Queens Hospital Research Articles

BHSeP17 Long term effects of systemic hypertensive patients needing emergency hernia repair surgeries in BHRUT; and its correlation to their recurrence. The 1 of 4 theory

Abstract Aim To assess the long term effects of emergency hernia repair in hypertensive patients in comparison to those with hypertension needing elective repair. To analyse common type of surgeries adopted for these patients in King George and Queens Hospital. Method 200 patients were selected between the year 2022 to 2023 who needed groin hernia repair. Amongst these, 51 patients had co morbidities that included hypertension. A log on information relating to gender, elective vs emergency and type of surgery was recorded. Exclusion criteria: People requiring ventral hernias were excluded. Results In total, 155 patients were selected who needed groin hernia repair, amongst them 25% of the patients suffered with Hypertension and required treatment. Amongst these patients, a total of 11.6% patients needed emergency hernia repair and nearly 88.2% patients had elective surgical repair. Amongst these patients a total of 5.8% patients suffered from minor complications such as wound site infection. Only a small margin of 0.19% of patients suffered from recurrence. The incidence of recurrence occurred in elective hernia repair. Conclusion It has therefore been understood that out of total number of patients needing hernia repair, 1/4th consists of people with hypertension, and 1/4 of these people with hypertension may end up needing emergency surgery. A routine and thorough history of all patients needing medical management of Hypertension must therefore be carried out in order to avoid serious complications needing emergency procedures.

Improving Patient Care and Streamlining Follow-Up: Compliance With National Institute for Health and Care Excellence (NICE) Guidelines for Pediatric Distal Radius Buckle Fractures.

Torus fractures, also known as buckle fractures, are among the most common types of fractures seen in children who present to the emergency department (ED). These injuries usually occur when a child falls onto an outstretched hand, resulting in the compression and buckling of the dorsal cortex of the radius while the volar cortex remains intact. These fractures generally have a good prognosis and heal well with simple immobilization with a low risk of complications. However, current treatment practices often involve using a rigid cast and scheduling multiple follow-up clinic visits, which increases the hospital's financial strain. We conducted an initial audit that reviewed the practice in our unit between August and October 2017 at Queen's Hospital, Burton Upon Trent, United Kingdom. It included all children below the age of 16 who had radiograph images confirming distal radius buckle fractures and have been referred to the fracture clinic. Patient demographics, clinic visits, treating doctor grade/specialty, radiographs, initial and final treatment outcomes, and cast application were collected. After the initial audit, compliance with National Institute for Health and Care Excellence (NICE) guidelines was promoted through the education of healthcare providers. A second audit was performed within 12 months to reassess the compliance. This study looked at the management of pediatric distal radius buckle fractures in a cohort of 152 patients, of which 65 and 87 children were included in audit cycles I and II, respectively. In the ED, splint usage increased from 0% in the first cycle (all children initially treated in a back slab) to 20% following new recommendations. In the fracture clinic, there was a notable improvement in the use of splints over full plaster casts between the first and second cycles. Initially, in the first cycle, only 5% of patients were treated in a splint, with 95% receiving full plaster casts. Following recommendations, splint use increased significantly in the second cycle, rising to 53%, while cast use decreased to 47%. In the first audit, only 7.7% (five patients) were discharged at the first visit, compared to 44.8% (39 patients) in the second audit. In the first audit, 86.2% (56 patients) required a second visit, whereas in the second audit, this decreased to 55.2% (48 patients). Four individuals received a cast owing to splint size difficulties or patient preferences. Despite the improvement seen regarding compliance with NICE guidelines, work is still needed to further enhance compliance. Staff education and optimizing splint availability will be a priority to reduce the burden on fracture clinic resources by unnecessary follow-up appointments.

Comparative Analysis of Viral Load and Cytokines during SARS-CoV-2 Infection between Pregnant and Non-Pregnant Women.

