Developing a transfer risk assessment tool for the Midlands Critical Care Network

Introduction: Inter-facility critical care transfers are a high-risk activity, with a significant reported critical incident rate.1 The 2019 ICS Transfer of the Critically Ill Adult Patient guideline2 recommends a consultant-led risk assessment is performed in order to provide a rationale for the make-up of the transfer team. Prior to our project, there was no formalised risk assessment process at our unit. Objective(s): We wished to assess whether any 'informal' risk assessment process was already being performed prior to transfers. We then aimed to implement a clear assessment process, initially for our unit but ultimately for our critical care network. Method(s): We performed a baseline audit of adult inter-facility critical care transfers undertaken by a team from our unit between 1st December 2019 and 28th February 2020. Notes were analysed for evidence of any risk assessment performed in discussion with the responsible consultant We then locally piloted a new risk assessment tool for our Critical Care Network's transfer documentation. It included the required elements from ICS guidance, and followed a systems-based approach to facilitate completion in time-critical situations. Colour coding enabled easy identification of potential high-risk transfers and guided team formation. Initial re-audit of the new tool was performed between 16th September and 16th October 2020, after which it was implemented across the network. A further re-audit was performed between 1st October and 31st December 2021. Result(s): Fifteen transfers occurred during the initial audit period. All were clinical. No risk assessments were documented (0% compliance), although all were accompanied by a transfer-trained, airway competent doctor and all but one by an ODP. Our second audit cycle identified 10 transfers, of which 4 had risk assessments completed (40% compliance). All transfers had been undertaken with a dual doctor/ODP team. We identified that there was limited knowledge of the risk assessment process among clinicians, so introduced the topic into our unit's transfer training programme. Assessment completion was made a key performance indicator, fed back to team members following each transfer. Our final cycle covered 14 clinical transfers. Eight had a fully completed risk assessment (57% compliance), 2 had partially completed risk assessments (14% partial compliance), 4 had no risk assessment and 2 cases were excluded due to incomplete data. Conclusion(s): Our tool is now used for all inter-hospital transfers across the Midlands Critical Care Network. It enabled risk assessments to be performed appropriately for transfers originating from our unit. Introduction was initially hampered by limited training for clinicians during the first wave of the Covid pandemic, and compliance improved once this was implemented. The recent introduction of a regional critical care transfer service means that the majority of transfers undertaken by our unit's staff are now time-critical clinical transfers. This may contribute to the failure to complete risk assessments in some cases, however these assessments are likely to be of higher importance since such transfers may be higher risk. We now aim to collect feedback from transferring staff to identify any barriers to correct completion.

Assessing the impact of COVID-19 pandemic on the performance indicators of safety management using the analytic hierarchy process (AHP) in an electricity industry.

Introduction: The importance of evaluating the performance of different management systems in industries necessitates examining the performance of the Health, Safety, and Environment (HSE) management system along with other management systems. Particularly during the COVID-19 pandemic, there is a greater need than ever to assess the impact of the COVID-19 spread on the performance of the HSE management system compared to before this pandemic. This research aims to investigate safety performance indicators (SPIs) on the performance of the HSE management system and the impact of the COVID-19 spread on these indicators. Methods: This cross-sectional, descriptive-analytical study was conducted to evaluate the influence of the COVID-19 outbreak on the safety performance to revise the industry safety index in an electricity distribution company using the multi-criteria decision-making method before and after the disease epidemic in three stages. In the first part, the safety indicators were identified according to the comprehensive safety indicators available in the industries and experts' opinions. In the second part, safety indicators were ranked, weighted, and prioritized using the Analytic Hierarchy Process (AHP). In the third part, these indicators were calculated and compared in the periods before and after the outbreak of COVID-19. Results: Two main criteria, namely the "effectiveness criterion" and the "applicability/calculation criterion", were identified for the evaluation and pairwise comparisons of performance indicators. Among these two criteria, the applicability/calculation criterion had higher priority and importance for the evaluation of indicators. Pairwise comparisons of the indicators indicated that the "accident frequency rate" and "safe T-factor" indicators (with weights of 0.238 and 0.023 respectively) had the highest and lowest priorities, respectively, for the assessment of organizational safety performance among the SPIs. Conclusion: Based on the calculations of the indicators and their analyses before and after the outbreak of COVID-19, the current status of the safety performance of the HSE unit was not significantly affected by this pandemic. However, the investigations carried out while collecting the data needed to calculate the indicators and evaluate the performance of this unit demonstrated that some indicators were not considered sufficiently in the studied electricity industry. Since conducting regular performance evaluations greatly impacts the achievement of continuous improvement, more attention should be paid to compiled indicators, which should be periodically assessed in the organization to achieve continuous improvement.

