ASYNCHRONOUS AND SYNCHRONOUS ONLINE LEARNING DURING A PANDEMIC

Online education led to the survival of many colleges and universities devastated by Hurricane Katrina. However, despite the subsequent recommendations of scholars to institutionalize distance education, many institutions found themselves ill-prepared for the shift to remote or online teaching during the COVID-19 pandemic. One university's strategy of building distance education infrastructure and instructional design capacity for fully online master (template) courses allowed learning and teaching to proceed-without closure-throughout the pandemic. Faculty increasing their use of instructor video and synchronous sessions resulted in high student satisfaction-equivalent to that before COVID. Recommendations for asynchronous and synchronous instruction are provided

Probable Transmission of SARS-CoV-2 from African Lion to Zoo Employees, Indiana, USA, 2021.

We describe animal-to-human transmission of SARS-CoV-2 in a zoo setting in Indiana, USA. A vaccinated African lion with physical limitations requiring hand feeding tested positive for SARS-CoV-2 after onset of respiratory signs. Zoo employees were screened, monitored prospectively for onset of symptoms, then rescreened as indicated; results were confirmed by using reverse transcription PCR and whole-genome virus sequencing when possible. Traceback investigation narrowed the source of infection to 1 of 6 persons. Three exposed employees subsequently had onset of symptoms, 2 with viral genomes identical to the lion's. Forward contact tracing investigation confirmed probable lion-to-human transmission. Close contact with large cats is a risk factor for bidirectional zoonotic SARS-CoV-2 transmission that should be considered when occupational health and biosecurity practices at zoos are designed and implemented. SARS-CoV-2 rapid testing and detection methods for big cats and other susceptible animals should be developed and validated to enable timely implementation of One Health investigations.

Supporting recovery in rural Indiana: From mobile to virtual

Many consumers, both youth and adults, are not accessing appropriate substance use treatment, necessitating the need for mobile response interventions. Choices Coordinated Care Solutions has developed a mobile response model that builds on Systems of Care values to engage consumers in intensive care coordination utilizing the evidence-based Screening, Brief Intervention, and Referral to Treatment approach and core values of wraparound. The choices emergency response team (CERT) model is an integrated, coordinated service delivery approach, relying on the skills and experience of its qualified staff to work with consumers in order to effectively identify the inherent strengths that all people have and to use those strengths to design innovative, trauma-informed approaches to treatment. A strong relationship with a broad network of stakeholders throughout the state and southeast Indiana serves as a foundation for the implementation of mobile response. These relationships with local resources empower consumers in their recovery journey. The evolution of the CERT model to strategically integrate technology, especially with incarcerated or justice-involved consumers, became an essential asset during the COVID-19 epidemic in 2020. The necessity of virtual consumer engagement has created opportunities for these recovery communities that may endure even after the pandemic is resolved. (PsycInfo Database Record (c) 2023 APA, all rights reserved) Impact Statement Crises related to substance use create significant burdens on individuals, families, and communities. Mobile response facilitates access to substance use treatments. This article describes key components of an emergency response model and how technology played an essential role in engaging consumers during the pandemic. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Public Defense after the Pandemic

[...]a significant number of backlogged cases are murder cases. According to a recent public defense workload study conducted by ABA SCLAID and consulting firm Crowe in Indiana, public defenders require, on average, 232 hours for a noncapital murder case in which the individual is not facing life without parole and 311 hours in a case in which the individual is facing life without parole. [...]the ability to adequately build or defend a case decreases as time goes past, meaning backlogs impact not only the timing of justice, but the quality of justice. According to the Prison Policy Initiative, even before the pandemic extended jail stays, "[s]omeone in jail is more than three times as likely to die of suicide as someone in the general U.S. population."

