Browsing by Author "Chia, Matthew C."

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    Managing Central Venous Access during a Healthcare Crisis
    (Elsevier, 2020-07-15) Chun, Tristen T.; Judelson, Dejah R.; Rigberg, David; Lawrence, Peter F.; Cuff, Robert; Shalhub, Sherene; Wohlauer, Max; Abularrage, Christopher J.; Anastasios, Papapetrou; Arya, Shipra; Aulivola, Bernadette; Baldwin, Melissa; Baril, Donald; Bechara, Carlos F.; Beckerman, William E.; Behrendt, Christian-Alexander; Benedetto, Filippo; Bennett, Lisa F.; Charlton-Ouw, Kristofer M.; Chawla, Amit; Chia, Matthew C.; Cho, Sungsin; Choong, Andrew M.T.L.; Chou, Elizabeth L.; Christiana, Anastasiadou; Coscas, Raphael; De Caridi, Giovanni; Ellozy, Sharif; Etkin, Yana; Faries, Peter; Fung, Adrian T.; Gonzalez, Andrew; Griffin, Claire L.; Guidry, London; Gunawansa, Nalaka; Gwertzman, Gary; Han, Daniel K.; Hicks, Caitlin W.; Hinojosa, Carlos A.; Hsiang, York; Ilonzo, Nicole; Jayakumar, Lalithapriya; Joh, Jin Hyun; Johnson, Adam P.; Kabbani, Loay S.; Keller, Melissa R.; Khashram, Manar; Koleilat, Issam; Krueger, Bernard; Kumar, Akshay; Lee, Cheong Jun; Lee, Alice; Levy, Mark M.; Lewis, C. Taylor; Lind, Benjamin; Lopez-Pena, Gabriel; Mohebali, Jahan; Molnar, Robert G.; Morrissey, Nicholas J.; Motaganahalli, Raghu L.; Mouawad, Nicolas J.; Newton, Daniel H.; Ng, Jun Jie; O’Banion, Leigh Ann; Phair, John; Rancic, Zoran; Rao, Ajit; Ray, Hunter M.; Rivera, Aksim G.; Rodriguez, Limael; Sales, Clifford M.; Salzman, Garrett; Sarfati, Mark; Savlania, Ajay; Schanzer, Andres; Sharafuddin, Mel J.; Sheahan, Malachi; Siada, Sammy; Siracuse, Jeffrey J.; Smith, Brigitte K.; Smith, Matthew; Soh, Ina; Sorber, Rebecca; Sundaram, Varuna; Sundick, Scott; Tomita, Tadaki M.; Trinidad, Bradley; Tsai, Shirling; Vouyouka, Ageliki G.; Westin, Gregory G.; Williams, Michael S.; Wren, Sherry M.; Yang, Jane K.; Yi, Jeniann; Zhou, Wei; Zia, Saqib; Woo, Karen; Surgery, School of Medicine
    Introduction During the COVID-19 pandemic, central venous access line teams were implemented at many hospitals throughout the world to provide access for critically ill patients. The objective of this study was to describe the structure, practice patterns and outcomes of these vascular access teams during the COVID-19 pandemic. Methods We conducted a cross sectional, self-reported study of central venous access line teams in hospitals afflicted with the COVID-19 pandemic. In order to participate in the study, hospitals were required to meet one of the following criteria: a) development of a formal plan for a central venous access line team during the pandemic, b) implementation of a central venous access line team during the pandemic, c) placement of central venous access by a designated practice group during the pandemic as part of routine clinical practice, or d) management of an iatrogenic complication related to central venous access in a patient with COVID-19. Results Participants from 60 hospitals in 13 countries contributed data to the study. Central venous line teams were most commonly composed of vascular surgery and general surgery attending physicians and trainees. Twenty sites had 2,657 lines placed by their central venous access line team or designated practice group. During that time, there were 11 (0.4%) iatrogenic complications associated with central venous access procedures performed by the line team or group at those 20 sites. Triple lumen catheters, Cordis® catheters and non-tunneled hemodialysis catheters were the most common types of central venous lines placed by the teams. Eight (14%) sites reported experience placing central venous lines in prone, ventilated patients with COVID-19. A dedicated line cart was used by 35 (59%) of hospitals. Less than 50% (24, 41%) of the participating sites reported managing thrombosed central lines in COVID-patients. Twenty-three of the sites managed 48 iatrogenic complications in patients with COVID-19 (including complications caused by providers outside of the line team or designated practice group). Conclusions Implementation of a dedicated central venous access line team during a pandemic or other healthcare crisis is a way by which physicians trained in central venous access can contribute their expertise to a stressed healthcare system. A line team composed of physicians with vascular skill sets provides relief to resource-constrained ICU, ward, and emergency medicine teams with a low rate of iatrogenic complications relative to historical reports. We recommend that a plan for central venous access line team implementation be in place for future healthcare crises.
