PubMed Health⌕ Search
Home/Archive/PubMed

PubMed · 1124841

Problem-oriented surgical audit in the community hospital. A concept in evolution.

G O Strauch
View original source ↗Export metadata ↓

Abstract

A system of surgical audit based on identification and solution of surgical problems is described. The system relies initially on universal review of patient records on a monthly basis by surgeons in the involved institution. Evolution of the system to one which the records of certain patients can be excluded from review by physicians is seen as practical, if careful definition of such records is maintained. Emphasis on the goal of meaningful quality of care assessment is critial. Utilizing this system, surgeons in Stamford, Connecticut, have found significant deficiencies in diagnostic, therapeutic, or both of these aspects of patient care in 5 per cent of records reviewed. Ninety-five per cent of patients were judged to have had no important inadequacies in their surgical care, based on evidence in their medical records. Attempts to evaluate surgeons' behavioral changes, when deficiencies in their patients' care have been demonstrated, are being pursued actively.

Explore related subjects

ConnecticutEducation, Medical, ContinuingHospital RecordsHospitals, CommunityHumansMedical AuditPeer ReviewSurgical Procedures, OperativeTime FactorsJournal Article

Keep this discovery

Explore connections, maps & timelines

BibTeXRIS

G O Strauch. 1975. Problem-oriented surgical audit in the community hospital. A concept in evolution.. https://doi.org/10.1016/0002-9610(75)90184-1

Cite the original work for its findings. Save a collection to share your selection of sources.

KEEP EXPLORING

Related citations

PubMed2006

Groundwater-surface water interaction and its role on TCE groundwater plume attenuation.

A field investigation of a TCE plume in a surficial sand aquifer shows that groundwater-surface water interactions strongly influence apparent plume attenuation. At the site, a former industrial facility in Connecticut, depth-discrete monitoring along three cross-sections (transects) perpendicular to groundwater flow shows a persistent VOC plume extending 700 m from the DNAPL source zone to a mid-size river. Maximum TCE concentrations along a transect 280 m from the source were in the 1000s of microg/L with minimal degradation products. Beyond this, the land surface drops abruptly to a lower terrace where a shallow pond and small streams occur. Two transects along the lower terrace, one midway between the facility and river just downgradient of the pond and one along the edge of the river, give the appearance that the plume has strongly attenuated. At the river, maximum TCE concentrations in the 10s of microg/L and similar levels of its degradation product cis-DCE show direct plume discharge from groundwater to the river is negligible. Although degradation plays a role in the strong plume attenuation, the major attenuation factor is partial groundwater plume discharge to surface water (i.e. the pond and small streams), where some mass loss occurs via water-air exchange. Groundwater and stream mass discharge estimates show that more than half of the plume mass discharge crossing the first transect, before surface water interactions occur, reaches the river directly via streamflow, although river concentrations were below detection due to dilution. This study shows that groundwater and surface water concentration measurements together provide greater confidence in identifying and quantifying natural attenuation processes at this site, rather than groundwater measurements alone.

Connecticut↗