Kerri E. Buch

Integration of a formalized handoff system into the surgical curriculum: resident perspectives and early results.

HYPOTHESIS The Situation, Background, Assessment, and Recommendation model (SBAR) provides an excellent framework for communication in daily resident handoffs. OBJECTIVE To evaluate implementation of SBAR into the surgical curriculum. DESIGN A curriculum using video and role-play scenarios to augment a didactic lecture on SBAR was implemented for general surgery residents. Resident assessment was achieved via an anonymous survey administered after training. Outcome was evaluated by assessing sentinel events and resident order entry 30 days before and after training. Surgical subspecialty resident order entries were used as controls. Duplicated, cancelled, and wrong patient orders were attributed to failed communication. SETTING Academic department of surgery. PARTICIPANTS Forty-five general surgery residents at our institution. RESULTS Survey response rate was 100%. Poor communication was identified as the leading cause of handoff failure, with nurse-to-resident handoffs considered the most problematic. Overall, the curriculum was well received. Outcomes analysis demonstrated no difference in sentinel events. A 2.3% decrease in pretraining and posttraining order entry errors (14.5% vs 12.2%; P = .003) was demonstrated. No difference was demonstrated in controls who did not undergo SBAR training (12.9% vs 13.6%; P = .47). CONCLUSIONS Most of the residents indicate that the SBAR curriculum addressed frequently encountered communication issues and taught clinically beneficial communication skills. The identified specific communication deficiencies will direct future curriculum goals. The SBAR model is an effective and valuable tool to standardize communication. Early outcomes analysis demonstrates a decrease in order entry errors after training. Sentinel events are infrequent and will require long-term evaluation.

Current Recommendations on Diagnosis and Management of Right-Sided Diverticulitis

We present the case of a 52-year-old female with recurrent symptomatic ascending colon diverticulitis who ultimately underwent elective laparoscopic right hemicolectomy. The following is a case report and literature review pertaining to right colonic diverticular disease.

Hemoperitoneum following inguinal hernia repair: a case report

Traditional inguinal herniorrhaphy continues to be one of the most common surgeries performed in the USA today. The procedure has developed into a straightforward, ambulatory procedure with postoperative complications being very rare. We describe the first report in the literature of the serious complication of hemoperitoneum after open inguinal hernia repair attributed to injury of the artery of Sampson.

Image of the month. Adrenal myelolipoma.

A 43-YEAR-OLD MAN WITH NO SIGNIFICANT medical history had a 3-month history of right upper quadrant pain with no associated gastrointestinal or urinary symptoms. On examination, he appeared well and was in no distress. His abdomen was not tender, but had a palpable right upper quadrant fullness. A computed tomographic (CT) scan revealed a 7.9-cm, bilobed, fat-containing mass adjacent to the upper pole of the right kidney (Figure 1). A magnetic resonance image (MRI) was performed to better assess its continuity with adjacent organ structures. It showed no hepatic or renal invasion (Figure 2).