York Hospital Research Articles

Lower Levels of Organizational Commitment among Generation Y and Z Workers within the Scope of Central New York Hospitals and Higher Turnover Rates

Lower Levels of Organizational Commitment among Generation Y and Z Workers within the Scope of Central New York Hospitals and Higher Turnover Rates

Multi-institution analysis of tumor mutational burden and outcomes in pediatric central nervous system tumor patients.

Pediatric central nervous system (CNS) tumors are the leading cause of pediatric cancer mortality. Research addressing genomic biomarkers and clinical outcomes is needed to inform therapeutic decision-making. We conducted a retrospective analysis of pediatric patients (age <21) diagnosed with a primary CNS tumor at four upstate New York hospitals from 2008 to 2021. Clinical and histopathologic data were identified from each patient, including genomic analysis of somatic mutations and tumor mutational burden (TMB) where available. These variables were each compared with overall survival using Cox regression analyses. Multivariable analysis was conducted to identify patient characteristics that may independently predict survival. We identified 119 patients. Common tumor types included low-grade glioma (N=51), high-grade glioma (N=29), and medulloblastoma (N=11). Common driver mutations included TP53 inactivation (N=16), BRAF-KIAA1549 fusion (N=16), FGFR1 amplification (N=12), BRAF V600E mutation (N=12), NF1 loss (N=12), and H3F3A K28M mutation (N=6). Median TMB was one mutation/megabase (mut/Mb, range=0-132). Overall survival was 79.9%. Variables associated with poorer survival on univariable analysis were higher TMB (p=.002, HR 4.97), high-grade tumors (p=.009, HR 84.3), and high-grade glioma histology (p=.021, HR 3.14). Multivariable analyses further identified TMB (p=.011, HR 4.46) and high-grade histology (p=.015, HR 5.28) as independently predictive of worse survival. Tumor progression was more common in high-TMB (N=15, 44%) than in low-TMB tumors (N=19, 35%). High TMB is correlated with higher rates of progression and death as compared to low-TMB tumors. These findings may help identify patients who may benefit from alternative treatments, such as immunotherapies.

1097B: A NOVEL HOSPITAL CAPABILITY MEASURE OUTPERFORMS CASE VOLUME IN EXPLAINING SEPSIS MORTALITY

Introduction: Regionalization of sepsis care could improve sepsis outcomes. There are no validated measures of sepsis capability to guide the identification of hospitals that can best serve sepsis patients. We previously empirically derived Capability-Based (CB) scores based on principal component analysis of several hospital characteristics. We compared the performance of CB scores and case volume as system predictors of mortality among adults with sepsis. Methods: We used the 2018 State Inpatient Databases to identify 90051 adult sepsis encounters at 157 non-federal New York hospitals (derivation cohort), and 130,249 sepsis encounters at 220 hospitals in Florida and Massachusetts (validation cohort). We evaluated the correlation of sepsis volume and each CB score with hospital mortality among non-transferred patients, and with outward sepsis transfer proportions. We fitted linear, nested, predictive models to compare the system predictive abilities of CB scores and sepsis volume in relation to hospital mortality. Results: In the derivation cohort, 83963 (93.2%) patients were non-transferred, of which 20230 (24.1%) died. The mean (range) score was 0 (-3 - +5) with higher scores denoting more capable hospitals. Higher scores were weakly and inversely correlated (spearman’s coefficient [r]: - 0.28) with outward sepsis transfer proportions. Higher scores had weak but better positive correlation with hospital mortality (r: 0.33), than sepsis volume (r: 0.24). The capability scores explained markedly more variation in sepsis mortality (R2 = 0.24, P <.001) than sepsis volume (0.09, P = .01). Predictive mortality models including the capability scores outperformed sepsis volume model (Derivation AUC: 0.53 vs. 0.50; Validation: 0.54 vs. 0.50). A clinical prediction model based on patient characteristics (AUC: 0.76) was not improved by adding sepsis volume or the CB scores (AUC: 0.76). Conclusions: Capability-based hospital scores account for three times more variation in sepsis mortality than sepsis volume and outperform sepsis volume as a system predictor of mortality. With further refinement and validation, these scores may find utility for improving system-based approaches to sepsis care.

