scholarly journals Protecting the emergency physician workforce during the coronavirus disease 2019 pandemic through precision scheduling at an academic tertiary care trauma center

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Moon O. Lee ◽  
Ryan Ribeira ◽  
Andrea Fang ◽  
Lauren Cantwell ◽  
Kajal Khanna ◽  
...  
Keyword(s):  
Emergency Physician ◽  
Trauma Center ◽  
Tertiary Care ◽  
Physician Workforce

scholarly journals Surgical Site Infections at a Level I Trauma Center in India: Data From an Indigenously Developed, e-SSI Surveillance System

2020 ◽  
Vol 41 (S1) ◽  
pp. s397-s398
Author(s):  
Ayush Lohiya ◽  
Samarth Mittal ◽  
Vivek Trikha ◽  
Surbhi Khurana ◽  
Sonal Katyal ◽  
...  
Keyword(s):  
Surveillance System ◽  
Trauma Center ◽  
Tertiary Care ◽  
Length Of Hospital Stay ◽  
Surgical Site Infections ◽  
Trauma Patients ◽  
Care Hospital ◽  
Middle Income ◽  
Predominant Pathogen ◽  
Level I

Background: Globally, surgical site infections (SSIs) not only complicate the surgeries but also lead to $5–10 billion excess health expenditures, along with the increased length of hospital stay. SSI rates have become a universal measure of quality in hospital-based surgical practice because they are probably the most preventable of all healthcare-associated infections. Although, many national regulatory bodies have made it mandatory to report SSI rates, the burden of SSI is still likely to be significant underestimated due to truncated SSI surveillance as well as underestimated postdischarge SSIs. A WHO survey found that in low- to middle-income countries, the incidence of SSIs ranged from 1.2 to 23.6 per 100 surgical procedures. This contrasted with rates between 1.2% and 5.2% in high-income countries. Objectives: We aimed to leverage the existing surveillance capacities at our tertiary-care hospital to estimate the incidence of SSIs in a cohort of trauma patients and to develop and validate an indigenously developed, electronic SSI surveillance system. Methods: A prospective cohort study was conducted at a 248-bed apex trauma center for 18 months. This project was a part of an ongoing multicenter study. The demographic details were recorded, and all the patients who underwent surgery (n = 770) were followed up until 90 days after discharge. The associations of occurrence of SSI and various clinico-microbiological variables were studied. Results: In total, 32 (4.2%) patients developed SSI. S. aureus (28.6%) were the predominant pathogen causing SSI, followed by E. coli (14.3%) and K. pneumoniae (14.3%). Among the patients who had SSI, higher SSI rates were associated in patients who were referred from other facilities (P = .03), had wound class-CC (P < .001), were on HBOT (P = .001), were not administered surgical antibiotics (P = .04), were not given antimicrobial coated sutures (P = .03) or advanced dressings (P = .02), had a resurgery (P < .001), had a higher duration of stay in hospital from admission to discharge (P = .002), as well as from procedure to discharge (P = .002). SSI was cured in only 16 patients (50%) by 90 days. SSI data collection, validation, and analyses are essential in developing countries like India. Thus, it is very crucial to implement a surveillance system and a system for reporting SSI rates to surgeons and conduct a robust postdischarge surveillance using trained and committed personnel to generate, apply, and report accurate SSI data.Funding: NoneDisclosures: None

Traumatic Spinal Injuries in Saudi Arabia: A Retrospective Single-center Medical Record Review

2021 ◽  
pp. 43
Author(s):  
Mohammed Alsabieh
Keyword(s):  
Saudi Arabia ◽  
Medical Record ◽  
Trauma Center ◽  
Motor Vehicle ◽  
Tertiary Care ◽  
Spinal Injuries ◽  
Medical Record Review ◽  
Common Mechanism ◽  
Mechanism Of Injury ◽  
Record Review

Introduction: The aim of this retrospective medical record review was to describe the patterns and outcomes of traumatic spinal injuries (TSIs) in a tertiary care trauma center in Riyadh, Saudi Arabia. Methodology: Data of all patients who presented at a setting level-1 trauma center with any type of spinal trauma between February 1, 2016 and December 31, 2018 were review. The data obtained included age, gender, nationality (as Saudi and non-Saudi), date of presentation, site of fracture/injury, associated injuries, mechanism of injury, presence of neurological involvement, and hospital mortality. The main outcome of the review was frequencies of different types of TSI across various subgroups. Result: We identified 692 patients who presented with TSI during the study period. The mean age was 36.9 years. Males represented 83.2% (n = 576) of the sample size, and the most common mechanism of injury was motor vehicle collision (MVC), accounting for 66.8% of the cases (n = 462), while fall-related injuries were seen in 31.6% of the cases (n = 219). A total of 454 (65.6%) of all patients were Saudi, and 332 (73.1%) of the TSIs in Saudis were due to MVC. Non-Saudi cases accounted for 238 (34.4%) of all patients, and 89 (37.4%) of the non-Saudi injuries were due to falls from height, this association was statistically significant (p < 0.001). Conclusion: TSI was not thoroughly examined in Saudi Arabia; therefore, this study is considered the first to be done in the Kingdom using a representative sample. The fact that non-Saudi patients had a higher proportion of falls as a mechanism of injury should be taken into consideration in terms of raising awareness and taking more safety precautions, as most construction workers tend to be expatriates.

