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Journal of General Internal Medicine ; 37:S138-S139, 2022.
Article in English | EMBASE | ID: covidwho-1995597


BACKGROUND: Adherence to guideline-concordant management of incidentally detected pulmonary nodules (PNs) is frequently poor. We designed and implemented a division-level intervention to improve Fleischner society guideline adherence at our institution. METHODS: Our intervention included: (1) radiology report templates for documentation of PNs, (2) generation of daily reports of incidentally identified PNs, (3) a population health coordinator who documented PN identification in the electronic health record (EHR) and managed patient outreach, and (4) EHR templates for clinician documentation of disclosure to patients and clinical care plan. Outcomes were rates of PN disclosure and completion of recommended surveillance chest computed tomography (CT) or sub specialist evaluation. Outcomes were assessed in patients with a PN identified before (01/02/ 2018-03/31/2019) and after (04/01/2019-09/30/2020) implementation of the intervention in 4 primary care practices. RESULTS: Pre-and post-implementation cohorts included 395 and 432 patients, respectively. Mean age was 65.1±10.8 vs 65.0±11.8 (p=0.881) and 59.5% vs 60.2% were female (p=0.895). Race was White in 52.4% vs 43.3%, Black in 39.5% vs 45.1%, and other 8.1%vs 11.6%(p=0.166). Recommended management was surveillance chest CT (72.4% vs 73.6%), subspecialist referral (21.0% vs 13.7%), or no further imaging (6.6% vs 12.7%;p=0.001). Disclosure of PNs increased from 78.5% to 94.9%, an improvement of 16.4% (95% CI 11.9-21.0%). Surveillance CT ordering increased from 66.4% [n=190/286] to 88.7% [n=282/318], an improvement of 22.3% (95% CI 15.8-28.7%) and CT completion increased from 67.1% [n=192/286] to 85.5% [n=272/318], an improvement of 18.4% (95% CI 11.7-25.1%). When CT was completed >30 days after the recommended time interval, median delay was reduced by 66.5 days (163.5 [n=72] vs 97.0 [n=97], p=0.004), despite post-intervention overlapping with the COVID-19 pandemic (Figure 1). The rate of completed sub specialist evaluation was similar (94.0% [n=78/83] vs 93.9% [n=46/49], p=1). CONCLUSIONS: A multicomponent division-level intervention improved rates of PN disclosure and surveillance CT ordering and completion. Our findings support expansion of system-level approaches that standardize and automate processes to improve guideline adherence.

Journal of Neuropathology and Experimental Neurology ; 81(6):476-476, 2022.
Article in English | Web of Science | ID: covidwho-1866087
International Review of Research in Open and Distributed Learning ; 21(4):238-244, 2020.
Article in English | Web of Science | ID: covidwho-1008410


Isolation can affect our well-being negatively. To prevent the spread of the infection COVID-19, many workers, including university lecturers, are required to work from home. In order to maintain high levels of well-being and team cohesion, academics at the University of Derby Online Learning initiated a virtual huddle to briefly socialise and check on their colleagues' well-being every morning. This piece of field notes reports the context (COVID-19 in the United Kingdom), the details of this morning socialization, the first-hand experience of attending this huddle, and possible applications. Perceived positive impacts of our huddles include better well-being, cultivating compassion in team culture, and enhanced team cohesion. These advantages can be also useful in student supervision, wider socialization with colleagues to counter the silo mentality, and other occupational sectors. Our field notes will be helpful for lecturers and other types of employees who work collaboratively yet in isolation during this uncertain and challenging time of crisis.