Identifying potential significant factors impacting zero-inflated proportion data.

Classical supervised methods like linear regression and decision trees are not completely adapted for identifying impacting factors on a response variable corresponding to zero-inflated proportion data (ZIPD) that are dependent, continuous and bounded. In this article we propose a within-block permutation-based methodology to identify factors (discrete or continuous) that are significantly correlated with ZIPD, we propose a performance indicator quantifying the percentage of correlation explained by the subset of significant factors, and we show how to predict the ranks of the response variables conditionally on the observation of these factors. The methodology is illustrated on simulated data and on two real data sets dealing with epidemiology. In the first data set, ZIPD correspond to probabilities of transmission of Influenza between horses. In the second data set, ZIPD correspond to probabilities that geographic entities (eg, states and countries) have the same COVID-19 mortality dynamics.

Performance of Indicators Used in the Regular Risk Assessment for Covid-19

Intro: Since November 2021, gradual changes in non-pharmaceutical interventions (NPI) had begun in consideration of the socio-economic cost and the high rate of COVID-19 vaccination. As an effort to monitor the COVID-19 situation and the effect of NPIs, regular risk assessment for COVID-19 has been conducted based on the input from the external advisory committee. This paper examines the correlation between the risk assessment results and other indicators, such as the incidence of COVID-19, public perception, community mobility, and the government policy from November 2021 to May 2022. Method(s): For weekly regular risk assessment of COVID-19, the data were collected from the National Infectious Disease Surveillance System website, which included incidence, mortality, and % of severe cases. Other indicators were from regular surveys on perceived risk among the public, community mobility from the Google website, and the government's response policy from The Oxford Stringency Index. The level of risk was classified into five levels from very low to very high. The level of COVID-19 risk and its correlation with the COVID-19 incidence, risk perception, community mobility, and government policy were examined. Finding(s): The result of the correlation analysis showed the highest positive correlation between the risk level and risk perception (r=0.86, CI 0.72-0.94). This indicates that the actual risk level and the risk perceived by the public are similar. Among the incidence-related indicators, the number of new severe cases of COVID-19 per week showed the highest correlation with the risk level (r=0.62, CI 0.33-0.80). Conclusion(s): The high correlation between the weekly severe cases and the overall COVID-19 risk level suggests that Korea's COVID-19 policy priority was mainly at protecting the high-risk populationCopyright © 2023

