Clinical Staff Research Articles

A Focused Literature Review of Missed Care in Residential Aged Care

Missed care is any aspect of required care that is omitted (either in part or whole) or delayed. Residential Aged Care Facilities (RACFs) are susceptible to missed care due to a range of factors, including residents’ complex needs, workforce composition, and constraints placed on resource availability. This focused literature review aims to evaluate the current evidence on missed care, including an analysis of the concept, causes, and outcomes of missed care in residential aged care in Australia. Within most of the available literature, missed care is typically considered only within the context of nursing. It is noted that although the nature and identification of missed care were discussed extensively to provide a broad picture of the phenomenon, including possible prevalence and outcomes, they need to explicitly discuss the impact of missed care on residents, families, and other clinical and operational staff. Further research is needed to inform and improve the care of the elders in RACFs, considering this gap in the literature. This review has identified potential areas for enquiry into missed care to inform policy and practice to improve the care of elderly residents in RACFs.

The Prevalence and Predictors of Workplace Violence Among Hospital Staff

Background: Workplace violence has always been a serious chal-lenge in health care systems. It reduces employees’ satisfaction and productivity, and increases the potential for adverse medical events. This study aimed to determine the prevalence and predictors of workplace violence among hospital clinical staff. Methods: This cross-sectional study was conducted on 140 hospital care staff including nurses and paramedics in 2022. The standard questionnaire of WHO on workplace violence in health sector was used to collect data. To describe the quantitative variables, the mean and standard deviations were utilized, and for analyzing the data, multiple logistic regression model was used. The analysis was performed using SPSS 26. Results: The results showed that 47.9% of the participants ex-perienced verbal violence at least once in the past year, and 19.3% experienced sexual violence. Regarding the perpetrators of violence, except for physical violence, colleagues accounted for the highest. Most physical violence cases against the clinical staff were perpetrated by one of the patient’s family members. Gender, marital status, and years of work experience were determined as predictors of workplace violence. Married male employees with limited work experience were disproportionately at risk of workplace violence. Conclusion: Hospital clinical staff were exposed to all kinds of violence, especially verbal violence. Training personnel on the management of workplace violence and enhancing their communication skills and determining the scope, and predictors of workplace violence can help healthcare managers reduce the violence and its complications.

Discrepancies between Promised and Actual AI Capabilities in the Continuous Vital Sign Monitoring of In-Hospital Patients: A Review of the Current Evidence.

Continuous vital sign monitoring (CVSM) with wireless sensors in general hospital wards can enhance patient care. An artificial intelligence (AI) layer is crucial to allow sensor data to be managed by clinical staff without over alerting from the sensors. With the aim of summarizing peer-reviewed evidence for AI support in CVSM sensors, we searched PubMed and Embase for studies on adult patients monitored with CVSM sensors in general wards. Peer-reviewed evidence and white papers on the official websites of CVSM solutions were also included. AI classification was based on standard definitions of simple AI, as systems with no memory or learning capabilities, and advanced AI, as systems with the ability to learn from past data to make decisions. Only studies evaluating CVSM algorithms for improving or predicting clinical outcomes (e.g., adverse events, intensive care unit admission, mortality) or optimizing alarm thresholds were included. We assessed the promised level of AI for each CVSM solution based on statements from the official product websites. In total, 467 studies were assessed; 113 were retrieved for full-text review, and 26 studies on four different CVSM solutions were included. Advanced AI levels were indicated on the websites of all four CVSM solutions. Five studies assessed algorithms with potential for applications as advanced AI algorithms in two of the CVSM solutions (50%), while 21 studies assessed algorithms with potential as simple AI in all four CVSM solutions (100%). Evidence on algorithms for advanced AI in CVSM is limited, revealing a discrepancy between promised AI levels and current algorithm capabilities.

Increasing Diabetic Retinopathy Screening in Resident-Run Clinic Through Partnership With Ophthalmology Clinic: A Pilot Study.

