The Economic Effects on Acute Care Surgery in a New York City Public Hospital During the COVID Pandemic

Background Since the start of the COVID-19 pandemic, less acute care surgical procedures have been performed and consequently hospitals have experienced significant revenue loss. We aim to investigate these procedures performed before and after the start of the COVID-19 pandemic, as well as their effect on the economy. Methods This is a retrospective analysis of patients who underwent cholecystectomies and appendectomies during March–May 2019 compared to the same time period in 2020 using Chi-square and t-tests. Results There were 345 patients who presented with appendicitis or cholecystitis to Elmhurst Hospital Center during the March–May 2019 and 2020 time period. There were three times as many total operations, or about 75%, in 2019 (261) compared to 2020 (84). There was a decrease in the number of admissions from 2019 to 2020 for both acute cholecystitis (149 vs 43, respectively) and acute appendicitis (112 vs 41, respectively). The largest decrease in the number of admissions in 2020 compared to 2019 was observed in April 2020 (98 vs 9, P < .01) followed by May [69 vs 20, P < .01], and March [94 vs 55, P < .01]. Corresponding to the decrease in operative patterns was a noticeable six-time reduction in revenue for the procedures in 2019 ($187,283) compared to 2020 ($30,415). Conclusion We observed almost a triple reduction in the number of cholecystitis and appendicitis procedures performed during the 2020 pandemic surge as compared to the 2019 pre-pandemic data. Elmhurst hospital also experienced four times the loss of revenue during the same time period.

Urgent Breast-Related Consults Seen by Acute Care Surgery at a Safety Net Hospital

Background Classically, urgent breast consults are seen by Breast Surgery or Surgical Oncology (BS/SO). At our safety net hospital, Acute Care Surgery (ACS) performs all urgent surgical consultations, including initial assessment of breast consults with coordinated BS/SO follow-up. The objective was to determine safety of ACS initial assessment of acute breast pathology. Methods All urgent breast-related consultations were included (2016-2019). Demographics, consult indications, and investigations/interventions were captured. Outcomes were compared between patients assessed by ACS versus both ACS and BS/SO at presentation. Results 234 patients met study criteria, with median age 39 years. Patients were primarily Hispanic (82%) women (96%). Most were not seen by BS/SO at presentation (69%), although BS/SO assessment was more frequent among patients ultimately diagnosed with cancer (8% vs 1%, P = .012). No patient had delay >90 days to core biopsy from presentation. Outcomes including time to cancer diagnosis (14 vs 8 days, P = .143) and outpatient BS/SO assessment (16 vs 13 days, P = .528); loss to follow-up (25% vs 21%, P = .414); and ED recidivism (24% vs 18%, P = .274) were comparable between patients seen by ACS versus ACS/BS/SO at index presentation. Conclusion Urgent breast consults at our safety net hospital typically underwent initial assessment by ACS with outpatient evaluation by BS/SO. Time to follow-up and cancer diagnosis, loss to follow-up, and ED recidivism were similar after index presentation assessment by ACS versus ACS and BS/SO. In a resource-limited environment, urgent breast consults can be safely managed in the acute setting by ACS with coordinated outpatient BS/SO follow-up.

Reducing Ventilator Alarms Through Decreased Rainout in Ventilator Circuits: A Bench Study

Background:Alarm fatigue is a significant problem in healthcare, particularly in high acuity settings such as intensive care, surgery, and emergency departments. Alarms are triggered by various devices such as anesthesia machines, ventilators, patient monitors or humidifiers. Heated humidifiers (HH) used with mechanical ventilators, while necessary to prevent other complications associated with mechanical ventilator, may cause condensation in the ventilator circuit, prompting occlusion alarms indicating a risk for the patient. Technological advances in heated humidifier (HH) circuits may reduce rainout and therefore occlusion alarms. Methods:Bench experiments measured alarms and rainout of two commercially available humidifiers (AirLife DuoTherm™ and Fisher & Paykel MR850) and four different pediatric and adult patient’s breathing. The tests examined condensation accumulation after 24 hours of low-, nominal-, or high-flow rates of gas at low-, nominal-, and high-ambient temperature settings. Dual-limb designs of adult- and neonate-sized circuits underwent evaluation. Data on alarms was collected for each system.Results:Low temperature and occlusion alarms were statistically significantly lower in DuoTherm vs. MR850 HH circuits (6 vs. 68 alarms, respectively; p<nn). DuoTherm products accumulated significantly less rainout for all three circuit sizes at all ambient temperatures. In general, the set flow rate did not dramatically affect the amount of rainout for adult and infant circuits, but low versus high ambient temperatures yielded increased rainout for all circuit types (p < 0.02). Conclusions:The DuoTherm HH device and patient circuits developed significantly less alarms due to rainout and low temperatures compared to those from MR850 under all the conditions tested. Such reduction in patient alarms should help reduce alarm fatigue among healthcare workers in critical care settings.