Optimizing the Interdisciplinary Design of Adaptive Platform Trials

Adaptive platform trials (APTs) are often complex clinical trials that, ideally, are well suited to answer the motivating clinical questions effectively and efficiently, with the motivating clinical questions and associated treatment arms expected to evolve over time as evidence accumulates. Recently, APTs have played a pivotal role in informing public health policy by efficiently generating compelling evidence regarding the effectiveness of therapies for COVID-19. For APTs to be maximally effective in informing future public health policy, they must be carefully tailored to address the right clinical questions, with the right balance of size, scope, rigor, and flexibility. The design process requires input from clinical and statistical domain experts and often includes input from trial implementation personnel, ethicists, and patient representatives. The design process is inherently iterative, with proposed designs evaluated through trial simulation, the identification of strengths and weaknesses of the proposed design, and revision by the team to address weaknesses. This iterative design process requires effective communication and collaboration between the statistical and clinical domain experts. This session is intended to present a current best practice in facilitating and enhancing the collaborative design process for APTs, including how best to present simulation-based trial performance to the design team and ensure effective interdisciplinary communication. The speakers have extensive experience in leading the design of APTs across multiple therapeutic areas, in both academic and industry settings. The session will begin with a brief presentation by Dr. Lewis on the basic structure of an APT and the tasks and challenges associated with the multidisciplinary design process. The subsequent discussion will be organized by the following themes: (1) considerations in the selection of the study population and primary outcome metric;(2) selecting treatment domains and factors to be compared;(3) trial simulation and communication of performance metrics to both statistical and non-statistical team members;and (4) defining and calibrating interim decision rules. Each of the 4 panel members will outline a recommended approach to facilitating 1 of the 4 design tasks, with examples drawn from their experience. The remaining time (15 min) will be available for a panel question-and-answer period. At the end of the session, the audience will have an understanding of the general organization of, and a process for facilitating, the design process for an adaptive platform trial. Panel Members Roger J Lewis, MD, PhD, is a Senior Physician in the Los Angeles County Department of Health Services, Professor of Emergency Medicine at the David Geffen School of Medicine at UCLA, and the Senior Medical Scientist at Berry Consultants, LLC, a group that specializes in innovative clinical trial design. He is also the former Chair of the Department of Emergency Medicine at Harbor-UCLA Medical Center. Dr. Lewis' expertise centers on adaptive and Bayesian clinical trials, including platform trials;translational, clinical, health services and outcomes research methodology;data and safety monitoring boards, and the oversight of clinical trials. Dr. Lewis was elected to membership in the National Academy of Medicine in 2009. He has authored or coauthored over 270 original research publications, reviews, editorials, and chapters. Dr. Lewis is a Past President of the Society for Academic Emergency Medicine (SAEM) and served on the Board of Directors for the Society for Clinical Trials. He is a fellow of the American College of Emergency Physicians, the American Statistical Association, and the Society for Clinical Trials. Juliana Tolles, MD, MHS, is an Assistant Professor of Emergency Medicine at the Harbor-UCLA Medical Center and the David Geffen School of Medicine at UCLA, and a Medical and Statistical Scientist at Berry Consultants, LLC. Her academic research interests include emergency medical services, resuscitation medicine, and trau a care. She has authored several reviews for Journal of the American Medical Association (JAMA) on statistical methodology and has lectured nationally on research methodology for the Society for Academic Emergency Medicine Advanced Research Methodology Evaluation and Design (ARMED) course. She is also a co-investigator for the Strategies to Innovate Emergency Clinical Care Trials (SIREN) network Southern California site. Kert Viele, PhD, is a Director and Senior Statistical Scientist with Berry Consultants, where he leads Berry Consultants' research enterprise. He is a leader in clinical trial implementation of Bayesian hierarchical modeling, with expertise in platform and basket trials as well as clinical trials incorporating the use of historical information. Prior to joining Berry Consultants in 2010, he was a faculty member at the University of Kentucky, where he received the Provost's Award for Outstanding Teaching and was an investigator for NSF and NIH-funded research. He has developed over 100 custom Bayesian adaptive clinical trials for clients in industry, government, and academia, and currently serves on several data safety monitoring boards for randomized clinical trials. A former editor of the journal Bayesian Analysis, Dr. Viele is also an author of FACTS (Fixed and Adaptive Clinical Trial Simulator), clinical trial simulation software currently licensed to multiple pharmaceutical, academic, and government organizations. William Meurer, MD, MS, is an Associate Professor of Emergency Medicine and Neurology at the University of Michigan Health System. In addition, he serves as a Medical and Statistical Scientist for Berry Consultants, LLC. He works to improve the care of patients with acute neurological disease both through his work on the acute stroke team and as a researcher. His work in the field focuses on the design of clinical trials with adaptive and flexible components. In addition, he is a principal investigator of the National Institutes of Neurological Disorders and Stroke (NINDS) Clinical Trials Methodology Course (http:// neurotrials.training) and a co-investigator in the clinical coordinating center of the Strategies to Innovate Emergency Care Clinical Trials (SIREN) network- also funded by NIH). He was a co-investigator on the Adaptive Designs Accelerating Promising Treatments into Trials (ADAPT-IT) project, as part of the FDA Advancing Regulatory Science initiative with NIH.

A regionwide analysis of breach causes and the correlation between processes, policies and service achievement

Introduction: The SSNAP stroke unit domain audit results have declined during the covid-19 pandemic. As recovery plans are implemented regionally, this study aims to understand the barriers to rapid admission to stroke speciality beds. Findings will inform quality improvement opportunities and change. Method(s): A mixed method approach was applied. Details pertaining to all patients that breached the four hour standard were collected across fourteen acute services for two months. This included all patients that were following the stroke pathway irrespective of final diagnosis. Additionally, details of all protocols pertinent to this KPI were established to identify effectiveness of local policy. The bed management was investigated for efficacy (stroke teams verses other) and differences in and out of hours explored. Covid as a direct cause was examined. Result(s): Analysis continues, however preliminary regional and team centred reports are collated. Eleven policies were examined. A negative association was identified between policies in place and admissions within four hours. A positive correlation existed between stroke team management of speciality beds and timely admissions, however, 67% of SU's were managed by other teams. 20% of breaches were multifactorial. Four covid related causes were detected. More breaches occurred in hours. The day of the week had no direct association with admission delay. Robust management of medical outliers is fundamental. Conclusion(s): Initial findings do not support assumptions. SU beds are not well managed well despite policies in place to support this. Breaches to stroke unit admissions is multifactorial but the failure to safeguard stroke speciality beds is key.