254: TELEMEDICINE CRITICAL CARE AVAILABILITY AND OUTCOMES AMONG MECHANICALLY VENTILATED PATIENTS

Introduction: Mechanical ventilation (MV) interventions like low tidal volume ventilation and daily spontaneous awakening and breathing trials are associated with improved survival but are unevenly implemented in real-world practice. Telemedicine Critical Care (TCC) improves adherence to these interventions. Whether or not hospitals with TCC have better MV outcomes than hospitals without TCC is unknown. We evaluated the association of hospital availability of TCC and outcomes among MV patients. Methods: We analyzed 19,679 adult non-surgical, mechanically ventilated patients in an Intensive Care Unit (ICU) in 2018 at 310 non-federal State Inpatient Database hospitals in Florida, Massachusetts, Maryland, and New York. The primary predictor variable was availability of TCC at a study hospital. The primary outcome was mortality defined as hospital death or discharge to hospice. Secondary outcomes were a composite of tracheostomy or re-intubation and duration of mechanical ventilation. We used a two-level hierarchical multivariable logistic regression model to investigate whether TCC availability was associated with study outcomes. Results: Among 19,679 mechanically ventilated patients, 6,177 (31.4%) occurred in TCC hospitals. Compared to non-TCC hospitals, TCC hospitals had reduced but insignificant odds of mortality (odds ratio [OR] 0.97, 95% CI 0.85–1.09), composite of tracheostomy/re-intubation (OR 0.93 [0.78–1.0]), and duration of mechanical ventilation (OR 0.95 [0.85-1.07]). Hospital size and annual mechanical ventilation case volume did not modify the association between TCC availability and mortality (P=0.75 and P=0.44 for interactions, respectively). Conclusions: Hospital availability of TCC was not associated with lower odds of mortality among mechanically ventilated patients.

1876. COVID-19 Reinfection and Disease Severity in the New York City Health + Hospitals System

Abstract Background Though reinfection with SARS-CoV-2 is well documented, there remains uncertainty about the potential for more severe symptoms with reinfections compared to index infections. Methods Patients who received SARS-CoV-2 PCR testing between March 1, 2020 and March 1, 2021 at New York City Health and Hospitals (NYC H+H) facilities and had two positive tests &amp;gt; =90 days apart were included in the analysis. Clinical and demographic data were extracted from the electronic medical record. Manual chart review was done to confirm symptomatology, assess COVID-19 related hospital admissions, and determine WHO disease severity. Patients were then classified as unlikely reinfection, possible reinfection, or probable reinfection based on symptomatology, PCR and antibody testing, and lack of alternative diagnoses. Patients were classified as “unable to be assessed” if symptomatology could not be assessed for both episodes of PCR positivity. Figure 1:Flow chart of selection process for study inclusionFigure 2:Reinfection Classification Results During our study timeframe, 1,255,584 unique patients received at least one SARS-CoV-2 PCR test, 265 of whom had two positive tests &amp;gt; =90 days apart. We categorized 20 patients as unable to be assessed, 28 as unlikely reinfection (1 persistent PCR positivity, 27 unlikely true infection at index or second PCR-positive episode), and 217 as possible or probable reinfection. Of the 217, at their index episode 79 had an asymptomatic infection (36.4%) and 17 were severe or critical (7.8%). At their second episode, 162 patients had an asymptomatic infection (74.7%), and 5 were severe or critical (2.3%). Only 24 patients with possible/probable reinfection had a more severe COVID reinfection than index infection, and 20 of the 24 had asymptomatic index infections. Three patients were hospitalized at both episodes, and two deaths possibly attributable to COVID-19 reinfection were noted in this cohort. Figure 3:Change in WHO disease severity classification from index to second infection among probable/possible reinfection cases (n=217) Red indicates increase in disease severity from index to reinfection (n=24), blue indicates decrease in disease severity from index to reinfection (n=100), white indicates no change (n=74) and gray indicates unable to assess disease severity at index or second infection (n=19). Conclusion COVID-19 reinfection was rare in a high incidence setting among patients tested at NYC H+H facilities. Disease severity was generally milder in reinfection, although severe and critical disease occurred in a small number of patients. These findings from earlier in the pandemic (presumably wild-type and alpha variant) provide data for comparison in understanding how reinfection is evolving with newer variants. Disclosures Carlos Salama, MD, Genentech: Advisor/Consultant Gabriel Cohen, MD, Daybreak Health: Advisor/Consultant|Daybreak Health: Board Member|Daybreak Health: Ownership Interest.

