Hospital Floor Research Articles

Ambulatory spinal anesthesia in infants ≤ six months of age: A retrospective review of outcomes and safety

PurposeTo review experience with outpatient spinal anesthesia (SA) from a single center in infants ≤6 months of age. MethodsRetrospective review of all SAs performed in the ambulatory setting in the outpatient surgery centers in infants ≤6 months of age from 2016 to 2020, focusing on success rate, adverse events, post-anesthesia care unit (PACU) times, and emergency department (ED) or urgent care (UC) returns within 7 days of the operation. ResultsThe study cohort included 175 SAs performed on 173 patients ≤6 months of age. One hundred and sixty-two patients (93%) were able to undergo their respective surgical procedures under SA without conversion to general anesthesia. One hundred and thirty-six patients (78%) did not require additional sedation or analgesic agents. The median time from entering the operating room until the start of surgical procedure was 17 min. One hundred and twenty-six patients (72%) were able to bypass Phase I of the PACU. One hundred and forty-seven patients (86%) were discharged in less than two hours postoperatively. Only one complication related to SA was noted. This was a patient who returned on postoperative day 2 with a possible CSF leak noted by ultrasound. After overnight hospital floor admission, he was discharged the next day after receiving intravenous fluids without further sequelae. ConclusionsSA is a viable option for anesthetic care in infants ≤6 months of age presenting for outpatient surgery. Advantages included the ability to bypass PACU Phase I and facilitation of hospital discharge. Level of evidenceIV. Retrospective cohort treatment study.

High flow nasal cannula outside the ICU provides optimal care and maximizes hospital resources for patients with multiple rib fractures

BackgroundHigh flow nasal cannula (HFNC) use reduces work of breathing and improves oxygenation for patients with hypoxemic respiratory failure. Limited prior work has explored protocolized use of HFNC for trauma patients outside the Intensive Care Unit (ICU). The purpose of this study is to describe and evaluate use of HFNC for patients with rib fractures when therapy was standard of care on all floors of the hospital. MethodsIn 2018, the study hospital expanded use of HFNC (AIRVO; Fisher Paykel, Auckland, NZ) to all floors of the hospital, making it available in the ICU, Emergency Department (ED), and on general inpatient floors. The study group included adult patients with three or more rib fractures who received HFNC at any location in the hospital (Phase 2: January 2018-December 2019). The study group was compared to a historical control group when HFNC was available only in the ICU (Phase 1: March 2013-July 2015). Patients were excluded from the study if they received invasive mechanical ventilation prior to HFNC. Primary outcomes were mechanical ventilation rates, ICU days, length of hospitalization, and mortality. ResultsDuring the study period, 63 patients received HFNC, with 35% of patients (n = 22) receiving the duration of therapy outside the ICU. When compared to the control group (N = 63), there were no significant differences in total hospital days (9 vs. 9, p=.64), mechanical ventilation (19% vs. 13%, p=.47), or mortality (3% vs. 5%, p = 1.00). Twenty-seven percent of patients (n = 17) in the study group avoided the ICU during hospitalization. ConclusionsFindings suggest that HFNC therapy can be safely initiated and managed on all hospital floors for patients with multiple rib fractures. Making the therapy available outside the ICU may reduce healthcare resource use without adversely affecting patient outcomes.

Impact of exposure to potentially contaminated hospital beds on risk of hospital-onset C. difficile infection

