Surgical complications seem to be a major reason for readmission at the neurosurgical practice studied. Results indicate that the outcomes that are amenable to and would have the greatest effect on quality improvement are CSF shunt-related complications, surgical site infections, and CSF leaks.

H ospital discharges frequently occur in the afternoon or evening hours. 1-5 Late discharges can adversely affect patient flow throughout the hospital, 3,6-9 which, in turn, can result in delays in care, 10-16 more medication errors, 17 increased mortality, 18-20 longer lengths of stay, 20-22 higher costs, 23 and lower patient satisfaction. 24 Various interventions have been employed in the attempts to find ways of moving discharge times to earlier in the day, including preparing the discharge paperwork and medications the previous night, 25 using checklists, 1,25 team huddles, 2 providing real-time feedback to unit staff, 1 and employing multidisciplinary teamwork. 1,2,6,25,26 The purpose of this study was to identify and determine the relative frequency of barriers to writing discharge orders in the hopes of identifying issues that might be addressed by targeted interventions. We also assessed the effects of daily team census, patients being on teaching versus nonteaching services, and how daily rounds were structured at the time that the discharge orders were written. METHODS Study Design, Setting, and Participants We conducted a prospective, cross-sectional survey of housestaff and attending physicians on general medicine teaching and nonteaching services from November 13, 2014, through

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Introduction Medical educators need to demonstrate that their trainees meet expected competency levels when progressing through medical education. This study aimed to develop competency-based pass/fail cut-scores for a graduation required Objective Structured Clinical Examination (OSCE), and examine validity evidence for new standards. Methods Six clinicians used the modified Angoff method to determine the cut-scores for an 8-station OSCE. The clinicians estimated the percentage of minimally competent students who would answer each checklist item correctly. Interrater reliability, differences in other academic achievements between pass/fail groups, educational impact, and response process were examined. Results One hundred seventy-four rising 4th-year medical students participated in the OSCE. The cut-scores determined for the OSCE resulted in a substantially lower failure rate (5% vs. 29% of the previous year). The inter-rater reliability across domains and cases was .98 (95% CI = .97-.99). The pass/fail groups significantly differed in six of the eight measures of academic achievements included in the study. Discussion The impact of the standards setting was substantial as it significantly reduced the failure rate and burdens of remediation for both students and faculty. The very high inter-rater reliability indicates that the modified Angoff method produced reliable cut-scores. The significant differences between the pass/fail groups in other measures support external validity of the standards and ensure no false passes. The study also supports response process