Admission Pathway Research Articles

HPB SO23 - Implementation and Outcomes of Index Admission Management of Acute Gallstone Pancreatitis on a Specialist Biliary Unit

Abstract Background While the management of acute gallstone pancreatitis (AP) has recognised guidelines, there are wide variations in compliance with these in various institutions for different reasons. The primary objective of this review was to evaluate the effects of implementing proactive management strategies on a specialist biliary firm receiving most biliary emergency admissions by protocol on the incidence of index admission laparoscopic cholecystectomy (LC) for AP. The secondary aims were to study the admission to LC interval, if such policy was safe and how it can help the optimisation of outcomes of AP. Method Analysis of prospectively collected data from AP patients treated by a specialist biliary unit dedicated to index admission LC and single session laparoscopic management of bile duct stones. Almost all patients were referred to the unit as soon as the diagnosis of AP was made. Only patients with severe pancreatitis on imaging or requiring intensive care were not included in the index admission pathway and subsequently underwent delayed surgery. Routine MRCP and ERCP were not part of the management protocol. Following clinical optimisation patients had LC with routine cholangiography (IOC). and if necessary bile duct exploration. Results 495/6140 patients were identified (8%), 70% females. Median age was 55 years. 92.3% had suspected ductal stones, half with jaundice. 11.9% had previous episodes. Only 6.2% had MRCPs and 2% ERCPs. Admission to LC interval was 5 days. 33.2% required bile duct explorations. LC difficulty grade was III to V in 37.2%. The median operative time was 62 minutes with no conversions, ductal injuries or mortality. Complications occurred in 9.2%, including 14 persistent pancreatitis/collections resulting in 6 of 25 readmissions. Two re-operations resulted from t-tube complications. Median hospital stay was 7 days, 72% having had only one admission. Conclusion Index admission LC on all AP patients fit for surgery is perfectly safe in the specialist setting. It optimises preoperative radiological investigations and endoscopic interventions and ,subsequently, a third of the patients require bile duct exploration. Implementing definitive surgical interventions during the index admission for AP offers a substantial reduction in hospital stay, re-admission rates and an overall decrease in hospital attendances. This not only yields significant cost benefits for the health service but also enhances the quality of life for patients.

Transmission of MRSA, ESBL E. coli, and C. difficile within a tertiary care hospital and across surrounding facilities in Japan: a molecular epidemiological study with the PCR-based Open-reading frame typing.

To determine the regional impact of transmission of multidrug-resistant organisms (MRDOs) and Clostridioides difficile (C. difficile) among a tertiary care hospital and surrounding facilities including long-term care facilities (LTCFs). Retrospective cohort study. Patients admitted to a tertiary care hospital from July 2019 to July 2021 were recruited if their clinically collected cultures grew the following pathogens: Methicillin-resistant Staphylococcus aureus (MRSA), Extended-Spectrum Beta-Lactamase (ESBL) producing Enterobacterales, Pseudomonas aeruginosa with difficult-to-treat resistance, Carbapenem-resistant Enterobaterales, Vancomycin-resistant Enterococci, and C. difficile. Patient characteristics including admission and discharge pathway were collected. For the isolates of MRSA, ESBL-producing Escherichia coli (E. coli), and C. difficile, a molecular epidemiological analysis was conducted, utilizing the PCR-based Open-Reading Frame Typing (POT) method. Three hundred-five patients were identified with a total of 332 culture specimens of the target pathogens. The top three were 132 MRSA isolates (43.3%, out of 305), 97 ESBL E. coli (31.8%), and 32 ESBL Enterobacterales (non-E. coli) (10.5%). The target pathogens were more detectable within 3 days among patients admitted from LTCFs or other hospitals than those admitted from home (Odds Ratio 4.6, 95% confidence interval 2.8-7.6, p-value < 0.001). The molecular epidemiological analysis suggested the transmissions of MRSA, ESBL E. coli and C. difficile occurred 52 out of 111 patients within the in-hospital environment, and 7 out of 128 within the prehospital environment, respectively. MDROs/C. difficile transmission is prevalent within a tertiary care hospital and further complicated by its inter-facility transmission across surrounding LTCFs and hospitals in Japan.

