Navigation Links
Smaller hospitals can provide safe and high-quality surgical care comparable to larger counterparts

Louisville, Ky. Smaller, rural hospitals may be quicker and more efficient at implementing surgical safety initiatives than their larger, urban counterparts, and are capable of providing a standard of surgical care that is at par with major hospitals that provide a comprehensive array of care services, according to an 18-month series of studies led by researchers from the University of Louisville Department of Surgery.

"The quality and standard of care in rural and small-town America is an important issue that gets a lot of attention in the mainstream media these days, and research efforts to measure and enhance surgical quality have largely omitted smaller town hospitals that care for a very high proportion of the American population," said Hiram C. Polk, M.D., former chair of the University of Louisville Department of Surgery, and the Ben A. Reid, Sr. Professor of Surgery at UofL. "These studies sought to address some of these previously unaddressed issues."

The results of these studies were published in the July issue of the American Journal of Surgery.

The investigators used the surgical safety tool "the expanded surgical time out" as a template by which to collect their data, Polk said. This is a method by which all participants in a surgical procedure, including, in some cases, the patient, take a moment to clarify critical details about the procedure that is about to take place.

"The basic surgical time-out includes identifying the correct patient, correct surgery and correct site," said Susan Galandiuk, M.D., professor of surgery at UofL and senior investigator on the first study, which served to define the current culture regarding surgical safety and quality initiatives. "The expanded time-out looks at preoperative timing and choice of antibiotics and discontinuation of postoperative prophylactic antibiotics, additional criteria for diabetics or other ill patients, or factors that come into play if a surgery will last longer than two hours, such as measuring core temperature, monitoring blood glucose level and a clear decision about continuing beta blocker drugs postoperatively if they have been used preoperatively."

The availability of blood for transfusion in a surgery and any special instruments needed also were helpful to include on the checklist, Galandiuk said.

The studies looked at how quickly the smaller hospitals four in Kentucky and one in Indiana adopted quality improvement measures, as evidenced by the implementation of surgical time-out; whether surgical specialists were committed to accepting the quality and safety parameters outlined in the expanded surgical time-out checklist; and how the payment structure may affect quality and safety measures.

Major surgeries examined included hip and knee replacements, hysterectomy, colon resections, and hernia repairs. In all, 2,300 surgeries were examined. The researchers found that all specialties had extremely high rates of adherence to timely administration of prophylactic antibiotics within the recommended one hour before surgery.

"We also found that, although almost one quarter to one third of patients were awake during the surgical time-out, surgical time-out was implemented in more than 97 percent of all cases among the different subspecialties," Polk said.

The researchers also found that all specialties successfully avoided hypothermia in most cases, and gynecologists, especially, made appropriate choices regarding antibiotics in a majority of cases.

"Our research showed that clinicians in these rural hospitals showed an extremely high standard of care to their patients, equal to that given at urban and tertiary counterparts," Polk said. "The hospitals' willingness to commit to participating in these studies with the goal of better patient care should be commended as well."

Approximately 40 percent of Americans get their surgical care in centers that are not large, urban or tertiary care facilities and the willingness and ability of these institutions to implement quality and safety measures is incredibly important, Polk said.

"These studies, looking at representative sites in Kentucky and Indiana demonstrated that these facilities can have the resources necessary, human and otherwise, to provide high quality, safe surgical care, and the commitment to doing so," he said.


Contact: Lauren Williams
University of Louisville

Related medicine news :

1. The private sale of drugs in public hospitals
2. Most pandemic plans in Ontario hospitals have not been tested: Queens University study
3. SHARECOR Partners With Quantros, Inc. to Facilitate Core Measures and Regulatory Reporting in Louisiana Hospitals
4. Kaiser Foundation Health Plan and Hospitals Report Fourth Quarter and Fiscal Year 2009 Financial Results
5. Father Channels His Grief into Advocacy, Promotes Simple Actions to Make Hospitals Safer for Children
6. Vestara and EXP Pharmaceutical Services Corp. Announce Partnership Making Available Industry's Only Automated Pharmaceutical Waste Management Solution to over 5,000 U.S. Hospitals
7. Small to Mid-Sized Hospitals Turn to Orion Health to Implement Health IT Solutions for Improved Patient Care and Outcomes
8. Patients Do Better at Hospitals That Follow Stroke Guidelines
9. Evidence-based care and outcomes improve at Get With The Guidelines-Stroke hospitals
10. Global Hospitals and Healthcare Suppliers Focus on Cutting Costs and Improving Quality at 2010 GHX Supply Chain Summit
11. COBRAGuard Partners With THA to Offer Texas Hospitals COBRA Relief
Post Your Comments:
(Date:11/30/2015)... ... November 30, 2015 , ... World Patent Marketing ... Swappables, a household invention that provides an economical and easy way of gaining ... is growing at 2.6%," says Scott Cooper, CEO and Creative Director of World ...
(Date:11/30/2015)... ... 30, 2015 , ... CTI Group (Holdings) Inc. (OTC:CTIG), a ... communication analytics, announced today that their Proteus® VoIP QMS solution now supports Skype ... Proteus® VoIP QMS (Quality Management System) does this by collecting the ...
(Date:11/29/2015)... Orion, Clarkston, Metamora, Michigan (PRWEB) , ... ... ... Women's Excellence is once again accredited by the American Institute of Ultrasound ... process that allows practices to demonstrate that they meet or exceed nationally ...
(Date:11/29/2015)... ... ... The Cyber Monday deal is a deep 40% or more discount on every item on ... the skin care lover in your circle. Each Christmas, Sublime Beauty offers a special ... serums are staples: Collagen, Retinol and Hyaluronic Serums. , Stocking stuffers like Skin Brushes, natural ...
(Date:11/29/2015)... ... November 29, 2015 , ... Khanna Vision Institute based in Los Angeles, announced ... November 25th 2015. Peer Certification by the Board is done so the public knows ... is first obtained after the completion of three years of training or Residency in ...
Breaking Medicine News(10 mins):
(Date:11/30/2015)... HANOVER, N.J. , Nov. 30, 2015  Novartis ... portfolio at the 57 th American Society of ... leukemias, lymphomas and myelomas as well as supportive care, ... in addition to personalized cell therapies. The ASH Annual ... Orlando, Florida . Novartis Oncology . ...
(Date:11/30/2015)... , Belgium , Nov. 30, 2015 ... sciences company focused on developing blood-based diagnostic tests for a ... the Company will present at the LD Micro Conference, which ... Los Angeles, CA. Attending from VolitionRx will be ... Scott Powell , Vice President of Investor Relations. ...
(Date:11/30/2015)... , Nov. 30, 2015  Precision Image ... services, is pleased to announce a dramatic expansion ... imaging services. Building on its ISO-9001:2008 certification for ... implemented comprehensive Core Lab protocols and procedures. This ... of research activities.  Their Core Lab services include ...
Breaking Medicine Technology: