ABSTRACT
INTRODUCTION: Same day discharge (SDD) for colorectal surgery shows increasing promise in the era of enhanced recovery after surgery protocols and minimally invasive surgery. It has become increasingly relevant due to constraints of the COVID-19 pandemic. This study aims to identify the patient cost, institutional charges, net margin revenue, and contribution margins associated with SDD, and analyze financial benefits when compared with admission. METHOD(S): Retrospective review of colectomy performed at a single institution over a 2-year period assessed for clinical outcomes, cost, charges, and revenue. The data was divided between 2 populations, SDD and postoperative day 1 (POD1) discharge. In addition to financial data, other outcomes included readmission, complication, and operative time. RESULT(S): There was a statistically significant difference favoring SDD over POD1 discharge in average: operating time (p = 0.00036), direct cost (p = 0.00000001), and charges (p = 0.00007711). SDD average patient cost were $9,186 USD compared with $11,698 USD for POD 1, and average hospital charges for SDD were $84,038 vs $97,566 for POD 1. Average net revenue was expectedly lower in SDD, $21,471, when compared with POD1, $26,719, however when comparing contribution margins (SDD $12,285 v POD1 $15,021), there was no statistically significant difference, p = 0.212. There were no statistically significant differences in readmission or operative complication between populations. CONCLUSION(S): Amidst pandemic-related resource constraints, we found that SDD was associated with lower patient cost and comparable contribution margin, without a significant difference in readmission and operative complication when compared with POD1 discharge.
ABSTRACT
Intro/Background: In 2019, our department created an Assistant Chair for Faculty Development position with the purpose of working with the Chair to establish a culture fully engaging all faculty and their tremendous, diverse talents and to maintain a rewarding and engaging workplace. From this collaboration, a departmental faculty development (FDC) committee was established. Purpose/Objective: The FDC mission is to foster faculty morale and promote professional growth at all career levels through: (1) amplification and recognition of faculty accomplishments by seeking and responding to award opportunities;(2) facilitation of skill building for teaching, mentorship, and leadership development in various niches and divisions;and (3) equipping faculty to publish and disseminate their innovations and scholarly work. Methods: An 8-member committee representing assignments in operations, research and education, at all ranks, and all clinical sites was formed (4 women, 4 men;1 professor, 4 associate professors, 3 assistant professors). The FDC meets monthly to discuss faculty needs previously identified through survey and issues raised ad hoc. The committee serves as a nomination letter-writing bureau for local and national award opportunities. It also identifies diverse candidates for appointments to hospital and university committees. Outcomes (if available): In the first year, we held 10 monthly meetings and produced a departmental website with faculty development resources. Micro-lectures on university-assigned mentorship, promotion and tenure, resident evaluations, and faculty ultrasound skills training were delivered in faculty meetings. We introduced a new annual faculty retreat model. Faculty received twelve international, national and university awards in 2020. The FDC managed submissions for university and hospital-wide committee appointments. A planned 2-day mentoring skills workshop was postponed for COVID-19. Summary: While many institutions focus on faculty development from a global perspective, our program is novel in that it is structured at the department, level addressing the unique challenges and opportunities encountered by Emergency Medicine faculty. A website with resources under the following headings was produced: “Annual evaluation, CV, Promotion,” “Mentorship and Coaching,” “Scholarly Productivity and Publications,” “Required CME,” “Faculty Awards,” and “Time Management Resources.” We coordinate faculty mentorship and coaching with assigned mentors, annual reviews and planned workshops to improve mentor/mentee relationships and skills. We coordinate with departmental research committees to identify and respond to faculty research needs. Utilizing a new faculty retreat model, we transitioned from a traditional business-meeting format to a new FDC-moderated small-group working agenda focusing on important topics in scholarly productivity, onboarding of new faculty, education, clinical practice and operations. Faculty reviewed prompts and met with departmental leadership to brainstorm solutions to departmental challenges. Working points were summarized and action items reviewed with all faculty in the next departmental meeting. These action items outline a departmental faculty development agenda for the year ahead. Informal faculty feedback responses are positive about the new format for faculty retreats, the delivered micro-lectures on faculty development and annual evaluation and mentorship meetings. Future evaluation of the committee could focus on faculty engagement with FDC initiatives and metrics related to scholarly outputs.