ABSTRACT
Objectives: Extracorporeal membrane oxygenation (ECMO) is a complex life support modality. To appropriately educate ECMO clinicians, a comprehensive program is required. However, there is no universal ECMO education (EE) program exclusively for intensive care unit Registered Nurses (RNs). Moreover, with the recent Coronavirus Disease 2019 (COVID-19) pandemic, the existing nursing shortage and the ability of ECMO programs to maintain an established EE program worsened. This continuous quality improvement (CQI) aims to reestablish the quality of an EE program at a large academic medical center at one of the past pandemic epicenters. Method(s): A CQI process with the Plan-Do-Study-Act (PDSA) cycle and Ishikawa diagram for root cause analysis (RCA), intervention implementation from July 2022 to June 2023 Results: The RCA revealed intrahospital pandemicrelated restrictions for employee gathering, EE instructor unavailability, increased nursing turnover, increased nursing shortage, and incomplete recordkeeping of ECMO educational activity (EEA) RN attendance as dominant factors disrupting the established EE processes. Six interventions were implemented, with one added in later: 1. Schedule 1 Certification Lecture Day/Quarter (Q), 1 Re-Certification Lecture/Q, and 1 Circuit Skills Class/ month, and 1 Simulation Lab/month 2. Reserve an education room for all EE activities, as COVID-19 policies allow 3. Increase the number of EE instructors 4. Increase Nursing Leadership-ECMO Manager collaboration for optimal RN signup 5. Optimize EEA schedule to help balance RN staffing needs 6. Develop a Master ECMO Folder in Google Drive and maintain updated attendance Five interventions showed positive preliminary results, whereas it was too soon for any conclusion for one (Table 1). Conclusion(s): While preliminary, the achieved results justify that restoring the quality of an ECMO education program after the negative impact of the recent pandemic is possible. However, final results are necessary to infer the effectiveness of each intervention. (Figure Presented).
ABSTRACT
Introduction: The COVID-19 pandemic disrupted health care delivery, particularly for high-volume procedural areas. To improve productivity in the Los Angeles County 1 University of Southern California Medical Center (LAC + USC) Endoscopy Unit, we initiated an iterative rapid cycle quality improvement process to identify inefficiencies and implement changes to our workflow. Method(s): A time-motion analysis of patient flow through the LAC + USC Endoscopy Unit was used to construct a time-tracked flow sheet to track individual patients as they moved through the Unit. Data were collected weekly over 3 9-10 week phases, and intervening plan-do-study-act (PDSA) cycles were conducted to direct interventions for subsequent phases. Following phase 1 (9/1/21 to 11/9/21) we implemented targeted interventions at the start of phase 2 (12/1/21 to 2/1/22) and phase 3 (3/15/22 to 5/31/22). Phase 2 was focused on our anesthesia supported endoscopy room which requires greater resource coordination. Metrics were compared to published benchmarks. Linear regression was used to compare outcome parameters for the lean process flow improvement project. Result(s): Our phase 1 analysis showed operational delays in room turnover time for all procedures and pre-operative assessment and first-case on time start percentage for procedures supported by anesthesia, when compared to published benchmarks (Table 1). In phase 2 we implemented an intervention of combining pre-anesthesia visits with endoscopy teaching visits for patients designated to have anesthesia support. This significantly improved both turnover time and throughput for the anesthesia room (Table 1). In phase 3 we initiated a policy of preparing the first patient of the day in the procedure room which dramatically increased first-case on time start percentage. We further streamlined inter-procedure processes by simultaneously consenting, placingmonitoring equipment and documenting in the time between procedures, leading to a greater than 20% increase in total procedure volume (Table 1). Procedure throughput for the anesthesia supported procedure room increased from 4.5 to 7 to 9 procedures per room per day for phases 1, 2, and 3 respectively (Table 1). EndoscopyUnit staffing remained unchanged throughout the study period. Conclusion(s): Time-motion analysis of patient flow may be used to perform targeted interventions with significant improvements in Endoscopy Unit efficiency. This may be achieved without costly interventions such as hiring additional support staff or faculty. (Table Presented).
