After-hours Services Research Articles

Working conditions in OOH-PC centres in Romania: an interview study with healthcare professionals

Abstract Considering the amplifying primary care workforce shortage, the existing knowledge gaps in out-of-hours primary care delivery (OOH-PC) in Romania, as well as the extreme county-to-county variation in the number of functioning OOH-PC centers across the country, from 0 to 32, we set out to document health workers’ perspectives on existing challenges in after hours primary care. Using a qualitative study design, we conducted semi-structured interviews with a purposive sample of 20 healthcare professionals (HCPs): family doctors and nurses providing clinical services in urban and rural OOH-PC centres, family doctors with coordinating and administrative roles, representatives of professional associations and health authorities, as well as emergency doctors and paediatricians. We examined interview transcripts employing thematic analysis. The data collected and analysed revealed several challenges in the provision of care, including physician shortages, increasing workload, low payments, and an organisational model that lacks coordination with other levels of care and services. The analysis of the interview data identified five key themes related to adverse working conditions in OOH-PC: working hours and shift length, increasing workload and patient influx, obstacles to achieving work-life balance, inconveniences related to OOH centre premises (rest space, security), and insufficient financial compensation for after-hours health service provision. Working conditions in OOH-PC centers in Romania constitute a drawback to after hours primary care service provision. Health workers shortage and extreme variation in the number of functioning centres across the country suggest inconsistencies in the governance of OOH-PC. Improving working conditions to recruit and retain health professionals in OOH-PC, combined with targeted policies to optimise organisation and coordination of OOH-PC with other levels of care are as timely as ever to ensure equitable services to the population. Key messages • Current working conditions in OOH-PC Romania impact negatively the health workforce and lead to uneven access for the population. • Improvements in working conditions, service integration, and organisation model are timely for the alleviation of OOH-PC provision.

Factors associated with early-career GPs' retention as independent specialists in former training practices.

Retention of general practice registrars in their training practices is important for addressing the GP workforce deficit and maldistribution of GPs. Given that rural and remote general practices are disproportionately affected by low retention, identifying the factors that promote retention may be as important as developing recruitment strategies in these areas. Quantifying the impact of relevant factors on registrar retention will enable a better understanding of how to incentivise retention and attenuate the loss of the rural workforce to other areas. We sought to establish the prevalence and associations of retention of general practice registrars in their training practices. This analysis was a component of the New alumni Experience of Training and independent Unsupervised Practice (NEXT-UP) study: a cross-sectional questionnaire-based study of early-career GPs in conjunction with evaluation of data contemporaneously recorded as part of vocational training. Participants were former registrars of three regional training organisations delivering general practice training in New South Wales, Tasmania, the Australian Capital Territory and Eastern Victoria, who had attained Fellowship of the Royal Australian College of General Practitioners or the Australian College of Rural and Remote Medicine between January 2016 and July 2018. The outcome measured was whether the registrar had previously worked at their current practice during vocational training. Multivariable logistic regression was used to estimate the association between relevant explanatory variables and the outcome. A total of 354 alumni responded (response rate 28%), of whom 322 provided data regarding previous training practice retention, with 190 (59%) having previously worked at their current practice as registrars. Among respondents who reported currently working in a regional-rural practice location (n=100), 69% reported having previously worked at their current practice during training. GPs were more likely to be retained by a practice they had trained at if it was of lower socioeconomic status (adjusted odds ratio (aOR) 0.82 (95% confidence interval (CI) 0.73-0.91), p<0.001 for each decile of socioeconomic status) and if the practice provided two or more of home visits, nursing home visits or after-hours services (aOR 4.29 (95%CI 2.10-8.75), p<0.001). They were less likely to be retained by the practice if training was completed in a regional-rural area (aOR 0.35 (95%CI 0.17-0.72), p=0.004). Regional-rural training location is associated with reduced odds of subsequent retention of general practice registrars. This is occurring despite significant government investment in expansion of general practice training in regional and rural areas. The practice factor most strongly associated with GP retention was the provision of out-of-practice and after-hours care. There may be altruistic, rather than monetary, reasons that explain this finding. Such training opportunities, if provided to all trainees, especially in regional and rural areas, would be a learning opportunity, a way of promoting holistic community-based care and an incentive for subsequent retention within the practice and community as an established GP.

