Paul Duffy - Academia.edu (original) (raw)

Papers by Paul Duffy

JAMA Surgery

ImportanceUnstable chest wall injuries have high rates of mortality and morbidity. In the last de... more ImportanceUnstable chest wall injuries have high rates of mortality and morbidity. In the last decade, multiple studies have reported improved outcomes with operative compared with nonoperative treatment. However, to date, an adequately powered, randomized clinical trial to support operative treatment has been lacking.ObjectiveTo compare outcomes of surgical treatment of acute unstable chest wall injuries with nonsurgical management.Design, Setting, and ParticipantsThis was a multicenter, prospective, randomized clinical trial conducted from October 10, 2011, to October 2, 2019, across 15 sites in Canada and the US. Inclusion criteria were patients between the ages of 16 to 85 years with displaced rib fractures with a flail chest or non–flail chest injuries with severe chest wall deformity. Exclusion criteria included patients with significant other injuries that would otherwise require prolonged mechanical ventilation, those medically unfit for surgery, or those who were randomly a...

Journal of orthopaedic trauma, Jan 7, 2016

To define the incidence, risk factors and anatomic location of articular malreductions in operati... more To define the incidence, risk factors and anatomic location of articular malreductions in operatively treated lateral tibial plateau fractures DESIGN:: Prospective Cohort Study SETTING:: Academic Level 1 Trauma CentrePatients/Participants: Study subjects were patients entered into a prospective cohort study of tibial plateau fractures. Surgical Fixation of tibial plateau fractures and post-operative computed tomography (CT) scans. The primary outcome was incidence of articular malreduction. Secondary outcomes included risk factors for malreduction and a descriptive analysis of malreduction location. Sixty-five post-operative CT scans were reviewed. Twenty-one reductions (32.3%) had a step or gap more than 2 mm. The frequency of malreductions in patients undergoing sub-meniscal arthrotomy or fluoroscopic-assisted reduction alone was 16.6% and 41.4%, respectively (p=0.0021). Age, body mass index, AO fracture type, operative time, use of bone graft or bone graft substitute and use of l...

The Lancet, 2017

Background High rates of re-operations after initial hip fracture fixation, the associated morbid... more Background High rates of re-operations after initial hip fracture fixation, the associated morbidity, mortality, and costs motivated the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) randomised controlled trial. Methods We randomised 1,079 patients with a low-energy femoral neck fracture fracture requiring fracture fixation in 81 centres to a single large diameter screw with a side-plate (sliding hip screw) or the current standard, multiple small diameter cancellous screws (Clinical Trials Identification Number: NCT01908751). The primary outcome was hip re-operation within 24 months. Health-related quality of life (HRQL) was measured by the SF-12, EQ-5D, and WOMAC score. Findings Re-operations did not convincingly differ by type of surgical fixation: 107 of 542 patients (19•7%) in the sliding hip screw group and 117 of 537 patients (21•8%) in the cancellous screws group (hazard ratio, 0•83; 95% CI, 0•63 to 1•09; p=0•18). Avascular necrosis was more common in the sliding hip screw group than in the cancellous screws group (50 patients [9•2%] vs. 28 patients [5•2%]; hazard ratio, 1•78; 95% CI, 1•09 to 2•91; p=0•02). The three HRQL instruments were consistent in showing no important difference by treatment group at 24 months. A priori subgroups suggested lower reoperation rates with sliding hip screws in patients with displaced fractures (interaction p=0•04), base of femoral neck fractures (interaction p=0•04), and current Page 3 of 33 smokers (interaction p=0•02); current smoking appeared the dominant effect modifier in an analysis that included all three variables. Interpretation Among patients with a femoral neck fracture fracture there was no convincing difference in hip re-operations or HRQL among patients allocated to sliding hip screw compared to cancellous screws. Avascular necrosis was higher with sliding hip screws.

