Procedure Based Telehealth Utilization in General Surgery

Introduction: After COVID-19, telehealth (TH) capabilities expanded relaying patient satisfaction, time savings, and efficient access to care. We hypothesize standardized TH scheduling processes improves TH utilization without increasing adverse events (AE). Method(s): The Telehealth Utilization Quality Improvement Initiative was conducted from 8/2021-1/2022 in the general surgery clinic. 50 visits pre-implementation and 70 visits post-implementation were audited over the study period. Stakeholders were engaged including faculty, clinic coordinators, and administrative staff to identify current workflows and potential interventions, targeting outpatient elective procedures. Process mapping outlined current TH scheduling workflows. Outcomes such as percent TH scheduled in clinic, in addition to cost, and adverse patient events were collected post-implementation. Result(s): Preliminary data revealed 50 patients who underwent elective outpatient surgeries, all appropriate for TH postoperative follow-up visits. Overall, the pre-implementation TH scheduling rate was 32%. TH was schedule dafter surgery in the preintervention group. The intervention required TH postoperative appointments to be scheduled in clinic at the time of surgery scheduling with TH being the default postsurgical appointment for a standardized list of eligible procedures. After implementation, 95% of patients undergoing elective, outpatient general surgery procedures were scheduled for a TH visit with 83% of patients completing their follow up via TH.This resulted in increased revenue of $30,431 in billable visits due to increased clinic visit availability. No AE were seen. Conclusion(s): Standardizing TH scheduling based on procedure improves the utilization of TH in outpatient, elective general surgery procedures resulting in improved clinic efficiency, increased revenue, and no AE.

Outpatient treatment of abdominal wall hernia. A strategy to reduce the impact of the COVID-19 pandemic

Outpatient treatment of the abdominal wall hernia. A strategy to reduce the impact of the Covid-19 AIM: The aim of this study is to demonstrate the feasibility and efficacy of the treatment of abdominal wall hernias in ambulatory setting in selected patients to break down long waiting lists due to the COVID 19 pandemic.METHODS: From February to June 2021, we performed 120 hernia repair operations with local anesthesia in ambulatory settings without anesthetists. (105 inguinal hernia, 6 femoral hernia and 9 umbilical hernia). All patients were selected from our waiting lists first through a telephone interview through an adequate collection of the anamnesis and then clinically (LEE index and ASA score) and based on the characteristics of the hernia.RESULTS: For all patients, the operation was performed under local anesthesia with lidocaine and naropine. Lichtenstein tension-free mesh repair were performed for all patients with inguinal hernia;polypropylene mesh-plug was the technique used to repair the crural hernias while a direct plastic was performed for the treatment of umbilical hernias.. The mean age was 58 years. We did not observe any intraoperative complications and patients were discharged after 4 hours of operation. There was no case of readmission. Only 3 (2.5%) patients developed scrotal bruising. We did not observe any other complications or recurrence at 30 days and 6 months. Most patients (97.5%) expressed satisfaction for local anesthesia and for the path created.CONCLUSION: Hernia pathologies could be treated in ambulatory setting with good results in selected patients and could represent an alternative to face the limitations imposed by the COVID pandemic on daily surgical activities.

Transthoracic echocardiography outcomes in critical COVID-19 and association with symptom burden - a longitudinal cohort study

Objective: To look for any relationship between severe/critical coronavirus disease 2019 (COVID-19) illness and post-discharge cardiac function, and also assess any correlation between this and post-COVID symptom burden. Design: Observational cohort study with both retrospective and prospective components. Setting: Intensive Care Unit (ICU) and subsequent outpatient clinic at a tertiary hospital in Western Sydney, New South Wales (NSW), Australia. Patients: All patients admitted to the ICU with COVID-19 infection between 01 July 2021 and 31 December 2021 were included (n=89). Interventions: The cohort was divided into survivors (n=61) and non-survivors (n=28). Those who underwent transthoracic echocardiography (TTE) (survivors, n=22;and non-survivors, n=23). The survivors who had an inpatient TTE were invited back for a repeat TTE and standardised symptom assessment questionnaire (COVID-19 Yorkshire Rehabilitation Scale [C19-YRS]). For all patients, demographic, clinical, biochemical, and pharmacologic data was collected. Measurements and results: Eighty-nine patients were included in the initial dataset, of which 45 had a TTE whilst acutely unwell, and 22/45 survived to hospital discharge. There were no significant differences in the measured TTE parameters between survivors and non-survivors. Of the survivors with a follow-up TTE, the majority of the changes seen in the initial study had resolved. Despite this, there was still an appreciable symptom burden in the domains of fatigue, breathlessness, ability to independently do activities of daily living, and overall reduced perception of health. Conclusions: In a cohort of critically unwell COVID-19 patients, there were no significant echocardiographic differences between survivors and non-survivors. For the survivors, whilst the majority of acute cardiac changes associated with COVID-19 infection resolved over time, however, there remained a significant symptom burden, including breathlessness and fatigability, suggesting a non-cardiac aetiology of these symptoms.