Temporal effects on death by suicide: empirical evidence and possible molecular correlates

Popular culture and medical lore have long postulated a connection between full moon and exacerbations of psychiatric disorders. We wanted to empirically analyze the hypothesis that suicides are increased during the period around full moons. We analyzed pre-COVID suicides from the Marion County Coroner's Office (n = 776), and show that deaths by suicide are significantly increased during the week of the full moon (p = 0.037), with older individuals (age ≥ 55) showing a stronger effect (p = 0.019). We also examined in our dataset which hour of the day (3–4 pm, p = 0.035), and which month of the year (September, p = 0.09) show the most deaths by suicide. We had blood samples on a subset of the subjects (n = 45), which enabled us to look at possible molecular mechanisms. We tested a list of top blood biomarkers for suicidality (n = 154) from previous studies of ours 7, to assess which of them are predictive. The biomarkers for suicidality that are predictive of death by suicide during full moon, peak hour of day, and peak month of year, respectively, compared to outside of those periods, appear to be enriched in circadian clock genes. For full moon it is AHCYL2, ACSM3, AK2, and RBM3. For peak hour it is GSK3B, AK2, and PRKCB. For peak month it is TBL1XR1 and PRKCI. Half of these genes are modulated in expression by lithium and by valproate in opposite direction to suicidality, and all of them are modulated by depression and alcohol in the same direction as suicidality. These data suggest that there are temporal effects on suicidality, possibly mediated by biological clocks, pointing to changes in ambient light (timing and intensity) as a therapeutically addressable target to decrease suicidality, that can be coupled with psychiatric pharmacological and addiction treatment preventive interventions.

The development of self-determination: A qualitative exploration of the Indiana choice scholarship program

The 1960s launched the school movement of choice. Today, school choice is nationally threaded through many states serving a diversity of students. Indiana developed and implemented the Indiana Choice Scholarship Program (ICSP) policy in 2011 to align with these national initiatives to benefit students. The goal for Indiana was to ease the burden of private education costs for families regardless of a family's income, but not all challenges within implementation have been remedied. The historical evolution of school choice currently focuses on the effectiveness of these state policies with regard to transitioning from the public to the private school for learners. Undergirded by Self-Determination Theory, this study focuses on high school students who matriculated from public to private ICSP Catholic schools. Participants were interviewed about their experience in both school settings after using the ICSP for at least one full schoolyear. Participants reflected on their ability to make autonomous decisions, the importance of feeling connected to others, and their understanding of actions needed for career readiness. By implementing qualitative inquiry (Saldana, 2016), interviews explored perceptions about the ICSP, focusing on SDT. This approach aided in analyzing individual students' perceptions behind the reasons why they chose to leave the public schools and enroll in Indiana's Choice Scholarship Program. Qualitative inquiry allowed for a discussion about what had worked well, what had been a challenge, and what had helped ICSP students imagine college and career readiness after transferring schools. This design gave participants an opportunity to discuss choices regarding behaviors developing autonomy, relatedness to peers and mentors, and competence within academic programs and extracurriculars. Qualitative inquiry also discussed relevant topics that naturally evolved from conversations (Crotty, 2015) such as the COVID pandemic. The rationale for this selection was to explore how the ICSP had shaped a student's opportunities for overall student success and college and career readiness using the SDT as a platform. The focus of this study was to have a discussion to understand if students see any benefit to a voucher scholarship program to attend an ICSP school. Cross-referencing responses added depth and understanding to the findings. Families still find school choice in Indiana difficult to sustain. Students in the study noted the challenge of transitioning from the public to the private school climates, commitment expectations, and financial costs associated with transferring to an ICSP school. While families still continue to struggle, Indiana continues to evolve the program to serve as many students K-12 as possible. Regardless of personal tests, participants in this study were satisfied with their decisions to leave the public school to attend the ICSP school. They felt for their college and career success, the transition was necessary. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

111. Adaptation and Delivery of a Partially Virtual Curriculum for Pre-Exposure Prophylaxis Peer Mentors in Kenya: Lessons Learned

