ECMO Program Quality Improvement Through Educational Resources Amidst Pandemic Staffing Crisis

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.

The impact of a novel dermatology teaching programme on medical students' understanding of and engagement with dermatology

It is well recognized that dermatology education across the UK is variable, sparse and oftentimes entirely absent from undergraduate medical curricula. However, annually 24% of the population in England and Wales present to general practitioners with a dermatological complaint. This quality-improvement project (QIP) aimed to improve medical students' understanding of common dermatological presentations as defined by one university's curriculum. Teaching sessions were conducted with penultimate and final-year medical students on their clinical placements. A questionnaire was used to establish student confidence levels at baseline, and following each session relating to various learning outcomes. Session 1 covered describing lesions with interactive cases, while session 2 included Objective Structured Clinical Examination (OSCE)-style scenarios for mock examination. Quantitative data were analysed using Microsoft Excel and qualitative data analysed using framework theory. A total of 67 datasets were analysed for key curriculum aspects as per university dermatological curriculum. Mean quantitative self-reported confidence levels preteaching (mean across all domains 6.04), post-cycle 1 (mean 7.62) and postcycle 2 (mean 8.01). A statistically significant improvement was identified in confidence for the domains 'confident describing cutaneous signs' (P = 0.026;Mann-Whitney U-test), 'management of chronic dermatological conditions' (P = 0.028), 'management of acute severe dermatological conditions' (P = 0.003), 'management of common benign, premalignant and malignant skin conditions' (P = 0.014), 'management of immunobullous skin conditions' (P = 0.004) from baseline to cycle 1, and 'dermatological history taking skills' (P = 0.232), 'examining skin' (P = 0.008) and 'dermatological prescribing' (P = 0.004) from baseline to after cycle 2. Thematic analysis of open-question feedback revealed that students found this teaching session useful, particularly with the examination-style of the sessions. Key areas to improve on included inclusion of ethnic skin types in the teaching. The statistically significant increase in student confidence levels suggests that the teaching programme was successful, thus our QIP outcomes were achieved. Furthermore, one can assume running similar programmes across other medical schools would be beneficial, particularly as dermatology education is underrepresented and variable across medical schools' curricula. Use of visual aids and a problem-centred approach is an effective tool that can be easily integrated into dermatology teaching. We aim to pursue further work to complete additional sessions, particularly focusing on the inclusion of ethnic skin types, which was identified as a key improvement point from students and reflects existing literature. Given the restrictions imposed by the COVID-19 pandemic, e-learning is vastly developing and we could also consider, in a repeat cycle, the use of video technology to help provide educational equality.

Towards assisting visually impaired individuals: A review on current status and future prospects

Visually impaired people require support with regular tasks including navigating, detecting obstacles, and maintaining safety, especially in both indoor and outdoor environments. As a result of the advancement of assistive technology, their lives have become substantially more convenient. Here, cutting-edge assistive devices and technologies for the visually impaired are reviewed, along with a chronology of their evolution. These methodologies are classified according to their intended applications. The taxonomy is combined with a description of the tests and experiments that can be used to examine the characteristics and assessments of assistive technology. In addition, the algorithms used in assistive devices are examined. This paper looks at solar industry innovations and promotes using renewable energy sources to create assistive devices, as well as, addresses the sudden advent of COVID-19 and the shift in the development of assistive devices. This review can serve as a stepping stone for further research on the topic. Copyright © 2022 The Author(s)

