Understanding the benefits and challenges of outpatient virtual care during the COVID-19 pandemic in a Canadian pediatric rehabilitation hospital.

PURPOSE: The evolving virtual health care experience highlights the potential of technology to serve as a way to enhance care. Having virtual options for assessment, consultation and intervention were essential during the coronavirus (COVID-19) pandemic, especially for children with disabilities and their families. The purpose of our study was to describe the benefits and challenges of outpatient virtual care during the pandemic within pediatric rehabilitation. METHODS: This qualitative study, part of a larger mixed methods project, involved in-depth interviews with 17 participants (10 parents, 2 youth, 5 clinicians) from a Canadian pediatric rehabilitation hospital. We analyzed the data using a thematic approach. RESULTS: Our findings demonstrated three main themes: (1) benefits of virtual care (e.g., continuity of care, convenience, stress reduction and flexibility, and comfort within the home environment and enhanced rapport); (2) challenges related to virtual care (e.g., technical difficulties and lack of technology, environmental distractions and constraints, communication difficulty, and health impacts); and (3) advice for the future of virtual care (i.e., offering choice to families, enhanced communication and addressing health equity issues). CONCLUSIONS: Clinicians and hospital leaders should consider addressing the modifiable barriers in accessing and delivering virtual care to optimize its effectiveness.

Families are invested in access to virtual care appointments and can benefit from clear communication about choices regarding appointment options and supports in how to access and use technology for equitable access to care.Hospitals should aim to provide clinicians with an appropriate workspace (i.e., private, quiet with adequate room to demonstrate what they need to do), equipment and technology to have virtual care appointments.Current understanding of virtual care delivery suggests a tailored approach, with some types of appointments, such as follow-ups or check-ins, more suited to this modality than other more hands-on therapy.

The Well for wellbeing

The NHS workforce is exhausted. The fallout from the COVID-19 pandemic is ever present and likely to continue for the foreseeable future. We have been utilising appreciative inquiry methodology to redress the level of negativity, and restore wellbeing and cohesiveness within our elective theatre team. Appreciative inquiry is an asset-based philosophy that can be used as a change management tool. Two of the main principles of appreciative inquiry are: 'what we choose to focus on will expand', and 'we can create our future by how we interpret our current reality'. We wanted to channel these principles to help us focus on the specific contributions from team members and how those contributions create the atmosphere in our operating theatres. Methods Our elective theatre lists usually close with a debrief session, which now incorporate The Well (see Fig. 1). The Well helps to identify moments in the working day that were effective or went well. Each team member picks discussion points and shares the story of what they noticed that was successful. We also collected feedback on the new format for the debrief session. Results All the stories were collated, and the top three themes were: making connections, shared decision-making, communication. Two examples shared during the sessions: 'There was a change to the list order, but this did not impact on the running of the list. There was a flow of communication between us - we were in sync.' and 'Decisions were shared - there was a complex patient and the decisions needed to be made early. The dialogue between the team was open.' Feedback on the session format included: 'I enjoy the stories shared during The Well session and I pay more attention to what is going on around me during the list so I can contribute more to the discussion.' 'The Well feels purposeful and it shows a level of appreciation that was not captured by the usual "thank you for your help today".' Discussion The Well has been well received and feedback shows that the appreciative inquiry methodology has helped to create and deepen connections between team members. We hope by sharing the stories of what has gone well we can encourage these behaviours to happen more often and flourish within our workplace. (Figure Presented).

Effects of the COVID-19 pandemic on secondary care for cardiovascular disease in the UK: an electronic health record analysis across three countries.

BACKGROUND: Although morbidity and mortality from COVID-19 have been widely reported, the indirect effects of the pandemic beyond 2020 on other major diseases and health service activity have not been well described. METHODS: Analyses used national administrative electronic hospital records in England, Scotland and Wales for 2016-2021. Admissions and procedures during the pandemic (2020-2021) related to six major cardiovascular conditions (acute coronary syndrome, heart failure, stroke/transient ischaemic attack, peripheral arterial disease, aortic aneurysm, and venous thromboembolism) were compared to the annual average in the pre-pandemic period (2016-2019). Differences were assessed by time period and urgency of care. RESULTS: In 2020, there were 31 064 (-6%) fewer hospital admissions (14 506 [-4%] fewer emergencies, 16 560 [-23%] fewer elective admissions) compared to 2016-2019 for the six major cardiovascular diseases combined. The proportional reduction in admissions was similar in all three countries. Overall, hospital admissions returned to pre-pandemic levels in 2021. Elective admissions remained substantially below expected levels for almost all conditions in all three countries (-10 996 [-15%] fewer admissions). However, these reductions were offset by higher than expected total emergency admissions (+25 878 [+6%] higher admissions), notably for heart failure and stroke in England, and for venous thromboembolism in all three countries. Analyses for procedures showed similar temporal variations to admissions. CONCLUSION: This study highlights increasing emergency cardiovascular admissions during the pandemic, in the context of a substantial and sustained reduction in elective admissions and procedures. This is likely to increase further the demands on cardiovascular services over the coming years.