Purpose: While Pre-Exposure Prophylaxis (PrEP) is highly effective at preventing HIV, uptake is low among adolescents. In low- and middle-income countries (LMIC), peer mentors (PMs) are considered best practice to increase PrEP acceptability and uptake. Globally, COVID19 has shifted much education and training to virtual formats. Most young people in LMIC have cell phones. Our objective is to describe our experiences developing and delivering a mixed virtual/physical curriculum for training PrEP PMs. Methods: IRB and local research ethics committee approval was obtained. A literature search (PubMed, EBSCO, USAID website, and MedEd Portal) yielded one published curriculum for PrEP PMs. This curriculum was combined with locally developed HIV PM education modules to create a new curriculum, with planned virtual and physical sessions. Curriculum materials were reviewed and agreed upon by all authors. All sessions were delivered by authors, with the majority delivered by Americans. The first 4 hours were done virtually via Zoom, covering the basics of HIV, detailed information on PrEP, adolescent development, and confidentiality. The remaining sessions were held in person and covered expectations of PMs, basic family planning, research ethics, action planning, role playing, and a review of virtual topics. Feedback was solicited from the PMs after virtual training. A debriefing session was held with the five facilitators involved in training: 1 research staff and 1 physician investigator from Kenya, 1 research staff and 2 physician investigators from the US - all female. Results: All five PMs (aged 21 – 27) participated. One identified as female, and one as LGBTQ. Feedback was solicited via anonymous survey (n=3) after the virtual sessions and debriefing with Kenyan research staff. Respondents strongly agreed that the virtual training was worth their time. Although PMs felt they were able to learn in the virtual format, facilitators noted more engagement during in-person sessions. Facilitators noted the importance of introductions and challenges of building cohesiveness for virtual sessions, particularly with sensitive content and internet limitations restricting video use (eg. low bandwidth, use of cell phones). Kenyan investigators noted that the Kenyan educational system is hierarchical, with students largely learning passively. They felt that this, combined with the newness of virtual learning and minimal dedicated time for introductions, may have hampered active virtual participation. While no PMs pointed to race or accent as limitations, facilitators noted differences between American and Kenyan English idioms, cadence, speed, and pronunciation that may have caused difficulty. Given Kenya's history of colonialism, all raised concerns that PMs may have been more deferential to light-skinned, foreign facilitators. Facilitators who observed both virtual and in-person sessions felt it was easier to break barriers of colonialism and assess for differences in spoken English in person. Facilitators felt that if virtual training were to be used in the future, it would be beneficial to have physical sessions first to set an interactive, educational tone and allow participants to build rapport. Conclusions: Virtual delivery of PM educator training in a LMIC setting is difficult and requires careful consideration or technological limitations and culture. Sources of Support: Indiana CTSI;Grant Number UL1RR025761-01.