Despite the importance of early detection of diabetic retinopathy, many diabetic patients fail to receive the recommended screening. The objective of this quality-improvement initiative was to increase diabetic retinopathy screening through a partnership between primary care and ophthalmology, where primary care clinic staff may schedule patients directly for screening appointments at point of referral. To our knowledge, this intervention is the first described to use an interspecialty partnership to increase screening. We implemented the intervention at a resident-run primary care clinic with a medically underserved patient population. The pilot intervention took place over a 6-month time frame. The completion rate of diabetic retinopathy screening examinations was compared before and after intervention and was found to increase in a statistically significant manner from 34.7% to 40.5% (p = .01). The no-show rate did improve from 66.7% preintervention to 46.0% postintervention; however, this change was not statistically significant (p = .44). During this pilot, the intervention was able to increase diabetic retinopathy screening completion rate; however, further efforts should be aimed at addressing no-shows. Overall, this initiative was a positive step toward the goal of every diabetic patient undergoing the appropriate screening examinations.

The implementation of a "safety officer" program: an innovative approach to improve infection prevention and control practices in Ethiopia.

Effective infection prevention and control (IPC) was central to keeping healthcare workers (HCWs) safe during the COVID-19 pandemic. However, as the pandemic continued, the maintenance of high-quality IPC practices waned, placing HCWs at increased risk of infection. A COVID-19 Safety Officer (SO) program was piloted by the United States Agency for International Development (USAID)-funded Reaching Impact, Saturation and Epidemic Control (RISE) project across two health facilities in Ethiopia, which trained clinical and non-clinical HCWs on IPC protocols to promote safe practices in patient care areas. We sought to evaluate the implementation and effectiveness of the SO program in improving IPC practices within the clinical setting. This is a post-implementation evaluation of the SO program, implemented in two hospitals in Ethiopia between May 2022 and December 2022. Participants completed a 4-day course on COVID-19 epidemiology, IPC, safety communication, and learning theory as a part of the Training of Trainers component (n = 23), and were posted in clinical wards to provide staff training and support to maintain IPC protocols. The program was evaluated at 6 months using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Effectiveness was measured using direct observation of IPC practices across intervention sites. Implementation outcomes were measured using surveys and qualitative interviews to capture training cascade, knowledge, comfort, acceptability, and maintenance. Participants were able to cascade training to an additional 167 clinical (67.6%) and 80 non-clinical (32.3%) staff across both sites. Direct observation of clinical staff at 6 months showed that 95% (59/62) wore at least a surgical mask with patients and were compliant with masking and/or distancing protocol. Clinical interviews revealed that SOs contributed to increased perceived comfort with screening and isolation procedures and environmental cleaning procedures. The SO training program was widely adopted, and effective in improving the implementation and comfort of maintaining IPC practices in clinical settings.

Development and Psychometric Evaluation of the Sexual Life Quality Evaluation Tool for Patients With Coronary Heart Disease.

Patients with coronary heart disease (CHD) will have a series of sexual problems, and their sexual life quality can be affected. However, a standardised evaluation tool for patients with CHD was lacking. Therefore, this study aimed to develop a sexual life quality questionnaire for patients with CHD and to evaluate its psychometric properties. Based on previous phenomenological studies, literature analysis and group discussion, questionnaire items were formed. After two rounds of expert consultation and pre-survey, the questionnaire items were modified. Items were screened by item analysis. Exploratory factor analysis and confirmatory factor analysis were used to explore and confirm the structure of the questionnaire. Content validity and criterion validity were evaluated using the expert consultation and correlation analysis, respectively. The questionnaire reliability was evaluated using internal consistency, split half reliability, and test-retest reliability. The sexual life quality questionnaire of patients with CHD was developed, which included two versions: male version and female version. The male version of the questionnaire contains 3 dimensions and 20 items, while the female version contains 3 dimensions and 17 items. After reliability and validity test, the two versions of the questionnaire have good reliability and validity. In this study, the sexual life quality questionnaire of patients with CHD was developed and its psychometric properties were confirmed, which can be used to evaluate the sexual life quality of patients with CHD. The development of a sexual life quality evaluation tool for patients with coronary heart disease to provide objective and quantitative tools for clinical staff to evaluate patients' sexual life status. Patients were invited to participate in a questionnaire survey for this study.