Quality, safety and equity of care outcomes for inflammatory bowel disease patients at four tertiary referral centres in Australia using a cloud based management system Crohn's Colitis Care (CCCare): A real world observational study

Background: Inflammatory bowel disease (IBD) is a global problem and Australia has amongst the highest prevalence rates. This study looked to assess the quality, safety and equity of care across four specialised IBD centres in Australia over a 12-month period using the cloud-based IBD clinical management system called Crohn's Colitis Care (CCCare). This study aimed to define existing care at each centre and the range of performance across each centre to propose potential benchmarks for optimal quality IBD care. Method(s): The study was conducted across four tertiary IBD centres in Australia (Centres A, B, and C were public hospitals and D was a private centre). De-identified data within the backend CCCare research registry was audited between 1st of July 2021 to 31st August 2022. People with IBD who had a clinical assessment documented within the platform during this 12-month period were included. We assessed quality of IBD care using disease activity based on patient reported outcome measures (PROMs), biomarkers and endoscopy;surgery rates;health maintenance indicators including vaccination and skin cancer screening rates and;key performance indicators including steroid use, smoking rates and current opioid use. Safety of care was assessed using adverse events from therapy and hospital admission due to therapeutic complications. Equity of care examined education levels and ethnicity. Result(s): A total of 1889 patients were included. 63% had Crohn's disease and 37% had ulcerative colitis. 51% of the cohort was female. The median age was 39 years (IQR 30-53) and the median disease duration was 8.4 years (IQR 3.3-15.7) (Table 1). Current steroid use was between 6% to 15.4%. Faecal calprotectin (FCP) remission rates (250mug/mg) were between 65-84% and patient reported outcome (PRO-2) remission rates were between 76-88% with the highest rates observed at Centre D (Figure 1). 74 patients underwent a surgical procedure. COVID-19 vaccination rates were between 40.1% to 88.8% with the highest rates once again observed at Centre D. 3% of the cohort was documented as currently using opioid medications. 12.2% were recorded as currently smoking at Centre A compared to 2.6% at Centre D. 55 medication related adverse events were recorded and 94 patients had a hospital admission during the study period. Conclusion(s): This study showcases how CCCare can readily provide researchers with granular, real-world data to audit the quality of IBD care at 4 specialised centres in Australia over a 12-month period. While there were some differences (higher vaccination rates, lower smoking and steroid use rates at Centre D), quality and safety of care was still fairly uniform across the various sites and can serve as a standard of care for IBD patients in Australia.

Learning Performance Indicators a Statistical Analysis on the Subject of Natural Sciences During the COVID-19 Pandemic at the Tulcán District

Learning systems during the COVID-19 period has been modified in terms of methodology strategies as well as teachers' remote teaching emergency approach at primary education and higher education institutions. As a consequence, educators had to limitedly teach the basics from prioritized academic curriculums during the health emergency. Natural Sciences was not an exception, and the majority of educators in this field of study have notably identified low-academic performance during the COVID-19 pandemic. In Ecuador, learning expected results was obtained through the evaluation of performance indicators, so in this research project a statistical analysis was performed using scores for these indicators obtained from Middle School samples of students of the Carchi province, with the aim of identifying significantly affected population strata by the application of remote learning and characteristics leading to low-academic performance. Data gathered was statistically evaluated and the test was calibrated using the Item Response Theory;significative difference among variables and performance indicators were analyzed via students' scores using ANOVA, Pairwise T-Tests, and T-tests. Difference tests were carried out using the weighted score of each student for each indicator as continuous variables and the categorical variables were the internet availability, students' residence location and quintile they belong to. Results proved that there exist significant differences in the student scores depending on the internet availability and the zone where they live, where the academic performance was significantly higher on those students that had stable internet connection in their homes and resided in urban zones during the pandemic. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Impact of COVID-19 on key performance indicators: analysis of diagnosis related groups in a vascular surgery department.

Objectives: to evaluate the impact of the COVID-19 on the hospital key performance indicators using the diagnosis-related groups (DRG). To compare the results of the Angiology and Vascular Surgery Department of the University Hospital of Cabuenes (HUCAB) with the database of the Ministry of Health. Material(s) and Method(s): hospital discharges from the Vascular Surgery Department of the HUCAB during the years 2019, 2020 and 2021. All patients refined (APR)-DRG system was extracted for discharge coding. The hospital key indicators studied were: number of discharges, mortality, mean stay (EM) and mean weight (PM) of the DRG. The overall results per year and according to the most prevalent DRGs were studied. The results obtained were compared with the annual data from the coding of the Minimum Basic Data Set (CMBD) of the Ministry of Health. The configured EM by adjusting the performance of the standard (EMAF) and by the casuistry (EMAC), the index of the adjusted EM (IEMA), the functional index (FI), casuistic index (CI) and the number of avoidable hospital stays were also analyzed. Result(s): number of discharges: it was 10 % inferior in 2020 compared to 2019. Discharges of the GRD 181 linked to admissions from the Emergency increased more than 50 % during 2020 and more than 100 % in 2021 compared to 2019. Mortality: there was no significant increase. EM: it decreased 20 % in 2020 and 18 % in 2021, compared to 2019. PM: it increased progressively to 7.7% on average in 2021. EMAF: it was superior to standard EM. The number of stays saved was higher than expected. Conclusion(s): the pandemic of COVID-19 influenced the hospital key performance indicators studied, reducing the number of discharges and ME and increasing the PM of the DRGs. The number of avoidable stays saved was greater than the standard.© Copyright 2023 SEACV.

