Elan Chanel Burton, MD, MHA

All Publications

• Type A Aortic Dissection With Concurrent Aortic Valve Endocarditis, Subarachnoid Hemorrhage, and Disseminated Intravascular Coagulation. JACC. Case reports Elde, S. F., Guenthart, B. A., de Biasi, A., Dalal, A. R., Casselman, K. G., Hiesinger, W., Burton, E. C. 2022; 4 (14): 839-843

  Abstract

  We describe surgical repair of a Stanford Type A aortic dissection with concurrent aortic valve Streptococcus equi endocarditis in the setting of subarachnoid hemorrhage and disseminated intravascular coagulation. Multidisciplinary collaboration among specialists from a variety of disciplines is essential when treating acutely ill cardiovascular patients with multisystem involvement. (Level of Difficulty: Beginner.).

  View details for DOI 10.1016/j.jaccas.2021.05.008

  View details for PubMedID 35912321

• Standardization of operative start times for non-emergent cardiac surgical procedures. Journal of cardiac surgery Burton, É., Medina, M., Antonio, H. 2022

  Abstract

  Late surgical start times have been associated with a multitude of adverse consequences such as increased cost, delay in treatment, increase in medical errors, and patient complications. From October 1, 2018 to September 30, 2019, 47% (67/144) of non-emergent cardiac cases in our institution had a late start by our institutional standard. Our objective was to decrease the percentage of late start non-emergent cardiac cases from 47% to 37% by October 2020.All non-emergent cardiac surgical procedures as first start cases in a single institution were included in our study. Preintervention cardiac surgical cases were reviewed from October 1, 2018 to February 28, 2020 to determine key drivers contributing to late start times. A multidisciplinary team was formed and utilized A3 process and problem-solving strategies to address our objective. A multipronged intervention approach was used to address key drivers contributing to late start times.All interventions were implemented in March 2020. Postintervention data was collected from March 1, 2020 to February 28, 2021, on all non-emergent cardiac surgical procedures. The percentage of non-emergent cardiac cases starting after 8:00 a.m. decreased to 27% (17/62). The decrease in late start cases translated into saving an average of 45min of operating room (OR) time (average cost savings of ~$5,000/case). Additionally, staff reported improved job satisfaction.Delayed surgical case start times can have negative effects on patients, employees, and lead to increase costs of medical care. Our research has shown adherence to on-time surgical start can improve OR efficiency, decrease cost, and improve employee satisfaction.

  View details for DOI 10.1111/jocs.16756

  View details for PubMedID 35842812

• Assessment of Bias in Patient Safety Reporting Systems Categorized by Physician Gender, Race and Ethnicity, and Faculty Rank: A Qualitative Study. JAMA network open Burton, E., Flores, B., Jerome, B., Baiocchi, M., Min, Y., Maldonado, Y. A., Fassiotto, M. 2022; 5 (5): e2213234

  Abstract

  Importance: Patient safety reporting systems (PSRSs) are designed to decrease the risk of harm to patients due to medical errors. Owing to the voluntary nature of PSRSs, implicit bias of the reporter may affect the management of safety events reported. Stanford Alert For Events (SAFE) is the PSRS used at Stanford Health Care.Objective: To examine whether variation exists in the content of SAFE reports based on demographic characteristics of physicians who are the subject of the event report.Design, Setting, and Participants: This retrospective qualitative analysis from a single academic medical center evaluated SAFE reports from March 2011 to February 2020. Event reports were coded by theme and categorized by severity (scale of 1 to 3, with 1 being the lowest and 3 the highest). The reports were then analyzed from October 2020 to February 2022 and categorized by physician gender, race and ethnicity, and faculty rank. A total of 501 patient safety events were collected from the adult hospital during the study period, and 100 were excluded owing to incompleteness of information.Main Outcomes and Measures: This qualitative study had no planned outcome.Results: A qualitative analysis was performed on 401 reports representing 187 physicians (138 [73.8%] male and 49 [26.2%] female). In terms of race and ethnicity, 4 physicians (2.1%) were African American, 49 (26.2%) were Asian; 7 (3.7%), Hispanic or Latinx; 108 (57.7%), White; and 19 (10.2%), declined to state. Female physicians had disproportionate representation among reports referencing communication and conversational issues and the lowest severity level. Male physicians had disproportionate representation for ignoring or omitting procedures, process issues, and physical intimidation. African American physicians had disproportionate representation for lack of communication and process issues. Asian physicians had disproportionate representation for lack of communication, process issues, conversational conduct, and the lowest severity level. Latinx physicians had disproportionate representation for conversational conduct. White physicians had disproportionate representation for ignoring or omitting procedures, verbal abuse, physical intimidation, and the highest severity level.Conclusions and Relevance: In this qualitative study, female physicians and physicians who were members of racial and ethnic minority groups were more likely to be reported for low-severity communication issues compared with their male and White counterparts, respectively. These findings suggest that there may be a lower threshold for reporting events when the subject of the report is female and/or a member of a racial or ethnic minority group. Restructuring the reporting and management of patient safety events may be needed to facilitate conflict resolution in a manner that reduces implicit bias and fosters team cohesion.