To better understand the vulnerabilities of pregnant women during the COVID-19 pandemic, we conducted a comprehensive, retrospective cohort study to assess differences in immune responses to SARS-CoV-2 infection between pregnant and non-pregnant women. Nasopharyngeal swabs and serum specimens from 90 pregnant and 278 age-matched non-pregnant women were collected from 15 March 2020 to 23 July 2021 at NewYork-Presbyterian Queens Hospital in New York City. Multiplex reverse transcription polymerase chain reaction, neutralizing antibody, and cytokine array assays were used to assess the incidence, viral load, antibody titers and profiles, and examine cytokine expression patterns. Our results show a lower incidence of SARS-CoV-2 infection in pregnant women compared with non-pregnant women. Pregnant women infected with SARS-CoV-2 exhibited a substantially lower viral load. In addition, the levels of both anti-spike protein receptor-binding domain IgG neutralizing antibodies and anti-N Protein IgG were elevated in pregnant women. Finally, cytokine profiling revealed differential expression of leptin across cohorts. These findings suggest that pregnancy is associated with distinct immune and virological responses to SARS-CoV-2 infection, characterized by lower infection rates, substantially lower viral loads, and enhanced antibody production. Differential cytokine expression indicates unique immune modulation in pregnant women.

An Audit of the First Stage of Service Development Initiatives Undertaken as Part of a Quality Improvement Process to Improve the Screening and Management of Older Adults Presenting With Delirium in Queen's Hospital (NELFT)

An Audit of the First Stage of Service Development Initiatives Undertaken as Part of a Quality Improvement Process to Improve the Screening and Management of Older Adults Presenting With Delirium in Queen's Hospital (NELFT)

“A Different Kind of Struggle”: Jacob Lawrence’s Hospital Series and the Politics of Art as Therapy

ABSTRACT Jacob Lawrence created eleven paintings in 1949–50, when he was treated for anxiety and depression at Hillside Hospital in Queens. Critics at the time praised the artworks’ similarities to the asylum art of Van Gogh and observed Lawrence’s apparent lack of interest in depicting Black struggles. My reinterpretation of the series shows, however, that Lawrence had much to say about the social and psychological conditions of African Americans in picturing the hospital’s predominantly white patients. Entering into conversation with Hillside’s clinical practices, his paintings offer powerful statements about both the aesthetics and politics of art as therapy.

PREVALENCE OF CEREBRAL VENOUS DRAINAGE STENOSES ON RETROSPECTIVELY ANALYZED CTA FOR STROKE TRIAGE

Abstract Cerebral venous congestion (CVC) has been identified as a hypothetic cause of cognitive impairment. Prior work has estimated that 15-30% of the population may have jugular venous narrowing, a potential cause of CVC, based on reviews of CT angiography (CTA) performed at a large academic medical center. However, few comprehensive studies exist. Therefore, for the current work, we reviewed fifty CTAs that were obtained for ischemic stroke triage and thrombectomy planning at a comprehensive stroke center in Hawaii (Queens Hospital, Honolulu HI). These brain CTAs were analyzed for arterial and venous variants and other abnormalities that might place the patient at increased risk for arterial injury and/or venous congestion, both of which may result in cognitive decline. The CTAs were analyzed retrospectively for every known level of venous and arterial stenosis, and CVC-associated pre-morbid symptoms were analyzed. Preliminary data support the hypothesis that venous anatomical anomalies may be a risk factor for cognitive impairment. CVC may be an under-diagnosed contributor to cognitive impairment, particularly in older patients.

Evaluation of Acute Outcomes and Factors Influencing the Care of Chest Trauma in a District General Hospital in the United Kingdom.

