Shorter Wait Times Research Articles

Hemolyzed Blood Samples in the Emergency Department - Finding Our “Why”

When patients present to the emergency department, they expect strong communication from the hospital staff and short wait times and to be treated with empathy and compassion.1,2 Patients commonly present during a time of high stress and uncertainty, so addressing these areas of patient care as well as other areas that invoke patient harm have remained a focus for ED leaders: one area for improvement of ED care that has not received as much attention as its potential warrants is the hemolysis of blood samples.

Early Experience With Full-scope Shared-care Teleglaucoma in Canada.

Large Canadian full-scope, shared-care teleglaucoma facilitates efficient management and diversion of medically stable patients away from overburdened subspecialty clinics while allowing patients the convenience of shorter travel, shorter wait time, and continuity with one provider. This report shares Care1 protocol, early patient characteristics, and quality data. This paper describes early experience with Care1, a large full-scope, shared-care teleglaucoma program. Optometrists located in high-demand locations saw patients in-person, acquired clinical history, performed a physical examination, organized diagnostic testing, then uploaded data to a proprietary online platform where they were able to collaborate with participating ophthalmologists to make plans for patient care. The Care1 database was queried for all patients with a diagnosis of glaucoma or glaucoma suspect seen between February 2016 and March 2017. Clinical characteristics like diagnosis, ocular medication history, best-corrected visual acuity, intraocular pressure, cup-to-disc ratios, optical coherence tomography imaging results, and central corneal thickness were collected. Quality metrics studied included rates of referral to an in-person ophthalmologist and consistency of cup-to-disc assessments between in-person optometrists and remote ophthalmologists. A total of 4070 patients received care at a Care1 teleophthalmology site in 2 provinces for glaucoma assessment from February 2016 to March 2017. The population was 55.1% female, and the average age was 57.8 years. Overall, 97.3% of patients had a best-corrected visual acuity between 20/20 and 20/40 and 3.3% had an intraocular pressure >26. An in-person consultation with an ophthalmologist was recommended for 1.9% of patients. Early experience with this full-scope, shared-care teleglaucoma program in Canada indicates it is a convenient, collaborative model of care for glaucoma suspects, and medically stable glaucoma patients.

Association of eConsult Implementation With Access to Specialist Care in a Large Urban Safety-Net System.

Accessing specialty care continues to be a persistent problem for patients who use safety-net health systems. To address this access barrier, hospital systems have begun to implement electronic referral systems using eConsults, which allow clinicians to submit referral requests to specialty clinics electronically and enable specialty reviewers to resolve referrals, if appropriate, through electronic dialogue without an in-person visit. Measure the effect of implementing an eConsult program on access to specialty care. Using an interrupted time series design with data from 2016 to 2020, this study analyzed 50 260 referral requests submitted during the year before and the year after eConsult implementation at 19 New York City Health + Hospitals (NYC H+H) specialty clinics that spanned 7 NYC H+H hospital facilities and 6 unique specialties. Referral request was submitted to a specialty clinic in the year following eConsult implementation. Main outcomes included the fraction of referral requests resolved without an in-person visit following eConsult implementation; and, among requests triaged to have an in-person visit, the fraction of referrals with a successfully scheduled appointment, mean wait time to a specialty appointment, and the fraction of referral requests with a completed specialty visit. Changes associated with eConsult implementation were estimated using multivariate linear regression adjusting for patient age, gender, and specialty clinic fixed effects. Across 19 NYC H+H specialty clinics, 26 731 referral requests were submitted in the year before and 23 529 referrals were submitted in the year after eConsult implementation. Following eConsult implementation, 13% of all requests were resolved electronically. Among requests requiring a follow-up visit, the fraction with an appointment successfully scheduled increased by 15.8%, from 66.5% to 82.3% (P < .001). The mean time to an appointment decreased from 61.0 days pre-eConsult to 54.1 days post-eConsult, an adjusted 8.2-day shorter wait time (or 13.3% reduction) following eConsult adoption (P < .001). The percentage of referrals with a completed follow-up visit with a specialist within 90 days of the request did not change (38.4% vs 37.9%, P = .07). Changes in outcomes were mitigated during months when most clinics underwent an electronic health record transition after implementing eConsult. In this quality improvement study, implementation of eConsults at a large multi-specialty safety-net system was associated with improvements in appointment scheduling rates and wait times. Despite an additional electronic health record transition, eConsults are a promising health care delivery tool for increasing access to specialty care.