The Respiratory Surge in Children Programmea National Approach to Connect and Educate the Workforce

Aims The Respiratory Surge in Children Programme, led by the London Transformation and Learning Collaborative (LTLC) a Health Education England and NHS England and Improvement initiative, aimed to prepare healthcare workers for a predicted paediatric respiratory surge, specifically RSV, during 2021/22. An innovate model that had previously been successfully used during the Covid 19 pandemic was used to approach this. This involved the creation of a national, online, open access repository of resources. The aim was to collate materials that differed in both length and style to ensure users had access to a variety of resources to suit their needs. Methods The programme pulled together the best of the existing resources from across the NHS. The content was organised into 6 main categories, including Recognition, Management and Escalation of the Sick Child, Respiratory Support (including CPAP and High flow/High Velocity therapy) and Emergency Stabilisation and Transfer. A team of multi-professional educators reviewed all content and led the curation of the wide-ranging resources, mapping them to a skills matrix whilst assessing them all for accessibility and relevance. Throughout the fast-paced project, the entire programme was regularly reviewed by a multidisciplinary expert advisory group. Working collaboratively and engaging with the group enabled real time feedback which shaped the programme in terms of both content and organisation/accessibility. In order to reach a wide range of practitioners across the spectrum of paediatric care, the team connected to various national bodies and the programme was endorsed by the. To aid the success and increase awareness of the programme, the team engaged with the regional Operational Delivery Networks who were pivotal in disseminating information and updates. There was also a strong push via social media to connect and engage users with the content. Results The programme launched in June 2021, and as of February 2022, 340 resources were categorised and uploaded to the programme hub site. As the project grew and developed the team not only collated resources suited to any user, but were also able to create categories for specific audiences such as educators. The programme has been accessed over 53,000 times by a wide variety of staff, both geographically and organisationally and has ensured the inclusion of a range of professional groups including but not limited to;nurses, doctors, AHPs, students and social care staff. Evaluations continue to demonstrate high degrees of satisfaction, coupled with suggestions for further development. 100% of those that completed the evaluation (n=17) either agreed or strongly agreed that they would recommend the programme to a colleague. Many respondents have commented about the refreshing and inspiring way the project has brought together paediatrics as a whole. Conclusion This project has worked at pace to create a valuable resource, and has demonstrated the value of sharing resources, skills and ideas. The flexible working environment, strong leadership and innovative use of technology to connect the remotely working team has been an inspiration, kept the team motivated and energised to deliver the key aims and ensure the success of the programme.

Smoking and OMFS – How well are we recording tobacco use and referring to smoking cessation services?

smoking. Evidence shows that smokers who develop oral cancer have poorer outcomes than non-smokers. Additionally, smoking incidence is reported to be increased because of the COVID pandemic.We have a duty to discuss smoking with our patients and offer appropriate advice or referrals. Objectives are as follows: - To assess department compliance with the recording of smoking and tobacco history at initial consultation appointments - To aim for 100% compliance with the recording of smoking and tobacco quantity and duration - To increase number of successful referrals to smoking cessation services. Materials and Methods: Retrospective data collectionwas completed from 20 initial new patient consultations. Notes were assessed for the presence of the following: Smoking status and history, duration of smoking history, number of cigarettes smoked daily, and whether smoking cessation advice was given and/or a smoking cessation referral offered. Results of first round data collectionwere presented to the department and a ‘help to stop smoking’ referral form for smoking cessation services made readily available in the department. A second round of data collection was subsequently completed. Results: 60% of initial consultations recorded patient smoking status. Of this group, 42% are confirmed smokers. When smoking history has been recorded, the quantity of cigarettes was always recorded. The duration of smoking history was only successfully recorded in 60% of cases. No referrals were made to the smoking cessation service;however 60% of the confirmed smokers declined a referral offer. After intervention, a vast improvement is noted – 85% of clinical notes recorded patient status, with 25% confirmed smokers. There was an increase in referrals to smoking cessation referral services. Conclusions: All patients should be asked about smoking status and evidence recorded in clinical notes. Furthermore, smoking cessation advice should be given to all patients and referrals to smoking cessation services offered. Collaborative projects with the smoking cessation service have begun to further improve our patient care and oral health improvement.

Gross Motor Function Parent Report (GMF-PR): Preliminary evidence of validity

Background and Objective(s): The need for family-centered measures that reflect children's abilities in their natural environments has come to forefront, accentuated by the recent shift to remote assessment necessitated by the COVID pandemic. This study describes the first steps in the validation of a new instrument, the Gross Motor Function Parent Report (GMF-PR), a parent-completed, modified 30-item version of the Gross Motor Function Measure to report gross motor function of children and youth with cerebral palsy in their home and community environments. Study Design: Measurement Study. Study Participants & Setting: Assessment records of 50 children and adolescents with CP, aged 1 year to 19 years, were used for this analysis. Gross motor abilities were classified using the Gross Motor Function Classification System (GMFCS). Materials/Methods: This study was approved by the Ethics Committee of Universidade Federal de Juiz de Fora. Gross Motor Function Measure (GMFM-66) scores were accessed from an existing data bank. GMF-PR scores were determined using related items in the GMFM assessments. Correlation coefficients were calculated using: (1) GMFM-66 and GMF-PR scores and, (2) GMF-PR scores and GMFCS levels. Intraclass correlation coefficients (ICC) were used to estimate inter-measure score agreement. Discriminative validity was evaluate using a one-way ANOVA and Tukey's pairwise comparisons to compare scores between the GMFCS levels (alpha=0.05). Results: Data were available from 50 children and adolescents (8.0 ± 4.2y), equally divided between levels I-V of the GMFCS. Pearson correlation showed a positive and strong association between GMFM-66 and GMF-PR scores (r=0.97, p<0.001). Spearman-rho showed an inverse and strong association between GMF-PR and GMFCS (rho=-0.91, p<0.001). There was excellent agreement between GMFM-66 and GMF-PR scores (ICC=0.93;0.88≥CI95%≥0.96). Lastly, analysis of variance showed a significant difference of GMF-PR scores among levels of GMFCS (p<0.001), demonstrating discriminative validity. Conclusions/Significance: These preliminary results on the validation of the GMF-PR show promising evidence for future use of this new measure. Work is underway to further explore discriminant validity of the measure. With continued evidence from the validation process, this instrument may be a useful tool for the evaluation of the motor functioning of children and adolescents with cerebral palsy in different contexts.