Girft in Action: Advanced Practice Physiotherapist and Advanced Practice Nurse Expertise Provides Valuable Triage and Assessment Clinics for Non-Urgent Rheumatology Referrals

Background/Aims Rheumatology referrals classified as non-urgent/routine are commonly non-inflammatory conditions or medically non-urgent and can have significant waiting times for appointments. These waits were further escalated by the COVID-19 pandemic. Early intervention for noninflammatory conditions can be crucial to good outcomes and long wait-times can have significant adverse impacts while appropriate care pathways are determined. Recent UK GIRFT recommendations include using non-medical health professional expertise in assessment and management pathways to support right place, right time, right care. This study evaluated effectiveness, impacts and patient experiences of Advanced Practice Physiotherapist (APP) and Advanced Practice Nurse (APN) Triage and Assessment Clinics for routine new referrals. Methods The non-urgent/routine referral waiting list was e-triaged by a Rheumatology APP and APN supported by clinical record searches. Patients were contacted by telephone to update on clinical status and appointment requirements determined. Triage criteria were applied to determine new referrals suitable for APP and APN Rheumatology clinics, which included low likelihood of inflammatory disease or new referrals for known diagnosis/stable conditions. Clinics were undertaken with collocated Consultant clinical supervision. Assessment findings were discussed and management agreed, or seen if needed. With waiting list attrition, clinics were expanded to include Consultantdetermined stable condition reviews and follow-up reviews for nonsuspected inflammatory disease. Results At 01 July 2021, 214 new routine referrals were waiting a Consultant appointment (n=103 over 2yrs). Since service initiation, clinic outcomes to date include: 69% (n=243/358) new routine referrals discharged to GP or directed to right pathway with information, advice and self-management resources;8% (n=29) escalated to urgent;3% (11/358) with medical complexity remained on Consultant waitlist. Most common presentations seen included: Osteoarthritis (general or hand);Back and other spinal pain;Fibromyalgia;Persistent Fatigue and Widespread Pain;JHS/hEDS;Positive ANA without clinical features;Musculoskeletal conditions- other. To date, no patients have been re-referred and 329 new patient and 89 follow-up Consultant direct consultations have been spared. There is currently no wait-time for non-urgent/routine appointments. Patient experience feedback on the service has offered a 100% recommendation to continue and expressed highly positive experiences with the MDT approach. Patients value the breadth of expertise and care support, and the timely, thorough and professional service provided. Conclusion Rheumatology non-urgent/routine new referrals with low probability of underlying autoimmune conditions may be effectively and efficiently managed in a collaborative model using an advanced practice physiotherapist and nurse. This innovation has expanded a traditionally medical pathway to an MDT model utilising value-adding nonmedical expertise in service delivery. It has enhanced interdisciplinary learning and is a valued, collaborative approach to patient care. The initiative provides support to GIRFT recommendations of using an MDT skill-set to support improved patient access, service efficiencies and earlier intervention.

Telehealth Policy and the Advanced Practice Nurse.

Telehealth is an efficient and effective method of care delivery used by advance practice registered nurses (APRNs) nationally, especially in the wake of the coronavirus disease 2019 pandemic. With the ever-changing rules and regulations governing telehealth practice, the APRN may struggle to keep abreast. Telehealth is governed by legislation and regulation in addition to telehealth-specific laws. APRNs delivering care through telehealth must be informed about the crucial aspects of telehealth policy and how their practice is affected. Telehealth-related policy is complex and evolving and varies by state. This article provides APRNs with essential knowledge about telehealth-related policy to support legal and regulatory compliance.