Integration of a facilitated access pathway for contraception into alcohol and other drug treatment services: A cohort study comparing metropolitan and regional settings.

Women who attend alcohol and other drug (AOD) services experience higher rates of unintended pregnancy, and access less contraception, than the general population. This study aims to observe contraceptive initiation and use after contraception services were offered at metropolitan and regional AOD services. Clinical staff were provided contraception education. One hundred women aged 16-49 were recruited from two services between 2017 and 2021. Women completed a questionnaire on their obstetrics and gynaecological history, pregnancy plans and contraception use. Women were provided education on contraception options and offered referral to a contraception pathway. The primary outcome was initiation of highly reliable contraception; secondary outcomes were the types of contraception initiated, and contraception use and pregnancy at 12 months. We compared the initiation of contraception across the two study sites. At baseline, 91% of women were not planning a pregnancy within 12 months, with 21% of these using highly reliable contraception. Of all women not planning a pregnancy, 28% initiated highly reliable contraception via the pathway (2% metropolitan, 51% regional, p < 0.001), with intrauterine devices being the most frequent method initiated (15%). At 12 months, 44% were using highly reliable contraception and 15% had recorded pregnancies. Contraception pathways for women in AOD treatment can improve initiation of highly reliable methods of contraception, although pregnancy rates were still high and there were large differences between the study sites. Care navigation and clinical champions are some potential facilitators to contraception access, and understanding additional barriers to access may be useful.

Summary of Best Evidence for Perioperative Management Practices in Hair Transplantation Patients : Facial Skeleton.

To integrate and summarize the best evidence on perioperative management practices for hair transplantation patients, providing an evidence-based reference for clinical. An exhaustive literature search was conducted to identify the best evidence for managing patients undergoing hair transplantation during the perioperative period. The databases searched included Up To Date, BMJ Best Practice, UK National Institute for Health and Care Excellence, National Guideline Clearing House, Scottish Intercollegiate Guidelines Network, Guidelines International Network, Cochrane Library, JBI Database of Systematic Reviews and Implementation Reports, PubMed, Web of Science, European Dermatology Forum, China National Knowledge Infrastructure, Wanfang Data, Medlive Guideline Network, and Sinomed. The search spanned publications from February 2013 to February 2024, focusing on clinical decisions, evidence summaries, guidelines, and expert consensus. We finally identified 22 articles with high-quality results (consisting of 9 clinical decisions, 6 guidelines, 7 expert consensuses), providing 41 pieces of evidence across seven categories: assessment of transplantation conditions, transplant planning and preoperative preparation, anesthetic preparations, surgical methods and operation skills, postoperative wound management, medication-related guidance, optimization of nursing and treatment strategies. Special emphasis has been placed on the sections covering anesthesia preparation, surgical methods, and operational techniques, with detailed explanations provided. The summarized best evidence on perioperative management practices for hair transplantation patients can serve as evidence-based guidelines for clinical. It is recommended that clinical staff adopt evidence-based recommendations to improve and optimize patient outcomes and promote postoperative recovery. As these evidences came from different countries, factors such as the clinical environment should be evaluated before application. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Motif discovery in hospital ward vital signs observation networks