Effects Of An Early Rehabilitation Program In COVID-19 Patients Weaned From Non-Invasive Mechanical Ventilation: The Experience Of A Respiratory Subintensive Unit

Background: The purpose of the study was to verify the variation of some physiopathological-respiratory parameters, physical performance indicators and the ability to carry out activities of daily living in a group of patients suffering from respiratory failure secondary to SARS-CoV2 pneumonia newly weaned from non-invasive ventilation. Method(s): This study was conducted on 20 patients with SARS-CoV2 pneumonia admitted in a COVID-19 subintensive respiratory unit of Cotugno Hospital in Naples, who have just been weaned from non-invasive mechanical ventilation. The experimental group underwent an early rehabilitation lasting 7 days in addition to a specific medical therapy. Result(s): The intragroup comparison showed in the rehabilitation group an improvement in PaO2/FiO2 ratio, respiratory function physical performance measured by "handgrip test" and by "sit to stand test" (number of repetitions, dyspnoea measured by Borg modified scale, muscular fatigue measured by Borg) and in Barthel Index score. The control group showed an improvement only in PaO2/FiO2 ratio and Bathel Index Score. Conclusion(s): An early rehabilitation program initiated immediately after weaning from NIV is effective in improving gas exchanges, physical performance and daily life activities in a group of patients with respiratory failure secondary to SARS-CoV2 pneumonia.

Evolution of academic data in the pharmacy degree of the University of Granada during COVID-19

Introduction: The Quality Internal Guarantee Committee of the Degree in Pharmacy is responsible for annually analysing the results of the teaching-learning process obtained from the databases of the Quality, Innovation and Prospective Unit of the University of Granada (UGR). During the academic year 2019/20, COVID-19 pandemic caused several adaptations in teaching methodologies. The objective of this work is to study the effect of COVID-19 pandemic on the performance indicators and satisfaction rate with the study plan in the Degree in Pharmacy of the UGR, and to conduct a comparative study with previous years. Method(s): The following indicators were analysed: satisfaction levels with the study plan, demand rate, performance rate, overall qualifications and number of final projects (TFG) performed for the Degree in Pharmacy during last academic years. Result(s): The general level of students' satisfaction with the study plan has decreased slightly in the academic year 2019/20. This decrease may be related to: a) the delay in the information on the adaptations made to the Teaching Guides, and b) the lack of teaching coordination between teachers, especially among those who teach different subjects in the same course. However, the performance indicators for pharmacy degree in this last academic year have been very positive (acceptable). A decrease in the initial dropout rate (7.7%) and an increase in the graduation, success and performance rates (52.4%, 78.8% and 88.4%, respectively), which reached maximum levels, were observed. However, failure and non-attend rates among pharmacy degree' students were lower than previous academic years (5% and 9%, respectively). Conclusion(s): The health crisis caused by COVID-19 has been a great challenge for the adaptation of the Pharmacy Degree curriculum. The analysis of the performance indicators and satisfaction rate has allowed the Quality Internal Guarantee Committee to implement several improvement actions to upgrade the adaptations in teaching methodologies for the pharmacy degree.

Opportunity to Change the Role of Academic Libraries during a Pandemic: The Concept

The COVID-19 pandemic has disrupted the entire human race's routine and put a temporary halt to global interactions. This epidemic has also had a negative influence on academic libraries. This is one of the most serious consequences of the COVID-19 Pandemic for academic libraries, particularly at Malaysia's Institute of Teacher Training. It also, predictably, gives libraries the potential to shift their traditional role in offering services by utilizing the most up-to-date technologies. The purpose of this study was to show how academic libraries use social media platforms to deliver library services, highlighting the importance of strong and structured collaboration to reach customers during this epidemic. At the same time to increase users in the virtual world, promote library services and activities in a more engaging way. Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.