Background: Environmental contamination increases risk for Clostridioides difficile infection (CDI) given that spores can remain on a hospital bed, floor, sink, and light switch despite appropriate cleaning measures. Using real-time asset management software (AgileTrac, GE Healthcare) for beds we examined the risk of a patient developing hospital-onset CDI (HO-CDI) when staying in a hospital bed that had a previous occupant with CDI. Methods: We retrospectively identified all patients in tracked beds from April 2018 to August 2019 to identify hospital-onset CDI (HO-CDI), defined as a positive PCR test for C. difficile in a patient hospitalized for >3 days. A patient was defined as being exposed to a potentially “contaminated” bed if within the preceding 7 days from their HO-CDI diagnosis they resided in a hospital bed that, within the prior 90 days, had held an occupant with CDI (Fig. 1). We used multivariable logistic regression to evaluate the association between being exposed to a contaminated bed and HO-CDI. Model covariates were chosen a priori based on known risk factors for CDI. As a sensitivity analysis, we varied the length of time that a bed could stay contaminated from 90 to 60, 30, 14, and 7 days. Results: We analyzed 25,032 hospital encounters representing 18,860 unique patients; we identified 237 (0.9%) hospital encounters with HO-CDI (Table 1). The Elixhauser comorbidity score, being exposed to a contaminated bed, and receiving antibiotics or a proton pump inhibitor (PPI) during the hospital admission were all associated with HO-CDI in the univariable analysis (Table 2). In the adjusted multivariable model, being exposed to a contaminated bed remained a significant risk factor for HO-CDI (OR, 1.60; 95% CI, 1.22–2.08) even after controlling for known risk factors for CDI including age >65, elevated Elixhauser score, and recent antibiotic or PPI use (Table 2). In the sensitivity analysis in which we adjusted the time a bed was considered contaminated after CDI, being exposed to a contaminated bed remained a risk factor for HO-CDI, with a similar odds ratios as the original model (Table 2). Conclusions: Residing in a hospital bed that contained a previous occupant with CDI is a risk factor for developing HO-CDI. Hospital epidemiologists, infection control personnel, and environmental services staff should consider this association when developing CDI risk mitigation strategies.Funding: NoneDisclosures: None

Does In-Hospital Opioid Use Affect Opioid Consumption After Total Joint Arthroplasty?

Preoperative opioid use strongly correlates with greater postoperative opioid use and complications following total joint arthroplasty (TJA). However, there is a lack of information regarding the effect of opioid consumption during the hospital stay and within the operating room on postoperative opioid use. We retrospectively reviewed 369 consecutive patients undergoing primary TJA at an academic center over a 9-month period. Ninety-day preoperative and postoperative opioid prescriptions were obtained from the state's drug monitoring database. In-hospital opioid consumption data was obtained from the preoperative unit, operating room, postanesthesia care unit (PACU), and hospital floor. Multivariate analysis was utilized to compare patients' total in-hospital opioid consumption with their preoperative and postoperative use, along with opioid use throughout the hospitalization. Total in-hospital opioid consumption was independently associated with postoperative opioid use (rs= 0.17, P= .0010). Opioids consumed on the hospital floor correlated with opioid use in the preoperative unit (rs= 0.11, P= .0338) and PACU (rs= 0.15, P= .0032). Increased preoperative opioid consumption was the greatest risk factor for excessive postoperative use (rs= 0.44, P < .0001). A greater proportion of patients <65 years of age were high posthospital opioid consumers (P= .0146) and significantly more TKA patients were in the higher use groups (P= .0006). In-hospital opioid use is independently associated with preoperative and postoperative consumption. Preoperative opioid use remains the greatest risk factor for increased opioid consumption after TJA. Multimodal approaches to decrease reliance on opioids for pain control during hospitalization may offer hope to further decrease postoperative usage. III.

Palliative Outcomes in Patients with Left Ventricular Assist Devices and Active Malignancies