An After-Hours Telemedicine Urgent Care Service May Not Improve Access to Care for Underserved Populations.

Background: After-hours telemedicine services for emergency care are thought to offer a solution for patients who live at a distance from traditional face-to-face emergency services. This study evaluates such a service in a Health Maintenance Organization, focusing on the differences between central and peripheral populations. Methods: In this cross-sectional database study, we collected data regarding the encounter and patient characteristics, including prescriptions, referrals for further evaluation in a traditional emergency department (ED), and the distance from a traditional ED. Other outcome measures included health care utilization after the encounter such as primary care physician (PCP) encounters, additional telemedicine encounters, ED visits, and hospitalization. Results: In total, 45,411 patient visits were analyzed. Medication was prescribed in 25% of the encounters, and a referral to an ED was given in 22%. In total, 17.7% of the patients visited an ED within 24 h of the index encounter. In total, 64.8% of patients visited a PCP in the following 30 days. No further care was needed in 32.4% of the encounters. In multivariable logistic regression, the odds of using the service were lower for low socio-economic status groups and inhabitants of the periphery than the central areas. A weak reverse correlation was observed in Jewish sectors regarding distance from traditional ED, whereas no correlation was found in the Arab sector. Conclusion: It is commonly believed that telemedicine overcomes geographical barriers. The results of this research do not support this hypothesis.

“No-one just does drugs during business hours!”: evaluation of a 24/7 primary needle and syringe program in St Kilda, Australia

BackgroundPrimary needle and syringe programs (NSPs) have been integral for the prevention of blood-borne virus (BBV) transmission among people who inject drugs. Despite this, many people who inject drugs face barriers accessing these services, particularly after-hours when most services are closed. To our knowledge, the St Kilda NSP, in Melbourne, Victoria, is the only primary NSP providing 24/7 dedicated stand-alone face-to-face services for people who inject drugs in Australia. We conducted an evaluation of the St Kilda NSP to assess its role and effectiveness in meeting client needs.MethodsMixed research methods were used to conduct the evaluation. We analysed four quantitative data sets including the Victorian Needle and Syringe Program Information System data; NSP ‘snapshot’ survey data; and St Kilda NSP records of after-hours contacts and naloxone training events. Qualitative interviews were conducted with 20 purposively selected NSP clients, which were focused on individual needs, expectations and experiences accessing the service. Interviews were audio recorded and transcribed, and data were analysed thematically. A convergent research design was used to merge the five data sets.ResultsSt Kilda NSP had 39,898 service contacts in 2018; 72% of contacts occurred outside business hours. Similarly, of 1,185,000 sterile needles and syringes dispatched, 71% were distributed outside business hours. Participants described valuing the after-hours service because drug use patterns did not always align with standard NSP opening hours and after-hours access afforded anonymity when collecting injecting equipment. Narratives highlighted several additional benefits of the 24/7 service, including: access to safer sex equipment; material support; naloxone training; referrals to specialist services; face-to-face emotional and social support from a non-judging worker; and for women involved in sex work in particular, being able to seek refuge when feeling unsafe on the streets.ConclusionsOur study provides evidence of the social and health benefits (beyond that of preventing BBV transmission) that can be gained through the provision of 24/7 primary NSP services. Findings support the need for the establishment of after-hours primary NSPs in other areas of Australia where active street-based drug markets operate outside business hours and concentrated numbers of people who inject drugs live and spend time.

An After-Hours Virtual Care Service for Children With Medical Complexity and New Medical Technology: Mixed Methods Feasibility Study.

