Improving Compliance With Evidence-Based Laboratory Testing Recommendations and Monitoring Associated Patient Outcomes.

A team comprising nursing, medical staff, and administrative leaders at an urban academic orthopedic hospital in the northeastern United States sought to revise a preoperative laboratory testing protocol based on evidence and practice guidelines. The goal was to decrease unnecessary tests by 20% without negatively affecting patient outcomes. After adding the revised protocol to the electronic health record, audits revealed that the target goal was not met and additional strategies were implemented, including educational webinars for surgeon office personnel who ordered tests, additional webinars for advanced practice professionals, and the creation of scorecards to track surgeons' progress. Overall, a downward trend in the ordering of unnecessary laboratory tests for patients without identified risks was observed, but a 20% reduction was not achieved. Surgical complications during the project were not associated with laboratory tests. Clinicians continue to use the revised preoperative laboratory testing protocol at the facility.

Are Rib Grafts Still Used for Temporomandibular Joint Reconstruction?

PURPOSE: Patients with end-stage temporomandibular joint (TMJ) pathology require TMJ reconstruction, which can be accomplished with autogenous tissue or alloplastic materials. This survey study evaluates experienced TMJ surgeons' preferences for autogenous costochondral grafts (CCGs) and/or alloplastic prostheses for TMJ reconstruction. MATERIALS AND METHODS: This cross-sectional study used an online public survey domain to query an anonymous cohort of volunteer surgeons from the American and European Societies of Temporomandibular Joint Surgeons about their TMJ reconstruction preferences. The survey questioned these surgeons' current and previous use of CCG for TMJ reconstruction, changes in practice pattern in this regard over the years, indications for CCG, and postoperative CCG outcomes. The responses were subsequently catalogued, means were calculated, descriptive statistics were analyzed, and trends were identified. RESULTS: Of 150 surgeons contacted, 92 responded to the survey. Of the respondents, 84 (91.3%) reported that they had performed total TMJ reconstruction in the past or continue to perform total TMJ reconstruction. However, only the 66 surgeons who completed the survey in its entirety were included in the analysis. Among these surgeons, 95.5% (63 of 66) reported that their current preferred method for TMJ reconstruction was an alloplastic TMJ replacement prosthesis; 86.4% (57 of 66) preferred a custom TMJ prosthesis, whereas 9.1% (6 of 66) preferred a stock TMJ prosthesis. Only 4.5% of the respondents (3 of 66) currently preferred CCG for TMJ reconstruction. CONCLUSIONS: Of the respondents, 95.5% preferred alloplastic TMJ replacement. This preference was reported based on fewer postoperative complications and more predictable outcomes using alloplastic TMJ prostheses. In cases in which CCG revision was indicated, an alloplastic TMJ prosthesis was used, indicating that surgeons should consider an alloplastic TMJ replacement device as the primary option for TMJ reconstruction for the management of most end-stage TMJ diseases.