Ancillary Staff Research Articles

Communication methods between outpatients with limited-English proficiency and ancillary staff: LASI study results

ObjectiveDescribe communication methods between primary care ancillary staff, including front desk administrative staff and medical assistants (MAs), and patients with limited-English proficiency (LEP). MethodsPatients with LEP completed a telephone survey after a primary care visit including questions about communication with ancillary staff (n = 1029).To inform practice improvements and lend qualitative perspective to these quantitative data, we subsequently conducted semi-structured interviews with ancillary staff and physicians. ResultsProfessional interpreter use was minimal with ancillary staff (<4%). Among patients who did not use their preferred language with bilingual staff, about one-third reported using English to communicate, despite most (≥ 80%) speaking English ‘not well’ or ‘not at all.’ In semi-structured interviews, ancillary staff felt basic English sufficient for most patient communication. However, physicians reported taking on extra visit tasks to compensate for the communication barriers between ancillary staff and patients with LEP. ConclusionsUse of professional interpretation by front desk staff and MAs was minimal. This led many patients with LEP to ‘get by’ with limited English when communicating with ancillary staff, in turn increasing burden on the physician visit. Practice implicationsFuture interventions should focus on increasing use of professional interpretation by outpatient ancillary staff when communicating with LEP patients.

Identifying homeless population needs in the Emergency Department using Community-Based Participatory Research

BackgroundAnnually 1.5 million Americans face housing insecurity, and compared to their domiciled counterparts are three times more likely to utilize the Emergency Department (ED). Community Based Participatory Research (CBPR) methods have been employed in underserved populations, but use in the ED has been limited. We employed CBPR in an urban American hospital with a primary goal of improved linkage to care, reduced ED recidivism, and improved homeless health care.MethodsA needs analysis was performed using semi-structured individual interviews with participants experiencing homelessness as well as with stakeholders. Results were analyzed using principles of grounded theory. At the end of the interviews, respondents were invited to join the “CBPR team”. At CBPR team meetings, results from interviews were expounded upon and discussions on intervention development were conducted.ResultsTwenty-five stakeholders were interviewed including people experiencing housing insecurity, ED staff, inpatient staff, and community shelters and services. Three themes emerged from the interviews. First, the homeless population lack access to basic needs, thus management of medical needs must be managed alongside social ones. Second, specific challenges to address homeless needs in the ED include episodic care, inability to recognize housing insecurity, timely involvement of ancillary staff, and provider attitudes towards homeless patients affecting quality of care. Lastly, improved discharge planning and communication with outside resources is essential to improving homeless health and decreasing ED overutilization. A limitation of results is difficulty for participants experiencing homelessness to commit to regular CBPR meetings, as well as possible bias towards social networks influencing included stakeholders.ConclusionCBPR is a promising approach to address gaps in homeless health care as it provides a comprehensive view incorporating various critical perspectives. Key ED-based interventions addressing recidivism include improved identification of housing insecurity, reinforced relationships between ED and community resources, and better discharge planning.

Physicians at the crossroad of prognosis and faith: practical help communicating with patients and families during the COVID-19 pandemic

ABSTRACT Physicians will ultimately face the necessary but unpleasant task of caring for a dying patient at some point in their careers. Communicating with patients or their families during such dire times is very important especially when the patient or family members have unrealistic expectations. Herein, we have highlighted practical suggestions which if applied can prevent unnecessary draining encounters with patients and families; for example, incorporating ancillary staff such as palliative and pastoral care into the care team. We have also proposed a new concept of ‘physician optimism’. Based on this concept, the physician can be classified as a pessimist or an optimist with realistic or unrealistic expectations and communicate to patients with or without requisite empathy. To ensure the best outcomes, we conclude that physicians must be realistic optimists who always communicate with empathy. Unrealistic optimism, no matter how well-intentioned, is deceiving to patients and their families will never allow a culture of trust.

Increasing face-mask compliance among healthcare personnel during the coronavirus disease 2019 (COVID-19) pandemic.

