Acute Care Teaching Hospital Research Articles

Designing, Implementing, and Evaluating a Practice Tutor Internship Model during an Acute Care Clinical Internship.

Purpose: The purpose of this study was to implement and evaluate a novel internship model that incorporates a practice tutor in physiotherapy clinical education during an acute care cardiorespiratory internship at a large acute tertiary care teaching hospital in Canada. Method: A prospective evaluation of this model was conducted by means of a mixed-methods approach using surveys and focus groups. The participants were students and clinical instructors (CIs) who were taking part in the internship. Results: Half of the CIs agreed that the practice tutor model gave them more time to manage their caseload and work with the student than did the traditional model, and 63% would recommend the model for future internships. In reviewing the focus group and open-ended data, we identified four themes: benefits, tensions, critical logistics, and unforeseen blind spots. There was a trend for patient attendance to increase with the practice tutor model compared with the previous year's internship session and with the 5 weeks immediately preceding the internship. Conclusions: On the basis of CIs' and students' self-reports, the piloted practice tutor model was perceived to facilitate students' clinical reasoning and collaborative learning skills. In addition, during the 5-week internship, the number of patients seen each day by the individual CIs and their students was not reduced, with a trend toward increased patient attendance. There was also a trend toward CIs having the same or more time to manage their caseload and work with the students compared with a non-practice tutor internship model. Recommendations to improve this model in future implementations are made.

Impact of a Multifaceted Antimicrobial Stewardship Intervention in a Primary Health Care Area: A Quasi-Experimental Study.

The aim of the study was to evaluate the impact of a multifaceted antimicrobial stewardship intervention on antibiotic consumption in a primary health care (PHC) area in Spain. Quasi-experimental study conducted in a PHC area with nine PHC centers, a 400-bed acute care teaching hospital, and 18 nursing homes serving a population of 260,561. The intervention was based on the 2016 CDC Core Elements of Outpatient Antibiotic Stewardship publication and targeted 130 PHC physicians, 41 PHC pediatricians, 19 emergency physicians, and 18 nursing home physicians. The components were commitment, actions for improving antibiotic prescribing, tracking and feedback, and education and experience. The primary outcome was overall antibiotic consumption. Secondary outcomes were consumption of antibiotics to treat pharyngotonsillitis, acute otitis media, acute sinusitis, acute bronchitis, and urinary tract infection (UTI), percentage of patients treated with specific antibiotics, and dispensing costs. Consumption was measured in defined daily doses per 1,000 inhabitants per day (DID) and compared pre- and postintervention (2016 vs. 2018). Overall antibiotic consumption decreased from 16.01 to 13.31 DID (−16.85%). Consumption of amoxicillin/clavulanic acid and quinolones decreased from 6.04 to 4.72 DID (−21.88%) and 1.64 to 1.23 DID (−25.06%), respectively. The percentage of patients treated with antibiotics decreased from 26.99 to 22.41%. The intervention resulted in cost savings of €72,673. Use of antibiotics to treat pharyngotonsillitis, UTI, and acute otitis media, sinusitis, and bronchitis decreased significantly. Our antimicrobial stewardship program led to a decrease in antibiotic consumption and significantly improved the use of antibiotics for the most prevalent PHC infections.

Predictive clinical features of cardioembolic infarction in patients aged 85 years and older.

