A novel saphenous nerve plexus with important clinical correlations

Pannell, William C.; Wisco, Jonathan J.

doi:10.1002/ca.21226

Cited by 6 publications

(2 citation statements)

References 7 publications

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“…Several studies at the interface of primary and subspecialty care [4-9] suggest poor referral coordination and communication as an important contributor to delays in care,[10,11] mainly due to inappropriate timing and detail of information [12] and lost paperwork. The use of information technology has significant potential to improve care coordination [13]. For instance, referrals may be more successful when transmitted through an integrated electronic health record (EHR; i.e ., e-referrals), allowing the PCP and subspecialist to exchange information electronically, and both have immediate access to the entire patient record.…”

Section: Introductionmentioning

confidence: 99%

Towards successful coordination of electronic health record based-referrals: a qualitative analysis

Hysong

Esquivel²,

Sittig

et al. 2011

Implementation Sci

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BackgroundSuccessful subspecialty referrals require considerable coordination and interactive communication among the primary care provider (PCP), the subspecialist, and the patient, which may be challenging in the outpatient setting. Even when referrals are facilitated by electronic health records (EHRs) (i.e., e-referrals), lapses in patient follow-up might occur. Although compelling reasons exist why referral coordination should be improved, little is known about which elements of the complex referral coordination process should be targeted for improvement. Using Okhuysen & Bechky's coordination framework, this paper aims to understand the barriers, facilitators, and suggestions for improving communication and coordination of EHR-based referrals in an integrated healthcare system.MethodsWe conducted a qualitative study to understand coordination breakdowns related to e-referrals in an integrated healthcare system and examined work-system factors that affect the timely receipt of subspecialty care. We conducted interviews with seven subject matter experts and six focus groups with a total of 30 PCPs and subspecialists at two tertiary care Department of Veterans Affairs (VA) medical centers. Using techniques from grounded theory and content analysis, we identified organizational themes that affected the referral process.ResultsFour themes emerged: lack of an institutional referral policy, lack of standardization in certain referral procedures, ambiguity in roles and responsibilities, and inadequate resources to adapt and respond to referral requests effectively. Marked differences in PCPs' and subspecialists' communication styles and individual mental models of the referral processes likely precluded the development of a shared mental model to facilitate coordination and successful referral completion. Notably, very few barriers related to the EHR were reported.ConclusionsDespite facilitating information transfer between PCPs and subspecialists, e-referrals remain prone to coordination breakdowns. Clear referral policies, well-defined roles and responsibilities for key personnel, standardized procedures and communication protocols, and adequate human resources must be in place before implementing an EHR to facilitate referrals.

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Section: Introductionmentioning

confidence: 99%

Towards successful coordination of electronic health record based-referrals: a qualitative analysis

Hysong

Esquivel²,

Sittig

et al. 2011

Implementation Sci

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“…We observed the SN provides usually two (90% cases) infrapatellar branches towards inferior aspect of patella approximately at the level of midpoint to lower end of patellar ligament, arising from SN 4–7 cm medial to midpoint of patellar ligament. Some variation of infrapatellar branches has been reported in previous studies [22]. This anatomic relation should be kept in mind to avoid damage to these branches during knee surgeries to avoid postoperative neuropathy [11112].…”

Section: Discussionmentioning

confidence: 96%

Morphology of saphenous nerve in cadavers: a guide to saphenous block and surgical interventions

Ghosh

Chaudhury

2019

Anat Cell Biol

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The knowledge about detailed morphology and relation of saphenous nerve is important to obtain successful saphenous nerve regional blocks to achieve pre- and post-operative anesthesia and analgesia, nerve entrapment treatments and to avoid damage of saphenous nerve during knee and ankle surgeries. The literature describing detailed morphology of saphenous nerve is very limited. We dissected 42 formalin fixed well embalmed cadaveric lower limbs to explore detailed anatomy, relation and mode of termination of saphenous nerve and measured the distances from the nearby palpable bony landmarks. The average distance of origin of saphenous nerve from inguinal crease was 7.89±1.42 cm, the distance from upper end of medial border of patella to saphenous nerve at that level was 8.11±0.85 cm, distance from tibial tuberosity was 7.53±0.98 cm and from midpoint of anterior border of medial malleolus was 0.45±0.14 cm. Saphenous nerve provided two infrapatellar branches at the level of mid to lower limit of patellar ligament in 90% cases. It was in close contact or adhered to great saphenous vein across the lower 2/3rd of leg lying either anterior, posterior or deep to the vein. The saphenous nerve terminated by bifurcating proximal to medial malleolus in majority of cases though no obvious bifurcation was observed in 9.52% cases. The detailed morphology, relations and the distances from palpable bony landmarks may be helpful for clinicians to achieve successful saphenous nerve block and to avoid saphenous nerve damage and related complications during orthopedic procedures.

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Saphenous Nerve

Carey

2014

Encyclopedia of the Neurological Sciences

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A novel saphenous nerve plexus with important clinical correlations

Cited by 6 publications

References 7 publications

Towards successful coordination of electronic health record based-referrals: a qualitative analysis

Towards successful coordination of electronic health record based-referrals: a qualitative analysis

Morphology of saphenous nerve in cadavers: a guide to saphenous block and surgical interventions

Saphenous Nerve

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