Prior studies of universal masking have not measured face-mask compliance. We performed a quality improvement study to monitor and improve face-mask compliance among healthcare personnel (HCP) during the coronavirus disease 2019 (COVID-19) pandemic. Mixed-methods study. Tertiary-care center in West Haven, Connecticut. HCP including physicians, nurses, and ancillary staff. Face-mask compliance was measured through direct observations during a 4-week baseline period after universal masking was mandated. Frontline and management HCP completed semistructured interviews from which a multimodal intervention was developed. Direct observations were repeated during a 14-week period following implementation of the multimodal intervention. Differences between units were evaluated with χ2 testing using the Bonferroni correction. Face-mask compliance between baseline and intervention periods was compared using time-series regression. Among 1,561 observations during the baseline period, median weekly face-mask compliance was 82.2% (range, 80.8%-84.4%). Semistructured interviews were performed with 16 HCP. Qualitative analysis informed the development of a multimodal intervention consisting of audit and passive feedback, active discussion, and increased communication from leadership. Among 2,651 observations during the intervention period, median weekly face-mask compliance was 92.6% (range, 84.6%-97.9%). There was no difference in weekly face-mask compliance between COVID-19 and non-COVID-19 units. The multimodal intervention was associated with an increase in face-mask compliance (β = 0.023; P = .002). Face-mask compliance remained suboptimal among HCP despite a facility-wide mandate for universal masking. A multimodal intervention consisting of audit and passive feedback, active discussion, and increased communication from leadership was effective in increasing face-mask compliance among HCP.

Medicolegal Cases and Their Management

No greater opportunity, no greater responsibility, no greater obligation can fall to any other human being than to become a medical professional. In the care of suffering the medical professionals need scientific knowledge, technical skill, moral understanding of profession and awareness about the relevant laws of the land. Primarily doctors but also other ancillary and administrative staff of the hospital have several ethical and legal obligations in the performance of their duties. It is important therefore, that every concerned person of the hospital, related with treatment and care of the patients must understand the nature of obligations and thus fulfills these obligations to the best of his ability, to maintain nobility of medical profession [1,2].

Wide-awake Local Anesthesia with No Tourniquet: An Updated Review.

Background:The wide-awake local anesthesia with no tourniquet (WALANT) technique has become popularized for various hand/upper extremity procedures. Before surgery, patients receive local anesthetic, consisting of lidocaine with epinephrine, and remain awake for the entire procedure. The purpose of this review was to investigate the advantages, diverse application, outcomes, cost benefits, use in challenging environments, patient considerations, and contraindications associated with WALANT.Methods:A comprehensive review of the literature on the WALANT technique was conducted. Search terms included: WALANT, wide-awake surgery, no tourniquet, local anesthesia, hand, wrist, cost, and safety.Results:The WALANT technique has proven to be successful for common procedures such as flexor tendon repair, tendon transfer, trigger finger releases, Depuytren disease, and simple bony procedures. Recently, the use of WALANT has expanded to more extensive soft-tissue repair, fracture management, and bony manipulation. Advantages include negating preoperative evaluation and testing for anesthesia clearance, eliminating risk of monitored anesthesia care, removal of anesthesia providers and ancillary staff, significant cost savings, and less waste produced. Intraoperative evaluations can be performed through active patient participation, and postoperative recovery and monitoring time are reduced. WALANT is associated with high patient satisfaction rates and low infection rates.Conclusions:The WALANT technique has proven to be valuable to both patients and providers, optimizing patient satisfaction and providing substantial healthcare savings. As its application continues to grow, current literature suggests positive outcomes.