ABSTRACT
The COVID-19 pandemic tasked affected healthcare programs to find creative solutions for preserving staff competency amidst high staffing turnover, limited resources, and increased patient acuity. In 2022, our ECMO leadership team aimed to provide additional educational resources to our ECMO specialist team, without adding to the workload of staff burnout. Prior to 2020, our educational structure involved an extensive onboarding process for new ECMO specialists, quarterly hands-on drill simulations, and a yearly recertification exam. From 2020 to 2021, we saw a significant amount of turnover within our ECMO department amidst the pandemic. We ended 2020 with 36 specialists and 2021 with 18 specialists, hiring 12 new specialists. Our ECMO census continued to increase with 72 total runs and average daily census of 2.2 in 2021, up to 99 total runs and average daily census of 2.4 in 2022. 2021 ELSO data showed that 60% of our patient runs contained mechanical errors including air entrainment, cannula problems, circuit exchanges, oxygenator failure, and thrombosis. In order to support our staff with so many new specialists who are expected to care for a higher quantity of patients with more complex morbidities, at the same exceptional quality as our most senior staff, we provided a variety of additional educational resources in 2022. Visual aids were created for our 3 ECMO pumps including pump physiology, basic handling skills, emergencies, and advanced scenarios. We also created a pocket guide combining the educational information taught in the onboarding class with other various resources provided to our staff. ECMO staff members can keep the pocket guide to reference, and to add their own notes as needed. Lastly, a monthly newsletter sent to our staff, containing programmatic updates, educational tips and quizzes, reminders, and helpful links. After surveying our specialists at the end of 2022, we found that >80% of the specialists watch the videos before or during shifts, 100% watch the videos to prepare for water drills, and >80% own a pocket guide. 75% found the additional resources helpful to succeed in water drills and staying prepared to sit pump. Our 2022 ELSO data also showed a decrease to 43% of patient runs containing mechanical errors. MUSC is ELSO-designated platinum-level for both the pediatric and adult ECMO program, signifying the highest level of performance, innovation, satisfaction, and quality. Our goal is to use current practices combined with mentioned innovative strategies to retain this status in the upcoming year.
ABSTRACT
Coronavirus disease 19 (COVID-19) is a highly contagious and lethal disease caused by the SARS-CoV-2 positive-strand RNA virus. Nonstructural protein 13 (Nsp13) is the highly conserved ATPase/helicase required for replication of the SARS-CoV-2 genome which allows for the infection and transmission of COVID-19. We biochemically characterized the purified recombinant SARS-CoV-2 Nsp13 helicase protein expressed using a eukaryotic cell-based system and characterized its catalytic functions, focusing on optimization of its reaction conditions and assessment of functional cooperativity among Nsp13 molecules during unwinding of duplex RNA substrates. These studies allowed us to carefully determine the optimal reaction conditions for binding and unwinding various nucleic acid substrates. Previously, ATP concentration was suggested to be an important factor for optimal helicase activity by recombinant SARS-CoV-1 Nsp13. Apart from a single study conducted using fixed concentrations of ATP, the importance of the essential divalent cation for Nsp13 helicase activity had not been examined. Given the importance of the divalent metal ion cofactor for ATP hydrolysis and helicase activity, we assessed if the molar ratio of ATP to Mg2+ was important for optimal SARS-CoV-2 Nsp13 RNA helicase activity. We determined that Nsp13 RNA helicase activity was dependent on ATP and Mg2+ concentrations with an optimum of 1 mM Mg2+ and 2 mM ATP. Next, we examined Nsp13 helicase activity as a function of equimolar ATP:Mg2+ ratio and determined that helicase activity decreased as the equimolar concentration increased, especially above 5 mM. We determined that Nsp13 catalytic functions are sensitive to Mg2+ concentration suggesting a regulatory mechanism for ATP hydrolysis, duplex unwinding, and protein remodeling, processes that are implicated in SARS-CoV-2 replication and proofreading to ensure RNA synthesis fidelity. Evidence is presented that excess Mg2+ impairs Nsp13 helicase activity by dual mechanisms involving both allostery and ionic strength. In addition, using single-turnover reaction conditions, Nsp13 unwound partial duplex RNA substrates of increasing doublestranded regions (16-30 base pairs) with similar kinetic efficiency, suggesting the enzyme unwinds processively in this range under optimal reaction conditions. Furthermore, we determined that Nsp13 displayed sigmoidal behavior for helicase activity as a function of enzyme concentration, suggesting that functional cooperativity and oligomerization are important for optimal activity. The observed functional cooperativity of Nsp13 protomers suggests the essential coronavirus RNA helicase has roles in RNA processing events beyond its currently understood involvement in the SARS-CoV-2 replication-transcription complex (RTC), in which it was suggested that only one of the two Nsp13 subunits has a catalytic function, whereas the other has only a structural role in complex stability. Altogether, the intimate regulation of Nsp13 RNA helicase by divalent cation and protein oligomerization suggests drug targets for modulation of enzymatic activity that may prove useful for the development of novel anti-coronavirus therapeutic strategies. This work was supported by the Intramural Training Program, National Institute on Aging (NIA), NIH, and a Special COVID-19 Grant from the Office of the Scientific Director, NIA, NIH.Copyright © 2023 The American Society for Biochemistry and Molecular Biology, Inc.