142. The Reach, Implementation, and Effectiveness of Virtual Sex Education for Youth in Foster Care

Purpose: Youth in foster care have high rates of adverse sexual health outcomes and are important targets for evidence-based sex education. With the COVID-19 pandemic, sexual health programming was moved to a virtual format. However, few data existed to guide this transition. While it lowers expenses and can potentially broaden geographic reach, it is unclear if virtual programming meets the needs of youth in foster care or other vulnerable populations. We conducted a mixed-methods analysis comparing the reach, implementation, and effectiveness of virtual vs in-person sex education for youth in foster care before and during the COVID-19 pandemic. Methods: Indiana Proud and Connected Teens (IN-PACT) provides evidenced-based sex education programs to system-involved youth. The data used in this study focused exclusively on foster-care programming and includes attendance records, facilitator session reviews (n=64) from 2020-2021 virtual programs, and youth surveys from 2018-2020 in-person (n=965) and virtual (n=50) programs. Reach was measured using youth baseline survey demographics and sexual behaviors;implementation by free responses from facilitators on challenges and adaptation for virtual teaching;and effectiveness by attendance records and youth behavior intention on follow-up surveys. Results: Reach: Youth demographic diversity was maintained for virtual programming in ethnicity, race, sex, and sexual orientation. However, youth in virtual programs had lower rates of self-reported risk behaviors including lower rates of involvement with juvenile justice (35.0% vs 59.4%, p<0.01) to have ever had sex (44.4% vs 78.8%, p<0.001) or contributed to a pregnancy (4.4% vs 23.4%, p<0.05). And though not statistically significant, virtual youth reported higher rates of condom use (44.4% vs 30.4%, p=0.371) and lower rates of substance use before sex in the past 3 months (15.6% vs 28.5%, p=0.114) as compared to in-person youth. Implementation: Technical challenges included connection difficulties and learning curves to using Zoom. Virtual facilitators incorporated more technology than they did in-person by playing videos on complicated topics such as conception and STIs. In terms of curriculum, hands-on condom demonstrations were changed to facilitator-run experiments such as having youth use socks at home to simulate condoms on their arms. Breakout rooms were utilized to maintain small group work but were cumbersome. Relational challenges included awkward silences, disengagement, and a decrease in group trust due to cameras being turned off during sensitive topics and less connection between youth and facilitators. Effectiveness: Attendance records show that fewer virtual youth completed 100% of programming, as compared to in-person youth (23% vs 54%). More virtual youth answered yes to the question "As a result of this program, will you abstain from sex for the next three months?” as compared to in-person youth (55% vs 45%, p=0.462). However, virtual youth were significantly less likely to have baseline sexual experience. Conclusions: In-person sexual health programming had a wider reach, experienced fewer implementation challenges, and was potentially more effective than virtual programming for youth in foster care. If virtual programming becomes necessary again, sex educators and researchers can use these data to redesign virtual programming that maximizes reach, implementation, and effectiveness. Sources of Support: HHS 90AK0041-02-00 to Health Care Education and Training Inc.

Devising in the Pandemic: Trauma and a Dramatic Redesign of a Youth Theatre Tour

Z402 Youth Theatre Tour was designed from a critical performative pedagogical positioning (Weltsek, 2019). Here learning emerges from how individuals and communities perform their emergent identities as they cross literal and metaphorical socio-cultural borders. Z402 resulted in a 100% student created new play, parallel workshop, and study guide. This new play was based solely upon the students' perspectives, voices, and ways of being. The design used devised theatre, the use of improvisation and games, to create a new play versus a solely written approach. The new play dealt with healing in the face of suicidal thoughts. The course addressed four Indiana educational licensing requirements, student technical, artistic, educational, and class practicum experiences. In March 2020, due to the novel coronavirus (COVID-19) pandemic, the University instituted obligatory Online instruction. Students redesigned their stage play into a virtual experience using Zoom and integrated their emotional struggles due to pandemic isolation. The live play, slated for three schools, is now accessible to a large virtual audience.

A New Network for a Changed World

Among the things that will be remembered about the year 2020 are phrases like "You're still on mute" and "Can I share my screen?" They are emblematic of how educators have been challenged to navigate uncharted waters of remote learning and overnight technological adaptation. To quote another phrase that will be remembered as a cliché, "These are unprecedented times." Learning Forward's newest network, Design Professional Learning for a Virtual World (DPLV), is designed to meet educators' pressing needs in this unusual moment by supporting districts and states with proactive planning tools and processes. Learning Forward and DPLV's first cohort of nine district and state education agency members are collaborating on how to stay strategic through the compounding challenges of responding to COVID-19, a national reckoning with racial injustice, and growing fiscal uncertainty caused by a mix of public health and public policy developments. This article describes the work of the DPLV as they engage in a planning process with customized coaching tailored to their local contexts and needs during and beyond the pandemic.

Student Outcomes Related to Academic Performance, Motivation, and Mental Health in an Online Materials and Energy Balances Course during the COVID-19 Pandemic

This study evaluates students' outcomes in an online materials and energy balances course during the COVID-19 pandemic. Using multiple linear regression, we found that students' "competence" and "autonomy" beliefs decreased across the semester, with a negative change in competence beliefs predicting higher grades for students, especially women. Also, we used path analysis to model the relationship between "psychological distress," motivation, and final grades. These results give insight into how to support students during difficult circumstances.