Acute Care Surgeons Spend More Time than General Surgeons on the Electronic Health Record (EHR)

Background The paradigm of Acute Care Surgery (ACS) emerged in response to decreasing operative opportunities for trauma surgeons and increasing need for surgical coverage in disciplines to which the expertise of trauma surgeons naturally extends. While the continued evolution of this specialty remains largely beneficial, unintended consequences may have arisen along the way. One aspect of ACS that remains to be thoroughly investigated is the impact of the electronic health record (EHR). The purpose of this study is to objectively quantify EHR usage for ACS and compare it to other general surgery specialties. Methods EHR user data were collected for fifteen ACS attendings and thirty-seven general surgery attendings from October 2014 to September 2019. Comparative analysis was conducted using two-tailed t-tests. Subgroup analysis was conducted for subspecialties included in the general surgery group. Results ACS attendings opened almost 3 times as many charts as general surgery attendings per month (180 vs 64 charts/month, P < .0001), and ultimately spent more time on the EHR as a result (10 vs 6.4 hours/month, P < .0001). Documentation was the most time consuming EHR task for both groups. Although ACS attendings spent less overall time per patient chart, the proportion of time spent on certain EHR tasks was similar to that of general surgery colleagues. Discussion The EHR imposes a disproportionate burden on ACS attendings compared to their general surgery counterparts, and additional study is warranted to improve usage. EHR usage burden has workforce implications for trainees considering a career in ACS.

Treatment approaches of electrical injuries

Background: The purpose of this study was to explore the differences in prehospital care, admission characteristics, burn intensive care, surgery and outcomes in patients requiring admission to a burn intensive care unit. Material and methods: The study was conducted on a group of 31 patients, who were hospitalized within the Clinical Hospital of Orthopedics and Traumatology in the period 2015-2019. The data analysis was carried out on the applied method of surgical treatment, the associated postoperative complications, antibiotic therapy applied, etc. Results: 27 out of the total number of patients underwent necrectomy and extensive wound debridement surgery in the first hours upon admission. 14 patients required additional decompression incisions in the underlying skin and fascia. 4 patients out of the total number presented visible signs of carbonization on the affected areas upon admission, therefore they were subjected to an emergency amputation. Out of 27 patients classified as “delayed emergency” cases, 13 patients were subjected to amputation of the corresponding segments. Conclusions: Electrical injuries are a severe cause of disability, as well as a challenging issue for reconstructive surgery, which is concerned with restoring the damaged structures with prosthetic amputation abutments, therefore improving the aesthetic and psychological appearance of the patients.

Reducing Ventilator Alarms Through Decreased Rainout in Ventilator Circuits: A Bench Study

Background:Alarm fatigue is a significant problem in healthcare, particularly in high acuity settings such as intensive care, surgery, and emergency departments. Alarms are triggered by various devices such as anesthesia machines, ventilators, patient monitors or humidifiers. Heated humidifiers (HH) used with mechanical ventilators, while necessary to prevent other complications associated with mechanical ventilator, may cause condensation in the ventilator circuit, prompting occlusion alarms indicating a risk for the patient. Technological advances in heated humidifier (HH) circuits may reduce rainout and therefore occlusion alarms. Methods:Bench experiments measured alarms and rainout of two commercially available humidifiers (AirLife DuoTherm™ and Fisher & Paykel MR850) and four different pediatric and adult patient’s breathing. The tests examined condensation accumulation after 24 hours of low-, nominal-, or high-flow rates of gas at low-, nominal-, and high-ambient temperature settings. Dual-limb designs of adult- and neonate-sized circuits underwent evaluation. Data on alarms was collected for each system.Results:Low temperature and occlusion alarms were statistically significantly lower in DuoTherm vs. MR850 HH circuits (6 vs. 68 alarms, respectively; p<nn). DuoTherm products accumulated significantly less rainout for all three circuit sizes at all ambient temperatures. In general, the set flow rate did not dramatically affect the amount of rainout for adult and infant circuits, but low versus high ambient temperatures yielded increased rainout for all circuit types (p < 0.02). Conclusions:The DuoTherm HH device and patient circuits developed significantly less alarms due to rainout and low temperatures compared to those from MR850 under all the conditions tested. Such reduction in patient alarms should help reduce alarm fatigue among healthcare workers in critical care settings.