.

Surgical anteriorization of the left common iliac vein results in improved venous outflow and quality of life for May-Thurner syndrome.

May-Thurner syndrome or left iliac vein compression occurs when the left common iliac vein is compressed by the right common iliac artery, leading to venous outflow obstruction. This obstruction can cause venous hypertension, resulting in lower extremity swelling, discoloration, pelvic congestion, and venous ulcerations. The standard surgical treatment of May-Thurner syndrome is endovascular venous stent placement.

Implementation of an arterial blood gas indication algorithm in cardiac surgery.

Problem: Arterial blood gasses (ABGs) account for an estimated 10-20% of all costs during an ICU stay. Non-clinically indicated ABGs increased costs of care, lengths of stay, ventilator days, and line days, increasing the risk of adverse outcomes in already vulnerable critically ill patients. A cardiac surgery intensive care unit (CSICU) within a large urban mid-Atlantic academic medical center accounted for 31% of the entire institution's ABG analyses between 2018-2019, was identified as a top utilizer due to inappropriate ordering practices compared to current guidelines.

Delayed Closure of Guillotine Lower Extremity Amputation in Obese Patients is Associated with Increased Mortality.

Background: Staged surgery with open guillotine amputation (OGA) prior to a definitive major lower extremity amputation (LEA) has been shown to be effective for sepsis control and improving wound healing. Studies have evaluated postoperative complications including infection, return to the operating room for re-amputation, and amputation failure following OGA. However, the role of timing to close OGA for predictive outcomes remains poorly understood.

Surgical treatment of nutcracker syndrome results in improved pain and quality of life.

Background: Left renal vein (LRV) compression, or nutcracker phenomenon, describes the compression of the LRV, most commonly between the aorta and the superior mesenteric artery. The outflow obstruction that occurs from the compression causes venous hypertension leading to the development of pelvic collaterals, lumbar vein engorgement and gonadal vein reflux. The symptoms associated with LRV compression include abdominal pain, left flank pain, back pain, headache, pelvic pain/pressure, and hematuria.

Discovering "What Matters" to patients: A quality improvement project.

Purpose: Age-Friendly Health Systems were developed to provide an evidenced based framework to provide high-quality care to older adults. The purpose of this quality improvement initiative was to increase the completion of the "What Matters" section of the "Get to Know Me" boards.

Methods: Face-to-face training was provided to staff via individual sessions on "What Matters" to patients and how to complete the boards.

Opioid Use Disorder in Patients Undergoing Major Lower Extremity Amputation: Prevalence and Outcomes.

Introduction: Patients with a history of Opioid Use Disorder (OUD) have higher postoperative complication rates and mortality in many settings. Yet, it remains poorly understood how the opioid epidemic has affected patients undergoing major lower extremity amputation (LEA) and whether outcomes differ by OUD status.

Methods: We conducted a retrospective chart review of all 689 patients who underwent major LEA at a large tertiary referral center from 2015 to 2021.

Mentorship Education for Advanced Practice Registered Nurses.

Mentorship is a vital part of the nursing profession. The evidence suggests that competent mentors aid in facilitating role transitions, improving job satisfaction, enhancing patient care, and decreasing nursing turnover. Advanced practice registered nurses (APRNs) have the skills and knowledge to provide safe, high-quality, patient-centered care; however, they may be lacking in mentorship abilities.

Comparison of Pre-existing Mood Disorders and Chronic Kidney Disease as Predictors of Ambulatory Status After Major Limb Amputation.

Objective We aim to compare the effects of pre-existing mood disorders and chronic kidney disease (CKD) on ambulation outcomes for patients who have undergone major lower extremity amputation (MLEA) while also stratifying by the presence of social factors. Methods  We performed a retrospective chart review of 700 patients admitted from 2014 to 2022 who underwent MLEA. We performed Chi-square tests and binomial logistic regression with p < 0.

Trauma-Induced Median Arcuate Ligament Syndrome is an Under-Recognized Source of Chronic Abdominal Pain.

Median arcuate ligament syndrome (MALS) can be a debilitating condition resulting in epigastric pain, nausea, difficulty eating due to postprandial pain, weight loss, and malnutrition in otherwise healthy individuals. The pain is caused by the compression of the celiac artery and neural ganglia by the median arcuate ligament as it attaches from the spine to the diaphragm. Diagnostic imaging, either duplex or angiography, can show the abnormality however, vague symptoms can lead to a missed diagnosis.

Chronic Kidney Disease Predicts Greater 5-Year Mortality Following Major Limb Amputation.

Severe chronic kidney disease (CKD) predicts greater mortality after major lower extremity amputation (MLEA), but it remains poorly understood whether this finding extends to patients with earlier stages of CKD. We assessed outcomes for patients with CKD in a retrospective chart review of all patients who underwent MLEA at a large tertiary referral center from 2015 to 2021. We stratified 398 patients by glomerular filtration rate (GFR) and conducted Chi-Square and survival analysis.

