Clinical Team Members Research Articles

The impact of surge adaptations on hospitalist care teams during the COVID-19 pandemic utilizing a rapid qualitative analysis approach

BackgroundHospital systems have rapidly adapted to manage the influx of patients with COVID-19 and hospitalists, specialists in inpatient care, have been at the forefront of this response, rapidly adapting to serve the ever-changing needs of the community and hospital system. Institutional leaders, including clinical care team members and administrators, deployed many different strategies (i.e. adaptations) to manage the influx of patients. While many different strategies were utilized in hospitals across the United States, it is unclear how frontline care teams experienced these strategies and multifaceted changes. As these surge adaptations likely directly impact clinical care teams, we aimed to understand the perceptions and impact of these clinical care and staffing adaptations on hospitalists and care team members in order to optimize future surge plans.MethodsQualitative, semi-structured interviews and focus groups with hospitalist physicians, advanced practice providers (APPs), and hospital nursing and care management staff at a quaternary academic medical center. Interviews focused on the impact of COVID-19 surge practices on the following areas: (1) the experience of clinical care teams with the adaptations used to manage the surge (2) the perception and experience with the communication strategies utilized (3) the personal experience with the adaptations (i.e. how they impacted the individual) and (4) if participants had recommendations on strategies for future surges. We utilized rapid qualitative analysis methods to explore themes and subthemes.ResultsWe conducted five focus groups and 21 interviews. Three themes emerged from the work including (1) dynamic clinical experience with a lot of uncertainty, (2) the importance of visible leadership with a focus on sense-making, and (3) the significant emotional toll on care team members. Subthemes included sufficient workforce, role delineation and training, information sharing, the unique dichotomy between the need for flexibility and the need for structure, the importance of communication, and the emotional toll not only on the provider but their families. Several recommendations came from this work.ConclusionsCOVID-19 surge practices have had direct impact on hospitalists and care team members. Several tactics were identified to help mitigate the many negative effects of COVID-19 on frontline hospitalist providers and care teams.

An examination of the implementation of a patient navigation program to improve breast and cervical cancer screening rates of Chinese immigrant women: a qualitative study

BackgroundChinese Americans have lower breast and cervical cancer screening rates than the national average and experience multiple barriers to cancer care. Patient navigators have improved screening and follow-up rates for medically underserved populations, yet investigations of cancer navigation programs and their implementation among Chinese Americans are limited. To address this gap, we used the Consolidated Framework for Implementation Research (CFIR) to examine facilitators and barriers to implementing the Chicago-based Chinatown Patient Navigation Program (CPNP) for breast and cervical cancer screening, follow-up, and treatment.MethodsStakeholders from clinical care, supportive care services, and community organizations were invited to participate in qualitative interviews to illuminate implementation processes and stakeholder perspectives of facilitators and barriers to implementing the CPNP. Interviews were audio-recorded, transcribed, and deductively coded according to CFIR domains, including (1) intervention characteristics; (2) outer setting; (3) inner setting; and (4) the implementation process.ResultsWe interviewed a convenience sample of 16 stakeholders representing a range of roles in cancer care, including nurses, clinical team members, administrators, physicians, a community-based organization leader, and a CPNP navigator. Findings detail several facilitators to implementing the CPNP, including patient navigators that prepared Chinese-speaking patients for their clinic visits, interpretation services, highly accessible patient navigators, and high-quality flexible services. Barriers to program implementation included limited regular feedback provided to stakeholders regarding their program involvement. Also, early in the program’s implementation there was limited awareness of the CPNP navigators’ roles and responsibilities, insufficient office space for the navigators, and few Chinese language patient resource materials.ConclusionsThese findings provide valuable information on implementation of future patient navigation programs serving Chinese American and other limited-English speaking immigrant populations.

