The prevalence of asymptomatic carriers of COVID-19 as determined by routine preoperative testing

Background: The coronavirus disease SARS-CoV-2 (COVID-19) has swiftly spread throughout the globe, greatly influencing all aspects of life. As in previous pandemics, concerns for limited resources and a sustainable medical workforce have been on the forefront of infrastructure modifications. Consequently, surgical specialties have needed to consider each surgical case for necessity and safety during the COVID-19 outbreak. At our institution, availability of SARS-CoV-2 assay has allowed preoperative testing of asymptomatic surgical patients. Aim/Objective: To better define the prevalence of asymptomatic carriers in a surgical population and to better understand the impact of testing on our personal protective equipment (PPE) supply. Methods: We began routine, preoperative testing for all asymptomatic patients coming to our academic medical centre on 30 March 2020. Scheduled surgeries were deemed urgent by the surgeon with a review for appropriateness by a novel surgical committee. A retrospective patient chart review was performed. Emergency surgeries were excluded. Asymptomatic patients with positive test results had their surgeries rescheduled at the discretion of the surgeon and patient. Patients who tested negative underwent surgery with staff using standard PPE. Results: Eighty-four asymptomatic surgical patients were tested preoperatively with three (3.6%) testing positive for SARS-CoV-2. Preoperative testing saved 498 N95 respirators over this time period. Discussion: This is the first report of routine COVID-19 preoperative testing in an asymptomatic surgical population. Within this population, there is a 3.6% rate of asymptomatic SARS-CoV-2 carriers. Through this practice, personnel exposure can be minimised and access to PPE can be preserved.

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Impact of the COVID-19 pandemic on neuroimaging scan volumes at a teaching hospital

The Neuroradiology Journal ◽

10.1177/1971400920988664 ◽

2021 ◽

pp. 197140092098866

Author(s):

Daniel Thomas Ginat ◽

James Kenniff

Keyword(s):

Magnetic Resonance Imaging ◽

Computed Tomography ◽

Magnetic Resonance ◽

The United States ◽

Radiology Department ◽

Magnetic Resonance Imaging Scan ◽

Resonance Imaging ◽

Academic Medical Centre ◽

Academic Medical ◽

The Impact

Background The COVID-19 pandemic led to a widespread socioeconomic shutdown, including medical facilities in many parts of the world. The purpose of this study was to assess the impact on neuroimaging utilisation at an academic medical centre in the United States caused by this shutdown. Methods Exam volumes from 1 February 2020 to 11 August 2020 were calculated based on patient location, including outpatient, inpatient and emergency, as well as modality type, including computed tomography and magnetic resonance imaging. 13 March 2020 was designated as the beginning of the shutdown period for the radiology department and 1 May 2020 was designated as the reopening date. The scan volumes during the pre-shutdown, shutdown and post-shutdown periods were compared using t-tests. Results Overall, neuroimaging scan volumes declined significantly by 41% during the shutdown period and returned to 98% of the pre-shutdown period levels after the shutdown, with an estimated 3231 missed scans. Outpatient scan volumes were more greatly affected than inpatient scan volumes, while emergency scan volumes declined the least during the shutdown. In addition, the magnetic resonance imaging scan volumes declined to a greater degree than the computed tomography scan volumes during the shutdown. Conclusion The shutdown from the COVID-19 pandemic had a substantial but transient impact on neuroimaging utilisation overall, with variable magnitude depending on patient location and modality type.

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Palliative care referral and associated outcomes among patients with cancer in the last 2 weeks of life

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2014-000791 ◽

2015 ◽

Vol 9 (1) ◽

pp. e16-e16 ◽

Cited By ~ 5

Author(s):

Mathilde Ledoux ◽

Wadih Rhondali ◽

Véronique Lafumas ◽

Julien Berthiller ◽

Marion Teissere ◽

...

Keyword(s):

