Implementation of Preoperative Screening Protocols in Otolaryngology During the COVID-19 Pandemic

Objective To highlight emerging preoperative screening protocols and document workflow challenges and successes during the early weeks of the COVID-19 pandemic. Methods This retrospective cohort study was conducted at a large urban tertiary care medical center. Thirty-two patients undergoing operative procedures during the COVID-19 pandemic were placed into 2 preoperative screening protocols. Early in the pandemic a “high-risk case protocol” was utilized to maximize available resources. As information and technology evolved, a “universal point-of-care protocol” was implemented. Results Of 32 patients, 25 were screened prior to surgery. Three (12%) tested positive for COVID-19. In all 3 cases, the procedure was delayed, and patients were admitted for treatment or discharged under home quarantine. During this period, 86% of operative procedures were indicated for treatment of oncologic disease. There was no significant delay in arrival to the operating room for patients undergoing point-of-care screening immediately prior to their procedure ( P = .92). Discussion Currently, few studies address preoperative screening for COVID-19. A substantial proportion of individuals in this cohort tested positive, and both protocols identified positive cases. The major strengths of the point-of-care protocol are ease of administration, avoiding subsequent exposures after testing, and relieving strain on “COVID-19 clinics” or other community testing facilities. Implications for Practice Preoperative screening is a critical aspect of safe surgical practice in the midst of the widespread pandemic. Rapid implementation of universal point-of-care screening is possible without major workflow adjustments or operative delays.

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Point of Care Ultrasound First: An Opportunity to Improve Efficiency for Uncomplicated Pregnancy in the Emergency Department

POCUS Journal ◽

10.24908/pocus.v6i1.14762 ◽

2021 ◽

Vol 6 (1) ◽

pp. 42-44

Author(s):

Sara Urquhart ◽

Kendall Stevens ◽

Mariah Barnes ◽

Matthew Flannigan

Keyword(s):

Emergency Department ◽

Random Sample ◽

Medical Center ◽

Point Of Care ◽

Tertiary Care ◽

Radiology Department ◽

Point Of Care Ultrasound ◽

Tertiary Care Medical Center ◽

Time To Diagnosis ◽

Emergency Department Patients

Introduction: Research suggests emergency providers using point-of-care ultrasound (POCUS) to confirm an uncomplicated intrauterine pregnancy (IUP) can decrease emergency department (ED) length of stay (LOS) compared to a radiology department ultrasound (RADUS). The objective of this study was to compare the time to diagnosis and LOS between POCUS and RADUS patients. Methods: This was a retrospective study at one urban medical center. A standardized tool was used to abstract data from a random sample of pregnant patients diagnosed with uncomplicated IUP between January 2016 and December 2017 at a single tertiary care medical center. Microsoft Excel 2010 software was used to measure time intervals, prepare descriptive statistics, and perform Mann-Whitney U tests to compare differences. Results: A random sample of 836 (36%) of the 2,346 emergency department patients diagnosed with an IUP between 8-20 weeks’ gestation during the study period was evaluated for inclusion. Three hundred sixty-six met inclusion criteria and were included in the final analysis. Patients were divided into 2 groups based on which type of ultrasound scan they received first: POCUS (n=165) and RADUS (n=201). Patients who received POCUS were found to have an IUP identified in an average of 48 minutes (95% CI, 43 to 53), while the RADUS group’s mean time to diagnosis was 120 minutes (95% CI 113 to 127) with a difference of 72 minutes (95% CI, 63 to 80; p<0.001). The mean LOS for patients who received POCUS was 132 minutes (95% CI, 122 to 142), while that of the RADUS group was 177 minutes (95% CI 170 to 184) with a difference of 45 minutes (95% CI 32 to 56; p<0.001). The study is limited by its single-center, retrospective design and by lack of blinding of data abstractors. Conclusion: Pregnant emergency department patients diagnosed with an uncomplicated IUP between 8-weeks and 20-weeks’ gestation had statistically significant reduction in time to diagnosis and disposition from the ED if assessed with POCUS as compared to RADUS.

