ABSTRACT
The COVID-19 pandemic forced universities to upend their class scheduling. At Clemson University, the administration implemented hybrid schedules for fall 2020, in which students attend classes partly online and partly in person. To limit exposures of COVID-19 in the classroom, we propose two rotational attendance models (the three-cohort model and the once-a-week model) that aim to allow in-person classroom time and minimize exposure between students. In a baseline strategy, students would interact with an average of 84 students per week and attend class in person 2.6 days a week. By contrast, the three-cohort model and once-a-week model achieve about 57 and 83 student interactions per week and 1.6 and 1.9 in-person student attendance days a week, respectively. Although these figures of merit may imply that the three-cohort model is preferable, it achieves its results by forcing about 1,600 of the 21,000 students who want to attend courses in person to participate online instead and forcing courses that meet twice a week to be attended twice in a three-week rotation. Considering the tradeoffs between the figures of merit related to student interaction and anticipated implementation challenges, Clemson University implemented the once-a-week model for fall 2020 and spring 2021.
ABSTRACT
BACKGROUND: Although the need for high-level care persists postdischarge, severely injured trauma survivors have historically poor adherence to follow-up. We hypothesized that a dedicated Center for Trauma Survivorship (CTS) improves follow-up and facilitates postdischarge specialty care. METHODS: A retrospective study of "CTS eligible" trauma patients before (January to December 2017) and after (January to December 2019) creation of the CTS was performed. Patients with an intensive care unit stay ≥2 days or a New Injury Severity Score of ≥16 are CTS eligible. The before (PRE) cohort was followed through December 2018 and the after (CTS) cohort through December 2020. Primary outcome was follow-up within the hospital system exclusive of mental health and rehabilitative therapy appointments. Secondary outcomes include postdischarge surgical procedures and specialty-specific follow-up. RESULTS: There were no significant differences in demographics or hospital duration in the PRE (n = 177) and CTS (n = 119) cohorts. Of the CTS group, 91% presented for outpatient follow-up within the hospital system, compared with 73% in the PRE group (p < 0.001). In the PRE cohort, only 39% were seen by the trauma service compared with 62% in the CTS cohort (p < 0.001). Center for Trauma Survivorship patients also had increased follow-up with other providers (80% vs. 65%; p = 0.006). Notably, 33% of CTS patients had additional surgery compared with only 20% in the PRE group (p = 0.011). Center for Trauma Survivorship patients had more than 20% more outpatient visits (1,280 vs. 1,006 visits). CONCLUSION: Despite the follow-up period for the CTS cohort occurring during the peak of the COVID-19 pandemic, limiting availability of outpatient services, our CTS significantly improved follow-up with trauma providers, as well as with other specialties. The CTS patients also underwent significantly more secondary operations. These data demonstrate that creation of a CTS can improve the postdischarge care of severely injured trauma survivors, allowing for care coordination within the health care system, retaining patients, generating revenue, and providing needed follow-up care. LEVEL OF EVIDENCE: Therapeutic/Care Management; Level IV.