Informed Consent
When one person causes another person to believe something based on the merits of an argument provided
Coercion
Controversial term typically defined as a clinical intervention that is ineffective, nonbeneficial, or disproportionately burdensome to the patient
Futility
ASA physical status classification of a 28 year-old-male, no chronic medical problems, social alcohol use, presenting for elective inguinal hernia repair.
A process aiming to raise the established standard, best achieved via a continuous cycle of data gathering, followed by critical analysis and development and implementation of an action plan
Quality improvement
When one person causes another person to believe something based on the merits of an argument provided
Persuasion
T/F: an adult patient with decisional capacity, or the adult patient's legal surrogate if the patient lacks decisional capacity, has the right to refuse any medical and/or surgical intervention, even if his or her physician believes the proposed therapy to be potentially lifesaving treatment
True: Patients have the legal "right to be free from unwanted bodily touching "
Legal documents that say either what the patient would want in a given situation (living will) or whom the patient would want to make decisions in the case they are unable to do so (durable power of attorney for health care)
Advanced directive
Most widely used scoring system to estimate ICU mortality
APACHE II
Calculated at ICU admission (worst values recorded during initial 24 hours of admission), calculation not repeated. Not accurate in patients transferred from another ICU or hospital. APACHE III and IV were developed but not utilized since statistical method under copyright.
T/F: Participation in national registries and programs such as NSQIP and TQIP have been shown to positively impact quality improvement in a hospital.
True
According to Michigan Law, what confidential medical services are minors entitled to?
1. Referrals, screening, counseling and treatment for sexually transmitted diseases including HIV
2. Referrals and counseling for family planning
3. Pregnancy testing and referrals
4. Substance abuse counseling and referral
Minors 14 years of age or older can receive limited outpatient mental health services not to exceed 12 visits over four months and not to include any medications or pregnancy termination
What information muse be conveyed in the informed consent process?
1. Risks and benefits of the proposed procedure
2. Alternatives to the proposed procedure
3. Risks and benefits of alternatives to the proposed procedure
4. Risks and benefits of doing nothing
A person designated by the patient to perform as a medical or health care power of attorney or, in the absence of this designation, is a family member or group of family members in order of relatedness
Surrogate decision-maker
GCS of a 37-year-old male who presents after MVC vs. pedestrian, A&O x2, confused, localizes to pain, opens eyes to speech
GCS 12
E3 V4 M5
What does the acronym NSQIP stand for?
National Surgical Quality Improvement Program
Nationally validated, risk-adjusted, outcomes-based program designed to measure and improve the quality of surgical care, uses data gathered from medical charts by clinically trained personnel and includes demographics, preoperative risk factors, and intraoperative through 30-day postoperative outcomes data.
What is the difference between quantitative futility and qualitative futility?
Quantitative: intervention is incapable of producing the desired outcomes
Qualitative: intervention will likely produce the intended result but will not alter the overall outcome
What is the hierarchy for heirs-at-law at HFHS? (Tier 1 Policy)
1. Surviving spouse
2. Children (no surviving spouse)
3. Parent (no surviving spouse)
4. Siblings (no surviving spouse)
The concept that surrogate decision-makers should make medical decisions based on “what the patient would have wanted” to protect patient autonomy
Substituted judgement
Concept based on surrogates' recollection of conversations, interpretation of written documents, or understanding of the patient’s general beliefs and values
What are the components of the qSOFA score?
1. Altered mental status
2. Respiratory rate ≥ 22
3. SBP ≤ 100
Identifies high-risk patients for in-hospital mortality with suspected infection outside the ICU. 1-point awarded for presence of each of above. Score ≥ 2 suggests high risk of poor outcome in patients with suspected infection.
The relationship between quality and cost
Value
High value indicates a relatively lower cost per unit of quality
ASA physical status classification of a 45 year old female, history of poorly controlled DM2, ESRD on HD, compliant, presenting for AV fistula creation.
ASA III
Legally relevant criteria for assessing decision-making capacity (4 items)
1. Communicate a choice
2. Understand relevant information
3. Appreciate situation and consequences
4. Reason about treatment options
What are the five conditions of the double doctrine effect?
1. Action must be morally good or neutral
2. The good effect is intended
3. The bad effect is merely foreseen, but not intended
4. The bad effect cannot be the means to the good effect
5. Proportionality - the good must outweigh the evil permitted
Scoring system specifically validated to calculate risk in non-traumatic emergency surgery patients
POTTER Score (2018)
Predictive Optimal Trees in Emergency Surgery Risk: NSQIP Surgical Risk Calculator based on logistic regression
According to the WHO, quality health should be... (six items)
Effective
Efficient
Accessible
Acceptable and patient centered
Equitable
Safe
Explain mnemonic "FAST HUG"
Feeding
Analgesia
Sedation
Thromboembolic prophylaxis
Head of bed elevation
Ulcer prevention
Glucose control
Addresses essential components of care for the critically ill, improves teamwork while addressing quality metrics