Exploring Introductory Communication Course Administrators' Relationship Management during COVID-19

The COVID-19 pandemic rapidly changed the context of higher education during the Spring 2020 semester. As the virus began to spread across the United States, colleges and universities canceled inperson classes and activities, closed campus, and moved all operations online. Within the communication discipline, introductory communication course (ICC) administrators and instructors were not only dealing with these challenges, but they were also navigating the transition of large multi-section, often standardized, courses online at large institutions. This research project used semistructured, in-depth interviews with 18 ICC administrators from institutions located in 14 states across the Midwest, mid-Atlantic, Southeastern, and West Coast regions of the U.S. to explore how they engaged in relationship management with their instructors and how their approach to relationship management informed their transition to remote learning due to COVID-19. The analysis results in four emerging themes: (1) rhetorical approaches to relationship management, (2) relational approaches to relationship management, (3) relationship management [right arrow] positive outcomes, and (4) relationship management as central to navigating COVID-19. Based on these findings we suggest a rhetorical/relational goals approach to course administration and offer practical implications ICC administrators can implement to engage in successful relationship management during times of crisis.

Service Learning during a Global Pandemic: How and Why?

This case study provides an overview as to how two faculty members co-taught an asynchronous online course with a service-learning component during the COVID-19 global pandemic. Within this paper, the authors recount the adjustments that were made in order to accommodate an online teaching modality while maintaining their commitment to service learning.

Burnout in the Early Childhood Education Sector: Considering the Roles of Stress, Distress, and Support

Objectives: Early childhood education (ECE) has been shown to increase cognitive-academic functioning, developmental outcomes, and social performance at the time of entering school with benefits persisting into adulthood. Turnover has been a longstanding issue in childcare, with estimates of 15%-25% of providers exiting the field each year. The COVID-19 pandemic has increased ECE workforce exit, leading to a crisis in childcare demand. Burnout contributes to turnover and negatively impacts the relationship between providers and children. In this study, we examined factors contributing to and protective against burnout for ECE providers. Method(s): Paper questionnaires were administered at 5 childcare centers in Indianapolis, Indiana, with responses from 47 ECE providers. A single-item burnout measure was used. Stress and distress were measured using the Perceived Stress Scale (PSS-10) and the Kessler-6 Psychological Distress Scale (K6). Additional single-item questions were utilized. The null hypothesis was that there would be no differences in the relationships between burnout with stress and distress and how those variables related to feelings toward childcare and sources of support. Analyses included descriptive statistics and correlations. Significant associations were entered into bivariate linear regression. Result(s): Stress (PSS-10, beta =.471) and distress (K6, beta =.489) were significantly (p <.001) associated with burnout. Feeling like quitting (beta =.696;p <.001), feeling stuck in childcare due to few other employment opportunities (beta =.494;p <.001), and liking providing childcare but finding it difficult to make a living (beta =.438;p <.01) were significantly related to burnout. Higher supervisor support (beta = -.743) and adequate breaks (beta = -.516) were significantly (p <.001) related to less burnout. Conclusion(s): Stress and distress for ECE providers were equally related to burnout. Burnout was related to feeling like quitting, feeling stuck, and finding it difficult to make a living in childcare. Only support from supervisors and adequate breaks were related to lower burnout scores. Our study supports the idea that a better understanding of perceived stress, adequate breaktimes, and support from supervisors may be important for addressing burnout and retention of quality ECE providers. EDUC, DEV, PSC Copyright © 2022

Clinical Features and Outcomes of Hospitalized Solid Organ Transplant and Hematopoietic Stem Cell Recipients with Sars- CoV-2 Infection in the Midwestern United States: A Multi-Center Retrospective Cohort Study