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    Prevalence and Risk Factors for Burnout in U.S. Vascular Surgery Trainees
    (Elsevier, 2022) Chia, Matthew C.; Hu, Yue-Yung; Li, Ruojia Debbie; Cheung, Elaine O.; Eng, Joshua S.; Zhan, Tiannan; Sheahan, Malachi G., III; Bilimoria, Karl Y.; Coleman, Dawn M.; Surgery, School of Medicine
    Objective: Burnout and suicidality are known risks for vascular surgeons above other surgical subspecialties, with surgical trainees at risk for exposure to factors that increase burnout. This study aimed to inform initiatives to improve wellness by assessing the prevalence of hazards in vascular training (mistreatment, duty-hour violations) and the rates of wellness outcomes (burnout, thoughts of attrition/specialty change/suicide). We hypothesized that mistreatment and duty-hour violations would predispose trainees to increased burnout. Methods: We performed a cross-sectional study of residents and fellows enrolled in accredited United States vascular surgery training programs using a voluntary, confidential survey administered during the 2020 Vascular Surgery In-Training Examination. The primary outcome assessed was burnout symptoms reported on a weekly basis or more frequently. The rates of wellness outcomes were measured. The association of mistreatment and duty hours with the primary outcome was modeled with multivariable logistic regression. Results: A total of 475 residents and fellows who were enrolled in one of 120 vascular surgery training programs completed the survey (84.2% response rate). Of 408 trainees completing burnout survey items, 182 (44.6%) reported symptoms of burnout. Fewer trainees reported thoughts of attrition (n = 42 [10.0%], specialty change (n = 35 [8.4%]), or suicide (n = 22 [4.9%]). Mistreatment was reported by 191 vascular trainees (47.3%) and was more common in female trainees (n = 63 [48.5%] reporting monthly or more frequently) compared with male trainees (n = 51 [18.6%]; P < .001). Duty-hour violations were also more commonly reported by female trainees (n = 31 [21.4%] reporting 3+ months in violation) compared with male trainees (n = 50 [16.2%]; P = .002). After controlling for race/ethnicity, postgraduate year, program type, and geography, female trainees were less likely to report burnout (odds ratio [OR], 0.49; 95% confidence interval [CI], 0.28-0.86). Trainees experiencing mistreatment monthly or more were three times more likely to report burnout (OR, 3.09; 95% CI, 1.78-5.39). Frequency of duty-hour violations also increased the odds of reporting burnout (1-2 months in violation: OR, 2.09; 95% CI, 1.17-3.73; 3+ months in violation: OR, 3.95; 95% CI, 2.24-6.97). Conclusions: Nearly one-half of vascular surgery trainees reported symptoms of burnout, which was associated with frequency of mistreatment and duty-hour violations. Interventions to improve well-being in vascular surgery must be tailored to the local training environment to address trainee experiences that contribute to burnout.