The Impact of the Constraints of Class Scheduling on Campus Dining: A Simulation-based Case Study

Waiting in queues in service systems is an inevitable part of the customer's everyday routine. Waiting time is an important indicator of a service system's performance. This paper studies the efficiency of service operations in a college campus dining setting. The authors implemented a discrete event simulation (DES) model in Simio to study how class scheduling may affect the overall customer waiting time and satisfaction at the college campus dining location. The results provide recommendations on how classes could be scheduled to optimize students' satisfaction with their lunchtimes and the quality of service. The results also provide valuable insights for operating during the COVID-19 pandemic, as campus dining locations have a decreased maximum capacity, which may lead to more bottlenecks than usual and increase waiting times. © 2021 The Authors.

A MIXED METHOD STUDY TO EVALUATE THE MEDICINES OPTIMISATION PATHWAY FOLLOWING VIRTUAL OUTPATIENT CLINICS

Aim In March 2020, COVID-19 triggered an NHS directive to reduce face-to-face consultations and adapt to virtual clinics. 1 Hospital pharmacies, each with their own model of care, quickly innovated to ensure patients received their medication safely. The aim of this study was to evaluate the provision of medications optimisation for paediatric patients following virtual outpatient consultations (VOC) and explore potential improvements for future implementations. Method This was a mixed method study using quantitative data;which reviewed medications sent to patients in red, amber, and green categories2 and qualitative data;using patient feedback, to evaluate the processes in three London hospitals. Pathway mapping (PM) sessions, with multidisciplinary team involvement, were conducted across these hospitals to identify areas for improvement and analyse gaps in services. Virtual PM sessions were attended by 30 representatives across the multidisciplinary team including: pharmacists, nurses, consultants, pharmacy technicians, post room attendants;and general, operational, and project managers. Semi-structured questionnaires were used to conduct one to one telephone interviews with patients' families. A separate topic guide was used to interview General practitioners (GP) and primary care network (PCN) pharmacists. The audio recordings were transcribed as 'intelligent verbatim' and analysed using Nvivo. Braun and Clarke's six phases approach was used to conduct an inductive thematic analysis.3 To improve the rigorousness of the study, more than 50% of the transcript were double coded.4 As this was a service evaluation, ethics approval was not necessary. The project was registered with each hospital's clinical audit department. Results The three process maps were analysed and potential improvements for the medicines optimisation pathway were assessed by a paediatric pharmacy subgroup using ease-impact matrix. Potential improvements include: exploration and use of Electronic Prescription Service by secondary and tertiary care, improving communication through Information Technology systems between prescribers and hospital pharmacists, and the creation of a transparent standard operating procedure regarding medication supply following VOC. Seventy-one patients' families across the sites were interviewed between January-May 2021 to reflect on their experience of receiving medications following a VOC. Four GPs and one PCN pharmacist were interviewed in May 2021 to assess on the impact of VOC on primary care. Key reflections from themes generated include the convenience of receiving medications from hospital pharmacies following VOC, satisfaction of the current process, including medicines packaging and medicines information provided to patients and their families. Other reflections included limitations of the current process and its implication on patient safety. Medicines information helplines and education provided by pharmacists were regarded by patients' families and GPs as a valuable attribute. Conclusion Patients' families appreciated the current model of care, however patients' families and primary care healthcare professionals have identified both challenges and suggestions for improvement in delivering the current model. Future research should focus on a mixed mode of integrated care with green and amber medications2 prescribed directly to community pharmacies with clinical screening and counselling conducted by hospital pharmacists.

Telemedicine and cystic fibrosis: Do we still need face-to-face clinics?

There has been growing interest in telemedicine for cystic fibrosis over recent years based largely on convenience for patients and/or increasing the frequency of surveillance and early detection which, it is assumed, could improve treatment outcomes. During 2020, the covid-19 pandemic catalysed the pace of development of this field, as CF patients were presumed to be at high risk of infection. Most clinics adapted to digital platforms with provision of lung function monitoring and sample collection systems. Here, we present the views of multidisciplinary team members at a large paediatric CF centre on what has worked well and what requires further optimisation in the future. In response to the question posed, 'Do we still need face to face clinics?' our answer is 'Yes, but not every time, and not for everyone'.

179 Ethnicity and Symptom Onset in the Emergency Department during the SARS-CoV-2 Pandemic at the “Epicenter of the Epicenter”

Study Objective: New York City Health + Hospitals/Elmhurst located in Queens, New York, has one of the most diverse patient populations in the United States, and likely the world, and was deemed the “epicenter” of the Covid-19 pandemic in 2020. Given its unique population, high number of Covid-19 cases and growing concern that Covid-19 disproportionately affects minority patients, this study seeks to examine the correlation between ethnicity and time from symptoms onset to ED presentation to further understand this disparity. Methods: This is a retrospective chart review of 2216 patients who tested positive for SARS-CoV-2 (COVID-19) with 2254 unique ED visits. Preliminary analysis was conducted on 212 of these patients with data extracted from Epic through chart review for time from symptom onset to ED presentation and documented ethnicity, defined for this study as Hispanic or non-Hispanic. Symptom onset to ED presentation was defined as one of seven categories: one through seven days or >1 week. The data were analyzed using statistical analysis software to assess for correlation between ethnicity and time of symptom onset to ED presentation. Results: Results demonstrated that 37.5% of Hispanics presented to the ED after one week of symptoms as compared to 34.9% of non-Hispanics (p>0.05). Of non-Hispanics, 22.2% presented after one day of symptoms. While not, statistically significant, this demonstrates a trend toward Hispanics having a delay from symptom onset to ED presentation. Further analysis of available data is pending. Conclusion: Based on preliminary data, ethnicity does not seem to predict symptom onset to ED presentation. This aids in determining causes of high mortality rates of COVID-19 minority populations. Several media outlets have suggested that COVID-19 has disproportionately affected minorities and this paper sought to examine possible confounders to this statement. Further research and analyses are underway and it is hypothesized that other social determinants of health care likely play a role in this disparity.