SSI/OR Safety Introductory Webinar. A partnership of the Healthcare Association of New York State and the Greater New York Hospital Association
|
|
- Derick Fox
- 5 years ago
- Views:
Transcription
1 SSI/OR Safety Introductory Webinar A partnership of the Healthcare Association of New York State and the Greater New York Hospital Association
2 Agenda 2
3 Introduction to SSI/OR Safety Approach Zeynep Sumer Nancy Landor 3
4 Overview of SSI/OR Safety Initiative o Goals o Objectives o Measurement Strategy/Data collection o Alignment with IPRO 4
5 Goals o Reduce Surgical Site Infection by 40% across New York State by December 2013 o Reduce Surgical Site Infections in the following procedures: o Hip and Knee replacement o Coronary artery bypass graft o Colon surgery o Hysterectomy o Reduce all other procedural harm 5
6 Measurement o Monthly Data Collection o SSI rates per 100 operative procedures (hip, colon, CABG, hysterectomy) (NHSN) o Surgical Care Improvement Project (SCIP) infection measures o Scip-Inf-1; Scip-Inf-2; Scip-Inf-3; Scip-Inf-4; Scip-Inf-9; Scip-Inf- 10) o Baseline and follow-up assessment of current practices o Hospitals internal monitoring for compliance and improvement 6
7 Interventions Implement a surgical safety checklist containing the following essential elements: 7
8 Objectives 8
9 SSI is part of OR Safety 9
10 Milestones 10
11 Milestones (Continued) 11
12 The Interdisciplinary Team Approach to Achieve OR Safety David Feldman Loraine O Neil Mark Lema 12
13 Polling Question o Who is in the room with you today participating on this webinar, members of the: (select all that apply) o Anesthesia team o Surgical Team o PACU Team o Infection Preventionist/ Control Team o Quality Improvement/Patient safety o Other: Please specify 13
14 Polling Question o Who is accountable for administering the preoperative antibiotics in your hospital? o Anesthetist o Anesthesiologist o Nurse in pre-op area/pacu o Nurse in OR o Surgeon o Other 14
15 Polling Question o Do you currently have a debrief/sign-out at the end of the procedure and, if yes, who leads it? o No, we do not have debrief o Yes, led by surgical attending o Yes, led by anesthesiologist/anesthetist o Yes, led by OR nurses o Yes, depends who is in the room 15
16 Patient Safety & OR culture David L Feldman, MD MBA CPE FACS Senior Vice-President & Chief Medical Officer Hospitals Insurance Company/FOJP Professorial Lecturer, Department of Surgery Mount Sinai School of Medicine New York, NY
17 Patient Safety o Reliable teams o Communication o Mutual support/respect o Leadership skills o Reliable processes o Systems that are consistent o Human factors engineering o Just Culture o Encourages open/honest reporting of errors 17
18 Safety v. Quality v. Efficiency Performance Improvement Quality Safety Efficiency Operating Room Time Outs 18
19 Polling question o Does you hospital have a policy that deals with disruptive behavior? o Yes and it is used in practice for all providers o Yes but in practice but doesn t seem to apply to physicians o Yes but is not followed at all for anyone o No 19
20 Teamwork & Respect...the key success factors in a safety effort are teamwork and respect, two basic ideas that are too often lacking in medicine. People have to be trained to work in teams and to respect others on the team. 20 Interview with Lucian Leape, MD. Journal of Healthcare Management. Volume 53, Number 2. March/April 2008.
21 Teamwork & Respect Medical Schools should teach: 1. Safety Science 2. In Interdisciplinary teams 3. Respect for Colleagues, coworkers, patients 21 Q&A with Lucian Leape, MD. Physician Executive Journal. March/April 2012.
22 The Joint Commission Universal Protocol o Pre-procedure verification process o Best practice: a conversation between Attending Anesthesiologist and Attending Surgeon o Site Marking o NYS surgeon marking site, must be present for time-out and perform procedure o Time-Out o NYS immediately prior to incision o Best practice requires presence of: o Attending Surgeon o Attending Anesthesiologist o Circulating RN 22
23 World Health Organization Safe Surgery Saves Lives o Sign-in o In OR with patient awake o Time-out o Immediately prior to incision o Sign-out o At conclusion of procedure 23
24 WHO Checklist
25 Polling question o Do you use the WHO checklist in your hospital s Operating Rooms? o Yes and it is used frequently o Yes but it is used rarely o No but we are working on one o No 25
26 Checklists and Time-outs o WHO Checklist Study 1 o Reduction from 1.5% mortality to.8% o Reduction in inpatient complications from 11% to 7% o Canadian Study with team briefing structured by a checklist 2 o Reduction in communication failures from 3.95 to 1.31 o 34% of briefings demonstrated utility 1 Haynes AB, et al. A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population NEJM Jan, Lingard L, et al. Evaluation of a Preoperative Checklist and Team Briefing Among Surgeons, Nurses, and Anesthesiologist to Reduce Failures in Commincation Arch Surg Jan, 2008.
27 Value of Briefings Mayo Briefing Protocol 1 o Reduction in total surgical flow disruptions from 5.4/case to 2.8/case o Reduction in miscommunication events from 2.5/case to 1.17/case o Fewer trips outside the OR 10 v. 4.7 o Less time spent outside the OR 397 sec v. 172 sec o Trend towards less waste 30% v. 17% 27 1 Henrickson SE, et al. Development and Pilot Evaluation of a Preoperative Briefing Protocol for Cardiovascular Surgery JACS June, 2009.
