Emergency general surgery transfer to lower acuity facility: The role of right-sizing care in EGS regionalization

Emergency general surgery transfer to lower acuity facility: The role of right-sizing care in EGS regionalization

When we think about regionalization of care, particularly in the setting of trauma, we often think about triage being done from a lower to a higher tier center. Today on the show we are joined by Dr. Maria Baimas-George to hear about the benefits of doing things the other way round. Dr. Baimas-George is currently a PGY 4 categorical general surgery resident at Carolinas Medical Center Atrium Health in Charlotte, North Carolina. She has been very active from a research and publication standpoint, and her recent paper, ‘Emergency general surgery transfer to lower acuity facility: The role of right-sizing care in EGS regionalization’ was selected as the best of EGS paper for the JTACS 2022 January edition. In this paper, Dr. Baimas-George evaluates a 16-month experience of a five-surgeon team triaging EGS patients at Carolinas Medical Center, a tertiary care, Level I trauma center to an affiliated community hospital 1.3 miles away. In this episode, we hear about how this practice evolved at CMC and the role COVID played as well as the benefits it has yielded in terms of expedited patient care, resource capacity, and more. Key Points From This Episode: * An intro to Dr. Baimas-George, her education, residency, and research contributions. * How Dr. Baimas-George came up with her triage program and the role COVID played. * Why Dr. Baimas-George’s transfer program was a good use of resources. * The short transfer times that have been achieved and how this was accomplished. * Criteria used to triage patients from the ER in virtual consultations. * Determining whether performing Surgery will be faster at CMC or Mercy. * Whether there were issues of inappropriate transfer or under/over-triaging. * Other key outcomes measured such as cost, operative minutes, and bed day savings. * Opening up space for more complex surgeries at the main hospital by shuttling less acute cases to the community hospital. * Other benefits such as solving care discontinuity, faster disposition, and more.

Evaluation and Management of Traumatic Pneumothorax: A Western Trauma Association Critical Decisions Algorithm with Dr. Marc deMoya

Joining us today is Dr. Marc de Moya, Professor and Chief of the Division of Trauma and Acute Care Surgery with the Depart- ment of Surgery at the Medical College of Wisconsin. Marc completed his general surgery resi- dency at St. Barnabas Medical Center in Livingston, New Jersey, followed by a fellowship in trauma and critical care surgery at the University of Miami Jackson Memorial Ryder Trauma Center. He also performed a K30 Career Research Development Grant through the Clinical Sci- entist Training Program and holds numerous local, regional, as well as national leadership and administrative positions on all of our key surgical societies. Marc is a great mentor, colleague, and leader in surgery who contributes regularly to the scientific literature, as evidenced by his publication record, which boasts well over 220 peer-reviewed articles, one of which is the topic of today’s conversation: ‘Evaluation and management of traumatic pneumothorax: A Western Trauma Association critical decisions algorithm’. Tuning in, you’ll learn the 35-millimeter rule for measuring pneumothoraces, the role of pre-procedural antibiotics in preventing infection, and some rules of thumbs to help you define physiologic instability, as as well as insight into hemothoraces, the use of ketamine, the safety of post-pull pneumo chest x-rays, and more! Make sure not to miss today’s insightful conversation with Dr. Marc de Moya!   Key Points From This Episode: * Find out how Dr. de Moya first became interested in this topic and went on to develop an al- gorithm with the Western Trauma Association (WTA). * Learn more about what he calls the 35-millimeter rule for measuring pneumothoraces. * Some insight into Dr. de Moya’s approach when it comes to chest tube drainage. * Dr. de Moya reflects on the failure rate of the 35-millimeter rule: between 5 and 10 percent. * Blunt versus penetrating trauma and how they relate to the location of the bronchial injury. * How to make pneumothorax measurements in a chest X-ray or CT scan. * Why Dr. de Moya believes that pre-procedural antibiotics are key to preventing infection. * Defining physiologic instability and what rules of thumb you can apply in your practice. * Nuances to this algorithm, including when to follow-up on pneumothoraces. * Dr. de Moya shares his view on the evolving role of ultrasound to quantify pneumothoraces. * Autotransfusions and hemothoraces, ketamine, post-pull pneumo chest x-rays, and more!

Interview with the Editor-in-Chief, Dr. Raul Coimbra

In this episode, Dr. Raul Coimbra shares with us his vision for the the Journal of Trauma & Acute Care Surgery.

Episode 0 - The JTACS Podcast Trailer

Welcome to the JTACS Podcast! Your source for current, up-to-date, and clinically relevant information on hot topics across the spectrum of basic science, trauma, EGS, and surgical critical care. Tune in every 2nd and 4th Friday for interviews with authors of the "Best of" series of papers.