Factors influencing sustainability and scale-up of rural primary healthcare memory clinics: perspectives of clinic team members

BackgroundThe aging of rural populations contributes to growing numbers of people with dementia in rural areas. Despite the key role of primary healthcare in rural settings there is limited research on effective models for dementia care, or evidence on sustaining and scaling them. The purpose of this study was to identify factors influencing sustainability and scale-up of rural primary care based memory clinics from the perspective of healthcare providers involved in their design and delivery.MethodsParticipants were members of four interdisciplinary rural memory clinic teams in the Canadian province of Saskatchewan. A qualitative cross-sectional and retrospective study design was conducted. Data were collected via 6 focus groups (n = 40) and 16 workgroup meetings held with teams over 1 year post-implementation (n = 100). An inductive thematic analysis was used to identify themes.ResultsEleven themes were identified (five that influenced both sustainability and scale-up, three related to sustainability, and three related to scale-up), encompassing team, organizational, and intervention-based factors. Factors that influenced both sustainability and scale-up were positive outcomes for patients and families, access to well-developed clinic processes and tools, a confident clinic leader-champion, facilitation by local facilitators and the researchers, and organizational and leadership support. Study findings revealed the importance of particular factors in the rural context, including facilitation to support team activities, a proven ready-to-use model, continuity of team members, and mentoring.ConclusionsInterdisciplinary models of dementia care are feasible in rural settings if the right conditions and supports are maintained. Team-based factors were key to sustaining and scaling the innovation.

Neuro-Oncology Patients as Human Research Subjects: Ethical Considerations for Cognitive and Behavioral Testing for Research Purposes.

Simple SummaryPrevious publications have elaborated on the exposure of ethical issues surrounding the enrollment and neurological testing of brain cancer patients into clinical studies. Existing literature has been tailored to provide insight on how to overcome ethical challenges for clinical team members but not for the research component that runs in parallel. The aim of this paper is to highlight the obstacles that researchers encounter when obtaining informed consent and administering language, cognitive or behavioral tasks for the sole purpose of research. Researchers should be encouraged to practice their best judgment and effectively communicate the purpose of the study while emphasizing the voluntary participation of neurologically impaired cancer patients. The solutions proposed in this paper can serve as future reference and a guide on maintaining a transparent balance between research and clinical testing for both researchers and clinical team members in the neuro-oncology field.Language, cognition, and behavioral testing have become a fundamental component of standard clinical care for brain cancer patients. Many existing publications have identified and addressed potential ethical issues that are present in the biomedical setting mostly centering around the enrollment of vulnerable populations for therapeutic clinical trials. Well-established guides and publications have served as useful tools for clinicians; however, little has been published for researchers who share the same stage but administer tests and collect valuable data solely for non-therapeutic investigational purposes derived from voluntary patient participation. Obtaining informed consent and administering language, cognition, and behavioral tasks for the sole purpose of research involving cancer patients that exhibit motor speech difficulties and cognitive impairments has its own hardships. Researchers may encounter patients who experience emotional responses during tasks that challenge their existing impairments. Patients may have difficulty differentiating between clinical testing and research testing due to similarity of task design and their physician’s dual role as a principal investigator in the study. It is important for researchers to practice the proposed methods emphasized in this article to maintain the overall well-being of patients while simultaneously fulfilling the purpose of the study in a research setting.

Abstract PO-021: LGBTQ cancer care: Assessing the benefits and limitations of a novel cancer care coordination tool

Abstract Background: Lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals experience health disparities at disproportionate rates which drive reduced cancer screenings and late-stage cancer diagnoses. These disparities are the result of barriers to care including a lack of LGBTQ-competent providers, lack of health insurance, unstable housing, and avoidance of care due to medical trauma and concerns about abuse and mistreatment. Community health centers are critical for providing primary care to LGBTQ+ patients with cancer. Unfortunately, once a patient is diagnosed with cancer and referred to specialty care outside the health center, primary care services are often disrupted or even discontinued as a result of gaps in communication between primary and oncological care providers. The © 4R Oncology Model (Right Information and Right Care for the Right Patient at the Right Time) is a novel, patient-centric care coordination tool developed to facilitate cancer planning and serve as a longitudinal primary care checklist for patients and their care team. Our project aims to assess the benefits and limitations of the 4R as a component of care delivered to LGBTQ cancer survivors. Methods: In collaboration with Howard Brown Health, we conducted semi-structured interviews with clinical care team members (N=10) to assess the benefits and limitations of the 4R implementation as a component of care delivered to LGBTQ cancer survivors. A Rapid analysis process, a method used when a quick analysis is required to adopt changes to ongoing processes, will be utilized. Results: Clinical care team members indicate that a lack of adequate research on solutions to the disruption of primary care services caused by cancer care for LGBTQ cancer patients is a significant barrier for this patient population. Team members agree that the 4R is a necessary intervention for addressing primary care gaps caused by inadequate care coordination. Conclusions: The 4R shows promise as a solution for initiating and sustaining more continuous communication between primary care and cancer care delivery for LGBTQ cancer survivors. Future interviews with patients, caregivers, and community organization members will further elucidate the barriers and facilitators to cancer care coordination for this population and how iterations of the 4R can improve access to care and outcomes. Citation Format: Nihmotallahi Adebayo, Will Dunne, Toni Madorsky, Sankirtana Danner, Juan Rivera, Elena Molina, Abbey Ekong, Elizabeth Adetoro, Cassandra Osei, Julia Trosman, Christine Weldon, Melissa Simon. LGBTQ cancer care: Assessing the benefits and limitations of a novel cancer care coordination tool [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-021.

