AHRQ July/August WebM&M Available

July 1, 2013    |   By: Calevir

The most recent edition of AHRQ’s Morbidity & Morality spotlight cases are now available.   This edition includes cases covering Emergency Error, Discharge Instructions in the PACU – Who Remembers, and Anesthesia: A Weighty Issue…

EMERGENCY ERROR

An incorrectly diagnosed patient condition that led to an emergency surgery, resulting in the patient’s death…

AHRQ’s Take-Aways:

  • Emergency surgery is common and carries significantly higher risk than elective surgery.
  • Emergency laparotomy is particularly high risk and carries a 30-day mortality of about 15%; mortality is significantly higher in elderly patients.
  • Diagnosis and decision making for these patients can be challenging. Senior physicians are likely to be able to do this more reliably than those with less experience.
  • Basic processes of care for these patients are frequently incomplete or omitted. Utilization of simple interventions such as checklists, formal job descriptions, and Plan-Do-Study-Act cycles can improve the reliability of care.

DISCHARGE INSTRUCTIONS IN THE PACU: WHO REMEMBERS?

A patient given verbal follow-up orders from her doctor while recovering in PACU, still groggy from anesthesia, was unable to recall the details and followed the non-specific written orders, resulting in an adverse outcome…

AHRQ’s Take-Aways:

  • Effective communication between providers, patients, families, and caregivers is a critically important aspect of patient care, which has significant implications for patient outcomes at times of transitions in care.
  • Communication with patients should be at or below a 6th grade reading level and the complexity and quantity of information should be limited.
  • Repetition and reinforcement of key information can provide patients the opportunity to receive and retain their instructions.
  • Opportunities to review (e.g., a teach-back), follow-up contact with a patient after discharge, and enhanced coordination of care with other providers may improve patient outcomes at times of transitions in care.
  • Providers should be sensitive to factors (related to the environment, patient, or themselves) that may make it difficult for a patient or family member to receive new information and consider approaches or interventions to minimize these challenges.

ANESTHESIA: A WEIGHTY ISSUE

The health risks of an obese patient under anesthesia, highlighting the potential need for obese patients to receive formal preoperative screenings for obstructive sleep apnea…

AHRQ’s Take-Aways:

  • While providing anesthesia for obese and overweight patients, whenever possible consider multimodal analgesia and minimize the use of narcotics.
  • Patients with a diagnosis of OSA should be monitored carefully prior to considering discharge to home.
  • Keep a high index of suspicion for inappropriate ventilation in the post-operative period; obese patients have a low functional residual capacity along with a high metabolic demand for oxygen.
  • For short, supine procedures, spontaneous ventilation intraoperatively may be considered in patients who have no other contraindication like reflux.

View the AHRQ WebM&M and review the cases in their entirety.

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