Bilateral Acetabular Fractures Associated with Seizures: A Report of 2 Cases.

CASES: Two elderly women with significant medical comorbidities presented to a community hospital setting after new-onset generalized seizure activity while in bed without a history of trauma. Both were diagnosed by computed tomography scan with bilateral acetabular fractures. Owing to altered mental status from a postictal period, both were unable to be reliably assessed for pain, which resulted in a diagnostic delay. CONCLUSIONS: These cases highlight the importance of a proper secondary survey on mentally altered patients even without a history of significant trauma, a high index of suspicion for associated injuries in seizure patients, and the use of appropriate advanced imaging.

Impact of a Resident-Guided Rounding Initiative on the Hospital Consumer Assessment of Healthcare Providers and Systems Survey Scores in Orthopaedic Surgery Inpatients.

Patient-centered medicine is becoming the main focus of many healthcare systems, and the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is a tool used to track patient satisfaction. In this study, we evaluate the HCAHPS scores in orthopaedic surgery inpatients before and after implementation of a resident-guided rounding protocol. Analyses of the HCAHPS surveys for 154 orthopaedic surgical inpatients at one community hospital were compared 6 months before and after implementation of a resident-guided rounding initiative. Specific questions of the HCAHPS survey were analyzed using the top box, mean, and positive scores. Implementation of the rounding initiative resulted in an increase in the top box, mean, and positive scores for all questions evaluated; however, no significance was noted in the results, with the exception of the positive score for a staff cohesiveness question (P = 0.046). Physician and hospital recommendation questions showed a 5-point increase (91st to 96th percentile) compared with 42-point increase (21st to 63rd percentile) by publicly reported national data. Implementation of the rounding initiative resulted in increases in HCAHPS scores across multiple questions and domains; however, these were not significant. These results suggest that simple interventions can help increase the overall patient satisfaction and promote future investigations.