Changes in the time of COVID-19: a quality improvement initiative to maintain services at a youth sexual health clinic.

OBJECTIVES: Adolescents and young adults (AYAs) face difficulties accessing sexual and reproductive health services. These difficulties were exacerbated for a variety of reasons by the COVID-19 pandemic. We document strategies and outcomes implemented at an urban youth sexual health clinic in Florida that allowed uninterrupted provision of services while protecting against spread of COVID-19. METHODS: The plan-do-study-act (PDSA) model was used to implement COVID-19 interventions designed to allow continued service delivery while protecting the health and safety of staff and patients. This method was applied to clinic operations, community referral systems and community outreach to assess and refine interventions within a quick-paced feedback loop. RESULTS: During the COVID-19 pandemic, changes made via PDSA cycles to clinical/navigation services, health communications and youth outreach/engagement effectively responded to AYA needs. Although overall numbers of youth served decreased, all youth contacting the clinic for services were able to be accommodated. Case finding rates for chlamydia, gonorrhoea, syphilis and HIV were similar to pre-pandemic levels. CONCLUSIONS: Quality improvement PDSA initiatives at AYA sexual health clinics, particularly those for underserved youth, can be used to adapt service delivery when normal operating models are disrupted. The ability for youth sexual health clinics to adapt to a changing healthcare landscape will be crucial in ensuring that under-resourced youth are able to receive needed services and ambitious Ending the HIV Epidemic goals are achieved.

Fracture of tissue dilator in the femoral vein during insertion of temporary dialysis catheter: a stitch in time can save nine.

A 48-year-old man presented to the surgery casualty with 1-day history of broken foreign body during the insertion of dialysis catheter and a failed surgical retrieval. A Doppler ultrasonography of the right groin and lower limb and a noncontrast CT of abdomen and pelvis were performed. Eventhough no intravascular foreign body could be identified on imaging, a decision to re-explore the wound was taken in view of definitive clinical history. A 9.5 cm-long, broken piece of tissue dilator was found inside the right external iliac vein, which was removed through venotomy of the femoral vein. Postoperative recovery was uneventful.