ABSTRACT
Background: National rollout of the Safer Baby Bundle (SBB) is recommended by the National Stillbirth Action and Implementation Plan for improving the standard of antenatal care at scale to reduce stillbirth. Progressive implementation over 2.5 years, commenced from mid-2019. This qualitative study aims to understand the process enablers and barriers influencing the effectiveness of SBB implementation. Method(s): Semi-structured interviews with SBB site leads/champions (17 maternity services) and state program leads across Queensland (QLD), Victoria (VIC) and New South Wales (NSW) were conducted post-implementation of SBB to explore local, regional, and state implementation strategies, processes and experiences. Normalization Process Theory was used as an analytic framework for thematic analysis to understand different approaches and contexts for SBB implementation. Result(s): 17 site leads (6 VIC, 5 NSW, 6 QLD) and 6 state program leads were interviewed from Sept to mid-Nov 2022. Findings indicate strong local leadership, shared regional and state-based learning opportunities, consistency of information and endorsement by clinical networks were key implementation supports. Barriers included limitations and inconsistencies across data and information systems, and constraints with protected time for training and improvement activities. High turnover and re-deployment of leads due to external factors (e.g., COVID, extreme weather events) disrupted timelines, impacting commitment and engagement with the initiative. Conclusion(s): Despite differences in resources, approaches, and timelines between sites and states for SBB implementation, similar key barriers and enablers were identified. An in-depth understanding of the factors underpinning successful implementation of the SBB will guide future activities to support sustainable change.
ABSTRACT
Topic significance and study purpose/background/rationale: Nursing schools today have placed greater emphasis on online learning leading to limitations in clinical experience and communication skills. Staff turnover has also led to an increase in novice nurses entering the BMT specialty who are then trained by those with limited experience themselves emphasizing the need to incorporate new teaching methods in our nursing residency programs. Methods, intervention, and analysis: An orientation program was developed incorporating nursing competencies, communication skills, critical thinking, and oncology/BMT knowledge aligned with the hospital's new graduate RN residency program. In addition to formal classroom education covering basic nursing skills, institutional protocols, and foundational oncology/BMT knowledge, simulation scenarios were developed reviewing multiple complications often seen in a BMT unit, including febrile neutropenia, septic shock, and cellular therapy infusion reactions. Debriefing and surveys were conducted evaluating the nurse's level of comfort with the scenarios prior to and after simulation. Findings and interpretation: Each simulation lasted thirty minutes followed by one hour of debriefing, analysis, and evaluation. Individual nursing interventions utilized in the scenario were aligned with appropriate hospital policies and best nursing clinical practices. A survey was conducted rating the level of comfort before and after the simulation. 100% of the nurses reported feeling more comfortable with the situations reviewed after undergoing the simulation. Feedback also included novice nurses' lack of experience with oncologic emergencies during their orientation as preceptors often felt compelled to intervene leaving the resident with less hands-on experience. The novice nurses also felt the simulation provided them with the practical clinical experience that had been limited during the COVID-19 pandemic when more novice nurses were training simultaneously with less numbers of cellular therapy patients. Discussion and implications: Simulation provides a safe and effective way of teaching novice nurses about the cellular therapy specialty and common complications when hands-on experience is limited. By incorporating simulation into training, the nurse residents feel more comfortable practicing independently. Greater confidence, enhanced critical thinking, and improved patient outcomes were advantages noted with this educational method. The benefits and success of these simulations will lead to more scenarios being incorporated into training as the BMT specialty continues to evolve.Copyright © 2023 American Society for Transplantation and Cellular Therapy
ABSTRACT
