Postoperative complications after surgery for lumbar spinal stenosis, assessment using two different data sources.

PURPOSE: Lumbar spinal stenosis (LSS) is a prevalent disorder, and surgery for LSS is a common procedure. Postoperative complications occur after any surgery and impose costs for society and costs and additional morbidity for patients. Since complications are relatively rare, medical registries of large populations may provide valuable knowledge. However, recording of complications in registries can be incomplete. To better estimate the true prevalence of complications after LSS surgery, we reviewed two different sources of data and recorded complications for a sample of Norwegian LSS patients. METHODS: 474 patients treated surgically for LSS during 2015 and 2016 at four hospitals reported to a national spine registry (NORspine). Postoperative complications were recorded by patients in NORspine, and we cross-referenced complications documented in NORspine with the patients´ electronic patient records (EPR) to re-test the complication rates. We performed descriptive statistics of complication rates using the two different data sources above, and analyzed the association between postoperative complications and clinical outcome with logistic regression. RESULTS: The mean (95%CI) patient age was 66.3 (65.3-67.2) years, and 254 (53.6%) were females. All patients were treated with decompression, and 51 (10.7%) received an additional fusion during the index surgery. Combining the two data sources, we found a total rate for postoperative complications of 22.4%, the NORspine registry reported a complication rate of 15.6%, and the EPR review resulted in a complication rate of 16.0%. However, the types of complications were inconsistent across the two data sources. According to NORspine, the frequency of reoperation within 90 days was 0.9% and according to EPR 3.4%. The rates of wound infection were for NORspine 3.1% and EPR review 2.1%. There was no association between postoperative complication and patient reported outcome. CONCLUSION: Postoperative complications occurred in 22% of LSS patients. The frequency of different postoperative complications differed between the two data sources.

Can a Fully Electronic Patient Record-Based Virtual Fracture Clinic Increase Compliance With British Orthopaedic Association Guidelines for the Assessment of Acute Orthopaedic Trauma Patients?

Introduction There is clear guidance for the follow-up of acute orthopaedic trauma patients within 72 hours of presentation as per British Orthopaedic Association (BOA) guidelines. The virtual fracture clinic (VFC) model has been adopted nationwide to increase compliance with these guidelines. Traditionally our VFC was paper-based, but recently it has been made completely electronic with the introduction of Hive which is a comprehensive electronic patient record (EPR). The aim of this audit was to assess the effectiveness of the Hive VFC and to see the impact it has on improving the patient experience. Methods Data was collected retrospectively by looking at referrals to the Hive VFC across a seven-month period from its date of introduction. No patients were excluded and data was collected for 2,158 patients. Patient demographics, referral details, and outcomes were recorded on a Microsoft Excel version 16.0 for Windows spreadsheet (Microsoft Corporation, Washington, United States). Data was analysed using Microsoft Excel. Results Data was collected for 2,158 patients between September 9, 2022, and March 31, 2023, in the Hive VFC. The largest proportion of injuries was found in the foot and ankle region with 32% of referrals (n=688), followed by hand and wrist with 30% (n=651), upper limb with 28% (n=595), and lower limb with 7% (n=142). There was a 50.4% (n=125) increase in the number of patients seen in the VFC across the study period with 248 patients being seen in September 2022, increasing to 373 in March 2023. The number of patients with acute traumatic orthopaedic injuries that were assessed within 72 hours on average was 94.5% per month. There was an increase of 7.3% during the study period from September 2022 to March 2023, 89.9% to 96.5%, respectively. Conclusion We believe that Hive VFC is a clinically sound and effective way of assessing acute traumatic orthopaedic patients and increasing compliance with BOA and NICE guidelines. The number of patients needing acute orthopaedic assessment is rising steadily, and this should alert us to find more convenient, time and cost-saving methods of delivering safe and effective patient care.

[Acceptance and status of digitalization in clinics and practices : Current assessment in German urology]. / Akzeptanz und Stand der Digitalisierung in Klinik und Praxis : Aktuelles Stimmungsbild in der deutschen Urologie.

BACKGROUND: Digitalization of patient documentation and introduction of the electronic patient record (ePA) pose challenges to everyday clinical practice. OBJECTIVES: We investigated the acceptance and status of the digitalization of patient data and the introduction of the ePA among German urologists. MATERIALS AND METHODS: A questionnaire with 30 questions about the acceptance and status of digitalization of patient documentation and ePA was sent out via the newsletter of the German Society of Urology. RESULTS: A total of 80 urologists participated in the survey (response rate 2%). Digital platforms such as Urotube or Researchgate are used by 63% of participants. The complete implementation of digital patient documentation was reported by 72% of respondents working in medical practice and by 54% of those working in the hospital (p = 0.042). While 76% see the digitalization process as reasonable, 34% expressed partial or strong concerns about the complete digitalization of patient documentation. Only 14% of the participants offer video consultations. Advantages for ePA include better networking of the healthcare system (73%), improved diagnosis, indication (41%) and treatment quality (48%), and avoidance of medication errors (70%). CONCLUSION: German urologists are open to the digitalization process and ePA. Especially younger urologists are using digital media. The advantages of digitalization are, in particular, an improvement in treatment processes. For a smooth introduction, a cross-departmental establishment and, if necessary, an adaptation of the treatment processes are necessary.

Lessons learned from a comprehensive electronic patient record procurement process-implications for healthcare organisations.

BACKGROUND: This study describes learning from procurement of a comprehensive electronic patient record (EPR/electronic health record (EHR)), system for a specialist clinical academic institution. METHOD: Retrospective review of procurement process in addition to evaluation of peer-reviewed literature in the field. RESULTS: Main lessons learned include the importance of detailed preparation of organisational requirements/specifications and organisational 'readiness'. Early staff involvement, resulting in ownership of the selected system by the organisation was a key achievement. The scoring process used required significant resource commitment but, despite being extensive in scope, provided relatively poor distinction between suppliers, despite significant variation in supplier self-scoring. Other elements, such as demonstrations and site visits, provided superior evaluation of functional abilities, and specification requirements should be regarded as threshold evaluation. CONCLUSION: While principles should be followed, the procurement process must be modified to meet the needs of the specific organisation, in terms of its clinical activities, digital maturity, existing infrastructure and budget.

Costs of health IT: beginning to understand the financial impact of a dental school EHR.

Health Information Technology (Health IT) constitutes an integral component of the operations of most academic dental institutions nowadays. However, the expenses associated with the acquisition and the ongoing maintenance of these complex systems have often been buried among costs for other electronic infrastructure systems, distributed across various cost centers including unmeasured central campus support, covered centrally and therefore difficult to quantify, and spread over years, denying school administrators a clear understanding of the resources that have been dedicated to Health IT. The aim of this study was to understand the financial impact of Health IT at four similar U.S. dental schools: two schools using a purchased Electronic Health Record (EHR), and two schools that developed their own EHR. For these schools, the costs of creating ($2.5 million) and sustaining ($174,000) custom EHR software were significantly higher than acquiring ($500,000) and sustaining ($121,000) purchased software. These results are based on historical data and should not be regarded as a gold standard for what a complete Health IT suite should cost. The presented data are intended to inform school administrators about the myriad of costs associated with Health IT and give them a point of reference when comparing costs or making estimates for implementation projects.