Background The rate of chest trauma admissions under the Queen Hospital Burton Orthopedic team has been steadily increasing, surpassing other hospital trusts. Patients are managed locally by the Orthopedic department, unlike in major trauma centres. Understanding the management outcomes and patient factors in this setting is crucial for enhancing patient safety. Methodology A retrospective analysis of 139 patients with chest trauma referred to the QHB Orthopedic team from October 2017 to May 2021 was conducted using the Meditech-V6 electronic medical records system (Meditech, Westwood, US). This study aims to evaluate the outcomes of patients admitted with chest trauma and improve current practices. The objectives include assessing patient factors influencing outcomes, initiating discussions with a major trauma centre, and enhancing the quality of care for chest trauma patients. Results The mechanism of injury in all cases of chest injuries was blunt trauma, accounting for 100% of the cases. The specific mechanisms of injury observed in the study included falls from standing, falls from height, road traffic collisions, and assault. The study comprised 139 individuals, 128 of whom were diagnosed with rib fractures, and 11 who did not have any rib fractures. In addition, two patients were hospitalized with bilateral rib fractures, both of which were life-threatening. Tragically, one of these cases resulted in the death of the patient. With regardto outcomes,67% of the patients received a consultation at Royal Stoke Hospital (RSH). Eight individuals were transferred to RSH for further management, while the remaining 131 patients were not transferred.Eighty-seven individuals were discharged from the hospital, indicating successful recovery and readiness for discharge. However, it is noteworthy that nine patients experienced complications during their hospital stay, highlighting the potential challenges and risks associated with chest trauma management. Tragically, seven patients succumbed to their injuries and passed away. Conclusions The majority of patients in this study were aged 65 and over and presented with multiple comorbidities, indicating the complex medical profile of this population. However, despite the presence of life-threatening injuries and the associated risks, only a minority of patients in the study were transferred to a designated trauma centre. This raises concerns about the adequacy of the current transfer protocols and the potential impact on patient outcomes.

A Comparison by Ethnicity of Usage of Medication, Intubation Use, and Mortality Rates of COVID-19 Patients in an Urban Hospital

International Journal of Medicine and Public Health,2023,13,1,14-19.DOI:10.5530/ijmedph.2023.1.3Published:June 2023Type:Original Article A Comparison by Ethnicity of Usage of Medication, Intubation Use, and Mortality Rates of COVID-19 Patients in an Urban HospitalHoward R. Baruch Howard R. Baruch School of Health Sciences and Public Policy, Walden University, Minneapolis, Minnesota, USA. Abstract:Objectives: The study took place at a central Queens Hospital and answered a total of three research questions. The research wanted to know whether the patients differed in the medications that they took, whether they were placed on a ventilator, and their survival based on their ethnicity while controlling for covariates such as the patients age, gender, and comorbidities while being managed and treated for COVID-19. Materials and Methods: Data was collected from 1188 patient charts from January 1, 2020 to January 1, 2021, and binary logistic regression was used to test hypotheses. Results: The analysis showed non-statistically significant differences in medication use, intubations, or mortality outcomes by ethnicity. The p-values for all the ethnic groups was far greater than 0.05 which indicated that for all the ethnic groups there were no differences that were statically significant for medication use, ventilator use, or survival for all ethnicities thus the null hypothesis must be considered. Conclusion: Ethnicity had no bearing on treatment modalities or mortality among patients admitted and diagnosed with COVID-19 symptoms. Patients at this hospital received equitable care despite ethnic differences that can help alleviate the ill-effects of treatment disparities. Keywords:COVID-19, Intubation use, Medication use, Mortality, Urban Hospital.View:PDF (207.23 KB)

Outcomes of a Colorectal Enhanced Recovery After Surgery Protocol Modified for a Diverse and Urban Community