Background: COVID-19 pneumonia is newly recognized illness has spread rapidly around the world. It causes much morbidity and mortality. Diabetes in COVID-19 patients is individual risk factor and documented in worldwide studies to contribute to severity of the disease, increased length of stay and higher mortality. Aggressive management of blood sugars and acute diabetic complications reduce the length of stay and mortality. Method(s): The improvement project carried over for four months in King Fahd Armed Forces hospital. Randomly selected 200 patients admitted to the hospital with diabetes and COVID-19 studied. The unified treatment protocol applied for all patients and blood sugars monitored closely and optimized. Data collected on bimonthly basis and analyzed. The patient characteristics taken from data extraction tool (Oasis) of hospital. Median values for length of stay and post discharge FBS and RBS were calculated Microsoft Excel tool. Mortality rates calculated by percentages. Result(s): 200 patients studied in the 4 months study period. The median length of stay was 3 days. The mortality rate was 2.5%. The median FBS and RBS in the patient group monitored in the post discharge clinic was 130 mg/dl and 170 mg/dl respectively. The results compared with the standard international studies and improvements in primary and secondary outcomes documented. Discussion(s): The length of stay in the study population in the project was 3 days as compared to 13 days in a major international study helping rapid turnover of beds and financial savings. The mortality was 2.5% compared to 7.3% in a major published study, reflecting the implications of aggressive management of diabetes by teamwork. The median values of FBS 130 mg/dl and RBS of 170mg/dl achieved by regular follow-up and support to the patient by running postdischarged clinic definitely help reducing readmissions and acute complications of uncontrolled diabetes. Conclusion(s): COVID-19 patients with diabetes are more prone to have more severe disease, and tend to stay longer in hospital and have higher mortality compared to non-diabetics. An aggressive preemptive strategy with unified treatment protocols and readily available service of endocrinologist and effective control of diabetes and acute complications of diabetes significantly reduces the length of and mortality in COVID-19 patients with diabetes.
ABSTRACT
Rationale: The COVID-19 pandemic has led to the deaths of millions with its ability to cause severe pneumonia. Diagnosis is based on PCR testing which has many limitations: lengthy turnaround times, lack of universal availability and variance in sensitivity. Imaging such as CXR could be a valuable and faster aid in diagnosing COVID-19 compared to PCR. It is widely available, cheap and can be performed at the bedside- enabling a rapid turnover of patients whilst minimising cross-link infection. However only a few studies have assessed its prognostic value. We aim to analyse the diagnostic accuracy of CXR in COVID-19 and to assess if severity of COVID pneumonitis on CXR correlated with mortality. Method(s): A retrospective study of all in-patients aged >= 18 years with a confirmed diagnosis of COVID-19 during the first and second waves of the pandemic. Admission CXRs and in-patient CT Thorax scans were analysed. Statistical analysis was performed using the Chi-Squared Test for independence. Result(s): 999 COVID-19 patients were included in the study. Severity of COVID pneumonitis on CXR correlated with mortality when patients were grouped into the following categories: normal (n=161, mortality=42%), mild (n=220,mortality=33%) moderate, (n=328, mortality=42%) and severe (n=290, mortality=58%) (P<0.001). 251 patients had both CT and CXRs. CT scans were superior in diagnosing COVID pneumonitis (63%) compared to CXR (47%) (P<0.001). Conclusion(s): Our study showed a positive correlation between the severity of COVID pneumonitis on CXR and mortality, supporting the use of CXR in the ED to help rapidly identify and treat patients at high risk of death.
ABSTRACT
We attempted to analyze the effect of changes in financial performance after digital transformation on firm value creation, compared to undigitalized firms for digitally transformed firms listed in the KOSPI market in Korea. To this end, we conducted an independent sample t-test and a multivariate regression analysis for a total of 12,143 firms listed on the KOSDAQ market, from 2011 to 2021. As a result of the empirical analysis of our study, it was confirmed that digitally transformed firms showed differential results in changes in financial performance compared to undigitalized firms. Overall, changes in profitability, stability, and growth are excellent, but in some aspects of activity and productivity, it is confirmed that they are weaker than undigitalized firms. In addition, it was confirmed that there was a difference in the change in the current ratio and the total asset turnover rate in the changes in the financial performance affecting the value creation. Nonetheless, there were insignificant differences in other variables.