Family caregivers (FCs) of children with medical complexity require specialized support to promote the safe management of new medical technologies (eg, gastrostomy tubes) during hospital-to-home transitions. With limited after-hours services available to families in home and community care, medical device complications that arise often lead to increased FC stress and unplanned emergency department (ED) visits. To improve FC experiences, enable safer patient discharge, and reduce after-hours ED visits, this study explores the feasibility of piloting a 24/7 virtual care service (Connected Care Live) with families to provide real-time support by clinicians expert in the use of pediatric home care technologies. This study aims to establish the economic, operational, and technical feasibility of piloting the expansion of an existing nurse-led after-hours virtual care service offered to home and community care providers to FCs of children with newly inserted medical devices after hospital discharge at Toronto's Hospital for Sick Children (SickKids). This exploratory study, conducted from October 2020 to August 2021, used mixed data sources to inform service expansion feasibility. Semistructured interviews were conducted with FCs, nurses, and hospital leadership to assess the risks, benefits, and technical and operational requirements for sustainable and cost-effective future service operations. Time and travel savings were estimated using ED visit data in SickKids' electronic medical records (Epic) with a chief complaint of "medical device problems," after-hours medical device inquiries from clinician emails and voicemails, and existing service operational data. A total of 30 stakeholders were interviewed and voiced the need for the proposed service. Safer and more timely management of medical device complications, improved caregiver and provider experiences, and strengthened partnerships were identified as expected benefits, while service demand, nursing practice, and privacy and security were identified as potential risks. A total of 47 inquiries were recorded over 2 weeks from March 26, 2021, to April 8, 2021, with 51% (24/47) assessed as manageable via service expansion. This study forecasted annual time and travel savings of 558 hours for SickKids and 904 hours and 22,740 km for families. Minimal technical and operational requirements were needed to support service expansion by leveraging an existing platform and clinical staff. Of the 212 ED visits related to "medical device problems" over 6 months from September 1, 2020, to February 28, 2021, enteral feeding tubes accounted for nearly two-thirds (n=137, 64.6%), with 41.6% (57/137) assessed as virtually manageable. Our findings indicate that it is feasible to pilot the expansion of Connected Care Live to FCs of children with newly inserted enteral feeding tubes. This nurse-led virtual caregiver service is a promising tool to promote safe hospital-to-home transitions, improve FC experiences, and reduce after-hours ED visits.

Hotline to Helpline: Reducing On-call Demands.

There is a growing societal trend in plastic surgery patients of viewing their medical care as a commodity product rather than as a healthcare service. Our four-provider private plastic surgery practice noticed this phenomenon through our patients' trend of overusing the emergency after-hours service call line. To affect this behavior, we designed a study educating patients on the emergency service call line's purpose and how to handle nonurgent issues independently. After a 6-month preintervention phase to categorize after-hours emergency calls, We improved preoperative patient education and implemented in-office protocols for quicker provider responses. Postintervention data were collected for another 6 months and compared statistically with the preintervention data. In the preinterventional period, we saw a total of 236 after-hours phone calls. The intervention led to a 22% significant reduction in total calls (P = 0.007). Calls were categorized as nonurgent, urgent, and emergent. While emergent calls remained unchanged (P = 0.56), nonurgent calls significantly decreased (P = 0.005). The most common nonurgent calls were regarding pain, routine postoperative concerns, and drain care, with the intervention resulting in a significant reduction of routine postoperative swelling/bruising/discomfort calls (P = 0.04) but not changing pain (P = 0.23) or drain-related calls (P = 0.78). We found that targeted preoperative patient education coupled with a real-time action board in the office, to ensure timely response to patient questions during office hours, can positively impact after-hours call use, and improve overall patient outcomes by catching urgent issues earlier.