Shorter outpatient wait-times for buprenorphine are associated with linkage to care post-hospital discharge

BackgroundInpatient addiction consult services (ACS) lower barriers to accessing medications for opioid use disorder (MOUD), however not every patient recommended for MOUD links to outpatient care. We hypothesized that fewer days between discharge date and outpatient appointment date was associated with improved linkage to buprenorphine treatment among patients evaluated by an ACS. MethodsWe extracted appointment and demographic data from electronic medical records and conducted retrospective chart review of adults diagnosed with opioid use disorder (OUD) evaluated by an ACS in Boston, MA between July 2015 and August 2017. These patients were initiated on or recommended buprenorphine treatment on discharge and provided follow-up appointment at our hospital post-discharge. Multivariable logistic regression assessed whether arrival to the appointment post-discharge was associated with shorter wait-times (0−1 vs. 2+ days). ResultsIn total, 142 patients were included. Among patients who had wait-times of 0−1 day, 63 % arrived to their appointment compared to wait-times of 2 or more days (42 %). There were no significant differences between groups based on age, gender, distance of residence from the hospital, insurance status, co-occurring alcohol use disorder diagnosis, or discharge with buprenorphine prescription. After adjusting for covariates, patients with 0−1 day of wait-time had 2.6 times the odds of arriving to their appointment [95 % CI 1.3–5.5] compared to patients who had 2+ days of wait-time. ConclusionFor hospitalized patients with OUD evaluated for initiating MOUD, same- and next-day appointments are associated with increased odds of linkage to outpatient MOUD care post-discharge compared to waiting two or more days.

Mismatch in Supply and Demand for Neuro-Ophthalmic Care.

Previous research suggests the number of neuro-ophthalmologists in the United States may be below a level that provides sufficient access to neuro-ophthalmic care in much of the United States. However, national estimates of the amount of clinical time spent on neuro-ophthalmology are lacking. The North American Neuro-Ophthalmology Society administered a survey on professional time allocation to its active members. Survey response was 95%. The survey characterized the hours each week each respondent allocated to overall work, clinical work, clinical work in ophthalmology/neurology, and clinical work in neuro-ophthalmology specifically. The survey additionally collected information regarding demographics, current wait times to be seen for new patients, and the difference in clinical time spent in neuro-ophthalmology spent between the current day compared with that shortly after completing clinical training. Linear regression was used to identify potential relationships between the above and average wait time. On average, responding physicians spent 70% of their clinical time on neuro-ophthalmology. In 6 states, there were no reported practicing neuro-ophthalmologists, and in only 8 states was the clinical full-time equivalent to population ratio below the suggested threshold of 1 for every 1.2 million. The median wait time for a new patient was 6 weeks. This wait time was associated with the fraction of clinical time spent in neuro-ophthalmology (0.2 weeks longer wait for a 10 percentage point increase in the fraction of time spent in neuro-ophthalmology; P = 0.02), and suggestively associated with training (training in ophthalmology was associated with 1.0 week shorter wait time; P = 0.06). The survey suggests that neuro-ophthalmologists are unable to see patients in a timely manner and a decreasing number of clinicians are entering the field. Future interventions should be considered to incentivize neuro-ophthalmology training in ophthalmology and neurology residents such that the United States population is able to appropriately access neuro-ophthalmic care.

Very Temporary Mechanical Support Prior to Heart Transplant: Post-Transplant Outcomes as Status 1-2 versus 3-6 in the Setting of Short Wait Times