ObjectiveTo assess predictive clinical factors of cardioembolic infarction in very old patients (85 years of age and older).MethodsProspective hospital-based stroke registry (“The Sagrat Cor Hospital of Barcelona Stroke Registry”) is an acute-care teaching hospital in Barcelona, Catalonia, Spain. From 956 first-ever cardioembolic stroke patients included in the stroke registry over a 24-year period, 639 were younger than 85 years of age and 317 were 85 years or older (mean age: 88.9 years). Demographics, clinical characteristics, risk factors and early outcome were compared. Predictors of cardioembolic infarction in the oldest age group were assessed by multivariate analyses.ResultsIn a logistic regression model based on demographics, risk factors, clinical features and complications, female gender (odds ratio [OR] = 1.74, 95% confidence interval [CI]: 1.27–2.39), heart failure (OR = 2.27, 95% CI: 1.46–3.56), altered consciousness (OR = 1.76, 95% CI: 1.28–2.42), and infectious complications (OR = 2.01, 95% CI: 1.39–2.91) were predictors of cardioembolic stroke in the oldest age group. By contrast, heavy smoking, heart valve disease, hypertension, headache, early seizures, sensory deficit, and involvement of the posterior cerebral artery were independently associated with cardioembolic stroke in the younger group.ConclusionsIdentification of a differential clinical profile of cardioembolic stroke between patients aged 85 years or more and those younger than 85 years helps clinicians to the optimal management of ischemic infarction in the oldest segment of the population.

The effect of an antimicrobial stewardship programme in two intensive care units of a teaching hospital: an interrupted time series analysis

ObjectivesTo evaluate the effect of an antimicrobial stewardship programme in two intensive care units (ICUs) of a teaching hospital. MethodsBetween January 2017 and June 2018 we conducted a prospective, interventional, interrupted time-series study, based on Prospective Audit and Feedback in two ICUs of an acute-care teaching hospital. The primary outcomes were the difference in the antibiotic consumption, and the incidence of bloodstream infections (BSI) caused by multidrug-resistant (MDR) organisms. The secondary outcomes included the hospital mortality rate, the mean length of stay and the antibiotic expense. ResultsDuring the study, 231 audits were performed, evaluating 693 antibiotic prescriptions. The programme led to a global reduction in antibiotic consumption, with a change in level (CL) of –324.8 defined daily doses (DDD)/100 patient-days (PD), p 0.04, and particularly in the use of fluoroquinolone: (CL: –63.48 DDD/100 PD, p < 0.001). A non-significant reduction was obtained for the consumption of carbapenems (CL: –34.7 DDD/100 PD, p 0.25) and third- and fourth-generation cephalosporins (CL: –27.3 DDD/100 PD, p 0.102). Furthermore, we registered a significant decrease in all BSI (CL: –5.8 events/100 PD, p 0.026) and in BSI due to MDR Gram-negative organisms (CL: –2.96 events/100 PD, p 0.043). No difference was observed in the hospital mortality and length of stay. ConclusionsOur study demonstrated that implementation of an antimicrobial stewardship programme in two ICUs of a teaching hospital induced a significant reduction in antibiotic consumption and in the incidence of BSI due to MDR Gram-negative organisms, without any impact on the mortality rate.

2472. Point Prevalence of Healthcare-Associated Infections and Antibiotic Use in a Tertiary Care Teaching Hospital in Nepal: A Cross-Sectional Study

BackgroundHealthcare-associated infections (HAIs) are a growing threat to patient safety, particularly in resource-limited settings. Information on the burden of HAIs will help in surveillance and prevention efforts. This study aims to estimate the prevalence of HAIs and antibiotics use in a tertiary care teaching hospital in Nepal.MethodsWe conducted a descriptive cross-sectional point prevalence survey in a 350 bedded acute care teaching hospital at Kathmandu, Nepal on April 2019 in a single day for every ward. We studied all the patients aged ≥ 18 years admitted for at least two calendar days on the day of the survey to collect data on patient characteristics, hospital stay, and invasive devices and antibiotics used. We evaluated for the three common HAIs – pneumonia, urinary tract infection and surgical site infection, active on the day of data collection using the clinical criteria by European Center for Disease Prevention and Control protocol version 5.3. We summarized continuous variables with median and interquartile range (IQR) and categorical variables with proportions. We reported the prevalence of HAIs as a proportion of the number of HAIs by the number of patients studied.ResultsOf 213 inpatients, 160 were eligible, 25 (15.6%) among them were from critical care units. The median age was 50 years (IQR 34–65). The median duration of hospital stay was 6 days (IQR 4–9). There were 18 HAIs for the prevalence of 11.25%. Urinary tract infection was the most common HAI (13 HAIs, 72.2% of all HAIs). We found invasive devices used in 42 patients (26.2%), the most common was urinary catheter (37 patients, 23.1%). The number of patients with any antibiotic used was 114 (71.25%) with 61 (38%) patients receiving two or more antibiotics. Third-generation Cephalosporins were the most common antibiotics (74, 64.9%) used. We found 91 (79.8%) patients being treated for community-acquired infections.ConclusionThis study provides an estimate of the burden of HAIs in our center that is comparable to that of the reports from other resource-limited settings. However, we believe a higher burden will be revealed when we add microbiological criteria as well to diagnose HAIs. This highlights an urgent need for HAI surveillance system, infection prevention and control, and antibiotics stewardship programs in our center. Disclosures All authors: No reported disclosures.