Moral injury: the effect on mental health and implications for treatment

Moral injury: the effect on mental health and implications for treatment

A descriptive Study Evaluating the Impact of COVID-19 on Delivery of Care and Mental Health of Geriatric Nursing Home Staff

IntroductionCOVID-19 has had an unprecedented global impact on public health and socio-economic matters. The magnitude of COVID-19 has undoubtedly affected every aspect of daily life and highlighted the need for increased preparedness, coordination, and monitoring. Amongst all social groups, the elderly is by far the most affected age group in morbidity and mortality [1]. Approximately 1.3 million individuals live in 15,600 nursing home facilities in the United States [2]. In fact, the beginning of COVID-19 may be marked by the 25 deaths in a single King County facility in Washington state. Nursing homes have faced the rapid spread of COVID-19 among residents and staff and have been at the center of the public health emergency during the pandemic. Factors that contribute to this rapid spread include crowding, sharing of bathroom facilities, and gathering in common areas that are not set up for infection control. Nursing homes, in particular, provide ideal environments for devastating infections to spread.Nursing homes, in particular, have essentially been in complete lockdown, not unlike inmates, who both deeply lack social interaction and are currently unable to exist outside the walls of their respective institutions. Those who do not have close family or friends, and rely on the support of voluntary services or social workers, could be at additional risk [6]. To lessen the chance of infection among older people in nursing homes, more local authorities are banning visitors to nursing homes and long-term care facilities. Furthermore, restrictions on group activities such as playing board games, watching TV in a common space, and engaging in art therapy, may harm residents’ mental and physical well-being [8]. Nursing home residents are already susceptible to loneliness, and the lack of social interaction due to decreased visitation from family and friends further compounds the traumatization of COVID-19 on daily living.MethodsMETHODS: This is a descriptive study over a period of 1 month conducted among nursing home staff in Lubbock, TX during the COVID-19 pandemic. Agreeable nursing home staff will have access to a survey (Qualtrics) accessing various aspects relating to the consequences of COVID-19. The survey will be open for a period of 1 month until which the participants will have the opportunity to complete the survey. Data from the surveys will then be collected and analyzed.The survey consists of a self-developed questionnaire along with the validated Perceived Stress Scale (PSS). The scale which was originally developed in 1983 by author Sheldon Cohen is one of the most widely used tools to measure the perception of stress. It has been used in studies assessing the stressfulness of situations and is widely available in the public domain [12].Type of study: Descriptive mixed method triangulation design studySubjects: Healthcare staff with direct patient careInclusion criteria:1. Geriatric Nursing home staff in Lubbock, TX2. Staff agreeable to participate in survey regardless of color, creed, age or sex.3. Staff in direct contact with patients (Nursing and Physicians)Exclusion criteria:1. Ancillary staff not involved in direct patient care2. Staff who refuse to give voluntary consent to participate in surveyDesign: This will be a descriptive, mixed method triangulation design studyutilizing an online, self-administered survey tool created using Qualtrics platform. An information sheet explaining the research project will be given to the nursing home staff. It will include: participation is completely voluntary, that participation will not affect their employment in anyway, and their employer will not have access to the results. It will also explain that by submitting an anonymous survey they are agreeing to take part in the research study. The survey questions will gauge mental health impact on staff and their perspectives on the impact on patients and their own mental health. The survey will contain a mix of 10 close- and open-ended questions.ResultsOutcomes: To determine the impact of COVID-19 on nursing home staff mental health and gather information that may be utilized to create measures to better deliver care in nursing homes.Survey will be sent to 40 members with an expected response rate of about 20 percent and possibly higher.Results will be available by March 2020 for further analysis and distribution.ConclusionsUltimately, COVID-19 has taught painful lessons in the difficulties of isolating the elderly. The need for controlling infection may come at a high cost to the mental health and well-being of patients and staff, which is a critical public health issue. We hope that the results of this study will help us better understand the challenges geriatric nursing facilities have faced during the COVID-19 pandemic and help us develop better strategies for similar threats in the future.FundingNo funding was obtained for the purposes of this study

The Psychological Impact of COVID-19 on Hospital Staff.

