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Since 1998, Quality Surgical Solutions, PLLC, has developed simple physician-authored protocols for delivering high-quality and cost-effective surgery that measure up to benchmark institutions. We have discovered wide areas for improvements in surgery by adherence to simple protocols, minimizing death and complications and clarifying cost issues.

Background-Timely reperfusion in ST-segment elevation myocardial infarction (STEMI) patients improves clinicaloutcomes. Implementing strategies to target institutional-specific delays are crucial for improved patient care. Methods and Results-Using a novel strategy to analyze specific components of door-to-balloon time (DBT) at our institution, we previously identified several specific interval delays in our prior STEMI protocol. We then implemented 4 strategies to reduce DBT: (1) emergency department physician activation of the STEMI protocol; (2) "single call" broadcast paging of the STEMI team by the page operator; (3) immediate feedback to the emergency and cardiology departments with joint monthly quality improvement meetings; and (4)

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With a prevalence rate of up to 5% in the population over 65 years of age, ulceration of the lower extremities is an important cause of morbidity, mortality, and increased healthcare costs.