The Impact of the 2011 Accreditation Council for Graduate Medical Education Duty Hour Reform on Quality and Safety in Trauma Care

Trauma - It is a party, but is everyone invited? A single center retrospective analysis of trauma patients at risk for early discharge after transfer

BACKGROUND

Transferred trauma patients frequently are discharged after short stays without undergoing treatments. Strategies to decrease unnecessary transfers are needed.

METHODS

We conducted a retrospective analysis of patients transferred to our level I center from 2019 to 2021. We identified patients discharged within 24 h without interventions and compared demographic, activation, injury, and mechanism of injury characteristics with patients requiring more care. A risk score was developed from these factors.

RESULTS

Of 2424 patients transferred, 463(19%) were discharged within 24 h. In an integer score, age (1 pt), Injury Severity Score (<6 = 5 pts, 7-9 = 2 pts), recreational mechanism (3 pts), no hypertension (1 pt), no diabetes (2 pts), no dementia (3 pts), chest (1 pt), external (4 pts), face (5 pts) and Head/neck trauma (2 pts) were associated with early discharge. The score stratified risk of early discharge from 4.8% (score <7) to 67% (score >15).

CONCLUSION

When prospectively validated the risk score may identify patients who can be managed without transfer.

Is It Time to Create Training Pathways Allowing Earlier Subspecialization within the "House of Orthopaedics"?: AOA Critical Issues

The ability to train an orthopaedic resident in all aspects of orthopaedics in 5 years has become increasingly difficult due to the growth in knowledge and techniques, work-hour restrictions, and reduced resident autonomy. It has become nearly universal for our residents to complete at least 1 subspecialty fellowship prior to entering practice. In some subspecialties, the skills necessary to practice competently have become difficult to master. Simply adding to the current length of training may not address these issues effectively and would add to the economic cost of residency training. Novel training pathways that allow residents to focus earlier and in greater depth on their intended subspecialty while maintaining general orthopaedic competencies can be created without lengthening training. It is time to initiate discussions about these possibilities.

Physicians' working time restriction and its impact on patient safety: an integrative review

BACKGROUND

Although shift work is a part of the physicians' routine, there is controversy on the length of shifts and adequate rest for safe professional practice. If on the one hand long working hours might have negative impact on patient safety by interfering with the psychological and physical functioning of physicians, on the other shorter working hours might impair the safety of patients due to interference with the continuity of care.

OBJECTIVE

To analyze the impact of restrictions to physicians' working hours on patient safety.

METHOD

Integrative literature review in which we surveyed studies on restriction to physicians' working time and patient safety included in databases National Library of Medicine (PubMed) and Scientific Electronic Library Online (SciELO) until May 2018. Thirty-five studies which met the inclusion criteria were included.

RESULTS

Patient safety outcomes analyzed in the included studies were mortality, adverse events, continuity of care, in-hospital complications, readmission rate and length of stay at hospital. Restriction to working time was associated with variable impact on patient safety indicators, but often did not modify their performance.

CONCLUSION

Restrictions to physicians' working time did not always improved patient safety indicators. Focusing on interventions which only seek to limit the workload of physicians might be insufficient to bring consistent improvement to patient care.