Palliative Care ◽

Advanced Cancer ◽

Academic Medical Centre ◽

Haematological Cancer ◽

Patients With Cancer ◽

Respiratory Cancer ◽

Academic Medical ◽

Cancer Types ◽

The Impact

BackgroundPalliative care (PC) improves the quality of life of patients with advanced cancer. Our aim was to describe PC referral among patients with advanced cancer, and associated outcomes in an academic medical centre.MethodsWe reviewed the medical records of 536 inpatients with cancer who had died in 2010. Our retrospective study compared patients who accessed PC services with those who did not. Statistical analysis was conducted using non-parametric tests due to non-normal distribution. We also conducted a multivariate analysis using a logistic regression model including age, gender, type of cancer and metastatic status.ResultsOut of 536 patients, 239 (45%) had PC referral. The most common cancer types were respiratory (22%) and gastrointestinal (19%). Patients with breast cancer (OR 23.76; CI 6.12 to 92.18) and gynaecological cancer (OR 7.64; CI 2.61 to 22.35) had greater PC access than patients with respiratory or haematological cancer. Patients referred to PC had significantly less chemotherapy in the last 2 weeks of life than non-referred patients, with 22 patients (9%) vs 59 (19%; p<0.001). PC-referred patients had significantly fewer admissions to intensive care units in the last month of life than non-referred patients, with 14 (6%) vs 58 (20%; p<0.001).ConclusionsThere was a large variation in access to PC according to the type of cancer. There is a need to improve collaboration between the PC service and the respiratory, cancer and haematology specialists. Further research will be required to determine the modality and the impact of this collaboration.

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The Impact of Interhospital Transfers on Surgical Quality Metrics for Academic Medical Centers

The American Surgeon ◽

10.1177/000313481408000725 ◽

2014 ◽

Vol 80 (7) ◽

pp. 690-695 ◽

Cited By ~ 10

Author(s):

Cristina J. Crippen ◽

Steven J. Hughes ◽

Sugong Chen ◽

Kevin E. Behrns

Keyword(s):

Pay For Performance ◽

Early Recognition ◽

Quality Metrics ◽

Resource Consumption ◽

Surgical Patients ◽

Case Mix Index ◽

Academic Medical ◽

Direct Admission ◽

Transferred Patients ◽

The Impact

The emergence of pay-for-performance systems pose a risk to an academic medical center's (AMC) mission to provide care for interhospital surgical transfer patients. This study examines quality metrics and resource consumption for a sample of these patients from the University Health System Consortium (UHC) and our Department of Surgery (DOS). Standard benchmarks, including mortality rate, length of stay (LOS), and cost, were used to evaluate the impact of inter-hospital surgical transfers versus direct admission (DA) patients from January 2010 to December 2012. For 1,423,893 patients, the case mix index for transfer patients was 38 per cent (UHC) and 21 per cent (DOS) greater than DA patients. Mortality rates were 5.70 per cent (UHC) and 6.93 per cent (DOS) in transferred patients compared with 1.79 per cent (UHC) and 2.93 per cent (DOS) for DA patients. Mean LOS for DA patients was 4 days shorter. Mean total costs for transferred patients were greater $13,613 (UHC) and $13,356 (DOS). Transfer patients have poorer outcomes and consume more resources than DA patients. Early recognition and transfer of complex surgical patients may improve patient rescue and decrease resource consumption. Surgeons at AMCs and in the community should develop collaborative programs that permit collective assessment and decision-making for complicated surgical patients.

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Reducing Unnecessary Preoperative Blood Orders and Costs by Implementing an Updated Institution-specific Maximum Surgical Blood Order Schedule and a Remote Electronic Blood Release System

Anesthesiology ◽

10.1097/aln.0000000000000338 ◽

2014 ◽

Vol 121 (3) ◽

pp. 501-509 ◽

Cited By ~ 39

Author(s):

Steven M. Frank ◽

Michael J. Oleyar ◽

Paul M. Ness ◽

Aaron A. R. Tobian

Keyword(s):

Medical Center ◽

Academic Medical Center ◽

Substantial Reduction ◽

Information Management System ◽

Surgical Patients ◽

Release System ◽

Time Period ◽

Academic Medical ◽

Utilization Data ◽

Transfusion Ratio

Abstract Background: Using blood utilization data acquired from the anesthesia information management system, an updated institution-specific maximum surgical blood order schedule was introduced. The authors evaluated whether the maximum surgical blood order schedule, along with a remote electronic blood release system, reduced unnecessary preoperative blood orders and costs. Methods: At a large academic medical center, data for preoperative blood orders were analyzed for 63,916 surgical patients over a 34-month period. The new maximum surgical blood order schedule and the electronic blood release system (Hemosafe®; Haemonetics Corp., Braintree, MA) were introduced mid-way through this time period. The authors assessed whether these interventions led to reductions in unnecessary preoperative orders and associated costs. Results: Among patients having surgical procedures deemed not to require a type and screen or crossmatch (n = 33,216), the percent of procedures with preoperative blood orders decreased by 38% (from 40.4% [7,167 of 17,740 patients] to 25.0% [3,869 of 15,476 patients], P < 0.001). Among all hospitalized inpatients, the crossmatch-to-transfusion ratio decreased by 27% (from 2.11 to 1.54; P < 0.001) over the same time period. The proportion of patients who required emergency release uncrossmatched blood increased from 2.2 to 3.1 per 1,000 patients (P = 0.03); however, most of these patients were having emergency surgery. Based on the realized reductions in blood orders, annual costs were reduced by $137,223 ($6.08 per patient) for surgical patients, and by $298,966 ($6.20/patient) for all hospitalized patients. Conclusion: Implementing institution-specific, updated maximum surgical blood order schedule–directed preoperative blood ordering guidelines along with an electronic blood release system results in a substantial reduction in unnecessary orders and costs, with a clinically insignificant increase in requirement for emergency release blood transfusions.

