Smaller, rural hospitals may be quicker and more efficient at implementing surgical safety initiatives than their larger, urban counterparts, and are capable of providing a standard of surgical care that is at par with major hospitals that provide a comprehensive array of care services, according to an 18-month series of studies led by researchers from the University of Louisville Department of Surgery.
“The quality and standard of care in rural and small-town America is an important issue that gets a lot of attention in the mainstream media these days, and research efforts to measure and enhance surgical quality have largely omitted smaller town hospitals that care for a very high proportion of the American population,” Hiram C. Polk, MD, former chair of the University of Louisville Department of Surgery, and the Ben A. Reid Sr. professor of surgery at University of Louisville, stated in a press release. “These studies sought to address some of these previously unaddressed issues.”
The investigators used the surgical safety tool – the expanded surgical time out – as a template by which to collect their data, Polk stated. This is a method by which all participants in a surgical procedure, including, in some cases, the patient, take a moment to clarify critical details about the procedure that is about to take place.
“The basic surgical time-out includes identifying the correct patient, correct surgery and correct site,” Susan Galandiuk, MD, professor of surgery at University of Louisville and senior investigator on the first study, which served to define the current culture regarding surgical safety and quality initiatives, stated. “The expanded time-out looks at preoperative timing and choice of antibiotics and discontinuation of postoperative prophylactic antibiotics, additional criteria for diabetics or other ill patients, or factors that come into play if a surgery will last longer than two hours, such as measuring core temperature, monitoring blood glucose level and a clear decision about continuing beta blocker drugs postoperatively if they have been used preoperatively.”
The studies looked at how quickly the smaller hospitals – four in Kentucky and one in Indiana – adopted quality improvement measures, as evidenced by the implementation of surgical time-out; whether surgical specialists were committed to accepting the quality and safety parameters outlined in the expanded surgical time-out checklist; and how the payment structure may affect quality and safety measures.
“We also found that, although almost one quarter to one third of patients were awake during the surgical time-out, surgical time-out was implemented in more than 97% of all cases among the different subspecialties,” Polk stated. “Our research showed that clinicians in these rural hospitals showed an extremely high standard of care to their patients, equal to that given at urban and tertiary counterparts. The hospitals’ willingness to commit to participating in these studies with the goal of better patient care should be commended as well.”