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Background: The COVID-19 pandemic catalyzed innovation in infection control measures, including widespread deployment of digital contact tracing systems. However, these technologies were not well understood by the general public and were complex for the public health community to implement, hampering adoption. Objective(s): To provide an overview of existing digital contact tracing systems, creating a framework for understanding design elements that impact their effectiveness as public health tools and offering a rubric for decision-makers to evaluate different systems for selection and implementation. Method(s): Scientific literature and publicly available information from relevant health authorities and other stakeholders was reviewed. Information was synthesized to develop a conceptual framework explaining how key design elements impact effectiveness of digital contact tracing systems and highlighting opportunities for future improvement. Result(s): A range of digital contact tracing interventions were deployed by governments worldwide and several professional sports leagues. Key design elements of the systems include: (1) data architecture (i.e., centralized versus decentralized systems, impacting privacy guarantees and data availability);(2) proximity detection technology (e.g., type of device signaling);(3) alert logic and timing (e.g., time- and distance-based criteria affecting sensitivity and specificity of alerts;real-time proximity alerts and/or bidirectional contact tracing, determining scope of infection prevention);(4) population (eligibility and availability);and (5) the structural and public health context of intervention (e.g., availability and timeliness of testing). Several systems demonstrated effectiveness in preventing transmission during COVID-19, though numerous limitations have also been documented in the literature. Conclusion(s): Digital contact tracing systems have the potential to mitigate the economic and public health impact of future infectious disease outbreaks, reducing community transmission and detecting potential cases earlier in the disease course. Lessons learned from solutions deployed during the COVID-19 pandemic provide an opportunity to improve multiple aspects of these systems, enhancing preparedness for future outbreaks.Copyright © 2023
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Introduction Maximising efficiency in endoscopy in the face of increasing service pressure, demand and complexity of endoscopy is imperative, particularly given the unparalleled impact of the COVID pandemic on service delivery and cancer pathways. Previous attempts to improve turnaround time through introduction of a turnaround nurse have been hindered by inadequate staffing. We aimed to improve list efficiency and improve turnaround time through the application of marginal gains theory and implementation of a multi-faceted improvement plan. Methods Data was collected from electronic patient records and audit entries made by endoscopy staff. List 'actual' start and stop times were audited against 'scheduled' times. Turnaround time was assessed by a Quality Improvement (QI) Fellow, observing the endoscopy list and collecting information in real time. Results were discussed at a departmental meeting and a 4-stage improvement plan was devised and implemented. Re-audit data was collected to determine effect. Results Preliminary audit data revealed 89% of list starts to be delayed. Lists ran beyond scheduled stop times in 73%. The improvement plan saw: 1) Review and re-organisation of the nursing rota. 2) Departmental commissioning of an external 'change agent' to conduct interviews with nursing and endoscopy managers and work with the QI fellow in designing a bespoke team-building day to address communication strategies and brainstorm perceived departmental issues hindering efficiency. 3) Introduction of an in-room debrief tool, to enhance situation awareness and teamwork. 4) Implementation of a multi-modal 'Nurse-led consent' training programme, combining didactic and in-situ scenariobased simulation training, measuring and recording competence using Directly-Observed-Procedural-Skills (DOPS) assessments. Re-audit data revealed improved list finish-times (49% cf. 27%) although delays in start-times remained. Median turnaround time was 10 minutes, a major improvement from a turnaround time in 20.8 minutes in 2018. Conclusions It is recognised that single improvement interventions are unlikely to result in significant, sustainable change. The aggregation of marginal gains theory dictates that small, marginal gains can add up to a remarkable improvement. Our 4-stage improvement plan saw the implementation of a revised nursing rota and a bespoke team-building day in tandem with the introduction of a 'Nurse Consent' training programme and a novel team debrief tool. In this way, we were able to implement change, whilst simultaneously assessing and addressing staff morale, engage key stakeholders and as a result significantly improve turnaround time. We plan to streamline admission and patient preparation processes to further address delayed start times in future cycles of the improvement project.
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INTRODUCTION: The incidence of CRC continues to increase at a rate of 2.1% per year in both men and women. Screening for CRC improves prognosis by identifying early-stages for treatment, resulting in lower mortality. Compliance rates for CRC screening have been low, and in optimized clinical settings, range from 50% to 70%. Fecal Immunochemical Test (FIT) has advantages over colonoscopy as it does not require bowel preparation and anesthesia, and is an easier test to complete. We hypothesize that CRC screening rates at our academic community hospital-affiliated clinic will improve by increasing resident education about FIT. METHODS: We reviewed the charts of patients aged 50-75 seen by resident physicians at our clinic from June 1, 2019 to December 31, 2019. Patients who did not have a follow-up or comprehensive visit within the mentioned timeframe, had an active diagnosis of CRC or history of colorectal surgery, or with risk factors placing them at high lifetime risk for CRC were excluded. Variables included patient age, gender, ethnicity, colonoscopy referral, FIT order, and reasons why CRC screening was not offered. Resident physicians were given an educational presentation and an informational e-mail addressing self-reported barriers to ordering FIT for patients. We then conducted a post-intervention chart review of patients aged 50-75 evaluated by residents from January 1, 2020 to March 31, 2020 and assessed the association of each variable with multivariate logistic regression. RESULTS: There was no significant difference in age, gender, ethnicity and overall CRC screening rates between the pre- and post-intervention groups (Figure 1.). There was a significant increase in FIT testing over colonoscopy (P=0.012, OR=2.10, 95% CI: 1.104-3.999) and in CRC screening rates in unscreened patients post-intervention (P=0.037, OR=1.55, 95% CI: 0.960-2.501) (Figure 2.). There was a significant reduction in amount of resident physicians forgetting to screen patients (P=0.003, OR=4.44, 95% CI: 1.664-11.82) (Figure 3.). CONCLUSION: Education improved the utilization of FIT testing over colonoscopy as well as the overall CRC screening rates in previously unscreened patients at our outpatient clinic. Recent EHR data showed a decrease of approximately 86% in CRC screenings across the U.S. - presumably due to access disruptions due to COVID-19. However, our clinic after resident education shifted towards theutilization of FIT, and ultimately increasing our CRC screening rates for previously unscreened patients. (Figure Presented) .