Effects of a Labor Dispute on a Hospital-Based Helicopter Air Ambulance Service's Volume and Destinations.

OBJECTIVE: In the United States, there are few unionized hospitals with air medical transport agencies. When labor disputes and strikes occur, information about the effect on helicopter air ambulances and critical care ground transport services is limited. For this study, a helicopter air ambulance and critical care ground transport agency's volume of transports was examined before, during, and after a strike and compared with volumes from the prior year. METHODS: This was a retrospective, descriptive comparative review of a unionized hospital's air ambulance and critical care mobile ground transport service records from March 28 to July 22, 2018 (control year, 872 transports) and March 28 to July 22, 2019 (strike year, 863 transports). RESULTS: Compared with the prior year, during the strike period alone, the volume of flight transports remained stable; however, there was a significant 31% loss in transports for time-critical diseases including trauma, stroke, and myocardial infarction. CONCLUSION: The unionized helicopter air ambulance experienced little change in overall volume, but there was a statistically and financially significant decline in flight transports for patients with time-critical diseases. When preparing for labor disputes, potential declines in the transportation of this population type should be considered, and future studies should look at patient and requesting agency preferences during strikes.

Initial distribution of COVID-19 vaccines to front-line hospital workers and community first responders-A prospective descriptive study.

As one of the initial ten sites in Ohio designated to receive and distribute the first COVID-19 vaccines in December 2020, we initiated a self-reported IRB-approved research survey to describe the demographics, side-effects, and missed work time experienced by front-line health care workers in an urban tertiary care center and a rural regional hospital. First responders from both the urban and rural surrounding communities were also included in the initial Tier 1A vaccine distribution. The primary outcome measure was to identify the most frequently experienced side effects from the Pfizer and Moderna vaccines, based on type of vaccine, first or second dose, age, gender, race and occupation. The secondary outcome measure was to document the total number of work shifts missed after receiving the vaccine. Of interest to health care risk managers, the survey identified the most common side effects and resulting missed time from work broken down by type of vaccine and first or second dose. This information will be helpful for those institutions who have not yet vaccinated a majority of their work force, employees who still need their second dose, and for strategic scheduling of employees when booster doses become available later in the year.

Retrospective analysis of small intracranial hemorrhage in trauma: Is acute care surgery team management alone safe?

Background: The Brain Injury Guidelines (BIG) provide a validated framework for categorizing patients with small intracranial haemorrhages (ICH) who could be managed by acute care surgery without neurosurgical consultation or repeat head computed tomography in the absence of neurological deterioration. This replication study retrospectively applied BIG criteria to ICH subjects and only included BIG1 and BIG2 subjects.Methods: The trauma registry was queried from 2014 to 2019 for subjects with a traumatic ICH <1 cm, Glasgow Coma Scale score of 14/15 and not on anticoagulation therapy. Patients were then categorized under BIG 1 or BIG2 and outcomes were evaluated.Results: Two hundred fourteen subjects were reviewed (88 BIG1 and 126 BIG2). Twenty-three subjects had worse repeat imaging, but only one had worsening exam that resolved spontaneously. None required neurosurgical intervention. One died of non-neurological causes.Conclusions: Retrospective analysis supported our hypothesis that patients categorized as BIG1 or BIG2 could have been safely managed by acute care surgeons without neurosurgical consultation or repeat head imaging. A review of minor worsening on repeat imaging without changes in neurological exams and no need for neurosurgical interventions supports this evidence-based approach to the management of small intracranial haemorrhages.

The impact of clinical crisis management on trauma team outcomes following a prolonged strike by nursing, technical, and support staff.

There is a paucity of literature describing the preparation of hospital institutions prior to a nursing strike and the quality outcomes during and after a prolonged nursing strike. No published study was found describing the effects of a prolonged strike on quality outcomes specific to trauma patients. The American College of Surgeons (ACS) suggests specific critiques and complications data that each trauma program may choose to track as quality indicators, and those metrics are submitted to regional, state and national databanks and closely examined during site accreditations. This research study analyzed data from three equal time periods following a multiservices strike involving both nurses and service/technical staff lasting 63 days. The purposes of this study were to (1) evaluate the effects of prestrike organizational leadership and crisis management planning on organizational staffing and emergency management to reduce health care risk during the strike, (2) describe outcomes data from three equal time periods: prestrike, strike, and poststrike, and (3) specifically compare the trauma program's selected ACS trauma metrics for critiques and complication rates for our high-risk/high-volume population as a level 1 trauma center.

Testing of estradiol in a compounded cream and a stock solution.

Potency testing (i.e., analysis of the concentration of the active ingredient) is an important part of the quality-control process for compounded preparations. However, concerns about the reliability and interpretation of potency testing results have been raised by compounding professionals. Standards detailed in United States Pharmacopeia Chapter 795 allow nonsterile preparations to be within 90% to 110% of the theoretical calculated and labeled quantity of active ingredient. Variability among independent testing laboratories could have significant implications for interpretaion of whether a compounded preparation meets these standards. The primary goal of this study was to characterize the variability among analytical testing laboratories when analyzing the potency of a nonsterile, compounded hormone cream (specifically, estradiol) and an estradiol stock solution used to compound the cream. Blinded to the theoretical concentration of the active ingredient, three analytical testing labs were sent samples and asked to determine the concentration and the percent potency in the samples. The stock solution samples were sent after the results for the cream were received. All three labs found the hormone cream to be within the acceptable Unied States Pharmacopeia range of 90% to 110%. Percent potency ranged from 95% to 103.1%, with an average of 98.5% +/- 4.2%. All labs also found the stock solution to be within acceptable United States Pharmacopeia range. The labs found an average of 6.21 +/- 0.24 mg/mL estradiol. The average difference between the lab and the theoretical concentration was 0.21 +/- 0.24 mg/mL. Percent potency ranged from 100% to 107.8%, with an average of 103.4% +/- 4.0%. This study found a variability of about 4% among labs when analyzing the same nonsterile compounded estradiol homrone cream. The magnitude of these variations was consistent when estradiol was combined with other ingredients in a compounded cream and when it was analyzed as a stock solution. Between-lab variability must be considered when interpreting whether a pharmacy's compounded preparation is within the United States Pharmacopeia potency critera.