Efficacy of cefoxitin versus carbapenem in febrile male urinary tract infections caused by extended spectrum beta-lactamase-producing Escherichia coli: a multicenter retrospective cohort study with propensity score analysis.

Cefoxitin has demonstrated good in vitro activity against extended spectrum beta-lactamase (ESBL)-producing Escherichia coli (ESBL-Ec) and is regarded as a carbapenem-sparing beta-lactam alternative in urinary tract infections. Its efficacy has never been compared to carbapenems in male UTIs. Our study aimed to compare the clinical and microbiological efficacy of cefoxitin (FOX) and carbapenems (CP) in febrile M-UTI due to ESBL-Ec (F-M-UTI). We conducted a multicenter retrospective cohort study of patients with F-M-UTI treated with FOX or CP as definitive therapy, between January 2013 and June 2015, in six French acute care teaching hospitals. The clinical and microbiological efficacies of FOX and CP were compared using multivariable logistic regression models, adjusting for propensity scores. Of the 66 patients included, 23 patients in FOX group and 27 in CP group had clinical assessment at follow-up. Median follow-up after end of treatment was 63days (interquartile range 26-114). Clinical success was observed for 17/23 (73.9%) and 22/27 (81.5%) patients and microbiological success for 11/19 (57.9%) and for 6/12 (50.0%) patients in FOX and CP groups respectively. We did not find any significant difference for clinical (OR = 0.90, 95% CI [0.12; 6.70]) neither microbiological (OR = 0.85, 95% CI [0.05; 14.00]) success between CP and FOX groups in univariate and multivariable models. In the FOX group, high dose with use of continuous infusion was associated with clinical success. These results add evidence that FOX is an effective alternative treatment to carbapenems for M-UTI caused by ESBL-Ec, particularly when high doses and continuous infusion are used.

Infectious disease consultations in a Japanese tertiary care teaching hospital: a retrospective review of 508 cases

ObjectiveLimited epidemiological data are available at tertiary care teaching hospitals in Japan. We reviewed infectious disease (ID) consultations in a tertiary acute care teaching hospital in Japan.MethodsThis is a retrospective review of the ID consultations from October 2016 to December 2017. The demographic data, such as requesting department, consultation wards, and final diagnosis, were analyzed.ResultsThere were 508 ID consultations during the 15-month study period. Among the 508 consultations, 201 cases (39.6%) were requested from the internal medicine department and 307 cases (60.4%) were requested from departments other than internal medicine. The most frequent requesting departments were Surgery (n = 102, 20.1%), Pulmonary Medicine (n = 41, 8.1%), and Plastic Surgery (n = 35, 6.7%). The most common diagnoses were intra-abdominal (n = 81, 16.0%), respiratory (n = 62, 12.2%), and skin and soft tissue infections (n = 59, 11.6%). ID consultations for disease diagnosis and management were more frequent in the internal medicine group than in the non-internal medicine group (37 cases, 20.8% vs. 40 cases, 13.7%, p = 0.046), and the number of requests for consultations for noninfectious diseases at the time of final diagnosis was higher in the internal medicine group than in the non-internal medicine group (21 cases, 11.8% vs. 16 cases, 5.5%, p = 0.0153).ConclusionSome physicians prefer ID specialists to identify and solve various medical problems. Internists had a greater tendency to request consultations for diagnostic problems, and noninfectious disease specialists have more requests for consultation at the point of final diagnosis. The role of ID specialists is expanding, from individual patient management to antibiotic stewardship, antibiotic prophylaxis, and development of and adherence to antibiotic protocol implementation based on the hospital’s microbial susceptibility and infection control. Although the number of specialists is limited in Japan, ID services now play an important role for achieving a good outcome in patient management.

