title: Standards of surgery beyond metropolitan centers: a fresh look at perioperative quality measures in small-town America.
abstract: BACKGROUND
  Surgical quality measures have room for improvement in both large- and small-town hospitals.
  
  
  METHODS
  We sought concurrence of surgical specialists (general, orthopedic, gynecologic) to study accepted quality and safety parameters using a surgical time-out-based platform.
  
  
  RESULTS
  Surgeons and hospitalists participated promptly and actively and recorded enhanced performance measures compared with prior work and within the period of study. Practice patterns varied, and interchange among participating hospitals was helpful.
  
  
  CONCLUSIONS
  Smaller institutions are more nimble than larger ones and developed interchangeable ideas for improvement. Surgical process measures improved such that all 4 hospitals are concerned about and committed to maintaining the gains.
authors.affiliation: Kings Daughters' Hospital and Health Services, Madison, IN, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Cronen
authors.forename: Motaz
authors.initials: M
authors.lastname: Qadan
authors.forename: Nathan Z
authors.initials: NZ
authors.lastname: Hicks
authors.forename: Hiram C
authors.initials: HC
authors.lastname: Polk
mesh_terms: D002985:Clinical Protocols; D015331:Cohort Studies; D005260:Female; D006276:Health Facility Size; D006801:Humans; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D019990:Perioperative Care / Q000458:organization & administration*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D019984:Quality Indicators, Health Care; D013043:Specialties, Surgical; D014481:United States