Association of hospital volume with postoperative outcomes in Crohn's disease.

Most patients diagnosed with Crohn's disease (CD) require surgery during their lifetime. While the literature has shown that certain cancer patients have superior postoperative outcomes at high-volume hospitals, there remains a paucity of data on the hospital volume-outcome relationship in CD. Given the complexities in both medical and surgical management, this study aims to determine whether patients with CD have superior postoperative outcomes at high-volume hospitals. A retrospective analysis of patients undergoing abdominal surgery for CD in New York hospitals between 2012 and 2018 was performed using data from the Statewide Planning and Research Cooperation System. Outcomes included postoperative mortality, 30-day readmission and postoperative complications. Using a penalized B-spline plot, high-volume centres were defined as those performing more than 160 abdominal surgeries for CD each year. A total of 13,221 surgeries were performed across 176 hospital centres in New York State. Of these, 73.9% of procedures occurred at low-volume centres. High-volume hospitals had lower in-hospital mortality (0.5% vs. 1.5%; p< 0.001) and 30-day readmission rates (8.3% vs. 10.4%; p< 0.001) than low-volume centres. Major postoperative complications and reoperation rates did not differ by hospital volume. On multivariate analysis, patients at high-volume hospitals had lower odds of in-hospital mortality (OR 0.54, 95% CI 0.38-0.75) and 30-day readmission (OR 0.79, 95%CI 0.64-0.98). Hospital volume remained an independent predictor of 30-day readmission for emergent admissions (OR 0.72, 95% CI 0.61-0.85) and in-hospital mortality for nonemergent admissions (OR 0.39, 95% CI 0.19-0.82). Patients undergoing abdominal surgery for CD have lower odds of postoperative mortality and 30-day readmission when the operation occurs at a high-volume hospital. These findings suggest that surgical patients with CD may benefit from care at specialized centres.

Assessing burnout among Obstetrics & Gynecology residents during night float versus day float in a large academic hospital

BackgroundThe prevalence estimates of burnout among residents vary widely. Resident physicians working overnight have additional stressors and therefore, may be at higher risk of developing burnout.ObjectiveTo determine the rates of burnout among residents working night rotations versus day rotations.MethodsThis is a prospective, cross sectional, survey-based assessment of the prevalence of burnout among Obstetrics and Gynecology (OBGYN) residents on nights versus days rotations conducted at a large academic residency program that spans two separate hospitals in New York. All residents in the residency program were asked to complete the Maslach Burnout Inventory – Human Services Survey for Medical Personnel (MBI-HSS (MP)) after the first rotation of the academic year in 2018, 2019, and 2020. The results for each of the three aspects of the MBI-HSS (MP): emotional exhaustion, depersonalization, and personal accomplishment, were then compared for those on nights versus day rotations using students t-test.ResultsA total of 76 responses were received, 13 from residents on night rotations and 63 from residents on day rotations with a response rate of 61.8%. Comparing resident responses for a night versus day rotation, the residents averaged a low level of emotional exhaustion (a score of 17 ± 9) on day shift, compared to a moderate level of emotional exhaustion (a score of 18 ± 14) on nights (p = 0.37). Similarly, 55.6% of respondents reports low personal accomplishment on days, compared to 76.9% while on nights.ConclusionsEmotional exhaustion scores were lower for residents on daytime rotations (mean score 17, SD 9), compared to those on nights rotations (mean 18, SD 14). Although there was no difference in depersonalization when comparing the day and night shift, 45% of the responses indicated high levels of depersonalization regardless of the type of shift. These results highlight the need to continue efforts to minimize burnout in medical training.

The Medawar Prize Acceptance Speech 2022.

