Optimizing mRNA vaccines and virusmediated CAR T-cell therapy for immuno-oncology: Synthetic tools for gene modification

With the success of mRNA vaccines during the COVID-19 pandemic and CAR T-cell therapies in clinical trials, there is growing opportunity for immunotherapies in the treatment of many types of cancers. Lentiviral vectors have proven effective at delivery of genetic material or gene editing technology for ex vivo processing, but the benefits and promise of Adeno-associated virus (AAV) and mRNA tools for in vivo immunotherapy have garnered recent interest. Here we describe complete synthetic solutions for immuno-oncology research programs using either mRNA-vaccines or virus-mediated cell and gene engineering. These solutions optimize workflows to minimize screening time while maximizing successful research results through: (1) Efficiency in lentiviral packaging with versatility in titer options for high-quality particles. (2) A highthroughput viral packaging process to enable rapid downstream screening. (3) Proprietary plasmid synthesis and preparation techniques to maintain ITR integrity through AAV packaging and improve gene delivery. (4) Rapid synthesis, in vitro transcription, and novel sequencing of mRNA constructs for complete characterization of critical components such as the polyA tail. The reported research demonstrates a streamlined approach that improves data quality through innovative synthesis and sequencing methodologies as compared to current standard practices.

Impacts of COVID-19 on proton therapy - Shaping the future of patient selection

Objectives: This scoping review aimed to determine whether the COVID-19 pandemic influenced any modifications to patient selection methods or prioritisation and services provided by proton therapy centres. Method(s): This review was conducted based on the PRISMA methodology and Joanna Briggs Institute scoping review guidelines.1,2 A literature search was performed in Medline, Embase, Web Of Science and Scopus as well as grey literature. Keywords including "COVID-19" and "Proton Therapy" were used. Articles published from 1 January 2020 in English were included. In total, 138 studies were identified of which 14 articles met the inclusion criteria. A scoping review design was chosen to capture the full extent of information published relating to the aim. Result(s): Six of 14 articles included statements regarding treatment of COVID-19 patients. Three publications recommended deferred or alternative treatment, two indicated to treat urgent/emergency patients and one reported continuous treatment for infectious patients. Recurring impacts on PT provision included more frequent use of alternative therapies, reduced referrals, delayed treatment starts and CT simulation, change in treatment volume and staffing limitations due to pandemic restrictions. Consequently, telehealth consults, remote work, reduction in patient visitors, screening procedures and rigorous cleaning protocols were recommended. Discussion/Conclusion: Few publications detailed patient selection or workflow methods used during the pandemic. Further research is needed to obtain more detailed information regarding current global patient selection methods in proton therapy, collecting this data could aid in future planning for proton therapy in Australia.

Lipid nanoparticle library towards development next generation genomic medicines

Ionizable amino lipids are a major constituent of the lipid nanoparticles for delivering nucleic acid therapeutics (e.g., DLin-MC3-DMA in ONPATTRO , ALC-0315 in Comirnaty , SM-102 in Spikevax ). Scarcity of lipids that are suitable for cell therapy, vaccination, and gene therapies continue to be a problem in advancing many potential diagnostic/therapeutic/vaccine candidates to the clinic. Herein, we describe the development of novel ionizable lipids to be used as functional excipients for designing vehicles for nucleic acid therapeutics/vaccines in vivo or ex vivo use in cell therapy applications. We first studied the transfection efficiency (TE) of LNP-based mRNA formulations of these ionizable lipid candidates in primary human T cells and established a workflow for engineering of primary immune T cells. We then adapted this workflow towards bioengineering of CAR constructs to T cells towards non-viral CAR T therapy. Lipids were also tested in rodents for vaccine applications using self-amplifying RNA (saRNA) encoding various antigens. We have then evaluated various ionizable lipid candidates and their biodistribution along with the mRNA/DNA translation exploration using various LNP compositions. Further, using ionizable lipids from the library, we have shown gene editing of various targets in rodents. We believe that these studies will pave the path to the advancement in nucleic acid based therapeutics and vaccines, or cell gene therapy agents for early diagnosis and detection of cancer, and for targeted genomic medicines towards cancer treatment and diagnosis.