<h3>Purpose</h3> To describe palliative outcomes in patients with left ventricular assist devices (LVADs) diagnosed with cancer at or after LVAD implantation. <h3>Methods</h3> In this retrospective cohort study, an LVAD database was reviewed (2005 to 2021) to identify patients diagnosed with cancer at or after LVAD implantation. Variables included demographic data, hospice referrals, changes in code status, number of palliative consults, length of hospitalization in the last year of life and location of death. <h3>Results</h3> We identified 24 patients who had or were subsequently diagnosed with an active malignancy after LVAD implantation. The average age was 60 years, 54% were male and 79% were African Americans, and 54% were deceased. 67% of the patients had a cancer diagnosis after LVAD implantation (average 2.1 years after implantation). Primary cancer types included breast (29%), prostate, lymphoma, and renal cell (13% each), and colorectal, lung, thyroid or multiple myeloma in the remainder. Average number of hospitalizations in the last year of life was 3.25 (range 1-8). Mean hospital length of stay (LOS) in the last year of life was 50.5 days (range 2-211). Location of death included the hospital ICU (47%), hospital floor (20%), home (20%), nursing facility (7%) and the OR (7%). Primary cause of death was cancer complications in 60% and heart failure complications in 27%, with the remaining due to other causes. Palliative service was consulted for 58% of the patients at an average of 1.13 times in the last year of life, with the number of consults increasing with LOS to a maximum of 4 times in a 211 day stay. 63% of patients had their code states changed from full code to DNR/DNI or comfort care. Hospice was discussed with 33% of the patients but only 13% enrolled in hospice care. <h3>Conclusion</h3> There is limited data on palliative outcomes in heart failure patients with cancer at or after LVAD implantation. The findings from this study demonstrate that the majority of patients with dual diagnoses have a reduction in LVAD longevity due to a concomitant malignancy. Primary location of death in a high acuity setting and low utilization of hospice care in this subset of patients suggests that palliative care services should be involved early to facilitate goals of care discussions. Lastly, the prolonged average hospital stay indicates high utilization of care and cost yet a disproportionately low average of palliative consultations.

Heparan sulfate mimetic fucoidan restores the endothelial glycocalyx and protects against dysfunction induced by serum of COVID-19 patients in the intensive care unit

Accumulating evidence proves that endothelial dysfunction is involved in coronavirus disease 2019 (COVID-19) progression. We previously demonstrated that the endothelial surface glycocalyx has a critical role in maintenance of vascular integrity. Here, we hypothesised that serum factors of severe COVID-19 patients affect the glycocalyx and result in endothelial dysfunction.We included blood samples of 32 COVID-19 hospitalised patients at the Leiden University Medical Center, of which 26 were hospitalised in an intensive care unit (ICU) and six on a non-ICU hospital floor; 18 of the samples were obtained from convalescent patients 6 weeks after hospital discharge, and 12 from age-matched healthy donors (control) during the first period of the outbreak. First, we determined endothelial (angiopoietin 2 (ANG2)) and glycocalyx degradation (soluble thrombomodulin (sTM) and syndecan-1 (sSDC1)) markers in plasma.In the plasma of COVID-19 patients, circulating ANG2 and sTM were elevated in patients in the ICU. Primary lung microvascular endothelial cell (HPMEC) and human glomerular microvascular endothelial cell (GEnC) cultured in the presence of these sera led to endothelial cell glycocalyx degradation, barrier disruption, inflammation and increased coagulation on the endothelial surface, significantly different compared to healthy control and non-ICU patient sera. These changes could all be restored in the presence of fucoidan.In conclusion, our data highlight the link between endothelial glycocalyx degradation, barrier failure and induction of a procoagulant surface in COVID-19 patients in ICU which could be targeted earlier in disease by the presence of heparan sulfate mimetics.

Remote video auditing in healthcare: A powerful tool for patient and clinician safety culture and operational efficiencies

Medicine struggles to effect meaningful improvements in patient safety that do not come at the expense of efficiency. Rarer still are evidence-based tools that can provide sustained safer care while delivering operational efficiencies that produce better clinical and financial outcomes. This paper describes how Northwell Health, New York’s largest health-care provider, has instituted innovative remote video auditing (RVA) technology in its operating rooms, intensive care units and hospital floors, and the results it has achieved in nearly a decade of progressive applications and expanding adoption across its 23 hospitals. The paper demonstrates that implementation of this technology, which is compliant with the Health Insurance Portability and Accountability Act of 1996 (HIPAA), and associated change management, has improved culture and productivity in the operating room and hospital-wide. Benefits achieved through the RVA-with-feedback methodology include increased capacity, improved first-case starts, higher compliance with hand hygiene and the surgical safety checklist, reduced surgical site infections, shorter room turnover and expedited patient flow. The associated increases in patient and surgeon satisfaction, and significant financial savings, have substantial implications for hospitals seeking new pathways to enhanced patient safety and profitability.

