811. Impact of the COVID-19 Pandemic on Surgical Volume and Surgical Site Infections (SSI) in a Large Network of Community Hospitals

Abstract Background The COVID-19 pandemic significantly impacted hospitalizations and healthcare utilization. Diversion of infection prevention resources toward COVID-19 mitigation limited routine infection prevention activities such as rounding, observations, and education in all areas, including the peri-operative space. There were also changes in surgical care delivery. The impact of the COVID-19 pandemic on SSI rates has not been well described, especially in community hospitals. Methods We performed a retrospective cohort study analyzing prospectively collected data on SSIs from 45 community hospitals in the southeastern United States from 1/2018 to 12/2020. We included the 14 most commonly performed operative procedure categories, as defined by the National Healthcare Safety Network. Coronary bypass grafting was included a priori due to its clinical significance. Only facilities enrolled in the network for the full three-year period were included. We defined the pre-pandemic time period from 1/1/18 to 2/29/20 and the pandemic period from 3/1/20 to 12/31/20. We compared monthly and quarterly median procedure totals and SSI prevalence rates (PR) between the pre-pandemic and pandemic periods using Poisson regression. Results Pre-pandemic median monthly procedure volume was 384 (IQR 192-999) and the pre-pandemic SSI PR per 100 cases was 0.98 (IQR 0.90-1.04). There was a transient decline in surgical cases beginning in March 2020, reaching a nadir of 185 cases in April, followed by a return to pre-pandemic volume by June (figure 1). Overall and procedure-specific SSI PRs were not significantly different in the COVID-19 period relative to the pre-pandemic period (total PR per 100 cases 0.96 and 0.97, respectively, figure 2). However, when stratified by quarter and year, there was a trend toward increased SSI PR in the second quarter of 2020 with a PRR of 1.15 (95% CI 0.96-1.39, table 1). Conclusion The decline in surgical procedures early in the pandemic was short-lived in our community hospital network. Although there was no overall change in the SSI PR during the study period, there was a trend toward increased SSIs in the early phase of the pandemic (figure 3). This trend could be related to deferred elective cases or to a shift in infection prevention efforts to outbreak management. Disclosures All Authors: No reported disclosures

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905. Surgical Site Infections Following Colon Surgery in a Large Network of Community Hospitals

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1093 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S486-S487

Author(s):

Jessica L Seidelman ◽

Arthur W Baker ◽

Maojun Ge ◽

Sarah S Lewis ◽

Sonali D Advani ◽

...

Keyword(s):