Stacking Classifier-based Automated Insurance Fraud Detection System

During the Covid-19 pandemic, the insurance industry's digital shift quickened, resulting in a surge in insurance fraud. To combat insurance fraud, a system that securely manages and monitors insurance processes must be built by combining a machine learning classification framework with a web application. Examining and identifying fraudulent features is a frequent method of detecting fraud, but it takes a long time and can result in false results. One of these issues is addressed by the proposed solution. By digitalizing the paper-based workflow in insurance firms, this paper intends to improve the efficiency of the existing approach. This method also aimed to improve the present approach's data management by integrating a web application with a machine learning stacking classifier framework experimented on a linear regression-based iterative imputed data for detecting fraud claims and making the entire claim processing and documentation process more robust and agile. © 2022 IEEE.

Implementing the Yorkshire Cancer Research funded Prehabilitation Radiotherapy Exercise smoking Habit cessation And Balanced diet Study (PREHABS): a therapeutic radiographer's perspective

Introduction: Lung cancer patients often have a number of comorbidities which impacts patient mortality and morbidity rates. Lifestyle changes for this group of patients have the potential to positively impact both quality of life and longevity. The Yorkshire Cancer Research funded Prehabilitation Radiotherapy Exercise smoking Habit cessation And Balanced diet Study (PREHABS) was designed to determine if it is feasible to embed interventions promoting a healthier lifestyle into the radical lung radiotherapy pathway. Method(s): The PREHABS study was led by therapeutic radiographers trained in smoking cessation provision, motivational interviewing, informed consent and good clinical practice and a dietitian. Radiographers screened and consented study participants, delivered the exercise intervention and up to 12-weeks of smoking cessation support, whilst dietary advice was provided by the dietitian. Patients diagnosed with chronic obstructive pulmonary disease (COPD), were referred to a community based pulmonary rehabilitation service rather than the PREHABS exercise intervention. Ethical and regulatory approvals were secured in September 2021. Result(s): 61 patients were recruited between September 2021 and October 2022. The majority were female (n=42), mean age 73.1 years (SD 9.36 years). Discussion(s): In addition to the training requirements detailed above and the challenges of COVID-19, the radiographers had to become adept in a number of study-specific aspects including writing the study standard operating procedures (SOPs), creating a study organisational workflow and patient recruitment. The PREHABS study has broadened the radiographer's perspective beyond the radiotherapy department, by further understanding the complex comorbidities that lung cancer patients present with, how to motivate patients to positively change their lifestyle, and how the side effects caused by cancer treatment can affect a patient's ability to change their lifestyle. Conclusion(s): Therapeutic radiographers, after appropriate training, are capable of delivering lifestyle intervention support within a radical lung cancer radiotherapy pathway. Disclosure: No significant relationships.Copyright © 2023 Elsevier B.V.

FlexiTeam: Flexible Team and Work Organization using Process-Oriented Case-Based Reasoning

During crises such as COVID-19, there is a need to adapt existing work processes and teams to the changing environment in a very flexible and dynamic way in many business and healthcare organizations. In this paper, we conceptualize the advances required for Process-Oriented Case-Based Reasoning to flexibly and dynamically organize human resources in a team and work processes. The novel contributions of this paper include an extended case representation to represent resources, profiles, and key performance indicators (KPIs) of processes, a query definition which covers the "context”, and an overall process to flexibly and dynamically organize work processes and human resources. We evaluate the FlexiTeam process using a cooking recipe casebase and analyze the quality of the retrieval using a quality measure. We also derive the research questions that need to be addressed to fully explore this approach and the specific difficulties involved in solving this problem. © 2022 Copyright for this paper by its authors. Use permitted under Creative Commons License Attribution 4.0 International (CC BY 4.0). CEUR Workshop Proceedings (CEUR-WS.org)

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.

