Surgery News - November 2008 - (Page 1)

VOL. 4 • NO. 11 • NOVEMBER 2008 Surgical Checklist Cut Complications, Risk of Death A trauma center could add revenue without substantially increasing the demand for its resources, said Dr. Ernest F.J. Block of the trauma program at Orlando (Fla.) Regional Medical Center. INSIDE 20/20N VISIO Med School Mix Students at racially diverse medical schools feel better prepared to provide equitable health care. • 1 2 THE Study based on 6,775 procedures. BY ROBERT FINN Else vier Global Medical Ne ws Acute Care Analysis Favors Trauma Centers B Y J E F F E VA N S Else vier Global Medical Ne ws process of transferring all nontrauma acute care surgery cases from community hospitals to trauma centers could benefit both types of institutions in the long term, according to an analysis of cases at a rural community hospital. By making such a move, a trauma center could add revenue without substantially increasing the demand for its resources, and a community hospital would no longer need to find and pay surgical specialists to be on call for patients who often are uninsured, A said Dr. Ernest F.J. Block, an ACS Fellow and medical director of the trauma program at Orlando (Fla.) Regional Medical Center. “Trauma centers have certain fixed costs that involve an operating team being there all the time [whereas] all the other hospitals are paying variable costs in the expectation that perhaps they’ll get a surgical emergency,” Dr. Block said in an interview. “If you have a small community hospital that gets one emergency surgery case every couple of days you’re now paying a lot of readiness costs.” See Acute Care • page 7 S A N F R A N C I S C O — Implementation of a simple checklist to be completed during surgical procedures reduced the overall incidence of complications by 32% and the risk of death by 46%, according to a study by the World Health Organization. The study measured adherence to six key safety measures before and after implementation of the checklist. Investigators looked at the proportion of operations in which surgeons used a pulse oximeter, took a time-out to confirm the name of the patient and the operative site, conducted an objective airway evaluation, administered antibiotics within 60 minutes before the start of the procedure, and ensured that they had intravenous access and at least 500 cc of blood available for transfusion, according to Dr. Atul A. Gawande, who shared preliminary results of the study at the annual clinical congress of the American College of Surgeons. The data are based on 6,775 operations performed at four sites in developed countries (Auckland, New Zealand; London; Seattle; and Toronto) and four in developing countries (Amman, Jordan; Ifakara, Tanzania; Manila; and New Delhi). At baseline, the eight sites varied widely in the proportion of patients who received all six safety measures. At two of the sites, none of the 675 patients received all six measures. At another, 94.2% of patients received all six measures. “You would think that these sites lined up by socioeconomics,” said Dr. Gawande, an ACS Fellow with Harvard Medical School, Boston. “But in fact, our best performance and our worst performance were seen in our richest sites.” The checklist consists of three See Checklist • page 6 ©TONY FIRRIOLO News Without a Stitch Researchers have made sutureless anastomoses on blood vessels in animals. • 6 News From the College New President Dr. John L. Cameron became the 89th President of the ACS during the Clinical Congress. • 1 4 General Surgery Diabetes Debate Experts at a recent world congress weighed the merits of bariatric surgery for type 2 diabetes. • 16 $260 Million in SBI Funds Not Used B Y A L I C I A A U LT Else vier Global Medical Ne ws VITAL SIGNS Rate of Alcohol-Related Emergency Department Visits Higher in 21- to 24-Year-Old Men (per 10,000 population) Males 184 Females 168 116 ELSEVIER GLOBAL MEDICAL NEWS 100 84 64 14-20 21-24 Age (years) 25-28 Source: 2002-2004 data, Centers for Disease Control and Prevention WA S H I N G T O N — More than $260 million in Medicaid funds set aside to pay physicians to conduct brief screening and interventions for substance abuse are practically untouched, according to federal experts in the White House Office of National Drug Control Policy. In January, the Centers for Medicare and Medicaid Services designated the matching funds for states that adopt Medicaid codes for substance abuse Screening and Brief Intervention (SBI). But so far, only nine states (Iowa, Indiana, Maine, Maryland, Minnesota, Montana, Oklahoma, Oregon, and Virginia) have begun using the codes, Bertha Madras, Ph.D., deputy director for demand re- duction at the White House Office of National Drug Control Policy (ONDCP) said at a meeting to discuss the program. Wisconsin and Washington are reimbursing for SBI in limited circumstances. The CMS established G codes for SBI in 2006 and followed with H codes. Last year, the American Medical Association established current procedural terminology codes for SBI; they SURGERY NEWS were published for the first time in the 2008 CPT manual. For CPT 99408, which involves screening and a brief intervention of 15-30 minutes, the reimbursement is $33.41. For SBI longer than 30 minutes (CPT 99409), the rate is $65.51. (See box on p. 4.) Dr. Madras did not say how much money has been reimSee SBI Funds • page 4 Presorted Standard U.S. Postage PAID Permit No. 384 Lebanon Jct. KY 60 Columbia Rd., Bldg. B Morristown, NJ 07960 CHANGE SERVICE REQUESTED

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Surgery News - November 2008 Contents News:�Without a Stitch The 20/20 Vision:�Med School Mix News From the College:�New President General Surgery: Diabetes Debate

Surgery News - November 2008

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