A Family-based Child Health Education Curriculum for Refugee Families

Background: Refugees are at risk for low health literacy and high rates of illness and hospitalization. A partnership between medical professionals at Yale and two New-Haven, CT-based refugee resettlement organizations aimed to create and implement a family-based, interactive pediatric healthcare curriculum with a goal of increasing childhood health knowledge among refugee families. Methods: Seven 1-hour, in-person classes and 1 virtual class were taught by pediatric residents with real-time translation in Pashto, Dari, Arabic, Swahili, and Kinyarwanda on the topics of child nutrition, safety, parenting, and oral health. Each class incorporated play-based activities for toddlers-a My Healthy Plate puzzle, street-crossing simulation, teeth-brushing demonstration, and block play-which were integrated into parental discussion with visual aids. Knowledge acquisition and satisfaction was assessed using pre- and posttests. Results: 67 adult participants had an 85% response rate. Average knowledge test scores increased in 5 of 7 classes, reaching significance in a class on parenting (mean 52% vs 90%, paired t-test p = 0.03) and child safety (mean 80% vs 97%, p = 0.04). 100% of respondents (67% response rate) reported increased understanding of the topic and would recommend the class to a friend. There were 5 participants for the virtual class. Conclusion: Child health education classes conducted for refugee families can improve knowledge of pediatric healthcare topics and provide positive experiences. A close relationship between healthcare providers and community refugee organizations has the potential to improve health education in refugee families. Future studies will assess efficacy and satisfaction of virtual classes during the COVID-19 pandemic.

RIGHT CHOICE - CONNECT CLINIC. THIS IS A SUPPORTIVE SPACE FOR PEOPLE WITH LEARNING DISABILITIES (PWLD) TO ACCESS SEXUAL AND REPRODUCTIVE HEALTH NEEDS, WITH PROFESSIONALS FEELING CONFIDENT AND SKILLED TO MEET THEIR NEEDS. THIS OUTLINES THE STEPS TAKEN TO BUILD A NEW OFFER TO PWLD, WHILST UPSKILLING THE MDT

Introduction People with Learning Disabilities are often invisible or deemed not being able to have sexual lives, however they are more likely to be exploited or abused, so being able to offer support and allow them to access good quality sexual and reproductive care was seen as important. Several clinicians felt poorly equipped to deal with this client group. Able to provide a welcoming space, looking at the specific support needed to allow this to work. Method The work was started by a MDT working party alongside, our partner the Family Planning Association (FPA) who had already supported another clinic, we were able to make use of their learning. Results Bespoke training was devised on three levels: introduction, specialist and Training the trainer which was of part of community involvement and networking opportunity. Building a library of recourses with visual aids to help illustrate common themes that might be presented in clinic. A booklet sent to new clients prior to attending, which outline what would be expected during consultations. Discussion Developing a welcoming space in a quiet community setting. We tabled a day where we would have one of the upskilled: clinician, health adviser with extended time slots. Building a rapport and trust over a few sessions might need to happen before any examination. We now have a code to be able to track the numbers. Covid as has made the provision moribund, we need to relaunch. CPD for new staff Annual training session for the Transition Team, working with young PWLD.

ADVANCE CARE PLANNING IN A LARGE TEACHING HOSPITAL EMERGING FROM THE COVID-19 PANDEMIC: A QUALITY IMPROVEMENT PROJECT

Background: Advance care planning (ACP) is an ongoing conversation where healthcare professionals explore patients' and families' wishes in order to act within their best interests. The COVID19 pandemic continues to highlight the importance of timely ACP, namely while our patients have capacity. We noted that despite advancing age, accumulating co-morbidities and high clinical frailty scores (CFS);ACP discussions were not taking place within our elderly department. We aimed to increase ACP conversations and ensure documentation on ReSPECT forms to allow continuity within primary care. Methods: 10 patients per ward were randomly selected. 69 patients met inclusion criteria (over 65 with CFS ≥5 or any patient with dementia). We reviewed electronic and paper records and defined evidence of ACP as ReSPECT form including preferred place of death (PPoD), or discussion with patient or relative in medical notes. We randomly selected a pilot ward and applied interventions over 4 weeks: • Small group teaching to junior doctors • Visiting ward MDTs to identify appropriate patients for ACP • Presenting baseline data to geriatricians • Visual aids from the palliative care team and prompt sheets for doctors. Results: Prior to our interventions, 22% of our sample had evidence of advance care planning, 33% of discussions documented on ReSPECT form. Following our intervention period we reviewed medical notes on our pilot ward. 58% patients now had evidence of ACP, with 66% documented on a ReSPECT form. Conclusion: We achieved a significant increase in advance care planning within our elderly medicine department, and are therefore better equipped to provide personalised care alongside our patients' wishes and values. Next steps: • Expanding teaching across the multi-disciplinary team • ACP 'champions' to highlight appropriate patients • Expansion of initial interventions across the departmentWe hope to embed and maintain this change through education, training and inspiring others.

