Abstract:
STUDY OBJECTIVE:Physician-led multidisciplinary care coordination decreases hospital-associated care needs. We aimed to determine whether such care coordination can show benefits through the posthospital discharge period for elective hip surgery. DESIGN:Time Series of prospectively recorded and historical data. SETTING:Academic tertiary care medical center and health system. PATIENTS:449 patients undergoing elective primary hip surgery. INTERVENTIONS:For the intervention group we redesigned care with a comprehensive 14-16 week multidisciplinary standardized clinical pathway, the Ochsner hip arthroplasty perioperative surgical home (PSH). Essential pathway components were preoperative medical risk assessment, frailty scoring, home assessment, education and expectation setting. Collaborative team-based care, rigorous application of perioperative milestones, and proactive postoperative care coordination were key elements. MEASUREMENTS:The intervention group was compared to historical controls with regard to demographics, risk factors, quality metrics, resource utilization and discharge disposition, the primary outcomes were hospital length of stay and postacute facility utilization. MAIN RESULTS:Compared to historical controls, the intervention group had similar risk factors and the same or better quality outcomes. It had less combined skilled nursing facility (SNF) and inpatient rehabilitation facility (IRF) utilization compared to controls (16.5% vs. 27.5%). More intervention patients were discharged with home self-care compared to historical controls (10.7% vs 5.3%). During the intervention period combined SNF/IRF utilization decreased substantially from 19.8% early on, to 13.2% during a later phase. Intervention patients had fewer hospital days compared to historical controls (1.86 vs 3.34 days, respectively; P < 0.0001). CONCLUSIONS:A perioperative population management oriented care model redesign was effective in decreasing hospital days and postacute facility-based care utilization, while quality metrics were maintained or improved.
journal_name
J Clin Anesthjournal_title
Journal of clinical anesthesiaauthors
Schubert A,Patterson M,Sumrall WD,Broussard D,Dias D,Aboalfaraj A,Thomas L,Bergeron B,Brandon P,Shum L,Ravipati L,Chimento Gdoi
10.1016/j.jclinane.2020.110072subject
Has Abstractpub_date
2021-02-01 00:00:00pages
110072eissn
0952-8180issn
1873-4529pii
S0952-8180(20)31064-3journal_volume
68pub_type
杂志文章abstract::A 13-year-old girl with Goltz's (Goltz-Gorlin) syndrome (focal dermal hypoplasia) and cloacal exstrophy underwent day surgery cystoscopy. During the administration of inhalation anesthesia by mask, persistent partial upper airway obstruction was noted. Direct laryngoscopy unexpectedly showed variously sized verrucous ...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/0952-8180(91)90190-x
更新日期:1991-09-01 00:00:00
abstract:STUDY OBJECTIVE:The aim of this study was to compare the speed of anesthetic recovery and the perioperative analgesic requirements in patients who received total intravenous anesthesia (TIVA) with either remifentanil-propofol or fentanyl-propofol for lumbar spine surgery. DESIGN:Retrospective cohort study. SETTING:Op...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/j.jclinane.2015.03.024
更新日期:2015-08-01 00:00:00
abstract:STUDY OBJECTIVE:To compare the intraoperative effects and recovery characteristics when either midazolam or propofol was used for sedation during local or regional anesthesia. DESIGN:Open-label, randomized study with blinded observer assessing recovery data. SETTING:Outpatients undergoing elective surgical procedures...
journal_title:Journal of clinical anesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/0952-8180(91)90203-y
更新日期:1991-01-01 00:00:00
abstract:STUDY OBJECTIVE:To confirm the relationship between bevel orientation, catheter direction, and radiopaque contrast spread in the lumbar region. DESIGN:Pilot cadaver study. SETTING:Anatomy laboratory of a university hospital. MEASUREMENTS:Cadavers were randomized to two groups of 4 cadavers each. In Group 1, needle b...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/j.jclinane.2014.04.004
更新日期:2014-12-01 00:00:00
abstract::Two patients are presented who underwent successful combined L1 and L2 paravertebral blocks as part of an anesthetic technique for hip arthroscopy. ...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/j.jclinane.2008.04.012
更新日期:2008-09-01 00:00:00
abstract:STUDY OBJECTIVES:To determine alfentanil levels with a specific radioimmunoassay in serum and ovarian follicular fluid. DESIGN:Observational study. SETTING:University hospital. PATIENTS:14 ASA status I women undergoing oocyte retrieval for in vitro fertilization. INTERVENTIONS:General anesthesia was induced with al...
