Reducing Hypotension and Acute Kidney Injury in the Elective Total Joint Arthroplasty Population: A Multi-Disciplinary Approach.

BACKGROUND: When critically analyzing our hospital system's rate of hypotension and acute kidney injury (AKI) after total joint arthroplasty, our incidence rates (14.54%, 6.02%) were much higher than our peers (7.17%, 2.03%) and national rates (2.0%, 3.3%). We present a multi-disciplinary management intervention that aimed to decrease overall complication rates. METHOD: A multi-disciplinary team implemented a protocol at our suburban hospital to limit complication rates after joint replacement surgery. Hypotension, AKI, length of stay (LOS), re-admission rates, and mortality rates were compared before the protocol was implemented, after protocol implementation, and after protocol integration into our EMR (electronic medical record). RESULTS: In total, 1233 patients over 36 months were followed. Hypotension rates after protocol implementation into EMR (group 3) were significantly lower than rates before the protocol (group 1) (P = .002), with rates after protocol implementation without EMR (group 2) trending toward a significant decrease from group 1 (P = .064). AKI rates in group 3 were significantly lower than group 1 (P = .000) and group 2 (P = .006). No difference was seen in hypotension rates between group 2 and 3 (P = .792) or AKI rates between group 1 and 2 (P = .533). Finally, no significant difference was seen between groups in LOS (P = .560), re-admission rates (P = .378), and mortality rates (all 0.0%). CONCLUSION: By implementing a comprehensive electronic protocol consisting of pre-operative risk stratification, multi-disciplinary medical optimization, and an evolving post-operative management plan, significant decreases in hypotension and AKI can be seen.

The Effect of an Orthopedic Hand Surgeon's Attire on Patient Confidence and Trust.

Background: Multiple studies have concluded that patients are more likely to understand and trust physicians who dress in more formal attire (shirt and tie) as opposed to casual attire (t-shirts and jeans). The white coat has repeatedly been reported as a major source of trust and confidence in a patient's eyes. Methods: This study explores the effect an orthopedic hand surgeon's attire has on a patient's perception of their surgeon's clinical values. All patients 18 years of age and older who visited our orthopedic hand surgeon's suburban outpatient practice were asked to participate in our survey-based study. Results: Ninety-seven surveys were completed and included. A majority of our responders are female (n = 59, 60.8%), Caucasian (n = 83, 85.6%) between the ages of 55 and 74 years (n = 40, 41.2%), currently employed (n = 59, 60.8%) with private health insurance (n = 69, 71.1%), and married (n = 64, 66.0%). Patients rated male and female hand surgeons wearing a white coat highest using the Likert scale and when asked about their perceived clinical qualities. Patients consistently poorly rated their surgeons wearing casual attire. Patients did note that the white coat, or any specific attire, was not necessary during the initial encounter to build a strong patient-surgeon relationship. Finally, goatees and beards do not positively or negatively impact a surgeon's patient-constructed image. Conclusions: Combining strong clinical skills with appropriate clinical attire highlighted by the physician wearing a white coat appears to be an effective way to enhance patient satisfaction while ultimately gaining the trust and respect needed to properly care for patients.