The Medawar Prize Acceptance Speech 2022.

Regional Health System Coordination via a Hospital Association: A Successful Model for Managing Downstate New York's Second COVID-19 Wave.

Based on the experiences and lessons of its first COVID-19 patient surge in spring of 2020 (Wave 1), the New York hospital community recognized the importance of preparation and coordination for the anticipated winter 2020-2021 surge (Wave 2). This case study describes the coordination function of the Greater New York Hospital Association in downstate New York during the second wave, carried out using 4 key elements: enhanced situational awareness coupled with proactive outreach, partnerships between independent hospitals and health systems, frequent coordination meetings with hospitals, and routine coordination meetings with the Governor's Office and the New York State Department of Health. Given the existing relationships, functions, and support structures of hospital associations, this type of collaborative structure between state government and an association can be valuable in any situation that broadly impacts a state's healthcare community.

Rethinking Surge Preparedness After COVID-19: Effective Patient Load Balancing Within Health Systems and Beyond.

Within weeks of New York State's first confirmed case of COVID-19, New York City became the epicenter of the nation's COVID-19 pandemic. With more than 80,000 COVID-19 hospitalizations during the first wave alone, hospitals in downstate New York were forced to adapt existing procedures to manage the surge and care for patients facing a novel disease. Given the unprecedented surge, effective patient load balancing-moving patients from a hospital with diminishing capacity to another hospital within the same health system with relatively greater capacity-became chief among the capabilities required of New York health systems. The Greater New York Hospital Association invited members of downstate New York's 6 largest health systems to talk about how each of their systems evolved their patient load balancing procedures throughout the pandemic. Informed by their insights, experiences, lessons learned, and collaboration, we collectively present a set of consensus recommendations and best practices for patient load balancing at the facility and health system level, which may inform regional approaches to patient load balancing.

Psoas muscle mass index as a predictor of long-term mortality and severity of complications after major intra-abdominal colorectal surgery – A retrospective analysis

Study objectiveDetermine if psoas muscle area measured in routine preoperative computed tomography scans (CT) can be used to identify patients at increased risk of adverse postoperative outcomes after major elective abdominal surgery. DesignRetrospective analysis of data from a single-centre cohort study conducted in York Hospital between the 1st August of 2015 and the 31st of august of 2020. SettingPreoperative clinic. Patients639 patients who attended the preoperative assessment clinic prior to major elective colorectal surgery and had an abdominal CT scan done up to 120 days before surgery. InterventionsNone. MeasurementsPsoas muscle area at the L3 level was measured in preoperative CT scans and normalised to patient height (psoas muscle index). The lowest sex-stratified tertile of psoas muscle index (PMI) was classed as sarcopenic.The primary outcome was 2-year mortality. Secondary outcomes included postoperative complications assessed using Clavien-Dindo graded major and minor complications, comprehensive complication index (CCI), and length of stay. Main resultsMultivariable regression analysis showed that sarcopenia was associated with 2-year mortality (aOR 1.79, 95% CI 1.03–3.10; p = 0.037) and survival at 2-years was significantly reduced in sarcopenic patients (log-rank test, p = 0.012). Sarcopenia was the only statistically significant predictor of major complications in multivariable logistic regression analysis (aOR 1.69, 95% CI 1.04–2.74, p = 0.034) and associated with an estimated increase of 16.6% in the comprehensive complication index (CCI) score of patients that had complications in multivariable linear regression analysis. Sarcopenia was not associated with length of stay. ConclusionsSarcopenia defined by psoas muscle mass is an independent predictor of 2-year mortality, major complications and severity of complications after major colorectal surgery and may be used for preoperative risk assessment.

