Michael Goldfarb1, Mark Cavaretta. 1. Department of Surgery, Monmouth Medical Center, Long Branch, New Jersey 07740, USA. mgoldfarb@sbhcs.com
Abstract
OBJECTIVE: Attempts at improvements in emergent bedside care of hospitalized patients is an ongoing process in many institutions. Recently, the development and role of rapid response teams has been well described in the literature. However, the role of surgical residents, who are typically not part of these "medical" teams, in emergent bedside care of patients, has not been well described in the literature. Surgical residents have been responsible for many bedside emergent "rescue successes," in teaching hospitals. We present 11 instances of surgical resident bedside rescues over a 1-year period at Monmouth Medical Center as a means of emphasizing their critical role in reducing adverse events and even mortalities. DESIGN: These cases were presented at our Morbidity and Mortality conferences and involved only surgical residents performing various technical maneuvers. SETTING: Monmouth Medical Center. PARTICIPANTS: The 11 cases are representative and do not include multiple central lines and do include 2 of many chest tube-related cases. There was no "failure to rescue case" that involved only the surgical residents. RESULTS: Surgical bedside rescues included: an emergent reintubation, 2 openings of neck incisions for expanding hematomas, replacement of a dislodged tracheostomy tube, rigid sigmoidoscopy for rectal bleeding, bronchoscopy for hemoptysis, control of a permacatheter bleed, control of a ruptured femoral-femoral crossover bypass, control of a bleeding tracheoinominate fistula, and emergent placement of chest tubes. CONCLUSIONS: Surgical residents possess bedside procedural skills beyond those of nonsurgical health care workers and rapid response members. These lifesaving skills are needed to reduce adverse events and even prevent mortalities in hospitalized patients. Bleeding complications and invasive procedures such as chest tube placement, venous cutdowns, and emergency endoscopy are situations where a surgical resident should be called first, in a teaching hospital. Copyright 2010 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.
OBJECTIVE: Attempts at improvements in emergent bedside care of hospitalized patients is an ongoing process in many institutions. Recently, the development and role of rapid response teams has been well described in the literature. However, the role of surgical residents, who are typically not part of these "medical" teams, in emergent bedside care of patients, has not been well described in the literature. Surgical residents have been responsible for many bedside emergent "rescue successes," in teaching hospitals. We present 11 instances of surgical resident bedside rescues over a 1-year period at Monmouth Medical Center as a means of emphasizing their critical role in reducing adverse events and even mortalities. DESIGN: These cases were presented at our Morbidity and Mortality conferences and involved only surgical residents performing various technical maneuvers. SETTING: Monmouth Medical Center. PARTICIPANTS: The 11 cases are representative and do not include multiple central lines and do include 2 of many chest tube-related cases. There was no "failure to rescue case" that involved only the surgical residents. RESULTS: Surgical bedside rescues included: an emergent reintubation, 2 openings of neck incisions for expanding hematomas, replacement of a dislodged tracheostomy tube, rigid sigmoidoscopy for rectal bleeding, bronchoscopy for hemoptysis, control of a permacatheter bleed, control of a ruptured femoral-femoral crossover bypass, control of a bleeding tracheoinominate fistula, and emergent placement of chest tubes. CONCLUSIONS: Surgical residents possess bedside procedural skills beyond those of nonsurgical health care workers and rapid response members. These lifesaving skills are needed to reduce adverse events and even prevent mortalities in hospitalized patients. Bleeding complications and invasive procedures such as chest tube placement, venous cutdowns, and emergency endoscopy are situations where a surgical resident should be called first, in a teaching hospital. Copyright 2010 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.