Can You Spare 100 Days? The Allogeneic Hematopoietic Cell Transplant Caregiver Requirement

Allogeneic hematopoietic cell transplantation (alloHCT) is a potentially curative treatment for patients diagnosed with blood cancers (such as acute myeloid leukemia) and blood disorders (such as sickle cell disease). It is a resource-intensive treatment that generally requires a long hospital stay and recovery period. If continuous caregiver support is not available, alloHCT likely will not be a treatment option. To learn more about caregiver requirements and perspectives on those requirements, we conducted web-based focus groups with alloHCT social workers who worked with adult patients at United States (US) transplant centers (TCs) from May-July 2022. Web-based interviews with adult alloHCT recipients,caregivers of adult alloHCT recipients, and physicians/advanced practice professionals will also be conducted. Twenty-two social workers from TCs across the US (Midwest [n=8];West [n=5];Northeast: [n=5];South, [n=4]) and with varying volumes (median: 97 alloHCTs performed/year) participated. All noted their TC required a caregiver to proceed to alloHCT. However, there was variation across TCs in the length of time a recipient was required to have a caregiver, the distance/time needed to stay near the TC post-alloHCT, and COVID-19 vaccination requirements. The majority of participants also noted variance among the transplant team in allowing exceptions for caregiver requirements. All participants noted it would be helpful to have a 'gold standard' of requirements across TCs, though there was discussion about what such a standard would include, as well as the need for flexibility to account for different patient and TC needs. Social workers were also asked to identify patient barriers to meeting the caregiver requirement;common barriers included patients feeling they did not have anyone to ask to be a caregiver, the need to relocate closer to the TC, and financial barriers. The impact of the COVID-19 pandemic was also noted (e.g., vaccination requirements, and increased telework allowing more flexibility for caregivers). In analysis of the first of four populations interviewed in this study, social workers reported variation in caregiver requirements across TCs. Finding a caregiver is one of many barriers patients face in accessing alloHCT. Though this variation may allow for some flexibility, it may also contribute to access barriers. This study focused on those who received an alloHCT, but further research is needed to learn about barriers faced by those unable to access alloHCT. Results from this and other cohorts will describe current practices related to caregiver requirements and help inform the development of new programs to reduce caregiver-related barriers to alloHCT.Copyright © 2023 American Society for Transplantation and Cellular Therapy

Developing Contemporary Survivorship Clinic for Recipients of Hematopoietic Cell Transplantation: A Single Center Experience

Introduction: Survival after hematopoietic cell transplantation (HCT) has improved tremendously over the last few decades. HCT survivors are at increased risk of long-term complications and secondary cancers. This poses unique challenges to the HCT-related healthcare system given the growing need for survivorship care. Developing a HCT survivorship program with a dedicated clinic to survivors ensures equitable access to care and ongoing patient education. Herein, we describe our program survivorship model and our initial experience. Method(s): The Moffitt Cancer Center (MCC) survivorship clinic (SC) planning committee was initiated in September 2019. The SC was launched in January 2021 with the mission to provide high-quality, comprehensive, and personalized survivorship care and to empower patients and community health care providers with education and a roadmap for screening for late effects. The SC initially focused on allogeneic (allo) HCT patients and later opened to autologous (auto) HCT recipients in February 2022. HCT patients are referred by primary HCT team after HCT with an emphasis on preferred timeframe of initial SC visit no earlier than 3 months but less than 12 months from HCT. SC is located at 2 physical locations: main campus and satellite, with virtual visit options to account for the distance from MCC and COVID considerations. SC applies a consultative model. SC is staffed by dedicated advanced practice professional (APP), supervised by SC faculty. The scope of SC care includes but is not limited to prevention of infections (education, vaccinations), surveillance of late effects (endocrine, pulmonary function, cardiac, bone health), and general cancer screenings (breast, colon, skin cancer). Patients' clinical data from SC inception to August 2022 were reviewed. Result(s): From January 2021 to August 2022, a total of 138 patients were seen in SC. The majority were seen in person (62% in clinic, 38% by virtual visit). Median age was 58 years (range, 19-82). Median time to first SC visit was 21 months (range, 3-1464) after HCT. Allo HCT was the most common type of HCT seen in clinic (87%, n=120). Most common diagnoses were acute myeloid leukemia (43%, n=59), myelodysplastic syndrome (17%, n=23), and acute lymphoblastic leukemia (10%, n=14). Only 17 patients (12%) were seen in 2021 but the volume increased significantly in 2022. Currently there are more than 10 patients seen in SC per month. Conclusion(s): We report successful experience in launching a contemporary HCT SC despite the challenges of an ongoing COVID pandemic. As a stand-alone cancer center, we serve a wide geographical location with subspecialty and primary care providers dispersed throughout the community. Our consultative model and experience could provide a useful guide for other programs. In 2023, we plan to expand our SC to a broader population of patients receiving other cellular immunotherapies.Copyright © 2023 American Society for Transplantation and Cellular Therapy