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Toward the triple aim: implementing a hospitalist co-management model for orthopaedic surgical patients in an academic medical centre

Future Hospital Journal ◽

10.7861/futurehosp.2-2-s33 ◽

2015 ◽

Vol 2 (Suppl 2) ◽

pp. s33-s33

Author(s):

David Martin ◽

Michael Kain ◽

Kasey-Jean Bramlett ◽

David Brabeck ◽

Andrew Marcantonio

Keyword(s):

Medical Centre ◽

Surgical Patients ◽

Management Model ◽

Triple Aim ◽

Academic Medical Centre ◽

Academic Medical

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The COVID-19 infection control arms race

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.211 ◽

2020 ◽

Vol 41 (11) ◽

pp. 1323-1325 ◽

Cited By ~ 5

Author(s):

Chanu Rhee ◽

Meghan A. Baker ◽

Michael Klompas

Keyword(s):

Infection Control ◽

Asymptomatic Infection ◽

Arms Race ◽

International Standards ◽

Test Results ◽

Personal Safety ◽

Control Approach ◽

Professional Groups ◽

Asymptomatic Patients ◽

N95 Respirators

AbstractUS hospitals are engaged in an infection control arms race. Hospitals, specialties, and professional groups are spurring one another on to adopt progressively more aggressive measures in response to COVID-19 that often exceed federal and international standards. Examples include universal masking of providers and patients; decreasing thresholds to test asymptomatic patients; using face shields and N95 respirators regardless of symptoms and test results; novel additions to the list of aerosol-generating procedures; and more comprehensive personal protective equipment including hair, shoe, and leg covers. Here, we review the factors underlying this arms race, including fears about personal safety, ongoing uncertainty around how SARS-CoV-2 is transmitted, confusion about what constitutes an aerosol-generating procedure, increasing recognition of the importance of asymptomatic infection, and the limited accuracy of diagnostic tests. We consider the detrimental effects of a maximal infection control approach and the research studies that are needed to eventually de-escalate hospitals and to inform more evidence-based and measured strategies.

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Privileging pharmacists improves time to patient notification in the microbiological test review process for patients discharged from the emergency department

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/zxz335 ◽

2020 ◽

Vol 77 (Supplement_1) ◽

pp. S19-S24

Author(s):

Steven M Loborec ◽

Jose A Bazan ◽

Nicole V Brown ◽

Mary Beth Shirk ◽

Trisha A Jordan

Keyword(s):

Emergency Department ◽

Medical Center ◽

Academic Medical Center ◽

Test Results ◽

Infectious Disease Physician ◽

Microbiological Test ◽

Test Review ◽

Academic Medical ◽

Before And After ◽

The Impact

Abstract Purpose Results of a study evaluating the impact of privileging pharmacists to manage microbiologic test results for patients discharged from the emergency department (ED) are reported. Methods This was a single-center, retrospective pre-post study that was conducted at an urban academic medical center. Patients discharged from the ED with a subsequent positive microbiologic test result before and after privileging of an ED specialty practice pharmacist (ED-SPP) to manage the results independently were screened for inclusion. Time to patient notification of a required change in antimicrobial therapy was compared between groups. Numbers of erroneous interventions before and after pharmacist privileging were compared to assess the safety of implementation. Results One hundred seventy-eight positive microbiologic test results (n = 92 pre- and n = 86 postimplementation) were included. The median time to patient notification in the pre-implementation group was 23.6 hours (range, 12.4-93 hours) and in the postimplementation group was 14.9 hours (range, 2.5-27.9 hours; P = 0.0023). As determined by the board-certified infectious disease physician, 1.1% of reviewed microbiologic test results (1 of 92) was erroneous prior to implementation of pharmacist privileging compared with 2.3% (2 of 86) after implementation (P = 0.6105). Conclusion Privileging ED-SPPs to assess microbiologic test results improved the time to patient notification with no statistical difference in the number of erroneous interventions between groups. These findings demonstrate the benefit of clinical privileging and provide support for expansion of this role to other ED-SPPs.