Acceptability and feasibility of recruitment and data collection in a field study of hospital nurses\u2019 handoffs using mobile devices

BackgroundThe portability and multiple functionalities of mobile devices make them well suited for collecting field data for naturalistic research, which is often beset with complexities in recruitment and logistics. This paper describes the implementation of a research protocol using mobile devices to study nurses’ exchanges of patient information at change of shift.MethodsNurses from three medical and surgical units of an acute care teaching hospital in Montreal, Canada, were invited to participate. On 10 selected days, participants were asked to record their handoffs using mobile devices and to complete paper questionnaires regarding these exchanges. Nurse acceptance of mobile devices was assessed using a 30-item technology acceptance questionnaire and focus group interviews. The principal feasibility indicator was whether or not 80 complete handoffs could be collected on each unit.ResultsFrom October to December 2017, 63 of 108 eligible nurses completed the study. Results suggest that the use of mobile devices was acceptable to nurses, who felt that the devices were easy to use but did not improve their job performance. The principal feasibility criterion was met, with complete data collected for 176, 84, and 170 of the eligible handoffs on each unit (81% of eligible handoffs). The research protocol was acceptable to nurses, who felt the study’s demands did not interfere with their clinical work.ConclusionsThe research protocol involving mobile devices was feasible and acceptable to nurses. Nurses felt the research protocol, including the use of mobile devices, required minimal investment of time and effort. This suggests that their decision to participate in research involving mobile devices was based on their perception that the study protocol and the use of the device would not be demanding. Further work is needed to determine if studies involving more sophisticated and possibly more demanding technology would be equally feasible and acceptable to nurses.

Scenario-based simulation health care education for performance of hand hygiene

Simulation health care education is widely used in medical education and has great potential. However, scenario-based simulation health care education for preventing health care-associated infections has not been described. A single-center, prospective cohort study was conducted at Tokyo Medical University Hospital (1,015 beds), an acute care teaching hospital, from January 2011 to December 2014. Each training course was held every month and lasted 2 hours. Trainees put on and removed personal protective equipment under scenarios of standard precaution (2 scenarios) and contact precaution with methicillin-resistant Staphylococcus aureus (1 scenario), while considering the timing of hand hygiene. We determined the correlations between the participation rate in the simulation education and the use of alcohol-based hand disinfection and reduction of catheter-related bloodstream infection. There were 1,077 trainees. The total participation rate for hospital staff, which increased gradually during the study period, was 76% by the end of the study. The overall correlation between the use of alcohol-based hand disinfection in the hospital and the course participation rate was significant (correlation coefficient, 0.97). An inverse correlation (-0.94) was observed for the relation between the training course participation rate and the incidence of catheter-related bloodstream infection. Our training course had a positive effect on hand hygiene. This study is the first effective scenario-based simulation health care education on hand hygiene and control of health care-associated infection.