Economics of a Health System's Direct-to-Consumer Telemedicine for Its Employees

Am J Manag Care. 2023;29(6):In Press _____ Takeaway Points The value of direct-to-consumer (DTC) telemedicine services offered by academic health systems is understudied. * DTC telemedicine services for low-acuity or minor illnesses are increasingly offered as an employee benefit, but any per-episode unit cost advantage may be offset by overuse of care. * DTC telemedicine staffed by an academic health system and offered to its employees resulted in lower per-episode unit costs for care within 7 days and only marginally increased the use of services. * DTC telemedicine staffed by an academic health system and offered directly to employees was cost-saving. _____ Employers in the United States have increasingly been offering a direct-to-consumer (DTC) telemedicine benefit for low-acuity or minor illnesses to their employees.1-3 By 2021, more than 95% of employers with 50 or more employees provided some coverage for DTC telemedicine in their largest health plan;more than 75% felt that offering telemedicine was important and nearly 20% either limited or eliminated cost sharing for telemedicine.4 Despite these trends among general employers, few health systems have directly provided DTC telemedicine to their own employees. [...]because these services are easy to access (often available immediately, around the clock, and without travel), they may induce overuse of care, especially for self-limited conditions such as viral upper respiratory infections for which the alternative to in-person care is no care at all, thus increasing the overall cost of care.5-11 Telemedicine will save money relative to in-person care if any unit price advantages are not overwhelmed by the increased use of care overall, induced by its convenience. Employers provide health insurance coverage for 158 million Americans or nearly 50% of the population. Since the COVID-19 pandemic began, telemedicine has represented a significantly larger portion of all medical claims—consistently more than 5% of all medical claims by mid-202112-15—and the estimated value of the global telemedicine industry is projected to reach a quarter of a trillion dollars by 2024.13 Yet, the future of telemedicine remains undetermined with reimbursement rates in debate,16-18 driven in large part because its economic value is understudied and uncertain. Penn Medicine is self-insured and more than 95% of employees use its only employer-sponsored plan—a preferred provider organization (PPO) plan—rather than insurance obtained individually or through a family member. Since 2017, these PPO-insured employees have been offered Penn Medicine OnDemand,19 a 24/7 DTC telemedicine benefit to employees and their adult (≥ 18 years) dependents.

Recent COVID-19 infection is associated with increased mortality in the ambulatory surgery population.

BACKGROUND: The effect of COVID-19 infection on post-operative mortality and the optimal timing to perform ambulatory surgery from diagnosis date remains unclear in this population. Our study was to determine whether a history of COVID-19 diagnosis leads to a higher risk of all-cause mortality following ambulatory surgery. METHODS: This cohort constitutes retrospective data obtained from the Optum dataset containing 44,976 US adults who were tested for COVID-19 up to 6 months before surgery and underwent ambulatory surgery between March 2020 to March 2021. The primary outcome was the risk of all-cause mortality between the COVID-19 positive and negative patients grouped according to the time interval from COVID-19 testing to ambulatory surgery, called the Testing to Surgery Interval Mortality (TSIM) of up to 6 months. Secondary outcome included determining all-cause mortality (TSIM) in time intervals of 0-15 days, 16-30 days, 31-45 days, and 46-180 days in COVID-19 positive and negative patients. RESULTS: 44,934 patients (4297 COVID-19 positive, 40,637 COVID-19 negative) were included in our analysis. COVID-19 positive patients undergoing ambulatory surgery had higher risk of all-cause mortality compared to COVID-19 negative patients (OR = 2.51, p < 0.001). The increased risk of mortality in COVID-19 positive patients remained high amongst patients who had surgery 0-45 days from date of COVID-19 testing. In addition, COVID-19 positive patients who underwent colonoscopy (OR = 0.21, p = 0.01) and plastic and orthopedic surgery (OR = 0.27, p = 0.01) had lower mortality than those underwent other surgeries. CONCLUSIONS: A COVID-19 positive diagnosis is associated with significantly higher risk of all-cause mortality following ambulatory surgery. This mortality risk is greatest in patients that undergo ambulatory surgery within 45 days of testing positive for COVID-19. Postponing elective ambulatory surgeries in patients that test positive for COVID-19 infection within 45 days of surgery date should be considered, although prospective studies are needed to assess this.