Acute Bed Avoidance, Direct Admissions from Frailty at the Front Door to Rehabilitation Beds in Partnership with the ICPOP Team

Abstract Background A key priority outlined in the Programme for Government is to support older people to live in dignity and independence in their own home. In line with the Slainte care vision for easier access of Right Care, Right Place and Right Time Clontarf Hospital have developed a pathway with the ICPOP Team/ FITT Team admitting patients directly from the front door of the acute hospital into a more appropriate environment, thus avoiding Acute Hospital admission or admitting directly from the community thus avoiding the Emergency Department presentation. The patients are over 65 years of age with multi comorbidities and complexities. Methods Both pathways have been developed and embedded. The ICPOP Consultant Geriatrician and the Patient Flow Teams in both Clontarf Hospital and the Mater Hospital collaborated to establish a seamless FITT to Rehab pathway which is person centred. At least 1 Rehabilitation bed is offered by Clontarf Hospital to the FITT ED Team 5 days a week Monday- Friday. An electronic communication group was instated to refer patients directly from the Emergency Department MMUH to Clontarf Hospital. The Comprehensive Geriatric Assessment Tool is utilised to refer and handover all patients. The data is collected on Clontarf Hospital Electronic Dash Board since the introduction of the service including: Results Since the start of the service mid-2022, 174 patients have been admitted saving acute hospital bed days. The MLOS is 22 days and ALOS is 27 bed days. Over 72% of patients are discharged directly home. There has been significant positive feedback from patients and families. Conclusion The establishment of a direct admission pathway from the Emergency Department and the community to a rehabilitation hospital has demonstrated positive patient outcomes and overall benefits to the healthcare system.

SP6.13 - Management of Older Major Trauma Patients: Impact of a dedicated guideline for facilitating older trauma care within a Pan London Trauma Network

Abstract Background and Aim Older age trauma is an increasing challenge for trauma networks with many clinical protocols needing to adapt and reflect age-related changes in physiology and management. In 2018, our older trauma guidance was introduced into our trauma system to improve early recognition of injury, admission pathways, clinical management and outcomes for those aged ≥65yrs (LMTS Older Trauma Guidance). The aim of our study was to assess the impact of the guideline on our trauma processes and patient outcomes. Methods This retrospective analysis of TARN compared process and outcome data for patients aged ≥65yrs admitted to hospitals within the North East London and Essex Trauma Network, pre (01/01/2016-31/07/2018) and post (01/08/2018-31/07/2020) guidance introduction. The primary outcome was mortality at 30 days post injury. Results and conclusions There were 4317 patients pre and 3992 patient post guidance. Time to CT reduced on average by 57 minutes, Neurotrauma transfers decreased from 2116 patients to 1519 patients and more older patients were discharged for rehabilitation. Older trauma mortality reduced across the network post guidance (13.59% vs 10.64%). The greatest mortality reductions were seen in Trauma Units, (19.20% pre vs 6.99% post) with increasing benefit seen with advancing age: reduced 75-84 years by 2.20%; 85-94 years 2.41%; 95+ years by 7.44%. This analysis suggests that dedicated guidance highlighting the special needs and risk profiles of older trauma patients significantly improves processes and outcomes. Improvements in early assessment and time to imaging appear to result in enhanced survival. Further research at a system level is required.

Characteristics and considerations of French medical education

Abstract French medical education, with a long history and guided by laws and decrees set by the French Ministry of Education and Ministry of Health, aims at elite training, focusing on the cultivation of students’ clinical practice and scientific research capabilities, and implementing a unified medical talent training model. The French medical education system continuously seeks innovation and change. In September 2020, a new round of reforms was initiated in aspects such as admission pathways, examination system, and assessment methods. These changes aim to enhance medical students’ disciplinary backgrounds, strengthen process-based assessment, and foster the development of versatile medical professionals. This article analyzes the characteristics of French medical education and the main measures of this round of reforms, providing insights and considerations for the training of cultivated medical talents in China.