Purpose: Immunocompromised hosts are at risk for severe complications or death from SARS-CoV-2 infection. Few studies describe the clinical features, outcomes and treatment strategies in this population across multiple sites. Method(s): A multi-center retrospective analysis from academic medical centers in the Midwestern US was conducted for hospitalized patients with SARS-CoV-2 infection. Data was collected electronically using standardized intake and 28-day follow up case report forms. The centers included Northwestern University, University of Nebraska, Cleveland Clinic, University of Chicago, Indiana University and University of Kansas. Result(s): The cohort included 272 patients hospitalized from March 2020 to November 2021. Demographics are in Table 1. Mean admission was 6.84 +/- 6.42 days after symptom onset. The most commonly reported symptoms were cough (71.4%), dyspnea (59.6%), fatigue (55.3%), fever (54.9%), and diarrhea (43.9%). Admission CXR had pneumonia in 31.6%;63% with multifocal or patchy opacities. 87 patients had a chest CT;72 (82.7%) showed pneumonia. 97 patients (36.1%) required ICU admission. Treatments included remdesivir (58.5%), dexamethasone (54.4%), convalescent plasma (3.0%), IL-6 inhibitor (4.5%). Immunosuppression management included holding (44.2%) or decreasing (26.6%) the dose of antimetabolite. 76 patients (28.3%) had documented bacterial co-infection, in blood (34.1%), lung (30.6%) and urine (30.6%). 6 (2.2%) patients experienced rejection within 30 days and 8 patients (3.0%) developed CMV viremia. 26 patients (9.7%) died by day 28. Conclusion(s): This cohort had high rates of ICU admission (36.1%), bacterial coinfection (28.3%), rehospitalization (31.5%) and mortality (9.7%).

The Silver Lining for Pandemic-Era International Education

In this chapter, the first 18 months of the COVID-19 pandemic are revisited from the perspective of Indiana University’s Europe Gateway Director in Berlin, Germany. She describes how, within a matter of days in March 2020, the global mobility on which the Gateway’s programs depended came to a screeching halt and, in the bigger picture, the entire international education industry unraveled. Yet the author and her colleagues made their proverbial lemonade from the lemons they were given, developing innovative program ideas that addressed needs the pandemic brought upon international education only weeks into the initial shock and sudden new normal of remote work and virtual interaction. Online-only programming brought challenges, but great benefits as well. The crisis affected internal and external university partnerships in both nuanced and sea-change ways, and with potentially lasting impact. A glimpse at the post-pandemic horizon has come into view at the Indiana University Europe Gateway—and beyond. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

DIARRHEA, ELEVATED AST, AND ELEVATION OF INFLAMMATORYRELATED BIOMARKERS IS A PREDICTOR FOR MORTALITY IN MINORITY HOSPITALISED COVID-19 PATIENTS

Background and Aims: Initial reports on US COVID-19 showed different outcomes in different races. In this study, we use a diverse large cohort of hospitalized COVID-19 patients to determine predictors of mortality. Methods: We analyzed data from hospitalized COVID- 19 patients (n=5,852) from 8 hospitals. Demographics, comorbidities, symptoms and laboratory data were collected. Results: The cohort contained 3,662 (61.7%) African Americans (AA), 286 (5%) American Latinx (LAT), 1,407 (23.9%), European Americans (EA), and 93 (1.5%) American Asians (AS). Survivors and dead patients' mean ages were 58 and 68 for AA, 58 and 77 for EA, 44 and 61 for LAT, and 51 and 63 for AS. Mortality rates for AA, LAT, and EA were 14.8%, 7.3%, and 16.3%. Mortality increased among patients with the following characteristics: age, male gender, New York region, cardiac disease, COPD, diabetes mellitus, hypertension, history of cancer, immunosuppression, elevated lymphocytes, CRP, ferritin, D-Dimer, creatinine, troponin, and procalcitonin. Use of mechanical ventilation, respiratory failure, shortness of breath (SOB) (p<0.01), fatigue (p=0.04), diarrhea (p=0.02), and increased AST (p<0.01), significantly correlated with death in multivariate analysis. Male sex and EA and AA race/ethnicity had a higher frequency of death. Diarrhea was among the most common GI symptom amongst AAs (6.8%). When adjusting for comorbidities, significant variables were age (over 45 years old), male sex, EA, patients hospitalized in Indiana, Michigan, Georgia, and District of Columbia. When adjusting for disease severity, significant variables were age over 65 years old, male sex, EA as well as having SOB, elevated CRP, and D-dimer. Glucocorticoid usage was associated with an increased risk of COVID- 19 death in our cohort. Conclusion: Among this large cohort of hospitalized COVID-19 patients enriched for African Americans, predictors of mortality include male gender, diarrhea, elevated AST, comorbidities, respiratory symptoms and failure, and elevation of inflammatory- related biomarkers. These findings may reflect the extent of systemic organ involvement by SARS-CoV-2 and subsequent progression to multi-system organ failure. High mortality in AA in comparison with LAT is likely related to a high frequency of comorbidities and older age among AA.

