With the expansion of Medicare readmission penalties to elective total-knee and total-hip arthroplasty patients in 2014 comes an increasing demand for OR leaders to ensure better postdischarge care. To avoid readmissions, OR management will have to be more proactive about reducing length of stay and complications and providing for care…

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When Mark Katlic, MD, MMM, FACS, descended into the basement of the hospital where he was a resident 30 years ago to satisfy his curiosity, he had no idea that what he found would set him on his career path. Dr Katlic had cared for a few surgical patients more…

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Cancelled surgical procedures at Carilion Roanoke Memorial Hospital (CRMH) in Roanoke, Virginia, are considered a success rather than a failure. “That’s because we cancel procedures for cause,” says Sandy Fogel, MD, FACS. Before 2010, many patients at CRMH were having surgery with undiagnosed, untreated medical problems, and postoperative 30-day mortality…

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Duke University Hospital has had a Pre-Operative Screening Unit (POSU) in place for the past 16 years to optimize patients prior to surgery, but until recently, there were no hard data on surgical cancellation rates. Now, a retrospective analysis has revealed that fewer cancellations occur when patients are seen in…

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The number of elderly people in the US is on the rise, and so is the number of older patients having surgery. However, while advances in technology and techniques may make surgery more feasible for those age 65 and older, ensuring successful outcomes for this cohort is challenging. Specific guidelines…

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OR teams are accustomed to using checklists to keep patients safe during surgery. Could extending presurgical checklists to the physician’s office or clinic produce even better results? The new Strong for Surgery initiative in Washington State is introducing checklists into offices and clinics to help address issues like nutrition, glycemic…

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Last month, we wrote about the long history of unnecessary preoperative testing for healthy patients. This month, we’re happy to report that some leading medical societies are publicly calling for physicians and patients to rethink certain kinds of testing. The recommendations are part of the Choosing Wisely campaign, an effort…

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This month’s article on preop testing research had a familiar ring (page 20). Researchers at the University of Texas Medical Branch (UTMB) in Galveston have found much more testing is being done than seems to be needed. They’re documenting the patterns. Seems not much has changed. These new studies join…

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Ten elements of safer surgery. The third in a series, this article focuses on presurgical evaluation.   Making sure patients have the appropriate preoperative preparation, including testing, is necessary not only for patients’ safe care but also for a smooth process on the day of surgery. Advocate Health Care, a…

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What preoperative tests does your facility require for a healthy 40-year-old having a knee arthroscopy? What about a healthy 82-year-old having an elective procedure? Do these patients need testing at all? A good deal of testing is performed without clinical indications, studies have found. Researchers at the University of Texas…

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