28 The Surgeon s Role It is also helpful for the surgeon to empower people to speak up. Surgeons should explicitly request that members of the surgical team speak up if they re concerned about the process. We ve seen the reverse of this, where people have spoken up and surgeons have disregarded these concerns and performed wrong-site surgery. 28 John Clark, MD, FACS, Clinical Director of the Pennsylvania Patient Safety Reporting System
29 Patient Safety o Reliable teams o Communication o Mutual support/respect o Leadership skills o Reliable processes o Systems that are consistent o Human factors engineering o Just Culture o Encourages open/honest reporting of errors 29
30 Something Close to Home Which dial turns on the burner? Stove A Stove B 30
31 Visual Controls in the OR 31
32 Human Factors Engineering 32
33 Patient Safety o Reliable teams o Communication o Mutual support/respect o Leadership skills o Reliable processes o Systems that are consistent o Human factors engineering o Just Culture o Encourages open/honest reporting of errors 33
34 Accountability for our behaviors Human Error Manage through changes in: o Processes o Procedures o Training o Design o Environment At-Risk Behavior Manage through: Removing incentives Creating incentive for healthy behavior Increasing situational awareness Reckless Behavior Manage through: o Remedial action o Disciplinary action Console Coach Punish
35 Teamwork & Safety Loraine O Neill, RN MPH Director of Quality Initiatives, Department of Ob/Gyn & Reproductive Sciences Mount Sinai Medical Center New York, NY
36 Polling Question o Do you use critical language in your daily practice? o Yes o If yes what? CUS Special local phrase other o No o Do not know what you mean? 36
37 Polling Question o What is included in the debrief? (select all that apply) o What went well o Opportunity for improvement o Review of PACU orders o Review of post-pacu orders o Review and ordering of prevention protocols for HACS 37
38 Patient Safety o Reliable teams Communication Mutual support/respect Leadership skills o Reliable processes Systems that are consistent Human factors engineering o Just Culture Encourages open/honest reporting of errors 38
39 Root Causes of Sentinal Events 39 39
40 Teamwork Is All Around Us 40 40
41 What is Teamwork Cooperative effort by the members of a group or team to achieve a common goal. The process of working collaboratively with a group of people, in order to achieve a goal. The actions of individuals, brought together for a common purpose or goal, which subordinate the needs of the individual to the needs of the group Work done by several associates with each doing a part but all subordinating personal prominence to the efficiency of the whole 41
42 Crew Resource Management o Aviation industry Teamwork failure - 70% of airline crashes Airlines develop training programs for cockpit personnel - Cockpit Resource Management Expanded to Crew Resource Management Entire flight crew Maintenance crews Air traffic controllers o No definitive study correlating CRM training with enhanced airline flight safety but aviation industry has accepted this practice on face validity 42
43 Crew Resource Management
44 TeamSTEPPS Team Strategies and Tools to Enhance Performance and Patient Safety Initiative based on evidence derived from team performance leveraging more than 25 years of research in military, aviation, nuclear power, business and industry to acquire team competencies 44
45 TeamSTEPPS 45
46 What Comprises Team Performance?
47 Outcomes of Team Competencies o Knowledge o Shared Mental Model o Attitudes o Mutual Trust o Team Orientation o Performance o Adaptability o Accuracy o Productivity o Efficiency o Safety 47
48 Impact of Impact Team of Team Training 48
49 Impact of Team Training Impact of Team Training 2 First case starts 69% to 81% SQIP antibiotic admin (p<0.05) 78% to 97% SQIP VTE Prophylaxis (p<0.05) 74% to 91% SQIP Beta Blocker (p<0.05) 19.7% to 100% NSQIP Morbidity (p<0.05) 20.2% to 11.0% NSQIP Surgical Mortality (p<0.05) 2.7 to 1% Note: Some results worsened 1 year after training, suggesting the need for continuous reinforcement. 49
50 Creating Highly Reliable Teams 50
51 The Nurses Role Nursing plays a central role in ensuring that patients consistently receive high-quality care and are protected from injury at all times. It may seem a strange principle to enunciate as the very first requirement in a Hospital that it should do the sick no harm. 51 Riley, et.al. A Model for developing high-reliability teams. Jnl of Nrsg Mgmt. July 2010:
52 Anesthetic Best Practices in Reducing SSIs Mark J. Lema, MD PhD Professor and Chair, Department of Anesthesiology, Critical Care & Pain Medicine Roswell Park Cancer Institute Buffalo, NY
53 Scope of the Problem o It has been estimated that surgical site infections (SSIs) occur in 2% to 5% of all patients who undergo surgery in the United States, resulting in 800,000 to 2 million surgical site infections annually. In addition, SSIs account for 38% of nosocomial infections in surgical patients and result in increased mortality, intensive care unit (ICU) admission, length of hospital stay, cost, and hospital readmission Boyce JM, Potter-Bynoe G, Dziobek L. Infect Control Hosp Epidemiol. 1990;11(2): Poulsen KB, Bremmelgaard A, Sorensen AI, Raahave D, Petersen JV. Epidemiol Infect. 1994;113(2): Martone WJ, Jarvis WR, Culver DH, Haley RW. In: Bennett JV, Brachman PS, eds. Hospital Infections. 3rd ed. Boston: Little, Brown & Co; 1992: Vegas AA, Jodra VM, Garcia ML. Eur J Epidemiol. 1993;9(5):
54 American Society of Anesthesiologists Recommendations for Infection Control for the Practice of Anesthesiology (Third Ed.) 1 II C. Prevention of Surgical Site Infection o i. Preoperative considerations o o o 1. Hair removal o 2. Glucose control o 3. Nicotine use o 4. Transfusion o 5. Antiseptic shower o 6. Antimicrobial prophylaxis ii. Intraoperative considerations o 1. Ventilation o 2. Cleaning o 3. Surgical attire o 4. Asepsis and surgical technique o 5. Normothermia iii. Postoperative considerations o 1. Postoperative incision care o 2. Surveillance