journal_title:Journal of clinical anesthesia
pub_type: 临床试验,杂志文章
doi:10.1016/0952-8180(96)00035-9
更新日期:1996-06-01 00:00:00
abstract:INTRODUCTION:There have been numerous reports studying the effect of neuraxial analgesia on breastfeeding success, but the results are inconsistent. METHODS:We performed a literature search in various databases for studies comparing neuraxial analgesia to non-neuraxial or no analgesia. Outcomes were the percentage of ...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章,评审
doi:10.1016/j.jclinane.2020.110105
更新日期:2021-02-01 00:00:00
abstract:STUDY OBJECTIVE:To compare analgesia and opioid-related side effects of intrathecal morphine and intrathecal hydromorphone after elective Cesarean delivery. DESIGN:Retrospective, comparative study. SETTING:Labor and delivery unit of an academic hospital. PATIENTS:114 parturients age ≥ 18 years, presenting for electi...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/j.jclinane.2013.01.014
更新日期:2013-08-01 00:00:00
abstract:STUDY OBJECTIVE:Perioperative fasting guidelines differ in their approaches to chewing gum in the preoperative period. Current recommendations range from canceling the surgery to proceeding with it. Given this lack of consensus, we performed gastric ultrasound assessments in healthy volunteers before and after a standa...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/j.jclinane.2019.01.021
更新日期:2019-09-01 00:00:00
abstract:STUDY OBJECTIVE:To evaluate the onset time, success rate, and recovery profile of unilateral spinal anesthesia produced with 4 mg, 6 mg, and 8 mg of 0.5% hyperbaric bupivacaine. DESIGN:Prospective, randomized, blinded study. SETTING:Outpatient anesthesia unit at a University Hospital. PATIENTS:90 ASA physical status...
journal_title:Journal of clinical anesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s0952-8180(03)00078-3
更新日期:2003-08-01 00:00:00
abstract::The anesthetic management of a parturient with a circulating lupus anticoagulant and an anticardiolipin antibody presenting to the obstetric suite taking heparin and aspirin is discussed. Issues concerning placement of a regional anesthetic with recent aspirin ingestion and heparin therapy are discussed. Documentation...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/0952-8180(95)00175-1
更新日期:1996-02-01 00:00:00
abstract:STUDY OBJECTIVE:To evaluate patient satisfaction and patient reported anaesthesia related outcome parameters after outpatient surgery. DESIGN:A three-year (2013-2016) observational study. SETTING:A surgical day care centre embedded in a tertiary care, university hospital. PATIENTS:Adult Dutch-speaking patients who u...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/j.jclinane.2017.09.007
更新日期:2017-12-01 00:00:00
abstract:STUDY OBJECTIVE:To evaluate the incidence and impact on clinical outcome of complications observed during high-frequency jet ventilation (HFJV) at interventional bronchoscopy and to identify the perioperative factors that may be associated to an increased incidence of such complications. DESIGN:Observational retrospec...
journal_title:Journal of clinical anesthesia
pub_type: 临床试验,杂志文章
doi:10.1016/j.jclinane.2005.12.011
更新日期:2006-08-01 00:00:00
abstract:STUDY OBJECTIVE:To determine the optimal time in which to make intraocular pressure (IOP) measurements in children following tracheal intubation. DESIGN:Randomized, controlled trial. SETTING:Operating rooms of a tertiary-care children's hospital. PATIENTS:Thirteen healthy children undergoing elective strabismus corr...
journal_title:Journal of clinical anesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/0952-8180(91)90226-d
更新日期:1991-07-01 00:00:00
abstract::"A professor is a gentleman with a different point of view." This characteristic and sarcastic statement was often recited by August Bier (1861-1949) and can also be aptly applied to him. As the father of spinal and intravenous regional neural blockade, Bier had a tremendous impact on surgery and anesthesia. It took h...
journal_title:Journal of clinical anesthesia
pub_type: 传,历史文章,杂志文章
doi:10.1016/s0952-8180(00)00202-6
更新日期:2000-11-01 00:00:00
abstract::A 27-year-old parturient developed a severe headache after placement of a labor epidural catheter. A presumptive diagnosis of an occult postdural puncture headache (PDPH) was made, and the patient was treated with an intravenous (IV) infusion of 500 mg of caffeine sodium benzoate (CSB) to vasoconstrict dilated cerebra...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/0952-8180(92)90121-g
更新日期:1992-01-01 00:00:00
abstract::With the advent of safety needles to prevent inadvertent needle sticks in the operating room (OR), a potentially new issue has arisen. These needles may result in coring, or the shaving off of fragments of the rubber stopper, when the needle is pierced through the rubber stopper of the medication vial. These fragments...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/j.jclinane.2013.10.007
更新日期:2014-03-01 00:00:00
abstract:OBJECTIVE:The American Society of Anesthesiologists physical status (ASA-PS) is associated with increased morbidity and mortality in the perioperative period. When surgeries are scheduled by surgeons and their staff at our large institution a presumed ASA-PS is chosen. This is because our institution (and, anecdotally,...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/j.jclinane.2017.02.002
更新日期:2017-05-01 00:00:00
abstract::Horner syndrome is considered a common finding after epidural analgesia or anesthesia in obstetric patients. Conversely, Horner syndrome is very uncommon in nonobstetric patients. We report 2 cases of Horner syndrome after attempted epidural lumbar anesthesia in 2 patients undergoing peripheral vascular surgery. Spina...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/j.jclinane.2004.09.010
更新日期:2005-09-01 00:00:00
abstract:STUDY OBJECTIVE:To quantify global coagulation and establish normal ranges for the celite-activated thrombelastograph (TEG) in healthy pediatric patients. DESIGN:Prospective observational study. SETTING:Operating suite of a university-based hospital. PATIENTS:110 healthy pediatric patients in four age groups and 25 ...