Abstract 12148: A New Perspective in the Management of Paroxysmal Atrial Fibrillation: Dual Anti-Arrhythmic Medications

Introduction: Atrial fibrillation is the most common disorder of cardiac rhythm, which is often associated with a high risk of morbidity and mortality. Antiarrhythmic medications (AAMs) continue to be the mainstay in the treatment of paroxysmal atrial fibrillation. However, the use of these medications has been limited by their modest anti-arrhythmic efficacy. Hypothesis: We hypothesized that dual AAMs (sodium/potassium channels blockers) improve the chance of maintaining sinus rhythm and decrease the need for catheter ablation when compared to single AAM. Methods: We conducted a retrospective observational study; we reviewed medical records of 150 patients with paroxysmal atrial fibrillation over five years at our hospital in New York. We collected the following data: age, sex, comorbidities, electrocardiogram findings, ejection fraction by echocardiography, classes of AAMs, duration and response to treatments. A successful response was defined as the absence of symptoms and the presence of sinus rhythm on electrocardiogram. A failed response was defined as persistence of symptoms and/or atrial fibrillation on electrocardiogram and the subsequent need for catheter ablation. Results: 86 patients met the inclusion criteria in our analysis. The average age of the patinets was 71.06 years. 45 patients were given the dual AAMs of either amiodarone+flecainide or dronedarone+flecainide, and were treated for an average of 15.4 months. 41 patients received a single AAM then catheter ablation if needed. A chi-square test was performed. X 2 =18.9429, p&lt;.0001. Patients taking dual AAMs were very likely to maintain sinus rhythm and less likely to need catheter ablation (Figure). Conclusions: Our preliminary results demonstrate that patients who receive dual AAMs are significantly less likely to need catheter ablation than those who receive single AAM. Well-designed prospective studies are needed to further explore the use of dual AAM therapy and its clinical impact.

Unexpected ICU Transfer and Mortality in COVID-19 Related to Hospital Volume.

Coronavirus 2019 (COVID-19) illness continues to affect national and global hospital systems, with a particularly high burden to intensive care unit (ICU) beds and resources. It is critical to identify patients who initially do not require ICU resources but subsequently rapidly deteriorate. We investigated patient populations during COVID-19 at times of full or near-full (surge) and non-full (non-surge) hospital capacity to determine the effect on those who may need a higher level of care or deteriorate quickly, defined as requiring a transfer to ICU within 24 hours of admission to a non-ICU level of care, and to provide further knowledge on this high-risk group of patients. This was a retrospective cohort study of a single health system comprising four emergency departments and three tertiary hospitals in New York, NY, across two different time periods (during surge and non-surge inpatient volume times during the COVID-19 pandemic). We queried the electronic health record for all patients admitted to a non-ICU setting with unexpected ICU transfer (UIT) within 24 hours of admission. We then made a comparison between adult patients with confirmed coronavirus 2019 and without during surge and non-surge time periods. During the surge period, there was a total of 86 UITs in a one-month period. Of those, 60 were COVID-19 positive patients who had a mortality rate of 63.3%, and 26 were COVID-19 negative with a 30.8 % mortality rate. During the non-surge period, there was a total of 112 UITs; of those, 24 were COVID-19 positive with a 37.5% mortality rate, and 90 were COVID-19 negative with a 11.1% mortality rate. During the surge, the mortality rate for both COVID-19 positive and COVID-19 negative patients experiencing an unexpected ICU transfer was significantly higher.

Low carbohydrate diet for diabetic cardiomyopathy: Protocol for a randomised controlled trial

Background: Insulin resistance (IR) and type 2 diabetes (T2DM) promote myocardial dysfunction in the absence of traditional cardiovascular risk factors such as hypertension or coronary heart disease. Termed diabetic cardiomyopathy (DMCM), this type of cardiomyopathy often evolves to heart failure (HF), therefore worsening outcomes for people living with T2DM. Low-fat diets (LF) have been recommended for patients with cardiovascular disease but have provided limited symptom relief.Aim: The aim of this research is to examine the effect of a low-carbohydrate (LC) diet compared with usual care (UC) in patients with DMCM. This study hypothesises that the LC diet will improve symptoms of HF and quality of life (QoL) in patients with DMCM.Setting: For this 16-week randomised controlled trial 80 adult patients ( 18 years of age) with T2DM (HbA1c ≥ 6.5) or IR (triglyceride glucose index value [TyG] 4.49) and HF from an outpatient HF clinic in Victoria, Australia were recruited.Methods: Participants will be randomised to a LC or a LF diet (UC) group. The primary outcome is a composite endpoint of changes in New York Heart Association (NYHA) class, hospital admissions, thirst distress and QoL. The secondary endpoint is a 2% change in HbA1c from baseline. Outcomes will be assessed at baseline, week 6 and week 16.Results: This article describes a protocol for a radomised controlled trial (RCT). The results of this trial will be published at the completion of the study.Conclusion: The results from this trial will provide an insight into the future dietary management of DMCM for both patients and healthcare practitioners.