National Study of the Emergency Physician Workforce, 2020

2020 ◽  
Vol 76 (6) ◽  
pp. 695-708 ◽  
Author(s):  
Christopher L. Bennett ◽  
Ashley F. Sullivan ◽  
Adit A. Ginde ◽  
John Rogers ◽  
Janice A. Espinola ◽  
...  
Keyword(s):  
Emergency Physician ◽  
Physician Workforce ◽  
National Study

Assessment of Anaerobic Culture Incubation Time: A Tertiary Care Center Experience

2019 ◽  
Vol 152 (Supplement_1) ◽  
pp. S132-S133
Author(s):  
Akanksha Gupta ◽  
Arti Easwar ◽  
Yanice Maldonado ◽  
Pam Hamilton ◽  
Lori Baumgartner ◽  
...  
Keyword(s):  
Incubation Time ◽  
Trauma Center ◽  
Care Center ◽  
Tertiary Care ◽  
Anaerobic Culture ◽  
Anaerobic Conditions ◽  
Gram Positive ◽  
Gram Negative ◽  
Level I ◽  
The Ideal

Abstract Background Currently, there is no consensus on the ideal incubation time for anaerobic cultures. A recent survey of CliniMicroNet reported anaerobic culture incubation times from 2 to 7 days. The goal of this study is to determine the ideal anaerobic culture incubation time and to retrospectively determine if longer incubation time affected management. Methods In this prospective study at Hartford Hospital, an 869-bed level I trauma center, 838 consecutive anaerobic cultures were Gram stained and planted on anaerobic blood, colistin and nalidixic acid (CNA), and kanamycin and vancomycin (KV) agar plates (BD Diagnostic Sparks). Plates were incubated in jars at 35°C and Anoxomat system (Advanced Instruments) was used to create anaerobic conditions. Plates were checked for growth on days 2, 3, 5, and 7. Although not all patient records (EPIC) were available, the type and duration of antibiotics were recorded for more than 100 records. Results Out of 74 cultures from bronchoalveolar lavage (1), bone (2), fluid (21), tissue (14), and wound (36), 53 grew 1 isolate, 15 grew 2 isolates, 5 grew 3 isolates, and 1 grew 4 isolates, for a total of 102 isolates. Sixty percent of isolates were Gram negative and 40% were Gram positive. Of these, 43% were detected on day 2, 21% on day 3, 20% on day 5, and 17% on day 7. In a majority of cases, broad-spectrum antibiotics (vancomycin/cefepime) were administered until culture results were obtained. Conclusion Overall, 73% Gram-negative isolates and 50% Gram-positive isolates were detected on day 2 or 3. Days 5 and 7 yielded 20% and 17% of all isolates, respectively. We conclude and corroborate with CLSI recommendations that anaerobic cultures should be incubated for at least 5 to 7 days.

Do Estimates of Emergency Physician Workforce Underestimate Current Needs?

1996 ◽  
Vol 28 (6) ◽  
pp. 666-670 ◽  
Author(s):  
Carolyn E Haase ◽  
Lawrence M Lewis ◽  
Bernard Kao‡
Keyword(s):  
Emergency Physician ◽  
Physician Workforce

scholarly journals The removal of coins from the upper esophageal tract of children by emergency physicians: a pilot study

CJEM ◽  
2004 ◽  
Vol 6 (06) ◽  
pp. 434-440 ◽  
Author(s):  
Edward J. Vargas ◽  
Ameer P. Mody ◽  
Tommy Y. Kim ◽  
T. Kent Denmark ◽  
James A. Moynihan ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pilot Study ◽  
Emergency Physician ◽  
Foley Catheter ◽  
Tertiary Care ◽  
Pediatric Emergency ◽  
Rapid Sequence Intubation ◽  
Emergency Physicians ◽  
Common Procedure ◽  
Data Set

ABSTRACT:Objective:There are few reports in the medical literature describing removal of a coin from the upper esophageal tract of a child by an emergency physician. However, given the nature of their training and practice, emergency physicians are well suited to perform this common procedure. We describe our experience with this procedure.Methods:This was a retrospective review of a continuous quality improvement data set from a university-based tertiary care pediatric emergency department between Nov. 1, 2003, and Mar. 31, 2004.Results:Thirteen children, with a median age of 20 months, underwent rapid sequence intubation and had coins successfully removed from their upper esophageal tract by emergency physicians. In 10 cases, the coin was visible at laryngoscopy and removed with Magill forceps. In 3 cases this approach failed and a Foley catheter was used to remove the coin. One child suffered a tonsillar abrasion and two sustained minor lip trauma, but all were extubated and discharged home from the emergency department with no significant complications. Eleven of the 13 patients were successfully followed up, and the parents reported no problems.Conclusions:This pilot study suggests that the removal of a coin from the upper esophageal tract by an emergency physician can be both safe and effective. A larger study is needed before this procedure can be generally recommended.

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