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Michael A Favata

Publications and source records attributed to Michael A Favata.

4 recordsLinked to original sources
PubMed2006

Computed tomography-based clinical diagnostic pathway for acute appendicitis: prospective validation.

BACKGROUND: Despite our regular use of CT for suspected appendicitis, a recent study at our institution demonstrated a negative appendectomy (NA) rate similar to our rate 15 years earlier. Based on analysis of this data, a diagnostic pathway was implemented prospectively for adult patients with possible appendicitis. STUDY DESIGN: Rates of CT, NA, and perforation for nonpregnant patients over 14 years of age undergoing appendectomy between August 2001 and August 2002 (PRE) were compared with prospectively collected pathway data (PATH, August 2004 to August 2005). All PATH patients were evaluated by a surgeon before CT. All females underwent CT. CT was obtained in male patients with low suspicion or pain for longer than 48 hours. After negative CT, patients were discharged from the emergency department or admitted for observation. RESULTS: There was a substantial decrease in NA rate after implementation of the pathway (4% PATH [8 of 183] versus 16% PRE [31 of 196], p < 0.001), without a change in the rate of perforation (11% PATH [20 of 175] versus 8% PRE [13 of 165], p = 0.28) or frequency of preoperative CT (59% PATH [108 of 183] versus 60% PRE [118 of 196], p = 0.84). CONCLUSIONS: Frequent appendiceal CT alone does not ensure surgical diagnostic accuracy. CT need not be used in all patients to achieve very low NA rates. An evidence-based diagnostic algorithm incorporating early surgical evaluation, objective criteria for preoperative CT, deterrence of early operation after negative CT, and use of CT to facilitate safe discharge led to substantial improvements in the care of our adult population presenting with possible appendicitis.

Acute Disease↗
PubMedDate not supplied

Ancillary services in the health care industry: is Six Sigma reasonable?

Within the naval medical center construct, the disparate disciplines encompassed within ancillary services lend themselves to formal quality analysis and process improvement. This analysis uses the Six Sigma approach. Error rates were investigated and calculated for various processes within ancillary services at Naval Medical Center, San Diego. These were translated into the common metric of defects per million opportunities (DPMO). DPMO rates vary between 21.5 and 420,000. These correspond to Sigma values from 1.7 to approaching 6. Rates vary with biological complexity of the system and the degree of automation available. Some ancillary services translate well into a Six Sigma schema. Systems with high potential patient risk if performed poorly and those amenable to second checking and computer oversight may be candidates for such optimization. This should be undertaken in a local environment conducive to individual error reporting, and in a corporate environment with the will and funding to support the transition.

Ancillary Services, Hospital↗
PubMedDate not supplied

Transureteral saline perfusion to obtain renal hypothermia: potential application in laparoscopic partial nephrectomy.

BACKGROUND: Partial nephrectomy for resection of renal tumors often requires renal artery clamping and external renal cooling using ice-slush. Laparoscopic surgery precludes traditional ice-slush cooling. To facilitate renal cooling during laparoscopic partial nephrectomy, we investigated a method of intrarenal cooling by retrograde transureteral iced saline perfusion. METHODS: Open laparotomy was performed in 6 pigs. After atraumatic renal artery clamping, one kidney was cooled externally by using standard ice-slush; the other was cooled transureterally. For transureteral cooling, the ureter was cannulated with a double lumen 12 Fr catheter. Chilled saline (4 degrees C) irrigation was flushed through the catheter into the renal pelvis (16.7 mL/min) and allowed to drain via the second lumen of the catheter. Using a 30-gauge hypodermic thermometer, kidney temperatures were measured at 5-minute intervals for 30 minutes at 3 locations and 2 depths (0.5 cm and 1.5 cm). The animals were euthanized, and the kidneys were harvested for histologic examination. RESULTS: Renal cooling was achieved with both external and transureteral cooling. However, lower (5.0 versus 26.1 degrees C, P<0.001) parenchymal temperatures were achieved more rapidly with external renal cooling. During transureteral cooling, medullary (1.5 cm) temperatures were lower than cortical (0.5 cm) temperatures were; this difference did not reach statistical significance. CONCLUSIONS: Although renal hypothermia can be achieved by transureteral iced saline infusion, external cooling by using ice-slush appears to be more efficient in the porcine model. With refinement of the technique, intrarenal cooling via a transureteral approach may allow more effective cooling of the renal medulla, and limit warm ischemia during laparoscopic partial nephrectomy.

Animals↗