Integrating Virtual Simulation into Nursing Education: A Roadmap

Background: Simulation education is needed to train a highly competent nursing workforce. In-person simulation requires many resources, such as faculty, space, and time, that can negatively affect its feasibility. These barriers have prompted educators to seek new technologies to provide experiential learning opportunities, such as virtual simulation (VS). The COVID-19 pandemic further highlighted the need for educators to investigate alternative learning opportunities.Methods: A quantitative cross-sectional study was conducted with pre-licensure and advanced practice nursing students. They participated in a VS learning experience that was evaluated using the System Usability Scale (SUS)(R), the Clinical Learning Environment Comparison Survey (CLECS 2.0), and the Simulation Effectiveness Tool-Modified (SET-M).Result: 197 pre-licensure and 11 advanced nursing practice students completed post-simulation eval-uations. The results from the SUS scale found the overall virtual system effective. Evaluating the CLECS tool found students' perceived experience was relatively similar for face-to-face simulation and screen-based simulation. The SET-M indicated students rated the VS simulation experience positively. Conclusion: VS for nursing education can be an effective experiential learning tool.

Addressing Barriers to APRN Practice: Policy and Regulatory Implications During COVID-19.

Advanced practice registered nurses (APRNs) play a pivotal role in providing healthcare, including preventive care services, to the public. However, barriers to APRN practice exist that impact the provision of vital healthcare services that APRNs are authorized to provide based on their education, training, licensure, and certification. This article provides an overview of APRN barriers to practice, including in the face of the COVID-19 pandemic, and discusses key policy and regulatory implications.

Substance Use Disorders and Medication-Assisted Therapies: Current Practices and Implications for Nursing.

In the United States, the opioid epidemic and COVID-19-related substance use have exacerbated the overall incidence of substance use disorders (SUDs). Medication-assisted therapy (MAT), or cognitive and behavioral therapy that combines medications that reduce substance use or acute withdrawal symptoms, has dramatically improved outcomes for SUD patients, including preventing mortality. With recent US Congressional funding for MAT, patients presenting for acute care on MAT-related medications will continue to increase. Nurses should be aware of these medications' mechanism of action, typical side effects, and implications on treating acute pain to optimize their care.

Innovating for mental health and wellbeing among foundation year doctors

Fern Raven, advanced nurse (clinical) practitioner, explains how her role and its associated innovations have helped to improve mental health and wellbeing among foundation year doctors at her trust.

Improving Data Quality in Multicenter Trials: Innovative Approaches Utilized within the Wake Forest Nci Community Oncology Research Program Research Base (Wf Ncorp Rb)