Journal of Orthopaedic Trauma, 2012

Foot & Ankle International, 2010

BMC Musculoskeletal Disorders, 2014

Case Reports in Orthopedic Research, 2022

We present a case of displaced femoral neck fracture (FNF) in a patient treated with closed reduc... more We present a case of displaced femoral neck fracture (FNF) in a patient treated with closed reduction and surgical fixation. An anatomic reduction was confirmed using intraoperative multidimensional fluoroscopy following reduction and surgical fixation. At the 1-year follow-up, the patient had returned to all activities and there were no signs of avascular necrosis. The quality of FNF reduction is an important modifiable treatment variable to reduce the risk of post-operative complications. Intraoperative multidimensional fluoroscopy enables the surgeon to utilize closed reduction techniques, limiting the risk of damage to vascular structures, while allowing for critical assessment of FNF reduction.

Journal of Orthopaedic Trauma, 2018

Purpose: With medial malleolar fractures, surgeons typically utilize 2 screws to ensure rotationa... more Purpose: With medial malleolar fractures, surgeons typically utilize 2 screws to ensure rotational control of the bone fragment. A prospective randomized trial was performed to determine whether single or double screw fixation of the medial malleolus resulted in better long-term health outcomes. The primary outcome was a comparison of physical functioning summary score on Short Form-36 (SF-36) questionnaires between patients in the 2 groups.

Journal of orthopaedic trauma, 2018

The surgical reduction of intra-articular olecranon fractures is judged primarily on the lateral ... more The surgical reduction of intra-articular olecranon fractures is judged primarily on the lateral elbow radiograph, as orthogonal imaging of the articular surface is not obtainable. We sought to determine surgeon accuracy in identifying intra-articular olecranon malreductions on the lateral elbow radiograph. Six human fresh-frozen cadaveric elbow specimens were sagittally sectioned in 5-mm increments after olecranon dissection, preservation of soft tissue envelope, and rigid fixation of the elbow in an external fixator. Three patterns of central intra-articular olecranon malreduction were created in each elbow using a ruler and bone saw. Perfect lateral elbow radiographs were taken of each malreduction, and these images were randomized along with x-rays of normal cadaveric olecranons. The image series was presented to 4 masked trauma-trained surgeons to determine whether the olecranon was malreduced or anatomic. Surgeons interpreted the same image series on 2 separate occasions separ...

Purpose Antibiotic prophylaxis plays an important role in minimizing surgical site infections as ... more Purpose Antibiotic prophylaxis plays an important role in minimizing surgical site infections as well as other nosocomial peri-operative infections in orthopaedic trauma patients. Pre-operative prophylaxis has been shown to be efficacious, but the role and duration of post-operative prophylaxis remains controversial. The goal of this study was to assess whether patients receive their antibiotic prophylaxis as prescribed. What dose and duration of antibiotics are typically ordered, what patients actually receive, and factors causing the ordered antibiotic regime to be altered were also investigated. This study did not investigate infection rates or the efficacy of various antibiotic prophylactic regimes. Method This study presents data collected through a retrospective chart review of 205 patients treated surgically for a closed fracture at one institution. A national survey was also distributed to all surgeon members of the Canadian Orthopaedic Trauma Society (COTS) concerning antib...