ABSTRACT
Despite improvements in cancer outcomes over time, significant disparities remain between Black and White cancer survivors. Medical care is estimated to account for 10-20% of health outcomes, while other modifiable factors explain as much as 80-90% of outcomes. These disparities may thus be driven by multiple factors including social determinants of health, differences in treatment or follow up, or attitudes and behaviors of care teams. As part of a larger project, we conducted a qualitative study to understand cancer survivor preferences for and experiences with social needs screening and referrals. The results of this assessment will inform the delivery of social risk screening for breast and prostate cancer survivors in the multi-site study. Semi-structured interviews were conducted in English between March and April 2022 with breast and prostate cancer survivors from two cancer institutes in Washington DC. Patients were purposively recruited to ensure diversity in age, race, and cancer stage (I-III). Each interview lasted 60 minutes. Transcripts were reviewed for consensus and preferences for social needs screening. Thirteen survivors participated in the interviews. Participants were mostly breast cancer survivors (n=10), African American (n=6), were equal in stages I and II at time of diagnosis (n=5), and ranged in age from 34 to 81 with a median age of 64. Most patients (n=7) did not report social needs screening during their treatment, though all patients welcomed having these conversations with their care team. The majority of patients (n=9) desired face-to-face conversations as opposed to on paper (n=1) or through the patient portal (n=1). Similarly, most patients (n=7) did not mind who on their care team held the conversations. There was difference in opinion on how often social needs should be discussed, with four participants suggesting every appointment to another patient suggesting once at diagnosis. When asked about the needs patients experienced during treatment, food insecurity and nutrition were most cited (n=6), followed by transportation (n=4) and emotional resources (n=4). Only one patient reported not desiring social needs referrals during treatment. Other avenues for seeking out social resources included self-initiated research online or through books (n=2), and another patient described utilizing their local church (n=1). Finally, patients also spoke about challenges in receiving treatment and transitioning to survivorship due to the COVID-19 pandemic, including hospital staff turnover and care team inconsistency (n=1), bringing loved ones to appointments (n=1), and transportation challenges for individuals who relied on public transport to and from the clinic (n=1). This research reveals important insight to the perspective on social needs screening among a group of breast and prostate cancer survivors in the Washington DC region and highlights the ways in which patients have experienced and desire screening for social needs. In future work we will expand the number of interviews and apply these findings into practice.
ABSTRACT
This paper aims to ingress the position of sale from the year 2016- 2022 . This current study aims to examine the profitability and working capital management of SAIL with the important statistical tools like mean, standard deviation, minimum and maximum coefficient of variation etc and ratios.Profitability is financial standard of Corporate ability to gain profit and it can be measured through profitability ratios such as Gross Profit ratio, Net profit ratio, return on capital employed etc.Working Capital Management incorporatethe relationship between a firm's current assets and current liabilities. It represent that a company can afford itsday to day operating expenses to continue its operations. It can be examine through current ratio, liquid ratio, current assets turnover ratio, total assets turnover ratio, working capital turnover ratio, debtor turnover ratio and inventory turnover ratio.Hence, it was concluded that the overall performance of SAIL regarding profitability was negative during the first two years of study period though the company's sales are growing but after that company started earning profit, but again during the covid period profit started declining, but again it recovered and profitability started rising with the increase in sales.This paper analysis that management of working capital detect the liquidity position and the area of weaknesses and also provide recommendation for removal of the weaknesses of the public sector enterprises with special reference to SAIL. Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.
ABSTRACT
Objectives: In general, the demand for medical tourism is influenced by several factors. The first is an aging population with a growing health problem and discretionary income and leisure. The second is changes in health behaviours that focus on disease prevention. Research seeks the answer to the changes in the demand for medical tourism in recent years in health spas. Method(s): We conducted secondary research, based on official data of the Hungarian Central Statistical Office. We examined the types of baths, the passenger traffic of the baths, the services used with National Health Insurance Fund Administration (NHIFA) support, the turnover of the baths Due to the Covid-19 pandemic, data for the year 2020 were not taken into account, so we are examining the period between 2012 and 2019 for health spas in Hungary. Result(s): During the period under review, between 2012 and 2019 the demand of spas showed an increase of 15 %, which was 6.6 million people. The number of visitors to the spas increased by an average of 945,000 per year, which means an average increase of 2.5 %. 92.6 % of spa visitors used the services without NHIFA reimbursement in 2012, which increased to 94.7 % by 2019, an annual average increase of 0.3 %. In connection with the turnover of the baths, there is no data for years 2012 and 2013, in the period between 2014-2019, it increased by 56.31 million HUF, an average increase of 11.26 million HUF per year. Conclusion(s): The continuous development of health spas resulted in the growth of spa favourites in Hungary. The increase in the number of spa favourites would mean to increase the scope of the NHIFA supported treatments and the degree of subsidies, which consists of the aspirations and suggestions of the Hungarian Baths Association. Copyright © 2022
