Objectives/Hypothesis: To determine the impact of electronic consultation on the otolaryngology clinic workflow at our high-volume public hospital.Study Design: Retrospective Observational Study. Methods: This is a retrospective observational analysis study. Operational data regarding clinic volume, referral patterns, and scheduling efficiency were assessed over a 9-month period in 2018 prior to implementation of electronic consultation. The same data were collected for the 9-month period immediately following implementation of electronic consultation in 2019.Results: During the pre-implementation (pre-EC) period, 3,243 otolaryngology referrals were made as compared to 4,249 post-implementation (post-EC). 86% of referrals were scheduled for a clinic appointment pre-EC, compared to 61% post-EC (P < .00001) 24.5% of patients were evaluated within 30 days pre-EC compared to 53.6% post-EC (P < .00001). The average time to be seen by an otolaryngology provider declined from 60.8 days pre-EC to 42.8 days post-EC (P = .0029). There was a 50% decline in the percentage of appointments canceled by patients in the post-EC period as compared to pre-EC.Conclusions: In our experience, implementation of electronic consultation significantly reduced both wait times for a clinic appointment and the percentage of no-show or canceled appointments. Electronic consultation may be a valuable tool in improving the efficiency and yield of the modern otolaryngology clinic.

Sepsis is a systemic inflammatory response to severe infection causing significant morbidity and mortality that costs the health care system $20.3 billion annually within the United States. It is well established that fluid resuscitation is a central component of sepsis management; however, to date there is no consensus as to the ideal composition of fluid used for resuscitation. In this review, we discuss the progression of clinical research comparing various fluids, as well as the historical background behind fluid selection for volume resuscitation. We conclude that the use of balanced fluids, such as Ringer’s Lactate, seems very promising but further research is needed to confirm their role.

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Background To date, 1‐year evaluation of pitch elevation in patients undergoing modified Wendler glottoplasty (WG) in combination with VT has not been assessed. Objectives To determine whether 1‐year pitch elevation is sustained in patients who undergo modified WG in combination with VT for voice feminization. Methods A retrospective review of patients who underwent WG in combination with voice therapy (VT) was performed from 2016 to 2020. Charts were reviewed for sustained vowel fundamental frequency (F0/a/), speaking fundamental frequency (SF0), and Trans Woman Voice Questionnaire (TWVQ) at preoperative, initial postoperative (3–6 months after surgery), and 12‐month postoperative visits. Results Change in average F0/a/, SF0 and TWVQ was 50.25 Hz, 32.96 Hz, and 32.6 at 12‐months postoperatively compared to preoperative values. Initial and 12‐month postoperative SF0 were significantly higher than preoperative SF0 (Mann–Whitney U test p = 0.0042, p = 0.0010). There was no difference in initial postoperative and 12‐month postoperative SF0 (p = 0.50). TWVQ at 12 months was significantly lower than preoperative TWVQ (ANOVA p < 0.001, Tukey honestly significant difference HSD p < 0.05). Conclusions Pitch elevation remains sustained at one year in patients undergoing modified WG in combination with VT. Modified Wendler glottoplasty combined with VT results in relatively long‐term improvements in voice‐related quality of life and is possibly a beneficial addition in the long‐term management of patients who desire voice feminization. Level of Evidence 4 Laryngoscope, 133:615–620, 2023