IntroductionEnhanced recovery after surgery (ERAS) colorectal programs have been shown to improve the length of stay (LOS) without increasing hospital resource utilization at academic centers worldwide. A multidisciplinary ERAS protocol that includes preoperative, intraoperative, and postoperative management guidelines was recently implemented at our urban, racially diverse, and academically affiliated community hospital. A delivery option was provided to reduce barriers to care. Given our unique patient population, the objective of our study was to determine if improvements in outcomes were reproducible in our hospital. MethodsThis is a retrospective study of patients undergoing elective colectomy at New York-Presbyterian Queens Hospital between January 1, 2015, and December 31, 2020. Patient outcomes were compared between surgeries performed under standard practice (all colectomies prior to April 2017) and those performed after the implementation of the ERAS protocol. Demographic and perioperative data were abstracted from a prospectively derived database used to submit data to the National Surgical Quality Improvement Program. Additional data were obtained from chart review. ResultsSix hundred five elective colectomies were performed by 12 surgeons (range 1-228 cases) during the study period. Of these, 22 were performed open (41% followed ERAS), 467 were performed laparoscopically (57% followed ERAS), and 116 were performed robotically (74% followed ERAS). The average patient age was 64 y. Of which, 55% were male; 34% were Asian, 27% were non-Hispanic Caucasian, 27% were Hispanic, and 11% were Black or African American (all P-values > 0.05 for ERAS versus non-ERAS). Average duration of procedure was longer in the ERAS group (262 min versus 243 min, P = 0.04), although when stratified by procedure type, this relationship held true only for laparoscopic procedures. Hospital LOS was significantly shorter in the ERAS group (4.3 versus 5.4 d, P < 0.001) and this relationship held true for procedures performed both laparoscopically (4.2 versus 5.3 d, P = 0.01) and robotically (4.1 versus 5.1 d, P = 0.04). Of the ERAS group, patients who opted for delivery of ERAS components (n = 205) had the shortest LOS when compared to patients who picked up components (n = 91) or opted out of ERAS (n = 309) (4.1 versus 4.4 versus 5.2 d, P = 0.003). No significant differences were found for 30-d mortality, 30-d readmission, wound infection, or other postoperative complications (all P-values > 0.05). ConclusionsImplementation of an ERAS protocol in an urban, diverse, academically affiliated community hospital is associated with reductions in LOS for colectomies performed both laparoscopically and robotically. Facilitating ERAS compliance with a delivery option was also associated with improvements in hospital LOS. Preoperative nutrition supplementation was not associated with outcomes. No differences in mortality, readmission rates, or rates of postoperative complications were found.

Physiotherapy-Led Musculoskeletal Telephone Triage and Advice Service: A Valid Option for Patients Referred From the Emergency Department.

Introduction Musculoskeletal (MSK) conditions create a significant demand for healthcare services in the United Kingdom. The emergency department is one of the main providers of initial care for patients with MSK disorders or injuries. As attendances increase within the emergency department the demand for MSK physiotherapy services also increases. The MSK physiotherapy department at Queens Hospital, Burton, GBR introduced a telephone triage and advice (TTAD) service for patients referred from the emergency department to try and reduce waiting times and the number of initial appointments not attended. The primary outcome of the study was to investigate the number of patients discharged via the TTAD service. Secondly, the study aimed to assess if the TTAD service eased the pressures of face-to-face appointments as well as analyze the effects on the number of failed attendances and canceled appointments for both initial and follow-up face-to-face appointments. Method Data were collected retrospectively from the electronic medical records system Meditech Version 6 (Medical Information Technology, Inc., MA) from the months of August, September, and October in 2017 (pre-TTAD) and 2018 (post-TTAD). Once the data had been collected, analysis was performed comparing results from 2017 to 2018 using Statistical Product and Service Solutions (SPSS) (IBM SPSS Statistics for Windows, Armonk, NY)analysis software. Results The overall number of referrals from emergency to MSK physiotherapy increased by 11.2% between 2017 and 2018. Following the introduction of the TTAD service, 59.8% of the total referrals were offered a face-to-face initial appointment with 40.2% of patients referred being discharged via the TTAD service in 2018. The percentage of patients that failed to attend the initial appointment in 2018 also fell by 4.9%. Conclusion The introduction of a TTAD service for referrals from the emergency department has been demonstrated to be effective in reducing the number of face-to-face appointments required in the MSK physiotherapy management of these patients. Both initial and follow-up face-to-face appointments were lower in 2018 when compared to 2017, this is despite an 11.2% increase in the number of referrals throughout August, September, and October. It can therefore be concluded that the TTAD service also had a positive impact on the failed attendance rate of initial face-to-face appointments.

Assessing the Correct Documentation of Time and Physician Information on Medical Records in the Emergency Department of Queen's Hospital: An Audit and Re-audit.

