An evidence-based demand management strategy using a hub and spoke training model reduces waiting time for children's therapy services: An implementation trial.

BACKGROUND: Waiting lists for community-based paediatric therapy services are common and lead to poorer health outcomes, anxiety and missed opportunities for treatment during crucial developmental stages. The Specific Timely Appointments for Triage (STAT) model has been shown to reduce waiting lists in a range of health settings. AIMS: To determine whether providing training and support in the STAT model to champions within five community health centres using a remote 'hub and spoke' approach could reduce waiting time from referral to first appointment. METHODS: Representatives from five community health centres providing paediatric therapy services (speech therapy, occupational therapy and other allied health services) participated in five online workshops over 6 months. They were guided sequentially through the steps of the STAT model: understanding supply and demand, reducing backlogs, preserving space for new patients based on demand and redesigning models of care to maintain flow. Waiting time was measured in three consecutive years (pre, during and post intervention) and compared using the Kruskal-Wallis test. Employee satisfaction and perception of the model were explored using surveys. RESULTS: Data from 2564 children (mean age 3.2 years, 66% male) showed a 33% reduction in waiting time from the pre-intervention (median 57 days) to the post-intervention period (median 38 days, p < 0.01). The total number of children waiting was observed to reduce from 335 immediately prior to the intervention (mean per centre 67, SD 25.1) to 112 (mean 22, SD 13.6) after implementation (t[8] = 3.56, p < 0.01). There was no impact on employee satisfaction or other aspects of service delivery. CONCLUSION: Waiting lists are a major challenge across the health system. STAT provides a practical, low-cost, data-driven approach to tackling waiting times. This study demonstrates its effectiveness in paediatric therapy services and provides evidence for a 'hub and spoke' approach to facilitate implementation that could be provided at scale.

Spelling monosyllabic English words.

We conducted a megastudy to examine the spelling of American English monosyllables with typewritten responses. We related both sublexical and lexical/semantic factors to spelling accuracy and reaction time (RT) for the first keypress and response duration for spelling 1,856 monophonic monosyllables. We found that (a) each of 13 predictor variables was significantly related to performance for at least one measure, (b) orthographic length was unrelated to the first key RT, but did relate to accuracy and response duration, (c) sound-spelling and spelling-sound consistency was related to performance, and in particular, onset consistency related to accuracy and first key RT, but was unrelated to response duration, (d) contextual diversity was consistently related to performance across all measures, and (e) age of acquisition (AoA) was related to all measures, but was related more to the first key RT than response duration. The results indicate that people begin the spelling process once they identify the first letter, and they continue to process the spelling pattern as the response unfolds. These results are best explained by a parallel-distributed-processing framework.

Anticoagulation and bleeding in patients with ventricular assist devices: walking the tightrope.

A left ventricular assist device (LVAD) is a lifesaving therapy for end-stage heart failure, but it is associated with major complications such as bleeding and thrombosis. Anticoagulation is an important part of LVAD therapy; it requires meticulous management and monitoring for prevention of thromboembolic and bleeding events. Recommendations for thromboprophylaxis vary among pulsatile and nonpulsatile devices and require multiple pharmacological agents to achieve adequate anticoagulation. Patients expected to undergo LVAD implantation must have a comprehensive evaluation for underlying coagulopathies. During the perioperative period, all measures must be taken to prevent excessive bleeding and maintain hemostasis. Postoperative bleeding and thromboembolic episodes must be minimized to prevent significant complications of ventricular assist device therapy. Bleeding and thromboembolism are an impediment to a patient's quality of life as they can result in multiple hospitalizations, along with serious consequences such as death and permanent disability.