Canadian Journal of Surgery

Background: Venous thromboembolism (VTE) is the second most common complication after hip fractur... more Background: Venous thromboembolism (VTE) is the second most common complication after hip fracture surgery. We used thrombelastography (TEG), a wholeblood, point-of-care test that can provide an overview of the clotting process, to determine the duration of hypercoagulability after hip fracture surgery. Methods: In this prospective study, consecutive patients aged 51 years or more with hip fractures (trochanteric region or neck) amenable to surgical treatment who presented to the emergency department were eligible for enrolment. Thrombelastography, including calculation of the coagulation index (CI) (combination of 4 TEG parameters for an overall assessment of coagulation) was performed daily from admission until 5 days postoperatively, and at 2 and 6 weeks postoperatively. All patients received 28 days of thromboprophylaxis. We used single-sample t tests to compare mean maximal amplitude (MA) values (a measure of clot strength) to the hypercoagulable threshold of greater than 65 mm, a predictor of in-hospital VTE. Results: Of the 35 patients enrolled, 11 (31%) were hypercoagulable on admission based on an MA value greater than 65 mm, and 29 (83%) were hypercoagulable based on a CI value greater than 3.0; the corresponding values at 6 weeks were 23 (66%) and 34 (97%). All patients had an MA value greater than 65 mm at 2 weeks. Patients demonstrated normal coagulation on admission (mean MA value 62.2 mm [standard deviation (SD) 6.3 mm], p = 0.01) but became significantly hypercoagulable at 2 weeks (mean 71.6 mm [SD 2.6 mm], p < 0.001). There was a trend toward persistent hypercoagulability at 6 weeks (mean MA value 66.2 mm [SD 3.8 mm], p = 0.06). Conclusion: More than 50% of patients remained hypercoagulable 6 weeks after fracture despite thromboprophylaxis. Thrombelastography MA thresholds or a change in MA over time may help predict VTE risk; however, further study is needed.

The Bone & Joint Journal

Aims Dislocation is the most common indication for further surgery following total hip arthroplas... more Aims Dislocation is the most common indication for further surgery following total hip arthroplasty (THA) when undertaken in patients with a femoral neck fracture. This study aimed to assess the complication rates of THA with dual mobility components (THA-DMC) following a femoral neck fracture and to compare outcomes between THA-DMC, conventional THA, and hemiarthroplasty (HA). Methods We performed a systematic review of all English language articles on THA-DMC published between 2010 and 2019 in the MEDLINE, EMBASE, and Cochrane databases. After the application of rigorous inclusion and exclusion criteria, 23 studies dealing with patients who underwent treatment for a femoral neck fracture using THA-DMC were analyzed for the rate of dislocation. Secondary outcomes included reoperation, periprosthetic fracture, infection, mortality, and functional outcome. The review included 7,189 patients with a mean age of 77.8 years (66.4 to 87.6) and a mean follow-up of 30.9 months (9.0 to 68.0)...

Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, Jan 29, 2018

This trial was conducted to determine the medium-term functional outcome of displaced tibial plat... more This trial was conducted to determine the medium-term functional outcome of displaced tibial plateau fracture patients treated with closed fluoroscopic assisted reduction and internal fixation (CRIF) versus patients treated with standard open reduction with sub-meniscal arthrotomy and internal fixation (ORIF). A prospective trial was conducted in adult patients with displaced AO/OTA 41 B and 41 C tibial plateau fractures. Patients were assigned to treatment based upon the standard treatment of the surgeon involved following the call schedule for the day, either CRIF or ORIF. Postoperative radiographs and CT were performed on all patients and patients were followed for a minimum of 2 years. Primary outcome measures were the KOOS, SMFA and SF-36. Seventy patients were recruited with 2 year follow-up on 35 patients in the CRIF group and 27 patients in the ORIF group. Postoperative CT scans showed that reductions were better with the ORIF group especially in the posterolateral quadrant ...

Canadian Journal of Surgery Journal Canadien De Chirurgie, Oct 1, 2010

Replacing missing issues Claims for missing issues must be made within 3 months of the date of pu... more Replacing missing issues Claims for missing issues must be made within 3 months of the date of publication to be honoured and replaced (subject to availability) free of charge. Replacement copies of older issues, when available, must be prepaid at the single-copy rates listed below. Please submit claims, with a copy of your mailing label, to the Member Service Centre.