<h3>Purpose</h3> With the introduction of the new heart allocation system, controversy persists over the potential negative impact of the use of temporary mechanical support (tMCS) prior to heart transplant (HT). However, the risks of tMCS may be mitigated in the setting of short wait times. <h3>Methods</h3> All patients with HT at a single institution from 10/20/18 - 10/26/20. Patients were categorized as tMCS (Status 1-2) or controls (Status 3-6). Multiorgan transplants were excluded. <h3>Results</h3> A total of 126 patients were included and received HT: Status 1 - 9 (7.1%), Status 2 - 45 (35.7%), Status 3 - 40 (31.8%), Status 4 - 19 (15.08%), Status 5 - 0, Status 6 13 (10.3%). Therefore, the tMCS group (Status 1-2) had 54 patients (43%) and the controls (Status 3-6) 72 patients (57%). Baseline characteristics were not different for groups: mean age 53 years, 80% male, and 54% white. Blood groups were not different: A 36%, B 15%, AB 5%, O 44%. Donor race was not different between groups and was 59% white. For tMCS compared to controls, donors were more likely to be male 82% v. 60%, p=0.009 and were younger 31 v. 37 years, p=0.008. Overall median time from listing to transplant was 9 days. The median time from listing to transplant for Status 1 was 5 days, Status 2 was 6.5 days, Status 3 was 16.5 days and Status 4-6 was 26 days. One-year survival was excellent and not significantly different for tMCS compared to controls, 97.7% v. 91.5%, p=0.18 (Figure 1). <h3>Conclusion</h3> The new heart allocation system prioritizes patients with tMCS and in the setting of short waiting times, there may be less exposure to the risks of tMCS. With a median time to HT of less than one week for tMCS, the one-year survival for patients supported with tMCS is excellent and not significantly different from those who are Status 3-6.

Bladder and Bowel Dysfunction Network: Improving the Management of Pediatric Bladder and Bowel Dysfunction.

We distributed a survey to pediatricians, and those interested attended training consisting of lectures and clinical shadowing. Patients referred to a hospital pediatric urology clinic were triaged to the BBDN and completed the dysfunctional voiding symptom score and satisfaction surveys at baseline and follow-up. The Bristol stool chart was used to assess constipation. Results were compared between BBDN and hospital clinic patients. Surveyed pediatricians (n = 100) most commonly managed BBD with PEG3350 and dietary changes and were less likely to recommend bladder retraining strategies. Baseline characteristics were similar in BBDN (n = 100) and hospital clinic patients (n = 23). Both groups had similar improvements in dysfunctional voiding symptom score from baseline to follow-up (10.1 ± 4.2 to 5.6 ± 3.3, P = 0.01, versus 10.1 ± 4.2 to 7.8 ± 4.5, P = 0.02). BBDN patients waited less time for their follow-up visit with 56 (28-70) days versus 94.5 (85-109) days for hospital clinic patients (P < 0.001). Both groups demonstrated high familial satisfaction. Community pediatricians may require more knowledge of management strategies for BBD. Our pilot study demonstrates that implementing a BBDN is feasible, results in shorter wait times, and similar improvement in symptoms and patient satisfaction than a hospital pediatric urology clinic.

The Impact of Referral Source on Voice Therapy

Adherence to voice therapy is essential in achieving successful voice outcomes. Previous studies within the field of voice therapy have suggested that shorter wait times and utilization of an interprofessional practice (IPP) model of care have a positive effect on voice therapy completion rates. While the implementation of IPP has gained popularity, especially at academic voice centers, the majority of speech-language pathologists (SLP) practice in a traditional (T) setting where they are unaffiliated with the referring otolaryngologist. This study aims to further examine how SLP practice models (interprofessional vs traditional) affect voice therapy initiation and completion rates. The secondary aim is to determine if voice therapy attendance rates have changed since the authors' initial investigations over 10 years ago. A retrospective chart review of 452 patients was conducted. Data was collected on patient demographics (sex, age), diagnosis, severity of dysphonia (CAPE-V), quality of life impact (V-RQOL raw score), practice setting (IPP vs T), date of referral, date of voice therapy initial evaluation, number of therapy sessions completed, and attendance to therapy sessions defined as completion or dropout. Initiation of voice therapy treatment was the point in the referral process that was most impacted by practice model. Over half (53%) of referrals to voice therapy in a traditional practice model did not lead to initiation of treatment, while only 23% of the referrals taking place in an IPP model failed to initiate (P < 0.001). This study also demonstrated an improving, but continued rate of noninitiation and dropout from voice therapy when compared to data that was collected 10 years prior.

Launching a Statewide COVID-19 Primary Care Hotline and Telemedicine Service.