Vital signs observations are regular measurements used by healthcare staff to track a patient’s overall health status on hospital wards. We look at the potential in re-purposing aggregated and anonymised hospital data sources surrounding vital signs recording to provide new insights into how care is managed and delivered on wards. In this paper, we conduct a retrospective longitudinal observational study of 770,720 individual vital signs recordings across 20 hospital wards in South Wales (UK) and present a network modelling framework to explore and extract behavioural patterns via analysis of the resulting network structures at a global and local level. Self-loop edges, dyad, triad, and tetrad subgraphs were extracted and evaluated against a null model to determine individual statistical significance, and then combined into ward-level feature vectors to provide the means for determining notable behaviours across wards. Modelling data as a static network, by aggregating all vital sign observation data points, resulted in high uniformity but with the loss of important information which was better captured when modelling the static-temporal network, highlighting time’s crucial role as a network element. Wards mostly followed expected patterns, with chains or stand-alone supplementary observations by clinical staff. However, observation sequences that deviate from this are revealed in five identified motif subgraphs and 6 anti-motif subgraphs. External ward characteristics also showed minimal impact on the relative abundance of subgraphs, indicating a ‘superfamily’ phenomena that has been similarly seen in complex networks in other domains. Overall, the results show that network modelling effectively captured and exposed behaviours within vital signs observation data, and demonstrated uniformity across hospital wards in managing this practice.

Understanding Ethical Concerns Involving Vulnerable Human Participant Populations in Medical Research: Mixed-Method Analysis of Liberian Ebola Survivors' Experiences in PREVAIL I-VII.

Background: As the number of large-scale outbreaks continues to rise worldwide, clinical trials are increasingly engaging disease-affected peoples within the Minority World (nations with over 80% poverty rates). Yet global health research inadequately addresses potential ethical issues of including impoverished, disease-affected populations and their contextual vulnerabilities in medical research. Objective: This paper presents a mixed-method analysis from our 2022 semi-structured survey capturing the experiences of Liberian Ebola Virus Disease (EVD) survivors serving as study participants in the Partnership for Research on Ebola Virus in Liberia (PREVAIL) clinical trials. Methods: Firstly, we conducted an extensive literature review of the scholarship related to biomedical research and ethical standards protecting study participants to inform our survey method and design. Applying a theoretical framework on vulnerability, we then qualitatively explored the survey responses of 19 EVD survivors' perceptions and experiences taking part in PREVAIL, including their expectations, treatment, delivered benefits, and quality of care. We further quantitatively codified their statements for underlying themes of reported negative experiences against standard ethical regulations in biomedical research, conducting a statistical analysis to inform generalizability. Most of the 19 survivors reported facing extreme ongoing vulnerabilities related to their disease status, including physical impairments, psychosocial stress, and socio-economic inequity. Results: Initially, the survivors tended to experience a sense of hope and pride in volunteering for PREVAIL. One in five participants reported benefiting from PREVAIL's regular medical diagnoses. However, most of their survey responses indicated prevalent negative shared experiences, including continually being confused or misinformed of their study participant rights, roles, and benefits; being burdened by heavy participation transaction costs; and repeated incidents of poor treatment and discrimination by PREVAIL staff after initial recruitment. PREVAIL participant satisfaction ranking is negatively correlated with receiving insufficient financial compensation (r = -0.51), extensive time requirements for each medical visit (-0.40), and being poorly treated by clinical staff (-0.67).

7366 Experience and perspectives of healthcare professionals regarding exercise directed guidance in pediatric type 1 diabetes