Perceptions of clinical pharmacy specialists' contributions in mental health clinical teams.

IntroductionMental health (MH) clinical pharmacy specialists (CPS) are increasingly functioning as integral providers in MH care teams. MH providers may delegate many medication management tasks to the CPS. As there is a shortage of primary care and specialist MH providers, CPS are increasingly being utilized in MH care clinics. We assess provider and CPS perceptions of the contributions of CPS to MH clinical teams in the Veterans Health Administration.MethodsWe examined the roles and functions of CPS in MH clinics through surveys (n = 374) and semistructured interviews (n = 16) with MH CPS and other members of MH clinical teams (psychiatrists, nurse practitioners, registered nurses, social workers) to gain insight into how CPS were integrated in these settings. We assessed perceptions of CPS contributions to MH teams, interactions between CPS and other providers, and challenges of integrating CPS into MH clinical teams.ResultsContributions of CPS in MH were received positively by clinical team members. Clinical pharmacy specialists providing comprehensive medication management were especially valuable in the management of clozapine. The knowledge and training of CPS reassured providers who frequently referred to them with questions about medication and medication therapy management. MH CPS were also perceived to be received well by patients.DiscussionThe integration of MH CPS into MH teams was well received by team members and patients alike. The MH CPS have become important members of the MH team and are widely viewed as being able to improve access, quality, and workflow.

Abstract IA-53: A multi-pronged approach to driving diversity in clinical trials: Bristol Myers Squibb & Bristol Myers Squibb Foundation efforts

Abstract Achieving diversity in clinical trials that reflects the epidemiology of the people and populations affected by diseases and conditions requires an integrated multi-pronged, multi-sector approach and one that is community-informed. This includes among other components community outreach and engagement, patient voice in study design, a culturally competent workforce of clinical trial investigators and team members who are committed to serving URM, and locating clinical trial sites in heavily diverse communities. Bristol Myers Squibb is taking steps and the Bristol Myers Squibb Foundation is making important philanthropic investments on these fronts to drive diversity in clinical trials. The presentation will provide an overview of these efforts, their specific interventions and lessons learned. Citation Format: Patricia M. Doykos. A multi-pronged approach to driving diversity in clinical trials: Bristol Myers Squibb & Bristol Myers Squibb Foundation efforts [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr IA-53.

Dementia-related continuing education for rural interprofessional primary health care in Saskatchewan, Canada: perceptions and needs of webinar participants.

Dementia-related continuing education opportunities are important for rural primary health care (PHC) professionals given scarce specialized resources. This report explores the initial perceptions and continuing education needs of rural interprofessional memory clinic team members and other PHC professionals related to a short series of dementia-related education webinars. Three webinars on separate topics were delivered over an 8-month period in 2020 in Saskatchewan, Canada. The research design involved analysis of webinar comments and post-webinar survey data. Sixty-eight individuals participated in at least one webinar, and 46 surveys were completed. Rural memory clinic team members accounted for a minority of webinar participants and a majority of survey respondents. Initial perceptions were positive, with webinar topics and interactivity identified as the most effective aspects. Continuing education needs were mainly aligned with professional roles; however, some overlap of interests occurred. Future webinars will further explore learning needs within an interprofessional environment.

Integrating the GSA KAER Toolkit Into Practical Training for Primary Care Clinics

Education is central to driving change in clinical practice. First, primary care providers and their clinic team members need to understand why detecting cognitive impairment is important, how it can be done efficiently, and what the next steps in referral and management are. To engage primary care clinics in this change process, we developed a continuing education intervention, based on the KAER Model, using a live video format. Four evidence-based, 45-minute training modules presented core knowledge skills, including how to have difficult conversations, which are essential to diagnosing cognitive impairment. To overcome the obstacles to doing so in primary care, our team relied on a deep understanding of busy primary care practice. With a combined 35 years of direct experience in primary care, our collaborative interdisciplinary team was able to use the KAER Model to develop a highly acceptable intervention for primary care.