Introduction: Efficient and comprehensive trial oversight and data management ensures valid, robust outcomes necessary to inform health policy and improve patient outcomes. This is particularly challenging in the context of multicenter trials. The format of this session will include four introductory presentations (15 min each), followed by 30-min panel discussion/Q&A focusing on recent experiences and innovative approaches utilized within the Wake Forest NCI Community Oncology Research Program Research Base (WF NCORP RB). Since 2017, WF has managed 15 studies with approximately 3000 patient and 1000 provider/stakeholder accruals across 1000 potential participating community oncology practices within the United States and Puerto Rico. These practices often operate differently from academic medical centers, with varying patient capacity, provider number and level of engagement, use of advanced practice providers, and services offered. In addition, practices within this network have heterogeneous utility of electronic health records (EHRs) and display a wide range of clinical research staffing models. The COVID-19 pandemic has highlighted the need for streamlining research visits and maximizing telehealth technologies when applicable, particularly for intervention non-therapeutic clinical trials. As such, research expectations must be standardized to ensure quality trial conduct and data collection across diverse practices. Recently, the WF NCORP RB has taken many steps to improve efficiency and data quality across our studies. This session will discuss a comprehensive approach to data quality and management across the lifespan of a trial. This starts with consent/ recruitment strategies and general oversight/ monitoring of our portfolio of trials. WF RB now utilizes REDCap for all data capture, as this allows direct data entry for site personnel and participant entered patient-reported outcomes using surveys. In addition, REDCap facilitates data monitoring, query, and auditing strategies. We will also introduce a team-based approach to adjudicate complex outcomes. Talk 1 (15 min): Specifically, Karen Craver, our RB administrator, will discuss approaches to obtain robust data as a result of strong screening and recruitment. She will provide an overview on how we survey practice research staff within the Landscape assessment and brief, pre-trial interest surveys to identify optimal target populations during the planning stage. We utilize our internal EHR to create custom screening reports to identify potential participants and generalize these for other practices to customize and use as a screening tool within their clinic. The RB has integrated remote consenting in part due to the pandemic, but we realize the need to continue offering flexibility in consent modality moving forward. Talk 2 (15 min): Emily Dressler, lead Biostatistician, will discuss oversight of the RB portfolio using dynamic reports within Tableau. These reports update daily and provide a comprehensive assessment of all ongoing and completed studies. RB personnel can filter reports to create custom results subset by timeframe, practice or set of practices, trial type, and/or other demographic characteristics. This has greatly reduced the request for study-specific accrual reports and has standardized our reporting across studies. She will also discuss the rationale for transitioning to REDCap, including strengths and weaknesses for integrating in multicenter studies. Talk 3 (15 min): Bill Stanfield, lead data manager, will demonstrate our utilization of the REDCap Data Resolution Workflow and Data Quality modules to efficiently manage data collection, data quality, and audits. He will show how REDCap can be used to seamlessly communicate with research staff to obtain missing or late data, verify out of range values, and then validate and lock responses for analysis. Talk 4 (15 min): Glenn Lesser, WF NCORP multiple principal investigator (mPI), will discuss a team approach to adjudicating cancer treatment information that often consists of combination of surgery, radiation, chemotherapy, or immunotherapy/targeted agents. This remains a particularly challenging problem in large trials enrolling patients with multiple types of cancer who may be treated with a wide spectrum of standard therapeutic regimens. This diversity limits both the effectiveness of automated reviews of remote data entries and the study-specific training of data management staff at sites. Data are pulled in real time from multiple forms within REDCap and collated into participant-level summaries of treatment, starting with the time of baseline assessment and sorted sequentially for each drug administration or event. A multidisciplinary team of data managers, biostatisticians, and clinicians meet to adjudicate each participant as data collection completes. Particularly for trials with multiple cancer types or treatment regimens, our experience with this approach has shown it identifies significant data gaps in treatment, with at least 75% of entries requiring clarification from research staff prior to finalizing and locking data. This process highlighted the challenge of real-time adjudication of treatment data in patients receiving multiple anti-cancer agents, given at varying doses and schedules, and in multiple combinations and/or phases over an individual patient's course of therapy. Panel (30 min): We will conclude with a panel discussion and Q&A. The panel will contribute additional perspective on implications of these strategies in the conduct of multilevel cancer care delivery research studies. We will also incorporate perspectives from NCORP community sites implementing these strategies. Panelists will discuss the broad applicability of these strategies for diverse trials, with attention to size/ complexity, database vendor, and patient population.

How transformational leaders increase nurse retention and decrease attrition

The COVID-19 pandemic exacerbated the problem of nurse attrition, which negatively impacted the lives of nurses, decreased patients' perception of their healthcare, and increased the cost of healthcare. Facility administrators who lack strategies to decrease nurse turnover may lose their ability to provide quality nursing services in their facility and control their costs of care. Grounded in the transformational leadership theory, the purpose of this qualitative multiple case study was to explore the strategies private medical treatment facility administrators use to decrease nurse attrition. Five private medical treatment facility administrators located in Southern Texas completed semistructured, open-ended interviews, and three employee engagement survey results were analyzed. Results were analyzed using thematic analysis. Four themes emerged: develop a culture of engagement, approach associates' concerns from a perspective of listening, provide financial benefits within the control of management, and advocate to the United States Federal Government. A key recommendation for facility administrators is to remain visible leaders and conduct unit rounding often. The implications for social change include the potential to improve the lives of nurses, increase patients' perception of their healthcare, and decrease the cost of healthcare. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Implementing System Solutions for Survivorship Care Plans