Abstract Disclosure: H. Reznik: None. A. Brener: None. F. Levy-Khademi: None. J. Yeshayahu: None. D. Pivko-Levy: None. I. Koren: None. O. Pinhas-Hamiel: None. M. Sharkia: None. L. Carmon: None. M. Rachmiel: None. M. Muller: None. L. de Vries: None. M. Cohen: None. Objective: Regular exercise can promote various aspects of health in pediatric type-1-diabetes (T1D). However, the management of exercise can be extremely challenging for the child, their family and the healthcare team involved. Studies suggest that children with T1D perform less than the recommended daily activity and that exercise does not always improve glycemic control. Multiple factors should be accounted for, including among others, the nature of the activity and individual child, as well as the treatment regimen. Proper guidance in preparation for exercise is crucial. We conducted a national study aimed at identifying strengths and limitations of exercise directed guidance (EDG) provided by staff in pediatric T1D clinics in Israel. Methods: Healthcare professionals from 8 pediatric diabetes clinics, including physicians, nurses and dietitians, were recruited. Participants completed an anonimized electronic questionnaire assessing: i) Demographics ii) Timing and content of the guidance provided to pediatric patients with T1D iii) Perceived challenges. Results: Ninety-nine professionals took part in this study, 53 physicians, 24 nurses and 23 dietitians. All reported providing EDG to pediatric T1D patients, 90 (90.9%) include EDG both during the initial post-diagnosis visits and periodically thereafter. However, while 83 (83.8%) reported offering guidance to all patients, 16 (16.1%) indicated guiding only specific children: either those that exercise, those that do not exercise or only those that asked for information. Only 64 (64.6%) reported to have specialized educational materials available in clinic, this varied even within the same clinic. The 3 most prevalent topics reported by participants as “usually included” in EDG, were: immediate effects on glucose (94.9%), adjusting carbohydrates (88.8%) and the equipment required during exercise (86.8%). The 3 least frequently addressed subjects were: addressing principals in planning exercise (28.2%) and involving family and friends (29.2% and 17.1% respectively). Challenges by order of prevalence were insufficient teaching aids, the complexity of the topic, lack of knowledge and insufficient time (reported by 44.4%, 39.4%, 34.3% and 34.3% respectively). The knowledge gap most commonly reported centered on understanding the impact of different types of exercise on blood glucose. Conclusions: Healthcare professionals recognize the importance of exercise in T1D management and all of them incorporate EDG in their routine practice. Interestingly, there is considerable variability in both timing and content of the EDG provided, even within the same clinic. We have identified important areas for improvement, with particular attention needed in increasing the availability of educational tools and enhancing staff knowledge. Our findings can assist in creating educational aids for both staff and patients. Presentation: 6/2/2024

8757 Contingency Planning in the Event of Insulin Pump Failure or Malfunction - a Quality Improvement Initiative

Abstract Disclosure: S. Avula: None. H. Hashmi: None. A.R. Ankireddypalli: None. S. Inkollu: None. M. Salim: None. A. Ahmed: None. J. Kohlenberg: None. T. Harindhanavudhi: None. Background: People using insulin pump therapy are at risk of adverse outcomes, including hyperglycemia and diabetic ketoacidosis, in the event of pump failure or malfunction. A standing prescription for subcutaneous basal insulin, which can be filled as needed, has the potential to prevent these adverse outcomes. Aim: We aimed to increase the percentage of standing prescriptions for subcutaneous basal insulin by 20 % over 6-month duration for people using insulin pump therapy. Methods: Pre-intervention: We retrospectively obtained baseline electronic health record data for people with diabetes on insulin pump therapy in our health system (M Health Fairview, University of Minnesota) from January 1, 2022, to December 31, 2022. Intervention: Over a six-month duration, a multifaceted intervention was implemented. (1) During the rooming process for endocrinology appointments, the medical assistants inquired if the person using insulin pump therapy had a standing prescription for basal insulin in the event of insulin pump failure or malfunction. If not, the medical assistant encouraged the person with diabetes to review this with their Endocrinologist. (2) Informational brochures, placed in the exam rooms, encouraged people using insulin pump therapy to discuss a standing order for basal insulin. (3) Emails were sent to all endocrinology providers to encourage discussion of the provision of a standing prescription for basal insulin for people on insulin pump therapy. Post - intervention: We recorded the number of people with a standing prescription for subcutaneous basal insulin from 5/1/2023 to 5/14/2023. Results: The total number of patients with diabetes on insulin pumps prior to the intervention was 256. Of 256 patients with insulin pump therapy, 109 patients (42.6%) had standing basal insulin prescribed. A post-intervention chart review of patients with diabetes on an insulin pump was conducted for a total of 69 patients, of which 56 patients (81.2%) had backup basal insulin prescribed. The estimation of difference was - 0.3858 (p= &amp;lt;0.05; 95% CI for difference -0.4961, -0.2754). Conclusion: This multipronged approach increased the prescription availability and awareness among providers and patients for a standing order of basal insulin in the event of insulin pump failure or malfunction from 42% to 81%. Limitations of this study include the limited duration of intervention and the need to send repeated reminders to all providers, including clinic staff. The next plan is to create a best practice alert in EMR to alert providers to have a backup basal insulin plan for anyone on an insulin pump. Create a custom dot phrase of insulin backup plan in EMR. Presentation: 6/3/2024