55 Glucose control ASA Recommendations 3ed Recommendation: Consider control serum blood glucose levels preoperatively in all diabetic patients and avoid perioperative hyperglycemia, to an extent that would not place the patient at risk of hypoglycemia. Rationale: data suggest that a significant relationship exists between increasing levels of hemoglobin (Hg) A1c and SSI rates. In addition, hyperglycemia (>200 mg/dl) has been associated with increased SSI risk in the immediate postoperative period 1, Zerr KJ et al. Ann Thoracic Surg. 1997;63(2): Terranova A. Plast Surg Nurs.1991;11(1):20-25
56 Society of Ambulatory Anesthesia (SAMBA) Consensus Statement on Perioperative Blood Glucose Management in Diabetic Patients Undergoing Ambulatory Surgery (2010) 56
57 SAMBA Guidelines
58 Artlice on Perioperative Blood Glucose o Uncontrolled blood glucose (BG) results in poor outcomes in cardiac, neurosurgical, general surgical and critical care patients. o Tight glucose control ( mg/dl) is related to increased mortality. o ADA and STS recommend: o Maintaining BG between mg/dl o Using insulin infusions to maintain BG control o Minimizing BG variability during surgery 58
59 o o o o o o o Article Inadequate Blood Glucose 8727 patients analyzed. Stratified into good BG control (<200), moderate BG control ( ) or poor BG control (>250) based on highest BG level over 60 hour period. 10% were in moderate control and 4% in poor control Diabetes was discovered in 8% of good, 31%of moderate and 52% of poor groups. Inadequate BGC and NOT diabetes was associated with in-hospital mortality. (1.8 vs. 4.2 vs. 9.6%). Inadequate BGC and NOT diabetes was associated with a 2.7x increase in MI and a 2.2x increase in pulmonary/renal complications. Conclusions: o More then 50% of moderate/poor BGC groups were previously undiagnosed for diabetes. o Inadequate postoperative BGC is a predictor of in-hospital morbidity and mortality. Ascione R et al.circulation 2008;118:
60 Normothermia ASA Recommendations 3ed Recommendation: Maintain patient normothermia. Rationale: Hypothermia (core temperature <36 C) has been associated with an increased SSI risk 1,2. Mild hypothermia seems to increase SSI risk by causing vasoconstriction, decreased oxygen delivery to the wound space, and impaired phagocytic leukocyte function 3, Sessler DI. N Engl J Med 1997;336(24): Kurz A et al. N Engl J Med 1996;334(19): Wenisch C et al. Anesth Analg 1996;82: Hunt TK, Hopf HW.Surg Clin North Am. 1997;77:
61 Article on Perioperative Normothermia o 200 colorectal surgical patients were randomized in a doubleblind, controlled trial into Normothermia v. Hypothermia groups o Wounds evaluated daily until discharge and 2 weeks later in clinic o Wounds with culture positive pus were considered to be infected Results: o Mean temp: Hypo 34.7 C v. Normo 36.6 C, p<.001 o Infections: Hypo 18/96 (19%) v. Normo 6/104 (6%), p=.009 o Sutures were removed one day later (p=.002)and 20% of patients were discharged 2.6 days later (p=.01) in Hypo group. 61 Kurz A et al. New Engl J Med. 1996;334(19):
62 Article on Hypothermia and Hyperoxia o Anesthesiologists have some control over six factors that can reduce surgical site infections 1. Hypothermia 2. Hyperoxia 3. Perioperative Fluid Management 4. Hyperglycemia 5. Blood Transfusion and the Risk of Infection 6. Antimicrobial Prophylaxis 62 Mauermann WJ, Nemergut EC. Anesthesiology 2006;105:
63 Hypothermia/Hyperoxia - Anesthesiology 2006 o The major relationship between hypothermia and increased SSI is thought to be a decrease in subcutaneous tissue perfusion mediated by vasoconstriction. o Providing adequate oxygen delivery maintains oxidative killing by neutrophils. o Patients with subcutaneous oxygen tension (P t O 2 ) greater than 90 mmhg had no infections while those with P t O 2 of mmhg had and infection rate of 43% Mauermann WJ, Nemergut EC. Anesthesiology 2006;105: Hopf HW et al. Arch Surg 1997, 132:
64 Hypothermia and Hypovolemia Hypothermia and Hypovolemia Hypothermia causes vasoconstriction which produces inadequate tissue oxygen perfusion and reduced neutrophil (PMNs) migration to the site. Blood and fluid loss (hypovolemia) also leads to inadequate tissue oxygen perfusion. Less oxygen and lower PMN migration reduces bacteria killing effect by neutrophils. Bacterial infection occurs. 64 Mauermann WJ, Nemergut EC. Anesthesiology 2006;105:
65 Normothermia, Euvolemia Normothermia, Euvolemia and Hyperoxia and Hyperoxia Benefits Normothermia maintains normal blood flow and oxygen delivery to tissue. Euvolemia maintains adequate tissue perfusion. Hyperoxia delivers sufficient oxygen for PMN cytotoxic and phagocytic activity. Bacterial growth is thwarted. Mauermann WJ, Nemergut EC. Anesthesiology 2006;105:
66 Hyperglycemia - Anesthesiology 2006 o Diabetic patients are at increased risk for SSIs. o Diabetic patients PMNs have impaired chemotaxis, decreased phagocytosis, and lower bactericidal ability. o Glucose challenge in healthy volunteers showed a transient reduction in PMN and all lymphocyte subset counts. o Hyperglycemia deactivates immunoglobulins and blocks complement C action. o Insulin infusions work better than a sliding scale. A 66% reduction in sternal SSI seen in cardiac patients 1, Furnary AP et al. Ann Thorac Surg.1999;67: Zerr KJ et al. Ann Thorac Surg. 1997;63:
67 Normoglycemia Anesthesiology 2006 Normoglycemia promotes PMN bactericidal actions, immunoglobulin and complement functions. 67 Mauermann WJ, Nemergut EC. Anesthesiology 2006;105:
68 Hyperglycemia Anesthesiology 2006 Hyperglycemia: Decreases PMN chemotaxis, phagocytosis and bacterial destruction Decreases IgG fixation of complement Decreases complement binding to bacteria 68 Mauermann WJ, Nemergut EC. Anesthesiology 2006;105:
69 Summary o Anesthesia personnel can play a key role in the perioperative setting to help surgical patients and surgeons in reducing surgical site infections. o There are six ways where SSI reduction may be accomplished by prophylactic maneuvers. The evidence is so strong for some of these factors that implementation have become quality measures. As always, teamwork and effective communication among caregivers is essential for optimal patient outcomes. 69
70 Next Steps Zeynep Sumer Nancy Landor 70