Characterizing Surgical Provider Use of Telemedicine: Barriers and Facilitators to Utilization

Introduction: The use of telemedicine in surgical care quickly increased due to the COVID-19 pandemic. However, uptake among surgical specialties has not been consistent. We aimed to characterize surgical provider perceptions of barriers and facilitators to telemedicine use. Method(s): Surgeons and nurses within the gastrointestinal surgery division at a high-volume, tertiary care academic center were contacted for participation in this study. Individual semi-structured interviews explored barriers and facilitators to telemedicine use. Qualitative analysis was conducted by multiple coders using NVivo12 software. Result(s): Six surgeons and three nurses participated in this study. Among the 9 participants, 44% identified as female and 33% were over age 50. Three themes were identified as facilitators to provider utilization of telemedicine: increased accessibility for rural patients due to decreased travel time and cost, enhanced provider productivity from reduced transition time between visits, and the ability of video telemedicine to facilitate non-verbal communication and visual examination. Three themes were identified as barriers to provider utilization of telemedicine: unreliable broadband connection, negative impacts on workflow due to scheduling challenges and insufficient IT support, and the inability to conduct a physical exam and immediately manage certain complications. Conclusion(s): As telemedicine becomes highly integrated into routine care, best practice guidelines to surgeon-patient telemedicine encounters should be established. This will improve virtual communication and consistency across providers, as well as provider satisfaction with telemedicine. Future interventions should address concerns with workflow logistics and technical support by developing comprehensive training and troubleshooting strategies for healthcare providers.

Past, present and future of RTT training in mainland China: Evaluation of trainee perspectives

Objective: The radiation therapy technologist fundamentals training program (RFTP) facilitates knowledge and skills development of newly employed radiation therapy technologists (RTTs) within our China network. Since its initial implementation in 2019, the RFTP has evolved to address the diversity of RTTs' education and experience, as well as changing local clinical contexts. In particular, a shift to remote delivery and assessment has been required during the COVID-19 pandemic. This quality improvement initiative aimed to evaluate the impact of the RFTP on learning engagement and outcomes, from trainee perspectives. Method(s): Online pre-interview surveys and semi-structured interviews were conducted with 16 RTTs from five China sites in July and August 2022.1 Participants provided verbal informed consent regarding the survey and interview recordings for subsequent analysis. Surveys were reported with descriptive statistics, and interview themes were developed using direct content analysis.2 Results: 15/16 participants qualified in a non-RTT field of study, with most practiced in medical imaging (N = 7);12/12 participants with previous RTT experience reported differences in practice standards. All participants rated the RFTP highly (see Figure), with IGRT (13/16), ARIA (14/16), and SimCT (7/16) most frequently identified as new areas of learning;14 participants who completed the RFTP reported the preparation for IGRT standard workflow was most valuable. Discussion/Conclusion: Results show that the RFTP is an essential on-boarding program that advances RTTs' knowledge and reduces the skills gap to perform our network's established workflows. Additional feedback gained through this initiative will be considered for future development of the RFTP.

COVID-19 Pandemic Learning: The Uprising of Remote Detailing in Pharmaceutical Sector Using Sales Force Automation and Its Sustainable Impact on Continuing Medical Education

The availability of resources is vital when rapid changes and updated medical information in the provision of care are needed, such as in the fight against COVID-19, which is not a conventional disease. Continuing medical education plays an essential role in preparing for and responding to such emergencies. Workflow has improved based on the virtual meetings, online trainings, and remote detailing conducted by medical representatives in order to deliver educational content instantly through digital tools, such as salesforce automation (SFA), webinars, etc. In terms of its regulatory barriers, the pharmaceutical industry mainly targets healthcare professionals, unlike most businesses that reach end users directly. Medical representatives are equipped with an SFA to enhance customer relationship management (CRM) and closed loop marketing (CLM) capabilities in pharmaceutical companies. This study aimed to fill a gap in the literature by investigating the use of SFA in work patterns, such as health professionals' loyalty and involvement in their medical knowledge in Turkey, and how it allows for differentiating training from marketing. This study intended to compare the data on internists and medical products gathered from a well-known pharmaceutical company's SFA. The data covered the first three months of the year 2020, when medical representatives had a normal daily routine, and that of 2021, when Turkey experienced the most powerful surge of the COVID-19 pandemic. The analysis was based on simple correspondence analysis (SCA) and multiple correspondence analysis (MCA) for 11 variables. Monitoring product, physician's segment, and medical representatives' behaviors with SFA had a significant influence on the pharma-physician relationship strategy, as expected. The findings supported the view that SFA technologies can be deployed to advance the medical knowledge of physicians, in addition to managing and designing superior CRM and CLM capabilities.