ABSTRACT
Background: Access to rehabilitation services for Aboriginal people following acquired brain injury (ABI) is frequently hindered by challenges navigating: i) complex medical systems, ii) geographical distances from services and iii) culturally insecure service delivery. Healing Right Way is the first randomised control trial (RCT) to address these issues in partnership with multiple health service providers across Western Australia (WA). Aims: To outline the multicomponent Healing Right Way intervention by providing case studies, and describing challenges, facilitators and implications for rehabilitation services. Method: This stepped-wedge cluster RCT involved four metropolitan and four regional sites across WA. Aboriginal adults hospitalised for ABI were recruited from 2018-2021. Intervention components comprised ABI-related cultural security training (CST) for hospital staff, and employment of Aboriginal Brain Injury Coordinators (ABICs) to support ABI survivors for six months post-injury. The primary outcome was quality of life (measured with Euro QOL-5D-3L VAS) at 26 weeks. Secondary outcomes included participants' overall function and disability, anxiety and depression, carer strain, and changes to service delivery across the 26-week follow-up period. Detailed process and cost evaluations were also undertaken. Results: 108 participants were recruited from the participating sites. The CST was delivered across all eight participating hospitals with 250 hospital staff trained. ABICs supported 61 participants, 70% residing in regional, rural or remote areas. Challenges to implementation of the intervention included impacts from COVID-19 responses, hospital staff turnover and availability, recruitment of people with traumatic brain injury and methods for maintaining contact with participants and next-of-kin across locations. Collaboration with Aboriginal health providers and community networks were invaluable to maintaining contact with participants during follow-up, as was telehealth and research partnerships. Discussion/Conclusions: This landmark trial provides a novel multicomponent intervention in an underserviced population to inform muchneeded service improvements for Aboriginal people with ABI across metropolitan and rural settings.
ABSTRACT
SESSION TITLE: Quality Improvement SESSION TYPE: Original Investigations PRESENTED ON: 10/17/22 1:30 pm - 2:30 pm PURPOSE: Organ transplant is the ultimate necessity in managing many end-stage organ pathologies. As per the health resource and service administration, 17 people die every day while waiting for an organ transplant. In the year 2020, 169 million Americans registered as organ donors, but due to the limitations of organ donation such as cause of death and condition of the organ at the time of death, only about 3 in 1000 people die in such a way that their organs are in an optimum condition for transplantation 1. The role of nurses in organ donation is critical in both acute and critical care settings 2. Educating nurses on certain aspects of organ donation, such as approaching the families and counseling regarding moral and legal considerations, will acclererate the process of organs retrieval from the interested donors. We hypothesized that in addition to Best Practice Alert (BPA) on Electronic Medical Record (EMR), educating nurses can optimize organ donation by timely referring the organs for transplantation. METHODS: ICU-wide nursing education sessions were conducted elucidating that when a ventilated patient qualifies for Life Gift notification and a BPA does not pop up in EMR, Nurses should immediately call the Houston Methodist organ donation service, Life Gift within one hour of the following two triggers: 1) Loss of one or more brainstem reflex(es), 2) Glasgow Coma Scale (GCS) ≤ 5. Nurses were also educated to start a timely discussion with the family proposing Life Gift prior to discussing the withdrawal of life-sustaining treatments, popularly known as terminal extubation. The data for timely organ referral from the preceding six months (January 2021 to June 2021) was compared to the four months (July 2021 to October 2021) following the nursing education sessions. RESULTS: The total number of timely referrals in the pre- and post-education period were n=23/33 Vs. n=29/31. The overall timely referral of the organ for transplantation increased from 69.2% to 95%. Out of four months post-education, two months record the compliance of 100%. Our chi-square statistic was 5.969 with a p-value of 0.01456. We performed Yates continuity correction due to small sample size and to compensate for deviations from the theoretical (smooth) probability distribution. Our chi-square statistic with Yates correction was 4.506, and the p-value was 0.034 (Significant at p < 0.05). Our study was limited by the small sample size, high nursing turnover due to the COVID-19 pandemic, and logistic restrictions due to the pandemic. CONCLUSIONS: The overall referring time for organs improved after nursing education sessions, including targeted triggers. CLINICAL IMPLICATIONS: Nursing education plays a crucial role in organ donation programs. Further studies are needed to better understand the issues that nurses face and develop new strategies that can be implemented to improve the organ and tissue referrals for organ donation. DISCLOSURES: No relevant relationships by Muhammad Mohsin Abid No relevant relationships by Sana Jogezai No relevant relationships by Iqbal Ratnani No relevant relationships by Salim Surani No relevant relationships by Muhammad Hassan Virk
ABSTRACT
Work-life balance (WLB) is very imperative for all married & working group. Factors namely Workload and responsibilities, Work Environment, Family dependents, Feelings about work, Absence from the job, Work-Family conflict and Family-Work conflict are the predictors of WLB in this study and WLB is the central variable of the study. Job satisfaction and Labor Turnover Intentions are the outcomes of WLB according to this study. It has been discovered that Feelings about Work (FAW) is the most influencing factor of WLB and there is a significant difference between job description and the variables affecting WLB except for Absence from work variable. Thus a survey is conducted for gathering data regarding satisfaction at work place along with work life balance. IBM SPSS tools is used for data analysis in this work.