71 Next Steps Ensure OR Safety Team in Place o o o o o o o o NYSPFP SSI lead Nursing (PAT, PACU, Surgical nurse) Physician (surgeon and anesthesiologist) champions Surgical Technicians, PAs, Anesthetist Infection prevention staff SSI/OR Safety Coordinator and Data lead Support Staff Executive sponsors and managers Attend In-Person Kick off Friday, February 15, 2013 Sign-in 6:30 a.m. 7:00 a.m. to 10:00 a.m. 13 Locations across the state Keynotes: Dr. Patchen Dellinger Ms. Caroline Jacobs 71
72 Questions and Answers Questions 72
Oscar Guillamondegui, MD, MPH, FACS Associate Professor of Surgery Tennessee Surgical Quality Collaborative
Oscar Guillamondegui, MD, MPH, FACS Associate Professor of Surgery Tennessee Surgical Quality Collaborative NSQIP 2014 A Collaborative that has Reduced Surgical Site Infections Tennessee Surgical Quality
More informationNational Priorities for Improvement:
National Priorities for Improvement: Standardization of Performance Measures, Data Collection, and Analysis Dale W. Bratzler, DO, MPH Principal Clinical Coordinator Oklahoma Foundation Contracting for
More informationUsing Evidence to Improve Outcomes for the Surgical Patient: Post-Operative Interventions
Using Evidence to Improve Outcomes for the Surgical Patient: Post-Operative Interventions January 16, 2014 1 A partnership of the Healthcare Association of New York State and the Greater New York Hospital
More informationTeamwork, Communication, O.R. Safety & SSI Reduction
2011 Infection Prevention Leadership Teamwork, Communication, O.R. Safety & SSI Reduction Teamwork, Communication, O.R. Safety & SSI Reduction 2 Presented by: E. Patchen Dellinger, MD, FACS Professor of
More informationStrategy/Driver Prevention Strategies Action Strategies
I. Hospital executive leadership commitment to prevention of surgical site infections 1. Establish Surgical Site Infection prevention as a strategic priority 2. Develop and implement business/strategic
More informationClinical Standardization
Clinical Standardization Joe Sharma, MD, FACS, FACE Associate Professor of Surgery Director, of Endocrine Surgery Chief Quality Officer Emory University School of Medicine Disclosures Engineer US Navy
More informationSURGICAL SAFETY CHECKLIST
SURGICAL SAFETY CHECKLIST WHY: INFORMATION, RATIONALE, AND FAQ May 2009 Building a safer health system INFORMATION, RATIONALE, AND FAQ May 2009 - Version 1.0 The aim of this document is to provide information
More information9/29/2017. Enhanced Recovery After Surgery at the University of Virginia Medical Center. Disclosures. Objectives. None
Enhanced Recovery After Surgery at the University of Virginia Medical Center Bethany Sarosiek, RN, MSN, MPH, CNL University of Virginia Health System Charlottesville, VA ErasRN@virginia.edu Disclosures
More informationENVIRONMENT Preoperative evaluation clinic. Preoperative evaluation clinic. Preoperative evaluation clinic. clinic. clinic. Preoperative evaluation
Goals and Objectives, Preoperative Evaluation Clinic Rotation, CA-1 and CA-2 year UCSD DEPARTMENT OF ANESTHESIOLOGY PREOPERATIVE EVALUATION CLINIC ROTATION GOALS AND OBJECTIVES, CA-1 and CA-2 YEAR PATIENT
More informationNQF-ENDORSED VOLUNTARY CONSENSUS STANDARDS FOR HOSPITAL CARE. Measure Information Form
Last Updated: Version 3.2 NQF-ENORSE VOLUNTARY CONSENSUS STANARS FOR HOSPITAL CARE Measure Information Form Measure Set: Surgical Care Improvement Project (SCIP) Set Measure I#: SCIP- Performance Measure
More informationThe dawn of hospital pay for quality has arrived. Hospitals have been reporting
Value-based purchasing SCIP measures to weigh in Medicare pay starting in 2013 The dawn of hospital pay for quality has arrived. Hospitals have been reporting Surgical Care Improvement Project (SCIP) measures
More informationImproving Compliance
Improving Compliance * The following planners, speakers, moderators, and/or panelists of this CME activity have no relevant financial relationships with commercial interests to disclose: Mary B. Johnson
More informationRisk Factor Analysis for Postoperative Unplanned Intubation and Ventilator Dependence
Risk Factor Analysis for Postoperative Unplanned Intubation and Ventilator Dependence Adam P. Johnson MD, MPH, Anisha Kshetrapal MD, Harold Hsu MD, Randi Altmark RN, BSN, Herbert E Cohn MD, FACS, Scott
More informationExpedition: Improving Safety and Reliability for Surgical Procedures
These presenters have nothing to disclose Expedition: Improving Safety and Reliability for Surgical Procedures Session 5 William Berry, MD, MPA, MPH, FACS Kathy Duncan, RN January 23, 2014 Expedition Coordinator
More informationHow do we know the surgical checklist is making a meaningful. impact in surgical care? Virginia Flintoft, MSc, BN Vancouver, BC March 9, 2010
How do we know the surgical checklist is making a meaningful impact in surgical care? Virginia Flintoft, MSc, BN Vancouver, BC March 9, 2010 1 Show Me the Evidence You simply have to MEASURE! 2 Why Measure?
More information4/10/2013. Learning Objective. Quality-Based Payment Models
Creating Best in Class Perioperative Services under Accountable Care and Value- Based Purchasing Becker s Healthcare Jeffry Peters Learning Objective How ACA/VBP changes how we measure surgical services
More informationEnsuring Your Surgical Service Line is Successful in an ACO Value-Based Purchasing and Bundled Payment Environment
Ensuring Your Surgical Service Line is Successful in an ACO Value-Based Purchasing and Bundled Payment Environment Jeffry Peters, President Surgical Directions, LLC Joseph Bosco, MD Associate Professor;
More information1/10/2012. Objectives. Normothermia as a SSI Reduction Tool. Disclosure. Darin Prescott, MSN, MBA, RN,BC, CNOR, CASC
Normothermia as a SSI Reduction Tool Darin Prescott, MSN, MBA, RN,BC, CNOR, CASC Disclosure Arizant Healthcare Inc., a 3M company Objectives Describe the impact of hypothermia on perioperative patient
More informationFINAL RECOMMENDATION REGARDING MODIFYING THE QUALITY- BASED REIMBURSEMENT INITIATIVE AFTER STATE FY 2010
FINAL RECOMMENDATION REGARDING MODIFYING THE QUALITY- BASED REIMBURSEMENT INITIATIVE AFTER STATE FY 2010 Health Services Cost Review Commission 4160 Patterson Avenue Baltimore, MD 21215 (410) 764-2605
More informationCarol J. Peden BSC, MB ChB, MD, FRCA, FFICM, MPH Royal United Hospital, Bath