Antimicrobial Resistance: The Next Probable Pandemic.

As the world still mourns the victims of the pandemic caused by Severe Acute Respiratory Syndrome Coronavirus-2, another pandemic that is expected to kill millions of people in less than a century, is already brewing. In the distant future, the global, mostly silent pandemic of antimicrobial resistance is increasingly claiming the lives of patients on hospital floors. Unfortunately, the global health community is now gradually and progressively facing the silently emerging pandemic that could endanger some of the most significant advances in modern medicine. Medical students as future physicians, have the potential to help address this problem sustainably keeping in mind that today's medical professionals will hand over the baton to them and hope for a greater improvement in antimicrobial resistance and antibiotic usage. Thus, the next generation of doctors must be better prepared to use antimicrobials more sparingly and appropriately.

Avoiding Spurious Low Platelet Counts by Redrawing Specimens with First Time Low Platelet Counts

Introduction We reviewed our policy of redrawing our pediatric patients with first time platelet counts <100 K/ml to assess the frequency of correction. Materials and methods In a Children’s Hospital 25-month review of patients that underwent automatic redraws due to low first time platelet counts, we determined the frequency of corrected counts and the sites where these original low platelet counts originated. Only the repeat draw results were reported. Results Of 99 children with redrawn specimens, 62% of platelet counts corrected. The most frequent corrections occurred in specimens from the emergency department (74%), pediatric intensive care (71%), and operating room (67%), the fewest from the cardiac intensive care (38%) and general hospital floors (44%). Conclusions The policy of redrawing patients with first time platelet counts <100 K resulted in correction in 62%, and avoided delays and additional charges for repeat testing ordered by the provider.

Hidden hazards of SARS-CoV-2 transmission in hospitals: A systematic review.

Despite their considerable prevalence, dynamics of hospital-associated COVID-19 are still not well understood. We assessed the nature and extent of air- and surface-borne SARS-CoV-2 contamination in hospitals to identify hazards of viral dispersal and enable more precise targeting of infection prevention and control. PubMed, ScienceDirect, Web of Science, Medrxiv, and Biorxiv were searched for relevant articles until June 1, 2021. In total, 51 observational cross-sectional studies comprising 6258samples were included. SARS-CoV-2 RNA was detected in one in six air and surface samples throughout the hospital and up to 7.62m away from the nearest patients. The highest detection rates and viral concentrations were reported from patient areas. The most frequently and heavily contaminated types of surfaces comprised air outlets and hospital floors. Viable virus was recovered from the air and fomites. Among size-fractionated air samples, only fine aerosols contained viable virus. Aerosol-generating procedures significantly increased (ORair =2.56 (1.46-4.51); ORsurface =1.95 (1.27-2.99)), whereas patient masking significantly decreased air- and surface-borne SARS-CoV-2 contamination (ORair =0.41 (0.25-0.70); ORsurface =0.45 (0.34-0.61)). The nature and extent of hospital contamination indicate that SARS-CoV-2 is likely dispersed conjointly through several transmission routes, including short- and long-range aerosol, droplet, and fomite transmission.