Hospital Volume ◽

Surgical Site Infections ◽

Colon Surgery ◽

Diabetes Diagnosis ◽

Large Network ◽

Community Hospitals ◽

Effect Measure ◽

Effect Measure Modification ◽

The Impact ◽

Emergent Surgery

Abstract Background Colon surgeries are commonly performed, and surgical site infections (SSIs) following these procedures are routinely reported to the National Healthcare Safety Network (NHSN). However, the impact of infections present at the time of surgery (PATOS) and emergent surgeries on the epidemiology of colon surgery SSIs has not been well described. Methods We retrospectively analyzed prospectively collected data on complex (i.e., deep incisional or organ space) SSIs following colon surgery performed at 34 community hospitals in the southeastern United States from January 2015 to June 2019. We excluded SSIs categorized as PATOS. We then stratified colon surgery SSI rates according to age, sex, body mass index (BMI), operation duration, diabetes diagnosis, American Society of Anesthesiologists (ASA) physical status, wound class, emergent procedure, endoscopic procedure, and hospital colon surgery volume. Finally, we explored effect measure modification of emergent surgery and open surgery on hospital volume using log-binomial modeling and tests of homogeneity. Results A total of 722 complex SSIs occurred following 28,642 colon surgeries (prevalence rate [PR], 2.52 per 100 procedures). After PATOS SSIs were excluded, 545 complex SSIs remained (PR 1.90 per 100 procedures). Risk factor analysis revealed that age < 75 years and operation time > 75th percentile (188 minutes) during the 5-year study period) significantly increased risk of SSI (Table 1). The most common pathogens that caused SSIs in this study cohort were Escherichia coli, Enterococcus, and Klebsiella. (Table 2) 105 (19%) SSIs were culture-negative and 378 (69%) of the SSIs were polymicrobial. We defined hospital volume as high (>500 procedures in the 5-year period) based on the median hospital volume in the dataset. No significant effect measure modification occurred between hospital volume and either laparoscopic surgery or emergent surgery (Table 3). Table 1: Characteristics of patients who underwent colon surgery from January 2015 to June 2018 in 34 community hospitals. Table 2: Count and frequency of pathogens that caused complex surgical site infections after colon surgery Table 3: Colon surgery complex surgical site infection rates, stratified by emergent, elective, open, and laparoscopic procedures and hospital colon surgery volume Conclusion In our cohort, we found that one-fourth of colon surgery SSIs were categorized as PATOS, which are no longer publicly reported to the Centers for Medicare & Medicaid Services. While most SSI literature describes higher volume hospitals having lower SSI rates, high colon surgery volume was associated with increased SSI rates in our community hospital cohort. Disclosures All Authors: No reported disclosures

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The impact of a multimodel approach to designing a new orthopedic department

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.1345 ◽

2020 ◽

pp. 1-6

Author(s):

Elad Keren ◽

Abraham Borer ◽

Lior Nesher ◽

Tali Shafat ◽

Rivka Yosipovich ◽

...

Keyword(s):

Hand Hygiene ◽

Antibiotic Stewardship ◽

Infection Prevention ◽

Tertiary Care ◽

Surgical Site Infections ◽

Antibiotic Use ◽

Prevention Measures ◽

Orthopedic Department ◽

Before And After ◽

The Impact

Abstract Objective: To determine whether a multifaceted approach effectively influenced antibiotic use in an orthopedics department. Design: Retrospective cohort study comparing the readmission rate and antibiotic use before and after an intervention. Setting: A 1,000-bed, tertiary-care, university hospital. Patients: Adult patients admitted to the orthopedics department between January 2015 and December 2018. Methods: During the preintervention period (2015–2016), 1 general orthopedic department was in operation. In the postintervention period (2017–2018), 2 separate departments were created: one designated for elective “clean” surgeries and another that included a “complicated wound” unit. A multifaceted strategy including infection prevention measures and introducing antibiotic stewardship practices was implemented. Admission rates, hand hygiene practice compliance, surgical site infections, and antibiotic treatment before versus after the intervention were analyzed. Results: The number of admissions and hospitalization days in the 2 periods did not change. Seven-day readmissions per annual quarter decreased significantly from the preintervention period (median, 7 days; interquartile range [IQR], 6–9) to the postintervention period (median, 4 days; IQR, 2–7; P = .038). Hand hygiene compliance increased and surgical site infections decreased in the postintervention period. Although total antibiotic use was not reduced, there was a significant change in the breakdown of the different antibiotic classes used before and after the intervention: increased use of narrow-spectrum β-lactams (P < .001) and decreased use of β-lactamase inhibitors (P < .001), third-generation cephalosporins (P = .044), and clindamycin (P < .001). Conclusions: Restructuring the orthopedics department facilitated better infection prevention measures accompanied by antibiotic stewardship implementation, resulting in a decreased use of broad-spectrum antibiotics and a significant reduction in readmission rates.