Carol J. Peden BSC, MB ChB, MD, FRCA, FFICM, MPH Royal United Hospital, Bath Up to 25,000 surgical deaths per year 5-10% of surgical cases are high risk 79% of deaths occur in the high risk group Overall
More informationTeamwork, Communication, Briefing, Checklists, & O.R. Safety
Teamwork, Communication, Briefing, Checklists, & O.R. Safety E. Patchen Dellinger, MD, FACS Professor of Surgery, Chief of General Surgery, Chief of Staff, University of Washington Medical Center (UWMC),
More informationK-HEN Acute Care/Critical Access Hospitals Measures Alignment with PfP 40/20 Goals AEA Minimum Participation Full Participation 1, 2
Outcome Measure for Any One of the Following: Outcome Measures Meeting Either A or B: Adverse Drug Events (ADE) All measures are surveillance data Hospital Collected Anticoagulant (ADE-12) Opioid (ADE-111)
More informationPerioperative Surgical Home
None Disclosures Debnath Chatterjee, M.D. Associate Professor of Anesthesiology CRASH 2015 - Vail, Colorado 2 Learning Objectives What is the PSH model? Describe the concept of the Perioperative Surgical
More informationSCIP. Surgical Care Improvement Project. Making Surgeries Safer. By: Roshini Mathew, RN
SCIP Surgical Care Improvement Project Making Surgeries Safer By: Roshini Mathew, RN Importance Hospitals could prevent 13,000 patient deaths and 271,000 surgical complications each year 4 measures are
More informationROLE OF THE ANESTHETIST IN ORGANIZING AMBULATORY SURGERY. Dr. Paul Vercruysse M.D. Belgium
ROLE OF THE ANESTHETIST IN ORGANIZING AMBULATORY SURGERY Dr. Paul Vercruysse M.D. Belgium DISCLOSURES - Conflicts of interest? I am an anesthesiologist... TRADITIONAL ROLE OF THE ANESTHESIOLOGIST EVOLVING
More informationTHE AMERICAN BOARD OF ANESTHESIOLOGY
THE AMERICAN BOARD OF ANESTHESIOLOGY 4208 Six Forks Road, Suite 1500 Raleigh, NC 27609-5765 Phone: (866) 999-7501 Fax: (866) 999-7503 Website: www.theaba.org MOCA PART 4: IMPROVEMENT IN MEDICAL PRACTICE
More informationPrinciples In developing these recommendations the Consensus Panel first established the following principles for anesthesia outcomes capture:
Outcomes of Anesthesia: Core Measures The following Core Measures are the consensus recommendations of the Anesthesia Quality Institute (AQI) and the Multicenter Perioperative Outcomes Group (MPOG). They
More informationSCIP-Inf-2, SCIP-Inf-3, SCIP-Inf-4, SCIP-Inf- 9, SCIP-Inf-10, SCIP-VTE-1, SCIP-VTE-2 Anesthesia End Time 5
Release Notes: Alphabetical Data Dictionary Version 3.3 Surgical Care Improvement Project (SCIP) - Data Dictionary The General Abstraction Guidelines explain the different sections of the data element
More informationNoCVA SSI/VTE Safe Surgery Collaborative
NoCVA SSI/VTE Safe Surgery Collaborative Orientation Webinar #3 Measures and Data Collection July 19, 2012 Presented by: Jan Mangun, MT(ASCP), MSA, CPHRM Executive Director, Quality and Patient Safety
More informationMeasure Abbreviation: TEMP 03 (MIPS 424)*
Measure Abbreviation: TEMP 03 (MIPS 424)* *TEMP 03 is built to the specification outlined by the Merit Based Incentive Program (MIPS) 424: Perioperative Temperature Management measure. MIPS measure specifications
More informationPatient Selection, Optimization and Disposition: Tools for Success in Orthopedic Bundles
Patient Selection, Optimization and Disposition: Tools for Success in Orthopedic Bundles Luann Tammany Tribus, PT, MBA SVP, Clinical Strategy & Innovation Remedy Partners John Kilgore, MD Orthopedic Surgeon
More informationCombined SSI Bundles and ERAS in Colorectal Surgeries
Combined SSI Bundles and ERAS in Colorectal Surgeries Joy Lanfranchi BSN, RN, CNOR, CMLSO Richard Bollin Jr. M.D. Kevin Kinzinger M.D. MBA, FACS, FASCRS Joanne Bonnot MSN, RN, BBA, NE-BC Claudia Skinner
More informationImproving Hospital Performance Through Clinical Integration
white paper Improving Hospital Performance Through Clinical Integration Rohit Uppal, MD President of Acute Hospital Medicine, TeamHealth In the typical hospital, most clinical service lines operate as
More informationWashington Patient Safety Coalition & Surgical Public Health:
Washington Patient Safety Coalition & Surgical Public Health: Surgical Quality in Washington State (SCOAP- Surgical Care and Outcomes Assessment Program), Surgical Safety, and the Introduction of the WHO/SCOAP
More informationORs in facilities that adopted team training had a lower rate of deaths for
Patient safety VA study shows fewer patient deaths after OR team training ORs in facilities that adopted team training had a lower rate of deaths for surgical patients than facilities that had not yet
More informationENVIRONMENT Preoperative evaluation clinic, Preoperative holding area. Preoperative evaluation clinic, Postoperative care unit, Operating room
Goals and Objectives, Main Operating Room Anesthesia, VAMC, CA-3 year UCSD DEPARTMENT OF ANESTHESIOLOGY OPERATING ROOM CLINICAL ANESTHESIA AT VAMC GOALS AND OBJECTIVES, CA-3 YEAR PATIENT CARE: To provide
More informationCost Effectiveness of Physician Anesthesia J.P. Abenstein, M.S.E.E., M.D. Mayo Clinic Rochester, MN
Mayo Clinic Rochester, MN Introduction The question of whether anesthesiologists are cost-effective providers of anesthesia services remains an open question in the minds of some of our medical colleagues,
More informationObjectives. Integrating Performance Improvement with Publicly Reported Quality Metrics, Value-Based Purchasing Incentives and ISO 9001/9004
Integrating Performance Improvement with Publicly Reported Quality Metrics, Value-Based Purchasing Incentives and ISO 9001/9004 Session: C658 2013 ANCC National Magnet Conference Thursday, October 3, 2013
More informationMeasure Abbreviation: TEMP 03 (MIPS 424)*
Measure Abbreviation: TEMP 03 (MIPS 424)* *TEMP 03 is built to the specification outlined by the Merit Based Incentive Program (MIPS) 424: Perioperative Temperature Management measure. MIPS measure specifications
More informationUsing the American College of Surgeons Strong for Surgery Toolkit to Optimize Patients for Surgery
Using the American College of Surgeons Strong for Surgery Toolkit to Optimize Patients for Surgery April 2018 1 A partnership of the Healthcare Association of New York State and the Greater New York Hospital
More informationRecommendation II. Recommendation I. Who s on Your Team? Recommendation III