Successful Inter-Professional Team (IPT) collaboration in the care of peripartum women with COVID-19 on Extracorporeal Membrane Oxygenation (ECMO)

Objectives: To describe the IPT collaborative approach for peripartum women with COVID-19 on ECMO and report the intervention outcomes. Method(s): A retrospective electronic health record review was performed from January 2020 through January 2022. All peripartum women on ECMO with COVID19 admitted to the cardiothoracic intensive care unit (CTICU) were included. The IPT came together to coordinate peripartum care and delivery. An algorithm was created to outline the roles and workflow in the care of these patients. The outcomes evaluated included delivery method, timing, and location, maternal survival at discharge, maternal ICU length of stay (LOS), and neonatal survival Results: Thirteen Peropartum women were placed on ECMO (5 antepartum and 8 postpartum, ages 27-42). None had been vaccinated against COVID-19. All received femoral vessel cannulation (11 venovenous and 2 venoarterial). Four patients underwent Caesareansection delivery while on ECMO. Maternal survival to hospital discharge was 84.6%. All neonates survived with COVID-19 negative status. Conclusion(s): The collaborative IPT approach with a structured algorithm facilitated survival outcomes. This report adds to the limited literature on peripartum. ECMO and provides insights to consider in planning for the care of these patients.

Multi-dose CT contrast injectors: Is it time for change?

Introduction: The COVID-19 pandemic presented new and exacerbated existing challenges to the Australian healthcare workforce. Principally, health care demands have grown by approximately 14.9% over the past four years, Medicare costs from CT alone rose from $145 to 790 million per annum over the past 20 years and disrupted global supply lines during 2021 resulted in an 80% reduction of available CT iodinated contrast worldwide.1-3 Innovations to improve workflow efficiencies as well as lower operational costs and wastage of CT contrast media have become paramount. This study sought to compare the savings metrics between an existing single-use CT contrast delivery system and a newly introduced multi-dose syringeless contrast injector. Method(s): Workflow efficiency savings were calculated through the average time each staff member (n = 5) spent refilling each injector system after a completed injection. A retrospective analysis assessed theoretical monetary and contrast media savings and based on one month (February 2022) of injection protocol data. Total contrast administration, consumable use and clinical wastage were calculated and compared through each contrast delivery system technique. Discussion/Conclusion: The multi-dose injector comparatively recorded in an average monthly workflow efficiency saving of 38.26% (seven hours and 29 minutes). Monthly contrast usage decreased 29% (15.2 L) and operational expenses declined 51% ($11,574) through utilisation of the multi-use injector. These findings indicate, when compared to a single-use system, the multi-use injector is a highly efficient contrast delivery system with significant financial return on investment.

Ultrasound service during COVID: A Singapore experience

The COVID pandemic has affected and changed the way we work in healthcare. Through this presentation, I aim to share with others about new workflow and procedure changes done in my institution, Singapore General Hospital. We identified ways to modify the ultrasound procedures to protect ourselves and patients during this pandemic disease outbreak. Finally, we modified the current ultrasound protocol to limit scanning time when attending to COVID positive patients.