Critical Race Theory Panel Discussion

Indiana University South Bend hosted the Symposium on Educational Inclusion on Nov 12-13, 2021. The Nove 12 event consisted of a panel and other programming. Here, Davis et al present an initial transcription of the panel that featured Bryan McKinley Jones Brayboy, Nicholas D. Hartlep, Marvin Lynn, and Teresa Sosa.

"The Emperor's New Clothes": Reciprocal Ethnography and Academic Leadership

The influence of the discipline of folklore on academic leadership has not been widely examined. This essay explores the connections between collaborative ethnographic research-one form of which Elaine Lawless labels reciprocal ethnography-and collaborative approaches to academic leadership through an examination of the author's leadership experience preceding and during the COVID-19 global pandemic.

Management of Isolation Precautions in Ambulatory Care Settings...Association for Professionals in Infection Control (APIC) Annual Conference, 13-15 June, 2022, Indianapolis, Indiana

Failure to discontinue transmission-based precautions (TBP) for eligible ambulatory patients may decrease stakeholder buy-in, adherence, and experience. Successful removal is hindered by unclear criteria and inadequate resources. We sought to create a pre-visit review process to identify TBP removal opportunities to support stakeholders without exhausting resources. Study period was 11/02/2020 – 11/30/2021. We generated an electronic medical record (EMR) report of ambulatory encounters in the coming week with a TBP flag. Interventions tested included: A spreadsheet macro to filter and format the EMR report (implemented 01/29/21);Standardized IP chart review and notification;Clinical stakeholder engagement to define and evaluate process expectations. We used a standard t-test for weekly encounter and percent no-change review comparisons. During 11/02/2020-01/28/21, 3,111 encounters were reviewed for TBP removal. Of those, 310(9.96%) had TBP status updated, 1,134(36.45%) required email communication to determine status, and 1,667(53.58%) had no change. These no-change encounters included cystic fibrosis patients (remain in life-long TBP) and ineligible long term TBP. We built the macro to remove no-change encounters to focus on encounters needing review. During 1/29/21-11/27/21, 6,060 encounters were reviewed, with 1,818(30.00%) updated, 1,646(27.16%) requiring email, and 2,596(42.84%) no-change. Macro implementation reduced average reviewed encounters weekly (246 to 142, p<.0001) and the proportion of no-change encounters (56.36% to 47.39%, p=0.0224). Subjectively, reviews took less time (approximately 15 hours to 5 hours per week). Process standardization and stakeholder engagement were well-received. Macro utilization increased review efficiency by removing no-change encounters. Despite a reduction in pre- and post-implementation proportions of no-change encounters, there is still opportunity to further reduce time wasted on no-change encounters. Standardizing our process allowed for cross training of IPs, alleviating burden on others. Stakeholder engagement improved relationships between IPs and ambulatory staff.