Delayed isolation of smear-positive pulmonary tuberculosis patients in a Japanese acute care hospital

BackgroundActive pulmonary tuberculosis (TB) is associated with intra-hospital spread of the disease. Expeditious diagnosis and isolation are critical for infection control. However, factors that lead to delayed isolation of smear-positive pulmonary TB patients, especially among the elderly, have not been reported. The purpose of this study is to investigate factors associated with delay in the isolation of smear-positive TB patients.MethodsAll patients with smear-positive pulmonary TB admitted between January 2008 and December 2016 were included. The setting was a Japanese acute care teaching hospital. Following univariate analysis, significant factors in the model were analyzed using the multivariate Cox proportional hazard model.ResultsSixty-nine patients with mean age of 81 years were included. The median day to the isolation of pulmonary TB was 1 day with interquartile range, 1–4 days. On univariate analysis, the time to isolation was significantly delayed in male patients (p = 0.009), in patient who had prior treatment with newer quinolone antibiotics (p = 0.027), in patients who did not have chronic cough (p = 0.023), in patients who did not have appetite loss (p = 0.037), and in patients with non-cavitary lesion (p = 0.005), lesion located other than in the upper zone (p = 0.015), and non-disseminated lesion on the chest radiograph (p = 0.028). On multivariate analysis, the time to isolation was significantly delayed in male patients (hazard ratio [HR], 0.47; 95% confidence interval [CI], 0.25 to 0.89; P = 0.02), in patients who did not have chronic chough (HR, 0.52; 95% CI, 0.28 to 0.95; P = 0.033), and in patients with non-cavitary lesion on the chest radiograph (HR, 0.46; 95% CI, 0.23 to 0.92; P = 0.028).ConclusionsIn acute care hospitals of an aging society, prompt diagnosis and isolation of TB patients are important for the protection of other patients and healthcare providers. Delay in isolation is associated with male gender, absence of chronic cough, and presence of non-cavitary lesions on the chest radiograph.

OI-169 - When It Hits the Fan: An Acute Care Infection Prevention Team's Response to an Unusual Regional Hepatitis A Outbreak

Background: Since August 2016, Southeastern Michigan has been experiencing a significant Hepatitis A virus (HAV) outbreak. As of mid-November 2017, there have been 495 cases, including 19 deaths (3.8%) and a hospitalization rate of 84%. Eleven healthcare providers (HCP) have been identified as primary cases. Given the outbreak's high hospitalization rate and unpublished evidence of patient-to-HCP transmission, our infection prevention (IP) department has identified opportunities to improve patient, visitor and HCP safety in our 772-bed acute care teaching hospital.

Accuracy of Inpatient Recall of Interaction With a Pharmacist: A Validation Study From 2 Acute Care Teaching Hospitals.

Background:Research has shown that inpatients may not accurately report interacting with a pharmacist.Objective:To determine accuracy of patients’ recollection of meeting with a pharmacist at 2 acute care teaching hospitals in Edmonton, Alberta, Canada.Methods:Retrospective review of 391 surveyed patients discharged from April 2013 to March 2014. Responses to meeting a pharmacist (yes/no) were compared with 2 reference standards: pharmacist documentation in patient charts and pharmacist clinical workload data. Sensitivity, specificity, positive predictive, and negative predictive values were calculated.Results:One hundred ninety-five (49.9%) respondents reported meeting with a pharmacist. Of these, 71 (36.4%) had corresponding pharmacist chart documentation. Of the 196 respondents who reported not speaking with a pharmacist, 73 (37.2%) had documentation present. Compared with patient charts, sensitivity and specificity were 49.3% and 49.8%, respectively. Positive and negative predictive values were 36.4% and 62.8%, respectively. Similar results were seen in comparison with the workload data.Conclusions:Patients often inaccurately reported meeting with a pharmacist in the acute care setting. The results are useful for pharmacist training, patient education, and for refinement of the current survey question.

Factors associated with low anterior resection syndrome after surgical treatment of rectal cancer.