eP236: TeleKidSeq: Incorporating telehealth into clinical care of children from diverse backgrounds undergoing clinical genome sequencing

Introduction: The global pandemic required healthcare institutions and clinical research programs to adapt quickly to non-traditional care models. TeleKidSeq is a pilot study that emerged from the NYCKidSeq program, an NIH-funded Clinical Sequencing Evidence-Generating (CSER) Consortium site focused on incorporating genomic medicine into the care of diverse New York City children with suspected genetic disorders. Embracing the opportunity to study the use of telehealth in delivering genomic results, TeleKidSeq will examine the impact of innovative remote genetic counseling modalities in medically underserved populations. Studies focusing on the use of telehealth performed before the COVID-19 pandemic have shown that patients prefer in-person visits to virtual visits;however, with the increased familiarity and widespread use of virtual platforms, we anticipate an increase in the preference for telehealth visits. TeleKidSeq aims to fill the gaps in current knowledge on the impact of visual aids in telehealth in diverse urban patient populations. Methods: TeleKidSeq will recruit 496 pediatric participants (aged 0-21 years) with neurologic, immunologic, or cardiac conditions suspected to have an underlying genetic cause who receive care predominantly within two large health systems in the New York metropolitan area. The Mount Sinai Genomics Stakeholder Board, consisting of diverse stakeholders and key community advisors, provided guidance about our study design and materials. Participants will be English- or Spanish-speaking, and based on prior enrollment data from NYCKidSeq study, we expect more than 65% will be from populations underrepresented in medical research. Prior to enrollment, participants will be randomized to receive their genomic results from a genetic counselor via telehealth either with screen sharing (ScrS) or without screen sharing (NScrS). All participants will receive genome sequencing (GS) from a clinically validated laboratory. Additionally, we will use GUÍA, a web-based application designed to enhance the delivery of genomic test results, in both the ScrC and NScrS arms to facilitate delivery of individualized genomic results and clinical information in a personalized, highly visual, and narrative manner. Surveys administered at baseline, after results disclosure, and 6-months post-results disclosure will be used to evaluate study outcomes. The primary outcome of the TeleKidSeq study will be participants’ perceived understanding of their GS results with a comparison between the results disclosed via videoconferencing with ScrS and NScrS arms. Secondary outcomes will include: objective understanding of GS results;understanding of medical follow-up recommendations and the actionability of genome sequencing results;adherence to medical follow-up recommendations made based on genomic results;and satisfaction with and ease of use of the telehealth experience, compared across the two arms. Diagnostic yield, clinical utility and cost of GS will also be assessed. Results: Not applicable. Conclusion: Overall, the TeleKidSeq pilot study will contribute to innovations in communicating genomic test results to diverse populations through telehealth technology. In conjunction with NYCKidSeq, this work will inform best practices for the implementation of genomic medicine in diverse, English- and Spanish-speaking populations.

Picture of a pandemic: visual aids in the COVID-19 crisis.

As a global crisis, COVID-19 has underscored the challenge of disseminating evidence-based public health recommendations amidst a rapidly evolving, often uncensored information ecosystem-one fueled in part by an unprecedented degree of connected afforded through social media. In this piece, we explore an underdiscussed intersection between the visual arts and public health, focusing on the use of validated infographics and other forms of visual communication to rapidly disseminate accurate public health information during the COVID-19 pandemic. We illustrate our arguments through our own experience in creating a validated infographic for patients, now disseminated through social media and other outlets across the world in nearly 20 translations. Visual communication offers a creative and practical medium to bridge critical health literacy gaps, empower diverse patient communities through evidence-based information and facilitate public health advocacy during this pandemic and the 'new normal' that lies ahead.