Respiration monitoring in PACU using ventilation and gas exchange parameters

The importance of perioperative respiration monitoring is highlighted by high incidences of postoperative respiratory complications unrelated to the original disease. The objectives of this pilot study were to (1) simultaneously acquire respiration rate (RR), tidal volume (TV), minute ventilation (MV), SpO2 and PetCO2 from patients in post-anesthesia care unit (PACU) and (2) identify a practical continuous respiration monitoring method by analyzing the acquired data in terms of their ability and reliability in assessing a patient’s respiratory status. Thirteen non-intubated patients completed this observational study. A portable electrical impedance tomography (EIT) device was used to acquire RREIT, TV and MV, while PetCO2, RRCap and SpO2 were measured by a Capnostream35. Hypoventilation and respiratory events, e.g., apnea and hypopnea, could be detected reliably using RREIT, TV and MV. PetCO2 and SpO2 provided the gas exchange information, but were unable to detect hypoventilation in a timely fashion. Although SpO2 was stable, the sidestream capnography using the oronasal cannula was often unstable and produced fluctuating PetCO2 values. The coefficient of determination (R2) value between RREIT and RRCap was 0.65 with a percentage error of 52.5%. Based on our results, we identified RR, TV, MV and SpO2 as a set of respiratory parameters for robust continuous respiration monitoring of non-intubated patients. Such a respiration monitor with both ventilation and gas exchange parameters would be reliable and could be useful not only for respiration monitoring, but in making PACU discharge decisions and adjusting opioid dosage on general hospital floor. Future studies are needed to evaluate the potential clinical utility of such an integrated respiration monitor.

A high performing piezoelectric and triboelectric nanogenerator based on a large deformation of the novel lantern-shaped structure

Energy shortage has been the most serious problem for generations. With the continuous consumption of fossil energy, there is an urgent need to find a renewable and sustainable energy source. However, the mechanical energy is ubiquitous and adequate in daily life. With the development of nanotechnology, nanogenerators can utilize and convert mechanical energy into electric energy, which provides an effective solution in modern society. Besides, the combination of functional materials, the coupling mechanism between piezoelectricity and triboelectricity as well as other methods can improve the output properties of nanogenerators to a large extent. Hence, in this paper, the raw materials of polyvinylidene fluoridetrifluoroethylene (PVDF-TrFE), barium titanate (BTO) together with polydimethylsiloxane (PDMS) are innovatively mixed to obtain both outstanding piezoelectricity and flexibility. In addition, from the structural perspective, the lantern-shaped nanogenerator (LSNG) with large deformation rate up to 86% and tri-piezoelectric and single-triboelectric coupling mechanisms is well fabricated. The output voltage, current and power density can go up to 171.2 V, 107.6 μA and 0.6 mW/cm2, respectively. What’s more, the pressure sensitivity of the LSNG approaches 46.37 ± 0.5 mV N−1 (R2 = 0.997) in the pressure ranging from 5 N to 25 N. The whole LSNG can maintain a stable electrical output even after 10,000 periodic operation cycles. Simulations were performed by using COMSOL and ANSYS in order to investigate the principle of the electricity generating and the relationship between strain and stress of the overall structure. Additionally, it can serve as a generator to light up several LED lights and collect mechanical energy from large deformations. Furthermore, it can serve as a sensor for detecting slight movements, mechanical position and realizing the patient positioning if integrated into the hospital floors. What’s more, it can convert mechanical energy into electrical energy from vehicles, bicycles, pedestrians, etc. in a large scale once they are placed under the pavements. In the future, this LSNG will play an important role in converting the vibration energy into electric energy. In the future, this LSNG will play an important role in converting the vibration energy into electric energy.

Clinical and Laboratory Profile of COVID-19 Pneumonia Patients With a Complicated Post-Intensive Care Unit Hospital Course