To assess factors independently associated with low anterior resection syndrome (LARS) following resection or rectal cancer. Cross-sectional study carried out in two acute-care teaching hospitals in Barcelona, Spain. Patients who had undergone sphincter preserving low anterior resection with curative intent, with total or partial mesorectal excision (with and without protective ileostomy) between January 2001 and December 2009 completed a self-administered questionnaire to assess bowel dysfunction after rectal cancer surgery. Predictors of LARS were assessed by univariate and multivariate analyses. The questionnaire was sent to 329 patients (response rate 57.7%). Six cases of incomplete questionnaires were excluded. The study population included 184 patients (66.8% men) with a mean age of 63 years. There were 44 (23.9%) patients with no LARS, 36 (19.6%) with minor LARS and 104 (56.2%) with major LARS. In the univariate analysis, total mesorectal excision (P = 0.0008), protective ileostomy (P = 0.002), preoperative and postoperative radiotherapy (P = 0.0000), postoperative chemotherapy (P = 0.0046) and age (P = 0.035) were significantly associated with major LARS, whereas in the multivariate analysis, total mesorectal excision (odds ratio [OR] 2.18, 95% confidence interval [CI] 1.02-4.65), preoperative radiotherapy (OR 4.33, 95% CI 2.03-9.27) and postoperative radiotherapy (OR 9.52, 95% CI 1.74-52.24) were independent risk factors for major LARS. In this study, the risk of having major LARS increases with total mesorectal excision and both neoadjuvant and adjuvant radiotherapy. This article is protected by copyright. All rights reserved.

The Use of Alvimopan as Prophylaxis against Post-Operative Ileus After Bowel Resection in Patients With Inflammatory Bowel Disease

BACKGROUND: Postoperative ileus (POI) is a temporary delay of coordinated intestinal peristalsis following major abdominal surgery, leading to significant symptoms such as nausea, vomiting, abdominal pain, prolonged hospitalization, nosocomial complications, and physical deconditioning. The use of opioids for postoperative pain control further exacerbates the problem. Opioids bind to the mu receptors in the intestinal tract, leading to gut hypomotility. Alvimopan, an oral, peripherally acting mu-opioid receptor antagonist, was FDA approved in 2008 for use before and after bowel resection to help prevent and treat POI. There are no dedicated studies of alvimopan in patients with inflammatory bowel disease (IBD). Therefore, we conducted a study to investigate alvimopan's role in IBD patients who underwent either laparoscopic or open bowel resection. METHODS: A retrospective chart review was conducted at a 725-bed acute care teaching hospital in New York City between January 2012 and February 2017. Data collected included age, sex, type of IBD, length of stay, post-operative gastrointestinal symptoms (nausea, vomiting, constipation, abdominal distention, first flatus, first bowel movement, PO tolerance), and dose of alvimopan, were collected. The primary outcome was time to GI recovery. Secondary outcomes were: time to first flatus, time to first bowel movement, time to tolerating a liquid diet, time to tolerating solid food, and total length of stay. Descriptive statistics reports were created through a secure web-based application called REDCap (Research Electronic Data Capture), and the data were exported into Stata to run further analyses. Of note, approximately 50% of patients who underwent bowel surgery after March 2015 were placed on a “colon surgery pathway”, which is an order set dedicated to strategies that decrease length of stay and post-operative complications. Key features include early feeding, optimized analgesia regimen to allow patients to ambulate, encouraging use of incentive spirometry, and administration of alvimopan peri-procedurally. RESULTS: Of 247 patients, 121 received alvimopan (49.0%) and 126 (51.0%) did not. The male to female ratio was 51:49. The mean age of the control group was 44.4 ± 16.3 and that of the alvimopan group was 43.2 ± 16.4. Patients who received alvimopan had faster GI recovery, with a hazard ratio (HR) of 2.11 (P<0.001), shorter time to first flatus (HR 2.02, P<0.001), shorter time to first bowel movement (HR 1.93, P<0.001), shorter time to tolerating liquid diet (HR 2.48, P<0.001), and shorter time to tolerating solid food (HR 2.00, P<0.001). After controlling for type of bowel resected (large vs. small bowel), laparoscopic vs. open, age, and type of IBD (ulcerative colitis vs. Crohn's disease) using linear regression, patients who received alvimopan spent 2.59 fewer days in the hospital compared to the control group (P<0.01). CONCLUSION(S): The results of this study suggest that alvimopan is effective in accelerating the time to GI recovery. Data analysis of all primary and secondary outcomes revealed that alvimopan had a statistically significant benefit during the post-operative period of IBD patients undergoing bowel resection. Length of stay for IBD patients was significantly decreased with peri-operative use of alvimopan.

