Restructuring a Physician Assistant Department at an Orthopedic Specialty Hospital in Response to the COVID-19 Pandemic.
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ABSTRACT:
SUBMITTER: Grimaldi PW
PROVIDER: S-EPMC7433271 | biostudies-literature | 2020 Nov
REPOSITORIES: biostudies-literature
Publications
Restructuring a Physician Assistant Department at an Orthopedic Specialty Hospital in Response to the COVID-19 Pandemic.
HSS journal : the musculoskeletal journal of Hospital for Special Surgery 20200818 Suppl 1
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Project description:As the world grapples with the COVID-19 pandemic, we as health care professionals thrive to continue to help our patients, and as orthopedic surgeons, this goal is ever more challenging. As part of a major academic tertiary medical center in New York City, the orthopedic department at New York University (NYU) Langone Health has evolved and adapted to meet the challenges of the COVID pandemic. In our report, we will detail the different aspects and actions taken by NYU Langone Health as well as NYU Langone Orthopedic Hospital and the orthopedic department in particular. Among the steps taken, the department has reconfigured its staff's assignments to help both with the institution's efforts and our patients' needs from reassigning operating room nurses to medical COVID floors to having attending surgeons cover urgent care locations. We have reorganized our residency and fellowship rotations and assignments as well as adapting our educational programs to online learning. While constantly evolving to meet the institution's and our patient demands, our leadership starts planning for the return to a new "normal".
| S-EPMC7195373 | biostudies-literature
Project description:BackgroundCOVID-19, the illness caused by the novel coronavirus, SARS-CoV-2, has sickened millions and killed hundreds of thousands as of June 2020. New York City was affected gravely. Our hospital, a specialty orthopedic hospital unaccustomed to large volumes of patients with life-threatening respiratory infections, underwent rapid adaptation to care for COVID-19 patients in response to emergency surge conditions at neighboring hospitals.PurposesWe sought to determine the attributes, pharmacologic and other treatments, and clinical course in the cohort of patients with COVID-19 who were admitted to our hospital at the height of the pandemic in April 2020 in New York City.MethodsWe conducted a retrospective observational cohort study of all patients admitted between April 1 and April 21, 2020, who had a diagnosis of COVID-19. Data were gathered from the electronic health record and by manual chart abstraction.ResultsOf the 148 patients admitted with COVID-19 (mean age, 62 years), ten patients died. There were no deaths among non-critically ill patients transferred from other hospitals, while 26% of those with critical illness died. A subset of COVID-19 patients was admitted for orthopedic and medical conditions other than COVID-19, and some of these patients required intensive care and ventilatory support.ConclusionProfessional and organizational flexibility during pandemic conditions allowed a specialty orthopedic hospital to provide excellent care in a global public health emergency.
| S-EPMC7431310 | biostudies-literature
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| S-EPMC7482371 | biostudies-literature
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| S-EPMC9526134 | biostudies-literature
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| S-EPMC7251625 | biostudies-literature
Project description:BACKGROUND: Limited time and funding are challenges to meeting the research requirement of the orthopedic residency curriculum. OBJECTIVE: We report a reorganized research curriculum that increases research quality and productivity at our academic orthopedic medical center. METHODS: Changes made to the curriculum, which began in 2006 and were fully phased in by 2008, included research milestones for each training year, a built-in support structure, use of an accredited bio-skills laboratory, mentoring by National Institutes of Health-funded scientists, and protected time to engage in required research and prepare scholarly peer-reviewed publications. RESULTS: Total grant funding of resident research increased substantially, from $15,000 in 2007 (8 graduates) to $380,000 in 2010 (9 graduates), and the number of publications also increased. The 12 residents who graduated in 2005 published 16 papers from 2000 to 2006, compared to 84 papers published by the 9 residents who graduated in 2010. The approximate costs per year included $19,000 (0.3 full-time equivalent) for an academic research coordinator; $16,000 for resident travel to professional meetings; reimbursement for 213 faculty hours; and funding for resident salaries while on the research rotation, paid through the general hospital budget. CONCLUSIONS: The number of grants and peer-reviewed publications increased considerably after our residency research curriculum was reorganized to allow dedicated research time and improved mentoring and infrastructure.