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Financial and Mortality Modeling as a Tool to Present Infection Prevention Data: What a SIR of 1.2 Means for the Hospital

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.550 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s64-s65

Author(s):

Vidya Mony ◽

Kevin Hultquist ◽

Supriya Narasimhan

Keyword(s):

Infection Prevention ◽

Excess Mortality ◽

Medical Center ◽

Meta Analysis ◽

Surgical Site Infections ◽

Excess Cost ◽

Effective Manner ◽

Population Mortality ◽

Tract Infections ◽

The Impact

Background: Presenting to hospital leadership is an annual requirement of many infection prevention (IP) programs. Most presentations include current statistical data of hospital-acquired infections (HAIs) and whether the hospital has met its goals according to the National Healthcare Safety Network (NHSN) criteria. We presented HAI data in a novel way, with financial and mortality modeling, to show the impact of IP interventions to leadership not attuned to NHSN metrics. Method: We looked at 4 HAIs, their trends, and their effect on our hospital, Santa Clara Valley Medical Center (SCVMC). To estimate the impact of specific HAIs, we used 2 metrics derived from a meta-analysis by the US Department of Health and Human Services (HHS): excess mortality and excess cost. Excess mortality is defined as the difference between the underlying population mortality and the affected population mortality expressed as deaths per 1,000 population. Excess cost is defined as the additional cost introduced per patient with a specific HAI versus a similarly admitted patient without that HAI. HHS data were multiplied by the number of HAI events at SCVMC to generate estimates. Result: In our presentation, we elucidated a previously unseen cost savings and decreased mortality with 2 HAIs, central-line–associated blood stream infections (CLABSIs) and catheter associated urinary tract infections (CAUTIs), which were below NHSN targets due to IP-led interventions. We then showed 2 other HAIs, Clostridium difficile infection (CDI) and surgical site infections (SSIs), which did not meet our expected NHSN and institutional goals and were estimated to increase costs and potential mortalities in the upcoming year. We argued that proactive monies directed toward expanding our IP program and HAI mitigation efforts would cost a fraction of the impending healthcare expenditures as predicted by the model. Conclusion: By applying financial and mortality modeling, we helped our leadership perceive the concrete effect of IP-led interventions versus presenting abstract NHSN metrics. We also emphasized that without proactive leadership investment, we would continue to overspend healthcare dollars while not meeting our goals. This format of presentation gave us critical leverage to advocate for and successfully expand our IP department. Further SHEA-led cost-analysis modeling and education are needed to help IP departments promote their efforts in an effective manner.Funding: NoneDisclosures: None

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EP.FRI.271 The impact of Surgical Assessment Unit on emergency and ambulatory surgical care in a district general hospital

British Journal of Surgery ◽

10.1093/bjs/znab312.050 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Aloka Suwanna Danwaththa Liyanage ◽

Philip Apter ◽

Gemma Causer ◽

Krishnan Gokul ◽

Paul Ainsworth

Keyword(s):

Care Delivery ◽

Surgical Care ◽

District General Hospital ◽

Direct Access ◽

Post Discharge ◽

Similar Time ◽

Assessment Unit ◽

Audit Period ◽

The Impact

Abstract Aims There has been a paradigm shift in the delivery of emergency and ambulatory surgical care necessitated by paucity of beds, improved expedited diagnostics and delayed transit in Emergency departments. The objective of a surgical assessment unit (SAU) is to reduce the number of semi-urgent admissions, provide direct access to urgent surgical admissions bypassing the ED, expeditious assessment by senior clinicians and to reduce the number of OPD follow up. In our setting, the SAU came into existence on all 5 working days at 12-hour daily schedule and its impact was evaluated retrospectively. Methods Prospectively maintained data base over a 2-month period was examined. Pre and post SAU figures were compared to judge any quantitative improvement in surgical services. Results During the audit period of 2 months there were 156 emergency patients and 190 ward attenders for follow up care. Majority of these patients were assessed within 4 hours and discharged or ambulated. Numbers being admitted overnight purely to facilitate investigations showed a decrease of 44.6% post SAU establishment. There was a reduction in post discharge outpatients appointments when compared to a similar time period pre SAU (14% difference). Conclusion The SAU, although initially conceived and designed purely to cope with increased admissions and to minimise breaching of emergency department targets, has shown quantitative and qualitative improvement in emergency and ambulatory surgical care delivery.

