Background: As the cost of care for patients with specific diagnoses becomes fixed, hospitals must develop systems to reduce length of stay and optimize the utilization of hospital resources while maintaining a high quality of care. The goal of this study is to evaluate the implementation and efficacy of a system designed to reduce average length of stay on a vascular surgery service. Study Design: To effectively reduce our average length of stay we restructured patient rounds, implemented multidisciplinary rounds, introduced clinical pathways to post-operative care, and expanded outpatient management of post-operative patients. 1697 adult vascular surgery patients discharged while under the medical direction of a vascular surgeon between 7/1/2013 and 6/30/2016 were included in the study. Results: Improving communication with critical staff and utilizing procedural space outside of the main operating rooms led to a 2.8-day reduction in length of stay (10.8 vs 8.0, P < 0.001). There was a trend toward a reduction in 30-day readmission rate (12% vs. 10%, respectively; P = 0.01) and no significant difference in case-mix index as a measure of illness severity (2.5 vs. 2.4, respectively; P = 0.15). Length of stay reductions were heterogeneous among the types of vascular disease studied, with greater improvements seen in patients undergoing lower extremity amputation, lower extremity angiogram, and endovascular aneurysm repair for non-ruptured abdominal aortic aneurysm. Less pronounced differences were observed in patients undergoing carotid artery endarterectomy/stenting and lower extremity bypasses. Conclusions: Restructuring team rounds and instituting a multidisciplinary approach to discharge planning produced significant reductions in length of stay without a deleterious effect on patient care that may impact hospital profitability.
A number of armed assaults on public officials occurred in the early 1970s, which prompted the Lightweight Soft Body Armor Program to develop modern, concealable, soft body armor. Methodology needed to be developed to (1) determine the effectiveness of the soft body armor to stop bullet penetration and (2) assess the potential injury from nonpenetrating blunt impacts to the body. Extensive research was performed under the program to develop methodologies to assess soft body armor, including behind-armor blunt trauma (BABT) evaluation. This methodology is still used today, and it has been applied extensively beyond the original intent. However, the origin of this methodology is not well understood by many researchers in the various fields in which it is being applied because the original documentation is difficult to obtain. Therefore, the purpose of this article is to provide a comprehensive review of the BABT to offer researchers information about its history and limitations.
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