Oregon Health & Science University's primary care team envisioned and implemented the COVID-19 Connected Care Center, a statewide telephone "hotline" service. The hotline has taken more than 5825 calls from patients in 33 of Oregon's 36 counties in less than 3 months. In preliminary survey data, 86% of patients said their questions were answered during the call, 90% would recommend this service, and 70% reported a reduction in stress levels about coronavirus. In qualitative interviews, patients reported their questions answered, short wait times, nurses spent time as needed, and appropriate follow-up was arranged. Academic health centers may have the capacity to leverage their extensive resources to rapidly launch a multiphased pandemic response that meets peoples' need for information and access to primary care, while minimizing risk of infection and emergency department use and rapidly supporting primary care teams to make the necessary operational changes to do the same in their communities. Such efforts require external funding in a fee-for-service payment model.

Factors that infertile couples from mainland China may take into consideration for cross-border reproductive care – A cross-sectional questionnaire study

ObjectiveCross-border reproductive care (CBRC) has become popular in the world, including mainland China. We designed a questionnaire and aimed to determine the main factors that infertile couples from mainland China may consider for CBRC. Materials and methodsIn this cross-sectional questionnaire-based study, we retrospectively analyzed the data from questionnaires collected at the Reproductive Center of Beijing BaoDao Obstetrics and Gynecology Hospital from January 2018 to June 2018. The questionnaire contained 38 items that belonged to six different categories (environment and equipment, service quality, patient safety, medical quality, information acquisition channel and overseas medical services). The item scores for each factor were calculated and then weighted using principal component analysis. ResultsA total of 297 infertile couples were identified. Most of the infertile women were aged 31–35 years, were married 1–3 years, and had a bachelor's degree. In the weighted factor analysis, “clean outpatient clinic and medical equipment” had the highest weight in the dimension of environment and equipment. The item with the highest weight in the dimension of service quality was “wait time for examination”. In the dimension of patient safety, “health education on medication and surgery by counselors” had the highest weight. The item with the highest weight in the dimension of medical quality was “fee charged for ART treatment”. The items with the three highest weights in the dimension of information acquisition channel were “other (seminar, exhibition, dissertation …)”, “introduction from friends and relatives”, and “telephone inquiry”. In the dimension of overseas medical services, the two items with the highest weights were “cultural similarities” and “language similarities”. ConclusionFor CBRC, infertile couples from mainland China may take following significant factors into consideration: a high success rate and inexpensive treatment, cultural and linguistic familiarity, high-quality service and short wait time.

Perspectives on pharmacy access to hormonal contraception among rural New Mexico women

ObjectiveIn 2017, New Mexico approved an amendment allowing pharmacists to prescribe and dispense hormonal contraception. We interviewed rural New Mexico women to determine their perceptions of pharmacy access to hormonal contraception. Study designWe conducted semi-structured telephone interviews with women recruited from rural New Mexico communities. The interview guide explained the amendment followed by questions about the advantages and disadvantages of pharmacy access to hormonal contraception within rural communities. ResultsBetween November 2017 and May 2018, we recruited 32 women to participate. Participants were young (26/32 18–29 years old), gravid (27/31), employed (30/32), white (22/32) and Hispanic (26/31). The majority used Medicaid as their primary insurance (16/28). Most participants were supportive of pharmacy access to hormonal contraception. Participants saw their rural communities as facing health care barriers, some of which could be alleviated by pharmacy access. Perceived benefits of pharmacy access included convenience of pharmacy hours, shorter wait times, and no need for an appointment. Participants expressed concerns about lack of privacy in their pharmacies. Many expressed trust in their pharmacist to review side effects and explain usage of contraception- a role that was considered separate from that of a primary care provider who offers regular medical visits for routine screening and nuanced or complex discussions about contraception. Some participants expressed that pharmacy access could be especially beneficial for teens. ConclusionsRural New Mexico women were supportive of pharmacy access to contraception and accept pharmacists as trusted members of the health care team. ImplicationsRural New Mexico women find benefit in pharmacy access to hormonal contraception, citing improved access to contraceptives in their communities.

Online Ratings of Primary Care Physicians: Comparison of Gender, Training, and Specialty.