Pengembangan Layanan dan Pengenalan Akademik di Lingkungan Kampus berbasis Aplikasi Chatbot bagi Calon Mahasiswa Baru

Technology has a crucial role in information dissemination, creating a need for interactive and user-friendly communication tools. One of tools that can be used in this research is chatbot. Chatbots serve as effective intermediaries in the information exchange process, providing a simple and interactive interface. This research aims to develop a Button-Based Chatbot using the Smojo AI platform, with an easy-to-use interface for delivering college preparation information to prospective students. The development of the chatbot employs the SDLC Waterfall method. The chatbot is named "KaKa: Campus Companion" and it provides information on interest tests recommendations, effective study methods, admission pathways to public universities, and scholarship recommendations. The results of this research demonstrate the successful development of a chatbot that delivers simple and interactive information. The implementation of the SDLC Waterfall method in chatbot development ensures a well-structured and coordinated approach, focusing on each menu within the chatbot. Based on the test results, which have been carried out both white-box and black-box testing, the application can run correctly 100% and UAT testing with an accuracy level of 91%.

Barriers, Benefits, and Enablers of Acute Home-Based Care (Hospital In The Home) in Australia for Older People: A Systematic Review

To determine the barriers, benefits, and enablers of acute home-based care in Australia for older people (aged 65 and over). A systematic review for people aged 65 and over receiving acute home-based care in Australia was conducted using various databases (CINAHL, Medline, PsycINFO, SCOPUS, Web of Science, PubMed, Informit) and citation searching in September 2023. The Critical Appraisal Skills Program (CASP) was used to assess the quality of the evidence and a thematic analysis approach was utilized to narratively synthesize results. Ten studies were included, consisting mostly of cohort studies in metropolitan areas. Barriers included inefficacy, patient demographics, and carers. Benefits included efficacy, high satisfaction, and medical management. Enablers included education, holistic assessments, and support interventions. Within the literature there was a significant research gap regarding HITH for older people in rural areas of Australia. Patient outcomes were closely aligned with admission pathways.

Effect of Emergency Green Channel Optimization on Ischemic Stroke Patients: Impact on Emergency Response Time, Effectiveness, Anxiety, and Acute Stress.

The aim was to assess the effectiveness of an optimized emergency green channel in the treatment of acute ischemic stroke (AIS) patients and its effect on emergency response time, effectiveness, anxiety, and acute stress. A retrospective analysis was conducted on 349 AIS patients treated with intravenous thrombolysis from January 2019 to May 2022. The patients were divided into those who received optimized emergency green channel treatment (155) and those who did not (194). Propensity score matching (PSM) was used to balance the admission pathways, living conditions, insurance methods, and residential locations of the 2 patient groups. The key metrics comprised the times from onset to admission, admission to computed tomography (CT), CT to thrombolysis, admission to thrombolysis (door-to-needle time (DNT)), National Institute of Health Stroke Scale (NIHSS) scores at various intervals post thrombolysis, heart rate, blood pressure, and scores in Self-Rating Anxiety Scale (SAS) and the Stanford Acute Stress Reaction Questionnaire (SASRQ). Post PSM, 118 patients were analyzed (54 control and 64 observation). The observation group showed significantly lower time results than the control group, which included the following: the time from onset to admission (t = 31.428, P < .001), door-to-imaging time (t = 27.317, P < .001), imaging-to-needle time (t = 20.951, P < .001, and DNT (t = 25.954, P < .001). Significant differences were observed in 24 hour-post thrombolysis NIHSS scores, heart rate, blood pressure, SAS, and SASRQ scores (P < .05) but not in NIHSS scores at 7 and 30 days. The optimized emergency green channel process effectively reduced the treatment time for ischemic stroke patients, improved rescue efficiency, and positively influenced the psychological stress levels of patients post treatment.

Influencing factors of hospitalization cost of hypertension patients in traditional Chinese medicine hospitals.

This study aimed to analyze the influencing factors of hospitalization cost of hypertensive patients in TCM (traditional Chinese medicine, TCM) hospitals, which can provide a scientific basis for hospitals to control the hospitalization cost of hypertension. In this study, 3,595 hospitalized patients with a primary diagnosis of tertiary hypertension in Tianshui City Hospital of TCM, Gansu Province, China, from January 2017 to June 2022, were used as research subjects. Using univariate analysis to identify the relevant variables of hospitalization cost, followed by incorporating the statistically significant variables of univariate analysis as independent variables in multiple linear regression analysis, and establishing the path model based on the results of the multiple linear regression finally, to explore the factors influencing hospitalization cost comprehensively. The results showed that hospitalization cost of hypertension patients were mainly influenced by length of stay, age, admission pathways, payment methods of medical insurance, and visit times, with length of stay being the most critical factor. The Chinese government should actively exert the characteristics and advantages of TCM in the treatment of chronic diseases such as hypertension, consistently optimize the treatment plans of TCM, effectively reduce the length of stay and steadily improve the health literacy level of patients, to alleviate the illnesses pain and reduce the economic burden of patients.

