It is possible to dramatically decrease the occurrence of after-hours orthopedic surgery in a level-one trauma center through the use of a dedicated room for unscheduled orthopedic trauma cases. Benefits include less frequent activation of after-hours operating room resources, fewer disruptions to the OR schedule and office hours, and more frequent fracture care by orthopedic traumatologists. The impact of a longer delay between admission and surgical treatment and more frequent transfer of care between surgeons deserves further evaluation.
Hematocrit (Hct), the volume percent of red cells in blood, is monitored routinely for blood donors, surgical patients, and trauma victims and requires blood to be removed from the patient. An accurate, noninvasive method for directly measuring hematocrit on patients is desired for these applications. The feasibility of noninvasive hematocrit measurement by using near-infrared (NIR) spectroscopy and partial least-squares (PLS) techniques was investigated, and methods of in vivo calibration were examined. Twenty Caucasian patients undergoing cardiac surgery on cardiopulmonary bypass were randomly selected to form two study groups. A fiber-optic probe was attached to the patient's forearm, and NIR spectra were continuously collected during surgery. Blood samples were simultaneously collected and reference Hct measurements were made with the spun capillary method. PLS multivariate calibration techniques were applied to investigate the relationship between spectral and Hct changes. Single patient calibration models were developed with good cross-validated estimation of accuracy (∼ 1 Hct%) and trending capability for most patients. Time-dependent system drift, patient temperature, and venous oxygen saturation were not correlated with the hematocrit measurements. Multi-subject models were developed for prediction of independent subjects. These models demonstrated a significant patient-specific offset that was shown to be partially related to spectrometer drift. The remaining offset is attributed to the large spectral variability of patient tissue, and a significantly larger set of patients would be required to adequately model this variability. After the removal of the offset, the cross-validated estimation of accuracy is 2 Hct%.
With no additional utilization of resources, a single Lean process improvement cycle increased productivity and capacity of our colonoscopy unit. We expect this to result in increased patient access and revenue while maintaining patient satisfaction. We believe these results are widely generalizable to other colonoscopy units as well as other process-based interventions in health care.
Background
Current preoperative assessment tools such as the American College of Surgeons Surgical Risk Calculator (ACS Calculator) are suboptimal for evaluating older adults.
Objective
To evaluate and compare the performance of the ACS Calculator for predicting risk of serious postoperative complications, with the addition of self-reported physical function versus a frailty score.
Design
Prospective cohort.
Setting
Two tertiary care academic medical centers in Massachusetts.
Participants
403 patients age 65+ with serious complication risk of ≥ 5%
Measurements
(1) Self-reported physical function with Late Life Function and Disability Instrument (LLFDI FUNCTION); (2) Frailty Phenotype (FP) with score ranging from 0 to 5 based on presence of slow gait speed, weak handgrip, exhaustion, weight loss, or low activity.
Main Outcome
Increase in c-statistic and net reclassification improvement (NRI) for LLFDI-FUNCTION vs. FP in addition to the ACS Calculator for predicting an adverse postoperative course (either serious complication, discharge to nursing home, readmission, or death within 30 days of surgery)
Results
Over 30 days, 26% of patients developed an adverse postoperative course. The increase in c-statistic for the ACS Calculator (baseline value 0.645) was slightly higher with LLFDI-FUNCTION vs. FP (0.076 vs. 0.058) with bootstrapped difference in c-statistic of 0.005 (95% CI 0.002–0.007). NRI was also better with LLFDI-FUNCTION.
Conclusion
LLFDI-FUNCTION provided slightly better prediction of postoperative complications than the FP. Further studies are needed to confirm these findings and validate the use of the LLFDI-FUNCTION with the ACS Calculator for preoperative assessments of older adults.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.