Association of Diagnosed Obstructive Sleep Apnea with Hospitalization and Mortality in a Retrospective New York City COVID-19 Surge Cohort with a Risk Prediction Model

Background: COVID-19 infection is more severe in patients with obstructive sleep apnea (OSA) with unclear modification by risk factors. Additionally, there is no scoring algorithm for probability of admission. Methods: On 8/4/2020 we queried New York City Health and Hospitals system database for patients above 15 years old who tested positive for COVID-19 during the surge. The target was diagnosed OSA. The timeframe was between 3/24/2020 and 6/7/2020 with limited elective hospital admissions. We calculated case-control-matched odds ratios for admission, intubation, and death. Additionally, we introduced a scoring system to predict the probability of admission due to COVID19 infection in the presence of OSA and other comorbidities. Results: Out of 19,593 COVID positive patients 306 (1.6%) had documented OSA. On multivariate analysis, the adjusted odds ratios for patients with OSA were 2.04 (CI 1.32-3.16, p 0.001) for admission, 1.05 (0.73-1.52, p 0.784) for intubation and 1.23 (CI 0.95-1.61, p 0.122) for mortality. After matching and comparing to a randomly selected non-OSA patients, the adjusted odds ratio for the same outcomes were 2.21 (1.41-3.46, p &lt;0.001)-admission, 1.28 (0.83-1.98, p 0.256)-intubation and 1.69 (1.24-2.28, p&lt;0.001)-mortality. Per our developed 11-point scoring algorithm, the risk of admission for these patients is almost 90% when the summation of points is as a low as 4 out of 11. Conclusion: Diagnosis of OSA is associated with hospital admission and mortality in COVID patients. This should be considered during triage and therapy decisions. Presented scoring model for estimated risk of admission could serve as a quantitative tool to estimate risk of admission.

EVALUATION OF LUNG CANCER SCREENING ELIGIBILITY IN A SMOKING CESSATION CLINIC LOCATED IN AN URBAN COMMUNITY: A QUALITY-IMPROVEMENT PROJECT

EVALUATION OF LUNG CANCER SCREENING ELIGIBILITY IN A SMOKING CESSATION CLINIC LOCATED IN AN URBAN COMMUNITY: A QUALITY-IMPROVEMENT PROJECT

358 The Impact of COVID-19 on Diabetic Ketoacidosis Patients

358 The Impact of COVID-19 on Diabetic Ketoacidosis Patients

Determinates of Clostridioides difficile infection (CDI) testing practices among inpatients with diarrhea at selected acute-care hospitals in Rochester, New York, and Atlanta, Georgia, 2020-2021.

We evaluated the impact of test-order frequency per diarrheal episodes on Clostridioides difficile infection (CDI) incidence estimates in a sample of hospitals at 2 CDC Emerging Infections Program (EIP) sites. Observational survey. Inpatients at 5 acute-care hospitals in Rochester, New York, and Atlanta, Georgia, during two 10-workday periods in 2020 and 2021. We calculated diarrhea incidence, testing frequency, and CDI positivity (defined as any positive NAAT test) across strata. Predictors of CDI testing and positivity were assessed using modified Poisson regression. Population estimates of incidence using modified Emerging Infections Program methodology were compared between sites using the Mantel-Hanzel summary rate ratio. Surveillance of 38,365 patient days identified 860 diarrhea cases from 107 patient-care units mapped to 26 unique NHSN defined location types. Incidence of diarrhea was 22.4 of 1,000 patient days (medians, 25.8 for Rochester and 16.2 for Atlanta; P < .01). Similar proportions of diarrhea cases were hospital onset (66%) at both sites. Overall, 35% of patients with diarrhea were tested for CDI, but this differed by site: 21% in Rochester and 49% in Atlanta (P < .01). Regression models identified location type (ie, oncology or critical care) and laxative use predictive of CDI test ordering. Adjusting for these factors, CDI testing was 49% less likely in Rochester than Atlanta (adjusted rate ratio, 0.51; 95% confidence interval [CI], 0.40-0.63). Population estimates in Rochester had a 38% lower incidence of CDI than Atlanta (summary rate ratio, 0.62; 95% CI, 0.54-0.71). Accounting for patient-specific factors that influence CDI test ordering, differences in testing practices between sites remain and likely contribute to regional differences in surveillance estimates.