Infection Prevention In the Surgical Suite Janie Kinsey, RN, CASC Administrator, St. Luke s South Surgery Center President, Kansas Association of Ambulatory Surgery Centers Objectives Recommendation I
More informationSurgical Care Improvement Project
Safer Surgeries: Surgical Care Improvement Project Leslie N. Ray Ph.D., RN Oregon Patient Safety Commission Ruth Medak, MD Acumentra Health What is SCIP? National effort to decrease preventable surgical
More informationCA-3 Curriculum for Cardiac Anesthesia West Virginia University Department of Anesthesiology
CA-3 Curriculum for Cardiac Anesthesia West Virginia University Department of Anesthesiology Description of Rotation or Educational Experience This rotation is a continuation of the CA-2 Cardiothoracic
More informationEffect of Colon Bundle Implementation in a Community Hospital. Michael Barringer, MD, FACS CHS Cleveland
Effect of Colon Bundle Implementation in a Community Hospital Michael Barringer, MD, FACS CHS Cleveland Doug Hobson, MD, Surgeon Champion Mike Barringer, MD, Surgeon Champion No Disclosures Except for
More informationCanadian Surgical Site Infection Prevention Audit Month
Canadian Surgical Site Infection Prevention Audit Month February 2016 CONTENTS KEY FACTS...3 SSI PREVENTION AUDIT RESULTS...3 BACKGROUND...4 METHODOLOGY...4 Data Scores... 5 How to Interpret the Indicator
More informationPatient Safety in Resource Poor Settings
Patient Safety in Resource Poor Settings Global Opportunities (MIT April 8, 2011) Pedro Delgado, Executive Director Institute for Healthcare Improvement www.ihi.org 1 Safe, Timely, Effective, Efficient,
More informationIntroduction to Perioperative Nursing
C H A P T E R 1 Introduction to Perioperative Nursing LEARNER OBJECTIVES 1. Define the three phases of the surgical experience. 2. Describe the scope of perioperative nursing practice. 3. Discuss application
More informationOrganizational Culture Change Results in Improvement in Outcomes, Value and Experience. Elizabeth C. Wick, M.D.
Organizational Culture Change Results in Improvement in Outcomes, Value and Experience Elizabeth C. Wick, M.D. Objectives To describe the burden and complexity of surgical site infections To outline the
More informationMalpractice Litigation & Human Errors. National Practitioners Data Bank. Judging Clinical Competence. Judging Physician Competence.
Judging Clinical Competence Robert S. Lagasse, MD Professor & Vice Chair Quality Management & Regulatory Affairs Department of Anesthesiology Yale School of Medicine New Haven, CT 64 th Annual Postgraduate
More informationKANSAS SURGERY & RECOVERY CENTER
Hospital Reporting Period for Clinical Process Measures: Fourth Quarter 2012 through Third Quarter 2013 Discharges Page 2 of 13 Hospital Quality Measures Your Hospital Aggregate for All Four Quarters 10
More informationQUALITY NET REPORTING
5/18/15% A webinar series that keeps you in the know Brought to you by Progressive QUALITY NET REPORTING Sarah Martin, MBA, RN, CASC Progressive Huddle May 18, 2015 ASCQR ASC Quality Reporting started
More information2010 PQRI REPORTING OPTIONS FOR INDIVIDUAL MEASURES: CLAIMS, REGISTRY
Measure #193: Perioperative Temperature Management 2010 PQRI REPTING OPTIONS F INDIVIDUAL MEASURES: CLAIMS, REGISTRY DESCRIPTION: Percentage of patients, regardless of age, undergoing surgical or therapeutic
More informationPRE OPERATIVE MANAGEMENT FOR PEDIATRIC HOSPITALISTS
Before the Operating Room: PRE OPERATIVE MANAGEMENT FOR PEDIATRIC HOSPITALISTS Presenters: Anjna Melwani, MD Sonaly McClymont, MD David Rappaport, MD Sarah Denniston, MD David Pressel, MD Amy Vinson, MD
More informationChasing Zero Infections Coaching Call Strategies to Reduce Surgical Site Infections March 14, 2018
Chasing Zero Infections Coaching Call Strategies to Reduce Surgical Site Infections March 14, 2018 Agenda Welcome & FHA Mission to Care HIIN Trends and Progress: Surgical Site Infections Cheryl Love, RN,
More informationAre You Preventing Surgical Site Infections? No Outcome, No Income
Are You Preventing Surgical Site Infections? No Outcome, No Income Dale Bratzler, DO, MPH Kathy Haig, RN Frances Griffin, RRT, MPA Jennifer Dingman Hayley Burgess, PharmD Charles Denham, MD February 25,
More informationChinwe Nwosu, GE/NMF Scholar Supervisor: Dr. Stephen Ttendo, Senior Lecturer/ Head of Department of Anesthesia
Chinwe Nwosu, GE/NMF Scholar Supervisor: Dr. Stephen Ttendo, Senior Lecturer/ Head of Department of Anesthesia According to the Uganda Ministry of Health 2010 Clinical Guidelines Read the notes/ medical
More information3 SCIP-Inf-2, SCIP-Inf-3, SCIP-Inf-4, SCIP-Inf-9, SCIP-Inf-10, SCIP-VTE-1, SCIP-VTE-2 Anesthesia End Time
Release Notes: Alphabetical Data Dictionary Version 3.0b Surgical Care Improvement Project (SCIP) - Data Dictionary The General Abstraction Guidelines explain the different sections of the data element
More informationMeasuring Harm. Objectives and Overview
Patient Safety Research Introductory Course Session 3 Measuring Harm Albert W Wu, MD, MPH Former Senior Adviser, WHO Professor of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health
More informationPatient Safety Research Introductory Course Session 3. Measuring Harm
Patient Safety Research Introductory Course Session 3 Measuring Harm Albert W Wu, MD, MPH Former Senior Adviser, WHO Professor of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health
More informationQuality Care Amongst Clinical Commotion: Daily Challenges in the Care Environment
Quality Care Amongst Clinical Commotion: Daily Challenges in the Care Environment presented by Sherry Kwater, MSM,BSN,RN Chief Nursing Officer Penn State Hershey Medical Center Objectives 1. Understand
More informationActionable Patient Safety Solution (APSS) #2C: SURGICAL SITE INFECTIONS (SSI)
Actionable Patient Safety Solution (APSS) #2C: SURGICAL SITE INFECTIONS (SSI) Executive Summary Checklist In order to establish a program to reduce surgical site infections (SSIs) the following implementation
More informationSCORING METHODOLOGY APRIL 2014
SCORING METHODOLOGY APRIL 2014 HOSPITAL SAFETY SCORE Contents What is the Hospital Safety Score?... 4 Who is The Leapfrog Group?... 4 Eligible and Excluded Hospitals... 4 Scoring Methodology... 5 Measures...
