Redesigning the Workflow Process to Upload Paper Consents into the Electronic Health Record

Background: Before starting cellular therapy treatment, patients and their physicians must sign consent forms for Standard of Care (SoC) treatment plans as well as ancillary protocols. To avoid delay in patient care, signed SoC consents are scanned into the Electronic Health Record (EHR) in a timely manner, and protocol consents are handed off to the research team to manage as needed. The COVID-19 pandemic forced our large academic center to adapt this consent management workflow to function with fewer onsite staff, which resulted in prolonged turnaround time for consents to be uploaded into the patient's EHR, and operational inefficiencies (e.g. lost consents requiring re-signing, increase workload for staff, etc.). The process involved 4 cross-functional teams, and handoffs spanning multiple physical locations. Combined with the increasing patient volume of our center, the consents process was unsus-tainable and inadequate. Method(s): Our first redesigned process involved physicians dropping off signed consents directly in the clinic workroom.A Research Coordinator would then sort out the protocol consents and hand off SoC consents to the Health Information Systems (HIS) team for EHR scanning. This new process reduced the number of stakeholders handling the consents and consolidated the handoff location to one location. While this allowed for marked improvement in turnaround times for SoC consent scanning, there were additional opportunities to integrate the workflow with the HIS team's existing processes to allow for further efficiencies. After 4 months, we implemented our second redesigned process: after drop-off in the clinic workroom by physicians, the HIS team would collect all consents three times per day and scan SoC consents while setting aside protocol consents for the Research team to pick up. This allowed for SoC consents to be scanned without delay and reduced workload for the Research team all while streamlining our workflow into existing HIS processes. See Figure 1 for workflow iteration details. Result(s): The new processes reduced the average turnaround time for SoC consents scanned into the EHR from 8 to 2 busi-ness days. Furthermore, we have increased the number of consents scanned same day into the EHR from 18% under the 1st redesign, to 52% with the 2nd redesign (see Figure 2). We have also diminished the error rate (including lost consents) to 1% of consents processed. (Figure Presented)(Figure Presented) Conclusion(s): The redesigned consents workflow resulted in quicker uploads into the EHR, increased same day uploads and has made lost consents statistically insignificant. Timely uploads of consents into EHRs have also allowed us to flag and resolve any issues earlierCopyright © 2023 American Society for Transplantation and Cellular Therapy

A psychological needs analysis of individuals with LongCovid

Introduction: Long-Covid is the continuation of broad and debilitating symptoms 4 weeks post-Coronavirus Disease 2019 onset. Our Long-Covid clinic provides holistic care to this population. It includes a variety of professionals but no in-clinic psychological intervention. The clinic requested a psychological needs analysis to inform the development of such intervention. Aim(s): To conduct a psychological needs analysis for the Long-Covid clinic population. Method(s): In addition to routine outcomes: anxiety, depression, and posttraumatic stress disorder (PTSD;GAD-7, PHQ-9, PCL-5), individuals completed the brief Illness Perceptions Questionnaire (b-IPQ). We conducted correlational and regression analyses to identify an interventional target. Result(s): We collected data in August-October 2021 (n=47, mean age=51.3, 32% male). GAD-7 and PCL-5 showed mild anxiety and PTSD (n=37, mean=7.8(6.8);n=37, mean=11.0(19.3)), PHQ-9 showed moderate depression (n=37, mean=11.0(6.9). Individuals reported low treatment control and low illness coherence (Table 1). PHQ-9 significantly correlated with GAD-7, PCL-5, timeline, and emotional representations. 84.5% of the variance of PHQ-9, (F5, 15)=22.8, p<0.001 was explained by our regression model. Three variables were statistically significant, (GAD-7, beta=0.48;PCL-5, beta=0.36;timeline, beta=0.36). Conclusion(s): The relationship between GAD-7, PCL-5, timeline, and PHQ-9 indicate an intervention for depression is warranted. We hypothesise it should also improve individuals' anxiety, PTSD, and illness perceptions.

A qualitative assessment of the pulmonary rehabilitation decision-making needs of patients living with COPD.

Pulmonary rehabilitation (PR) is highly evidenced but underutilised in patients living with chronic obstructive pulmonary disease (COPD). A menu of centre and home-based programmes is available to facilitate uptake but is not routinely offered. An appraisal of the current PR referral approach compared to a menu-based approach was warranted to explore the decision-making needs of patients living with COPD when considering a referral to PR. Face-to-face or telephone, semi-structured interviews were conducted with patients diagnosed with COPD and referred to PR and referring HCPs. Interviews were audio-recorded, transcribed verbatim and analysed using the enhanced critical incident technique. 14 HCPs and 11 patients were interviewed (n = 25). Interview data generated 276 critical incidents which informed 28 categories (30 sub-categories). Five high-level themes captured patients' decision-making needs for PR: Understanding COPD, understanding PR, perceived ability to access PR, a desire to accept PR, and supporting the offer. A menu-based approach would further support patients' PR decision-making, however, insufficient knowledge of the programmes would limit its perceived feasibility and acceptability. The development of shared decision making interventions (e.g., a patient decision aid) to elicit patient-centred, meaningful discussions about the menu is suggested.

P271 Sexual health service adaptations to the coronavirus disease 2019 (covid-19) pandemic in Australia: a nationwide online survey

BackgroundWe aimed to examine the changes public sexual health services across Australia made during the national lockdown (March-May 2020) due to the COVID-19 pandemic.MethodsFrom July-August 2020, we emailed a link to an online survey to 21 sexual health clinic directors/managers who were part of the Australian Collaboration for Coordinated Enhanced Sentinel Surveillance of Sexually Transmissible Infections and Blood-borne Viruses (ACCESS) network.ResultsAll 20 participating clinics remained open but reported changes during the lockdown, including suspension of walk-in services in 8 clinics.Some clinics stopped offering asymptomatic screening for heterosexuals (n=11), men who have sex with men (MSM) (n=3), or transgender persons (n=2). Most clinics offered a mix of telehealth and face-to-face consultations for asymptomatic MSM (n=11), asymptomatic transgender persons (n=12), post-exposure prophylaxis (PEP) prescription (n=13) or to initiate pre-exposure prophylaxis (PrEP) (n=14). People who were symptomatic for STIs and contacts of STIs were offered face-to-face and telehealth consultations across all clinics. Seven clinics suspended STI test-of-cure consultations and four clinics suspended hepatitis vaccinations for people not living with HIV. Nineteen clinics reported delays in testing and 13 reported limitations in testing during lockdown. Most clinics changed to phone consultations for HIV medication refill (n=15) with faxed (n=14) or mailed (n=13) prescriptions. Fourteen clinics had staff redeployed to assist the COVID-19 response;14 clinics reported a reduction in total number of full-time equivalent (FTE) clinical nurses from 74.4 to 45.6 FTE collectively and three clinics reported reduction in FTE clinical doctors, from 20.1 to 17.1 FTE collectively.ConclusionAustralian public sexual health clinics rapidly pivoted service delivery to reduce the risk of COVID-19 transmission in their clinical settings, managed staffing reductions and delays in molecular testing, released staff to support the COVID-19 response, and maintained a focus on urgent and symptomatic STI presentations and those at higher risk of HIV/STI acquisition.