The purpose of this study was to explore patient perceptions of primary care providers and their offices relative to their physician’s philosophy (medical degree [MD] vs doctorate in osteopathic medicine [DO]), specialty (internal medicine vs family medicine), US region, and gender (male vs female). Using the Healthgrades website, the average satisfaction rating for the physician, office parameters, and wait time were collected and analyzed for 1267 physicians. We found female doctors tended to have lower ratings in the Midwest, and staff friendliness of female physicians were rated lower in the northwest. In the northeast, male and female MDs were rated more highly than DOs. Wait times varied regionally, with northeast and northwest regions having the shortest wait times. Overall satisfaction was generally high for most physicians. Regional differences in perception of a physician based on gender or degree may have roots in local culture, including proximity to a DO school, comfort with female physicians, and expectations for waiting times.

Chinese PhD Students’ Perceptions of Predatory Journals: A Survey Study

This study investigates the attitudes of Chinese PhD students toward predatory journals. Data were gathered using an online questionnaire to which 332 Chinese PhD students responded. Our main conclusions are 1) in the sciences, technology, and medicine, respondents frequently confused predatory journals with open access journals; 2) in the humanities and social sciences, the respondents identified only Chinese-language (not English-language) journals as predatory and made a number of misidentifications; and 3) most respondents indicated that they would not submit papers to predatory journals, mainly because doing so would hurt their reputation, yet the minority who were willing to do so mentioned easy acceptance and a short wait time for publication as the top reasons for considering it.

Abstract 15673: Racial Disparities in Referral for Pre-operative Cardiovascular Evaluation, Surgical Wait Time, and Weight Loss in Patients Undergoing Bariatric Surgery

Introduction: White patients undergo bariatric surgery more frequently and with fewer complications compared to non-white patients. Yet, racial disparities in referral pattern for preoperative cardiovascular evaluation (CVE) are unexplored. We hypothesized that racial disparities exist in preoperative CVE in white vs. non-white patients undergoing bariatric surgery. Methods: We identified consecutive patients undergoing bariatric surgery at our institution from 2014-2018. The association of white vs. non-white race with referral for CVE, cardiac testing, surgical wait time, and postoperative weight loss was determined in a multivariate model adjusting for baseline demographic comorbidities and income. Additional adjustment for insurance provider was made for surgical wait time. Results: Of the 797 patients undergoing bariatric surgery during the study period, 86% (n=682) were non-white. White vs. non-white patients had similar age, gender distribution, and prevalence of hypertension, hyperlipidemia, Type 2 diabetes, and heart failure. A similar proportion of whites vs. non-whites were referred to cardiology for pre-operative evaluation (65% vs. 68%, p=0.52), while whites were more likely to undergo further preoperative cardiac testing after adjustment (68% vs. 55%, p=0.04; adjusted, OR 0.6, 95%CI 0.35-1.0, p=0.05). Despite less cardiac testing, non-white patients referred to cardiology waited longer for surgery (9.9 months vs. 12.1 months, p=0.008), including after adjustment (HR 0.7, 95%CI 0.53-0.91, p= 0.008. Weight loss at 6 months was higher in whites (12.9 kg/m 2 vs. 11.95 kg/m 2 , p=0.03), but equivalent at 1 year (whites 14.9 kg/m 2 vs. non-whites 14.3 kg/m 2 , p=0.33). Conclusions: In a bariatric surgery population, white vs. non-white patients were referred for CVE in similar proportion. However, white patients underwent more subsequent cardiac testing pre-operatively when compared to non-whites yet had a shorter wait time for surgery. Early weight loss was greater in whites, but equivalent between groups at 1 year.

The impact of integrating electronic referral within a musculoskeletal model of care on wait time to receive orthopedic care in Ontario