Characterizing Patients and Themes of SARS-CoV-2 Vaccine Hesitancy in a New York City High-Risk Older Population

Background: Vaccines to prevent SARS-CoV-2 infection are deemed one of the most promising measures in controlling the devastating pandemic, yet there is significant vaccine hesitancy in some communities. Historic systemic health, discrimination, and structural inequities in specific racial and ethnic communities contribute to vaccine hesitancy with disproportionately negative impact. It is therefore critical to better understand vaccine hesitancy in this high-risk older population. The ALIGN (Acute Life Interventions, Goals, and Needs) program co-manages a panel of older patients with complex medical and psychosocial needs in an urban academic medical center. Methods: ALIGN enrolled or graduated Patients or designated healthcare proxies were contacted by telephone to discuss SARS-CoV-2 vaccine willingness and hesitancy using a standardized web-based survey. Qualitative data was categorized into themes and subgroups. Demographic data was collected by chart review. Results: Complete results are forthcoming and will include patient reported race and ethnicity baseline, vaccine hesitancy perceptions, with common overarching themes, and clinical team member debriefing. Iterative quality improvement actions taken based on elicited patient themes will also be included and assessed in telephone follow-up for changes in vaccine hesitancy. Conclusions: We are conducting a qualitative and quality improvement study characterizing vaccine perceptions and hesitancy in a high-risk older group with focus on racial and ethnic disparities in this population. This preliminary data informs healthcare providers of potential health literacy, cultural and language, and other potential barriers in order to help further understand how to optimize SARS-CoV-2 vaccine acceptance and delivery in a patient population with elevated risk.

The life rafts sailed; Now let's take stock and set the course ahead (Commentary)

The topics discussed in the article by Van Citters and colleagues [1] feel both totally familiar and shockingly foreign in equal part: on the one hand, the practicalities required for the rapid adaptation to telemedicine during the COVID-19 pandemic, likely similar to those encountered in many regions of the world. On the other hand, the impacts and considerations of a financial reimbursement system experienced directly by clinical team members and which, in some centres, adversely impacted service delivery.

Debriefing the Debriefings: Caring for Our Patients and Caring for Ourselves.

Debriefing the Debriefings: Caring for Our Patients and Caring for Ourselves.

Experience-based learning: how a crisis solution informed fundamental change in a clinical education curriculum.

Clinical education represents the most important formative period in undergraduate medical education. It is often criticised as haphazard and inefficient. Experience-based learning (ExBL) is a novel clinical education design that utilises practices of support, learner participation and real patient learning to enhance students' development of vital professional capabilities. We introduced ExBL to address the challenges of a 50% reduction in clinical placement time that arose during the COVID-19 pandemic. Final year medical students were assimilated into clinical teams as co-workers to facilitate learning through participation rather than observation. Placement education was supported by an integrated case-based learning and high-fidelity simulation program. Real patient learning in workplace contexts was supported by a network of clinician mentors. A qualitative evaluation revealed that granting students co-worker status strongly supported participatory learning and professional identity formation. Furthermore, the triangulation of placements with cognitive coaching and high-fidelity simulation greatly enhanced skills development and students' sense of readiness for practice. Utilisation of ExBL significantly enhanced the quality of informal learning on clinical placements despite the reduced clinical placement time. In addition, the integration of cognitive coaching with simulation opportunities meant students were better prepared for meaningful participation as members of clinical teams. The introduction of ExBL increased the workload of clinical teachers. Moreover, favouring learning through participatory experience reduced exposure to more traditional formal bedside teaching encounters. Despite these challenges, we have adopted an ExBL model created in a crisis as our core educational design for our final year clinical programme.