1725 From care home to the emergency department; a snapshot of frailty admissions

Abstract Background Care home residents form a large number of admissions to the Emergency Department (ED). Over an 8-month period, care home admissions to ED were reviewed, examining the nature of admissions to inform how to improve current pathways. Method Patients with a frailty score ≥6 (N=180), admitted from 34 care homes to Chelsea and Westminster Hospital ED over 6 months were included. Data was collected from medical and London Ambulance Service (LAS) records. Data collected included; Presenting Complaint (PC), LAS attendance times, prior discussion with a Health Care Professional (HCP), Length of Stay (LOS). Results LAS attendances during normal working hours (9am-5pm Monday- Friday) formed 34% (N=61) of admissions with only 43% (N=26) being discussed with an HCP prior to attendance. Of these, 30% (N=18) were discharged &amp;lt;24hrs and up to 39% (N=7) of these may not have required emergency admission. For all admissions, ‘fall’ was the most common PC, 33% (N=59) followed by ‘respiratory issue’ 21% (N=38). Overall, 24% (N=47) of total admissions were discharged &amp;lt;24hrs but total care home admissions accounted for a total of 454 bed stay days. Factors impacting discharge included COVID status, requiring care home re-assessment prior to discharge and no longer having a bed available. Conclusion This data demonstrates that there is an opportunity to improve care home support and admission pathways. Discussing patients with an HCP prior to contacting LAS may reduce requirement for ED attendance alongside access to rapid response community teams. Expanding an HCP accessible service out of hours (OOH) could facilitate this and implementing a frailty telephone service may also support with this initiative. Collaboration with care homes and community partners will form the next steps in this quality improvement work.

Virtual surgical planning for mandibular reconstruction in an abbreviated admission pathway

ObjectivesVirtual Surgical Planning (VSP) creates individualized surgical plans for free flap reconstruction of mandibular defects. Prior studies indicate that VSP can offer cost benefits due to reduced operative time and length of stay (LOS). We assessed the impact of VSP in the context of a validated postoperative abbreviated LOS clinical pathway. MethodsThis study assessed patients undergoing VSP vs conventional fibular free flap reconstruction for mandibular defects (12/2015–10/2020) and their operative time, ischemia time, and LOS were evaluated. ResultsForty-four patients underwent VSP reconstruction, while 52 patients underwent conventional reconstruction for mandibular defects. VSP was associated with significantly lower total operative time (6 h and 57 mins vs 7 h and 54 mins, p = 0.011), but not length of stay or ischemia time. Total OR time was significantly increased with increasing number of segments needed in both the VSP group (p = 0.002) and the conventional group (p = 0.015). ConclusionShorter operative times and LOS have been attributed to the use of VSP in free tissue transfers. It is argued that these reductions offset the added cost of VSP. Our study indicates that there is no cost benefit for VSP utilization due to a significantly reduced operative time with no impact on length of admission in an abbreviated admission clinical pathway following free tissue transfer.

Routine, molecular point-of-care testing for SARS-CoV-2 and other respiratory viruses within an acute oncology service improves patient care

COVID-19 has caused significant challenges for infection prevention measures and patient flow in hospital admission pathways. We aimed to assess the impact of replacing laboratory PCR with molecular point-of-care testing (mPOCT) for respiratory viruses including SARS-CoV-2, within an Acute Oncology Service (AOS). This pre- and post-implementation study took place in the AOS of a large teaching hospital, in Southampton, UK. We collected data from two periods: November 25th, 2019 to November 24th, 2020, when respiratory virus testing utilised laboratory PCR, and December 1st, 2020 to May 31st, 2021 following the introduction of mPOCT. The primary outcome was the time to results. 2189 patients were tested in the pre-implementation period and 1540 in the post implementation period. Median (IQR) time to results was 5.8h (4.2-10.6) pre-implementation and 1.9h (1.5-3.0) post-implementation (difference -3.6h [95%CI to -3.8 to -3.5]; p<0.0001). Median time spent in assessment areas was 6.0h (4.1-7.9) pre-implementation and 5.5h (3.8-7.4) post-implementation (p<0.0001). 20 (0.9%) patients admitted via AOS assessment unit developed hospital-acquired respiratory virus infection pre-implementation versus 0 (0%) post-implementation (p=0.031). Routine mPOCT for respiratory viruses, including SARS-CoV-2, was associated with a reduced time to results, reduced time in assessment areas, and a reduction in the rates of hospital-acquired respiratory virus infection in an acute oncology assessment unit.

