Outcomes of COVID-19 With the Mayo Clinic Model of Care and Research.

OBJECTIVE: To report the Mayo Clinic experience with coronavirus disease 2019 (COVID-19) related to patient outcomes. METHODS: We conducted a retrospective chart review of patients with COVID-19 diagnosed between March 1, 2020, and July 31, 2020, at any of the Mayo Clinic sites. We abstracted pertinent comorbid conditions such as age, sex, body mass index, Charlson Comorbidity Index variables, and treatments received. Factors associated with hospitalization and mortality were assessed in univariate and multivariate models. RESULTS: A total of 7891 patients with confirmed COVID-19 infection with research authorization on file received care across the Mayo Clinic sites during the study period. Of these, 7217 patients were adults 18 years or older who were analyzed further. A total of 897 (11.4%) patients required hospitalization, and 354 (4.9%) received care in the intensive care unit (ICU). All hospitalized patients were reviewed by a COVID-19 Treatment Review Panel, and 77.5% (695 of 897) of inpatients received a COVID-19-directed therapy. Overall mortality was 1.2% (94 of 7891), with 7.1% (64 of 897) mortality in hospitalized patients and 11.3% (40 of 354) in patients requiring ICU care. CONCLUSION: Mayo Clinic outcomes of patients with COVID-19 infection in the ICU, hospital, and community compare favorably with those reported nationally. This likely reflects the impact of interprofessional multidisciplinary team evaluation, effective leveraging of clinical trials and available treatments, deployment of remote monitoring tools, and maintenance of adequate operating capacity to not require surge adjustments. These best practices can help guide other health care systems with the continuing response to the COVID-19 pandemic.

Preoperative chlorhexidine shower or bath for prevention of surgical site infection: a meta-analysis.

BACKGROUND: Chlorhexidine showering is frequently recommended as an important preoperative measure to prevent surgical site infection (SSI). However, the efficacy of this approach is uncertain. METHODS: A search of electronic databases was undertaken to identify prospective controlled trials evaluating whole-body preoperative bathing with chlorhexidine versus placebo or no bath for prevention of SSI. Summary risk ratios were calculated using a DerSimonian-Laird random effects model and a Mantel-Haenzel dichotomous effects model. RESULTS: Sixteen trials met inclusion criteria with a total of 17,932 patients: 7,952 patients received a chlorhexidine bath, and 9,980 patients were allocated to various comparator groups. Overall, 6.8% of patients developed SSI in the chlorhexidine group compared with 7.2% of patients in the comparator groups. Chlorhexidine bathing did not significantly reduce overall incidence of SSI when compared with soap, placebo, or no shower or bath (relative risk, 0.90; 95% confidence interval: 0.77-1.05, P = .19). CONCLUSIONS: Meta-analysis of available clinical trials suggests no appreciable benefit of preoperative whole-body chlorhexidine bathing for prevention of SSI. However, most studies omitted details of chlorhexidine application. Better designed trials with a specified duration and frequency of exposure to chlorhexidine are needed to determine whether preoperative whole-body chlorhexidine bathing reduces SSI.

Effect of audit and feedback on improving handovers: a nonrandomized comparative study.

BACKGROUND: High-quality, shift-to-shift handovers by residents are critical to ensuring to patient safety. The 2011 Accreditation Council for Graduate Medical Education duty hour requirements have increased the number of handovers occurring daily, necessitating new approaches to this challenge. Research suggests standardized approaches, electronic systems, and education programs can improve the handover process. METHODS: We conducted a 2-phase, observational study comparing an electronic handover system (experimental) in one clinical setting to a standard card-based system (control) at a second site. Outcome data included an objective assessment of the completeness and accuracy of handovers, and resident assessment of the handover systems. In phase 1, data were recorded at both sites and not shared with residents. In phase 2, data from the experimental system were used to provide standardized feedback to residents on the quality of their handovers. RESULTS: A total of 3184 individual patient sign-outs were evaluated during the 11-month period. Following introduction of a feedback intervention in the experimental arm, errors were present in only 5.2% of handovers, compared with 16.1% of controls (P < .001), and 67% of the 38 residents responding reported they perceived the experimental system as facilitating better patient care. CONCLUSION: Regular, real-time feedback through an electronic handover system can improve the accuracy and completeness of handovers in patient care.