OVERCOMING CHALLENGES OF CLINICIAN BURNOUT, STAFFING LIMITATIONS, AND ABERRANT PATIENT BEHAVIOR THROUGH PROACTIVE TELEHEALTH ASSESSMENTS

Introduction There is compelling evidence that telehealth is the solutional advancement to recent staffing limitations caused by the Covid-19 pandemic (Doraiswamy et al. 2020). We sought to improve clinic flow, enable safe patient oversight, increase access to care, and reduce clinician burnout through personal tele-notification of patients. Methods We scheduled patients for routine follow-up in the Supportive Care Clinic (SCC) at University Cancer Institute. Each was called within 48 hours of their appointment to confirm or cancel and a brief clinical assessment. We recorded patients' responses and the results (arrival time or absent). If the patient deviated from their attendance at their appointment, a physicianled qualitative analysis of patient's chart was performed. Results We reduced absentee appointments from 17.4% to 12.6%, improving clinical efficiency by 38.3%. Post-Intervention, new patient access to the SCC was increased 106%(6/month to 12/month). We discovered 48/355 patients were deviating from the plan of care, which required further intervention. 19/48 of these had barriers to care preventing consistent follow-up. Conclusions Personal telecommunication reduces appointment non-attendance, increases clinic efficiency, and screens for patients deviating from plan of care and barriers to care. This telehealth system provides a unique avenue of proactive patient oversight, while reducing clinician workload and thereby burnout.

COVID-19 Pharmacotherapy Was Not Associated with Mortality in a Community Teaching System

Background. During the COVID-19 pandemic, a task force was assembled to collect data on patient characteristics and treatment exposures to assess what factors may contribute to patient outcomes, and to help develop institutional treatment guidelines. Methods. A retrospective study was performed on COVID-19 inpatient admissions within a four-hospital community health system over a six-month period from April-October 2020. Positive COVID-19 immunology results and/in conjunction with an inpatient admission was criteria for inclusion. Covariates for age, gender, race were added apriori. Covariates of interest included baseline comorbidities, admission levelof-care, vital signs, mortality outcomes, need for intubation, and specific pharmacological treatment exposures. Logistic regression was performed on our final model and reported as OR +/- 95% CI. Results. A total of 349 patients met inclusion criteria. Pharmacotherapies were not associated with a difference in mortality in a four-hospital system. Corticosteroids (p = 0.99);Remdesivir (p = 0.79);hyrdroxychloroquine (p = 0.32);tocilizumab (p = 0.91);were not associated with mortality. ACE-inhibitor or angiotensin II receptor blockers OR 0.29 (0.09-0.93) (p = 0.03);convalescent plasma OR 7.85 (1.47-42.1) (p = 0.02);neuromuscular blocking agents (NMBA) OR 5.51 (1.28-23.8) (p = 0.02);vasopressors OR 17.6 (5.62-54.9) (p = 0.00) were associated with in-hospital mortality. Covariates that were associated with a difference in mortality were: age > 60 years OR 2.73 (1.04-7.14) (p = 0.04);structural lung disease OR 3.02 (1.28-7.10) (p = 0.01). Covariates not associated with mortality included African American race (p = 0.30);critical care admission (p = 0.19);obesity (p = 0.06);cardiovascular disease (p = 0.89);diabetes (p = 0.28). Conclusion. The use of corticosteroids, remdesivir, tocilizumab, and hydroxychloroquine, and admission to a critical care bed was not associated with a difference of in-hospital mortality. Patients who required vasopressors or NMBA were associated with in-hospital mortality. Despite national trends reporting increased mortality in patients with obesity, diabetes, cardiovascular disease, and of African American race, this was not observed in our health system safety net hospitals.

Achieving operational resilience in the financial industry: Insights from complex adaptive systems theory and implications for risk management

Financial institutions face a perfect storm of nonfinancial risks: climate change, COVID-19, Brexit, digital transformation and cyberattacks generate new threats and exacerbate the impact to existing systemic and organisational vulnerabilities. Regulators recognise the magnitude of the risks that institutions face and are demanding that they become resilient — that is, they are able to absorb, adapt or recover from threats, stressors or shocks. This, however, is more easily said than done. The objective of this paper is to inform senior risk professionals on how resilience might be achieved by providing a much-needed frame of reference for those planning to transform their complex and chaotic organisations to resilient complex adaptive systems. Inter alia we delineate a logical model, based on conceptualising firms as resilient complex adaptive systems (RCASs), which elaborates the necessary and sufficient conditions for resilience in organisations. This general model can be applied to substantive areas of operations within financial enterprises to make them resilient in the face of endogenous and exogenous risk events, while meeting regulatory requirements. © Henry Stewart Publications.