Background: A survivorship care plan (SCP) is a detailed cancer care summary and future care plan that is generally given to a patient upon completion of adjuvant treatment for a cancer diagnosis. The initial goals of SCPs were to educate patients and other health care professionals about the treatments received, make them aware about potential long-term effects of therapy, and emphasize recommendations for future cancer screening and care (1). Due to numerous barriers-scheduling, staffing, and lack of awareness-SCPs are not delivered to all eligible patients. To address this unmet need our multidisciplinary breast clinic (MDBC) established an Advanced Practice Professional (APP) Survivorship Clinic. With the acute impact of the COVID-19 pandemic, survivorship referrals decreased. We, therefore, developed and implemented system solutions to address SCP access. Method(s): System solutions include partnering with the Cancer Registry to provide the list of patients potentially in need of survivorship visits, partnering with pharmacy to confirm patient eligibility, creating specifically designated telemedicine survivorship visits in our electronic scheduling system, prospectively scheduling persons identified, engagement of APPs across the MDBC, and establishing a single coordinating point. Numbers of SCPs delivered are tracked monthly and patient satisfaction is assessed through data collected Press Ganey surveys. Result(s): This presentation will share our process interventions and outcomes as they mature. Our early data demonstrate the efficacy of the workflow and appear promising. Conclusion(s): We anticipate that system-based solutions will provide more patients with SCPs and demonstrate patient satisfaction. Blaes AH, Adamson PC, Foxhall L, Bhatia S. Survivorship Care Plans and the Commission on Cancer Standards: The Increasing Need for Better Strategies to Improve the Outcome for Survivors of Cancer.

Quality Improvement Project for Antibiotic Stewardship in Urgent Care

Overprescribing antibiotics is currently a major issue in the outpatient setting. Inappropriate antibiotic prescriptions are leading to costly adverse effects, including antibiotic resistance. Antibiotic stewardship interventions are adaptable tools that are readily available to prescribers to reduce the overuse of antibiotic prescriptions. The purpose of this project was to implement an Antibiotic Stewardship Bundle in an urgent care clinic. The overall aims of this project were to decrease the amount of unnecessary antibiotics prescribed and increase best prescribing practice. The results of the quality improvement project showed inappropriate antibiotic prescription rates decreased from 54.7% to 35.4% (P = 0.0006).

Clinician barriers, perceptions, and practices in treating patients with hepatitis C virus and substance use disorder in the United States.

The likelihood of clinicians prescribing direct-acting antiviral (DAA) therapy for patients with chronic hepatitis C virus (HCV) and substance use disorder (SUD) was assessed via a survey emailed throughout the United States to clinicians (physicians and advanced practice providers) in gastroenterology, hepatology, and infectious disease specialties. Clinicians' perceived barriers and preparedness and actions associated with current and future DAA prescribing practices of HCV-infected patients with SUD were assessed. Of 846 clinicians presumably receiving the survey, 96 completed and returned it. Exploratory factor analyses of perceived barriers indicated a highly reliable (Cronbach alpha = 0.89) model with five factors: HCV stigma and knowledge, prior authorization requirements, and patient- clinician-, and system-related barriers. In multivariable analyses, after controlling for covariates, patient-related barriers (P < 0.01) and prior authorization requirements (P < 0.01) were negatively associated with the likelihood of prescribing DAAs. Exploratory factor analyses of clinician preparedness and actions indicated a highly reliable (Cronbach alpha = 0.75) model with three factors: beliefs and comfort level; action; and perceived limitations. Clinician beliefs and comfort levels were negatively associated with the likelihood of prescribing DAAs (P = 0.01). Composite scores of barriers (P < 0.01) and clinician preparedness and actions (P < 0.05) were also negatively associated with the intent to prescribe DAAs. Conclusion: These findings underscore the importance of addressing patient-related barriers and prior authorization requirements-significant problematic barriers-and improving clinicians' beliefs (e.g., medication-assisted therapy should be prescribed before DAAs) and comfort levels for treating patients with HCV and SUD to enhance treatment access for patients with both HCV and SUD.

