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Patient Safety Data : How it Can Improve Our Performance
| Content Provider | Semantic Scholar |
|---|---|
| Author | Einstein, Albert B. |
| Copyright Year | 2010 |
| Abstract | This issue of Aesthetic Surgery Journal features several articles focusing on patient safety issues. In addition to a panel discussion and case report dealing with safety concerns, it includes 2 articles on advances in patient safety. The article by Drs. Bill, Clayman, Morgan, and Gampper and the accompanying commentary highlight the need for an understanding of lidocaine metabolism at the level of the P450 cytochrome oxidase system and the effects exerted by other substances on the performance of this enzyme system. Such information is useful to the clinician assessing whether a patient is at greater risk for lidocaine toxicity as a result of impaired ability to metabolize the lidocaine that is used during lipoplasty. The take-home message is clear: To prevent patient injury when performing aesthetic surgery, be mindful of drug interactions. In another article, Drs. Stevens, Vath, and Stoker report that they achieved similar patient outcomes with abdominoplasty when performed alone and in combination with other aesthetic procedures including significant lipoplasty. They attribute their success to a regimen that included the use of prophylactic antibiotics, attention to prophylaxis of deep vein thrombosis, expedient surgery, avoidance of Foley catheters and bedpans, and almost immediate postoperative ambulation. Their findings contrast significantly with earlier and current reports regarding the perils of combined procedures in terms of adverse outcomes, including patient death. The authors’ efforts over a 10-year span clearly demonstrate that good protocols, executed faithfully, can prevent adverse events in certain surgical situations. The take-home message here is a bit more complex: The authors suggest that there need not be increased morbidity as a result of combined procedures, including significant lipoplasty performed at the time of abdominoplasty, provided the surgeon is capable of doing surgery their way. Before scheduling a variety of aesthetic procedures to be performed in a single surgical session, however, the reader might want to ponder the likelihood of replicating the methods the authors have developed and whether his or her patients might be at greater risk. Pooled data from multiple practitioners can be useful in identifying trends and making assessments on a broad basis. An individual surgeon’s data may often appear better than pooled data, which is exactly why such data have much to teach us. The importance of the second study’s results is in demonstrating that some surgeons can perform procedures exceptionally well, with a methodology that consistently delivers safe outcomes, far beyond the reported norm. In breast augmentation, whether it’s a 3% reoperation rate or 25 years of clinical experience with no incidence of postoperative implantspace infection, such results demonstrate that the avoidance of complications or adverse outcomes involves more than just luck. Quality improvement requires that changes be made in the “real world,” one patient at a time, and subject to adjustment — then, if they work, they are institutionalized. This is known as a “best practice.” What is the value of best practices in medicine? First, they are transferable from one practitioner to another. Second, they support evidence-based surgical practices, in combination with guidelines and improved access to knowledge. Algorithms such as those developed by John and Terrye Tebbetts and their 2004 Breast Augmentation Surgeons for Patients Initiative can provide effective management solutions to problems common in breast implant patients (capsular contracture, stretch deformity, infection/seroma, symptom surveillance, implant-size change, implant rupture). Achievement of a superior surgical outcome should always be followed by reflection on what went right and Editorial |
| File Format | PDF HTM / HTML |
| Alternate Webpage(s) | https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/asj/24/4/10.1016/j.asj.2004.05.005/2/24-4-346.pdf?Expires=1493008132&Key-Pair-Id=APKAIUCZBIA4LVPAVW3Q&Signature=RIJfHW-F6r2~YJnez0SakCx~CcQxuljv4kW98synIgiw0rVVOjv6uQ1R4GJd896~ctbaOBcPHRm6XhtKRfZ9euhY8GPviO4qIZeoxHIoJFCNS8b~v5x4hYCe4QoYGWita7xmSiGc~Z8gYsXDlQbvpeYEQcKj3Q-qlKrKVTuxL0xcmqcjtfUzLePaYGmoneN7VDlvn-wCAHfzuqufYI7LRDWeB8SXpylwfNHzhLTM9lGI6DFdtyhC~KHY~CpLn7~XbV6LEtKyzgdKFs8MHFC-cyOQ~vMfGr-~nBH5SYRZmV0Fo35ifXOwCm-iRbpEj6UTx3OigSVyh~e52y~NgRR1QQ__ |
| Language | English |
| Access Restriction | Open |
| Content Type | Text |
| Resource Type | Article |