More informationMedicare Value Based Purchasing August 14, 2012
Medicare Value Based Purchasing August 14, 2012 Wes Champion Senior Vice President Premier Performance Partners Copyright 2012 PREMIER INC, ALL RIGHTS RESERVED Premier is the nation s largest healthcare
More informationNEW JERSEY HOSPITAL PERFORMANCE REPORT 2012 DATA PUBLISHED 2015 TECHNICAL REPORT: METHODOLOGY RECOMMENDED CARE (PROCESS OF CARE) MEASURES
NEW JERSEY HOSPITAL PERFORMANCE REPORT 2012 DATA PUBLISHED 2015 TECHNICAL REPORT: METHODOLOGY RECOMMENDED CARE (PROCESS OF CARE) MEASURES New Jersey Department of Health Health Care Quality Assessment
More informationEnhanced Recovery in NSQIP (ERIN): an update on the collaborative. Julie Thacker, LianeFeldman, and Julia Berian ACS NSQIP National Conference 2015
Enhanced Recovery in NSQIP (ERIN): an update on the collaborative Julie Thacker, LianeFeldman, and Julia Berian ACS NSQIP National Conference 2015 No disclosures ERIN, ERAS, and ERP ERIN-Enhanced Recovery
More informationEHR Enablement for Data Capture
EHR Enablement for Data Capture Baylor Scott & White (15 min) Bonnie Hodges, RN University of Chicago Medicine(15 min) Susan M. Sullivan, RHIA, CPHQ Kaiser Permanente (15 min) Molly P. Clopp, RN Tammy
More informationRobert J. Welsh, MD Vice Chief of Surgical Services for Patient Safety, Quality, and Outcomes Chief of Thoracic Surgery William Beaumont Hospital
Robert J. Welsh, MD Vice Chief of Surgical Services for Patient Safety, Quality, and Outcomes Chief of Thoracic Surgery William Beaumont Hospital Royal Oak, Michigan, USA 1 ARE OUR OPERATING ROOMS SAFE?
More informationOver the past decade, the number of quality measurement programs has grown
Performance improvement Surgeon sees standardization and data as keys to higher value healthcare Over the past decade, the number of quality measurement programs has grown exponentially as hospitals respond
More informationWebinar: Practical Approaches to Improving Patient Pre-Op Preparation
Webinar: Practical Approaches to Improving Patient Pre-Op Preparation Your Presenters Michael Hicks, MD, MBA, FACHE Chief Executive Officer EmCare Anesthesia Services Lisa Kerich, PA-C Vice President Clinical
More informationReducing the Risk of Wrong Site Surgery
Joint Commission Center for Transforming Healthcare Reducing the Risk of Wrong Site Surgery Wrong Site Surgery Project Participants The Joint Commission s Center for Transforming Healthcare aims to solve
More informationWorking together to improve health care quality, outcomes, and affordability in Washington State. Coronary Artery Bypass Graft Surgical Bundle
Working together to improve health care quality, outcomes, and affordability in Washington State. Coronary Artery Bypass Graft Surgical Bundle TBD 2015 The intent of the Coronary Artery Bypass Graft Surgical
More informationPSI 12 - Perioperative Pulmonary Embolism or Deep Vein Thrombosis Rate Opportunity
MAY 2018 A MESSAGE FROM THE SAINT LUKE S CARE CMO Table of Contents PSI 12 - Perioperative Pulmonary Embolism or Deep Vein Thrombosis Rate Opportunity 1,2 NEW Order Sets & Documents 3 Saint Luke s Care
More informationEnhanced Recovery After Surgery in OB/GYN
Enhanced Recovery After Surgery in OB/GYN Audra Williams, MD Ashley Wright, MD University of Alabama at Birmingham Department of OB/GYN Women s Reproductive Healthcare Division Outline Brief background
More informationWelcome and Instructions
Welcome and Instructions For audio, join by telephone at 877-594-8353, participant code 56350822# Your line is OPEN. Please do not use the hold feature on your phone but do mute your line by dialing *6.
More information2014 Partnership in Prevention Award. November 21, :00-1:00PM EST. Introduction
2014 Partnership in Prevention Award November 21, 2014 12:00-1:00PM EST Introduction Don Wright, MD, MPH Deputy Assistant Secretary for Health (Disease Prevention and Health Promotion) U.S. Department
More informationValue-based incentive payment percentage 3
Report Run Date: 07/12/2013 Hospital Value-Based Purchasing Value-Based Percentage Payment Summary Report Page 1 of 5 Percentage Summary Report Data as of 1 : 07/08/2013 Total Score Facility State National
More informationMinnesota Statewide Quality Reporting and Measurement System: Appendices to Minnesota Administrative Rules, Chapter 4654
Minnesota Statewide Quality Reporting and Measurement System: Appendices to Minnesota Administrative Rules, Chapter 4654 Minnesota Department of Health October 2011 Division of Health Policy Health Economics
More informationSSI bundle reduces post-cesarean sections infections by 84% Infection Control Weekly Monitor, May 5, 2010
USE OF BUNDLE TO PREVENT SURGICAL SITE INFECTIONS IN COLORECTAL SURGERY: THE MODEL OF PIEMONTE HOSPITALS Massimiliano Caccetta, Pier Angelo Argentero*, Enzo Carlo Farina**, Silvia Romagnoli, Carla Maria
More informationCHALLENGES TO IMPROVE PATIENT SAFETY IN THE OPERATING ROOM
CHALLENGES TO IMPROVE PATIENT SAFETY IN THE OPERATING ROOM Rouba Rassi El-Khoury, Pharm.D, M.Sc, MBA HM Quality Director, Hôtel-Dieu de France University Medical center President of the LSQSH The 9th Congress
More informationHRET HIIN Surgical Site Infection (SSI) Guidance to Prevent Surgical Site Infections in the Era of Unresolved Issues June 29, 2017
HRET HIIN Surgical Site Infection (SSI) Guidance to Prevent Surgical Site Infections in the Era of Unresolved Issues June 29, 2017 1 WELCOME AND INTRODUCTIONS Elizabeth Ross, MPH, Program Manager HRET
More informationAugust 1, 2012 (202) CMS makes changes to improve quality of care during hospital inpatient stays
DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services Room 352-G 200 Independence Avenue, SW Washington, DC 20201 FACT SHEET FOR IMMEDIATE RELEASE Contact: CMS Media Relations
More informationBUILDING THE PATIENT-CENTERED HOSPITAL HOME
WHITE PAPER BUILDING THE PATIENT-CENTERED HOSPITAL HOME A New Model for Improving Hospital Care Authors Sonya Pease, MD Chief Medical Officer TeamHealth Anesthesia Kurt Ehlert, MD National Director, Orthopaedics
More informationBeth Israel Deaconess Medical Center Perioperative Services Manual. Guidelines for Perioperative Handoffs from OR to receiving units.