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The Impact of COVID-19 on Patient Safety: A Survey of Acute-Care Registered Nurses in New Jersey

Antimicrobial Stewardship & Healthcare Epidemiology ◽

10.1017/ash.2021.105 ◽

2021 ◽

Vol 1 (S1) ◽

pp. s54-s55

Author(s):

Monika Pogorzelska-Maziarz ◽

Mary Lou Manning ◽

Angela Gerolamo ◽

Mary Johansen ◽

Irina Grafova ◽

...

Keyword(s):

Patient Safety ◽

New Jersey ◽

Registered Nurses ◽

Acute Care ◽

Prevention And Control ◽

Infection Prevention ◽

Care Delivery ◽

Infection Prevention And Control ◽

And Control ◽

The Impact

Background: As the world grapples with the pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), it is important to consider the full impact of coronavirus disease 2019 (COVID-19) on healthcare delivery. Evidence from outbreaks of novel H1N1 and Ebola indicates that response to these types of outbreaks requires extraordinary resources, which are diverted from routine infection prevention and control activities. However, little is known about the impact of COVID-19 on adherence to patient safety protocols in hospitals, including infection prevention and control activities. We have described the reports of acute-care registered nurses (RNs) in adhering to patient safety protocols while delivering care to COVID-19 patients. Methods: In October 2020, we conducted a cross-sectional electronic survey of all active RNs in the state of New Jersey who provided direct patient care in a New Jersey hospital in an emergency or adult inpatient unit during the onset of the COVID-19 pandemic. Results: More than 3,027 RNs participated in the survey, for a 15% response rate based on number of eligible RNs. Moreover, 15% of respondents reported that they tested positive for COVID-19 during the initial peak of COVID-19 in New Jersey (March–June 2020). Most RNs reported that the number of patients they were assigned during the first peak of the pandemic affected their ability to adhere to patient safety protocols (eg, deep-vein thrombosis screening, central-line bundles, pressure ulcer prevention). In open-ended responses, they shared that being understaffed, the extra time it took for downing and doffing of PPE, the lack of access to ancillary staff (ie nursing assistants, runners), and the need to cluster care affected the quality of care. A nurse working in the intensive care unit (ICU) lamented, “We were sometimes given 4–5 ICU patients who were very sick and required a lot of care. Shortcuts had to be taken to prioritize the most important needs. Sometimes IVs remained longer than desired. Foleys remained in longer. To avoid PPE shortages, we didn’t go into the rooms nearly as much as we normally would, [and] things got missed.” Feelings of being overwhelmed and helpless permeated the nurses’ comments. Conclusions: When caring for COVID-19 patients, frontline nurses struggled with adherence to necessary patient safety protocols, which ultimately disrupted care delivery. Future research should quantify the extent to which the COVID-19 pandemic affected care delivery, including adherence to patient safety protocols among frontline providers.Funding: NoDisclosures: None

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The Impact of Depth of Infection and Postdischarge Surveillance on Rate of Surgical-Site Infections in a Network of Community Hospitals

Infection Control and Hospital Epidemiology ◽

10.1086/664053 ◽

2012 ◽

Vol 33 (3) ◽

pp. 276-282 ◽

Cited By ~ 30

Author(s):

David Y. Ming ◽

Luke F. Chen ◽

Becky A. Miller ◽

Daniel J. Sexton ◽

Deverick J. Anderson

Keyword(s):