An MSK model of care for hip and knee patients integrated with an electronic referral solution (eReferral) has been deployed within four subregions across Ontario. Referrals are sent from primary care offices to a central intake (CI), where the referral forms are reviewed and forwarded, if appropriate, to a rapid access clinic (RAC) where patients are assessed by an advanced practice clinician (APC). The pragmatic design of eReferral allows for a seamless flow of electronic orthopedic referrals from primary care to CI. It also enables CI to process and transcribe faxed referrals into the eReferral system for a smooth flow of data electronically to the RACs. In general, wait time is the time interval between receiving the patient’s referral at CI or the surgeon’s office until receiving the orthopedic surgeon's first consultation. Wait time is further broken down into wait 1 a and wait 1 b. Wait 1 a is the time between the receipt of the referral at CI until the date of the first initial assessment at the RAC. This study aimed at: a) assessing the processing time of orthopedic referrals at central intakes (CI) to be forwarded to the RAC, b) assessing the wait time (wait 1 a) of orthopedic referrals processed through the eReferral system to receive an initial assessment at the RACs. c) comparing the ability of the RACs to meet the target wait time for assessment (four weeks) by the method of referral (eReferrals vs. fax). d) evaluating patients’ satisfaction with the length of time they waited to receive care at the RACs with eReferral. We used Ocean eReferral database to access MSK hip and knee referral data processed through the system. Patients whose referrals were initiated electronically through the system and opted to receive email notification of their referral status had the opportunity to take an online satisfaction survey embedded in the booked appointment notification message. There were 1,723 patients initially referred electronically for hip, and knee pain consults, while 13,780 referrals started as paper-based and transcribed into the system to be forwarded later electronically by CI to a RAC. Higher mean processing time at CI by 21.76 days for paper-based referral was detected as opposed to referrals received electronically (p<0.001). RACs took significantly less time to book appointments for referrals initiated electronically with a shorter average wait 1a of 21.42 days for eReferrals compared to paper-based referrals (p<0.001). RACs timeframe to book an appointment was significantly shorter for eReferrals versus fax referrals. A total of 393 patients completed the patient satisfaction survey with a response rate of 16%. Overall, 87.7% were satisfied with their experience with the eReferral process, and 81% agreed that they had waited a reasonable time to receive the needed care. eReferral can elicit faster processing of referrals and shorter wait time for patients, which improved patient satisfaction with the referral process.

Expanding Pharmacy Services for Sustainable Universal Health Coverage: Lessons from the Canadian Health Care System

Japan's health care system can be regarded as one of the best worldwide, provided it remains sustainable. It has relatively low costs, short wait times, low disease incidence, and high life expectancy. However, universal coverage in Japan faces financial challenges due to the country's rapidly aging population. Canada is another of the few developed countries that have universal health coverage. In contrast to Japan, Canada's health care spending is still sustainable according to recent studies. Effective cost control by payers has played a major role, with providers being steered toward evidence-based and cost-effective drug therapies. Furthermore, expanded pharmacy services have been important in suppressing spending on prescription drugs and minor health care services such as vaccination, government-funded smoking cessation, and medication review programs. This article outlines the services provided by Canadian pharmacists with expanded scope of practice. The pharmaceutical profession and its advocacy body in Canada have not only played a role in regulatory changes, but also put in place technological infrastructure called PharmaNet and contributed to appropriate prescribing. Given the current economic situation and demographic trends in Japan, more options should be explored in order to maintain universal health coverage by meeting the funding gap. Utilizing community pharmacies and pharmacists is proposed as one option.

Shorter Wait Times to Cardiac Rehabilitation Associated With Greater Exercise Capacity Improvements

Comprehensive exercise-based cardiac rehabilitation (CR) results in improved, though highly variable, exercise capacity outcomes. Whether modifiable factors such as CR program wait time and session duration are associated with exercise capacity outcomes has not been adequately investigated. Patients with coronary heart disease (±primary and elective percutaneous coronary interventions, cardiac surgery) who participated in CR programs involved in a three-state audit (n = 32 sites) were eligible. Exercise capacity was measured using the 6-min walk test before and after a 6- to 12-wk supervised exercise program. CR program characteristics were also recorded (wait time, number of sessions). Correlations and linear mixed-effects models were used to identify associations between sociodemographic and CR program characteristics and change in exercise capacity. Patients (n = 894) had a mean age of 65.9 ± 11.8 yr, 71% were males, 33% were referred for cardiac surgery, and median wait time was 16 d (interquartile range 9, 26). Exercise capacity improved significantly and clinically (mean increase 70.4 ± 61.8 m). After adjusting for statistically significant factors including younger age (<50 vs ≥80 yr [β = 52.07]), female sex (β = -15.86), exercise capacity at CR entry (β = 0.22) and those nonsignificant (ethnicity, risk factors, and number of sessions), shorter wait time was associated with greater exercise capacity improvement (β = 0.23). This study confirms that greater exercise capacity improvements occur with shorter wait times. Coordinators should prioritize implementing strategies to shorten wait time to optimize the benefits of CR.