IntroductionThe coronavirus 2019 (COVID-19) pandemic has created a mental health crisis among hospital staff who have been mentally and physically exhausted by uncertainty and unexpected stressors. However, the mental health challenges and complexities faced by hospital staff in the United States has not been fully elucidated. To address this gap, we conducted this study to examine the prevalence and correlates of depression and anxiety among hospital staff in light of the COVID-19 pandemic.MethodsThe design is a single-center, cross-sectional, online survey evaluating depression and anxiety among all hospital employees (n = 3,500) at a safety-net hospital with a moderate cumulative COVID-19 hospitalization rate between April 30–May 22, 2020. We assessed depression with the Patient Health Questionnaire-9. Anxiety was measured with the Generalized Anxiety Disorder-7 scale. Logistic regression analyses were calculated to identify associations with depression and anxiety.ResultsOf 3,500 hospital employees, 1,246 (36%) responded to the survey. We included 1,232 individuals in the final analysis. Overall, psychological distress was common among the respondents: 21% and 33% of staff reported significant depression and anxiety, respectively, while 46% experienced overwhelming stress due to COVID-19. Notably, staff members overwhelmed by the stress of COVID-19 were seven and nine times more likely to suffer from depression and anxiety, respectively. In addition to stress, individuals with six to nine years of work experience were two times more likely to report moderate or severe depression compared to those with 10 or more years of work experience. Moreover, ancillary staff with direct patient contact (odds ratio [OR] 8.9, confidence interval (CI), 1.46, 173.03) as well as administrative and ancillary staff with indirect patient contact (OR 5.9, CI, 1.06, 111.01) were more likely to be depressed than physicians and advanced providers.ConclusionWe found that a considerable proportion of staff were suffering from psychological distress. COVID-19-associated depression and anxiety was widespread among hospital staff even in settings with comparatively lower COVID-19 hospitalization rates. Ancillary staff, administrative staff, staff with less job experience, and staff overwhelmed by the stress of COVID-19 are particularly susceptible to negative mental health outcomes. These findings will help inform hospital policymakers on best practices to develop interventions to reduce the mental health burden associated with COVID-19 in vulnerable hospital staff.

Abstract P865: Pediatric Stroke Algorithm Revision: Focus on Education Process

Background: While the incidence of Pediatric stroke is low at 2.3 to 13 per 100,000 children, our institution saw a need for a pediatric stroke algorithm to provide guidance when children present with stroke symptoms. The process began with development and release of a pediatric stroke guideline in 2017. After initiation of the guideline, mock stroke alerts periodically were performed with feedback provided by staff. After several reviews and revisions, the paradigm of a guideline was discarded in favor of an algorithm, a more accurate reflection of the necessity for clinical judgement rather than a series of predetermined steps. In June 2020, the Pediatric Stroke Algorithm was revised to incorporate one algorithm for both Emergency Room (ER) and inpatient areas after a recent mock stroke alert in the Pediatric Intensive Care Unit (PICU) and following feedback. The purpose behind our process improvement project was to provide education regarding the updated Pediatric Stroke Algorithm to all relevant clinical areas. Methods: The first step was to identify the staff in patient care areas that would need education on the updated Pediatric Stroke Algorithm. Next, we identified the methods of communication that would be utilized to ensure all staff received proper education. Results: In 2020, the updated Pediatric Stroke Algorithm document was placed on the UK HealthCare Care Web page (Clinical Web Page). Information on the location of the document was sent to the key stakeholders for nursing, physician, and appropriate ancillary staff in the ER and PICU for further distribution. The algorithm was presented in various stroke committee meetings and sent by email to team members of these committees to share with their staff. The algorithm was further presented at the PICU Collaborative Practice Meeting and posted on the PICU share point site, in the ER, and PICU areas. Conclusions: A comprehensive educational process of the revised Pediatric Stroke Algorithm was successfully completed with all the appropriate staff.

Curtailing Unnecessary Waste Among Operating Room Personnel: Evaluating the Cost Awareness of Commonly Used Surgical Items.