Optimising staff utilisation in rural animal veterinary practice in Aotearoa/New Zealand

Utilisation of veterinary professional staff in rural animal veterinary practice has long been anecdotally reported as poor in Aotearoa / New Zealand. Evidence shows that skill utilisation is poor, and this is likely impacted by the low ratios of non-veterinarian staff to each veterinarian in rural animal veterinary practice. This participative action research utilised focus groups with a range of staff practising in rural animal veterinary practice in Aotearoa / New Zealand, who self-selected as having experience with excellent utilisation. Participants were asked to imagine what a future with excellent utilisation in rural animal veterinary practice in Aotearoa / New Zealand would look like. This research clarifies role definitions of a veterinarian, rural animal veterinary technician and rural animal healthcare assistant, and documents examples of task allocation in an interprofessional team. The participants identified that the outcomes of achieving appropriate utilisation are likely to be beneficial to individuals, the team, animals, clients, and the business profitability, however, a significant number of barriers were identified that may prevent implementation of appropriate utilisation. These included a disconnect between the current rural animal veterinary technician qualifications and the requirement from veterinary clinical practice for specific skills, rather than a full qualification; the current veterinary training pathway not setting up veterinarians to be consultants; lack of regulation of allied veterinary professionals; current skills in the team; lack of trust in technicians from veterinarians; perception of client expectations that a vet will attend; willingness of veterinarians to relinquish control; lack of availability of technical staff; the requirement for veterinarians to provide 27/4 after-hours service; and the risk of technicians leaving after being trained up to go out on their own. Whilst overcoming some of these barriers requires industryled solutions, many can be resolved immediately within individual teams. Therefore, there is no need to wait for industry change to begin creating veterinary teams with excellent utilisation within individual rural animal veterinary practices.

Implementation of After-Hours Nurse Line in an Academic Pediatric Endocrinology Practice

Background. After-hours triage of pediatric patients by trained nurses improves consistency of triage decisions, access, and quality of care, and decreases burden on physicians on-call. There is a lack of published experience with this approach in the pediatric diabetes population. Methods. An after-hours call service was established in September 2019 in our large urban pediatric teaching hospital. Barton Schmitt guidelines, which are widely accepted as the standard for telephone triage care, were modified to include institution specific diabetes management protocols. We analyzed demographics, reasons for call, clinical presentation to the emergency room, and clinical disposition of the callers. Results. The after-hours call service handled 70% of calls without physician involvement. There were no patients triaged to home care who subsequently required an emergency room visit or hospitalization. Patients who called the after-hours nurse line prior to coming to the emergency room were less sick and were discharged more often from the emergency room. Spanish-speaking parents utilized the service less than English speakers. There were no disparities in utilization based on the insurance status or race. Conclusions. The after-hours service accurately triaged calls and reduced physician burden. Patients of all races and insurance statuses utilized the after-hours service equally well. Language was a barrier in the utilization.

"You Can't Meet Everyone's Needs After-Hours": After-Hours Domestic and Family Violence Services in Rural and Remote Areas.

Domestic and family violence is a significant issue in the Murrumbidgee region of New South Wales, Australia, mirroring national and international concerns about gender-based violence. Generally, there are known barriers associated with providing domestic and family violence (DFV) services in rural and remote communities; however, little research has considered the specific service needs and service barriers in the after-hours period. This is crucial. The already limited rural and remote services available during business hours are further constricted in the after-hours period. This article reports on research about after-hours service need and service challenges in six target communities in the Murrumbidgee region.

1060-P: After-Hours Nurse Line Utilization Decreased Call Burden in an Academic Pediatric Endocrinology Practice

Background: Optimal management of childhood diabetes benefits from access to a 24-hour support line. If staffed by on-call physicians, repeated interruptions to sleep can lead to physician burn out. Utilization, and outcomes of an after-hours nurse call service in a pediatric endocrinology practice have not been previously reported. Methods: Barton Schmitt guidelines, which are widely accepted as the standard for telephone triage care, were modified to include our institution specific diabetes management protocols. We analyzed demographics, reasons for call, clinical presentation to the emergency room, and clinical disposition of the callers. Results: After we instituted our after-hours nurse triage service (September 2019), the call burden to the on-call physicians decreased by 70%. Patients who called the after-hours line before coming to the emergency room were less sick (higher pH and lower glucose) and were more likely to be discharged home. We cannot infer causality from our data. Nevertheless, given that &amp;lt;10% of patients called first, encouraging earlier and more consistent utilization of the nurse line seems like a low-cost intervention that might reduce hospital admissions for diabetic ketoacidosis. After-hours service was utilized well by our patients of all races and insurance statuses. We noted that language was a barrier in utilization which is an opportunity for improvement. Disclosure A.Choudhary: None.

Low agreement among patients and clinicians about urgency and safety to wait for assessment in primary care after hours medical care: results of cross-sectional matched surveys

BackgroundDiscordance between patient and clinician perceived urgency may drive “inappropriate” presentations to after-hours medical services. This paper investigates the level of agreement between patient and clinicians’ perceptions of urgency and safety to wait for an assessment at after-hours primary care services in the ACT.MethodsCross-sectional survey voluntarily completed by patients and then clinicians at after-hours medical services in May/June, 2019. Agreement between patients and clinicians is measured by Fleiss kappa. Agreement is presented overall, within specific categories of urgency and safety to wait, and by after-hours service type.Results888 matched records were available from the dataset. Overall inter-observer agreement between patients and clinicians on the urgency of presentations was slight (Fleiss kappa = 0.166; 95% CI 0.117–0.215, p < 0.001). Agreement within specific ratings of urgency ranged from very poor to fair. Overall inter-rater agreement on how long it would be safe to wait for assessment was fair (Fleiss kappa = 0.209; 95% CI 0.165–0.253, p < 0.001). Agreement within specific ratings ranged from poor to fair. By site type, agreement between patients and clinicians on urgency ranged from not significant to fair and agreement for safety to wait ranged from very poor to slight. Agreement on urgency of issue was more often reported among patients attending their usual health service or seeing their usual clinician compared to patients attending an unfamiliar health service or clinician (χ2(1) = 7.283, p = 0.007 and χ2(1) = 16.268, p < 0.001, respectively).ConclusionsLow levels of agreement between patients and clinicians on perceived urgency and safety to wait for issues to be assessed indicate potential inefficiency in primary care use after-hours. Agreement on urgency of issues was more common among patients attending a familiar health service or familiar clinician. Improving health literacy, particularly health system literacy, and supporting continuity of care may help to support patients to engage with the most appropriate level of care at the most appropriate time.

Association of individual-socioeconomic variation in quality-of-primary care with area-level service organisation: A multilevel analysis using linked data.

Ensuring equitable access to primary care (PC) contributes to reducing differences in health related to people's socioeconomic circumstances. However, there is limited data on system-level factors associated with equitable access to high-quality PC. We examine whether individual-level socioeconomic variation in general practitioner (GP) quality-of-care varies by area-level organisation ofPC services. Baseline data (2006-2009) from the Sax Institute's 45 and Up Study, involving 267,153 adults in New South Wales, Australia, were linked to Medicare Benefits Schedule claims and death data (to December 2012).Small area-level measures of PC service organisation were GPs per capita, bulk-billing (i.e., no copayment) rates, out-of-pocket costs (OPCs), rates of after-hours and chronic disease care planning/coordination services. Using multilevel logistic regression with cross-level interaction terms we quantified the relationship between area-level PC service characteristics and individual-level socioeconomic variation in need-adjusted quality-of-care (continuity-of-care, long-consultations, and care planning), separately by remoteness. In major cities, more bulk-billing and chronic disease services and fewer OPCs within areas were associated with an increased odds of continuity-of-care-more so among people of high- than low education (e.g., bulk-billing interaction with university vs. no school certificate 1.006 [1.000, 1.011]). While more bulk-billing, after-hours services and fewer OPCs were associated with long consultations and care planning across all education levels, in regional locations alone, more after-hours services were associated with larger increases in the odds of long consultations among people with low- than high education (0.970 [0.951, 0.989]). Area GP availability was not associated with outcomes. In major cities, PC initiatives at the local level, such as bulk-billing and after-hours access, were not associated with a relative benefit for low- compared withhigh-education individuals. In regional locations, policies supporting after-hours access may improve access to long consultations, more so for people with low- compared with high-education.

Physiotherapy services in intensive care. A workforce survey of Australia and New Zealand

BackgroundIn Australia and New Zealand, there are currently no recommendations to guide staffing levels for intensive care unit (ICU) physiotherapy services, and there is limited information about the current services provided. ObjectivesThe objective of this study was to document the profile of intensive care physiotherapy services currently offered in Australia and New Zealand. MethodsA binational survey was distributed to physiotherapists. The survey sought information on staffing and service profiles for weekday, weekend, and after-hour services including on-call and evening shifts. ResultsEighty-six sites completed the survey, with responses primarily from Level 3 (47/86, 55%) and public ICUs (74/86, 86%). For weekday services, the ratio of full-time equivalent physiotherapy staff allocated per bed was similar between all intensive care levels (0.11 [0.08–0.15], p = 0.421). Thirty respondents (35%) were satisfied with their staffing and reported higher levels of physiotherapy staff per bed (0.15 [0.1–0.2], p < 0.001). Most sites reported lower levels of staffing for weekend services (76/86, 88%), and many physiotherapists indicated that they were not satisfied with this service (55/86, 64%). Most Level 2, Level 3, and paediatric ICUs had a designated senior physiotherapist, with similar levels of senior physiotherapy staff allocated per bed between all ICU levels (0.05 [0.03–0.08], p = 0.844). Few sites reported dedicated staff attributed to intensive care education, research, tracheostomy service, or outreach roles. On-call physiotherapy services were available in 49 of 86 (57%) hospitals surveyed; however, utilisation of the service by ICUs was mainly reported to be less than once per month (19/49, 39%). ConclusionsPhysiotherapy staffing ratios were similar across different ICU levels. While weekend services are available for most ICUs, staffing levels are reduced. Higher staffing ratios were associated with higher levels of satisfaction to complete professional roles and responsibilities.

The use of telehealth in the provision of after-hours palliative care services in rural and remote Australia: A scoping review.

BackgroundAccessing quality palliative care, especially at the end of life is vital in reducing physical and emotional distress and optimising quality of life. For people living in rural and remote Australia, telehealth services can be effective in providing access to after-hours palliative care.ObjectiveTo review and map the available evidence on the use of telehealth in providing after-hours palliative care services in rural and remote Australia.MethodScoping review using Arksey and O’Malley methodological framework. Findings are reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Scopus, Web of Science, CINAHL Complete, Embase via Ovid, Emcare via Ovid, and Medline via Ovid databases were searched. Peer-reviewed studies and grey literature published in English from 2000 to May 2021 were included.ResultsTwelve studies were included in the review. Four main themes were identified: 1) Stakeholder perceptions of service; 2) benefits to services and users; 3) service challenges; and 4) recommendations for service improvement.ConclusionTelehealth can connect patients and families with healthcare professionals and enable patients to continue receiving care at home. However, challenges relating to patients, service, staff skills, and experience need to be overcome to ensure the success and sustainability of this service. Improved communication and care coordination, better access to patient records, and ongoing healthcare professional education are required.ImplicationsProtocols, comprehensive policy documents and standardized operating procedures to guide healthcare professionals to provide after-hours palliative care is needed. Ongoing education and training for staff is crucial in managing patients’ symptoms. Existing service gaps need to be explored and alternative models of after-hours palliative care need to be tested.

After-hours radiology reporting in an Australian tertiary hospital: Factors influencing the rate of discrepancy for computed tomography reporting.

Demand for after-hours radiology services across Australia has been rapidly increasing for many years. Public hospital radiology departments are generally staffed by trainees after hours, often 1-2 doctors. This study reviewed 1 year of after-hours data at a tertiary hospital in Sydney, to determine overall discrepancy rates and factors which influenced the rate of discrepancy after hours. Overall radiology and after-hours case volumes are increasing, and the goal was to ensure that our department practices are within safe limits at current staffing levels. After-hours computed tomography scan reports issued by registrars were reviewed over 1 year between 01 January 2019 and 01 January 2020. Data recorded included overall case numbers on each shift, discrepancy rates and rates of clinically significant discrepancy. Caseload was measured by equivalent ascribed reporting time as described by Pitman etal. (2018). There were 10,886 cases reported after hours during the study period and 1,412 discrepancies (13% cases). Of these, 300 (3.7%) were clinically significant. Factors that increased the rate of significant discrepancy included shifts with caseloads greater than 3 h of equivalent consultant reporting time per 8-h shift and the radiology trainee's level of training. The frequency of discrepancy for trauma cases was similar to non-trauma after adjusting for study type; however, the frequency of significant discrepancy was higher. In all instances, the rates of discrepancy and clinically significant discrepancy remained well within ranges previously described.

The role of after-hours house-call medical service in the treatment of COVID-19 patients awaiting hospital admission: A retrospective cohort study.

Due to the increasing number of coronavirus disease 2019 (COVID-19) cases in Japan, hospitals are unable to provide admission and immediate inpatient care. The after-hours house call (AHHC) service offers telephone consultations and in-home care to patients awaiting admission. Currently, there is no report on the management of COVID-19 patients when inpatient beds are insufficient.We aimed to describe the clinical characteristics and outcomes of COVID-19 patients treated by an AHHC medical service in Osaka and Tokyo, between April and May 2021 (during the fourth wave in Japan). Patients were classified into 2 groups: Moderate I and Moderate II, according to the severity of infection under Japanese guidelines. A retrospective study of the hospital records and follow-up telephone consultations was performed.The AHHC treated a total of 55 COVID-19 patients (17 with Moderate I, 38 with Moderate II disease). The median ages (interquartile range) were 63 (49–80.5) and 64 (50.8–81), respectively. In each group, approximately 30% of AHHC patients received out-of-hospital oxygen therapy for the duration of their treatment until it was no longer required. Major symptoms, including shortness of breath or difficulty breathing (47.1% and 78.9%, respectively) and fever or chills (41.2% and 76.3%, respectively) were lower in the Moderate I group than in the Moderate II group. Overall, 16.4% of patients died, with 17.6% in the Moderate I group and 15.8% in the Moderate II group.We found the proportion of mortality in patients treated by the AHHC was slightly higher to that of patients treated in Japanese hospitals. This study will provide an alternative management of patients requiring oxygen in situations where hospital beds are in short supply.

Telepharmacy services in acute care: Diverse needs within a large health system.

In this paper, we describe CommonSpirit Health's telepharmacy service, which serves 64 hospitals in 10 states. Hospitals range in size from critical access to quaternary care centers. Telepharmacy services in acute care may be divided into 2 primary styles: hospitals requiring after-hours support utilizing telepharmacists to bridge shifts otherwise uncovered by pharmacists and hospitals with round-the-clock onsite pharmacy services utilizing telepharmacists to enhance efficiency in processing medication orders. When providing after-hours service, telepharmacists review all medication orders. The primary goal is to provide pharmacist care at all hours. In hospitals with round-the-clock onsite pharmacy services, telepharmacists focus on efficiency of medication order review. Median turnaround times in these hospitals decreased 50% to 70% after implementing a telepharmacy service. Barriers to implementation include managing different electronic health records, variability in hospital practices, and communicating with onsite clinicians. Regular interaction with onsite leaders is a key component in overcoming these barriers. This enables the telepharmacy team to respond to hospital-specific changes and maintain competence. The service adjusts to provide additional support based on the needs of the sites. Most telepharmacists work from home. While this can present challenges, we consider it an advantage in recruitment and retention. CommonSpirit Health utilizes its telepharmacy service for hospitals large and small to enhance efficiency in processing medication orders and to provide round-the-clock pharmacist care.

Use of telehealth in the provision of after-hours palliative care services in rural and remote Australia: A scoping review protocol.