Maximizing hospital capacity to serve pandemic patient surge in hot spots via queueing theory and microsimulation

This paper presents a mixed-integer mathematical program with embedded equations developed from concepts of queueing theory and Jackson networks for estimating the steady-state maximum potential hospital capacity for COVID-19 patient care in extreme surge conditions, where a hospital must turn nearly all of its existing resources toward the care of pandemic patients. Estimating the potential maximum hospital capacity for pandemic patient care can aid in assessing regional healthcare capacity during surges in pandemic patient demand, predicting shortfalls, and designing preparedness and response actions. To obtain such estimates and inform action, the program determines a best assignment of a heterogeneous staff of nurses and doctors to key units appropriate for their skills to create the optimal allocation of staffed beds. An alternative trial-and-error approach is offered that decision-makers without optimization or software expertise can use to obtain similar estimates. Under a given assignment of resources, a variety of key performance indicators can be obtained through the direct use of the queueing equations. Results of comparisons to outcomes from a detailed discrete event simulation model of an identical hospital design show the accuracy of the equations to be high despite the added simplifications needed for the use of a closed-form equation-based methodology. KEYWORDS: Micro-simulation;hospital capacity planning;COVID-19;pandemic;queueing theory;surge planning;KPIs. Copyright © 2022 "IISE".

Surgical training salvage during COVID-19: A hospital quality perspective

Introduction: Vicissitudes including re-deployment, elective cancellations, and remote educational events have restricted training opportunities during The COVID pandemic. This study aimed to analyse COVID's impact on global Higher Surgical Trainee (HST) performance metrics including hospital adaptability and variance. Material(s) and Method(s): Intercollegiate Surgical Curriculum Programme (ISCp) portfolios of 50 HSTs (median age 36 (range 29-46) yr., female 15, male 35), including 191 six-month rotational placements, were analysed over two years (March 2019 to 2021). Primary effect measures were: operative logbook numbers, index procedures validated against curriculum requirements and Work Based Assessments (WBA). Result(s): During COVID-19, operative experience per placement declined 26.1% (median 211 vs. 156, p<0.010), with a 32.1% decline in trainee primary surgeon experience (162 vs. 110, p<0.010). Regarding index procedures: cholecystectomy declined 45.5% (11 vs. 6, p=0.027) and inguinal hernia 62.5% (8 vs. 3, p<0.010). WBAs were similar (17 vs. 13, p=0.364). Despite relative equivalence before COVID, median total number of operative procedures performed in District General Hospitals (DGH, n=65) were 40.9% fewer than Tertiary Hospitals (TH, n=110, p<0.010). Radar plots of composite metrics ranged from 11.1 to 75.6% coverage before (p=0.011) vs. 13.3 to 68.9% after COVID (p=0.015). Discussion(s): Hospital training metrics varied over five-fold, a difference likely amplified by COVID, with THs more adaptable to existential shared lessons.

Door to Disposition Key Performance Indicator in Three Saudi Arabian Hospitals' Emergency Departments during COVID-19 Pandemic.

OBJECTIVE: The COVID-19 pandemic impacted health systems and Emergency Departments (ED) services worldwide. This study attempts to assess the impact of COVID-19 on the performance of the emergency department during COVID-19 in three hospitals in Riyadh city, Saudi Arabia. METHODS: Ada'a data was used for this retrospective cohort study. The hospitals included in this study were: a 300-bed maternity and children's hospital; a 643-bed general hospital; and a 1230-bed tertiary hospital. All patients who visited the ED in the time period from September 2019 to December 2021 were included. The outcome variable was the Door to Disposition (DTD) which estimates the percentage of patients seen within 4 h from Door to Disposition. A two-way ANOVA test was used to examine the differences in the outcome variable by hospital and by the phase of COVID-19. RESULTS: Both hospital and the phase of COVID-19 were significantly different in terms of the percentage of patients seen within four hours in the ED (DTD) (p-value < 0.05). On average, the DTD percentages dipped slightly in the early phase of COVID-19 (64.0% vs. 69.8%) and jumped sharply in the later phase (73.6%). Additionally, the average DTD score for the maternity and pediatric hospital (87.6%) was sharply higher than both general and tertiary hospitals (63.2%, and 56.5%, respectively). CONCLUSION: COVID-19 led to a significant drop in emergency department services performance in the early stage of the pandemic as patients spent more time at the ED. However, for the designated COVID-19 hospital, the ED performance improved as more patients spent less than 4 h at the ED in the early stages of COVID-19. This is a clear indication that careful planning and management of resources for ED services during a pandemic is effective.