Operating rooms (ORs) generate 70% of hospital waste, leading to increased costs for the hospital, patient, and the environment. The lack of cost awareness among physicians has been well documented; however, there is little information on anesthesiologists or ancillary OR staff. This study aimed to evaluate the cost awareness of commonly used items at an academic medical center among OR personnel. Anonymous surveys were distributed to OR personnel (nurses, surgical technicians (STs), nurse anesthetists, anesthesiologists, surgeons, and residents), asking for the estimated costs of ten commonly used items. These costs were then compared against actual costs to evaluate the accuracy of participants' estimates. Responders were clustered by job, highest level of education, and years of experience for comparison. 167 surveys were collected, and overall only 16.4% of estimates were accurate within 50% of actual price. No significant differences in accuracy between groups were identified overall (P = .2), but both surgical and anesthesia attendings had significantly higher rates of correct responses than their respective residents. No difference was seen in accuracy when all attendings (surgeons and anesthesiologists) were compared with either nurses or STs. Linear regression demonstrated no correlation between number of years at current position or years at institution and number of correct responses (R2 = .0025 and R2 = .005, respectively). Addressing the knowledge deficit around item costs via global education of all OR personnel (surgeons, anesthesia providers, and ancillary staff) could be a viable pathway to reduce waste, and thus cost, for our healthcare system.

A Systematic Review and Scoping Analysis of Smoking Cessation after a Urological Cancer Diagnosis

Smoking cessation after a urologic cancer diagnosis significantly benefits patients. It is not well known how often patients quit after diagnosis or how urologists intervene to support patients' smoking cessation efforts. To examine rates of smoking cessation after diagnosis among patients with urologic cancers and to assess how often patients are given advice and support to quit smoking in the urology setting. Following the PRISMA guidelines, a systematic review was conducted of the available studies on smoking cessation after a urologic cancer diagnosis during April 2020 by a trained medical librarian using the MEDLINE, PsycInfo, Embase, and Cochrane CENTRAL databases. Studies were included based on three independent reviews and if they met a priori inclusion/exclusion criteria. In total, 2568 records were identified, 31 of which were included for final analysis. Four studies (patient n=587) reported outcomes related to the prospective implementation of a smoking cessation program with patient-level quit rates ranging from 3.2% to 47.3%. Twenty one studies reported outcomes of passive (no directed, active intervention) smoking cessation after the diagnosis of a urologic cancer (patient n=3669) with widely varying quit rates. In general, the quality of included studies was poor. There was no standardization of the measurement or timing of outcomes and few studies included validated survey instruments or biochemical confirmation of cessation. Seventeen studies included data on whether patients received advice to quit smoking after diagnosis. The proportion of patients in each study who were told to quit ranged from 2.8-78.3%. There are few smoking cessation interventions that have been prospectively implemented and reported in the urology literature and studies on quit rates after diagnosis are limited. The paucity of quality data and lack of smoking cessation interventions being used in routine urologic oncology care underscores the need for more rigorous study and implementation of evidence-based practices in this area.

RadTranslate: An Artificial Intelligence-Powered Intervention for Urgent Imaging to Enhance Care Equity for Patients With Limited English Proficiency During the COVID-19 Pandemic.

PurposeDisproportionally high rates of coronavirus disease 2019 (COVID-19) have been noted among communities with limited English proficiency, resulting in an unmet need for improved multilingual care and interpreter services. To enhance multilingual care, the authors created a freely available web application, RadTranslate, that provides multilingual radiology examination instructions. The purpose of this study was to evaluate the implementation of this intervention in radiology.MethodsThe device-agnostic web application leverages artificial intelligence text-to-speech technology to provide standardized, human-like spoken examination instructions in the patient’s preferred language. Standardized phrases were collected from a consensus group consisting of technologists, radiologists, and ancillary staff members. RadTranslate was piloted in Spanish for chest radiography performed at a COVID-19 triage outpatient center that served a predominantly Spanish-speaking Latino community. Implementation included a tablet displaying the application in the chest radiography room. Imaging appointment duration was measured and compared between pre- and postimplementation groups.ResultsIn the 63-day test period after launch, there were 1,267 application uses, with technologists voluntarily switching exclusively to RadTranslate for Spanish-speaking patients. The most used phrases were a general explanation of the examination (30% of total), followed by instructions to disrobe and remove any jewelry (12%). There was no significant difference in imaging appointment duration (11 ± 7 and 12 ± 3 min for standard of care versus RadTranslate, respectively), but variability was significantly lower when RadTranslate was used (P = .003).ConclusionsArtificial intelligence–aided multilingual audio instructions were successfully integrated into imaging workflows, reducing strain on medical interpreters and variance in throughput and resulting in more reliable average examination length.

