Eddie Blay

Initial public reporting of quality at veterans affairs vs non-veterans affairs hospitals

Acquisition, analysis, or interpretation of data: Barocas, Beiser, León, Gaeta. Drafting of the manuscript: Barocas. Critical revision of the manuscript for important intellectual content: Barocas, Beiser, León, Gaeta, O’Connell, Linas. Statistical analysis: Barocas. Obtained funding: Barocas, Gaeta. Administrative, technical, or material support: Barocas, Beiser, Gaeta, Linas. Study supervision: León, Gaeta, O’Connell, Linas.

Oversedation of a Patient With Obstructive Sleep Apnea Prior to Imaging

Case Summary An elderly smoker with a body mass index of 39 presented to the emergency department (ED) with acute-onset dizziness. The patient had a history of stable coronary artery disease after bare-metal stent placement with medication (clopidogrel). Hypertension, hyperlipidemia, and carotid endarterectomy were also part of the patient’s history. The nurse’s communication notes included a history of obstructive sleep apnea (OSA), but this was absent from the physician’s history. In the ED, the patient received meclizine for dizziness and ondansetron for nausea. A neurologist was consulted and recommended magnetic resonance imaging (MRI)/magnetic resonance angiography. The patient indicated feeling claustrophobic and was given 1 mg of lorazepam to reduce anxiety prior to MRI. During the MRI, the patient had a gradual change in mental status over 15 minutes beginning with progressively incoherent answers to various prompts by the MRI technician. The patient eventually stopped responding to prompts, and soon after, a cardiac arrest code was called.

Evaluating the Impact of the Venous Thromboembolism Outcome Measure on the PSI 90 Composite Quality Metric

INTRODUCTION Patient Safety Indicator (PSI) 90 is a composite measure widely used in federal pay-for-performance and public reporting programs. A component metric of PSI 90, venous thromboembolism (VTE) rate, has been shown to be subject to surveillance bias and not a valid measure for hospital quality comparisons. A study was conducted to examine how hospital PSI 90 scores would change if the VTE measure were removed from calculation of this composite measure. METHODS Using 2014 Medicare inpatient claims data, PSI 90 scores were calculated with and without the VTE measure for 3,203 hospitals. Hospital characteristics obtained from the American Hospital Association Annual Survey and Centers for Medicare & Medicaid Services Payment Update Impact File were merged with PSI 90 scores. RESULTS Removing the VTE outcome measure from the calculation of PSI 90 version 5 improved PSI 90 scores for 17.1% of hospitals but lowered scores for 20.8% of hospitals, while 62.1% had no change in scores. Hospitals were more likely to improve on PSI 90 when the VTE measure was removed if they were larger (odds ratio [OR] = 1.60; 95% confidence interval [CI] = 1.00-2.58), were major teaching hospitals (OR = 1.76; 95% CI = 1.10-2.79), had greater technological resources (OR = 2.03; 95% CI = 1.40-2.94), or cared for sicker patients (OR = 1.12; 95% CI = 1.01-1.25). CONCLUSION Inclusion of the surveillance bias-prone VTE outcome measure in the PSI 90 composite disproportionately penalizes larger, academic hospitals and those that care for sicker patients. Removal of the VTE outcome measure from PSI 90 should be strongly considered.

Evaluation of Reasons Why Surgical Residents Exceeded 2011 Duty Hour Requirements When Offered Flexibility: A FIRST Trial Analysis.

bechallenging.Withoutgovernment-subsidizedhealthcare,families and patients can spend considerable portions of income on NCD management.6 In our population, only half of the patients with diabetes were receiving therapy before admission. DownstreamconsequencesofNCDs, includingamputation,furtherimpair a family’s or individual’s ability to cover cost of medical care as income from potentially employable individuals is lost.6 Addressing the rapid increase of NCDs in SSA is critical now and represents an opportunity for collaboration among surgeons, physicians,andpublichealthprofessionals.Studylimitationsinclude the retrospective design and incomplete capture of all amputations performed.

The effect of smoking on 30-day outcomes in elective hernia repair

BACKGROUND Adverse postoperative outcomes related to smoking are well established, yet current smokers continue to be offered elective surgery in the US. It is unknown whether patients undergoing low-risk, elective procedures, who actively smoke experience increased risk of complications. We sought to determine the increased burden of complications following elective hernia repair procedures in patients identified as current smokers. METHODS We identified patients undergoing elective incisional, inguinal, umbilical, or ventral hernia repair from 2011 to 2014 using the American College of Surgeons National Surgical Quality Improvement Project (ACS NSQIP) database. Multivariable logistic regression analysis was used to examine the association between current smoking and 30-day postoperative outcomes, adjusting for demographics and comorbidities. RESULTS Of 220,629 patients who underwent elective hernia repair, 40,446 (18.3%) self-identified as current smokers within the past 12 months. Current smokers experienced an increased likelihood (Odds Ratio [95% Confidence interval]) of reoperation (OR 1.23 [95% CI 1.11-1.36]), readmission (OR 1.24 [95% CI 1.16-1.32]), and death (OR 1.53 [95% CI 1.06-2.22]). Furthermore, smokers experienced an increased risk of postoperative pulmonary, infectious, and wound complications, but there was no increased risk of requiring transfusion or of postoperative cardiac or thromboembolic events. CONCLUSIONS Current smokers were more likely to experience serious postoperative complications within 30 days. Given the volume of elective hernia surgery performed in the US, encouraging smoking cessation prior to offering elective repair could reduce postoperative complications, reoperation, readmission, and mortality.