Medical records are confidential medical and legal documents describing a patient's contact with a healthcare facility. Thequality of documentation has been found to be lower in settings of high patient volume and complex cases, such as the emergency department (ED). The variety and number of healthcare professionals involved in the care of the patient also negatively affect the quality of documentation. The aim of this paper is to present the results of an audit and re-audit conducted in the ED of Queen's Hospital, Romford, to assess ED record documentation against General Medical Council (GMC) and Royal College of Physicians (RCP) standards. For the audit, all records of patients who were discharged from the ED of Queen's Hospital in one day were reviewed and evaluated on whether they have a date, time, the full name of the physician, their GMC number, and signature documented, as per GMC and RCP official guidelines. No medical information or patient data were recorded. After the implementation of the change aiming to raise awareness of ED staff, a new sample was collected two months later, and the same parameters were assessed against the set standards. Results of the audit showed a low percentage of documentation of all parameters, especially of GMC number and signature. After the presentation of the results and implementation of change, the results of the re-audit demonstrated significant raise in all percentages, with a relative improvement of 40% regarding the recording of GMC number and 65% regarding signature. However, the documentation of these two parameters remained low and below acceptable levels. The re-audit results underline that the low compliance was significantly improved after the implementation of measures aiming to increase correct documentation awareness among ED staff. However, to maintain and even raise the level of current practice, additionalsystematic measures need to be put into action.

B3 Lesions of Breast: Two Year Retrospective Analysis of 4478 Cases Carried out in a Single Centre in the UK

Background: B3 category mainly consists of lesions that provide benign histology on core biopsy, but either are known to show heterogeneity or have increased risk of associated malignancy. However, the level of risk is very different for different entities. All the cases should be looked for atypia. The objective of this study is to compare various B3 lesions in two audits, to calculate the median rate and upgrade rates (the rate at which they turn into malignancy on subsequent excision) for different B3 lesions and to compare them with the national standards and published literature. The study aims to see whether vacuum assisted excision or surgical excision has been done in such lesions. Methods: This is a retrospective study and encompasses two audits done in 2017-18 and 2020-21 at Queen's hospital, Barking, Havering and Redbridge NHS trust. A total of 4478 cases were reviewed and 206 cases were graded as B3 on core biopsy. Results: Overall, 113 cases were graded as B3 in 2020-21 and 93 cases in 2017-18 giving the median rate of 5% and the overall upgrade rate of 12%. Intraductal papilloma was the most commonly seen lesion in both audits. Also, 31 cases underwent vacuum assisted excision and 62 cases underwent surgical excision, with 38 cases not undergoing further excision. Conclusion: The median rate was within the 'preferred median rate'- 4.5-8.5% and the upgrade rate was comparable (16.57%) with those of National Breast Cancer screening audit, 2016-2019. The type of excision for various lesions was in line with the criteria stated by the Royal College of Pathologists. The lesions which were not excised did not turn into malignancy on follow-up.

COMPARISON OF SEVERITY AND CLINICAL OUTCOMES OF PATIENTS WITH COVID-19 FROM MULTIETHNIC BACKGROUNDS IN A TERTIARY CARE CENTER

TYPE: Abstract TOPIC: Chest Infections PURPOSE: To evaluate association between severity of COVID-19 infection in hospitalised patients belonging to different ethnic backgrounds. METHODS: Retrospective analysis of 728 COVID-19 affected patients admitted to King George Hospital and Queens Hospital between April 2020 and March 2021. Ethnic groups included were White (British), Asian, Black, White (Other) and others. Admission chest X-ray was classified as mild (score less than 6), moderate (between 7 and 12) and severe (more than 13) using a semiquantitative severity score. Rates of admission to intensive care unit, modes of respiratory support required and mortality were also compared between the groups. RESULTS: Of the 728 patients admitted, White (British) constituted 51% of total patients. X-ray data was unavailable for 9% (n=51). Severe X-ray scores was found in 12% of White (British) and 15% of patients from other ethnic background (p=0.24), whereas moderate scores were seen in 33% and 39% respectively (p=0.07). ITU admission was required in 11% of white (British) compared to 20% from other ethnicities (p=0.001). Continuous positive airway pressure (CPAP) was required for 21% vs 26% (p=0.12) and mechanical ventilation for 5% vs 10% (p=0.013) of White (British) and other ethnicities respectively. Proportion of death was more in White (British) as compared to other ethnicities (12% vs 5%; p=0.001). CONCLUSIONS: There was no significant difference in chest X-ray severity amongst COVID-19 patients from different ethnic backgrounds. Requirement of mechanical ventilation and ITU admissions were significantly more among non-whites, whereas mortality was more in White (British). CLINICAL IMPLICATIONS: Ethnicity did not have a substantial prognostic factor in Covid-19 survival. DISCLOSURE: Nothing to declare. KEYWORD: Continuous positive airway pressure -CPAP, MV- mechanical ventilation, ITU- intensive therapy unit

Anti-hyperglycemic Medication Compliance: A Quality Assurance Project.

