Peri-Operative Medicine

Perioperative Care: Top of Mind & Topic for #Periop #JHMChat on April 4th

With great successes in hosting our first couple of Twitter chats over the last six months, we’re excited to bring you the third in our quarterly series, #JHMChat, where you ask Journal of Hospital Medicine (JHM) authors about their research and corresponding clinical implications for managing inpatient care. We invite you to join us for the next #JHMChat on Monday, April 4th at 9pm EDT, when we will discuss Dr. Kurt Pfeifer et al.’s article from JHM, “Updates in perioperative medicine”, which you can read here. Perioperative care is a critical skillset for today’s hospitalists. The article authored by Dr. Pfeifer and colleagues highlights key clinical pearls from recent research on best practices in perioperative medicine. As the patient population ages and cases become more medically complex, hospitalists are key providers in ensuring safe, quality care for patients before, during and after surgery. In keeping with our theme of promoting…

Do You Speak Surgeon-ese?

by Dr. Kurt Pfeifer MD, FACP, FHM
Kurt Pfeifer, MD, FACP, FHM Does the phrase “medical clearance” make your skin crawl? Perioperative medicine continues to be a growing part of the practice of hospitalists everywhere, yet for many this is an area they feel uncomfortable with. Never fear! Hospital Medicine 2016 has more perioperative medicine educational offerings than ever! On Sunday, March 6 the all-day Perioperative Medicine precourse (Spy Into the World of Perioperative Medicine) provides an overview of all major aspects of the field, from the basics to the controversies. Speaking of controversies, watch Steven Cohn and me duke it out over hotly contested perioperative topics in The Great Debate – Controversies in Perioperative Medicine on March 9th at 8:45 am. For a sweeping update of all things periop, check out Paul Grant’s Update in Perioperative and Consultative Medicine on March 9th at 7:40 am. Have you ever wondered what goes on in the OR when…
Dr. Kurt Pfeifer MD, FACP, FHM completed medical school and Internal Medicine residency at the Medical College of Wisconsin prior to serving there as chief resident. He subsequently joined the faculty of the Medical College of Wisconsin and served as Associate Program Director for the Internal Medicine Residency for nine years. He is currently the director of the preoperative evaluation clinic at the Froedtert and Medical College Eye Institute and a course director in MCW’s Discovery Curriculum. His clinical and scholarly activities focus primarily on perioperative and consultative medicine, medical education and career development. Dr. Pfeifer has co-authored over 300 student and resident abstracts, case reports and national presentations and has written and lectured extensively on perioperative medicine and medical education. He is also Associate Editor for two innovative, online learning portals - shmConsults.com, an online curriculum for perioperative and consultative medicine, and ClinicalAccess, a point-of-care evidence-based medicine search engine.

A “Never Event” Happened to My Family Member. Don’t Let It Happen to You.

It is odd being on the other end of the doctor/patient interaction and having a surgeon calling me in the middle of the night apologizing for a mistake. I was scared and then I started to feel anger creeping in. How could this happen? Swiss cheese models and checklists danced in my brain. The analytical part of me was appreciative of the straight-forward manner the surgeon spoke to me, holding nothing back and owning up to the mistake, telling me the hospital would be investigating and assuring me that my family would incur no costs due to the error. He had performed an unnecessary abdominal surgery, a Never Event in the lexicon of patient safety. As you may know, Never Events are loosely defined as events that should never happen. The history of Never Events is rooted in the patient safety and quality revolution of the last two decades. In 1999 the Institute of Medicine produced…

Surgical Co-management, The Global Package, and Consciously Uncoupling

There is an upcoming Medicare rule that will go into effect in two phases beginning in 2017 that has a lot of surgeons and hospitalists concerned about the direction of peri-operative care and surgical co-management. [caption id="attachment_11629" align="alignright" width="200"] source: www.imnotobsessed.com[/caption] Medicare’s proposal apes the words of Gwyneth Paltrow when describing her divorce from now ex-husband Chris Martin of Coldplay, “Consciously Uncoupling.” An awesome euphemism to describe the schism and separation of that annoying celebrity couple. It is also a great term to describe what CMS is moving forward with in relation to the Global Surgical Fee, or “the Global Package.” We hospitalists may know of this system of bundling, but don’t really live in that world today. We have heard plenty about how payment systems of the future will be moving toward bundling, but to see one un-bundling seems at odds with the general trend. In today's world, the…

Quitting smoking before surgery

This large analysis from NSQUIP found past smokers (>1 year quit) had similar post-op mortality compared to non-smokers, but current smokers had an odds ratio of post-op mortality of 1.17. Arterial events and respiratory events were higher in past smokers than non-smokers, but still significantly less than current smokers. This data adds to the existing literature of the benefits of smoking cessation before surgical intervention (abstract).
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