The Implications of Transfer to an Acute Care Surgical Tertiary Service.

Tertiary hospitals are increasingly called on by smaller hospitals and free-standing emergency rooms (ERs) to provide surgical care for complex patients. This study assesses patients transferred to an acute care surgery service. The ER and transfer center logs, as well as billing data, were reviewed for 12 months for all cases evaluated by acute care surgery. The charts were reviewed for demographics, comorbidities, and outcomes. A total of 111 transferred patients with complete data were identified, with 59 transferred from another hospital and 52 from a free-standing ER. The hospital transfer patients were older with more comorbidities, had a longer length of stay, and were more likely discharged to skilled care. There was no difference in the percent of patients requiring a procedure; however, significantly more procedures in the hospital transfer group were done by nonsurgical specialties Better infrastructure to monitor the impact of hospital transfers is warranted in the setting of the complex patient population transferred to tertiary hospitals.

Ultrasound-guided breast biopsy for surgical residents: evaluation of a phantom model.

BACKGROUND: Ultrasound is increasingly used by surgeons for evaluation of breast lesions. While surgical residents have sufficient exposure to breast surgery, many lack exposure to office-based procedures, such as ultrasound-guided breast biopsy. A phantom model was created to teach surgical residents basic breast ultrasound and biopsy skills and to evaluate the resident's response when incorporated into the curriculum. METHODS: The model was created using a pork roast and 10 variably-sized pimento olives. Twenty-four surgical residents were given a brief introduction to breast ultrasound followed by up to 5 minutes to ultrasound the model and note the embedded lesions. The number and location of lesions found and the time spent per resident were recorded. Residents were then introduced to the vacuum-assisted core biopsy system and observed performing ultrasound-guided biopsies. Pre- and postsession evaluations were completed by all residents. Scatterplot regression models were used for data analysis. RESULTS: Most residents had previous ultrasound instruction. The intermediate level residents (postgraduate year [PGY]2 and 3) found the most lesions in the shortest time, missing on average 1.125 lesions in 3:09 minutes. Time spent did not correlate with number missed or previous ultrasound experience. Over 50% of residents sampled the center of the lesion on their first biopsy attempt, with no correlation to PGY or ultrasound experience. All residents rated this experience good to excellent, and 67% believed their ultrasound skills were improved. Ninety-five percent of residents felt the model was fairly realistic and 95% would like to have more experiences like this in the curriculum. The residents surveyed thought the curriculum would be best suited to a PGY2 experience. CONCLUSIONS: The phantom breast is a realistic and valuable teaching model for breast ultrasound. Further evaluation regarding skill retention is needed.