Background The COVID-19 pandemic has caused disruption to healthcare delivery worldwide including in the delivery of surgical services. The introduction of mRNA COVID vaccines and the significant reactogenicity seen with vaccination has caused an unanticipated impact on the operating room workforce via unanticipated paid time off after employee vaccination. Methods A retrospective cross-sectional survey was made available to approximately 33,000 front-line healthcare workers, students and volunteers who were offered voluntary vaccination in a state-wide healthcare system during phase one of the state's vaccine roll-out. The primary study aim was to determine the frequency of unanticipated paid time off, and the secondary study aim was to identify any demographic determinants influencing the need for unanticipated time off work secondary to adverse effects. Results 4009 responses were received, a 12.15% response rate. When looking specifically at individuals who did not proactively schedule themselves for time off after vaccination, we determined that unanticipated paid administrative leave was required for 4.9% and 19.79% of individuals after the first and second doses of vaccine, respectively. The average lengths of absence were 1.66 days and 1.39 days for the first and second doses, respectively. There were no statistically significant differences found in the need for unanticipated leave when compared by vaccine manufacturer, gender, age, ethnicity, or job description. However, individuals with a bachelor's degree demonstrated a significantly higher unanticipated leave requirement than respondents who reported other educational backgrounds. Conclusions The ability to staff operating rooms and other critical healthcare services may be negatively affected as a result of COVID-19 mRNA vaccination reactogenicity and subsequent unanticipated paid administrative leave. For future COVID-19 boosters or during other pandemics in which mRNA vaccination is recommended, employees should proactively schedule their vaccination(s) in conjunction with their work schedules to minimize the impact of reactogenicity and unanticipated time off on the operating room schedule and patient care.
BackgroundThe transition from internship to clinical anesthesiology (CA) training is often difficult given the differences in workflow, procedures, environment, and clinical situations. The primary aims of this study were to determine if a standardized introductory bootcamp could improve clinical knowledge and self-perceived comfort level of new anesthesiology residents in performing common operating room procedures and management of common intraoperative problems. The secondary aim of the study was to see if a standardized bootcamp could be replicated at other programs. MethodsThe introduction to anesthesiology resident bootcamp was developed at one institution in 2015 then expanded to a second program in 2019. The bootcamp was a one-day experience consisting of simulation and task trainers that all rising first-year CA residents (CA-1) participated in during their first month of anesthesiology training. All participating residents were given a survey immediately before and after the bootcamp. The average ratings of the questions were calculated and used as the primary measure. The Anesthesia Knowledge Test (AKT) was used as a surrogate measure of participant knowledge. ResultsFrom 2015 to 2020, a total of 105 residents completed the pre-survey and 109 completed the post-survey across the two sites. The improvement in average rating was significant (Pre: 2.04±0.46 versus Post: 3.09±0.52 p<0.0001). Individual item analysis also showed significant improvement on all of the eight items (p<0.0001). Analyses by site revealed the same results at both average score and item level. There was no significant cohort difference in either p=0.14) or AKT-1 (Control: 41.06±26.42 versus Intervention 41.70±26.60, p=0.90) percentile scores. ConclusionsIncorporation of an introduction to anesthesia bootcamp for new residents significantly improves participant comfort level and is reproducible across institutions. However, it does not improve resident performance on standardized tests.
Alpha-gal allergy, also known as, mammalian meat allergy (MMA) is well described in the Allergy literature, however, the Anesthesiology literature remains soft in supporting recommendations for perioperative management. The goal of the Centers for Disease Control and Prevention (CDC) is to better understand the pathogenesis, signs and symptoms, and prevention of this delayed anaphylactic reaction compared to the rapid onset of most food allergies, especially immunoglobulin E (IgE) mediated allergy. MMA is not limited to dietary beef, bison, goat, pork, lamb, and venison intake alone but includes some perioperative medication formularies containing inactive ingredients such as gelatin, glycerin or stearate; surgical products such as surgical powder, xenografts, and porcine derived heart valve per the manufacturer's specifications. This report will include the brief of 6 patients with alpha-gal allergy who presented during 2018 for elective surgery at a North Carolina community hospital when no patients prior were identified with MMA. The patients described have demonstrated one or more of the several perioperative challenges unique to alpha-gal allergy outlined in this manuscript. Authors have identified eight challenges representing knowledge gaps impacting safe anesthesia care.
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