A 23-year-old male trauma patient with a cervical spine fracture underwent an anterior and posterior discectomy and spinal fusion surgery. The patient presented to the operating room with a stabilizing halo fixation device in place, and a fiberoptic intubation was performed with dexmedetomidine for sedation. During the surgical procedure, general anesthesia was maintained with a propofol and remifentanil infusion as the patient was monitored using somatosensory and motor evoked potentials. The patient's urine output increased gradually during the nine-hour surgical procedure from 150 mL/hour to over 700 mL/hour in the eighth hour of the procedure, where it remained until the end of the procedure. Postoperatively, the patient's laboratory values and urine output returned to baseline levels the following day. A search of the literature revealed few case reports of polyuria under similar conditions. Dexmedetomidine, being an alpha-2 agonist that blocks arginine-vasopressin release, may be responsible for inducing the polyuria noted in this patient case.
This analysis looks at the application of a robust process improvement methodology to achieve a sustained organizational change. The implementation took place in a safety net hospital’s operating suites that had a problem with relatively long, nonproductive turnover times between surgical procedures. Organizational leadership empowered stakeholders to use Lean and Six-Sigma tools to develop more efficient organizational processes. These processes were then implemented in a phased approach with careful attention to the organization’s culture. The result was a significant reduction in turnover times leading to greater operational efficiency.
Being a well-rounded physician requires competencies that extend beyond traditional medical training. This study explores one residency program’s attempt to address the need to foster career management and leadership skills. A year-long didactic program was initiated to tackle both career management and leadership development. At the conclusion of the program, a survey revealed an increase in perceived competency in the domains taught. There was also a measurable increase in the amount of scholarly and quality improvement projects done in the department where the program was implemented. To support and develop physician competencies, healthcare organizations may derive immense benefit from a program that fosters both career management and leadership skills.
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During the coronavirus disease 2019 (COVID-19) pandemic, anxiety regarding hospitals resulted in patients risking their lives and not seeking emergency medical care when needed. Early into the pandemic, hospital emergency room utilization plummeted more than 40% in some hospitals, according to the Centers for Disease Control and Prevention. As COVID-19 outbreaks intensified in the Western regions of the country, emergency room census began to increase significantly in the middle of June. Local safety net health care resources were struggling with the increase in emergency room utilization and scrambled to increase patient care capacity, especially their emergency rooms and intensive care units. The data collected during this time is of great value. Unfortunately, it is often poorly reported, overlooked, and ignored when it should be used to make better decisions and allocations. During the pandemic, underserved populations were especially impacted, overwhelming safety net health organizations. The findings from a simple data analysis provide a template for resource acuity among communities and depict the importance of health equity.
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