ABSTRACT
Introduction: Transition to the critical care environment for new and redeployed nurses is challenging due to the complex knowledge, skills and technical abilities that underpin safe and effective practice.1 Aim/Objectives: The aim was to develop a visual learning tool to display complex information in a manner that could be quickly consumed and easily understood. This aids comprehension, enhances quality of learning and retention of the material. The infographic ('Cheat Sheet') was seen as a unique way to present this multi-modal information. We aimed to engage staff and encourage further information seeking. Bradshaw and Porter (2017)2 state that 65% of people are visual learners -conveying complex information in an easy to understand manner is fundamental to the Cheat Sheet's success. Our critical care unit has encountered significant staff turnover in the past 12 months, as well as increased patient numbers and acuity of illness secondary to COVID-19. Lack of a designated clinical nurse educator is an added constraint and adds pressure to experienced critical care nurses to provide education and support to new and redeployed staff. Methods: We conducted an informal survey of new and redeployed staff, asking which areas of critical care they perceived to be most daunting. We used the PDSA cycle to produce multiple iterations of the resulting infographic. After discussion with colleagues, we produced the final version, focusing on cardiac, respiratory and neuro principles. This incorporates essential aspects of the CC3N Step 1 and 2 Competencies.3 Results: Extensive qualitative feedback has been universally positive and we have had significant interest from other Critical Care Units throughout the country hoping to emulate our success. Staff reported that patients are receiving treatment quicker due to the presence of the 'cheat sheet'. Electrolyte replacement in initiated promptly and early stages of delirium are picked up and treated appropriately. Conclusion: The infographic 'cheat sheet' first and foremost enhances patient safety. To ensure equity of care delivery, itmakes sense to strive for a critical care workforce that is trained to common standards, assuring quality of workforce across geographical boundaries. This leads to an enhanced patient journey and can reduce length of stay. Nurses utilising the 'cheat sheet' learn about skills and knowledge needed to deliver safe high quality bedside care to the critically ill patient. Being able to involve and work closely with the multidisciplinary team to best meet the patient's needs is essential to providing person centred care. The infographic cheat sheet has been added to our Organisations teaching app which all hospital staff can access. It has been uploaded on to the British Association of Critical Care Nurses website so it can be utilised throughout the UK.
ABSTRACT
Aim: To improve education in patients with new urinary catheters on discharge from the Emergency Department (ED), decreasing the incidence and healthcare burden of subsequent catheter-associated complications. Method: Qualitative study design was employed to survey all Healthcare Professionals (HCPs) working in the ED and establish the quality and means of information currently provided. A novel trust-endorsed proforma with information leaflet was created with urology team input and uploaded to the ED website. Staff were updated via email, WhatsApp and verbally and re-surveyed after 6 months. Survey responses were evaluated with descriptive statistical analysis. Results: The majority of HCPs in the department reported nearly always/ often providing information verbally to patients, with similar findings on re-surveying. The most commonly discussed topic with patients remained: Common complications and where to seek advice. HCPs reported never/rarely offering written information (75%, 74% before and after respectively) and nearly all HCPs surveyed did not know where to find patient information resources (81%, 79% respectively). Conclusions: Written information provision remained poor despite creation of a proforma with information leaflet. A high departmental turnover of HCPs, alongside varying seasonal Covid burden may have reduced the efficacy of interventions. The findings may also be as a result of HCPs still not knowing where to locate such resources. 'Nudge theory' through placing leaflets next to catheter supplies, combined with improved education of new staff rotating through the department at individual inductions and the introduction of checklists are changes that have been since actioned and due to be re-surveyed in February 2022.