Surgical Procedures ◽

Surgical Site Infections ◽

Inpatient Setting ◽

Community Hospitals ◽

Comparative Performance ◽

Median Proportion ◽

Inpatient Settings ◽

The Impact ◽

Reporting Method ◽

Performance Ranking

Objective.To describe the epidemiology of surgical-site infections (SSIs) in community hospitals and to explore the impact of depth of SSI, healthcare location at the time of diagnosis, and variations in surveillance practices on the overall rate of SSI.Design.Retrospective cohort study.Setting.Thirty-seven community hospitals in the southeastern United States.Patients.Consecutive sample of patients undergoing surgical procedures between July 1, 2007, and December 31, 2008.Methods.ANOVA was used to compare rates of SSIs, and the F test was used to compare the distribution of rates of SSIs. Wilcoxon rank-sum was used to test for differences in performance rankings of hospitals.Results.Following 177,706 surgical procedures, 1,919 SSIs were identified (incidence, 1.08 per 100 procedures). Sixty-four percent (1,223 of 1,919) of these were identified as complex SSIs; 87% of the complex SSIs were diagnosed in inpatient settings. The median proportion of superficial-incisional SSIs was 37% (interquartile range, 29.6%–49.5%). Postdischarge SSI surveillance was variable, with 58% of responding hospitals using surgeon letters. As reporting focus was narrowed from all SSIs to complex SSIs (incidence, 0.69 per 100 procedures) and, finally, to complex SSIs diagnosed in the inpatient setting (incidence, 0.51 per 100 procedures), variance in rates changed significantly (P = .02). Performance ranking of individual hospitals, based on rates of SSIs, differed significandy, depending on the reporting method utilized (P = .0006).Conclusions.Inconsistent reporting mediods focused on variable depths of infection and healthcare location at time of diagnosis significandy impact rates of SSI, distribution of rates of SSI, and hospital comparative-performance rankings. We believe that public reporting of SSI rates should be limited to complex SSIs diagnosed in the inpatient setting.Infect Control Hosp Epidemiol 2012;33(3):276-282

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Driving quality improvement: How clinical decision support can facilitate compliance with evidence-based pathways.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.2045 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. 2045-2045

Author(s):

Debra A. Patt ◽

Bo He ◽

Jody S. Garey ◽

Paul Rowan ◽

Michael D Swartz ◽

...

Keyword(s):

Quality Improvement ◽

Decision Support ◽

Clinical Decision Support ◽

Cancer Care ◽

Care Delivery ◽

Clinical Decision ◽

Clinical Informatics ◽

Evidence Based ◽

Large Network ◽

The Impact

2045 Background: Cancer care is changing rapidly with more detailed understanding of disease and more numerous therapeutic choices. As treatment choice is more complex, mechanisms to improve compliance with evidence based treatment can improve the quality of cancer care. Methods: A retrospective cohort study was conducted from January 2014-May 2016 evaluating the impact of a clinical decision support system (CDSS) on compliance with evidence based pathways (EBP) across 9 statewide community based oncology practices. These EBP are developed with physician input on efficacy toxicity and value and incorporated in to a CDSS that is used within the Electronic Health Record (EHR) at point of care to alter the choice architecture a clinician sees when prescribing therapy. A multi-level logistic regression model was used to adjust for group effects on physician or practice behavior. SAS 9.4 software was used and GLIMMIX was applied. Individual physician benchmark compliance was evaluated using McNemar's test. Results: Regimen compliance with EBP was measured pre- and post- implementation of the CDSS tool across a large network encompassing 9 statewide practices and 633 physicians who prescribed over 30,000 individual patient treatment regimens over a 6 month period. The CDSS that is incorporated within the EHR significantly improved compliance with EBP across the entire cohort of practices, and in individual practices (see Table). Individual oncologists reached a target of 75% compliance more often (58% vs 72%) after implementation of the tool (p < 0.001). Conclusions: CDSS is a tool that improves compliance with EBP that is effective at improving targets of compliance broadly, at the practice, and at the individual clinician level. Clinical informatics solutions that influence physician behavior can be inclusive of physicians in design, iterative in process, and nudge as opposed to force clinician behavior to drive quality improvement. These clinical informatics solutions grow in importance as the complexity of cancer care continues to increase and we seek to improve upon the quality and value of care delivery. [Table: see text]

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Prospective surveillance after implementation of a colorectal surgical site infection prevention bundle

British Journal of Surgery ◽

10.1093/bjs/znab202.018 ◽

2021 ◽

Vol 108 (Supplement_4) ◽

Author(s):

J Jurt ◽

D Clerc ◽

P Curchod ◽

M Hübner ◽

D Hahnloser ◽

...