7902 Improvement In Follow-Up Of Post-Hospital Discharge Patients After Targeted Approach

Abstract Disclosure: S. Ward: None. Q. Aziz: None. A.L. Champion: None. K.E. Izuora: None. Improvement in Follow-up of Post-hospital Discharge Patients after Targeted Approach Introduction: Outpatient follow up after discharge from the hospital is a well-established factor affecting health outcomes in patients with chronic medical conditions. A prior QI project at our institution utilizing a Plan-Do-Study-Act (PDSA) cycle showed that overall follow up rate was 24% in patient expected to follow up in our outpatient clinic. The aim of this QI project was to identify and implement a targeted approach to improve outpatient follow up at our clinic. Methods: This study was a second round of a PDSA cycle with the goal of improving outpatient follow up. Analysis of prior data identified 54 patients referred for outpatient follow up in our endocrinology clinic after hospital discharge (non-targeted approach). Of these 54 only 13 patients had established follow up care (24%). We looked closer at the 39 patients who did not follow up to identify areas we could act on to improve follow up; 38% of these patients did not follow due to one of the following: did not know they needed to follow up, lack of knowledge of how to contact office, unable to reach office by phone. To overcome these obstacles, we developed a targeted approach for all patients seen in the hospital who were expected to follow up in the outpatient setting. This approach included the following: clinic business card with contact information given to patient, follow up instructions included in discharge instructions including how and when to contact office, message sent from physician to outpatient clinic staff requesting staff contact patient and schedule follow up appointment. This targeted approach was implemented for all patients requiring outpatient follow up seen by the UNLV Endocrinology consult service from August 1, 2023 to September 30, 2023. Results: During the two months of recruitment we identified 34 patients who needed outpatient follow up. All 34 of these patients had the targeted approach implemented. Of the 34 patients 12 have successfully followed up and one patient has a future appointment scheduled. This is a follow up rate of 35%, an increase of 11% compared with the prior QI data that did not use a targeted approach. If all future appointments are kept the follow up rate will be 38%. Five patients who had scheduled appointments did not show up to their appointment and are not counted in the successful follow group . Conclusions: Our targeted approach showed an improvement in outpatient follow up from 24% to 35% compared to a non-targeted approach. Five patients that scheduled appointments did not keep those appointments. Future steps would include evaluating reasons for no-show and identifying approaches to improve our no-show rate. . Presentation: 6/2/2024

Responsibility of follow-up regarding medical recommendations in primary care and challenging patients: The perspective of doctors, nurses, pharmacists, and administrative staff

ObjectiveThis study examines the way healthcare staff describe challenging patients and perceive responsibility for follow-up of patients with chronic conditions. MethodsInterviews were conducted with 46 healthcare staff (15 primary care physicians/12 nurses/15 administrative staff/4 pharmacists) at 12 clinics in Israel. They were audiotaped, transcribed, and thematically analyzed using Atlas qualitative data analysis software. ResultsParticipants defined patients as “challenging” either because they are less likely to follow medical recommendations or are felt to overconsume care. Staff believed that patients did not follow medical recommendations because they were indifferent, unaware, in denial about deteriorating medical condition, or fear of the unknown. Participants generally perceived a shared responsibility for follow-up between the staff and the patient. Staff who endorsed closer relationships with staff members expressed empathy toward challenging patients and felt responsible for follow-up. ConclusionsHealthcare staff perceive themselves as partially responsible for helping patients follow up with medical recommendations. Cohesive staff relationships may promote higher levels of empathy toward challenging patients and may contribute to helping patients follow up with recommended care.Practice implicationsTo improve follow-up with medical recommendations, there is a need to develop and test interventions to promote more cohesive ties among clinic staff.

Implementation and analysis of clinic administered behavioural health screen in an outpatient paediatric cardiology clinic.