  View details for DOI 10.1001/jamanetworkopen.2022.13234

  View details for PubMedID 35594045

• Incidentally Found Ascending AorticThrombus: Presentation and Management. JACC. Case reports Quach, N., Medina, M., Burton, E. 2021; 3 (13): 1489-1493

  Abstract

  Aortic thrombus can be rare, requiring prompt recognition and management to prevent sequelae. Treatment modalities for aortic thrombus include systemic anticoagulation, endovascular, and/or surgical intervention. We present an incidental finding of an aortic annular mass in a 53-year-old male consistent with an aortic thrombus. (Level of Difficulty: Intermediate.).

  View details for DOI 10.1016/j.jaccas.2021.07.027

  View details for PubMedID 34693348

• Successful beating-heart repair of pulmonary artery dissection using a composite valve-tube graft. Journal of cardiac surgery de Biasi, A. R., Wang, H., Medina, M. G., Burton, E., Ogden, W. D. 2021

  Abstract

  Pulmonary artery dissection is rare but highly lethal. Recent reports suggest that surgical repair of pulmonary artery dissection may yield good outcomes in selected patients, although postoperative right ventricular failure and death have been described. Currently, only one patient over age 60 years old has been reported to survive open surgical repair of pulmonary artery dissection. Here, we present the case of a sexagenarian with pulmonary artery hypertension complicated by a dissected pulmonary artery aneurysm which was successfully repaired using a composite valve-tube graft under a beating-heart strategy.

  View details for DOI 10.1111/jocs.15459

  View details for PubMedID 33651429

• A Novel Alternative to The Commando Procedure: Constructing a Neo-Aortic Root by Anchoring to the Sewing Ring of the Replaced Mitral Valve. JTCVS techniques Elde, S., de Biasi, A., Woo, Y. J., Burton, E. 2020

  View details for DOI 10.1016/j.xjtc.2020.08.037

  View details for PubMedID 32875308

• COVID-19: Health disparities and social determinants of health INTERNATIONAL SOCIAL WORK Burton, E. C., Bennett, D. S., Burton, L. M. 2020

  View details for DOI 10.1177/0020872820944985

  View details for Web of Science ID 000554540700001

• Remote Working 2.0: Balancing Work and Family during the Coronavirus Pandemic California Management Review Bennett, D., Andonova, Y., Anaza, N., Burton, E. 2020
• Ascending Aortic B-Cell Lymphoma Masquerading as Intramural Hematoma: A Case Report Ascending Aortic B-Cell Lymphoma Masquerading as Intramural Hematoma: A Case Report Holley, C. T., Spratt, J. R., Missov, E., Burton, E. C., Shumway, S. J. 2014

  View details for DOI 10.15744/2348-9820.1.404

• Intracystic Papillary Carcinoma of the Breast. Radiology case reports Burton, É. C., Stahlfeld, K. R., McKeating, J. A. 2009; 4 (3): 279

  Abstract

  We present the case of a 63-year-old woman with intracystic papillary carcinoma of the breast who presented with a palpable mass, one year after a negative mammogram. Sonography showed a complex mass and ultrasound-guided aspiration cytology was negative, and the patient returned 6 months later with a recurrent mass. Excisional biopsy revealed invasive intracystic papillary carcinoma. Intracystic papillary carcinoma is a rare malignancy of the breast primarily affecting postmenopausal women. As opposed to invasive micropapillary carcinoma, intracystic papillary carcinoma is a low-grade carcinoma with a favorable prognosis.