Associations Between Management Pathway and Opioid Prescriptions for Patients Entering the Emergency Department With Neck and Back Pain

ObjectiveTo determine associations between post-emergency department (ED) management pathways and downstream opioid prescriptions in patients seeking care for incident neck and/or back pain. Patients and MethodsWe identified patients seeking first-time ED care for neck and/or back pain from January 1, 2013, through November 6, 2017. We reported demographic characteristics and opioid prescriptions across management pathways using descriptive statistics and assessed the relative risk of any opioid prescription 12 months post-ED visit among 5 different post-ED management pathways using Poisson regression adjusted for patient demographic characteristics. ResultsWithin 12 months after the index ED visit, 58.0% (n=10,949) were prescribed an opioid, with most patients prescribed an opioid within the first week (average daily morphine milligram equivalents of 6.8 mg (SD 9.6 mg). The morphine milligram equivalents decreased to 0.7 mg (SD 8.2 mg) by week 4 and remained consistently less than 1 mg between week 4 and 12 months. Compared with the ED to primary care provider pathway, the relative risk of opioid prescription between 7 days and 12 months after the index ED visit was similar for the ED to physical therapy pathway, higher for both the ED to hospital admission or repeat ED visit pathway (30% increase; relative risk (RR), 1.3; 95% CI, 1.17-1.44) and the ED to specialist pathway (19% increase; RR, 1.19; 95% CI, 1.07-1.33), and lower in the ED with no follow-up visits pathway (41% decrease; RR, 0.59; 95% CI, 0.54-0.65). ConclusionIn general, more conservative care was associated with lower opioid prescription rates, and escalated care was associated with higher opioid prescription rates.

Rural secondary school leaver attainment inequities for students entering medical programmes in Aotearoa New Zealand

ABSTRACT The education literature suggests that there are rural–urban differences in educational achievement. Lower educational achievement in rural schools may impact entry into highly competitive medical programmes and disadvantage rural students. Within this study, the National Certificate of Educational Achievement (NCEA) and University Entrance (UE) attainment rates are compared across Aotearoa New Zealand secondary schools for 2012–2021. High schools were classified as urban or rural according to the two rural admission schemes used in the medical programmes at the University of Otago and the University of Auckland. Descriptive statistics were calculated and regression models created to adjust for a range of variables. The data demonstrates that rural high schools have lower NCEA and UE attainment. Lower Māori student NCEA and UE attainment, greater socioeconomic disadvantage and differing characteristics account for the majority of differences between rural and urban schools. The lower UE attainment rate for rural schools will likely mean that rural students will have greater difficulty in entering medical programmes and that this inequity is worse for rural Māori students. Medical programme admission pathways need to undergo a fundamental shift–from workforce pathways to workforce and equity pathways in order to address rural workforce issues.

Prevalence and predictors of admission at the time of presentation in first episode psychosis.

