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Joel C Rosenfeld

Publications and source records attributed to Joel C Rosenfeld.

4 recordsLinked to original sources
PubMed2003

Institutioning a clinical practice guideline to decrease the rate of normal appendectomies.

With the advent of laparoscopic appendectomy, the rate of normal appendectomies increased at our institution. To decrease our rate of normal appendectomies, we instituted a clinical practice guideline in January 1999 for the preoperative evaluation and treatment of patients with possible acute appendicitis. The medical records of 464 consecutive patients who underwent either open or laparoscopic appendectomy with a preoperative diagnosis of acute appendicitis between January 1, 1997, and December 31, 2000, were reviewed. The decision of open versus laparoscopic appendectomy was made at the time of surgery by the attending surgeon. Two hundred twelve patients (116 females, 96 males) underwent an appendectomy for acute appendicitis (142 open, 70 laparoscopic) from January 1, 1997 through December 31, 1998, prior to the institution of the guideline. Two hundred fifty-two patients (117 females, 135 males) underwent an appendectomy for acute appendicitis (193 open, 59 laparoscopic) from January 1, 1999, through December 31, 2000 (after the guideline was instituted). Prior to the guideline, the normal appendectomy rate was 21.7 per cent (18.3% open, 28.6% laparoscopic). After the guideline was instituted, the normal appendectomy rate was 16.7 per cent (14.5% open, 23.7% laparoscopic). In females, the normal appendectomy rate prior to the guideline was 31.0 per cent (26.6% open, 36.5% laparoscopic) while the normal appendectomy rate after the guideline was 23.1 per cent (19.0% open, 31.6% laparoscopic), P = 0.172. In males, the normal appendectomy rate prior to the guideline was 10.4 per cent (11.5% open, 5.6% laparoscopic) while the normal appendectomy rate after the guideline was 11.1 per cent (11.4% open, 9.5% laparoscopic), P = 0.861. By instituting a guideline for the diagnosis and treatment of possible acute appendicitis, we were able to decrease our rate of normal appendectomies. Although statistical significance was not reached, there is a trend toward decreasing the rate of normal appendectomies in females after the guideline was instituted.

Acute Disease↗
PubMedDate not supplied

Using the Morbidity and Mortality conference to teach and assess the ACGME General Competencies.

PURPOSE: The weekly Morbidity and Mortality (M&M) conference, a Residency Review Committee on Surgery required conference, is a hallmark of general surgery residency training. This conference has been used traditionally to teach and assess the ACGME General Competencies of patient care and medical knowledge. The author's department has changed the format of their weekly M&M conference so that it enables them to teach and assess residents also in terms of the ACGME General Competencies of practice-based learning and improvement, professionalism, interpersonal and communication skills, and systems-based practice. METHODS: Each Monday the chief resident on each teaching service compiles a list of patient discharges and deaths for the previous week. Although all deaths are presented, only significant patient complications are selected for the following week's M&M conference. This 2-week preparation period enables the resident, who was primarily involved in the care of the patient, to thoroughly review the case and prepare his/her presentation. At the conference, the resident presents the patient's history and discusses the complication or death, not only in terms of the patient care provided (traditional M&M model), but also it analyzes the case in terms of health-care systems problems that may have contributed to the patient's morbidity and/or mortality; patient safety issues; communication problems with the patient, family, or other health-care workers; and ethnic or ethical issues related to the care provided. The case is then reviewed by faculty surgeons. Again, not only is the patient care critiqued, but also systems problems, communication problems, and ethical dilemmas. Each resident who presents a case at the M&M conference also completes a practice-based improvement log. This form analyzes the patient's outcome including factors leading to the complication and/or mortality, opportunities for systems improvement, patient safety or communication problems, ethnic or ethical issues, what the resident would do different in his/her practice, and references consulted for this case. These forms are reviewed with the resident by the Residency Director and become part of the resident's portfolio. CONCLUSION: The restructuring of the M&M conference so that a case is analyzed with all ACGME General Competencies has made the M&M conference more interesting and has improved the educational aspects of the conference. Analyzing a case according to the various ACGME General Competencies has provided another method to teach these competencies to their residents and a tool to determine whether the residents are meeting the competencies.

Clinical Competence↗