Free-living monitoring of ambulatory activity after treatments for lower extremity musculoskeletal cancers using an accelerometer-based wearable - a new paradigm to outcome assessment in musculoskeletal oncology?

PURPOSE: Ambulatory activity (walking) is affected after sarcoma surgery yet is not routinely assessed. Small inexpensive accelerometers could bridge the gap. Study objectives investigated, whether in patients with lower extremity musculoskeletal tumours: (A) it was feasible to conduct ambulatory activity assessments in patient's homes using an accelerometer-based wearable (AX3, Axivity). (B) AX3 assessments produced clinically useful data, distinguished tumour sub-groups and related to existing measures. METHODS: In a prospective cross-sectional pilot, 34 patients with musculoskeletal tumours in the femur/thigh (19), pelvis/hip (3), tibia/leg (9), or ankle/foot (3) participated. Twenty-seven had limb-sparing surgery and seven amputation. Patients were assessed using a thigh-worn monitor. Summary measures of volume (total steps/day, total ambulatory bouts/day, mean bout length), pattern (alpha), and variability (S2) of ambulatory activity were derived. RESULTS: AX3 was well-tolerated and feasible to use. Outcomes compared to literature but did not distinguish tumour sub-groups. Alpha negatively correlated with disability (walking outside (r=-418, p = 0.042*), social life (r=-0.512, p = 0.010*)). Disability negatively predicted alpha (unstandardised co-efficient= -0.001, R2=0.186, p = 0.039*). CONCLUSIONS: A wearable can assess novel attributes of walking; volume, pattern, and variability after sarcoma surgery. Such outcomes provide valuable information about people's physical performance in their homes, which can guide rehabilitation. Implications for rehabilitationRoutine capture of ambulatory activity by sarcoma services in peoples' homes can provide important information about individuals "actual" physical activity levels and limitations after sarcoma surgery to inform personalised rehabilitation and care needs, including timely referral for support.Routine remote ambulatory monitoring about out of hospital activity can support personalised care for patients, including identifying high risk patients who need rapid intervention and care closer to home.Use of routine remote ambulatory monitoring could enhance delivery of evidence-based care closer to peoples' homes without disrupting their daily routine and therefore reducing patient and carer burden.Collection of data close to home using questionnaires and objective community assessment could be more cost effective and comprehensive than in-hospital assessment and could reduce the need for hospital attendance, which is of importance to vulnerable patients, particularly during the Covid-19 pandemic.

Role and impact of a clinical pharmacist in an ambulatory reproductive endocrinology and infertility clinic.

In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

[Validation of a symptom scale for COVID-19 patients in ambulatory care]

Background: A symptom scale can be useful for the standardization of clinical evaluations and follow-up of COVID-19 patients in ambultaroy care. Scale development should be accompanied by an assessment of its reliablility and validity. Objective: To develop and measure the psychometric characteristics of a COVID-19 symptom scale to be answered by either healthcare personnel or adult patients in ambulatory care. Material and methods: The scale was developed by an expert panel using the Delphi method. We evaluated inter-rater reliability, where we defined a good correlation if Spearman's Rho was >= 0.8;test-retest, where we defined a good correlation if Spearman's Rho was >= 0.7;factor analysis using principal component methodology;and discriminant validity using Mann-Whitney's U test. A p < 0.05 was considered statistically significant. Results: We obtained an 8 symptom scale, each symptom is scored from 0-4, with a total minimum score of 0 and a maximum of 32 points. Inter-rater reliability was 0.995 (n = 31), test-retest showed correlation of 0.88 (n = 22), factor analysis detected 4 factors (n = 40) and discriminant capacity of healthy versus sick adults was significant (p < 0.0001, n = 60). Conclusions: We obtained a reliable and valid Spanish (from Mexico) symptom scale for COVID-19 ambulatory care, answerable by patients and health care staff. Copyright © 2023 Revista Medica del Instituto Mexicano del Seguro Social.

