Trauma

BACKGROUND: Variability in flow of patients through operating rooms has a dramatic impact on a hospital's performance and finances. Natural variation (uncontrollable) and artificial variation (controllable) differ and require different resources and management. The aim of this study was to use variability methodology for a hospital's surgical services to improve operational performance. STUDY DESIGN: Over a 3-month period, all operations at a referral center were classified as either scheduled (artificial variation) or unscheduled (natural variation)...

BACKGROUND: In multiply injured patients, bilateral femur fractures invoke a substantial systemic inflammatory impact and remote organ dysfunction. However, it is unclear whether isolated bone or soft tissue injury contributes to the systemic inflammatory response and organ injury after fracture. QUESTIONS/PURPOSES: We therefore asked whether the systemic inflammatory response and remote organ dysfunction are attributable to the bone fragment injection, adjacent soft tissue injury, or both...

BACKGROUND: Sleep deprivation, common in intensive care unit (ICU) patients, may be associated with increased morbidity and/or mortality. We previously demonstrated that significant numbers of nocturnal nursing interactions (NNIs) occur during the routine care of surgical ICU patients. For this study, we assessed the quantity and type of NNIs in different ICU types: medical, surgical, cardiothoracic, pediatric, and neonatal. We hypothesized that the number and type of NNIs vary among different ICU types...

OBJECTIVES: Trampoline injuries represent a preventable cause of injury in children. This study identified the characteristics of children injured while using trampolines who presented to a pediatric trauma center in Sydney, Australia. METHODS: The Pediatric Trauma Database at our institution was reviewed to identify children with trampoline-related injuries between January 1999 and June 2008. Data collected included age, sex, Injury Severity Score, anatomical region injured, type of injury, mechanism of injury, site of injury and surface fallen onto, level of supervision, treatment, and hospital length of stay...

BACKGROUND: Financial pressures drive efforts to optimize hospital resource use, but inefficiencies occur in systems as volume nears total capacity. We examined how operating room use impacts efficiency and costs of treating an urgent surgical condition. METHODS: A retrospective review of patients who underwent appendectomy for appendicitis at a single hospital from 2004 to 2009 was performed. Patient demographics, operative characteristics, pathologic diagnoses, hospital time intervals, and costs were analyzed...

BACKGROUND: Computed tomographic angiography (CTA) has been established as a valid modality for the assessment of extremity vascular injury. Over the last several years at our institution, CTA has evolved as the primary diagnostic modality for penetrating extremity injuries, largely replacing diagnostic angiography. The purpose of this study was to evaluate the outcomes with this imaging modality at a high-volume Level I trauma center. METHODS: A retrospective review was conducted of all patients presenting with penetrating lower extremity trauma between 2008 and 2009...

PURPOSE: The purpose of this study is to examine the effect of establishing a dedicated operating room for unscheduled orthopedic cases and to evaluate a group of patients with isolated femur fractures. The frequency of after-hours surgery and the impact of patients who present with acute orthopedic injuries are reviewed. METHODS: A retrospective review of all orthopedic cases from the operating room scheduling system at a level-one trauma center was undertaken from October 2003 to September 2005...

Optimal outcome in the treatment of multiple trauma patients requires an initial management fulfilling a high standard of quality assurance. A prerequisite is the availability of adequate resources at all times with respect to personnel, technical equipment, and emergency room design. The aim is-based on standardized and prioritized clinical pathways and algorithms-to identify and treat not only life-threatening and debilitating but all other injuries in a timely fashion. Diagnostic and therapeutic measures to manage airway, breathing, and circulatory problems (including transfusion and surgery for bleeding control) have priority, even over the operative treatment of severe head injuries...

In this paper we develop a three-phase, hierarchical approach for the weekly scheduling of operating rooms. This approach has been implemented in one of the surgical departments of a public hospital located in Genova (Genoa), Italy. Our aim is to suggest an integrated way of facing surgical activity planning in order to improve overall operating theatre efficiency in terms of overtime and throughput as well as waiting list reduction, while improving department organization. In the first phase we solve a bin packing-like problem in order to select the number of sessions to be weekly scheduled for each ward; the proposed and original selection criterion is based upon an updated priority score taking into proper account both the waiting list of each ward and the reduction of residual ward demand...

BACKGROUND: Despite the vast number of traumatic injuries that are orthopaedic in nature, comprehensive epidemiological data that characterise orthopaedic trauma are limited. The aim of this study was to investigate the nature of orthopaedic trauma admitted to adult Level 1 Trauma Centres. METHODS: Data were obtained from the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR), which includes all patients with orthopaedic trauma admitted to the two adult Level 1 Trauma Centres in Victoria (Australia)...

No abstract text is available yet for this article.

Overcrowded motor vehicle crashes caused by the very active criminal enterprise of smuggling illegal immigrants in the desert of the Southwest is a recent and under-recognized trauma etiology. A computerized database search from 1990 through 2003 of local newspaper reports of overcrowded motor vehicle crashes along the 281 miles of Arizona's border with Mexico was conducted. This area was covered by two level I trauma centers, but since July 2003 is now served only by the University Medical Center. Each of these crashes involved a single motor vehicle in poor mechanical shape packed with illegal immigrants...

During the past decade many scientific advances have been made concerning the development of methodologies to maximize efficiency of surgical facilities through allocating and scheduling of operating rooms. In this article such a methodology is described. Using the analysis of historical data of surgical activity in a facility, future demand is predicted and planned. Part of the methodology includes principles and rules needed for the daily organization and operative management of surgical facilities. They are also derived from the same science and therefore the basis for rational and structured decision making...

No abstract text is available yet for this article.

Optimal sequencing of urgent cases (i.e., selecting which urgent case should be performed first and which second) may enhance patient safety, increase patient satisfaction with timeliness of surgery, and minimize surgeons' complaints. Before determining the optimal sequence of urgent cases, an operating room (OR) suite must identify the primary scheduling objective to be satisfied when prioritizing pending urgent cases. These scheduling objectives may include: 1) perform the cases in the sequence that minimizes the average length of time each surgeon and patient waits; 2) perform the cases in the order that they were submitted; or 3) perform the cases based on medical priority, as prioritized by an OR director, or surgeons discussing the cases among themselves...

The belief that trauma may precede or exacerbate multiple sclerosis (MS) has come primarily from anecdotal reports and case series that provide no rates and no basis for critical comparison. Each year in the United States, approximately 10,000 persons develop MS. A high proportion of the estimated 250,000 prevalence cases have one or more exacerbations, whereas one-third (or 83,000,000 persons in the United States) suffer a memorable injury; therefore, when trauma precedes MS onset or exacerbation, coincidence, as well as causal association, must be considered...