Canadian journal of surgery. Journal canadien de chirurgie, 2010

Acute compartment syndrome of the lower extremity is a clinical condition that, although uncommon... more Acute compartment syndrome of the lower extremity is a clinical condition that, although uncommon, is seen fairly regularly in modern orthopedic practice. The pathophysiology of the disorder has been extensively described and is well known to physicians who care for patients with musculoskeletal injuries. The diagnosis, however, is often difficult to make. In this article, we review the clinical risk factors of acute compartment syndrome of the lower extremity, identify the current concepts of diagnosis and discuss appropriate treatment plans. We also describe the Canadian medicolegal environment in regard to compartment syndrome of the lower extremity.

We report on the use of discrete event simulation modeling to support process improvements at an ... more We report on the use of discrete event simulation modeling to support process improvements at an orthopedic outpatient clinic. The clinic was effective in treating patients, but waiting time and congestion in the clinic created patient dissatisfaction and staff morale issues. The modeling helped to identify improvement alternatives including optimized staffing levels, better patient scheduling, and an emphasis on staff arriving promptly. Quantitative results from the modeling provided motivation to implement the improvements. Statistical analysis of data taken before and after the implementation indicate that waiting time measures were significantly improved and overall patient time in the clinic was reduced.

Canadian journal of surgery. Journal canadien de chirurgie, 2014

In surgery, preoperative handover of surgical trauma patients is a process that must be made as s... more In surgery, preoperative handover of surgical trauma patients is a process that must be made as safe as possible. We sought to determine vital clinical information to be transferred between patient care teams and to develop a standardized handover checklist. We conducted standardized small-group interviews about trauma patient handover. Based on this information, we created a questionnaire to gather perspectives from all Canadian Orthopaedic Association (COA) members about which topics they felt would be most important on a handover checklist. We analyzed the responses to develop a standardized handover checklist. Of the 1106 COA members, 247 responded to the questionnaire. The top 7 topics felt to be most important for achieving patient safety in the handover were comorbidities, diagnosis, readiness for the operating room, stability, associated injuries, history/mechanism of injury and outstanding issues. The expert recommendations were to have handover completed the same way every...

Foot & Ankle International, 2010

JAMA Surgery

ImportanceUnstable chest wall injuries have high rates of mortality and morbidity. In the last de... more ImportanceUnstable chest wall injuries have high rates of mortality and morbidity. In the last decade, multiple studies have reported improved outcomes with operative compared with nonoperative treatment. However, to date, an adequately powered, randomized clinical trial to support operative treatment has been lacking.ObjectiveTo compare outcomes of surgical treatment of acute unstable chest wall injuries with nonsurgical management.Design, Setting, and ParticipantsThis was a multicenter, prospective, randomized clinical trial conducted from October 10, 2011, to October 2, 2019, across 15 sites in Canada and the US. Inclusion criteria were patients between the ages of 16 to 85 years with displaced rib fractures with a flail chest or non–flail chest injuries with severe chest wall deformity. Exclusion criteria included patients with significant other injuries that would otherwise require prolonged mechanical ventilation, those medically unfit for surgery, or those who were randomly a...

Journal of orthopaedic trauma, Jan 7, 2016

To define the incidence, risk factors and anatomic location of articular malreductions in operati... more To define the incidence, risk factors and anatomic location of articular malreductions in operatively treated lateral tibial plateau fractures DESIGN:: Prospective Cohort Study SETTING:: Academic Level 1 Trauma CentrePatients/Participants: Study subjects were patients entered into a prospective cohort study of tibial plateau fractures. Surgical Fixation of tibial plateau fractures and post-operative computed tomography (CT) scans. The primary outcome was incidence of articular malreduction. Secondary outcomes included risk factors for malreduction and a descriptive analysis of malreduction location. Sixty-five post-operative CT scans were reviewed. Twenty-one reductions (32.3%) had a step or gap more than 2 mm. The frequency of malreductions in patients undergoing sub-meniscal arthrotomy or fluoroscopic-assisted reduction alone was 16.6% and 41.4%, respectively (p=0.0021). Age, body mass index, AO fracture type, operative time, use of bone graft or bone graft substitute and use of l...

