INTRODUCTION The VA hospital is located on a sprawling campus that serves nine rural counties in the Mid-Atlantic region of the United States. The hospital has a 16-bed medical-surgical suite with three operating rooms. Orthopedics is the second highest volume subspecialty and has a dedicated operating room used by three orthopedic surgeons. Nearly three-fourths (74%) of all inpatient orthopedic procedures performed at the hospital are total j

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