Outcomes following liver transplantation in young infants: Data from the SPLIT registry.

Liver transplantation (LT) in young patients is being performed with greater frequency. We hypothesized that objective analysis of pre-, intra-, and postoperative events would help understand contributors to successful outcomes and guide transplant decision processes. We queried SPLIT registry for pediatric transplants between 2011 and 2018. Outcomes were compared for age groups: 0-<3, 3-<6, 6-<12months, and 1-<3years (Groups A, B, C, D respectively) and by weight categories: <5, 5-10, >10kg; 1033 patients were available for analysis. Cholestatic disease and fulminant failure were highest in group A and those <5kg; and biliary atresia in group C (72.8%). Group A had significantly higher life support dependence (34.6%; P<.001), listing as United Network for Organ Sharing status 1a/1b (70.4%; P<.001), and shortest wait times (P<.001). The median (interquartile range) for international normalized ratio and bilirubin were highest in group A (3.0 [2.1-3.9] and 16.7 [6.8-29.7]mg/dL) and those <5kg (2.6 [1.8-3.4] and 13.5 [3.0-28.4]mg/dL). A pediatric end -stage liver disease score ≥40, postoperative hospital stays, rejection, and nonanastomotic biliary strictures were highest in group A with lowest survival at 93.1%. Infants 0 to <3 months and those <5kg need more intensive care with lower survival and higher complications. Importantly, potential LT before reaching status 1a/1b and aggressive postoperative management may positively influence their outcomes.

P68. The impact of spine surgeon training, office wait times, and social media presence on physician review websites

P68. The impact of spine surgeon training, office wait times, and social media presence on physician review websites

PULSATILE PERFUSION IN PEDIATRIC KIDNEY TRANSPLANTATION

Introduction: Pulsatile perfusion of deceased donor kidneys is commonly practiced in adult kidney transplantation. We examined the practice of pulsatile perfusion in pediatric patients undergoing kidney transplantation and compared outcomes from preservation using pulsatile perfusion (PUMP) and static cold storage (COLD) in pediatric recipients. Methods: The UNOS database was used to determine outcomes in all pediatric kidney recipients (<18 years) who were transplanted between 1994—2018. Living donor and multi-organ transplant recipients were excluded. Patients were divided according to preservation method into PUMP or COLD groups. Donor and recipient demographic data were examined, as were survival and outcomes. A p-value of <0.05 was considered to be significant. Results: There were 10,045 pediatric kidney transplants performed during the study period, of which 1,619 were PUMP (16.1%) and 8,426 were COLD (83.9%). PUMP donors were significantly younger (22.7 vs. 23.8 years), had a higher KDPI (22.4% vs. 19.7%), longer cold storage time (18.8 vs. 14.1 hours), more frequent donation after cardiac death (DCD) donor status (12.9% vs. 1.3%), and more likely to be an increased risk of disease (IRD) transmission donor (9.1% vs. 4.8%). PUMP kidneys were also more likely to have been biopsied (18.1% vs. 3.3%). There were no differences in donor creatinine (0.99 vs. 0.96 mg/dL). Recipients of PUMP kidneys were significantly older (12.0 vs. 11.6 years), had a shorter wait time (287.7 vs. 320.2 days), and greater HLA mismatch (4.5 vs. 4.3). There were no differences in BMI, initial or final cPRA, length of stay, or serum creatinine at the time of discharge (1.42 vs. 1.42 mg/dL). No differences in allograft survival at 10 years were noted between PUMP and COLD groups (Figure 1). Additionally, delayed graft function (DGF) occurrence (8.5% vs. 12.5%, p<0.05) and rejection rate in the initial 12 months post transplant (11.5% vs. 13.8%) were significantly lower in the PUMP group compared with the COLD group.Conclusions: Despite multiple unfavorable characteristics noted in PUMP donors, recipients of these kidneys have no difference in allograft survival and have a lower DGF rate. These data support the utilization of pulsatile perfusion during the evaluation of higher risk pediatric kidney donors and a possible role in improving outcomes for pediatric kidney transplantation.