Previous studies investigating behavioural health screening processes have focused on selected diagnoses within paediatric cardiology and focused on a smaller number of potential concerns. We developed and administered a brief survey in our paediatric heart centre to assess the presence of a wider variety of behavioural health concerns and to connect patients with resources. A cohort of 305 patients aged 2-29 years (M = 11.97 years; SD = 6.00 years; 50.49% female), representing a variety of indications for a cardiology clinic visit, or a parent, completed a survey of 14 common behavioural health concerns. Behavioural health concerns were included based on practice patterns within paediatric psychology. Respondents indicated if they were currently receiving behavioural health services and if they were interested in behavioural health follow-up. Surveys were administered during check in and collected by clinic staff. A behavioural health provider attempted to reach all those who indicated interest by phone. Approximately 45% of the sample endorsed one or more behavioural health concerns and 30.16% of the sample endorsed at least one concern but were not already connected to services. Only 27.17% of this group requested follow-up. Most commonly endorsed concerns were anxiety, sleep problems, depressed/irritable mood, and somatic complaints. Survey results converge with existing literature to indicate that behavioural health concerns are common among youth seen in a paediatric cardiology clinic but most patients are not connected to appropriate services. Screening programmes can help meet this need but challenges remain. Clinical implications and future directions are discussed.

Interventions to improve clinical trial recruitment with a focus on clinical staff from the recruiting site: a systematic review

Interventions to improve clinical trial recruitment with a focus on clinical staff from the recruiting site: a systematic review

Health Care Workers' Perspectives on Collecting Sexual Orientation and Gender Identity in the Adult Primary Care Setting.

Despite numerous calls for standardized collection of sexual orientation and gender identity (SOGI) data in clinical settings, uptake of this practice still lags. This study conducted a preimplementation assessment of staff attitudes toward SOGI data collection within an adult primary care practice in an urban academic medical center in the northeastern United States. We created a process map of the flow of patient data from the point of registration to the clinical encounter to identify all staff roles associated with registration and patient demographic data collection. We purposively sampled staff members across these roles and conducted semistructured virtual interviews between November 2021 and February 2022. The research team used deductive and inductive coding and conducted a thematic analysis to identify barriers and facilitators to implementation. Nine clinical staff and eleven nonclinical staff were interviewed. Participants were asked about their general experiences with lesbian, gay, bisexual, transgender, and queer (LGBTQ) patients, their perspectives on collecting this data, and potential barriers and facilitators to incorporating this into the workflow. The main themes that emerged were the relevance of SOGI data to the clinical practice; concerns about patient acceptability; the prevalence of cis-gender, heteronormative assumptions; and concerns about linguistic, cultural, and generational differences. Differences were noted between clinical and nonclinical staff. Greater education is needed to help both clinical and nonclinical staff understand how patients' SOGI demographics can be used to provide affirming, patient-centered care. Implementation strategies can be tailored to address specific barriers at the individual, organizational, and social levels.

A-192 Effectiveness in Communicating Critical Results: impact of technology and consultive actions on improving performance indicators in a laboratory in Northeast Brazil