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An Extended Laboratory Validation Study and Comparative Performance Evaluation of the Abbott ID NOW™ COVID-19 Assay in a Coastal California Tertiary Care Medical Center

10.1101/2020.06.14.20130518 ◽

2020 ◽

Cited By ~ 1

Author(s):

Stewart Comer ◽

David Fisk

Keyword(s):

Test Performance ◽

Medical Center ◽

Point Of Care ◽

Tertiary Care ◽

Molecular Diagnostic ◽

Patient Classification ◽

Optimal Test ◽

Comparative Performance ◽

Tertiary Care Medical Center ◽

Molecular Diagnostic Test

AbstractThe Abbott ID NOW™ COVID-19 assay is a rapid molecular diagnostic test particularly designed for on-site, rapid turnaround point of care (POC) testing. The utilization of rapid diagnostic tests is integral to optimizing workflow within the hospital and/or procedural-based clinics. The capability to provide both rapid disposition and correct patient classification during this COVID-19 pandemic is critically important with broad infection control implications for both patients and healthcare staff. A tightly controlled, extended laboratory validation was performed at our medical center to determine the negative test agreement of the Abbott ID NOW™ compared with the BD MAX™ analyzer, a laboratory-based, two target, molecular analyzer with a sensitive cycle threshold (Ct) positive cutoff value of ≤ 42. There was strict adoption of the procedures listed in the Abbott ID NOW™ Instruction for Use (IFU)1 insert delineating preferred practices for “optimal test performance.” Under these conditions, our institution demonstrated a significant negative percent agreement with 116 out of 117 patients correlating, which equates to a 99.1% concordance similar to a recently reported correlation study2.

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Evaluation of Healthcare Personnel Exposures to Patients with SARS-CoV-2 Associated with Personal Protective Equipment Use

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2021.219 ◽

2021 ◽

pp. 1-14

Author(s):

Vishal P. Shah ◽

Laura E. Breeher ◽

Caitlin M. Hainy ◽

Melanie D. Swift

Keyword(s):

Personal Protective Equipment ◽

Medical Center ◽

Tertiary Care ◽

Healthcare Personnel ◽

Protective Equipment ◽

Critical Aspect ◽

Eye Protection ◽

Post Exposure ◽

Healthcare Settings ◽

Tertiary Care Medical Center

Abstract Objective: Personal Protective Equipment (PPE) is a critical aspect of preventing transmission of SARS-CoV-2 in healthcare settings. We aimed to identify factors related to lapses in PPE usage that may influence transmission of SARS-CoV-2 from patients to healthcare personnel (HCP). Design: Retrospective cohort study Setting: Tertiary care medical center in Minnesota Participants: A total of 345 HCP that sustained a significant occupational exposure to a patient with Coronavirus Disease 2019 (COVID-19) from May 13th, 2020 through November 30th, 2020 were evaluated. Results: Eight HCP (2.3%) were found to have SARS-CoV-2 infection during their 14-day post-exposure quarantine. A lack of eye protection during the care of a patient with COVID-19 was associated with HCP testing positive for SARS-CoV-2 by RT-PCR during the post-exposure quarantine (RR 10.25 (95% Confidence Interval (CI) 1.28-82.39), p=.009). Overall, the most common reason for a significant exposure was the usage of a surgical facemask instead of a respirator during an aerosolizing generating procedure (AGP) (55.9%). However, this was not associated with HCP testing positive for SARS-CoV-2 during the post-exposure quarantine (RR 0.99 (95% CI 0.96-1), p=1). Notably, transmission primarily occurred in units that did not regularly care for patients with COVID-19. Conclusions: The use of universal eye protection is a critical aspect of PPE to prevent patient to HCP transmission of SARS-CoV-2.

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EVALUATION OF FACTORS ASSOCIATED WITH MORTALITY AMONGST PATIENTS ADMITTED TO A TERTIARY CARE MEDICAL CENTER FOR COVID-19 INFECTION

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(21)04478-8 ◽

2021 ◽

Vol 77 (18) ◽

pp. 3123

Author(s):

Anish Samuel ◽

Ashesha Mechineni ◽

Robin Craven ◽

Wilbert Aronow ◽

Mourad Ismail ◽

...

Keyword(s):

Medical Center ◽

Tertiary Care ◽

Factors Associated ◽

Tertiary Care Medical Center

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Evaluation of post-ERCP pancreatitis after biliary stenting with self-expandable metal stents vs. plastic stents in benign and malignant obstructions

Endoscopy International Open ◽

10.1055/a-1388-6964 ◽

2021 ◽

Vol 09 (06) ◽

pp. E888-E894

Author(s):

Nichol S. Martinez ◽

Sumant Inamdar ◽

Sheila N. Firoozan ◽

Stephanie Izard ◽

Calvin Lee ◽

...