Background: Characteristics of intensive care unit (ICU) downgrades who experience a complicated post-ICU ward course (ICU return or floor death) and the incidence of this phenomenon have not been examined in ICU survivors of coronavirus disease 2019 (COVID-19) pneumonia. The aim of the present study was to establish the rate of a complicated post-ICU ward course among survivors of COVID-19 pneumonia and describe the associated patient, ICU management, and serum biomarker characteristics. An additional aim was to compare these parameters between those who experienced a complicated post-ICU course and those who did not. Methods: This was a retrospective study of patients who were admitted to the ICU with COVID-19 pneumonia and were downgraded to a hospital floor at the end of their initial ICU stay. Patients were divided based on a complicated or uncomplicated post-ICU course. Groups were compared with respect to relevant clinical variables. Serum biomarker levels were compared on day of ICU exit and were trended in the days preceding the downgrade. Ward stay of patients who had a complicated course was examined for notable floor events surrounding their decompensation. Results: Eighteen out of 99 downgraded patients (18%) experienced a complicated post-ICU course, among them there were 14 returns (14%) and four deaths (4%). They had higher Charlson Comorbidity Index, higher Acute Physiology and Chronic Health Evaluation (APACHE) IV score, as well as higher D-dimer and C-reactive protein (CRP) at ICU departure. They were less likely to have received therapeutic anticoagulation and convalescent plasma during their ICU stay. On multivariable analysis, these parameters except D-dimer remained independently associated with a complicated course. Review of biomarker trends preceding ICU exit demonstrated an upward trajectory of D-dimer, CRP, and lactate dehydrogenase (LDH) in the complicated course group not mirrored by the uncomplicated course group. Examination of notable floor events leading up to decompensation revealed that in 50% the ward course was characterized by new cardiac disturbances. Conclusions: Our rate of ward death among ICU downgrades was similar to pre-COVID data, but the rate of ICU return was higher. Complicated post-ICU course patients were exhibiting upward biomarker trends at ICU exit, and their ward stay was punctuated by acute cardiac abnormalities. J Clin Med Res. 2021;13(10-11):487-496 doi: https://doi.org/10.14740/jocmr4555

Clinical and Laboratory Profile of COVID-19 Pneumonia Patients With a Complicated Post-Intensive Care Unit Hospital Course.

BackgroundCharacteristics of intensive care unit (ICU) downgrades who experience a complicated post-ICU ward course (ICU return or floor death) and the incidence of this phenomenon have not been examined in ICU survivors of coronavirus disease 2019 (COVID-19) pneumonia. The aim of the present study was to establish the rate of a complicated post-ICU ward course among survivors of COVID-19 pneumonia and describe the associated patient, ICU management, and serum biomarker characteristics. An additional aim was to compare these parameters between those who experienced a complicated post-ICU course and those who did not.MethodsThis was a retrospective study of patients who were admitted to the ICU with COVID-19 pneumonia and were downgraded to a hospital floor at the end of their initial ICU stay. Patients were divided based on a complicated or uncomplicated post-ICU course. Groups were compared with respect to relevant clinical variables. Serum biomarker levels were compared on day of ICU exit and were trended in the days preceding the downgrade. Ward stay of patients who had a complicated course was examined for notable floor events surrounding their decompensation.ResultsEighteen out of 99 downgraded patients (18%) experienced a complicated post-ICU course, among them there were 14 returns (14%) and four deaths (4%). They had higher Charlson Comorbidity Index, higher Acute Physiology and Chronic Health Evaluation (APACHE) IV score, as well as higher D-dimer and C-reactive protein (CRP) at ICU departure. They were less likely to have received therapeutic anticoagulation and convalescent plasma during their ICU stay. On multivariable analysis, these parameters except D-dimer remained independently associated with a complicated course. Review of biomarker trends preceding ICU exit demonstrated an upward trajectory of D-dimer, CRP, and lactate dehydrogenase (LDH) in the complicated course group not mirrored by the uncomplicated course group. Examination of notable floor events leading up to decompensation revealed that in 50% the ward course was characterized by new cardiac disturbances.ConclusionsOur rate of ward death among ICU downgrades was similar to pre-COVID data, but the rate of ICU return was higher. Complicated post-ICU course patients were exhibiting upward biomarker trends at ICU exit, and their ward stay was punctuated by acute cardiac abnormalities.

An operationally implementable model for predicting the effects of an infectious disease on a comprehensive regional healthcare system.

An operationally implementable predictive model has been developed to forecast the number of COVID-19 infections in the patient population, hospital floor and ICU censuses, ventilator and related supply chain demand. The model is intended for clinical, operational, financial and supply chain leaders and executives of a comprehensive healthcare system responsible for making decisions that depend on epidemiological contingencies. This paper describes the model that was implemented at NorthShore University HealthSystem and is applicable to any communicable disease whose risk of reinfection for the duration of the pandemic is negligible.