Online Education And Price Volatility Of Selected Nse & Bse Stocks Of Education Sector

During the period of pandemic, education officials have been forced to cancel classes and close the doors to campuses across the world in response to the growing coronavirus outbreak. In addition, all over country’s’ academic institutions have switched classes to online learning, cancelled spring break trips and students studying abroad in China, Italy and South Korea have been encouraged to return home to complete their studies. Besides, the most effective tool in keeping student retention and maintaining access to learning has been online courses. Universities across the country have adjusted their programs in response to the spread of the coronavirus While the majority of colleges and universities around the world integrate some form of online education into their coursework, moving all programs online may prove challenging. Therefore, this paper evaluates and quantifies the impact of the coronavirus disease of 2020 to 2021(COVID-19) on stock market performance of selected four educational sector by using daily stock market data spanning from Jan 2021 to July 2021. Hence, this research employed a basic statistical analysis to estimate the relative effects of the COVID-19 pandemic on stock market performance in those educational sector stocks. The analysis of the study found that there is a strong relationship among the stock price of educational sector and its financial performance indicators.

Impact of the COVID-19 Pandemic on CMS Organ Procurement Organization Performance Metrics

Purpose: CMS introduced new performance metrics for Organ Procurement Organizations (OPO). CDC death records define donation eligible deaths, the denominator of the donation and transplant rate metrics. The COVID-19 pandemic has had an unprecedented and geographically varied impact on United States death statistics. Thus, we examined the potential impact of COVID-19 on the calculation of the OPO performance metrics. Method(s): Eligible deaths include hospitalized decedents with "donation appropriate" diagnoses. We extracted death certificate data from the CDC WONDER system for baseline years (2015-2019) and the CDC COVID Data Tracker (after 2019). CDC aggregates data by state and broad disease groups including Circulatory Death (CD), death from Cerebrovascular Disease ICD-10 i60-i69 and Ischemic Heart Disease ICD-10 i20-i25. Deaths related to COVID (ICD-10 U07.1) were separately grouped. The proportion of CD during the pandemic was compared to baseline and correlated with COVID. Result(s): At baseline, CD accounted for 66.2% of OPO eligible deaths, increasing markedly in 2020 and 2021. (Figure A) The week of April 11, 2020, the national proportion of CD peaked at +23.8% over baseline, paralleling the dramatic increase in the proportion of deaths due to COVID (20%). Early in the pandemic, the proportion of CD and COVID deaths were strongly correlated (2020 r=.44). This attenuated over time (2021: r=.25). The CD and COVID death association evolved as the pandemic spread geographically. (Figure B) In 2020, the change in proportion of CD varied from New York (+20.6%) to Massachusetts (-6.5%). The COVID - CD correlation was highest in the Northeast and Florida, (New Jersey [.78], New York [.75] and Florida [.75]). By 2021, the change in proportion of CD was highest in Mississippi (+14.5%) and lowest in West Virginia (-28.6%), while the COVID - CD correlation diminished and spread west (Florida [.65], Tennessee [.54] and California [.53]. Conclusion(s): Accurate eligible death assessment has been difficult, leading to a shift in calculations based on ICD-10 coded death certificates instead of OPO reported deaths. CD constitutes 2/3 of recorded donation eligible deaths historically, which has been substantially, but variably, impacted by the COVID-19 pandemic. Thus, these metrics based on CDC data may be sensitive to unanticipated and uneven shocks such as disease outbreaks, leading to inaccurate estimates of donor potential. CMS metrics should be refined to better account for external shocks such as the COVID-19 pandemic. (Figure Presented).

Achieving equitable access to abortion care in regional, rural and remote Australia: recommendations from the SPHERE Women's Health Coalition

Background: Improving access to abortion services is a priority of the National Women's Health Strategy 2020-2030. However, access remains highly inequitable in Australia, with limited availability and inconsistent access to both medical and surgical abortion services and few publicly-funded options available in most states, particularly in regional, rural and remote areas. Rates of unintended pregnancy are disproportionately higher in non-urban areas, and access to abortion services similarly differs by geographical location. Aim(s): The SPHERE Women's Sexual and Reproductive Health COVID-19 Coalition aimed to develop a consensus statement to highlight current challenges and call for increased access to abortion care. Method(s): The statement was drafted and ratified by members of the Coalition (clinician experts and consumers, representatives from peak bodies and key stakeholder organisations and eminent Australian and international researchers) and disseminated in November 2021. Finding(s): Key recommendations outlined in the consensus statement included: (1) development of an abortion care standard that includes key performance indicators (KPIs);(2) annual public reporting against KPIs to monitor progress;(3) a National Federation Reform Council process that mandates that major regional or tertiary hospital services provide comprehensive abortion care with appropriate referral, as well as abortion training for hospital-based health professionals and students;and (4) that Primary Health Networks develop an integrated regional approach to abortion care that involves identifying gaps in local service provision, commissioning services to fill those gaps, and maintaining strong collaborative links and referral pathways. Implications: Increasing access to abortion care for women in rural and remote areas will contribute to meeting the goals of the National Women's Health Strategy and improving health outcomes. Government and stakeholder commitment to implementation of these recommendations is critical to ensure equitable access to abortion care for all women.