In order to determine the prevalence of adherence among diabetes patients treated at Queens Hospital Center's Diabetes Clinic and to determine barriers preventing adherence, 50 patients were asked a series of questions regarding their medication intake. The majority of patients reported that they understood the self-management steps that were necessary in order to control their diabetes. However, 30% of the interviewed patients with type 1 or type 2 diabetes reported that they missed a dose of their diabetes medication on at least one day in the last month. Forgetting and lifestyle inconveniences were the two most frequently reported reasons for non-adherence. Side effects and problems with the pharmacy or insurance were also significant reasons for non-adherence. Adherence can potentially be increased by combining new forms of treatment and increasing educational reinforcement.

COVID-19 and Neurologic Manifestations: An Experience at Major New York City Hospitals.

Introduction: The exact incidence of neurologic manifestations in coronavirus disease 2019 (COVID-19) patients is not clear. The New York City Hospital system has been severely affected by the COVID-19 pandemic between December 2019 and 202. A large number of patients were treated at these centers. This study aims to investigate the incidence of such neurologic manifestations. Secondly, we wanted to find out if there is a correlation between comorbidities and neurologic manifestations in patients with COVID-19.Methodology: A retrospective analysis of 5,455 Electronic Medical Records of patients with a positive polymerase chain reaction (PCR) result admitted to Elmhurst Hospital, Queens Hospital Center, Jacobi Medical Center, and North Central Bronx Hospitals, four of the 11 teaching hospitals in the NYCHH (New York Health + Hospitals) between 3-1-2020 to 8-31-2020 was carried out. Comprehensive data were collected using medical documentation in five categories: demographic details, comorbidities, symptoms, laboratory findings, and radiologic examinations. All neurologic manifestation keywords were provided to the statisticians by two trained and board-certified physiatrists. Neurologic manifestations were categorized into central nervous system (CNS) manifestations and peripheral nervous system (PNS) manifestations.Results; Out of the 5,455 patients, 285 patients (5.2%) had central nervous system manifestations, a prevalence in people older than 50, and had a high incidence of comorbidities. We found increased D-dimer and high C reactive protein levels. Our findings agree with two of the three authors with significant case volume.

AD-LAST! An interdisciplinary clinical workshop to improve cultural and spiritual awareness in advance care planning skills.

Clinicians report training deficits in advance care planning (ACP), including limits to their understanding of cultural/spiritual influences on patient decision-making and skills in interdisciplinary teamwork. This study describes Advance Directives-Live Action Simulation Training (AD-LAST), an interdisciplinary experiential and didactic training program for discussing ACP and end-of-life (EOL) care. AD-LAST highlights cultural/spiritual variations in medical decision-making. Prospective educational cohort study with pre-post intervention survey. AD-LAST incorporated standard curricular tools for didactic and experiential training in ACP/EOL communication. Study conducted in an urban community teaching hospital in Queens, NY, one of the most diverse counties in the USA. Participants included physicians, house staff, nurses, therapists, and other disciplines. AD-LAST format was a one-day workshop. The morning focused on didactic teaching using widely available curricular tools. The afternoon involved experiential practice with standardized patient-actors. Pre-post intervention questionnaires assessed ACP operational knowledge and self-efficacy (i.e., self-confidence in skills) in ACP and EOL communication. Repeated measure ANOVAs evaluated changes from pretest to posttest in knowledge and self-efficacy. A total of 163 clinical staff participated in 21 AD-LAST training sessions between August 2015 and January 2019. Participants displayed a significant increase from pretest to posttest in total knowledge (p < 0.001), ACP procedural knowledge (p < 0.001), ACP communication/relationships knowledge (p < 0.001), and self-efficacy (p < 0.001). Knowledge and self-efficacy were not correlated and represented independent outcomes. Postprogram evaluations showed greater than 96% of participants were highly satisfied with AD-LAST, especially the opportunity to practice skills in real-time and receive feedback from members of other professional groups. AD-LAST, a multifaceted training program deployed in an interdisciplinary setting, is effective for increasing ACP knowledge and self-efficacy, including the capacity to address cultural/spiritual concerns. The use of standard tools facilitates dissemination. The use of case simulations reinforces learning.

