Lessons Learned in the Transformation of a Multispecialty Medical Group to a Management Services Organization Supporting Multiple Service Lines

A three-year growth of 30% in the number of providers within our health system's multispecialty medical group, Centra Medical Group (CMG), was associated with increasing operational costs, redundancies and inefficiencies of unfocused incentivized production, and poor alignment around population-based healthcare2 to support the Quadruple Aim.3 Service lines (SLs) of clinical care that are patientfocused and efficient have been proposed as a method to meet these rapidly changing goals of combined clinical value and cost-efficient care. Operational support of these SLs needs to be consistent, effective, and include many elements of the multispecialty medical group that can now be better described as a management services organization (MSO).4,5 Such dramatic changes in healthcare require leaders6 with insight, courage, and clinical acumen who have empathy with the patient and the patient care delivery team. Self-governance of the SLs by way of the SL Council reporting to senior leaders and not the CMG emerged from the Executive Clinical Enterprise Medical Leaders Forum (ECEMLF) in Period II, facilitated by COVID-19 (Table 1;Self Governance). In February 2020, the ECEMLF recommended to the CEO and senior leaders that elective procedures be discontinued and that critical care areas be shifted to COVID-19 areas well before this action became a national trend (Table 1;Self-Governance).

Emergency Operation in Dr Wahidin Sudirohusodo and Hasanuddin University Hospital during the COVID-19 Pandemic

BACKGROUND: In December 2019, the world was shocked by a respiratory infectious disease caused by the novel coronavirus which was later referred to as COVID-19. This virus is transmitted from human to human very quickly through droplets, aerosols, and direct contact with COVID-19 patients. One of the health services suspected of playing a role in the spread of this virus is surgery. Surgical procedures involve much medical personnel and direct contact with patients causes surgery to be considered. In addition, surgery is also prone to causing nosocomial infections because generally post-operative patients have an increased inflammatory process and decreased immune response. In contrast to elective surgery, emergency surgery has a higher risk of post-operative morbidity and mortality than elective surgery because of the limited time to prepare and assess the patient. AIM: To find out the number of positive cases of COVID-19 after emergency surgery at our institution. METHODS: The type of research conducted is descriptive where this study uses secondary data in the form of medical records of post-operative emergency patients who meet the inclusion and exclusion criteria. RESULTS: A total of 741 medical records were obtained, with 691 of them being COVID-19 negative and 50 being COVID-19 positive. CONCLUSION: We found 93.3% of negative post-operative COVID-19 cases and 6.7% of positive post-operative COVID-19 cases in patients underwent emergency surgery procedures.

Consent for orthopaedic trauma surgery during the COVID-19 Pandemic

Surgical services have been hugely disrupted by COVID-19 and have had to evolve rapidly in response. The best practice for consent mandates that risks associated with surgical treatment during a pandemic be discussed. This study aimed to assess whether patients undergoing orthopaedic operations were being consented for the risk of contacting COVID-19 and ITU care. All orthopaedic consent forms from four-week periods in March, June and July were reviewed. Measures such as staff education were implemented after the second cycle. Of consent forms for 37 operations performed in March, only 1 mentioned the risk of contracting COVID-19 and zero mentioned ITU. During June, 89 consent forms were reviewed, 32 mentioned COVID-19 and 10 discussed ITU admission. Following educational measures, the third cycle showed a significant improvement as of 100 consent form records available for review, 73 included risk of COVID-19 whilst 26 mentioned ITU. The results show that earlier in the pandemic, surgeons at our centre were not counselling patients regarding COVID-19. This improved slightly between the first and second cycles, likely reflecting increased awareness of the nosocomial transmission of COVID-19. Educational measures contributed to a significant improvement in the third cycle. Planned interventions include use of electronic consent forms which incorporate COVID-19 infection and associated risks.

Diagnostic Salivary Tests for SARS-CoV-2.

The diagnosis of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection relies on the detection of viral RNA by real-time reverse transcription polymerase chain reaction (rRT-PCR) performed with respiratory specimens, especially nasopharyngeal swabs. However, this procedure requires specialized medical personnel, centralized laboratory facilities, and time to provide results (from several hours up to 1 d). In addition, there is a non-negligible risk of viral transmission for the operator who performs the procedure. For these reasons, several studies have suggested the use of other body fluids, including saliva, for the detection of SARS-CoV-2. The use of saliva as a diagnostic specimen has numerous advantages: it is easily self-collected by the patient with almost no discomfort, it does not require specialized health care personnel for its management, and it reduces the risks for the operator. In the past few months, several scientific papers, media, and companies have announced the development of new salivary tests to detect SARS-CoV-2 infection. Posterior oropharyngeal saliva should be distinguished from oral saliva, since the former is a part of respiratory secretions, while the latter is produced by the salivary glands, which are outside the respiratory tract. Saliva can be analyzed through standard (rRT-PCR) or rapid molecular biology tests (direct rRT-PCR without extraction), although, in a hospital setting, these procedures may be performed only in addition to nasopharyngeal swabs to minimize the incidence of false-negative results. Conversely, the promising role of saliva in the diagnosis of SARS-CoV-2 infection is highlighted by the emergence of point-of-care technologies and, most important, point-of-need devices. Indeed, these devices can be directly used in workplaces, airports, schools, cinemas, and shopping centers. An example is the recently described Rapid Salivary Test, an antigen test based on the lateral flow assay, which detects the presence of the virus by identifying the spike protein in the saliva within a few minutes.