A department of surgery looks at outcomes.

Quality screens for care of surgical patients were selected and implemented in 1993 by a department in a moderate-sized community hospital. The screens were selected so that assessment might be made of all surgical care and that each surgeon annually might know results compared to peers. There were 127 quality screen failures (2.3%) in 5,615 surgical patients. The incidence of wound infection was 0.1%. Twenty-seven of the screen failures (21.3%) were confirmed by peer review. Issues of quality of care in the confirmed screen failures were resolved by letter or morbidity/mortality conference. The approach merits replication.

Small area analysis shows differences in utilization.

Adjusted admission rates for respiratory distress (COPD, asthma, bronchitis, and pneumonia) varied up to 3.09-fold between the highest and lowest hospital market areas in 1986 for the state of Ohio. Reasons for the variability can be determined through small area analysis techniques with the help of area physicians. Substantial improvements in the availability, delivery, and cost of respiratory care would reasonably be anticipated as a result of such analysis and feedback.

Recidivism in the management of medical back pain.

One Ohio hospital underwent three years of 100% focused review of admissions for medical back problems (DRG 243) due to excessive numbers of admissions previously noted. On cessation of the focused review, the volume of admissions rose at this hospital, and the admission denial rate increased. Reinstitution of focused review appeared to decrease the number of admissions, but did not affect the rate of admission denials.

Primary repair in transection of duodenum with avulsion of the common duct.

In combined pancreatoduodenal trauma, the surgeon usually chooses a diverting or resectional procedure at substantial risk. Simple closure of the duodenum and transposition of the common duct was accomplished at early operation in an 18-year-old boy who had almost complete transection of the duodenum with avulsion of the ampulia of Vater from blunt abdominal trauma. Transgastrojejunostomy and use of Chaffin tubes were discontinued prior to discharge from the hospital three weeks later. The postoperative course was complicated only by a brief pancreatitis. The excellent result persists more than two years later. In similar anatomic situations, consideration might be given to this operative approach.