| S-EPMC3886466 | biostudies-other
Project description:ObjectiveTo create a roster that eliminated unnecessary cross-staff exposure to ensure the hospital had sufficient staff to run the ED in the event that a group of staff are affected by COVID-19. This roster was aimed at providing staff with 'manageable shift lengths, down-time between shifts, regular breaks and access to refreshments' as dictated by the Victorian Department of Health and Human Services.MethodsCreating six fixed teams in our ED. Teams work blocks of three consecutive days of 12 h shifts, each block alternates between day and night shifts.ResultsWe managed to completely eliminate unnecessary crossover of staff thus reducing risk of having a large part of our workforce incapacitated should any member be affected by COVID.ConclusionA pandemic roster plan to minimise staff exposure from other colleagues during a pandemic was possible. This helps to ensure an adequate workforce in the unfortunate event a staff contracts the disease leading to other close contact staff requiring isolation or succumbing to the same illness.
| S-EPMC8013502 | biostudies-literature
Project description:ImportanceAltruism-putting the patient first-is a fundamental component of physician professionalism. Evidence is lacking about the relationship between physician altruism, care quality, and spending.ObjectiveTo determine whether there is a relationship between physician altruism, measures of quality, and spending, hypothesizing that altruistic physicians have better results.Design, setting, and participantsThis cross-sectional study that used a validated economic experiment to measure altruism was carried out between October 2018 and November 2019 using a nationwide sample of US primary care physicians and cardiologists. Altruism data were linked to 2019 Medicare claims and multivariable regressions were used to examine the relationship between altruism and quality and spending measures. Overall, 250 physicians in 43 medical practices that varied in size, location, and ownership, and 7626 Medicare fee-for-service beneficiaries attributed to the physicians were included. The analysis was conducted from April 2022 to August 2024.ExposurePhysicians completed a widely used modified dictator-game style web-based experiment; based on their responses, they were categorized as more or less altruistic.Main measuresPotentially preventable hospital admissions, potentially preventable emergency department visits, and Medicare spending.ResultsIn all, 1599 beneficiaries (21%) were attributed to the 45 physicians (18%) categorized as altruistic and 6027 patients were attributed to the 205 physicians not categorized as altruistic. Adjusting for patient, physician, and practice characteristics, patients of altruistic physicians had a lower likelihood of any potentially preventable admission (odds ratio [OR], 0.60; 95% CI, 0.38-0.97; P = .03) and any potentially preventable emergency department visit (OR, 0.64; CI, 0.43-0.94; P = .02). Adjusted spending was 9.26% lower (95% CI, -16.24% to -2.27%; P = .01).Conclusions and relevanceThis cross-sectional study found that Medicare patients treated by altruistic physicians had fewer potentially preventable hospitalizations and emergency department visits and lower spending. Policymakers and leaders of hospitals, medical practices, and medical schools may want to consider creating incentives, organizational structures, and cultures that may increase, or at least do not decrease, physician altruism. Further research should seek to identify these and other modifiable factors, such as physician selection and training, that may shape physician altruism. Research could also analyze the relationship between altruism and quality and spending in additional medical practices, specialties, and countries, and use additional measures of quality and of patient experience.
| S-EPMC11581536 | biostudies-literature
Project description:ICUs are increasingly staffed with nurse practitioners/physician assistants (NPs/PAs), but it is unclear how NPs/PAs influence quality of care. We examined the association between NP/PA staffing and in-hospital mortality for patients in the ICU.We used retrospective cohort data from the 2009 to 2010 APACHE (Acute Physiology and Chronic Health Evaluation) clinical information system and an ICU-level survey. We included patients aged ≥ 17 years admitted to one of 29 adult medical and mixed medical/surgical ICUs in 22 US hospitals. Because this survey could not assign NPs/PAs to individual patients, the primary exposure was admission to an ICU where NPs/PAs participated in patient care. The primary outcome was patient-level in-hospital mortality. We used multivariable relative risk regression to examine the effect of NPs/PAs on in-hospital mortality, accounting for differences in case mix, ICU characteristics, and clustering of patients within ICUs. We also examined this relationship in the following subgroups: patients on mechanical ventilation, patients with the highest quartile of Acute Physiology Score (> 55), and ICUs with low-intensity physician staffing and with physician trainees.Twenty-one ICUs (72.4%) reported NP/PA participation in direct patient care. Patients in ICUs with NPs/PAs had lower mean Acute Physiology Scores (42.4 vs 46.7, P < .001) and mechanical ventilation rates (38.8% vs 44.2%, P < .001) than ICUs without NPs/PAs. Unadjusted and risk-adjusted mortality was similar between groups (adjusted relative risk, 1.10; 95% CI, 0.92-1.31). This result was consistent in all examined subgroups.NPs/PAs appear to be a safe adjunct to the ICU team. The findings support NP/PA management of critically ill patients.
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