Abstract 13954: Family Caregivers’ Experience of Caring for Patients Implanted With Left Ventricular Assist Device: A Mixed-Method Study

Introduction: Informal caregivers of patients with left ventricular assist device (LVAD) juggle benefits and burdens of caregiving and experience uncertainty of LVAD trajectory. This study explored the experience of caring for patients with LVAD and factors leading to uncertainty among caregivers. Methods: This mixed-methods, descriptive study included online surveys and focus groups. Family caregivers (N=140) were recruited from Facebook communities for the online survey (demographic variables, patient factors, Uncertainty in Illness Scale, Medical Outcome Study Social Support Survey, and CAregiver Perceptions About Communication with clinical Team member measure) and a subset of these (N=20) were recruited for online focus groups. Data were summarized and quantitative / Qualitative data compared for convergence. Results: Caregivers averaged 54 years (SD=12), were female (89%) spouses (66%) who had been caregiving for less than 5 years (83%). The quantitative results regarding uncertainty and its associated variables: social support, perception of change after implant, and communications with health care providers were mirrored in the content of three of the categories that evolved from the qualitative analysis. Caregivers with lower social support reported high uncertainty in focus groups and had higher uncertainty scores. Those with higher social support reported lower uncertainty. Caregivers with higher uncertainty reported varying levels of communication with providers. Majority of caregivers reported life changed for the worse (increase burdens, lifestyle adjustments, patient care regime) after LVAD implantation regardless of their uncertainty levels. Conclusions: Caregivers' experiences varied as they adjusted to this complex life-transforming experience. Overall, the survey and focus group data were convergent. Caregivers with higher social support and better communication with health care providers may experience less uncertainty. This study underscores the need to enhance social support and communication with healthcare team to decrease uncertainty and improve the caregiver experience.

Rectal specimen self-collection for chlamydia and gonorrhea screening: a cross-sectional feasibility study at a community health center

BackgroundMen who have sex with men (MSM) are at increased risk for extra-genital sexually transmitted infections (STIs). Without extra-genital screening, many chlamydia and gonorrhea infections would be missed among MSM. Yet, many barriers exist to extra-genital testing, and, in particular, to rectal collection. Self-collection increases screening and detection of asymptomatic chlamydia and gonorrhea among at-risk MSM and transgender women. This feasibility study assessed use of rectal self-collection and its acceptance among patients and primary care providers (PCPs) at a large, general practice community health center. The primary objective of this project was to assess the feasibility of including rectal self-collection as part of an implementation study looking to embed an STI care program in a safety-net primary care setting that would shift routine screening tasks to non-provider clinical team members such as medical assistants and nurses.MethodsThree PCPs identified and offered rectal self-collection to their MSM and transgender female patients who were due for routine or risk-based STI screening. For those patients who elected to participate in the study, the PCP’s medical assistant (MA) reviewed the self-collection instructions with them as part of their routine preventive care duties, and patients collected their own sample. Patients and PCPs completed brief cross-sectional surveys assessing the self-collection process.ResultsOf 1191 patients with sexual orientation and gender identity (SOGI) data on file who were seen for a medical visit by one of the three PCPs, 87 (7.3%) identified as MSM or transgender female. Seventy-five were due for rectal screening, of whom 33 (44%) were offered and completed rectal self-collection. Survey results indicated that self-collection was acceptable to and preferred over clinician-collection by both PCPs and patients.ConclusionsThis study demonstrated that rectal self-collection is feasible as part of STI screening in a high-volume primary care setting, and can be administered as part of the clinical tasks that MAs routinely conduct. The overall acceptance by both PCPs and patients will allow the inclusion of rectal self-collection in an implementation study looking to increase STI screening at a large community health center by facilitating MA-led collection during medical provider visits and by establishing standalone nurse-led STI visits.

Advancing Personalized Care for Patients with Myeloproliferative Neoplasms (MPNs): Findings from a Phase 2 Scale-up Quality Initiative across Two Large U.S. Oncology Systems