Superficial placement of endotracheal tubes associated with unplanned extubation: A case-control study.

Unplanned extubations (UEs) refer to the inadvertent removal of endotracheal tubes (ETTs). Superficially placed ETTs anecdotally increases the risk of UEs. This study aims to assess the impact of ETT position as well as other factors that could be associated with risk of UEs. A retrospective case-control study was conducted at NewYork-Presbyterian Queens Hospital from January 2017 to February 2020. All adults admitted to intensive care units (ICUs) who received mechanical ventilation (MV) through ETTs were screened to identify UEs. For each case with UE, two controls with planned extubation were identified. A multivariate logistic regression was conducted to identify risk factors associated with UEs. 1100 patients received MV through ETTs during the time period. The incidence of UE was 4.9%. 53 patients with UEs and 106 patients with planned extubation were included for statistical analysis. Overall, patients with UE had higher in-hospital mortality rates (26.4% versus 11.3%, P=0.02) and reintubation rates (28.3% versus 6.6%, P<0.001). Within the UE group, patients who required reintubation had significantly higher in-hospital mortality rates than those who did not require reintubation (53.3% versus 15.8%, P=0.005). Multivariate logistic regression showed higher APACHE II scores (Odds ratios (OR) 1.07; 95% Confidence interval (CI), 1 to 1.13), distance of ETT tips to carina ≥6cm (OR 6.41; 95% CI, 1.1 to 37.3), physical restraint use (OR 2.98; 95% CI, 1.28 to 6.95) and continuous infusions of sedatives and/or analgesics (OR 10.72, 95% CI, 4.19 to 27.43) were associated with UE. UE and the need for reintubation is associated with worse outcomes. Distance of ETT tips to carina ≥6cm may be associated with higher risks of UE. Further prospective studies are needed to establish the optimal position of ETT to prevent UE.

Abstract 74: Area Deprivation Index, Stroke Outcomes, And Structural Changes To Improve Access To Thrombectomy

Introduction: In New York City (NYC), expanding the reach of thrombectomy-capable stroke centers (TSC) is key to combating socioeconomic disparities in stroke care. The Area Deprivation Index (ADI), a validated, neighborhood-level composite measure (scored 1-100) that includes income, education, employment, and housing quality, has informed healthcare delivery but has not been used to identify disadvantaged neighborhoods with poor access to stroke care. We sought to evaluate the impact of establishing Mount Sinai Queens Hospital (MSQ) as a TSC in 2017 on transfer times and to explore the association between ADI and stroke care access. Methods: Thrombectomy patient pick-up addresses were obtained through Emergency Medical Services runsheets from June 2016 to July 2021 and matched to census-tract level ADI scores from Neighborhood Atlas. Preliminary analyses compared both ADIs and time to stroke care access in both Queens and Manhattan. The primary outcome measure was the duration between ambulance arrival and groin puncture. Simple linear regression and T-tests were used to assess the association between ADI and time to groin puncture by borough. Results: Among 517 cases between 2016-2021, the average ADI of pick-up locations was 10.35 (range: 1 - 70.5). Across all centers, higher ADI (greater deprivation) was significantly associated with increased time to groin puncture (p = 0.024). Notably, Queens patients were picked up in census tracts with higher ADI (p=0.0289) but had a faster pick up to groin puncture time (p=0.006). Conclusions: Across urban census tracts, a higher ADI was associated with delays in access to thrombectomy. Thrombectomy centers in areas with higher ADI can play a role in reducing healthcare disparities for stroke patients.