  View details for DOI 10.2484/rcr.v4i3.279

  View details for PubMedID 27307817

  View details for PubMedCentralID PMC4898007

• Abdominal aortic pseudoaneurysm managed with endovascular stent graft. Surgical laparoscopy, endoscopy & percutaneous techniques Hower, J., Burton, E., Agrawal, S. T., Simone, S., Stahlfeld, K. 2009; 19 (3): e106-8

  Abstract

  Angioplasty, stenting, endovascular stent grafts, and other minimally interventional techniques are becoming common techniques used for a myriad of vascular pathology. As the technology, comfort level, and technical expertise improve, the envelope of overuse is being approached or possibly superceded. We present an unusual complication of pancreatitis, pseudoaneurysm of the abdominal aorta, which was successfully treated with an endovascular stent graft.

  View details for DOI 10.1097/SLE.0b013e3181a493e1

  View details for PubMedID 19542831

• What do physician extenders in a general surgery residency really do? JOURNAL OF SURGICAL EDUCATION Stahlfeld, K. R., Robinson, J. M., Burton, E. C. 2008; 65 (5): 354-358

  Abstract

  The 80-hour workweek has forced surgical training programs to employ physician extenders to reduce work hours and improve the educational environment. The purpose of our study was to document objectively the specific workload provided by physician extenders and to evaluate any objective or subjective benefit provided to the residency program.Over 4 consecutive months, all orders written by 2 physician extenders associated exclusively with the general surgery residency program at our institution were reviewed. They were categorized as daytime or evening orders and were subdivided into admission, routine preoperative and postoperative, acute care, daily laboratories, pain medications, Pro re nata (PRN), wound care, and discharge orders. Acute care issues and PRN orders were individually examined and subdivided. The appropriateness, total volume, and the orders for each category were totaled and reviewed.Overall, 3101 total orders (1128 daytime and 1973 nighttime) were reviewed in a 4-month time period. On average, physician extenders at night wrote 35 orders per shift, compared with only 18.8 orders during the day. During the night, admission orders totaled 547 (27.7%), preoperative orders 442 (22%), acute care issues 324 (16.4%), PRN orders 239 (12%), and pain medication and PRN sleeping pills 156 (8%). During the day, routine postoperative orders totaled 305 (27%), daily laboratories 184 (16%), and discharge orders 253 (22%).Physician extenders wrote appropriate orders and reduced resident workload. Educational opportunities increased because fewer residents left conference for acute patient care issues, and 1 fewer resident was absent during the day secondary to 1 less resident being sent home postcall. Performance on the American Board of Surgery In-Training Examination (ABSITE) increased dramatically for a focused group of residents. As the expense of each extender is approximately $90,000, justification to administration is dependent on the institutional support and efficiency of the residency program. A clear simple outcome is that by improving standing orders and clinical pathways, and by using an electronic medical record system, noneducational work hours can be reduced significantly.

  View details for DOI 10.1016/j.jsurg.2008.06.002

  View details for PubMedID 18809165

• Laparoscopic management of a small bowel obstruction of unknown cause JSLS-JOURNAL OF THE SOCIETY OF LAPAROENDOSCOPIC SURGEONS Burton, E., McKeating, J., Stahlfeld, K. 2008; 12 (3): 299-302

  Abstract

  With the expanding indications for minimally invasive surgery, the management of small bowel obstruction is evolving. The laparoscope shortens hospital stay, hastens recovery, and reduces morbidity, such as wound infection and incisional hernia associated with open surgery. However, many surgeons are reluctant to attempt laparoscopy in patients with significantly distended small bowel and a history of multiple previous abdominal operations. We present the management of a patient with a virgin abdomen who presented with a small bowel obstruction most likely secondary to Fitz-Hugh-Curtis syndrome who was successfully managed with laparoscopic lysis of adhesions.

  View details for PubMedID 18765057