Keyword(s):

Pancreatic Duct ◽

Medical Center ◽

Tertiary Care ◽

Plastic Stents ◽

Metal Stents ◽

Limited Data ◽

Sems Group ◽

Tertiary Care Medical Center ◽

Stent Type ◽

Pancreatic Duct Stent

Abstract Background and study aims There are conflicting data regarding the risk of post-ERCP pancreatitis (PEP) with self-expandable metallic stents (SEMS) compared to polyethylene stents (PS) in malignant biliary obstructions and limited data related to benign obstructions. Patients and methods A retrospective cohort study was performed of 1136 patients who underwent ERCP for biliary obstruction and received SEMS or PS at a tertiary-care medical center between January 2011 and October 2016. We evaluated the association between stent type (SEMS vs PS) and PEP in malignant and benign biliary obstructions. Results Among the 1136 patients included in our study, 399 had SEMS placed and 737 had PS placed. Patients with PS were more likely to have pancreatic duct cannulation, pancreatic duct stent placement, double guidewire technique, sphincterotomy and sphincteroplasty as compared to the SEMS group. On multivariate analysis, PEP rates were higher in the SEMS group (8.0 %) versus the PS group (4.8 %) (OR 2.27 [CI, 1.22, 4.24]) for all obstructions. For malignant obstructions, PEP rates were 7.8 % and 6.6 % for SEMS and plastic stents, respectively (OR 1.54 [CI, 0.72, 3.30]). For benign obstructions the PEP rate was higher in the SEMS group (8.8 %) compared to the PS group (4.2 %) (OR 3.67 [CI, 1.50, 8.97]). No significant differences between PEP severity were identified based on stent type when stratified based on benign and malignant. Conclusions PEP rates were higher when SEMS were used for benign obstruction as compared to PS. For malignant obstruction, no difference was identified in PEP rates with use of SEMS vs PS.

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Utility of electroencephalography: Experience from a U.S. tertiary care medical center

Clinical Neurophysiology ◽

10.1016/j.clinph.2016.08.013 ◽

2016 ◽

Vol 127 (10) ◽

pp. 3335-3340 ◽

Cited By ~ 12

Author(s):

Kapil Gururangan ◽

Babak Razavi ◽

Josef Parvizi

Keyword(s):

Medical Center ◽

Tertiary Care ◽

Tertiary Care Medical Center

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Nosocomial Methicillin-Resistant and Methicillin-SusceptibleStaphylococcus AureusPrimary Bacteremia: At What Costs?

Infection Control and Hospital Epidemiology ◽

10.1086/501641 ◽

1999 ◽

Vol 20 (6) ◽

pp. 408-411 ◽

Cited By ~ 224

Author(s):

Murray A. Abramson ◽

Daniel J. Sexton

Keyword(s):

Hospital Stay ◽

Medical Center ◽

A Priori ◽

Tertiary Care ◽

Length Of Hospital Stay ◽

Bloodstream Infections ◽

Methicillin Resistant ◽

Tertiary Care Medical Center ◽

Matching Criteria ◽

Nested Case Control

Objective:To determine the attributable hospital stay and costs for nosocomial methicillin-sensitive Staphylococcus aureus (MSSA) and methicillin-resistantS aureus(MRSA) primary bloodstream infections (BSIs).Design:Pairwise-matched (1:1) nested case-control study.Setting:University-based tertiary-care medical center.Patients:Patients admitted between December 1993 and March 1995 were eligible. Cases were defined as patients with a primary nosocomialS aureusBSI; controls were selected according to a priori matching criteria.Measurements:Length of hospital stay and total and variable direct costs of hospitalization.Results:The median hospital stay attributable to primary nosocomial MSSA BSI was 4 days, compared with 12 days for MRSA (P=.023). Attributable median total cost for MSSA primary nosocomial BSIs was $9,661 versus $27,083 for MRSA nosocomial infections (P=.043).Conclusion:Nosocomial primary BSI due toS aureussignificantly prolongs the hospital stay. Primary nosocomial BSIs due to MRSA result in an approximate threefold increase in direct cost, compared with those due to MSSA.

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