Individuals presenting with first episode psychosis (FEP) constitute a population with high admission rates. Across psychiatric services, community based treatment is aimed for where appropriate. Therefore, further knowledge on predictors of admission is required. The objectives were to: (i) determine the proportion of individuals with FEP admitted at time of presentation (voluntarily and involuntarily) (ii) identify associated demographic and clinical factors. This study included all young people (aged 15-24) who presented with FEP to the Early Psychosis Prevention and Intervention Centre, Melbourne, Australia from 01.01.11 to 31.12.16. Binary logistic regression was used to determine unadjusted and adjusted odds ratios. Of 1208 participants, 58.6% were male and the median age was 20years (I.Q.R.17-22). At time of presentation, 50.2% were admitted. On multivariate analysis, the following factors predicted admission: being a migrant (OR = 1.75, 95% CI [1.17, 2.62]), aggression (OR = 1.42, 95% CI [1.02, 1.99]), and more severe psychotic symptoms. Longer duration of untreated psychosis was associated with lower admission rates. 70.1% of admissions were involuntary (33.7% of the cohort). Risk factors for involuntary admission were consistent with any admission, other than aggression, and with the addition of older age and male sex. There remains a high admission rate for FEP, even in an established early intervention service, with severity of psychopathology being the strongest predictive factor. There is an independent association between migrancy and admission. Potential reasons for these findings are discussed, and initiatives to reduce admission rates including (i) interventions to prevent admission and (ii) alternative care pathways.

The Role of Professional Learning Communities for Teacher Innovation: A Comparative Study in Beijing and Hong Kong

This research explores how professional learning communities influence teacher innovation and how contextual factors differ in their impact. Teacher innovation, which refers to the implementation of innovative ideas raised by teachers, has become increasingly popular over the last decades. Teachers as innovators can significantly enhance the likelihood of improving schools' educational practices due to their professional judgment and knowledge engagement. Teachers' ongoing learning is crucial for successful innovation, and professional learning communities have been widely accepted as an effective way for schools and educational institutions to sustain professional learning with the collective purpose of enhancing students' performance. The theoretical framework guiding this research is the social capital theory. Through semi-structured interviews with 94 teachers and school leaders, this study reveals that professional learning communities foster teacher innovation through four key dimensions: 1) mutual trust and respect as a foundation; 2) shared practice and knowledge as a source of inspiration; 3) peer collaboration to provide feasibility; and 4) shared responsibility to provide guarantee. When comparing Beijing and Hong Kong, it is observed that promoting teacher innovation through professional learning communities is easier in Hong Kong due to the relatively diverse admission pathways and low power distance. However, the low in-group collectivism in Hong Kong may limit teacher innovation due to weak peer collaboration. This research offers valuable guidance for teachers and school leaders on how to promote teacher innovation effectively during professional learning communities.

Performance of admission pathways within acute medicine services: Analysis from the Society for Acute Medicine Benchmarking Audit 2022 and comparison with performance 2019 - 2021

Urgent and emergency care services face increasing pressure, impacting patient care. We evaluated the performance of acute medicine services, assessing clinical quality indicators for unplanned medical admissions to acute hospital services.152 acute UK hospital services accepting unplanned admissions to acute and general internal medicine completed a day-of-care survey incorporating organisational structure questionnaire and patient-level data over a pre-defined 24-hour period in June 2022. Clinical quality indicators were: Early Warning Score (EWS) measurement within 30 min of hospital arrival; clinician assessment within 4 h; assessment by consultant physician within 6 h (daytime) or 14 h (night-time). Results were compared with 2019, 2020, 2021.7293 sequential patients were included (and compared with 19,817 patients across 2019–2021). In 2022, 69% of patients (95%CI 67.7–69.9%) had an EWS documented within 30 min. 79% of patients (95%CI 77.8–79.7%) were reviewed by a clinical decision maker within 4 h of hospital arrival. Patients assessed in Same Day Emergency Care services were more likely to meet this target than those assessed in Acute Medical Units or Emergency Departments (OR 2.4, 95%CI 2.02–2.87, p<0.001). Overall, 50% of patients received consultant physician review within the target time (3065/6161, 95%CI 48.5–51.0%); performance varied with time of arrival and location of initial assessment. Performance against all three clinical quality indicators was lower than 2019, 2020 and 2021 (p<0.001 for all).Performance against all quality indicators within acute medicine services is deteriorating. However, performance in Same Day Emergency Care Units is greater than in Acute Medical Units or Emergency Departments.

Trends in the neurological emergency room focusing on persons with seizures.