journal_title:Journal of clinical anesthesia
pub_type: 临床试验,杂志文章
doi:10.1016/s0952-8180(00)00238-5
更新日期:2001-02-01 00:00:00
abstract::Subcutaneous targeted neuromodulation has been used successfully in chronic neuropathic pain. A 26 year-old patient with severe postthoracotomy pain and ipsilateral "wing scapula" due to intraoperative injury of the long thoracic nerve, is reported. Application of targeted neuromodulation resulted in immediate pain re...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/j.jclinane.2009.10.018
更新日期:2010-12-01 00:00:00
abstract:STUDY OBJECTIVE:To evaluate patient acceptability of continued versus divided anesthetic care. DESIGN:Patient satisfaction ratings with continuous and divided anesthetic care were assessed by patient questionnaire. In addition, the effect of training anesthesia personnel in communication regarding divided anesthesia c...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/j.jclinane.2006.04.004
更新日期:2007-02-01 00:00:00
abstract:STUDY OBJECTIVE:To compare the hemodynamic effects of two different concentrations of pentastarch hydroxyethyl starch (HES; 200/0.5) solutions with a 4% human albumin solution for fluid resuscitation. DESIGN:Open-label, randomized, controlled study. SETTING:Medical-surgical intensive care unit. PATIENTS:34 consecuti...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jclinane.2008.05.022
更新日期:2008-11-01 00:00:00
abstract::In conclusion, providing anesthesia for a small child undergoing craniofacial reconstructive surgery is an enormous challenge. Even with the most experienced pediatric anesthesiologist and pediatric surgeons, problems can develop suddenly and lead, as they did in this case, to serious morbidity and even death. It is d...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/s0952-8180(97)00162-1
更新日期:1997-11-01 00:00:00
abstract:STUDY OBJECTIVE:To evaluate airway changes in patients undergoing surgery in the prone position. DESIGN:Single-arm observational study. PATIENTS:Patients between 18 to 65 years old, scheduled for prone spinal surgery; 74 patients were enrolled and 54 patients were analyzed. INTERVENTION:The initial airway examinatio...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/j.jclinane.2014.04.010
更新日期:2014-12-01 00:00:00
abstract:STUDY OBJECTIVE:To determine the optimal concentration of lidocaine that reduces pain on injection of a propofol-lidocaine mixture. DESIGN:Prospective, randomized, double-blinded, clinical investigation. SETTING:Medical center, university teaching hospital. PATIENTS:240 ASA physical status I and II female outpatient...
journal_title:Journal of clinical anesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s0952-8180(99)00040-9
更新日期:1999-06-01 00:00:00
abstract::Fibrodysplasia ossificans progressiva (FOP) is a rare disorder of the connective tissue leading to progressive tissue ossification and immobilization. Soft-tissue trauma may exacerbate this condition, causing further ossification. Multisystem involvement includes restrictive lung disease, cervical ankylosis with limit...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/j.jclinane.2010.11.004
更新日期:2011-11-01 00:00:00
abstract:STUDY OBJECTIVE:To evaluate whether alkalizing local anesthetic with sodium bicarbonate reduces pain related to infiltration of local anesthetic during dorsal penile nerve block for circumcision. DESIGN:Prospective, randomized, double-blind, controlled study. SETTING:E. Wolfson Medical Center, Holon, Israel. PATIENT...
journal_title:Journal of clinical anesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s0952-8180(99)00097-5
更新日期:1999-11-01 00:00:00
abstract:STUDY OBJECTIVE:To compare the ease of cannulation, success/failure rate, and complication rate between ulnar and radial arteries. DESIGN:Randomized, controlled study. SETTING:Operating room. PATIENTS:100 ASA physical status I, II, and III patients undergoing general anesthesia and requiring arterial cannulation. I...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jclinane.2006.10.012
更新日期:2007-05-01 00:00:00
abstract:STUDY OBJECTIVE:Breast cancer is the most common malignancy of women all over the world. In this study, we compared the effects of ultrasound-guided modified pectoral nerve (PECS) block and erector spinae plane (ESP) block on postoperative opioid consumption, pain scores, and intraoperative fentanyl need of patients un...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jclinane.2018.10.040
更新日期:2019-05-01 00:00:00