Not FIT for Use: Fecal Immunochemical Testing in the Inpatient and Emergency Settings

BackgroundFecal immunochemical testing (FIT) is widely used for colorectal cancer screening, its only indication. Its effect on clinical decision-making beyond screening is unknown. We studied the use of FIT in emergency and inpatient settings and its impact on patient care. MethodsUsing electronic medical records, we reviewed all non-ambulatory FITs performed from November 2017 to October 2019 at a tertiary care community hospital. We collected data on demographics, indications, gastroenterology consultations, and endoscopic procedures. Multivariate logistic regression was performed to determine the effect of FIT on gastroenterology consultation and endoscopy. ResultsWe identified 550 patients with at least 1 FIT test. Only 3 FITs (0.5%) were performed for colorectal cancer screening. FITs were primarily ordered from the emergency department (45.3%) or inpatient hospital floor (42.2%). Anemia (44.0%), followed by gastrointestinal bleeding (40.9%), were the most common indications. FIT was positive in 253 patients (46.0%), and gastroenterology consultation was obtained for 47.4% (n = 120), compared with 14.5% (n = 43) of the 297 FIT-negative patients (odds ratio 3.28; 95% confidence interval, 2.23-4.82, P < .0001). A potential bleeding source was identified in 80% of patients with reported or witnessed overt gastrointestinal bleeding, a similar proportion (80.7%; P = .92) to patients who were FIT positive with overt gastrointestinal bleeding. Multivariate analysis showed that melena, hematemesis, and a positive FIT were associated with gastroenterology consultation (all P < .05), while only melena (odds ratio 3.34; 95% confidence interval, 1.48-7.54) was associated with endoscopy. ConclusionsNearly all emergency department and inpatient FIT use was inappropriate. FIT resulted in more gastroenterology consultation but was not independently associated with inpatient endoscopy.

Bridging the preclinical-clinical divide in response to COVID-19.

The COVID-19 pandemic posed unique challenges to educational institutions throughout the world, especially medical education programs. The usual demands of residency were heightened by increased patient volume and need for intensive care. Many hospitals, including Hackensack University Medical Center, enacted administrative changes including modifying staffing models to minimize disease exposure and remodeling hospital floors to increase the capacity of intensive care units. Many of these changes were enacted to allow for greater focus on patient care and social distancing, but they came at the expense of medical education, as traditional practices such as in-person lectures and participation in group clinical rounds were suspended to accommodate these changes. At a time when new information about SARS-CoV-2 and various treatment modalities was emerging rapidly, there was an urgent need for providing factual, relevant, concise educational materials to resident and attending physicians whose time was limited by the volume and urgency of COVID-19 patient care activities. This opened up an opportunity for students in our new medical school associated with the Hackensack Meridian Health network to provide this much needed informational resource. In March through June of 2020, first- and second-year students and medical science faculty at the Hackensack Meridian School of Medicine collaborated with resident and attending physicians at Hackensack University Medical Center via online web-conferencing. Each week, residents and attending physicians sent clinical questions to the medical school faculty that students would then research and convert into an educational presentation. The topics centered around actionable clinical queries. Students gathered relevant clinical studies and critically evaluated the methods, procedures, findings and conclusions of each report. Studies from hospitals and institutions around the world were emerging rapidly, most as preprints prior to peer-evaluation and often with a broad range of quality. Critical appraisal of data-gathering methods was essential to provide hospital staff with accurate information. Student presentations were supported by medical science faculty using standard evidence-based medicine methodology to ensure that a high-quality review had been conducted. After presentations concluded, residents and attendings posed further questions, reflected on what they were seeing clinically, and suggested new topics for discussion. This process allowed medical students to increase their skills in public speaking, critical appraising data and methodology, and presenting research in a concise, clear manner. These presentations also allowed frontline workers to receive up-to-date information in a setting of rapidly evolving knowledge of epidemiology, clinical presentation and disease management of COVID-19 patients. This innovative response to the pandemic provided a powerful opportunity to bridge medical education's preclinical-clinical divide. This example should serve as a prototype for sustained collaboration as different strains of SARS-CoV-2 emerge as a threat, as well as in post-pandemic times. This learning model can be applied to emerging diseases and is particularly useful for cutting-edge, novel research topics which significantly impact patient care.