Optimising workflow processes in an advanced medication dispensary.

The workload measurement of an inpatient hospital dispensary is critical to improve efficiency in the face of limited budgets. This single-centre pilot study used work sampling to observe and identify areas to improve efficiency of dispensing prescribed medications at one tertiary level acute care teaching hospital. Workload sampling was conducted at a 1096-bed hospital in Calgary, Alberta, Canada. The dispensary services the entire hospital, 24h per day, seven days per week. Pharmacists are solely involved in clinical screening. The hospital uses a tech-check-tech practice. The observer was a registered pharmacist who collected data in the dispensary over two-hour blocks during November 14-24, 2017. A pre-made data collection sheet was used to record observations. Pharmacists duplicated tasks performed by dispensary technicians, such as ensuring STAT orders were delivered or identifying floor stock medications. Assistants inconsistently organised orders for filling. The assistant delivering STAT medications was difficult to find. Not all STAT medications were delivered first on a scheduled delivery route. Overall, areas for improvement in the dispensary process may include reinforcing the pharmacist clinical duties, establishing clinical competency baseline, supporting the full scope of practice of registered technicians, and consistent training of assistants, and clarifying communication processes.

Elucidating the information exchange during interfacility care transitions: Insights from a Qualitative Study

ObjectiveTo explore the perceptions of patients, their caregivers and healthcare professionals associated with the exchange of information during transitioning from two acute care hospitals to one rehabilitation hospital.DesignAn exploratory qualitative...

Evaluation of hospital staff's perceived quality of librarian-mediated literature searching services.

ObjectiveThe research evaluated the perceived quality of librarian-mediated literature searching services at one of Canada’s largest acute care teaching hospitals for the purpose of continuous quality improvement and investigation of relationships between variables that can impact user satisfaction.MethodsAn online survey was constructed using evidence-based methodologies. A systematic sample of staff and physicians requesting literature searches at London Health Sciences Centre were invited to participate in the study over a one-year period. Data analyses included descriptive statistics of closed-ended questions and coding of open-ended questions.ResultsA range of staff including clinicians, researchers, educators, leaders, and analysts submitted a total of 137 surveys, representing a response rate of 71%. Staff requested literature searches for the following “primary” purposes: research or publication (34%), teaching or training (20%), informing a policy or standard practice (16%), patient care (15%), and “other” purposes (15%). While the majority of staff (76%) submitted search requests using methods of written communication, including email and search request forms, staff using methods of verbal communication, including face-to-face and telephone conversations, were significantly more likely to be extremely satisfied with the librarian’s interpretation of the search request (p=0.004) and to rate the perceived quality of the search results as excellent (p=0.005). In most cases, librarians followed up with staff to clarify the details of their search requests (72%), and these staff were significantly more likely to be extremely satisfied with the librarian’s interpretation of the search request (p=0.002).ConclusionsOur results demonstrate the limitations of written communication in the context of librarian-mediated literature searching and suggest a multifaceted approach to quality improvement efforts.

Physician Perceptions and Attitudes Towards an Antimicrobial Stewardship Program and Computerized Decision-making Systems: A Focus Group Study