General Anesthesia Strategies for Safe, Rapid Recovery, Fast Turnaround, and Same-Day Discharge for Complix Abalations in the Ep-Specialized Asc Setting

Background: Many EP procedures are moving from the hospital to the ambulatory surgery center (ASC) outpatient setting. The COVID-19 pandemic and the CMS Hospitals Without Walls (HWW) program has been an impetus in accelerating this transition. Anesthesia provider perioperative management is critical in facilitating safe procedures with rapid, same-day discharge. Our EP-dedicated 2-OR ASC completed more than 3,000 procedures and more than 500 left-sided ablations utilizing general anesthesia with endotracheal intubation with same-day discharge. To our knowledge, this experience is unique within an ASC setting in both volume and complexity. Objective(s): We present our comprehensive anesthesia strategy and lessons learned to facilitate safe, efficient procedures and discharge in an EP ASC. Method(s): A nurse anesthesiologist with more than a decade of EP-dedicated experience developed and taught a perioperative anesthesia strategy to facilitate high volume, safe and quick discharge care. Fundamental to this is the avoidance of opioids and benzodiazepines whenever possible. Propofol or general anesthesia with sevoflurane and complete reversal with sugammadex allow for quick recovery. Mandatory video laryngoscope utilization minimizes airway trauma, while liberal antiemetic use eliminates most nausea. All femoral access is device closed. Positive inotropes are used liberally during anesthetic to avoid heart failure. The goal is to deliver all patients to PACU on room air with stable hemodynamics. Anesthesia providers manage the preop and recovery area. Result(s): More than 90% of all patients undergoing general anesthesia and heparinization for left-atrial ablation were discharged home in under 3 hours. Nearly all procedures not requiring femoral access were discharged within 30-60 minutes. High procedure volumes with efficiencies far exceeding our in-hospital experience were thus facilitated with improved patient safety. Since HWW began, five patients have required transfer to the hospital without any deaths. All others were discharged same day. Conclusion(s): We suggest that a dedicated anesthesia team with a tailored perioperative anesthesia plan facilitates performing nearly all EP-related surgical procedures in an ASC. This success is facilitated by appropriate patient selection, preoperative evaluation, intraoperative care prioritizing quick return to baseline, and end-to-end anesthesia perioperative management. We believe this type of anesthesia management is critical to the transition of EP procedures to ASCs.Copyright © 2023

Evaluation of the Prevalence of Psychological Disturbances in Patients with Immune-Mediated Rheumatic Diseases and Covid-19 Infection in an Ambulatory Service

Objectives: COVID-19 is an acute respiratory infection caused by the new coronavirus that has spread around the world, becoming an international public health emergency. Studies have shown a high prevalence of psychiatric symptoms such as depression, anxiety and post-traumatic stress disorder in patients after the infection, a situation that can be evenmore pronounced in patients with chronic diseases such as Immune-mediated rheumatic diseases (IRMD). The aim of this study is to evaluate the psychological impact of the COVID-19 infection and pandemic on patients with IRMD as well as to describe the epidemiological profile of the selected population. Method(s): A longitudinal cohort observational study was carried out with a comparison group, based on the analysis of data from patients of Project Reumacov, organized by de Brazilian Society of Rheumatology, in Manaus/ Amazonas. Data regarding the psychological impact was obtained through the application of DASS-21 forms, which evaluated levels of depression, anxiety and stress. Possible answers were divided into four categories according to the frequency of the symptoms presented, such as Not applicable;Present for a short time;Present for a significant amount of time or Present most of the time. Result(s): In total, 283 patients were included in the study. The mean age was 44 years and the majority of the patients were female. The most frequent diagnosis was systemic lupus erythematosus, followed by rheumatoid arthritis. Of the patients included, 270 answered the DASS-21 questionnaire, being 152 in the Case group (patients with COVID-19) and 118 in the Control group (patients without COVID-19). There was a significant statistic correlation between high levels of depression, anxiety and stress and the presence of COVID-19 related symptoms. Conclusion(s): Our study demonstrated that high levels of stress, depression and anxiety were associated to the coronavirus infection. It is, however, difficult to determine whether this scenario is a result of a physiological response to the infection or a consequence of the social context of a pandemic. This knowledge may contribute to a better understanding of COVID-19 infection and its repercussions as well as to highlight the necessity of a multidisciplinary approach aimed at the mental health of patients with rheumatic diseases.