Just a can of soda.

There is a peculiarity in our emergency department: the conspicuous absence of any soda. Water? Orange juice? Even prune juice for those who desire. But not even a single off-brand soda will turn up in the patient nutrition refrigerator. And not for general lack of soda; all other units across eleven floors have cupboards overflowing with stacks of cans. This has found me trudging up and down the hospital floors over the years, seeking out the particular beverages my patients desire. I encourage custom orders at the conclusion of every patient encounter. What brand? What flavor? Regular or diet? But . . . why, my colleagues ask? Why am I always found carrying cans bright red and green seven floors down to the emergency department? Why all that effort for just a can of soda; don't I want to finish my notes and get home on time for once?

Lessons Learned From Helplessness: Reflections Volunteering as a "Cuddler".

Lessons Learned From Helplessness: Reflections Volunteering as a "Cuddler".

Predictive Monitoring-Impact in Acute Care Cardiology Trial (PM-IMPACCT): Protocol for a Randomized Controlled Trial.

BackgroundPatients in acute care wards who deteriorate and are emergently transferred to intensive care units (ICUs) have poor outcomes. Early identification of patients who are decompensating might allow for earlier clinical intervention and reduced morbidity and mortality. Advances in bedside continuous predictive analytics monitoring (ie, artificial intelligence [AI]–based risk prediction) have made complex data easily available to health care providers and have provided early warning of potentially catastrophic clinical events. We present a dynamic, visual, predictive analytics monitoring tool that integrates real-time bedside telemetric physiologic data into robust clinical models to estimate and communicate risk of imminent events. This tool, Continuous Monitoring of Event Trajectories (CoMET), has been shown in retrospective observational studies to predict clinical decompensation on the acute care ward. There is a need to more definitively study this advanced predictive analytics or AI monitoring system in a prospective, randomized controlled, clinical trial.ObjectiveThe goal of this trial is to determine the impact of an AI-based visual risk analytic, CoMET, on improving patient outcomes related to clinical deterioration, response time to proactive clinical action, and costs to the health care system.MethodsWe propose a cluster randomized controlled trial to test the impact of using the CoMET display in an acute care cardiology and cardiothoracic surgery hospital floor. The number of admissions to a room undergoing cluster randomization was estimated to be 10,424 over the 20-month study period. Cluster randomization based on bed number will occur every 2 months. The intervention cluster will have the CoMET score displayed (along with standard of care), while the usual care group will receive standard of care only.ResultsThe primary outcome will be hours free from events of clinical deterioration. Hours of acute clinical events are defined as time when one or more of the following occur: emergent ICU transfer, emergent surgery prior to ICU transfer, cardiac arrest prior to ICU transfer, emergent intubation, or death. The clinical trial began randomization in January 2021.ConclusionsVery few AI-based health analytics have been translated from algorithm to real-world use. This study will use robust, prospective, randomized controlled, clinical trial methodology to assess the effectiveness of an advanced AI predictive analytics monitoring system in incorporating real-time telemetric data for identifying clinical deterioration on acute care wards. This analysis will strengthen the ability of health care organizations to evolve as learning health systems, in which bioinformatics data are applied to improve patient outcomes by incorporating AI into knowledge tools that are successfully integrated into clinical practice by health care providers.Trial RegistrationClinicalTrials.gov NCT04359641; https://clinicaltrials.gov/ct2/show/NCT04359641International Registered Report Identifier (IRRID)DERR1-10.2196/29631