BackgroundMyeloproliferative neoplasms (MPNs), a group of rare hematologic malignancies comprised of myelofibrosis, polycythemia vera and essential thrombocythemia, significantly impact the lives of patients with historically few effective treatment options. In this quality improvement (QI) initiative we assessed barriers to patient-centered MPN care in 2 large U.S. hospital systems.MethodsBetween 3/2021 and 5/2021, 24 hematology/oncology healthcare professionals (HCPs) from 2 large hospital systems completed surveys designed to characterize self-reported practice patterns, challenges, and barriers to collaborative MPN care. Additionally, 26 Black patients and 25 non-Black patients with MPNs completed surveys regarding their goals for treatment, barriers to care, and communication with providers. Findings from all surveys paired with patient chart data was presented to 18 HCPs from the systems in AF sessions to reflect on their own practice patterns and prioritize areas for improvement in MPN care. Participants developed team-based action plans to overcome identified challenges, including barriers in risk stratification, care coordination, and shared decision-making (SDM) for patients with MPNs. Surveys conducted before and after the small-group AF sessions evaluated changes in participants' knowledge and confidence in delivering collaborative, patient-centered MPN care.ResultsTeam-Based Surveys: HCPs identified difficulty managing their symptoms (35%) and difficulty choosing therapy that best meets their treatment preferences and goals (25%) as the most pressing challenges their patient's face in their MPN care. The most challenging issue encountered by HCPs in selecting therapies for patients with MPNs is identifying when patients are undergoing disease progression/transformation (48%). HCPs reported effects on quality of life (75%) and treatment effectiveness (65%) as the most important factors for treatment decision-making among patients with MPNs. Teams were underutilizing SDM to provide patient-centered care, citing not enough time to engage in SDM (55%) and patients' low health literacy (50%) as the largest barriers.Patient Surveys: In contrast to HCP responses, the biggest challenge faced in their MPN care reported by Black patients was lack of reliable transportation or long distance to and from my care center (46%) difficulty managing my symptoms (36%) for non-Black patients. Furthermore, Black patients with MPN identified cost of treatment (56%) and advice from loved ones (40%) as the top factors for treatment decision-making, whereas, non-Black patients cited how the treatment is taken (52%) and how well the treatment will control my symptoms (50%). All patients identified they wish they had more time to discuss goals and preferences for treatment (62% Black, 64% non-Black ) with their provider. Black patients reported their MPN care team could improve most in education about MPNs and treatment options (73%), while non-Black patients felt improvements in empathy throughout the emotional journey of managing my MPN (68%) would be most beneficial.Small-Group AF Sessions: Across the 2 oncology centers, teams participating in the AF sessions (Table 1) shared a self-reported caseload of 219 patients with MPNs per month. HCPs reported meaningful shifts in confidence in their ability to provide optimal, patient-centered care (Figure 1) and knowledge of treatment options for MPNs (Figure 2). The aspects of patient-centered care HCPs will routinely discuss in more detail with patients are patients' goal and preferences (81%), results of genetic testing (63%), and risks and benefits of treatment options (56%). To achieve these goals, 63% of HCPs committed to improve team skills in appropriate risk stratification and differentiation of therapy based on patient-centered factors followed by sharing action plans with additional clinical team members (56%).ConclusionsParticipation in this QI initiative resulted in increased confidence in hematology/oncology HCPs ability to deliver patient-centered MPN care and improve commitment to team-based collaboration. Remaining practice gaps and challenges can inform future QI programs.Study Sponsor StatementThe study reported in this abstract was funded by an independent educational grant from Incyte Corporation. The grantors had no role in the study design, execution, analysis, or reporting. [Display omitted] DisclosuresVerstovsek: CTI BioPharma: Research Funding; NS Pharma: Research Funding; Ital Pharma: Research Funding; Celgene: Consultancy, Research Funding; Roche: Research Funding; Protagonist Therapeutics: Research Funding; Promedior: Research Funding; PharmaEssentia: Research Funding; Gilead: Research Funding; Incyte Corporation: Consultancy, Research Funding; Genentech: Research Funding; Blueprint Medicines Corp: Research Funding; AstraZeneca: Research Funding; Novartis: Consultancy, Research Funding; Sierra Oncology: Consultancy, Research Funding; Constellation: Consultancy; Pragmatist: Consultancy. Mesa: Sierra Oncology: Consultancy, Research Funding; Gilead: Research Funding; Novartis: Consultancy; Celgene: Research Funding; Genentech: Research Funding; CTI: Research Funding; Abbvie: Research Funding; CTI: Research Funding; Incyte Corporation: Consultancy, Research Funding; Promedior: Research Funding; Samus: Research Funding; Constellation Pharmaceuticals: Consultancy, Research Funding; Pharma: Consultancy; AOP: Consultancy; La Jolla Pharma: Consultancy.

The Health Equity Impact Assessment: A Case Study in COVID-19 Visitor Policy.

The Health Equity Impact Assessment: A Case Study in COVID-19 Visitor Policy.