IntroductionAfter-hours services are essential in ensuring patients with life limiting illness and their caregivers are supported to enable continuity of care. Telehealth is a valuable approach to meeting after-hours support needs of people living with life-limiting illness, their families, and caregivers in rural and remote communities. It is important to explore the provision of after-hours palliative care services using telehealth to understand the reach of these services in rural and remote Australia. A preliminary search of databases failed to reveal any scoping or systematic reviews of telehealth in after-hours palliative care services in rural or remote Australia.AimTo review and map the available evidence about the use of telehealth in providing after-hours palliative care services in Australian rural and remote communities.MethodsThe proposed scoping review will be conducted using the Arksey and O’Malley methodological framework and in accordance with the Joanna Briggs Institute methodology for scoping reviews. The reporting of the scoping review will be guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). This review will consider research and evaluation of after-hours services using telehealth for palliative care stakeholders in rural and remote Australia. Peer reviewed studies and grey literature published in English from 2000 to May 2021 will be included. Scopus, Web of Science, CINAHL Complete, Embase via Ovid, PsycINFO via Ovid, Emcare via Ovid, Medline via Ovid, and grey literature will be searched for relevant articles. Titles and abstracts will be screened by two independent reviewers for assessment against the inclusion criteria. Data will be extracted and analysed by two reviewers using an adapted data extraction tool and thematic analysis techniques. Diagrams, tables, and summary narratives will be used to map, summarise and thematically group the characteristics of palliative care telehealth services in rural and remote Australia, including stakeholders’ perceptions and benefits and challenges of the services.

After-hours presentations to community-based primary care in the Australian Capital Territory.

This study describes patient characteristics and presentations to community-based primary care medical services in the after-hours period. A cross-sectional survey completed by practitioners was voluntarily conducted over one weeknight and weekend in 2019 at 31 of 51 extended hours general practices (GP), three of three medical deputising services and three of three nurse-led walk-in clinics (WICs). Of 3371 community-based after-hours presentations, 934 consultation records were obtained (overall response: 28%). Emergency departments reported 524 triage code 4 and 5 patients within the study period. Problems managed in community-based after-hours services were most often rated as non-urgent (n = 482; 51.6%) and new (n = 606; 64.9%). The most common community-based after-hours presentations were diagnostic or disease related (e.g. infections or injury; n = 667; 59.5%). The most common body systems impacted were respiratory (n = 329; 29.6%), skin (n = 164; 16.4%) and general/unspecified (e.g. fever; n = 164; 16.4%). Community-based after-hours services reported different types of presentations, with medical deputising services reporting more urgent presentations, GPs reporting more procedural presentations and walk-in clinics reporting more skin-related issues (e.g. wound care). Community-based after-hours medical services contribute significantly to after-hours medical care in the ACT. Patients are self-selecting community-based after-hours medical services appropriately based on problems managed by practitioners.

Why patients attend after-hours medical services: a cross-sectional survey of patients across the Australian Capital Territory.

Almost half of Australian after-hours emergency department (ED) presentations are rated as 'non-urgent' by clinicians and are suggested to be managed by community-based services, such as general practice (GP). This paper reports patient reasons for presenting for medical care after hours, and reasons for selection of specific services across a health system. A cross-sectional survey was conducted across the Australian Capital Territory. Patients voluntarily completed questionnaires in waiting rooms during the after-hours periods of one weekday and one weekend in 2019 at 28/51 extended hours GPs, 3/3 medical deputising services (MDS), 3/3 nurse-led walk-in-clinics (WICs), and 2/2 public emergency departments (EDs). Of 3371 presentations, 1992 patients completed a survey, with 58% from GPs (n =1149), 16% from WIC (n =317), 10% from MDS (n =193), and 17% from EDs (n =333). Most patients presented with self-rated new issues (n =987, 49.5%) and were uncertain of the urgency of their issues (n =723, 36.7%). Common reasons for presenting to WIC, MDS, and EDs included the problem occurring after hours, and patients concern about the issue. Common reasons for presenting to GP were related to personal preference for after-hours care. Patients present to after-hours medical services for both perceived need and convenience. Most patients appear to be self-selecting after-hours services appropriately aligned with advertised services; except for GP patients who were attending after hours for care that is often non-urgent and could be seen in usual working hours. This study should be replicated to account for local health systems, and coronavirus disease 2019 (COVID-19)-related changes to health care.