The Lancet, 2017

Background High rates of re-operations after initial hip fracture fixation, the associated morbid... more Background High rates of re-operations after initial hip fracture fixation, the associated morbidity, mortality, and costs motivated the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) randomised controlled trial. Methods We randomised 1,079 patients with a low-energy femoral neck fracture fracture requiring fracture fixation in 81 centres to a single large diameter screw with a side-plate (sliding hip screw) or the current standard, multiple small diameter cancellous screws (Clinical Trials Identification Number: NCT01908751). The primary outcome was hip re-operation within 24 months. Health-related quality of life (HRQL) was measured by the SF-12, EQ-5D, and WOMAC score. Findings Re-operations did not convincingly differ by type of surgical fixation: 107 of 542 patients (19•7%) in the sliding hip screw group and 117 of 537 patients (21•8%) in the cancellous screws group (hazard ratio, 0•83; 95% CI, 0•63 to 1•09; p=0•18). Avascular necrosis was more common in the sliding hip screw group than in the cancellous screws group (50 patients [9•2%] vs. 28 patients [5•2%]; hazard ratio, 1•78; 95% CI, 1•09 to 2•91; p=0•02). The three HRQL instruments were consistent in showing no important difference by treatment group at 24 months. A priori subgroups suggested lower reoperation rates with sliding hip screws in patients with displaced fractures (interaction p=0•04), base of femoral neck fractures (interaction p=0•04), and current Page 3 of 33 smokers (interaction p=0•02); current smoking appeared the dominant effect modifier in an analysis that included all three variables. Interpretation Among patients with a femoral neck fracture fracture there was no convincing difference in hip re-operations or HRQL among patients allocated to sliding hip screw compared to cancellous screws. Avascular necrosis was higher with sliding hip screws.

Journal of Orthopaedic Trauma, 2012

Foot & Ankle International, 2010

BMC Musculoskeletal Disorders, 2014

Case Reports in Orthopedic Research, 2022

We present a case of displaced femoral neck fracture (FNF) in a patient treated with closed reduc... more We present a case of displaced femoral neck fracture (FNF) in a patient treated with closed reduction and surgical fixation. An anatomic reduction was confirmed using intraoperative multidimensional fluoroscopy following reduction and surgical fixation. At the 1-year follow-up, the patient had returned to all activities and there were no signs of avascular necrosis. The quality of FNF reduction is an important modifiable treatment variable to reduce the risk of post-operative complications. Intraoperative multidimensional fluoroscopy enables the surgeon to utilize closed reduction techniques, limiting the risk of damage to vascular structures, while allowing for critical assessment of FNF reduction.

Journal of Orthopaedic Trauma, 2018

Purpose: With medial malleolar fractures, surgeons typically utilize 2 screws to ensure rotationa... more Purpose: With medial malleolar fractures, surgeons typically utilize 2 screws to ensure rotational control of the bone fragment. A prospective randomized trial was performed to determine whether single or double screw fixation of the medial malleolus resulted in better long-term health outcomes. The primary outcome was a comparison of physical functioning summary score on Short Form-36 (SF-36) questionnaires between patients in the 2 groups.

Journal of orthopaedic trauma, 2018

The surgical reduction of intra-articular olecranon fractures is judged primarily on the lateral ... more The surgical reduction of intra-articular olecranon fractures is judged primarily on the lateral elbow radiograph, as orthogonal imaging of the articular surface is not obtainable. We sought to determine surgeon accuracy in identifying intra-articular olecranon malreductions on the lateral elbow radiograph. Six human fresh-frozen cadaveric elbow specimens were sagittally sectioned in 5-mm increments after olecranon dissection, preservation of soft tissue envelope, and rigid fixation of the elbow in an external fixator. Three patterns of central intra-articular olecranon malreduction were created in each elbow using a ruler and bone saw. Perfect lateral elbow radiographs were taken of each malreduction, and these images were randomized along with x-rays of normal cadaveric olecranons. The image series was presented to 4 masked trauma-trained surgeons to determine whether the olecranon was malreduced or anatomic. Surgeons interpreted the same image series on 2 separate occasions separ...

