Journal of the American College of Surgeons
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Changes in care providers and hospitals after emergency general surgery (EGS) (care discontinuity) are associated with increased morbidity and mortality. The cause of these worse outcomes is unknown. Our goal was to determine if hospital quality is associated with mortality after readmissions independent of continuity in care. ⋯ Both care discontinuity and hospital quality are independently associated with mortality in EGS patients. These data support maintaining continuity of care, even at low performing hospitals.
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As the coronavirus disease 2019 (COVID-19) pandemic continues to spread, swift actions and preparation are critical for ensuring the best outcomes for patients and providers. We aim to describe our hospital and Department of Surgery's experience in preparing for the COVID-19 pandemic and caring for surgical patients during this unprecedented time. ⋯ By developing an enabling infrastructure, a department can nimbly respond to crises like COVID-19 by promoting trust among colleagues and emphasizing an unwavering commitment to excellent patient care. Sharing principles and practical applications of these changes is important to optimize responses across the country and the world.
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Although physician health promotes retention to the profession and encourages higher-quality patient care, residents can face challenges seeking routine medical care. Erratic working hours, time constraints, easy access to informal health consultation, and a culture of self-reliance can deter help-seeking behavior. Despite national focus on physician burnout and efforts to promote wellness, little is known about the self-care habits of residents. The goal of this study was to evaluate the routine healthcare practices of resident physicians. ⋯ Despite a high prevalence of self-reported depression and prescription medication use, a significant proportion of surveyed resident physicians in New England do not seek mental health resources and lack consistent, routine healthcare. Resident health is vital to the mission of physician well-being and mitigating the escalating problem of burnout. Barriers to self-care and help-seeking behavior should be evaluated to promote sustainable behavior that will encourage a long professional career.
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This article proposes systems for the fair distribution of scarce resources to healthcare providers. It builds on classic ethical structures and adapts them to the equitable distribution of personal protective equipment (PPE) to clinicians at risk of contracting novel corona virus-19 (COVID-19). ⋯ It is recognized that unless the supply of PPE is quickly replenished, or viable alternatives to traditional equipment are devised in the coming days to weeks, hospitals and healthcare systems will face the difficult task of rationing PPE to at-risk clinicians. This paper suggests an ethical framework for that process.