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Assessment of health care cost for complex surgical patients: review of cost, re-imbursement and revenue involved in pancreatic surgery at a high-volume academic medical centre

HPB ◽

10.1111/hpb.12349 ◽

2015 ◽

Vol 17 (4) ◽

pp. 311-317 ◽

Cited By ~ 11

Author(s):

Swapnil D. Kachare ◽

Kendall R. Liner ◽

Nasreen A. Vohra ◽

Emmanuel E. Zervos ◽

Todd Hickey ◽

...

Keyword(s):

Health Care ◽

Pancreatic Surgery ◽

Health Care Cost ◽

High Volume ◽

Medical Centre ◽

Surgical Patients ◽

Academic Medical Centre ◽

Academic Medical

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Impact on quantitative fit test results after application of prophylactic hydrocolloid dressing under N95 respirators

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2021.293 ◽

2021 ◽

pp. 1-16

Author(s):

Irene Ng ◽

Benjamin Kave ◽

Fiona Begg ◽

Sarah Sage ◽

Reny Segal ◽

...

Keyword(s):

Healthcare Workers ◽

Respiratory Protection ◽

Test Results ◽

Pass Rates ◽

Hydrocolloid Dressing ◽

Fit Testing ◽

Pressure Injury ◽

N95 Respirators ◽

The Impact

Abstract Objective Discomfort and device-related pressure injury (DRPI) caused by N95 filtering facepiece respirators (FFRs) are common. The use of prophylactic hydrocolloid dressings is one of the strategies that may improve comfort and reduce DRPI. In this study, we investigated the impact of these dressings on N95 respirator fit. Methods We performed a repeat quantitative fit testing through the Respiratory Protection Program on 134 healthcare workers (HCWs), who applied hydrocolloid dressings on the bridge of their nose under the N95 FFRs that they passed the initial fit test but reported discomfort with. Results We found that the fit test pass rates, with the hydrocolloid dressings in place, for the semi-rigid cup style (3MTM 1860), the vertical flat-fold style (BYD), the duckbill style (BSN medical ProShield® and Halyard Fluidshield*), and the three-panel flat-fold style (3MTM Aura) N95 FFRs were 94% (108/115), 85% (44/52), 81% (87/108) and 100% (3/3) respectively. There was a statistically significant reduction in the overall fit factors for both the vertical flat-fold and duckbill type N95 respirators, after the application of hydrocolloid dressings. Conclusions Hydrocolloid dressings are likely to disturb the mask seal for non-rigid style N95 FFRs, in particular, the vertical flat-fold style and the duckbill style N95 FFRs. Given the risk of mask seal disturbance of N95 respirators as shown in this study, we advocate that any HCW requiring the use of prophylactic dressings should undergo repeat quantitative fit testing with the dressing in place prior to using the dressing and mask in combination.

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A single-center cost analysis assessing a change in vasopressin formulation

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/zxab153 ◽

2021 ◽

Cited By ~ 1

Author(s):

Courtney E Kelly ◽

Christopher Miller ◽

William Darko ◽

Greg Cwikla ◽

Bryan Mogle ◽

...

Keyword(s):

Medical Center ◽

Academic Medical Center ◽

Cost Savings ◽

Single Center ◽

Cost Estimates ◽

Time Period ◽

Academic Medical ◽

Formulation Change ◽

The Impact ◽

Pharmacy Leaders

Abstract Purpose Cost savings achieved at an academic medical center by reformulating the institution’s standard vasopressin infusions to reduce waste are described. Summary After a retrospective review of vasopressin utilization over a 4-month period revealed that only approximately 40% of dispensed vasopressin units were actually administered to patients, pharmacy leaders determined that the institution’s standard vasopressin concentration for continuous infusions (100 units in 100 mL of sodium chloride 0.9% injection) was resulting in substantial waste, as many infusion preparations were not needed within the 18- to 24-hour expiration window. A concentration of 20 units/100 mL was adopted as the new standard formulation for vasopressin continuous infusions, with use of alternative concentrations allowed on a restricted basis. A pre-post study to assess the impact of the formulation change indicated a 38.7% decrease in vasopressin utilization (from 21,900 to 8,480 units) relative to utilization in a retrospective sample of patients who received vasopressin infusions prior to the formulation change. This reduced utilization equated to a cost decrease of $55,656.20 (as calculated on the basis of 2017 cost estimates) or $77,214.23 (as calculated on the basis of 2019 cost estimates) for the time period collected. It was estimated that the new formulations could yield annual cost savings ranging from $222,625 to $308,857. Conclusion To our knowledge, this is the first description of cost savings following a change in formulation of vasopressin for continuous infusions. Other institutions could consider employing a similar approach in addition to the previously reported cost-saving interventions, such as lower vasopressin starting doses and vasopressin restriction policies.

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