Veränderungen in anhaltenden Extremsituationen: Psychosoziale Belastungen von Angehörigen der Gesundheits- und Krankenpflegeberufe während der Covid-19 Pandemie.

Background: The Covid-19 virus caused increased challenges for nursing professionals. Objectives: This study aims to explore psychosocial stress in the work environment of nursing staff resulting from the pandemic within an Austrian hospital. In addition, differences in the experience between nurses and nursing assistants, in leadership and management positions, as well as between wards with (suspected) Covid-19 positive patients and wards without Covid-19 patients will be recorded. Design and Methods: In a mixed-method study, a web-based survey was conducted using the Copenhagen Psychosocial Questionnaire (COPSOQ). The qualitative data was collected with four open questions. The results were analysed descriptively and inferentially with a one-way analysis of variance and the Mann-Whitney-U test. The qualitative data were analysed using content analysis. Results: A total of 104 participants completed the survey. The results show that there is a burden on nursing professionals (p = 0.03) within the area of emotional and quantitative demands (p < 0.01), but no differences between the individual nursing groups emerged. Leadership and management positions report less stress than the rest of the nursing staff (p ≤ 0.05). When distinguishing between Covid-19 (suspected) wards and non-Covid-19 wards, two scales (demands for hiding emotions % possibilities for development) were statistically significant (p ≤ 0.04). Conclusion: The results of this study illustrate the psychosocial burden of the Covid-19 pandemic on nurses with different characteristics and are in line with current research. Further studies should address the impact of the burden on nursing practice.

In Service to Others: APRNs as Serving Leaders During the COVID-19 Pandemic

The impact of the SARS-CoV-2 virus on delivery of hospital care during the ongoing COVID-19 pandemic has required effective nursing leadership of large teams of Advanced Practice Registered Nurses (APRNs). At a large academic medical center in the mid-Atlantic United States, nurse leaders combined knowledge of the psychological phases of disaster and principles of the Serving Leadership framework to mobilize and lead APRN teams to deliver high-quality care to all patients and provide a safe working environment for healthcare teams. In this article, we discuss exemplars that demonstrate the flexibility and strengths of APRNs in all roles who addressed rapidly evolving needs such as resource allocation and education. The conclusion highlights the value and relevance of APRN skillsets to clinical practice and the opportunity to further capitalize on these strengths during the continuing journey through this COVID-19 pandemic and beyond.

Family Communication in the Icu: Challenges and Solutions

INTRODUCTION: The COVID-19 pandemic created major barriers to communication with patient families, impacting patient care and staff satisfaction. We surveyed an interprofessional group of medical intensive care unit (MICU) stakeholders to identify their concerns surrounding family communication and solicited recommendations for performance improvement. METHOD(S): An anonymous survey was distributed electronically to 260 MICU physicians, advanced practice providers (APPs), nurses, and physical, occupational, and respiratory therapists, with a 1 week reminder. The results were analyzed using thematic analysis. RESULT(S): Thirty-nine participants (response rate 15%) completed the survey, providing 95 unique comments. Major themes included challenges created by visitor policy restrictions (providers unable to connect well with families by phone;families not understanding how to work video platforms;frequent misunderstandings);medical system distrust (antivaccine and overall hostility, unrealistic expectations, challenging treatment decisions);trainee communication concerns (lack of communication training, not seeing the "big picture", nurse not knowing whether families were contacted/what was discussed), and A2F bundle failures (F component not organized, family updates too infrequent, distorted messages). This feedback prompted a quality improvement initiative to strengthen our family communication process. The responsible resident or APP is now encouraged to use a "Get to Know Me Board" to structure the collection of relevant social history with patient and family on admission, establishing an initial relationship and line of communication. Our rounding template was modified to discuss the family communication plan each day using a tiered structure (brief summary/introduction on admission;update;serious update/acute event;goals of care;transition to comfort) and clarify which team members will be present for the conversation. Afternoon rounds were also modified to routinely confirm successful family contact and address any concerns. CONCLUSION(S): We describe the results of our interprofessional survey to define the barriers to family communication during the COVID-19 pandemic, and process improvements in our MICU to make daily family involvement and contact feasible and efficient within our daily workflow.

