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* Upper-extremity numbness has a wide differential diagnosis and can arise from pathology in the cervical spine, brachial plexus, shoulder, elbow, and hand.* Physical examination must include evaluation of both nerve root and peripheral nerve function to aid in determining if symptoms are due to central or peripheral pathology.* Double-crush syndrome, with both spinal and peripheral etiology, is not uncommon and, if not recognized, may lead to treatment failure.* A team approach including orthopaedic surgeons, neurologists, physiatrists, radiologists, and occupational therapists can be crucial in making the diagnosis and designing the treatment plan.* Nonoperative treatment can include observation, physical and occupational therapy, functional bracing, and injections of corticosteroids and/or local anesthetics.* Operative treatment is appropriate after an appropriate course of nonoperative management has failed or with specific diagnoses in which a delay in definitive treatment may put a patient at risk for long-term functional deficits.

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Given the rising costs of healthcare delivery and reimbursement constraints, large academic medical centers (AMCs) must improve efficiency while delivering high-quality care. With standardized cases and high volumes, ambulatory surgery is a high-value target for efficiency improvement. Mining a data set of more than 7,500 cases consisting of the three highest-volume ambulatory procedures in orthopedics, otolaryngology-head and neck surgery, and urology, we analyzed process times and wait times involved in patient flow. We examined differences among delayed versus early versus on-time cases, as well as differences in scheduled start times, day of the week, and each individual operating room. Our analysis found statistically and clinically significant differences in registration and setup wait times when comparing delayed versus early versus on-time cases. We then developed recommendations to increase value-added time. Using activity-based cost accounting, we created a model to quantify economic impact. Hospitals can adopt these methods to identify operational bottlenecks and employ our financial model to forecast changes in revenue. Application of this model can position AMCs for success in an increasingly competitive landscape.

The authors regret that there were incorrect values in Table 2. The correct n values for Table 2 are readmissions n = 38 and controls n = 129. The corrected Table 2 is also presented below. The authors would like to apologize for any inconvenience caused.