ABSTRACT
Aim: To determine the orthopaedic trauma theatre efficiency in two large major trauma centres (MTCs) in Scotland before and after the outbreak of Coronavirus disease (COVID-19) pandemic. Method: All trauma patients presented to the North and East of Scotland's MTCs prior to the outbreak of COVID-19 (7th May to 7th June 2019), during the first peak of COVID-19 (7th May to 7th June 2020), after Aerosol Generating Procedures updates (7th November to 7th December 2020) and the 'new normal' (7th May to 7th June 2021) were retrospectively reviewed. Training opportunities and theatre time were compared. The Kruskall-Wallis test was used. Results: There were no significant differences in the length of hospital stay (p=0.117, 0.065) and time from injuries and surgery within groups in both MTCs (p=0.508, 0.384). The pandemic has negatively affected the anaesthetic and surgical preparation time, time between end of procedure and send for next case, and turnover time, with more profound effect on the North of Scotland's MTC. The trainee's involvement as main surgeon had decreased with the outbreak of the pandemic, with the junior trainees being affected most severely in North of Scotland. The time taken for patient to arrive to theatre after sending and total downtime were twice as long in the North of Scotland. Conclusion: The COVID-19 pandemic has negatively impacted the orthopaedic trauma theatre efficiency and training opportunities. Actions should be taken to improve the turnover time to maximise theatre efficiency while prioritizing training opportunities.
ABSTRACT
The aviation system has been hugely impacted by COVID-19 but will be a critical enabler of economic recovery. There is an urgent need for models to help understand the potential infection risks posed by air travel, as well as the impact of different mitigations available to aviation stakeholders. This paper presents a modeling system to address these needs. Elements of the model are described and it is then exercised to explore the relative effectiveness of airport and aircraft cabin passenger density restrictions, air turnover rate and passenger mask utilization. The model is then extended to explore the impacts on infection risk of different ATC delay scenarios. The model can be built upon in the future to not only help in the recovery from COVID, but also to develop system robustness strategies to better prepare for future challenges. © ATM 2021. All rights reserved.
ABSTRACT
Background: The impact of clinician burnout on patient care is pervasive across medical delivery systems. The effects are also felt in preventive care where cancer screening efforts rely on clinician referrals through the electronic medical records (EMRs). Though designed to support healthcare, EMRs are a significant source of clinician burnout given the number of clicks or navigation time needed to refer a patient. This is a barrier to Patient Navigation (PN) when ordered tests do not materialize into screenings or when clinicians order labs/imaging and the pending orders are not created. This causes frustration for all clinical staff involved, delays the workflow processes, and leads to missed opportunities for PN. We implemented an 'order set' intervention to reduce the click burden linked to colorectal cancer (CRC) screening referral among clinicians in South Georgia. Methods: The 'order set' intervention was developed to facilitate PN for a Colorectal Cancer Control Program (CRCCP) aimed at implementing Evidence- Based Interventions to increase CRC screening rates in Georgia. The 'order set' was designed to address workflow issues by consolidating steps associated with CRC screening. This reduced typing input and the need to click between multiple windows within the EMR while making a referral to PN. The intervention was piloted in the Albany Area Primary Health Care (AAPHC) system after modifications were made to the EMR and clinician workflows. The monthly CRC screening rates continue to be generated and tracked post-implementation. Results: The use of the 'order set' reduced the click burden from 78 to 7 inputs and clinician EMR interaction time from 110 seconds to 29 seconds. Providers from 4/7 clinics have adopted the 'order sets' when making referrals for CRC screening. Two clinics provided post-implementation screening data. The pre-implementation screening rates for one clinic were comparable (August = 59.3%, September = 57.6%) to post-implementation (October = 56.3%, November = 56.6%, December = 57.2%), while the second clinic showed some increase (August = 58.6%, September = 60%) vs. (October = 61%, November = 62.1%, December = 62.8%). Conclusions: The 'order sets' intervention reduced the time clinicians spent creating referrals for CRC screening, including fecal immunochemical tests (FIT) and colonoscopies. Additional follow-up and rollout to clinics participating in the program is underway to evaluate further the impact of the order sets on CRC screening outcome and process measures, including qualitative interviews with clinicians. There is significant potential in the application of order sets to various workflow processes to aid in preventative health efforts. Challenges linked to the COVID-19 pandemic and staff turnover affected acquisition of patient referral data.