A quality assurance initiative on improving cefazolin perioperative redose compliance.

Compliance with perioperative antibiotic prophylaxis is crucial for preventing surgical site infection. Anesthesiologists can play a significant role in reducing surgical site infections by following clinical practice guidelines for antibiotic prophylaxis and redosing during surgery. A quality assurance initiative was implemented at a tertiary hospital with the goal of improving cefazolin perioperative antibiotic compliance. This was a retrospective observational study. Main operating room of a tertiary care teaching hospital in New York, USA. Our main operating room includes 22 operating rooms that incorporates surgeries from general surgery, vascular surgery, neurology, gynecology, urology, orthopedics, ear, nose and throat (ENT) etc. All cases in the main operating room from March 1, 2018 to March 31, 2021 that received first dose of Cefazolin and in which the duration of surgery was more than 4 hrs. A multifaceted intervention was initiated to address low compliance with cefazolin redosing. Multifaceted interventions included the development of a perioperative antibiotic guide for anesthesia providers, automated reminders in anesthesia electronic medical records, grand rounds education, survey and email communications, and regular feedback reports to the anesthesia department. Cefazolin perioperative redose compliance rate. Rates of redose compliance were examined in three time periods: preintervention, intervention and postintervention. Cefazolin redosing compliance was 58% in the preintervention period and 90% in the postintervention period. There was a significant positive change in the trend of compliance during the intervention period, indicating that the odds of compliance increased by 13% per month in the intervention period compared to the preintervention period (odds ratio = 1.13, P < 0.001). Redose compliance improvements were sustained a year after the postintervention period (an average of 91%). Surgical site infection rates for colon, coronary artery bypass graft and hip surgeries did not show any significant trend during these time periods. Multifaceted interventions led to significant and sustained improvements in cefazolin redosing compliance in the main operating room of a tertiary hospital.

Assessing the Variability of Antibiotic Management in Patients With Open Hand Fractures Presenting to the Pediatric Emergency Department.

Open hand fractures may be difficult to recognize and treat. There is variability in management and administration of antibiotics for these types of injuries. Unlike open long bone fractures, there is no standardized protocol for antibiotic administration for open hand fractures in children. The objective of this study is to assess the variability of antibiotic management of open hand fractures in children. We performed a retrospective chart review at a tertiary hospital in New York of patients with hand injuries between ages 0 and 18 years presenting to the emergency department during January 2019 and December 2020. Patient encounters were reviewed for open fractures of the hand. Descriptive statistics were included for demographic and physical characteristics. There were 80 encounters with open hand fractures, of which the most common being tuft fractures (77.5%). The mean age was 7.6 years (SD, 4.7 years) with male predominance (58.8%). Crush injuries were the most common mechanism of injury (78.8%). Bedside repair was performed on 62 encounters (77.5%), of which 45 (72.5%) required nail bed repair, 56 (90.3%) required suturing, and 24 (38.7%) required reduction. Antibiotics were given to 62 (77.5%) encounters, most commonly oral cefalexin (45.2%), oral amoxicillin-clavulanic acid (27.4%), and intravenous cefazolin (14.5%). Median time to antibiotics from emergency department registration to administration was 150 minutes (interquartile range, 92-216 minutes). Antibiotic prescriptions were sent for 71 encounters (88.8%). Seventy seven (96.3%) of the encounters were discharged home. Pediatric open hand fractures have a variability of type and timing to antibiotics. Future initiatives should attempt to create standardized guidelines for management of open hand fractures.