Identifying the Next Mutation of Concern - Exploiting Genomics for Tracking Sars-Cov-2 Mutations and Their Biological Impact in Canada

Intro: Viruses, including SARS-CoV-2, which causes COVID-19, are constantly changing. These genetic changes (aka mutations) occur over time and can lead to the emergence of new variants that may have different characteristics. After the first SARS-CoV-2 genome was published in early 2020, scientists all over the world soon realized the immediate need to obtain as much genetic information from as many strains as possible. However, understanding the functional significance of the mutations harbored by a variant is important to assess its impact on transmissibility, disease severity, immune escape, and the effectiveness of vaccines and therapeutics. Method(s): Here in Canada, we have developed an interactive framework for visualizing and reporting mutations in SARS-CoV-2 variants. This framework is composed of three stand-alone yet connected components;an interactive visualization (COVID-MVP), a manually curated functional annotation database (pokay), and a genomic analysis workflow (nf-ncov-voc). Finding(s): COVID-MVP provides (i) an interactive heatmap to visualize and compare mutations in SARS-CoV-2 lineages classified across different VOCs, VOIs, and VUMs;(ii) mutation profiles including the type, impact, and contextual information;(iii) annotation of biological impacts for mutations where functional data is available in the literature;(iv) summarized information for each variant and/or lineage in the form of a surveillance report;and (v) the ability to upload raw genomic sequence(s) for rapid processing and annotating for real-time classification. Discussion(s): This comprehensive comparison allows microbiologists and public health practitioners to better predict how the mutations in emerging variants will impact factors such as infection severity, vaccine resistance, hospitalization rates, etc. Conclusion(s): This framework is cloud-compatible & standalone, which makes it easier to integrate into other genomic surveillance tools as well. COVID-MVP is integrated into the Canadian VirusSeq data portal (https://virusseqdataportal.ca) - a national data hub for SARS-COV-2 genomic data. COVID-MVP is also used by the CanCOGeN and CoVaRR networks in national COVID-19 genomic surveillance.Copyright © 2023

An observational study of the cause and frequency of prescription rework in community pharmacies.

BACKGROUND: When prescriptions are being processed in pharmacies, 'rework' is a phenomenon where an activity occurs that requires the return to a prior procedural step in the process for correction. To date, little is known regarding rework prevalence in community pharmacies or how this might be minimised. AIM: To evaluate the cause and frequency of prescription rework in community pharmacies. METHOD: A list of reworks was designed for community pharmacists to self-record prescription rework instances and causes in their workplace across a two-week period. Community pharmacists in Ireland were recruited via convenience sampling and snowballing. Descriptive statistics were used to assess rework frequency according to the various causes, as well as the pharmacist and pharmacy characteristics. RESULTS: Eight pharmacists participated, recording 325 reworks across 92.9% of the 65 study days (mean 5 reworks/day). The pharmacists' mean ranged from 1.82 to 15 reworks/day. Pharmacists and pharmacy technicians alone or together were involved in 72.3% of reworks. The three most common rework categories were involving labelling errors (22.8%), prepared prescriptions which necessitated opening and repackaging (15.1%), and medication owings to patients (13.9%). CONCLUSION: This study reveals that prescription rework occurs frequently in community pharmacies and has provided an indication of some of the main causes. These findings demonstrate areas where pharmacy staff can address rework and should aid the development of approaches to minimise rework in future - thus decreasing workload and facilitating more time for community pharmacy staff to focus on providing patient care.

Modelling Information Needs and Sources in a COVID-19 Designated Hospital.

COVID-19 remains an important focus of study in the field of public health informatics. COVID-19 designated hospitals have played an important role in the management of patients affected by the disease. In this paper we describe our modelling of the needs and sources of information for infectious disease practitioners and hospital administrators used to manage a COVID-19 outbreak. Infectious disease practitioner and hospital administrator stakeholders were interviewed to learn about their information needs and where they obtained their information. Stakeholder interview data were transcribed and coded to extract use case information. The findings indicate that participants used many and varied sources of information in the management of COVID-19. The use of multiple, differing sources of data led to considerable effort. In modelling participants' activities, we identified potential subsystems that could be used as a basis for developing an information system specific to the public health needs of hospitals providing care to COVID-19 patients.

Tápcsatornai endoszkópos eljárásokkal összefüggo infekciós kockázat a SARS-CoV-2-járvány idején.