Back Pain and Right Leg Swelling: Unusual Presentations of May-Thurner Syndrome.

May-Thurner (MT) syndrome refers to compression of the left common iliac vein by the right common iliac artery. Symptoms reported are generally left-sided leg swelling or pain. It is unusual for patients to report right-sided symptoms that are alleviated by treating MT compression.

Utilizing an office based laboratory (OBL) during the COVID-19 pandemic for vascular surgical patients.

COVID-19 pandemic brought new challenges in healthcare including the need to create tiered class recommendations about which types patients to treat urgently and which surgical cases to defer. This is a report of a single center's Office Based Laboratory (OBL) system to prioritize vascular patients and preserve acute care resources and personnel. In reviewing three months of data, it appears that by continuing to provide the urgent care needed for this chronically ill population, the insurmountable backup of surgical procedures is prevented in the operating room once elective surgeries resumed.

Utility of Removable Rigid Dressings in Decreasing Discharge Narcotic Use and Improving Ambulation Following Below-Knee Amputation.

Background: Lower extremity amputations are often associated with limited postoperative functionality and postoperative complications. Removable rigid dressings (RRDs) have been used following below-knee amputation (BKA) to improve limb maturation, decrease postoperative complications, reduce time to prosthesis casting, and limit conversion rates to above-knee amputation (AKA). We hypothesized that usage of RRD following BKA will correlate with decreased prescription narcotics required at discharge and improved ambulatory status at follow-up.

Right Access, Right Time: How Nurses Can Advocate for Best Practice.

Hemodialysis requires vascular access by way of an arteriovenous fistula (AVF), arteriovenous graft (AVG), or intravenous hemodialysis catheter. There is overwhelming evidence that an AVF should be the access of choice due to its lowest infection rate compared to an AVG or hemodialysis catheter; however, less than 17% of patients on hemodialysis have a functional AVF when hemodialysis treatment is initiated. Most patients with end stage kidney disease begin hemodialysis using a hemodialysis catheter, which has a higher infection rate.

Nurse driven outpatient wound center: Reducing readmission with wound care excellence.

There is a growing need for new and innovative ways to care for patients in the ambulatory setting, including providing wound care for patients. A vascular surgery department in a large urban academic medical center noted there was an increasing number of patients with chronic wounds that needed weekly care. The number of patients, the time needed to provide wound care, and limited clinic space was creating a strain on traditional clinic hours.

Utilizing of Removable Rigid Dressing to Decrease Below the Knee Amputations to Above the Knee Amputations Conversion Rates.

Introduction/objective: Below the knee amputations (BKAs) are preferred to above the knee amputations (AKAs) due to better rehabilitation and functional outcomes. Assessment of literature for best practice identified that utilization of a removable rigid dressing (RRD) improves post-operative BKA care by expediting wound healing and reduces the hospital length of stay compared to a soft dressing. We hypothesized that there would be a decrease of conversions from BKA to AKA following utilizing of RRD device.

A Tiered Mentorship Program to Integrate Medical Students Into Clinical Research Projects.

Objective: Herein we describe the development, implementation, and growth of our Vascular Research Training Program (VRTP), emphasizing the intentional involvement of medical students in clinical research.

Methods: We developed a VRTP focusing on medical student engagement to encompass 4 pillars: ownership, mentorship, experience, and independence within the research process. The program is organized by clinical projects with an attending surgeon, surgical trainee (fellow or resident), and medical student comprising each research project team.

Integration of TeamSTEPPS Framework and Escape Room to Improve Teamwork and Collaboration.

Background: As the need for healthcare professionals continues to grow, different learning environments have been assessed to optimize knowledge while keeping the student engaged. Escape rooms, live action, team-based exercises, supplemented with TeamSTEPPS tools can assist in overall team performance, while keeping the participant engaged in a new learning environment.

Objective: The goal of this quality improvement project was to enhance teamwork and collaboration through the integration of TeamSTEPPS concepts and escape room active learning.

Resection of Anterior and Lateral Muscle Compartments Does Not Preclude Limb Salvage and Functions.

Background: Fasciotomy with resection of nonviable muscle is often necessary when there is a delay in compartment syndrome (CS) diagnosis after revascularization. The reported rate of major amputation following missed CS or delayed fasciotomy ranges from 12% to 35%. Herein, the authors present a series of critically ill patients who experienced delayed CS diagnosis and required complete resection of the anterior and/or lateral compartments but still achieved limb salvage and function.

Innovative Use of Emergency Medicine Providers in an Urban Setting to Reduce Overutilization of 9-1-1.

Background: Emergency Departments (ED) and Emergency Medical Services (EMS) are relied on to address nonemergent needs causing long ED wait times. Baltimore City EMS provided over 100,000 transports, many for low-acuity medical needs.

Objective: Minor Definitive Care Now (MDCN) is designed to address low-acuity complaints and decrease ED visits.