Keyword(s):

Temperature Control ◽

Surgical Care ◽

Surgical Site Infections ◽

Care Bundle ◽

Control Group ◽

Wound Protection ◽

Duration Of Surgery ◽

American Society ◽

Definition Of ◽

The Impact

Abstract Objective Surgical site infections (SSI) are the most frequent complications after colorectal surgery. The aim of the present study was to evaluate the impact of a standardized SSI prevention bundle. Methods The multimodal, evidence-based care bundle included 9 intraoperative items (antibiotic type, timing and re-dosing, desinfection, induction temperature control >36.5°, glove change, intracavity lavage, wound protection and closure strategy). The bundle was implemented in November 2018 and applied to all consecutive patients undergoing colonic resections. Demographics, surgical specifics and overall compliance to the care bundle were prospectively assessed until October 2020. The primary outcome SSI was defined according to the definition of the Center for Disease Control (CDC) and independently assessed by the National Infection Surveillance Committee (Swissnoso) up to 30 postoperative days. A historical, institutional pre-implementation control group (2012-2017, DOI: 10.1016/j.jhin.2018.09.011) with identical methodology was used for comparison. Results In total, 243 patients were included. The control group included 1’263 patients. Both groups were comparable regarding main demographics (age, sex, body mass index, American Society of Anaesthesiologists class) and surgical characteristics (type and duration of surgery). Overall compliance to the care bundle was 77% (IQR 77-88). Lowest compliance was observed for temperature control (48%), intracavity lavage (59%) and predefined wound closure strategy (74%). Surgical site infections were reported in 54 patients (22.2%) vs. 21.4% in the control group, p = 0.79. Infection rates were comparable throughout the CDC categories: superficial: 11 patients (4.5%) vs. 4.2%, p = 0.82, deep incisional: 9 patients (3.7%) vs. 5.1%, p = 0.34, organ space: 34 (14%) vs. 12.4%, p = 0.48. Conclusion Implementation of a standardized surgical care bundle had no impact on SSI rates according to these preliminary results. Improved compliance to individual measures may help to achieve a clinical benefit.

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The Impact of Social Determinants of Health in Facial and Craniomaxillofacial Reconstruction: Can We Do Better?

The Cleft Palate-Craniofacial Journal ◽

10.1177/10556656211037510 ◽

2021 ◽

pp. 105566562110375

Author(s):

Sumun Khetpal ◽

Daniel C. Sasson ◽

Joseph Lopez ◽

Derek M. Steinbacher ◽

Arun K. Gosain

Keyword(s):

Social Determinants Of Health ◽

Social Determinants ◽

Care Delivery ◽

Surgical Care ◽

Multidisciplinary Care ◽

Determinants Of Health ◽

Facial Trauma ◽

Multidisciplinary Care Team ◽

The Impact ◽

Team Model

Social determinants of health (SDOH) are integral to consider when delivering craniomaxillofacial and facial reconstructive care for patients. The American Cleft Palate-Craniofacial Association (ACPA) has instituted a formalized multidisciplinary care team model that recognizes such determinants and has aggregated patient-led organizations to strengthen patients’ education and support system. This review discusses the need for all surgeons engaged in facial and craniomaxillofacial reconstruction to consider SDOH in their practice. Additionally, we explore how factors such as race, insurance status, education level, cost, and access to follow-up care, impact surgical care for craniosynostosis, facial trauma, orthognathic surgery, head and neck cancer, and facial paralysis. We propose that the ACPA team model be applied to other societies that care for the broader scope of patients in need of facial and craniomaxillofacial reconstruction to strengthen the communication, collaboration, and standardization of care delivery that is personalized to the needs of each patient.

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Center Effects on Outcomes in the Treatment of Acute Myelogenous Leukemia (AML): A Multilevel, Community-Based, Case-Controlled Study

Blood ◽

10.1182/blood-2019-130640 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 4780-4780

Author(s):

Charles F. Lemaistre ◽

Ju-Hsien Chao ◽

Tonya Cox ◽

Jose Carlos Cruz ◽

William B. Donnellan ◽

...