Abstract 10796: Patient and Clinician Perspectives of Decision Quality Surrounding Atrial Fibrillation Ablation: A Mixed-Methods Study

Introduction: Catheter ablation is a common treatment for atrial fibrillation (AF) with nuanced risks and benefits. Shared decision-making (SDM) could guide the decision to undergo ablation based on patient values and goals of care. Understanding whether and how SDM about ablation is conducted in clinical practice would allow us to determine how to optimize patient decision making and decision quality. The objective of this study was to investigate decision quality and SDM practices surrounding AF ablation. Methods: We conducted a mixed-methods study guided by Sepucha &amp; Scholl’s (2014) SDM framework which specifies decision antecedents, processes, and outcomes. We recruited a convenience sample of AF ablation patients (n=15) and clinicians (n=5; 3 MDs, 1 PA, 1 NP) from a hospital in Queens, New York. Patients completed the AF Symptom Survey (AFSS), Controls-Preferences scale (CPS), and Decisional Conflict scale (DCS), which were summarized using descriptive statistics (median, interquartile range [IQR], and frequency). Patients and clinicians completed semi-structured interviews, which were analyzed using directed content analysis. Participants received $25 as compensation. The Weill Cornell Medicine IRB approved this study. Results: Patients’ median age was 71.0 years (IQR 69.0-78.5), 27% were female, 67% were White, and 73% spoke English. The median AFSS score was 0 (IQR 0-1.0) out of 35 indicating low symptom burden post-ablation. The median DCS score was 7.0 (IQR 0-16.4) out of 100 indicating low levels of conflict. On the CPS 4 patients (27%) preferred to have some control in decision-making; the remainder preferred to share control or relinquish it to clinicians. Qualitative findings underscore low levels of decisional conflict but limited patient agency (Table) . Conclusion: Findings suggest opportunities to improve decision quality surrounding AF ablation by bolstering patient agency, possibly through educational materials and decision aids.

Outcomes of COVID-19 Admissions in the New York City Public Health System and Variations by Hospitals and Boroughs During the Initial Pandemic Response.

Introduction: In the initial pandemic regional differences may have existed in COVID-19 hospitalizations and patient outcomes in New York City. Whether these patterns were present in public hospitals is unknown. The aim of this brief study was to investigate COVID-19 hospitalizations and outcomes in the public health system during the initial pandemic response.Methods: A retrospective review was conducted on COVID-19 admissions in New York City public hospitals during the exponential phase of the pandemic. All data were collected from an integrated electronic medical records system (Epic Health Systems, Verona, WI). Overall, 5,422 patients with at least one admission each for COVID-19 were reviewed, with a study of demographic characteristics (including age, gender, race, BMI), pregnancy status, comorbidities, facility activity, and outcomes. Data related to hospitalization and mortality trends were also collected from City of New York website. These data often involved more than one facility and/or service line resulting in more location or treatment facility counts than patients due to utilization of services at more than one location and transfers between locations and facilities.Results: Higher mortality was associated with increasing age with the highest death rate (51.9%) noted in the age group >75 years (OR 7.88, 95%CI 6.32–10.08). Comorbidities with higher mortality included diabetes (OR 1.5, 95% CI 1.33–1.70), hypertension (OR 1.62, 95% CI 1.44–1.83), cardiovascular conditions (OR 1.66, 95% CI 1.47–1.87), COPD (OR 1.86, 95% CI 1.39–2.50). It was deduced that 20% of all New York City COVID-19 positive admissions were in public health system during this timeframe. A high proportion of admissions (21.26%) and deaths (19.93%) were at Elmhurst Hospital in Queens. Bellevue and Metropolitan Hospitals had the lowest number of deaths, both in borough of Manhattan. Mortality in public hospitals in Brooklyn was 29.9%, Queens 28.1%, Manhattan 20.4%.Conclusion: Significant variations existed in COVID-19 hospitalizations and outcomes in the public health system in New York City during the initial pandemic. Although outcomes are worse with older age and those with comorbidities, variations in hospitals and boroughs outside of Manhattan are targets to investigate and strategize efforts.