Documenting New Ways of Delivering Care Under Oregon's Alternative Payment and Advanced Care Model.

The fee-for-service reimbursement system that dominates health care throughout the United States links payment to a billable office visit with a physician or advanced practice provider. Under Oregon's Alternative Payment and Advanced Care Model (APCM), initiated in 2013, participating community health centers (CHCs) received per-member-per-month payments for empaneled Medicaid patients in lieu of standard fee-for-service Medicaid payments. With Medicaid revenue under APCM no longer tied solely to the volume of visits, the Oregon Health Authority needed a way to document the full range of care and services that CHCs were providing to their patients, including nontraditional patient encounters taking place outside of traditional face-to-face visits with a billable provider. Toward this end, program leadership defined 18 visit and nonvisit-based care activities-"Care Services That Engage Patients" (Care STEPs)-that APCM CHCs were asked to document in the electronic health record to demonstrate continued empanelment. To describe trends in rates of traditional face-to-face office visits and Care STEPs documentation among CHCs involved in the first 3 phases of APCM implementation. The study population included the 9 CHCs involved in the first 3 phases of APCM implementation. Using data from the electronic health record, quarterly summary rates for office visits and Care STEPs were calculated for the first 18 quarters of implementation (March 1, 2013 to June 30, 2017). Among participating CHCs, the mean rate of face-to-face visits with billable providers declined from 635 ± 128 to 461 ± 109 visits/1000 patients/quarter (mean difference, -174; 95% CI, -255, -94). Care STEPs documentation increased from 831 ± 174 to 1017 ± 369 Care Steps/1000 patients/quarter, but the difference was not statistically significant. Care STEPs within the category of New Visit Types were documented most frequently. There were significant increases in documentation of Patient Care Coordination and Integration and a small, albeit significant, increase in Reducing Barriers to Health. There was a significant decline in the documentation of Care STEPs by physicians and advanced practice providers an increase in documentation by ancillary staff. These findings suggest that APCM is increasing CHCs' capacity to experiment with new ways of providing care beyond the traditional face-to-face office visit with a physician or advanced practice provider. However, CHCs may choose different ways to change the delivery of care and some CHCs have implemented these changes more quickly than others. Future mixed-methods research is needed to understand barriers and facilitators to changing the delivery of care after APCM implementation.

Assessment of Clinical Leadership Training Needs in Senior Pediatric Residents

Introduction:Although clinical leadership in physicians is associated with improved healthcare, leadership training is rarely integrated into residency training. Our objective was to perform a comprehensive needs assessment of our pediatric residents’ existing leadership experiences and knowledge and to identify training gaps within our program.Methods:First, we held focus groups with senior pediatric residents to understand their clinical leadership experiences and identify training needs. Notes were transcribed and independently coded by 2 researchers, with thematic saturation achieved. Next, we focused each session on 1 leadership content area identified from the aforementioned themes to better understand the specific training needs for each topic.Results:Four major themes were identified: (1) Effective and timely communication with supervisors, learners, ancillary staff, and patients is indispensable in promoting safe patient care, avoiding conflict, and preventing misunderstanding. (2) Training in teaching methods is desired, especially gaining the skills needed to teach various levels of learners, in different settings and under time constraints. (3) Time management, availability of resources, and team logistics were often learned through trial-and-error. (4) Self-care, self-acceptance, emotional regulation, and peer debriefing are relied upon to manage negative emotions; rarely are resilience and wellness strategies employed in “real-time.”Conclusion:Senior residents currently face gaps in clinical leadership training and may benefit from additional instruction in content areas related to these 4 themes. Our next steps are to utilize the identified themes to develop a longitudinal and skills-based clinical leadership curriculum to address the gap in graduate medical education.