Abstract Background Critical results consist of laboratory test results that require immediate intervention or decision-making by the responsible medical team, as they pose a risk to the patient's life. To manage the process of communicating critical results, it is also necessary to define the indicators, goals and systematic comparability through benchmarking. Methods The performance of the indicators measuring the critical results process for the year 2023 was analyzed. Performance indicators such as resolution time, success and failure rate in communication, delay rate in communication and the rate of open incidents related to the communication of critical results were monitored using a Business Intelligence tool. Results In the first two months of 2023 the results reflected the absence of parameters in the LIS for effective communication of critical results. September and October there was a high turnover rate in the laboratory in addition to the change in the hospital care profile in which the laboratory medicine service was inserted. These causes culminated in a number of 122 (1.48%) communication failures, representing an increase of 1,120% compared to the first two months of the year. On the other hand, there was a significant improvement in the average communication time for critical results, decreasing from approximately 736 hours to 184 hours(reduction of around 75%). There was also a reduction in communication delay of approximately 67%. These numbers corroborate the parameterization actions in the system aimed at speeding up the process. As a continuation of the improvement actions, the laboratory implemented goal setting for the resolution time indicator and also the periodic meeting for critical analysis of the results.In addition to these actions, the laboratory approached the hospital's clinical staff, making it possible to provide clarity on the difference between compulsory notification and critical results. This clarification allowed for the establishment of a list of exams considered critical, in order to meet the hospital profile, as well as to define the communication flow. For the success indicator in communicating critical results, there was a 22% improvement when comparing the last two months of 2023 with the first two months of the same year. In the last two months of the year, this indicator performed at 99.4%, corroborating the study published by Noronha et al., (2016), where the effectiveness rate in critical results communication was 96.1%. Comparing with the study by Noronha et al., (2016), where the biochemistry sector had the highest rate of critical results communication failures (73.8%), followed by the Emergency Room (78.6% ) and ICU (16.7%), the findings of this study highlighted the top 3 detracting sectors: Biochemistry (68%), “UPA” - Emergency Care Unit (42.1%) and ICU (21.4%), making data superimposable. Conclusions The communication of critical results has challenges related to its effectiveness, especially in hospital contexts. As a critical and high-impact activity, constant actions are necessary to continuously improve the process. Actions should take into account: interactions with attending physicians, the development and training of the internal team, and constant checks of the LIS, as technology can support the process management.

Impact of a Disease-Focused Electronic Health Record Dashboard on Clinical Staff Efficiency in Previsit Patient Review in an Ambulatory Pulmonary Hypertension Care Clinic.

We aimed to improve the operational efficiency of clinical staff, including physicians and allied health professionals, in the previsit review of patients by implementing a disease-focused dashboard within the electronic health record system. The dashboard was tailored to the unique requirements of the clinic and patient population. A prospective quality improvement study was conducted at an accredited pulmonary hypertension (PH) clinic within a large academic center, staffed by two full time physicians and two allied health professionals. Physicians' review time before and after implementation of the PH dashboard was measured using activity log data derived from an EHR database. The review time for clinic staff was measured through direct observation, with review method-either conventional or newly implemented dashboard-randomly assigned. Over the study period, the median number of patients reviewed by physicians per day increased slightly from 5.50 (interquartile range [IQR]: 1.35) before to 5.95 (IQR: 0.85) after the implementation of the PH dashboard (p = 0.535). The median review time for the physicians decreased with the use of the dashboard, from 7.0 minutes (IQR: 1.55) to 4.95 minutes (IQR: 1.35; p < 0.001). Based on the observed timing of 70 patient encounters among allied clinical staff, no significant difference was found for experienced members (4.65 minutes [IQR: 2.02] vs. 4.43 minutes [IQR: 0.69], p = 0.752), while inexperienced staff saw a significant reduction in review time after familiarization with the dashboard (5.06 minutes [IQR: 1.51] vs. 4.12 minutes [IQR: 1.99], p = 0.034). Subjective feedback highlighted the need for further optimization of the dashboard to align with the workflow of allied health staff to achieve similar efficiency benefits. A disease-focused dashboard significantly reduced physician previsit review time while that for clinic staff remained unchanged. Validation studies are necessary with our patient populations to explore further qualitative impacts on patient care efficiency and long-term benefits on workflow.

Blinatumomab infusion interruptions in pediatric patients rarely lead to readmission.

Blinatumomab is a bispecific T-cell engager administered as a 28-day continuous infusion. Infusions can be associated with interruptions requiring support from clinical staff, but the frequency of interventions with outpatient blinatumomab has not been characterized. This study is a single-center, retrospective review of patients who received blinatumomab between December 3, 2014 and October 31, 2021 to determine frequency and type of interventions. Forty patients received blinatumomab for 69 cycles. Clinical staff intervention was required in 31 (45%) cycles, only six (8.7%) cycles needed readmission. Management of outpatient blinatumomab infusions requires education and training of clinical staff and caregivers to quickly troubleshoot interruptions.