Previous studies in neurological emergency rooms (nER) reported many non-acute, self-presenting patients, delayed presentation of stroke patients, and frequent visits of persons with seizures (PWS). This study evaluated current trends during the last decade, providing special focus on PWS. We retrospectively analyzed patients in our specialized nER during 5 months in 2017&2019, comprising information on admission/referral, hospitalization, discharge diagnosis, and nER diagnostics/treatment. 2791 patients (46.6% male, mean age 57±21years) were included. Most common diagnoses were cerebrovascular events (26.3%), headache (14.1%), and seizures (10.5%). Most patients presented with symptoms >48 hours (41.3%). PWS showed the largest proportion of patients presenting within 4.5 hours of symptom onset (171/293, 58.4%), whereas only 37.1% of stroke patients presented in this time window (273/735). Self-presentation was the most common way of admission (31.1%), followed by emergency service referrals (30.4%, including majority of PWS: 197/293, 67.2%). Despite known diagnosis of epilepsy in 49.2%, PWS more often underwent accessory diagnostics including cerebral imaging, compared to the overall cohort, (93.9% vs. 85.4%; 70.1% vs. 64.1%). EEG in nER was only performed in 20/111 patients (18.0%) with a first seizure. Nearly half of the patients (46.7%) were discharged home after ER work-up, including most self-presenters (632/869, 72.7%) and headache patients (377/393, 88.3%), as well as 37.2% (109/293) of PWS. After 10 years, nER overuse remains a problem. Stroke patients still do not present early enough, whereas PWS, even with known epilepsy, often seek acute and extensive assessment, indicating gaps in pre-hospital management and possible overdiagnostic.

Racial and Ethnic Diversity in Medical School Admissions in Canada

Medical schools promote admission pathways as well as diversity and inclusivity to prospective students who are underrepresented in medicine (UIM) primarily via their websites. Research from organizational structures supports the use of instrumental values (which focus on behavior and core beliefs), rather than terminal values (which focus on the end goal), to promote diversity. To characterize the use of instrumental and terminal values to promote institutional diversity and inclusivity on Canadian medical school websites. This qualitative study analyzed the contents and themes of Canadian medical school websites based on a theoretical value framework and an organizational diversity management framework. A literature review was conducted to explore the use of instrumental and terminal values in promoting diversity and inclusivity, and a codebook was created that outlined the characteristics of these values. The content of all application pathway websites for UIM applicants to all Canadian medical schools was coded between July and August 2022. Use of terminal vs instrumental values across the UIM-targeted admission websites of medical schools. Twenty-two websites for 17 Canadian medical schools were included. Content on most of these websites promoted diversity in response to government policies or public accountability and often supported a dominant culture while treating diversity as an exception. The use of terminal rather than instrumental values was also more prominent on websites that targeted Indigenous prospective students compared with Black prospective students and applicants with lower socioeconomic status (11 [50%] websites vs 5 [23%] and 4 [18%] websites). Instrumental values, although seldom used, promoted diversity as a means to improve health care and training for all students in a program. Results of this qualitative study suggested that medical schools in Canada promoted diversity and inclusivity to prospective students primarily as an end goal rather than as a core value. Medical schools should highlight the benefits of diverse lived experiences and reinforce their commitment to diversity and inclusion by aligning their website content with their ongoing work in this area.

Assessing Multiple-Mini Interview Performance Across Pharmacy Admissions Pathways

ObjectiveTo assess whether students who are admitted to a Doctor of Pharmacy program through different admissions pathways (early assurance vs other pathways) have significantly different affective domain competencies, as measured by multiple-mini interview (MMI) evaluations. MethodsA secondary analysis of existing data was conducted at a single pharmacy school in the upper Midwestern U.S. over 3 admissions cycles. The program offers a 6-year, early assurance admission pathway as well as more traditional admissions pathways which can be completed in 7–8 years. Differences in MMI scores, overall and by individual question, were assessed using the Kruskal-Wallis test. ResultsNo differences in total MMI scores exist between individuals applying through the program’s early assurance pathway and those applying through other pathways. In the first admissions cycle, early assurance applicants performed significantly lower on the responsibility MMI item (mean = 7.01 vs 8.50) and significantly higher on the cross-cutting MMI item (mean = 6.95 vs 5.45). In the second admissions cycle, early assurance applicants scored significantly higher on the self-awareness MMI item than other applicants (mean = 8.22 vs 7.14). No statistically significant differences were found between early assurance and non-early assurance applicants during the final admissions cycle. ConclusionIndividuals applying through an early assurance pathway produce MMI scores that are similar to individuals applying through other admissions pathways.