23  Jul  19 marta-crispens category Marta Crispens

The hazards of sleep deprivation | Marta Ann Crispens, MD, MBA, FACOG

A recent study in the New England Journal of Medicine reported that within the constraints of an 80-hour work week, more flexible work hour restrictions for internal medicine residents that did not specify shift lengths or time off between shifts did not adversely affect 30-day mortality or other measures of patient safety.A randomized trial of surgical residents similarly found that less restrictive work hours was associated with non-inferior patient outcomes as compared to a more restrictive work hours policy.2  But what if this is the wrong question?  Perhaps the question is not how to optimize the 80-hour week, but whether it is possible to reconcile the 80-hour week and 24-hour shifts with the realities of human physiology. Continue reading


01  Dec  16 marta-crispens category Marta Crispens

Continuous performance improvement | Marta Crispens, MD

The patient described here is fictitious, but is based on situations that we have all experienced.

Mrs. Smith is a delightful, 48-year old woman with stage IIIc high grade serous carcinoma of the ovary. She undergoes an optimal cytoreductive surgery, including modified posterior pelvic exenteration with low colon anastomosis. She is slender and healthy. The surgery goes well, except for some challenges with the colon anastomosis. In the end, it is airtight, and all seems well. She is discharged from the hospital quickly, but returns within 24 hours with a pelvic abscess due to a leak from her anastomosis.
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