BackgroundAntimicrobial stewardship programs (ASPs) often employ multi-pronged strategies, including Computerized Decision Support Systems (CDSSs), to promote appropriate hospital antibiotic prescribing. Physicians are key determinants of the program’s effectiveness; yet little is known about their attitudes towards these interventions. We aimed to examine hospital physicians’ attitudes toward ASPs and their delivery via computerized systems, and their potential influence on physician antibiotic prescribing habits.MethodsThe focus group study was conducted in a large acute tertiary care teaching hospital in Singapore. We recruited physicians by purposive sampling and snowballing. Focus group discussions (FGDs) for junior and senior physicians were conducted separately. They were audio-recorded and transcripts were independently coded with subsequent adjudication. Major themes on facilitators and barriers to the adoption of ASPs were extracted. FGDs and coding occurred concurrently, consistent with the grounded theory approach.ResultsTwenty-nine junior physicians and eight senior physicians participated in six and two FGDs respectively. Theme saturation was achieved. Two motivators for adoption of ASPs were: (1) helpfulness of ASP initiatives/strategies; and (2) ASP team members’ proactive contact, both of which guide antibiotic prescription. Four barriers were identified: (1) the primary team’s clinical judgment is deemed of utmost importance; (2) the attending physician makes the final decision; (3) lack of awareness of ASP initiatives/strategies; and (4) complexity of the CDSS.ConclusionThemes extracted from the FGDs revealed that communication and education has a major influence on the adoption of ASP. The authors proposed a set of solutions for enhanced uptake of ASP initiatives through inter-professional collaboration. Future work is needed to identify the best and most effective methods to enhance collaboration between the physicians and the ASP team to improve antibiotic prescribing habits.Disclosures All authors: No reported disclosures.

Surgical outcomes of total thyroidectomy using the LigaSure™ Small Jaw versus LigaSure Precise™: A retrospective study of 2000 consecutive patients

BackgroundWe compared surgical outcomes of LigaSure™ Small Jaw, which is a multifunctional thermal device that incorporates a tissue divider versus LigaSure Precise™ in thyroid surgery. MethodsA retrospective, single-center study was carried out in an acute-care teaching hospital in Barcelona, Spain. Between January 2008 and June 2015, consecutive patients scheduled for total thyroidectomy were included in the study. Surgical outcomes were operative time, length of skin incision, use of a suction drain, intraoperative bleeding, postoperative complications and length of hospital stay. ResultsA total of 2000 patients were included (LigaSure™ Small Jaw, n = 1000; LigaSure Precise™, n = 1000). Demographics and indication for surgery were similar in both groups. A significant and independent shorter operative time (median 40 vs. 65 min, P = 0.002), smaller length of the skin incision (mean [SD] 4 [2] vs. 7 [3] cm, P = 0.031), lower percentages of patients with suction drain (15% vs. 66%, P = 0.012) and intraoperative bleeding (4% vs. 9%, P = 0.045) and reduced length of stay (median 1 vs. 3 days, P = 0.039) were found in the LigaSure™ Small Jaw than in the LigaSure Precise™. Postoperative complications including haematoma, hypoparathyroidism and recurrent laryngeal nerve injury were similar. ConclusionsThe LigaSure™ Small Jaw in thyroid surgery results in significant less blood loss and operative time as well as shorter hospital stay compared to LigaSure Precise™. These findings could have direct application in daily practice.

Factors influencing the effectiveness of audit and feedback: nurses' perceptions.

To explore the perceptions of nurses in an acute care setting on factors influencing the effectiveness of audit and feedback. Audit and feedback is widely used and recommended in nursing to promote evidence-based practice and to improve care quality. Yet the literature has shown a limited to modest effect at most. Audit and feedback will continue to be unreliable until we learn what influences its effectiveness. A qualitative study was conducted using individual, semi-structured interviews with 14 registered nurses in an acute care teaching hospital in Montreal, Canada. Three themes were identified: the relevance of audit and feedback, particularly understanding the purpose of audit and feedback and the prioritisation of audit criteria; the audit and feedback process, including its timing and feedback characteristics; and individual factors, such as personality and perceived accountability. According to participants, they were likely to have a better response to audit and feedback when they perceived that it was relevant and that the process fitted their preferences. This study benefits nursing leaders and managers involved in quality improvement by providing a better understanding of nurses' perceptions on how best to use audit and feedback as a strategy to promote evidence-based practice.