Collaboration between pharmacists in community pharmacy and ambulatory clinic settings: Current state and future directions

Pharmacists in the community and ambulatory settings are primed for collaboration that can optimize care. Now is the time to capitalize on the momentum and positive disruption of the COVID-19 pandemic that propelled pharmacists and their organizations to respond with agility to deliver care in new ways, pivot to develop new partnerships, and leverage technology. The growth of collaborative practice agreements within ambulatory care settings, the enhancement of clinically integrated networks, and the growth in professional organization support create an environment ripe for implementation of pharmacist-to-pharmacist collaborations. The American College of Clinical Pharmacy 2022 Clinical Practice Affairs B Committee sought out literature, as well as prepublication contemporary examples, demonstrating models of intraprofessional collaboration among pharmacists in community and ambulatory settings. The committee formulated six key recommendations to optimize pharmacist collaborations in the community and ambulatory settings and formed a framework for practical implementation strategies at the levels of individual pharmacists, organizations, and educational institutions and for legislative advocacy.Copyright © 2023 Pharmacotherapy Publications, Inc.

Innovations in Ambulatory Stewardship

Ambulatory antibiotic use accounts for most of the global consumption of antibiotics leading to selection pressure, multidrug resistance, and significant healthcare costs (https://www.cdc.gov/antibiotic-use/community/pdfs/16_268900-A_CoreElementsOutpatient_508.pdf) The Centers for Disease Control and Prevention established the Core Elements of outpatient antimicrobial stewardship in 2016 as a framework to develop, expand, and evaluate ambulatory stewardship programs, which must address overuse in multiple settings (e.g., urgent care centers, adult and pediatric outpatient practices, dental practices, and retail clinics). As such, we present examples of innovative yet adaptable outpatient stewardship initiatives encompassing a variety of settings. We also address patterns of ambulatory antibiotic prescribing and novel stewardship initiatives implemented during the novel coronavirus disease 2019 (COVID-19) pandemic. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Feasibility of Outpatient Robot Assisted Laparoscopic Prostatectomy

INTRODUCTION AND OBJECTIVE: Research demonstrates the benefits of robotic-assisted prostatectomies (RARP) in regard to blood loss and post-operative recovery, there is a paucity in the literature regarding RARP as an outpatient procedure. With minimal operating room capacity during COVID-19, advances in minimally invasive surgical techniques and a relatively healthy patient population, outpatient RARP may be feasible. The aim of our study was to demonstrate the safety and feasibility of RARP as a same day outpatient procedure. METHOD(S): A retrospective cohort study at a single institution was performed by four fellowship trained surgeons who routinely perform RARP. Patients were identified through billing records who underwent RARP between January 2019 and December 2021. Patients were divided into two cohorts, inpatient (one stay past midnight) and outpatient (defined as same day surgery with no stay past midnight). Individual surgeons admission necessity during COVID-19 limitations. We then extracted data using the electronic health record (EHR). The two groups were then compared using standard statistical methods for cohort studies. Statistical significance was defined as p<0.05. RESULT(S): Over a two-year period, a total of 497 RARP were performed with 139 (28%) outpatient cases. There was no difference in baseline demographics between the cohorts. There was a statistically significant difference in estimated blood loss (142 vs 102 mLs, p>=0.001) and operative time (193 vs 180 mins, p=0.004) in the inpatient vs outpatient cohorts, respectively. There was no significant difference in cancer stage, prostate size, or node/margin positivity between cohorts. There was a higher rate of readmissions (5% vs 0%, p=0.007) and number of ED presentations (0.15 vs 0.05, p=0.019) in the inpatient group. There was no difference in complication rates between the groups. Importantly, there was no significant difference in burden on the clinical staff demonstrated by no difference in number of phone calls to clinic, number of EHR messages, or opioid prescriptions on discharge. CONCLUSION(S): Overall, our data suggests that in a well selected patient group, RARP can safely be performed as an outpatient procedure with no significant differences on clinic staff workload or oncologic outcomes. While there was no pre-defined "algorithm" to determine outpatient vs inpatient surgery, the similarity in demographics and pre-operative characteristics between the groups lends support to performing this procedure as an outpatient with inpatient admission being reserved for select patients.