Prevalence of Seropositivity to SARS-CoV-2 among Health Care Workers in Tertiary COVID-19 Hospital, Ahmedabad, Gujarat

Introduction: Healthcare Workers (HCW) are at increased risk of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection due to occupational exposure to infected patients and contaminated surfaces. Aim: To determine the prevalence of seropositivity against SARS-CoV-2 among HCW in a tertiary COVID-19 designated hospital in Ahmedabad, Gujarat. Materials and Methods: This cross-sectional study was conducted between 1st July to 31st July, 2020 on 1333 HCWs. HCWs included doctors, nurses, lab personnel, general service assistants and ancillary staff who work in hospital. Anti SARS-CoV-2 total antibodies were measured in serum sample by chemiluminescent technique. Results: Prevalence of seropositivity was found in 27.76% (370 out of 1333). It was highest among general service assistant 34.76% (especially among house keeping staff, 43.44%) and lowest among doctors (19.33%). The percentage of seropositivity among asymptomatic HCWs was 24.84%. Conclusion: The percentage of seropositivity among asymptomatic HCWs indicates that a large amount of infection passes asymptomatically. The discrepancy between various job categories might be due to differential occupational exposure and risk, lack of awareness and seriousness regarding transmission and risk of getting infection, various demographic factors like literacy, residential environment, community prevalence etc.

Leveraging Interdisciplinary Teams for Pre-Visit Planning to Improve Pneumococcal Immunization Rates Among Internal Medicine Subspecialty Practices.

Background:Despite the ready availability of pneumococcal vaccines and recommendation of vaccination by Center for Disease Control and Prevention (CDC), the immunization rates among adults less than 65 years of age with chronic and immunocompromised conditions remain low.Methods:This interventional (cohort) study aimed to improve the pneumococcal vaccination rate for patients with an increased risk of pneumococcal disease by utilizing a three-pronged approach. This included: (1) clinician education webinar, (2) pre-visit counseling performed by registered nurses, targeted toward patients with upcoming appointments, to address vaccination status, and (3) modified pre-visit interdisciplinary team huddle with clinicians and registered nurses to review which patients are amenable to vaccination at the time of visit and those who may benefit from re-engagement and further motivational interviewing. After the completion of the 10-week intervention, study organizers reviewed the percent of patients with completed pneumococcal vaccinations.Results:In this 10-week rapid cycle initiative, a total of 482 patients were eligible for vaccination. During the intervention phase, 370 patients were contacted and of these 38% of patients were amenable to receiving a vaccine during the pre-visit counseling, 5% were previously vaccinated, 18% were not amenable, and 38% were unreachable prior to visit. This initiative resulted in a 43% increase in the vaccination rate in this cohort.Conclusions:The significant increase in vaccination rate supports the utilization of a framework in the multidisciplinary approach to pre-visit planning in non-primary care specialties and other vaccination efforts, especially emerging diseases such as COVID-19. Future directions of study include the efficacy of telemedicine counseling with a same-day appointment for vaccination, co-location of registered nurses within the practice sites, as well as the use of other ancillary staff (such as medical office assistants) to engage patients in pre-visit planning.

Supporting Medical Providers to Combat Vaccine Hesitancy.