Purpose Antibiotic prophylaxis plays an important role in minimizing surgical site infections as ... more Purpose Antibiotic prophylaxis plays an important role in minimizing surgical site infections as well as other nosocomial peri-operative infections in orthopaedic trauma patients. Pre-operative prophylaxis has been shown to be efficacious, but the role and duration of post-operative prophylaxis remains controversial. The goal of this study was to assess whether patients receive their antibiotic prophylaxis as prescribed. What dose and duration of antibiotics are typically ordered, what patients actually receive, and factors causing the ordered antibiotic regime to be altered were also investigated. This study did not investigate infection rates or the efficacy of various antibiotic prophylactic regimes. Method This study presents data collected through a retrospective chart review of 205 patients treated surgically for a closed fracture at one institution. A national survey was also distributed to all surgeon members of the Canadian Orthopaedic Trauma Society (COTS) concerning antib...

Canadian Journal of Surgery

Background: Venous thromboembolism (VTE) is the second most common complication after hip fractur... more Background: Venous thromboembolism (VTE) is the second most common complication after hip fracture surgery. We used thrombelastography (TEG), a wholeblood, point-of-care test that can provide an overview of the clotting process, to determine the duration of hypercoagulability after hip fracture surgery. Methods: In this prospective study, consecutive patients aged 51 years or more with hip fractures (trochanteric region or neck) amenable to surgical treatment who presented to the emergency department were eligible for enrolment. Thrombelastography, including calculation of the coagulation index (CI) (combination of 4 TEG parameters for an overall assessment of coagulation) was performed daily from admission until 5 days postoperatively, and at 2 and 6 weeks postoperatively. All patients received 28 days of thromboprophylaxis. We used single-sample t tests to compare mean maximal amplitude (MA) values (a measure of clot strength) to the hypercoagulable threshold of greater than 65 mm, a predictor of in-hospital VTE. Results: Of the 35 patients enrolled, 11 (31%) were hypercoagulable on admission based on an MA value greater than 65 mm, and 29 (83%) were hypercoagulable based on a CI value greater than 3.0; the corresponding values at 6 weeks were 23 (66%) and 34 (97%). All patients had an MA value greater than 65 mm at 2 weeks. Patients demonstrated normal coagulation on admission (mean MA value 62.2 mm [standard deviation (SD) 6.3 mm], p = 0.01) but became significantly hypercoagulable at 2 weeks (mean 71.6 mm [SD 2.6 mm], p < 0.001). There was a trend toward persistent hypercoagulability at 6 weeks (mean MA value 66.2 mm [SD 3.8 mm], p = 0.06). Conclusion: More than 50% of patients remained hypercoagulable 6 weeks after fracture despite thromboprophylaxis. Thrombelastography MA thresholds or a change in MA over time may help predict VTE risk; however, further study is needed.

The Bone & Joint Journal

Aims Dislocation is the most common indication for further surgery following total hip arthroplas... more Aims Dislocation is the most common indication for further surgery following total hip arthroplasty (THA) when undertaken in patients with a femoral neck fracture. This study aimed to assess the complication rates of THA with dual mobility components (THA-DMC) following a femoral neck fracture and to compare outcomes between THA-DMC, conventional THA, and hemiarthroplasty (HA). Methods We performed a systematic review of all English language articles on THA-DMC published between 2010 and 2019 in the MEDLINE, EMBASE, and Cochrane databases. After the application of rigorous inclusion and exclusion criteria, 23 studies dealing with patients who underwent treatment for a femoral neck fracture using THA-DMC were analyzed for the rate of dislocation. Secondary outcomes included reoperation, periprosthetic fracture, infection, mortality, and functional outcome. The review included 7,189 patients with a mean age of 77.8 years (66.4 to 87.6) and a mean follow-up of 30.9 months (9.0 to 68.0)...

Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, Jan 29, 2018

This trial was conducted to determine the medium-term functional outcome of displaced tibial plat... more This trial was conducted to determine the medium-term functional outcome of displaced tibial plateau fracture patients treated with closed fluoroscopic assisted reduction and internal fixation (CRIF) versus patients treated with standard open reduction with sub-meniscal arthrotomy and internal fixation (ORIF). A prospective trial was conducted in adult patients with displaced AO/OTA 41 B and 41 C tibial plateau fractures. Patients were assigned to treatment based upon the standard treatment of the surgeon involved following the call schedule for the day, either CRIF or ORIF. Postoperative radiographs and CT were performed on all patients and patients were followed for a minimum of 2 years. Primary outcome measures were the KOOS, SMFA and SF-36. Seventy patients were recruited with 2 year follow-up on 35 patients in the CRIF group and 27 patients in the ORIF group. Postoperative CT scans showed that reductions were better with the ORIF group especially in the posterolateral quadrant ...

Canadian Journal of Surgery Journal Canadien De Chirurgie, Oct 1, 2010

Replacing missing issues Claims for missing issues must be made within 3 months of the date of pu... more Replacing missing issues Claims for missing issues must be made within 3 months of the date of publication to be honoured and replaced (subject to availability) free of charge. Replacement copies of older issues, when available, must be prepaid at the single-copy rates listed below. Please submit claims, with a copy of your mailing label, to the Member Service Centre.

Canadian journal of surgery. Journal canadien de chirurgie, 2010

Acute compartment syndrome of the lower extremity is a clinical condition that, although uncommon... more Acute compartment syndrome of the lower extremity is a clinical condition that, although uncommon, is seen fairly regularly in modern orthopedic practice. The pathophysiology of the disorder has been extensively described and is well known to physicians who care for patients with musculoskeletal injuries. The diagnosis, however, is often difficult to make. In this article, we review the clinical risk factors of acute compartment syndrome of the lower extremity, identify the current concepts of diagnosis and discuss appropriate treatment plans. We also describe the Canadian medicolegal environment in regard to compartment syndrome of the lower extremity.

We report on the use of discrete event simulation modeling to support process improvements at an ... more We report on the use of discrete event simulation modeling to support process improvements at an orthopedic outpatient clinic. The clinic was effective in treating patients, but waiting time and congestion in the clinic created patient dissatisfaction and staff morale issues. The modeling helped to identify improvement alternatives including optimized staffing levels, better patient scheduling, and an emphasis on staff arriving promptly. Quantitative results from the modeling provided motivation to implement the improvements. Statistical analysis of data taken before and after the implementation indicate that waiting time measures were significantly improved and overall patient time in the clinic was reduced.

Canadian journal of surgery. Journal canadien de chirurgie, 2014

In surgery, preoperative handover of surgical trauma patients is a process that must be made as s... more In surgery, preoperative handover of surgical trauma patients is a process that must be made as safe as possible. We sought to determine vital clinical information to be transferred between patient care teams and to develop a standardized handover checklist. We conducted standardized small-group interviews about trauma patient handover. Based on this information, we created a questionnaire to gather perspectives from all Canadian Orthopaedic Association (COA) members about which topics they felt would be most important on a handover checklist. We analyzed the responses to develop a standardized handover checklist. Of the 1106 COA members, 247 responded to the questionnaire. The top 7 topics felt to be most important for achieving patient safety in the handover were comorbidities, diagnosis, readiness for the operating room, stability, associated injuries, history/mechanism of injury and outstanding issues. The expert recommendations were to have handover completed the same way every...

Foot & Ankle International, 2010