Becker's Clinical Quality & Infection Control

30 QUALITY IMPROVEMENT & MEASUREMENT Look to physicians' experience with related surgeries when credentialing for rare procedures, study suggests By Gabrielle Masson S urgical experience with related proce- dures could help when setting volume standards for relatively rare operations, and adjusting credentials based on volume could ensure better patient outcomes, a study published in JAMA Network Open found. Researchers examined how outcomes for pancreaticoduodenectomies — or Whip- ples — a relatively uncommon and complex operation, are affected by a surgeon's volume of related procedures. Researchers analyzed Whipple case data from 2012 through 2014 from the all-payer State Inpatient Databases in New York, Florida, Maryland, Wash- ington, Michigan and New Jersey, which included more than 1,000 surgeons and 175,000 patients. e study revealed that surgeons conduct- ing a high volume of related procedures, but relatively few Whipples, had outcomes similar to their colleagues who performed more Whipples. "is study is meant to show that we can do simple things to permit greater flexibility in surgeon-specific credentialing strategies that are intuitive and easy to measure," said study author Kyle Sheetz, MD, a general surgery resident at Ann Arbor-based Uni- versity of Michigan. Surgeons who performed a higher volume of related procedures had better Whipple outcomes, but only if they had conducted enough of those related procedures. e lowest volume surgeons (performing one or two Whipples annually) would have to per- form 27 more related procedures each year to see their Whipple outcomes match those of surgeons conducting 12 or more Whipples per year. e findings suggest hospitals can still pro- vide safe patient outcomes by using flexible credentialing considerations, Dr. Sheetz said in a university news release. "It's good for patients because in theory it expands the number of surgeons who are safe to perform their operations," Dr. Sheetz said. "For surgeons, it makes sense because it reflects their scope of practice." n Scientists find 3 biomarkers that help predict death from COVID-19 By Anuja Vaidya R esearchers identified three biomarkers that can be measured in the blood to help clinicians predict which COVID-19 patients may die, a study published in Nature Machine Intelligence found. For the study, researchers examined a database of blood samples from 485 infected patients in Wuhan, China. They used machine learning tools to pinpoint the biomarkers that can help predict death from COVID-19. They found that lactic dehydrogenase, lymphocyte and high-sensitivity C-reactive protein can all help predict a patient's death. An increase in lactic dehydrogenase is regarded as a common sign of tissue/cell damage, while an increase in high-sensitivity C-reactive protein indicates inflam- mation and is an important marker for poor outcomes in acute respiratory distress syndromes. Low levels of lymphocytes, white blood cells that are one of the main types of immune cells in the body, have been linked to severe COVID-19 disease and death. The biomarkers can help predict death more than 10 days in advance with more than 90 percent accuracy, researchers said. n 1 in 5 COVID-19 patients in NYC hospitals were critically ill By Anuja Vaidya A bout 22 percent of COVID-19 patients admitted to two New York City hospitals were critically ill, and nearly all had at least one chronic illness, a study published in The Lancet found. The study examined the clinical characteristics of critically ill COVID-19 patients admitted to two NewYork-Presbyterian hospitals affiliated with Columbia University Irving Medical Center in New York City from March 2 to April 1. Of the 1,150 COVID-19 patients admitted to both hospitals, 257 (22 percent) were critically ill. Five study findings: 1. The median age of the critically ill patients was 62. 2. Sixty-seven percent were men. 3. Eighty-two percent of the patients had at least one chronic illness — most commonly hypertension (63 per- cent) and diabetes (36 percent). 4. About 46 percent were obese. 5. Seventy-nine percent of the patients received invasive mechanical ventilation for a median of 18 days. 6. The researchers conducted a follow-up April 28, and found 39 percent of the patients had died and 37 percent remained hospitalized. n

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