Supporting Medical Providers to Combat Vaccine Hesitancy Magdi Awad, PharmD, MSA, Kenneth Furdich, PharmD, BCACP, Dana Webb, PharmD, and E. Demond Scott, MD, MPH To the Editor: COVID-19 vaccine hesitancy during the SARS-CoV-2 public health crisis has the potential to significantly increase disease burden throughout the world.1 Vaccinations currently available have an increasing amount of data to support both their safety and efficacy at preventing disease.2,3 However, serious efforts, both educational and logistical, must take place to maximize the public's vaccination uptake.4 Polls assessing vaccine hesitancy in the general population have shown hesitancy persisting despite vaccination campaigns being underway. National polling data as of February 2021 has demonstrated up to 44% of the general population is still displaying vaccine hesitancy. Specifically, 22% report they would want to wait and see how the vaccine is working before getting it, 7% would get the vaccine if required by school or work, and 15% would definitely not get the vaccine.5 Despite Centers for Disease Control recommendations, health care workers are also displaying vaccine hesitancy. A study conducted in a large university health care system observed attitudes towards COVID-19 vaccination among health care personnel. The various personnel being surveyed ranged from physicians to non-clinical ancillary staff. Results from this survey showed 58% of respondents said they would get vaccinated, 26% were unsure, and 16% reported they would not get vaccinated. Additionally, 20% of physicians and 45% of master's-level clinicians reported they were not sure or strongly disagreed to getting a COVID-19 vaccine if one were offered to them for free.6 Among the most significant contributors to vaccine hesitancy is the misinformation projected on social media. Misinformation being spread to the public include assertions the vaccine trials were rushed, the vaccine technology is new, or that the vaccine alters one's genetic makeup.7 While this information is false, clinicians must be ready to provide demonstrated facts and recommendations to combat the spread of misinformation. Health care providers have not only an opportunity, but an obligation, to dispel the myths about COVID-19 and its vaccines. They must anticipate, validate, and be prepared to address patients' questions and concerns about the vaccine. To do so, health professionals must be able to demonstrate their own confidence in the benefits of the vaccine being greater than any possible difficulties.8 Moreover, health care providers' ability to combat vaccine myths is especially important in underserved and minority [End Page xiv] communities. Patients tend to accept preventative medicine recommendations from providers with the same ethnicity and race as themselves, and providers of color are disproportionately likely to practice in communities of color.9 Educational interventions for providers may be helpful to increase confidence in deflating vaccination myths and help them to promote vaccination in their patients. As an example, a small community health center with multiple locations serving underserved communities in Ohio used its pharmacy-led academic detailing approach to educate the medical and pharmacy providers about the COVID-19 vaccines.10 Before and during the educational presentation, questions were sought from the providers and free engagement was promoted to share insights. The academic detailing session also covered common misinformation as well as factual information refuting common erroneous claims. A survey of the medical providers was then circulated to assess comfort in recommending the COVID-19 vaccination to patients (item #1), addressing vaccine hesitancy (item #2), and addressing use of the vaccine in special populations (e.g., immune-deficient, previous COVID-19 exposure) (item #3). Results from the survey (n=12, 75% response rate) were analyzed using Cohen's D to evaluate effect size.11 The analysis revealed the academic detailing session had a medium positive effect on item #1, a large positive effect on item #2, and a very large positive effect on item #3. Education and the dissemination of factual data are pathways to reduce vaccine hesitancy. This education empowers providers to educate their patients regarding COVID-19 vaccines and dispel misinformation which could lead to greater public harm. Educational interventions as described above should be considered by clinics and health centers to aid in combatting the SARS-CoV-2 pandemic. References...

Treatment and Diagnostic Considerations in a Complex Psychiatric Case - a Case Report

A patient with a history of autism spectrum disorder and epilepsy was hospitalized for management of acute onset psychosis and agitation. The acuity of his behaviors warranted abrupt shifts in treatment and multiple pharmacologic interventions were ineffective. The atypical nature of his presentation and intense pressure from ancillary staff to consider organic etiologies drove frequent transitions of care within the hospital setting. Multiple diagnoses were considered including a primary psychosis, excited catatonia and antiepileptic drug-induced psychotic disorder. Ultimately the patient was diagnosed with bipolar disorder and effectively treated with quetiapine and valproic acid. The authors suggest that rapid consideration of comorbid bipolar disorder in autism spectrum disorder patients presenting with affective dysregulation may expedite trial of an anticonvulsant with mood stabilizing properties, which would have simplified this patient’s clinical course and limited potential for iatrogenic harm. This course of treatment should especially be considered when a history of epilepsy is present.

Medical Error, Adverse Events, and Complications in Interventional Radiology: Liability or Opportunity?

This review suggests that there is a critical need to renew understanding of adverse events and complications within interventional radiology and to redefine a robust commitment to patient safety a...