Increasing Awareness for the Opioid Aftercare Coordination Service (OACS)

Background The United States is in a crisis of opiate related adverse events. From 1999 2017, more than 700,000 people in the U.S. died from drug related overdose; 68% of those involved opioids Admissions at Jefferson Hospital for opioid abuse complications are common among the medicine services. Treating patients for their opiate addiction is essential to prevent future opioid overdoses and other complications Jefferson has initiated an Opioid Aftercare Coordination Service (OACS) consult system in response to this crisis in order to increase the number of patients who receive medications for opioid use disorder on discharge OACS serves both Jefferson Hospital and Methodist and aims to: – Link patients with medications for opioid use disorder after discharge – Provide access to ancillary resources inpatient and outpatient – Provide in hospital counselinghttps://jdc.jefferson.edu/patientsafetyposters/1122/thumbnail.jp

Critical errors in infrequently performed trauma procedures after training

Background: Critical errors increase postoperative morbidity and mortality. A trauma readiness index was used to evaluate critical errors in 4 trauma procedures. In comparison to practicing and expert surgeon benchmarks, we hypothesized that pretraining trauma readiness index including both vascular and nonvascular trauma surgical procedures can identify residents who will make critical errors. Methods: In a prospective study, trained evaluators used a standardized script to evaluate performance of brachial, axillary, and femoral artery exposure and proximal control and lower-extremity fasciotomy on unpreserved cadavers. Forty residents were evaluated before and immediately after Advanced Surgical Skills for Exposure in Trauma training, and 38 were re-evaluated 14 months later. Residents were compared to 34 practicing surgeons evaluated once 30 months after training, and 10 experts. Results: Resident trauma readiness index increased with training (P \u3c .001), remained unchanged 14 month later and was higher, with lower variance than practicing surgeons (P \u3c .05). Expert trauma readiness index was higher than residents (P \u3c .004) and practicing surgeons (P \u3c .001). Resident training decreased critical errors when evaluated immediately and 14 months after Advanced Surgical Skills for Exposure in Trauma training. Practicing surgeons had more critical errors and performance variability than residents or experts. Experts had 5 to 7 times better error recovery than practicing surgeons or residents. Trauma readiness index area under the receiver operating curve with Youden Index \u3c0.60 or \u3c6 decile in their cohort, predicts a surgeon will make a critical error. Conclusion: Low trauma readiness index was associated with critical errors occurring in all surgeon cohorts and can identify surgeons in need of remedial intervention

Cadaver-Based Trauma Procedural Skills Training: Skills Retention 30 Months after Training among Practicing Surgeons in Comparison to Experts or More Recently Trained Residents

Background: Long-term retention of trauma procedural core-competency skills and need for re-training after a 1-day cadaver-based course remains unknown. We measured and compared technical skills for trauma core competencies at mean 14 months (38 residents), 30 months (35 practicing surgeons), and 46 months (10 experts) after training to determine if skill degradation occurs with time. Technical performance during extremity vascular exposures and lower-extremity fasciotomy in fresh cadavers measured by validated individual procedure score (IPS) was the primary outcome. Study Design: We performed a prospective study between May 2013 and September 2016. Results: Practicing surgeons had lower IPS and IPS component scores (p = 0.02 to 0.001) than residents (p \u3c 0.05) and experts (p \u3c 0.002) for vascular procedures. Frequencies of errors were no different among residents and experts. Practicing surgeons made more critical errors (p \u3c 0.05) than experts or residents. Experts had shortest time to proximal vascular control. Fasciotomy procedural errors occurred in all participants. Cluster analysis of anatomy vs procedural steps identified tertiles of performance and wide variance (32.5% practicing surgeons, 26.5% residents vs 13% experts) for vascular procedures. Vascular control duration \u3e 20 minutes (n = 21) and failure to decompress fasciotomy compartments were correlated with incorrect landmarks and skin incisions. Modeling found interval trauma skills experience, not time since training, was associated with lower IPS. Conclusions: Practicing surgeons with low trauma skills experience since training had lower IPS and component scores (p = 0.02 to 0.001) and more errors compared with experts and residents (p \u3c 0.05). Surgeons, including experts with low interval experience performing trauma procedures, may benefit from refreshing of correct landmarks and skin incision placement identification

Cadaver-Based Trauma Procedural Skills Training: Skills Retention 30 Months after Training among Practicing Surgeons in Comparison to Experts or More Recently Trained Residents

Background: Long-term retention of trauma procedural core-competency skills and need for re-training after a 1-day cadaver-based course remains unknown. We measured and compared technical skills for trauma core competencies at mean 14 months (38 residents), 30 months (35 practicing surgeons), and 46 months (10 experts) after training to determine if skill degradation occurs with time. Technical performance during extremity vascular exposures and lower-extremity fasciotomy in fresh cadavers measured by validated individual procedure score (IPS) was the primary outcome. Study Design: We performed a prospective study between May 2013 and September 2016. Results: Practicing surgeons had lower IPS and IPS component scores (p = 0.02 to 0.001) than residents (p \u3c 0.05) and experts (p \u3c 0.002) for vascular procedures. Frequencies of errors were no different among residents and experts. Practicing surgeons made more critical errors (p \u3c 0.05) than experts or residents. Experts had shortest time to proximal vascular control. Fasciotomy procedural errors occurred in all participants. Cluster analysis of anatomy vs procedural steps identified tertiles of performance and wide variance (32.5% practicing surgeons, 26.5% residents vs 13% experts) for vascular procedures. Vascular control duration \u3e 20 minutes (n = 21) and failure to decompress fasciotomy compartments were correlated with incorrect landmarks and skin incisions. Modeling found interval trauma skills experience, not time since training, was associated with lower IPS. Conclusions: Practicing surgeons with low trauma skills experience since training had lower IPS and component scores (p = 0.02 to 0.001) and more errors compared with experts and residents (p \u3c 0.05). Surgeons, including experts with low interval experience performing trauma procedures, may benefit from refreshing of correct landmarks and skin incision placement identification

Endurance Sports Medicine : A Clinical Guide

Endurance Sports Medicin