Prospective study of unplanned admission to the intensive care unit after total hip arthroplasty.

The morbidity associated with elective total hip arthroplasty (THA) may result in intensive care unit (ICU) admission. A total of 175 consecutive THA patients were prospectively triaged to either an ICU bed or routine post-operative floor according to admission criteria based on a prior published study of 1259 THA patients. Primary end points were a reduction in unplanned ICU admission, as well as major complications. With our triage model, the rate of unplanned ICU admissions dropped from 7.1% to 2.2% (P=0.013). The as-treated odds of unplanned admission pre- versus post-intervention were 3.2 (1.2, 10.6). The complication rate fell from 12.5% to 2%, and the mortality index decreased from 4.77 to 1.62. Triage according to selected risk factors affects a reduction in unplanned ICU admissions and major complications after THA.

The effect and durability of a pregraduation boot cAMP on the confidence of senior medical student entering surgical residencies.

OBJECTIVE: Medical school does not specifically prepare students for surgical internship. Preinternship courses are known to increase confidence in multiple key areas. We examined the immediate effect and durability of effect of a surgical pregraduation preparatory course or "boot camp" on provider confidence in technical and medical management skills. DESIGN: A 5-day boot camp was offered to senior medical students (SMS) entering surgical programs. SMS were anonymously surveyed before, after, and 6 months following the course. The same survey was given 6 months into internship to a control group of surgical interns who graduated from the same medical school but did not participate in boot camp before graduation. Data were compared between the time intervals and across cases and controls using the Wilcoxon rank-sum and signed-rank tests and the Student t test. SETTING: A joint effort between the University of Pennsylvania School of Medicine, the Department of Surgery at the Hospital of the University of Pennsylvania, and the Penn Medicine Simulation Center in Philadelphia, PA. PARTICIPANTS: All senior medical students set to graduate from a single institution entering general surgery or surgery subspecialties were offered the course. Twenty-nine students participated in the course. RESULTS: Post-boot camp confidence scores of SMS were significantly greater in all areas except placement of a peripheral intravenous catheter compared with pre-boot camp scores. Six months into internship, the SMS boot camp group felt more confident than controls in their ability to perform a cricothyroidotomy (median 2.5 vs 1.0, p = 0.04) and to insert a chest tube (median 3.3 vs 1.0, p = 0.05). Otherwise, there was no residual difference in confidence levels between the boot camp group and the controls. CONCLUSIONS: Boot camps can improve self-confidence in young doctors in many areas of perioperative care before enrolling in surgical residency. The effect is most durable in high risk, infrequently performed technical tasks. Future studies are under design to examine the impact of boot camps on the "July Effect."