Beth Israel Deaconess Medical Center Perioperative Services Manual Title: Guidelines for Perioperative Handoffs from OR to receiving units. Policy #: PSM 100-102A Purpose: This guideline provides a standard
More informationReducing Surgical Site Infections in Colon Surgery Patients
Reducing Surgical Site Infections in Colon Surgery Patients Mercy Health St. Elizabeth Boardman Hospital A Catholic healthcare ministry serving Ohio and Kentucky Mercy Health St. Elizabeth Boardman Hospital
More informationThe How to Guide for Reducing Surgical Complications
The How to Guide for Reducing Surgical Complications Post operative wound (surgical site) infections Maintaining perioperative normothermia Main contacts for Reducing Surgical Complications Campaign Director:
More informationPreoperative Clinic Waiting
Preoperative Clinic Waiting This talk includes many similar slides Paging through produces animation View with Adobe Reader for mobile: ipad, iphone, Android Slides were tested using Adobe Acrobat You
More informationEnhancing Patient Safety through Team Work and Communication Strategies
Enhancing Patient Safety through Team Work and Communication Strategies St. Joseph Medical Center- Towson Maryland Program/Project Description. In July 2009, Catholic Health Initiatives, of which St Joseph
More informationMedicare Value-Based Purchasing for Hospitals: A New Era in Payment
Medicare Value-Based Purchasing for Hospitals: A New Era in Payment Daniel J. Hettich March, 2012 I. Introduction: Evolution of Medicare as a Purchaser Cost reimbursement rewards furnishing more services
More informationQuality Payment Program Year 2: 2018 MIPS Participation. An Introductory Guide for CRNAs in 2018
Quality Payment Program Year 2: 2018 MIPS Participation An Introductory Guide for CRNAs in 2018 Quality Payment Program (QPP) The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) established
More informationTranslating Evidence to Safer Care
Translating Evidence to Safer Care Patient Safety Research Introductory Course Session 7 Albert W Wu, MD, MPH Former Senior Adviser, WHO Professor of Health Policy & Management, Johns Hopkins Bloomberg
More informationNOTE: New Hampshire rules, to
NOTE: New Hampshire rules, 309.01 to 309.08 Email Request: Selected Items in Table of Contents: (8) Time Of Request: Sunday, August 07, 2011 18:11:07 EST Send To: MEGADEAL, ACADEMIC UNIVERSE UNIVERSITY
More informationBundled Payments to Align Providers and Increase Value to Patients
Bundled Payments to Align Providers and Increase Value to Patients Stephanie Calcasola, MSN, RN-BC Director of Quality and Medical Management Baystate Health Baystate Medical Center Baystate Health Is
More informationImpact of Regional Anesthesia on Quality, Cost and Patient Satisfaction: Minor Changes, Immediate Impact. April 26, :15 p.m.
Impact of Regional Anesthesia on Quality, Cost and Patient Satisfaction: Minor Changes, Immediate Impact April 26, 2011 2:15 p.m. EST Hugh Morgan Director, Quality Assurance John LaFratta Corporate Training
More informationSPECIAL ARTICLES Guideline for Prevention of Surgical Site Infection, 1999
SPECIAL ARTICLES Guideline for Prevention of Surgical Site Infection, 1999 Alicia J. Mangram, MD; Teresa C. Horan, MPH, CIC; Michele L. Pearson, MD; Leah Christine Silver, BS; William R. Jarvis, MD; The
More informationCare Coordination What Matters
Care Coordination What Matters Researchers, Improvers, Providers, Patients and Caregivers Jane Brock, MD, MSPH Telligen 2 A little background how did we get here? Transitional care/care coordination A
More informationOptimal Resources for Children s Surgical Care. Keith T. Oldham, MD. ACS Quality and Safety Conference New York, New York July 22, 2017
Optimal Resources for Children s Surgical Care The American College of Surgeons Children s Surgery Verification Quality Improvement Program Keith T. Oldham, MD ACS Quality and Safety Conference New York,
More informationMinnesota Statewide Quality Reporting and Measurement System: Appendices to Minnesota Administrative Rules, Chapter 4654
This document is made available electronically by the Minnesota Legislative Reference Library as part of an ongoing digital archiving project. http://www.leg.state.mn.us/lrl/lrl.asp Minnesota Statewide
More informationBeth Israel Deaconess Medical Center Department of Anesthesia, Critical Care, and Pain Medicine Rotation: Post Anesthesia Care Unit (CA-1, CA-2, CA-3)
Beth Israel Deaconess Medical Center Department of Anesthesia, Critical Care, and Pain Medicine Rotation: Post Anesthesia Care Unit (CA-1, CA-2, CA-3) Goals GOALS AND OBJECTIVES To analyze and interpret
More informationTHE ROLE OF THE APP IN CARDIAC SURGERY. Mark Morosco PA-c Chief PA cardiac surgical services Southcoast Hospital Group Fall River,MA
THE ROLE OF THE APP IN CARDIAC SURGERY Mark Morosco PA-c Chief PA cardiac surgical services Southcoast Hospital Group Fall River,MA OBJECTIVES Who are APPs PA history Np history APP advancement of clinical
More informationEffectiveness of a care bundle to reduce surgical site infections in patients having open colorectal surgery
COLORECTAL SURGERY Ann R Coll Surg Engl 2016; 98: 270 274 doi 10.1308/rcsann.2016.0072 Effectiveness of a care bundle to reduce surgical site infections in patients having open colorectal surgery J Tanner
More information