A performance analysis of diabetic retinopathy screening at a student-run free clinic before and during the COVID-19 pandemic period

Purpose : To evaluate the impact of the COVID-19 pandemic on diabetic retinopathy screening (DRS) to uninsured, predominantly Latino patients at the UC San Diego Student-Run Free Clinic Project (SRFCP). Methods : A retrospective analysis of the electronic medical records of all diabetic patients seen in the years 2019, 2020, and 2021 (N = 196, 183, and 178 respectively) at the SRFCP was performed. Ophthalmology specialty clinic metrics from before, during, and after the COVID-19 pandemic-related lockdowns were compared to assess the impact of the COVID-19 pandemic lockdowns on DRS rates. All statistical analyses were performed in Microsoft Excel. Results : In patients with available demographic data (N=164), 92.1% were Latino, 69.5% female, with a mean age of 58.7 years (SD=10.6). A chi-squared test for goodness of fit showed that the distribution of patients seen (p<0.001), referred (p=0.012), or scheduled (p<0.001) in 2020 and 2021 differed significantly when compared to 2019. In 2019, 99 (50.5%) of 196 patients requiring DRS were referred, of which 97 (49.5%) were scheduled, and 89 (45.4%) were seen by the ophthalmology clinic (Figure 1). In 2020, a similar percentage of patients were referred (76/183 patients, or 41.5%), but the number of patients scheduled and seen dropped to 37 (20.2%) and 21 (11.4%), respectively. In 2021, clinic performance recovered with 113 (63.5%) of 178 patients eligible for DRS referred, 100 (56.2%) scheduled, and 82 (46.1%) seen. No-shows and cancellations constituted 12 (12.4%) and 6 (6.2%) of the 97 encounters in 2019. Conversely, of the 37 encounters scheduled in 2020, the no-show (10.8%) and cancellation (40.5%) rates were notably higher. Conclusions : The COVID-19 pandemic significantly diminished the delivery of eye care to patients at the SRFCP. 2020 saw a meaningful decline from 2019 in all clinic performance metrics which was reversed in 2021. These results show the current need for annual DRS surpassed the ability of the ophthalmology specialty clinic to schedule and deliver care to these patients in all years evaluated, especially in 2020 due to COVID-19 restrictions. SRFCP patients may benefit from telemedicine-based DRS programs such as remote imaging during primary care visits to further improve screening capacity. (Figure Presented).

Enhancing Core Surgical Training with the Implementation of Key Performance Indicators: A Closed Loop Quality Improvement Project

Aim: The COVID-19 pandemic has brought innumerable challenges to surgical training, especially with regard to theatre opportunities for core surgical trainees. This study aims to evaluate the implementation of training-oriented key performance indicators (KPIs) in supporting trainees to meet the Joint Committee on Surgical Training (JCST) quality indicators for core surgical training. Method: A six-month long closed-loop quality improvement project. Two KPIs were developed following discussion with trainees and departmental leads, evaluation of the rota, and review of the JCST quality indicators: theatre/normal-working-day-attendance (T/A) ratio and missed-theatre-sessions/normal-working-day-attendance (M/A) ratio. Our calculations projected a T/A ratio of 1.00 and M/A ratio of 0.20 to be fully compliant with the JCST quality indicators. Data were collected prospectively from eight trainees, who provided feedback on training opportunities and allocation equitability. Results: Following implementation of the KPIs, there was a significant increase in the mean T/A ratio from 0.70 (range=0.55-0.82) to 1.00 (range=0.95-1.17) (p=0.03), and a significant decrease in the mean M/A ratio from 0.55 (range=0.45-0.70) to 0.20 (range=0.11-0.22) (p=0.01). There were significant improvements in trainee satisfaction with training opportunities from 50% to 85% (p=0.02) and allocation equitability from 66% to 95% (p=0.01). Conclusions: The development and implementation of training oriented KPIs led to increased allocation and fewer missed theatre sessions, enabling trainees to meet the JCST quality indicators. Furthermore, our data demonstrate smaller variances between trainees, thus, highlighting greater equitability of training opportunities. These findings are supported by the improved trainee satisfaction with training opportunities and allocation equitability reported.