Keyword(s):

Cox Regression ◽

Care Delivery ◽

Community Setting ◽

Charlson Index ◽

Myelogenous Leukemia ◽

Controlled Study ◽

Seer Database ◽

Community Hospitals ◽

Exact Matching ◽

The Impact

Background As with other complex therapies, treatment of AML varies among centers (ctrs) due to differences in patients (pts), infrastructure and care delivery models. Variation in ctrs practices, experience and resources may influence pt outcomes. Few studies have examined the association of ctr characteristics and survival in AML. Previous research offers conflicting results regarding outcomes of AML pts treated in National Cancer Institute Comprehensive Cancer Centers (NCICCC) versus community settings; neither study investigated ctr-level differences other than volume. We sought to compare AML outcomes in any of the HCA Healthcare (HCA) network of 131 community hospitals from 2011-18 with those reported in the Surveillance, Epidemiology, and End Results (SEER) database. We then examined pt, disease and center-related characteristics influencing outcomes in HCA hospitals. Methods We identified pts with AML (excluding APL) > 18 yrs treated between 10/31/11 and 10/31/18 in an HCA hospital (N = 4,882) and obtained pt level data from electronic medical records. A comparative population treated was developed from the most recent SEER database (2011-15; N = 19,349). We used coarsened exact matching to control for as many potential biases as possible. We compared mortality at 30, 90 and 120-days and overall survival curves between HCA and SEER . A Cox regression model was used to investigate differences in hazard rates among HCA facilities while simultaneously assessing the impact of patient characteristics and facility characteristics. Of the HCA patients, 1339 were treated in 6 hospitals that meet defined metrics of infrastructure, staffing, processes and volume as part of certification to participate in the Sarah Cannon Blood Cancer Network (SCBCN). Results Matching for age, gender and race, HCA pts were found to have significantly lower mortality than SEER at 30, 90 and 120 days (p<.001) as well as significantly better survival (p<0.001; fig.1). We next investigated how pt and facility characteristics interact to predict outcomes for HCA patients (table 1). Elevated White Count at diagnosis (HR=1.3), Charlson index (HR=1.1), older age (HR= 1.04), and receiving treatment at a hospital with larger bed count (HR=1.26) were associated with significantly worse survival. Commission on Cancer (COC) accreditation status, Socio-economic status (SES), distance to facility, and gender did not significantly impact risk. Being treated in the SCBCN (HR=0.68) and African American race (HR= 0.66) were associated with improved survival Conclusions Previous research utilizing registry data demonstrated better survival for pts with AML treated in higher volume centers but provides conflicting information about survival for pts treated in a NCICCC versus a community setting. Neither study examined center characteristics beyond NCI designation. This report examines a large pt cohort treated in community hospitals across the US. Pts treated in these hospitals had significantly better survival than a matched cohort from the SEER database. We validate the importance of age, acuity and Charlson index as adverse factors. Analysis of facility characteristics demonstrated that qualification as a member of SCBCN was associated with improved survival underscoring the importance of infrastructure, quality systems and volume in achieving improved outcomes. Disclosures Lemaistre: HCA: Employment. Chao:HCA: Employment. Cruz:1. Daiichi Sankyo advisory board: Membership on an entity's Board of Directors or advisory committees; Takeda: Consultancy, Speakers Bureau. Eghtedar:Verastem Oncology: Consultancy; Novartis: Consultancy, Honoraria, Speakers Bureau; Jazz: Consultancy, Honoraria, Speakers Bureau; Celgene: Honoraria, Speakers Bureau; Takeda: Honoraria, Speakers Bureau. Holder:Sarah Cannon: Employment. Malik:Kite Pharma: Honoraria. Rotta:Kadmon Corporation, LLC: Consultancy; Jazz: Speakers Bureau.

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