INTRODUCTION: COVID-19 significantly affects endoscopic labs' workflow. Endoscopic examinations are considered high-risk for virus transmission. OBJECTIVES: To determine impact of COVID-19 pandemic on Hungarian endoscopic labs' workflow and on infection risk of endoscopic staff. METHOD: A nation-wide, cross-sectional online questionnaire was sent to heads of endoscopic labs in Hungary. The average number (with 95% confidence intervals) of upper and lower gastrointestinal endoscopies performed in 2020 was compared to that in 2019. The number of SARS-CoV-2-infected endoscopic staff members and the source of infection was also investigated. RESULTS: Completion rate was 30% (33/111). Neither the number of upper (1.593 [743-1.514] vs. 1.129 [1.020-2.166], p = 0.053), nor that of lower gastrointestinal endoscopies (1.181 [823-1.538] vs. 871 [591-1.150], p = 0.072) decreased in 2020, but both upper and lower gastrointestinal endoscopies' number decreased by 80% during peak phases. Separate examination room was available in 12% of institutes. Appropriate quality personal protective equipment (PPE) was available during the first and second peak phase in 70% and 82%, respectively. Infection risk stratification by questionnaire and PCR testing was routinely performed in 85% and 42%, respectively. Employee number decreased by 33% and 26% for physicians, and by 19% and 21% for assistants during peak phases, mainly due to age restrictions and COVID care assignments. 32% of assistants and 41% of physicians were infected (associated with inappropriate PPE use in 16% and 18%, respectively). CONCLUSION: Peak phases' restrictions increase endoscopic workload afterwards. Despite PPE availability, 15% of employees' COVID infection resulted from inappropriate PPE use in pre-vaccination era. Orv Hetil. 2022; 163(46): 1814-1822.

A Quality Improvement Project Impacts Resident Satisfaction with the Depart Process

Purpose of Study The current depart process resulted in slow work-flow and patient safety and equity concerns. The QI project aimed to improve resident satisfaction with the hospital discharge process. Methods Used The QI project was designed using the Model for Improvement. Starting April 2020, Plan-Do-Study-Act cycles included: hiring clinical team coordinators;creating standard depart instructions for diabetic ketoacidosis, pyelonephritis, seizures, croup and dehydration;uploading instructions to Powerchart;and clinician reminders to use instructions with families. Measures examined monthly, included resident satisfaction and patient readmissions. Summary of Results Resident satisfaction improved from 4.8 (February 2020) to 7.8 (August 2020) for the overall discharge process;from 5.3 to 7.9 for family education on all key points;from 6.0 to 7.7 for smooth transition of care;from 3.0 to 7.4 for no language barriers;and from 3.0 to 6.7 for no unnecessary delays, on a scale of 0/strongly disagree/ terrible to 10/strongly agree/excellent. Readmissions also trended downward. Conclusions During this QI project to address the depart process, resident satisfaction improved and readmissions declined. These results are encouraging, but should be interpreted in the context of decreased patient census due to COVID-19 and non-respiratory season, which may have decreased workload and increased education time and interpreter access. Next steps include PDSAs related to health literacy and Spanish translation.

Redesigning the Workflow Process to Upload Paper Consents into the Electronic Health Record