Multitasking: Is It Worth the Risk?

[...]the nurse may be triaging a patient who is reporting symptoms and at the same, a staff member gives the nurse a critical lab result. Despite the perception that multitasking is an impressive skill, it is actually detrimental and, in some cases, risky. Since human multitasking became a phenomenon, it has been studied by many scientists. For the well-being of you and your patients, slow down, pause, and focus. * Kathryn Koehne, DNP RN, AMB-BC, C-TNP is Director of Nursing and Operations, Crescent Cove, Minneapolis, MN;Consultant and Presenter, Telephone Triage Consulting, Inc.;and Adjunct Faculty, Viterbo University, La Crosse, WI. Sg2 Health Care Intelligence. https://www.sg2.com/health-care-intelligence-blog/2021/06/sg2-2021-impact-ofchange-forecast/ Merriam-Webster.

National assessment of school resources in cystic fibrosis care centers

Background: Assessment of the prevalence and correlates of educational risk and school support needs of children with cystic fibrosis (CF) is limited. Educational support for people with CF has become even more pressing with the onset of COVID-19 and the dramatic changes seen in the education system nationally. Method(s): A cross-sectional needs assessment survey for pediatric and adult CF center care team members across the United States was distributed to assess student and family school needs, resources, services offered, and current processes for identification of concerns and intervention. Care teams were asked to complete the survey as a group or specify respondents who routinely provide school support. Result(s): The survey was sent to 3684 individuals within the CF care center network, on April 1, 2022, with a closure date of April 22, 2022. Preliminary results at time of this submission include 56 survey responses, completed primarily by social workers (40%) and physicians (23%), representing approximately 20% of all centers. Thirty-eight percent of respondents reported that their center administered a screening tool to assess general school functioning routinely or as needed. Specific school topics most widely assessed included need for CF care (treatments and medications) to occur at school (73%), concerns about emotional and behavioral functioning in the school setting (70%), CF daily care burden affecting school attendance and performance (63%), and CF-specific needs in university settings (63%). According to the care team report, families most often asked for help with school accommodations related to ability to carry enzymes (74%), carrying awater bottle (50%), additional bathroom passes (43%), and ability to step out of the classroom as needed for gastrointestinal problems (50%). Nurses, program coordinators, and social workers are the team members addressing school needs most often (55%, 42%, and 90%, respectively). Sixty-two percent of respondents reported having access to a hospital-based teacher for education support during inpatient stays, 10% had access to school services or educational support, and 5% had access to someone with a background or training in education or teaching (other than hospital-based teacher) for ambulatory care. Upon closure of the survey, the above data will be updated, and more complete identification of current resources and future needs will be described at the 2022 North American Cystic Fibrosis Conference. Conclusion(s): This survey will be the most comprehensive assessment to date of ongoing school services at CF centers nationally. Results will be used to identify specific areas of need to guide development of a roadmap addressing proactive monitoring of school functioning and resources in the CF care modelCopyright © 2022, European Cystic Fibrosis Society. All rights reserved

WORKER WELL-BEING: Transforming From a Traditional to a More Holistic OSH Program

[...]in 1996, with campus president support, an umbrella safety council was created that includes representation of both OSH and non-OSH activities. Over time, the non-OSH representation has expanded, incorporating representatives from areas such as human resources, building facilities management, employee assistance and wellness, mental health, environmental waste management, campus security and disaster preparedness. With the safety councils support, the wellness and employee assistance programs conducted focus group discussions and determined a major cause of the observed stress was rooted in personal financial management challenges. With the onset of the COVID-19 pandemic in 2020, the safety council members became concerned about the overall well-being of the university community and, as such, assisted in the conduct of two waves of a campus-wide survey measuring aspects such as mental health, well-being concerns about COVID-19, personal finance worries and accessing reliable sources of information.