Response to rapidly changing healthcare information regarding COVID-19 with virtual journal club

Virtual twice weekly COVID-19 journal club (JC) created to optimize residency and faculty education regarding COVID-19 management, critical appraisal of new literature, and improve departmental collaboration and connection

Limiting Waste: Reducing Urine Culture Testing in Inpatients

To reduce waste and improve antibiotic stewardship, the ABIM Foundation’s Choosing Wisely Campaign and The Infectious Diseases Society of America recommend against screening and treating for suspected urinary tract infections (UTI) unless patients are symptomatic or meet specific clinical parameters. However, ordering a urine culture in patients with no urinary symptoms or appropriate indication is still prevalent. A retrospective chart review in this study on two general medical wards revealed that 60% of urine cultures collected were inappropriate. Reasons included reflexive testing for fever and sepsis workup and lack of clinician awareness of correct indications for testing. This project aimed at reducing the inappropriate collection of urine cultures in asymptomatic patients in the inpatient setting using a multifaceted approach. The Model for Improvement tool was used to develop, test, and implement change. Interventions include implementing a urine culture ordering algorithm, restricting orders in the electronic medical record, front-line provider education, and empowering nurses using existing institutional tools

Thomas Jefferson University Hospital COVID-19 Clinical Questions with EBM Answers

Table of Contents Prognosis, Clinical Characteristics, Clinical Course: Diagnosis Organizational Response Management Reference

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population