Background: Before starting cellular therapy treatment, patients and their physicians must sign consent forms for Standard of Care (SoC) treatment plans as well as ancillary protocols. To avoid delay in patient care, signed SoC consents are scanned into the Electronic Health Record (EHR) in a timely manner, and protocol consents are handed off to the research team to manage as needed. The COVID-19 pandemic forced our large academic center to adapt this consent management workflow to function with fewer onsite staff, which resulted in prolonged turnaround time for consents to be uploaded into the patient's EHR, and operational inefficiencies (e.g. lost consents requiring re-signing, increase workload for staff, etc.). The process involved 4 cross-functional teams, and handoffs spanning multiple physical locations. Combined with the increasing patient volume of our center, the consents process was unsus-tainable and inadequate. Method(s): Our first redesigned process involved physicians dropping off signed consents directly in the clinic workroom.A Research Coordinator would then sort out the protocol consents and hand off SoC consents to the Health Information Systems (HIS) team for EHR scanning. This new process reduced the number of stakeholders handling the consents and consolidated the handoff location to one location. While this allowed for marked improvement in turnaround times for SoC consent scanning, there were additional opportunities to integrate the workflow with the HIS team's existing processes to allow for further efficiencies. After 4 months, we implemented our second redesigned process: after drop-off in the clinic workroom by physicians, the HIS team would collect all consents three times per day and scan SoC consents while setting aside protocol consents for the Research team to pick up. This allowed for SoC consents to be scanned without delay and reduced workload for the Research team all while streamlining our workflow into existing HIS processes. See Figure 1 for workflow iteration details. Result(s): The new processes reduced the average turnaround time for SoC consents scanned into the EHR from 8 to 2 busi-ness days. Furthermore, we have increased the number of consents scanned same day into the EHR from 18% under the 1st redesign, to 52% with the 2nd redesign (see Figure 2). We have also diminished the error rate (including lost consents) to 1% of consents processed. (Figure Presented)(Figure Presented) Conclusion(s): The redesigned consents workflow resulted in quicker uploads into the EHR, increased same day uploads and has made lost consents statistically insignificant. Timely uploads of consents into EHRs have also allowed us to flag and resolve any issues earlierCopyright © 2023 American Society for Transplantation and Cellular Therapy

Integrating Bioethics and Neonatal Palliative Care in a Pandemic: The Scope of Advocacy and Online Collaboration for Exceptional Life-Sustaining Medical and Surgical Interventions in a Regional Neonatal Intensive Care Unit

Purpose of Study: The regional NICU is an essential healthcare resource for families of newborns with serious life-threatening illnesses. Mechanical ventilation, cardiovascular therapies, therapeutic hypothermia, and neonatal surgeries are common life-sustaining interventions. Our NICU serves an underprivileged population in a resource poor environment and several ethical questions frequently emerge when facing extremes of innovative therapies. The pandemic and rapidly changing institutional protocols accentuated challenges faced by frontline NICU teams caring for newborns at risk for devastating illnesses and death. Concurrently, evolving paradigms in neonatal ethics required urgent and high quality palliative care in a background of racial and socioeconomic inequities, restrictive visitation policies, and limited healthcare resources. The purpose of this study was to ensure that neonates and their families receive ethically sound care, timely referrals for innovative therapies, and specialized palliative care in the strained and uncertain environment of the COVID-19 pandemic. Methods Used: The key steps consisted of structured and impromptu discussion forums for specialized palliative care and medical ethics, perinatal case conferences and pediatrics grand rounds on virtual platforms, educational webinars for interdisciplinary teams, and improved electronic communication. Online collaboration and innovative combinations of in-person and virtual meetings were utilized for urgently Incorporating clinical updates. Summary of Results: 1. A neonate with severe HIE and postnatally diagnosed congenital diaphragmatic hernia required emergent ECMO center referral. NICU providers utilized a structured bioethics and palliative care framework for providing family support and discussing the prognostication challenges of acute illnesses. 2. Many important bioethical questions emerged while caring for infants with life-threatening chromosomal abnormalities. Ethical tension was addressed by teaching tools, quality of life and pediatrics ethics conversations, mitigation of moral distress, contemporary clinical and surgical experience, community engagement, and family perspectives. 3. Ethical conflicts are central in the decision to resuscitate neonates born between 22 and 23 weeks of gestation. To provide urgent prenatal consultations and attend high risk deliveries, we collaborated across geographically distant healthcare systems, unified management strategies and analyzed outcomes data. 4. NEC in several extremely preterm babies had devastating outcomes and the team respected each family's voice with compassionate, shared decision-making for both curative care surgeries and palliative care. Conclusion(s): The new workflows, telephone and video conferences, and redirection to telehealth based family meetings did not change important outcomes during the pandemic. Advocacy and education for integrating bioethics and palliative care were vital facets of neonatal critical care in a resource poor and ever-changing pandemic environment.