Identification of Wasted Blood Products at Staten Island University Hospital in 2020 and Institutional Efforts to Reduce Wastage

Abstract Introduction/Objective Blood products are precious resources obtained from donors who donate with the intention to help people. These blood products however do not always go to the patients, instead sometimes ending up in the waste. It is inevitable to have some degree of the wastage due to limited blood product shelf life, the inherent need to have stock on hand at all times, and the often unpredictable demand of these products. However, it is possible to minimize the wastage of blood products with careful management of inventories, proper documentation, and education1. In this study, we aim to identify the amount and cost of wasted blood products at Staten Island University Hospital in 2020, the reasons behind the wastage, and solutions to reduce the wastage. Methods/Case Report A retrospective statistical analysis of blood product waste data in 2020 was performed manually with Microsoft Excel. Wastage rate and average cost was calculated, the reasons behind the wastage were identified, and low cost interventions to reduce wastage were planned. Results (if a Case Study enter NA) Total number of the wasted blood product is 425 which represents 3.8% of the total inventory at a total cost of $ 97,309.46 which does not include the hours spend by the lab personnel for the wasted products. The most wasted blood component is fresh frozen plasma (FFP) (Table 1). Thawing the frozen blood products (FFP and cryoprecipitate) significantly shortens the shelf life and triggers a lot of wastage through expiration (Table 2). 32.5 % of the wasted products are wasted due to expiration on the shelf (Diagram 1). Other reasons for the wastage includes patient unreadiness, patient refusal, late return of unused products etc. (Graph 1). Conclusion Educating clinical and laboratory team members about the reasons for wasted blood products and strategies to reduce it might significantly reduce the wastage. Appropriate activation and immediate deactivation of massive transfusion protocol (MTP) would be one of the most important aspect of this education. Expired thawed blood product is the largest contributor to wastage, and MTP is the main reason for thawing. Preventing unnecessary MTP activation minimizes over-thawing and therefore minimizes the expiration and wastage. Documentation of the wasted blood product should be improved to better identify the reasons behind wastage.

Physical and information workflow mapping of vancomycin therapeutic drug management: A single site case study revealing potential gaps in the process.

Vancomycin is one of the most prescribed antibiotics in pediatric intensive care units (PICU) in US hospitals. However, a detailed understanding of workflow and information flow among various stakeholders regarding vancomycin treatment processes in clinical settings is lacking. We conducted direct observations and informant interviews to develop the mapping of key processes and information flow for vancomycin treatment, with an emphasis on therapeutic drug monitoring (TDM) dose adjustment decision-making. A health information technology (HIT) sociotechnical framework was used to identify EHR related safety concerns. A total of 27 vancomycin treatment activities were observed over a 60-h duration including infusion administration, infusion completion, trough concentration blood draw and therapeutic decision making processes. Workflow and information flow mappings revealed (1) deviations between the documented timestamp used for TDM decision making and the actual time the tasks executed and (2) the lack of information flow regarding infusion completion and interruption. Missing features, insufficient usability and lack of integration with workflow and communication in the EHR were deemed safety gaps that may affect the accuracy of therapeutic decisions. Our case study identified gaps in information flow among clinical team members via EHR in TDM processes to provide insights for the improvement of the EHR system for antibiotic treatment purposes. In particular, the potential harm of the missing, uncertain, and inaccurate documented TDM task times warrant further investigations.

Optimizing Radiation Oncology Consult Visits Using Patient Flow Analysis (PFA)

An efficient workflow in the oncology ambulatory care setting can improve patient experience and decrease provider burnout. The purpose of this study was to identify inefficiencies, develop an optimized workflow, and measure the resulting post-implementation impact in a high-volume radiation oncology department.We conducted an IRB-approved study in Gastrointestinal Radiation Oncology (GIRO) at a large academic cancer center. Patient Flow Analysis (PFA) was used to track 556 consults from check-in to check-out. Process maps were created and an improved clinical workflow was designed based on the findings. The specific roles and responsibilities of each clinical team member were defined and clearly communicated. Timepoints were collected using the electronic medical record (EPIC) status board, which was updated by clinical staff. Pre- vs. post-implementation metrics, including total clinic cycle times, waiting times, rooming times, and time spent with each clinical team member were compared.Initial PFA led to recommendations targeting four principal inefficiencies: (1) protracted patient rooming, (2) delays due to inefficient communication, (3) duplicated tasks, and (4) ambiguous clinical roles. There were 485 pre- and 71 post-implementation consults available for analysis. The optimized workflow resulted in reduction in overall median cycle times by 21% (91 vs. 72 min; P < 0.001). