Biomedical subjects

L Kilberg

Publications and source records attributed to L Kilberg.

4 recordsLinked to original sources

PubMed1995

Short-stay carotid endarterectomy is safe and cost-effective.

BACKGROUND: Carotid endarterectomy (CEA) is conventionally performed following a contrast arteriogram, under general anesthesia, and with postoperative admission to an intensive care unit (ICU). We investigated whether any of these traditional adjuncts to CEA is necessary. PATIENTS AND METHODS: Eighteen consecutive patients had CEA performed according to a protocol of duplex scanning only, operation under regional anesthesia, and admission to the ICU only in cases of a proven need for services unique to the ICU (group I). Utilization of preoperative arteriography, admission to the ICU, postoperative complications, total hospital length of stay, and hospital charges were calculated for this group and results were compared with a group of 178 patients undergoing conventional CEA (arteriography, general anesthesia, routine ICU admission) during the same period (group II). RESULTS: In group I, 1 patient (6%) underwent preoperative arteriography and 4 patients (22%) were admitted to the ICU after CEA. Most group II patients (114 of 178, or 64%) underwent preoperative arteriography and virtually all (175 of 178, or 98%) were admitted to the ICU. Compared with group II, the average hospital length of stay for group I was significantly shorter (1.3 +/- 0.1 versus 3.1 +/- 0.3 days, P = 0.03) and hospital charges were significantly reduced ($5,861 +/- 229 versus $11,140 +/- 729, P = 0.02). CONCLUSIONS: This pilot study suggests that CEA can be safely performed without routine preoperative carotid arteriography; that routine ICU admission is unnecessary for the majority of cases; and that elimination of routine arteriography and ICU admission can reduce hospital charges for CEA by nearly one half.

Anesthesia, Conduction↗

PubMed1994

Case study in physician profiling.

In this article sustained and significant patient day reductions were accomplished over a short period of time with low capital investment. Using an education focus and concentrating on attempting to rationalize observed ranges of physician-resource use across peers, the hospital was able to reduce the length of stay by .5 days in a one-year period. This reduction was accomplished over a period where other local hospitals experienced minimal decreases in their lengths of stay. The success of this project suggests how the sharing of credible information with physicians within a constructive context can lead to significant and timely resource use reductions.

Data Collection↗

PubMed1991

Carotid endarterectomy in a community hospital: a change in physicians' practice patterns.

A total of 243 consecutive carotid endarterectomies (CEA) performed at Providence Medical Center in Portland, Oregon, were retrospectively reviewed over a 22-month period. Of these, 137 patients (56%) underwent CEA for asymptomatic disease, 52 (37%) of whom had stenotic lesions of 79% or less. There were 6 deaths (3%) and 12 strokes (5%). Four strokes were in asymptomatic patients. These data prompted development of criteria for CEA: (1) hemisphere-specific transient ischemic attacks, reversible ischemic neurologic deficits, or amaurosis fugax with an appropriate carotid lesion; (2) completed stroke with major recovery and significant carotid stenosis; (3) asymptomatic lesion with greater than 80% stenosis (D+) either by carotid arteriogram or non-invasive lab evaluation; and (4) other indications only with a supporting second opinion from a disinterested vascular surgeon, neurosurgeon or neurologist. A prospective review followed institution of the guidelines. In 21 months, 148 operations were performed, a 36% reduction over the initial study period. Of these, 46 (31%) were for asymptomatic lesions. Two patients (4%) did not fulfill the guideline criteria. There were six strokes (4%) and no deaths. The reduction of CEAs appears to be related to a significant decrease in "inappropriate" operations being performed. Surgeons' familiarity with the data rather than external pressures seems to be the major factor in changing practice patterns. The decrease in stroke/death rate is not statistically significant.

Aged↗

PubMed1988

Effectiveness of implementing a trauma triage system on outcome: a prospective evaluation.

A 9-month prospective study was conducted in Salt Lake County to evaluate the efficacy of a field trauma triage system using the CRAMS score. Before the triage system was implemented trauma victims were taken to the nearest appropriate hospital. Post-implementation, trauma victims with field CRAMS scores of 1 through 6 were triaged to the Level I Trauma Center. Of the 113 study patients, 53 were in the pre-implementation phase and 60 in the post-implementation phase. The study patients with CRAMS scores of 4 or less had lower mortality when cared for at the Level I Trauma Center (p = 0.013). We conclude that trauma patients who are severely injured (CRAMS less than or equal to 4) have a significantly higher rate of survival if taken to the Level I Trauma Center. The use of the CRAMS triage system appears to be an effective approach toward improving trauma care in Salt Lake County.

Adult↗