ABSTRACT
OBJECTIVE: To evaluate the impact of regionalization on the outcomes of 16 surgical procedures performed in the Capital Health Region (Edmonton) of Alberta. DESIGN: A computer search of hospital discharge abstracts coded for the Canadian Institute for Health Information. SETTING: Two major hospitals in Edmonton. PATIENTS: The study population comprised 9250 patients (9727 procedures [4524, pre-regionalization, 5203 post-regionalization]) who underwent any of 16 major procedures in the 2 years before and the 2 years after restructuring. OUTCOME MEASURES: Demographic data, Charlson's comorbidity index, number of urgent and emergent cases, death rate, average length of hospital stay and the readmission rate. RESULTS: The post-regionalization patient group was slightly older, had a higher comorbidity index, and fewer urgent and emergent cases. The case volume increased by 15%, and 43.6% of patients used some form of community-based health care services. The median length of hospital stay decreased from 8.0 days pre-regionalization to 7.0 days post-regionalization (p < 0.001). Overall and for specific procedures the death rate was unchanged (3.1% pre-regionalization, 2.4% post-regionalization, p = 0.06). The readmission rates were similar for both groups (8.0% versus 7.0%). CONCLUSIONS: The consolidation of these 16 major surgical procedures had minimal impact on death and readmission rates even though patients in the post-regionalization group were slightly older and had greater comorbidity. There was a significant decline in the length of hospital stay, which occurred nationally over the same period, and a corresponding increase in the use of community-based services.
Subject(s)
Outcome Assessment, Health Care/statistics & numerical data , Regional Medical Programs/organization & administration , Surgical Procedures, Operative/statistics & numerical data , Adult , Aged , Alberta , Comorbidity , Delivery of Health Care, Integrated , Female , Hospitals, Community/organization & administration , Hospitals, University/organization & administration , Humans , Length of Stay/statistics & numerical data , Male , Middle Aged , Odds Ratio , Patient Readmission/statistics & numerical dataABSTRACT
This article presents a comprehensive review of neuromuscular blocking agents and their uses in the emergency department. These medicines are divided into two categories: depolarizing relaxants (including succinylcholine and decamethonium) and nondepolarizing relaxants (including d-tubocurarine, pancuronium, atracurium, and vecuronium). Also reviewed are pharmaco-kinetics, toxicity, and principal applications of these important agents.