Clinician Experiences Related to Requests for Ivermectin and Healthcare Distrust in the Rural South

INTRODUCTION: Ivermectin has been widely requested or prescribed as treatment for COVID-19 despite NIH and WHO recommendations against its use. Even so, clinicians commonly receive requests for unproven COVID-19 therapies (UCTs) and face substantial disruption to the therapeutic alliance when clinicians deny these requests from patients. METHOD(S): This study was conducted from 2021-2022 in Moultrie, Georgia. Physicians or advanced practice clinicians who treated a COVID-19-positive patient in the health system were eligible. Purposive, convenience sampling was used to recruit clinicians to participate in a 30-minute qualitative interview exploring experiences and thoughts related to UCT requests, patient trust in the healthcare system, and personal impact of distrust and UCT requests. Thematic analysis was applied to transcripts. RESULT(S): Participants were 8 clinicians (7 physicians, 1 advanced practice nurse) from several fields (outpatient setting=2, inpatient or mixed setting=6): pulmonary/critical care (n=3), internal medicine/hospitalists (n=2), nephrology (n=1), and family medicine (n=2). Five themes emerged: 1) Clinicians do not understand why people trust social media and not their clinical expertise;such distrust is hurtful and frustrating;2) Clinicians feel ambivalence about discussions about UCTs and are generally accepting of community beliefs;3) Clinicians perceived that distrust in healthcare originates outside of the healthcare system yet patients exhibit trust within the local healthcare system;4) Clinicians are torn about whether to use UCTs to build trust and rapport;5) Counseling strategies are variable yet clinicians spend significant time focusing on education. CONCLUSION(S): Clinicians experience distress related to perceived patient distrust in their recommendations about COVID-19 vaccination and UCT requests. Some clinicians perceive that acquiescing to UCT requests may help repair therapeutic relationships with minimal harm. Clinician perspectives are aligned with themes from a related study of patient trust and UCT request from the same healthcare system. Taken together, these studies provide insight for clinicians looking to craft savvy and ethical messages that are responsive to patient needs while upholding professional standards in prescribing medications.

Influence of Covid-19 on Burnout among Critical Care Advanced Practice Providers

INTRODUCTION: Burnout results from physical and mental exhaustion and affects the intentionality to leave the profession. Unfortunately, burnout scenarios have been quite common among Critical Care Advance Practice Providers (APPs). The calls to action to sustain the critical care workforce were in full force before COVID-19 attacked the world and rapidly turned into a pandemic. Already overburdened and depleted critical care workforce was further exacerbated by overwhelming work demands. Our research was aimed at understanding the influence of COVID-19 on the critical care APPs. METHOD(S): We utilized a cross-sectional REDCap survey to understand the self-perceived extent to which the burnout among critical APPs had changed. A single link to survey was emailed to 2775 SCCM physician assistant and nursing section members. There were 578 responses (response rate 20.8%). After excluding 60 non-APPs responses, our sample size was 518. Survey questions asked about the symptoms of emotional exhaustion, depersonalization, perception of reduced personal accomplishments and intention to leave. RESULT(S): We found an increase in burnout and related dimensions. Emotional exhaustion increased from 28.8%- 69.9%, depersonalization increased from 17.2%-37.6%%, and perception of reduced personal accomplishments increased from 18.1%-38% among our study population. We also asked about the intentions to leave critical care and a total of 513 participants engaged with this question. Twenty-two percent (n=114) of our sample expressed an intention to leave critical care. We also asked about the intention to leave the profession altogether and only 21.8% (n=113) participants responded. A total of 43.3% (n=49) respondents reported the intention to leave the profession altogether within the following 2-5 years. Of those who responded, 22.1% (n=25) intended to leave within 1 year and 25.7% (n=29) intended to leave between 5-10 years while 8.9% (n=10) stated that they intended to stay beyond 10 years. CONCLUSION(S): COVID-19 pandemic exacerbated the burnout and its dimensions among critical care APPs. It is crucial to attend to the trends in burnout and intention to leave and mitigation strategies must be employed to sustain the critical care workforce which is key to planning the future of critical care in the US and globally.