If you are interested in hosting a SIGN program in your hospital or clinic, please provide the information requested below. Please complete the following questionnaire. Include any other information that you believe to be important or appropriate about you or your hospital.
When the information is complete, press the SUBMIT button and your information will be emailed to SIGN Staff.
All fields are required.
Please answer the following important questions:
14. What is the size of your hospital (number of beds)?
15. What is the size of your orthopaedic department (number of surgeons)?
16. How many fractures does your hospital treat per year by surgery?
Tibias:
Femurs:
Humerus:
What percentage of these are treated best with IM Nail?
17. Have you had experience in IM nailing?
Yes: No:
If yes, please explain your experience:
18. How many IM Nailings have you done?
19. What are the usual dimensions of your patient's tibias and femurs?
Tibia Lengths:
Tibia Widths:
Femur Lengths:
Femur Widths:
20. What is your hospital's orthopaedic infection rate?
21. Are the other doctors in your hospital interested in treating tibia and femur fractures with SIGN IM nails?
Yes: No:
If yes, then how many doctors would like to participate?
22. Do you have real-time (C-arm) imaging in your operating room?
Yes: No:
23. Does your hospital have an agreement in place with the government to receive donations of implants free from customs duty?
Yes: No:
24. Is there medical liability for SIGN, the SIGN physician, or the SIGN system?
Yes: No:
25. Would Dr. Zirkle or another physician be permitted in your operating rooms to perform and assist in using the SIGN nail? Our ultimate goal, of course, is for the host physicians to do the surgery.
Yes: No:
26. Will you be willing to serve as the SIGN Program Manager for your hospital?
Yes: No:
The SIGN system is donated to your hospital for use in treating poor patients. A program manager is the main contact between SIGN and the hospital. He/she is responsible for coordinating proper training of SIGN technique and reporting of cases.
27. Do you have access to a computer, digital camera and the internet?
Yes: No:
28. SIGN programs are established in hospitals where the hospital administration, the head of the department and the surgeons agree that the system is to be used for the poor. Are the hospital administration and the head of the orthopaedic department willing to sign an agreement to this?
Yes: No:
29. Will you agree to report all SIGN surgeries done at your hospital on a weekly basis?
Yes: No:
This will include filling in drop-down boxes, sending pre- and post-operative x-rays and follow-up x-rays. We will respond to questions or comments you pose in the comments section. The data from your hospital is private. You may access your data at any time using your username and password.
Reasons for reporting:
Exchange of information so SIGN can continue to improve. We consider all comments and suggestions you send. I will comment on them as time allows.
Due to increased demand, we must adjust our manufacturing schedule to meet the needs of our programs. This includes sizes and types of nails.
Many questions in fracture treatment arise in the SIGN programs. We can develop data to answer these questions and you will have access to this data.
You can use your data for your own use.
We at SIGN work very hard to provide you with a high quality system that is approved by the FDA for use in the United States. Together we will work towards our vision of
Creating Equality of Fracture Care throughout the World.
I confirm that the above information is true and accurate to the best of my knowledge.
SIGN | 509.371.1107
451 Hills Street, Suite B, Richland WA 99354
SIGN (Surgical Implant Generation Network) is registered as a non-profit, tax-exempt corporation in the State of Washington
and in the U.S.A. with IRS 501(c)(3) status. Any financial or in-kind contributions are fully tax-deductible in the United States.
