The development and implementation of a postfall template to improve the content of provider documentation related to falls in the hospital setting.

Patient falls are the focus of many hospital prevention and continuous improvement initiatives. This is due to the potential negative impact on patient quality and safety outcomes, cost of care, and litigation risk. The published literature includes an abundance of information regarding fall-prevention programs; however, there is a gap in the knowledge base pertaining to implications of what is documented by providers (physicians, nurse practitioners, physician assistants). There is concern that inadequate documentation may be associated with patient safety and quality issues. These include potential delays in the identification and treatment of fall-related injuries and increased legal risk. A routine analysis of submissions to the hospital's Safety Event Reporting System identified inconsistencies in provider postfall documentation. Because of the potential impact on patient care, safety, financial, and medical-legal implications, a project team was created to optimize the workflow and improve provider documentation as part of the comprehensive postfall program. This article describes the process of creating and implementing a postfall template to standardize and improve the content of postfall notes. The standardized template aligns with the organization's current initiatives to increase caregiver awareness of the impact of patient falls, and to improve patient safety and quality of care.

Long-term outcomes of postoperative septic arthritis after anterior cruciate ligament reconstruction.

BACKGROUND: Septic arthritis is a rare but potentially devastating complication of anterior cruciate ligament (ACL) reconstruction surgery. Several studies, including one by this group, have reported short- and medium-term outcomes, but to our knowledge there are no long-term follow-up studies. HYPOTHESIS: Postoperative septic arthritis after ACL reconstruction surgery will lead to diminished long-term outcomes compared with surgery without infectious complications, likely related to the development of arthritis. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Four of 831 consecutive patients undergoing arthroscopically guided ACL reconstruction surgeries performed by 1 surgeon were previously reported on by this group at an average follow-up of 36 months. These same patients were contacted and reevaluated. Each patient underwent a physical examination, functional testing, and subjective evaluations with the SF-36, Lysholm, International Knee Documentation Committee (IKDC), and Tegner activity scale scores. Plain film radiographs and magnetic resonance imaging (MRI) scans were analyzed by 2 musculoskeletal radiologists. RESULTS: Average follow-up time for this study was 17.9 years, and average age was 44.3 years. No other injuries or surgeries had occurred from the time of the previous study. Each patient had a decline in SF-36, Lysholm, and IKDC score, and the average Tegner score was unchanged. Average vertical hop test performance and Biodex dynamometry were both improved. The average side-to-side displacement measured via the KT-1000 arthrometer was increased. Radiographic and MRI studies revealed progression of arthritis in all patients and ACL graft rupture in 1 patient. CONCLUSION: Patients who develop septic arthritis as a complication of ACL reconstruction surgery have diminished long-term subjective, functional, and radiographic outcomes compared with historical reports of uncomplicated cases, likely related to pain from advanced arthritis. As compared with their own earlier follow-up, these patients had declines in pain-related subjective measures but remained stable or improved in both functional testing and activity-related subjective scales.

Return to play and future ACL injury risk after ACL reconstruction in soccer athletes from the Multicenter Orthopaedic Outcomes Network (MOON) group.

BACKGROUND: There is limited information on outcomes and return to play (RTP) after anterior cruciate ligament reconstruction (ACLR) in soccer athletes. PURPOSE: The purpose of this study was to (1) test the hypotheses that player sex, side of injury, and graft choice do not influence RTP and (2) define the risk for future ACL injury in soccer players after ACLR. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Soccer players in a prospective cohort were contacted to determine RTP after ACLR. Information regarding if and when they returned to play, their current playing status, the primary reason they stopped playing soccer (if relevant), and incidence of subsequent ACL surgery was recorded. RESULTS: Initially, 72% of 100 soccer athletes (55 male, 45 female) with a mean age of 24.2 years at the time of ACLR returned to soccer. At average follow-up of 7.0 years, 36% were still playing, a significant decrease compared with initial RTP (P < .0001). Based on multivariate analysis, older athletes (P = .006) and females (P = .037) were less likely to return to play. Twelve soccer athletes had undergone further ACL surgery, including 9 on the contralateral knee and 3 on the ipsilateral knee. In a univariate analysis, females were more likely to have future ACL surgery (20% vs 5.5%, P = .03). Soccer athletes who underwent ACLR on their nondominant limb had a higher future rate of contralateral ACLR (16%) than soccer athletes who underwent ACLR on their dominant limb (3.5%) (P = .03). CONCLUSION: Younger and male soccer players are more likely to return to play after ACL reconstruction. Return to soccer after ACLR declines over time. ACLR on the nondominant limb potentially places the dominant limb at risk for future ACL injury.

Hop tests correlate with IKDC and KOOS at minimum of 2 years after primary ACL reconstruction.

PURPOSE: The hypothesis of this study was that single-legged horizontal hop test ratios would correlate with IKDC, KOOS, and Marx activity level scores in patients 2 years after primary ACL reconstruction. METHODS: Individual patient-reported outcome tools and hop test ratios on 69 ACL reconstructed patients were compared using correlations and multivariable modeling. Correlations between specific questions on the IKDC and KOOS concerning the ability to jump and hop ratios were also performed. RESULTS: The triple-hop ratio was moderately but significantly correlated with the IKDC, KOOS Sports and Recreation subscale, and the KOOS Knee Related Quality of Life subscale, as well as with the specific questions related to jumping. Similar but weaker relationship patterns were found for the single-hop ratio and timed hop. No significant correlations were found for the Marx activity level or crossover-hop ratio. Multivariable modeling showed almost no significant additional contribution to predictability of the IKDC or KOOS subscores by gender, BMI, or the number of faults on either leg. CONCLUSIONS: The triple-hop test is most significantly correlated with patient-reported outcome scores. Multivariable modeling indicates that less than a quarter of the variability in outcome scores can be explained by hop test results. This indicates that neither test can serve as a direct proxy for the other; however, assessment of patient physical function by either direct report using validated outcome tools or by the hop test will provide relatively comparable data.

Efficacy of continuous intra-articular bupivacaine infusion for postoperative analgesia after anterior cruciate ligament reconstruction: a double-blinded, placebo-controlled, prospective, and randomized study.

BACKGROUND: The increasing trend toward outpatient surgery has stimulated the development of techniques focused on decreasing perioperative and postoperative pain. Pain control infusion pumps are gaining in popularity in orthopaedic procedures to control postoperative pain. HYPOTHESIS: Continuous infusion of bupivacaine via a catheter placed intra-articular into the knee after anterior cruciate ligament reconstruction using ipsilateral autograft quadrupled semitendinosus will decrease postoperative pain scores and narcotic and NSAID consumption. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: Three randomized study groups of 21 subjects were evaluated: group I, 0.25% bupivacaine infused intra-articular at 4 mL/hour for 72 hours (study); Group II, 0.9% saline infused intra-articular at 4 mL/hr for 72 hours (placebo); Group III, no intra-articular infusion catheter (control). Each subject received general anesthesia and preemptive intra-articular anesthesia. Visual analog scale pain scores and analgesic use were compiled for the 96-hour study period. RESULTS: With the exception of significantly higher total narcotic usage in the control group compared with the study group only for the time period of 48 to 72 hours, there were no other statistically significant differences between each of the study groups with respect to pain and narcotic and NSAID use for the entire study period. CONCLUSION: The continuous infusion of intra-articular bupivacaine via pain control infusion pumps after anterior cruciate ligament reconstruction using ipsilateral autograft quadrupled semitendinosus cannot be supported when postoperative visual analog scale pain scores and analgesic use are the rationale for justification.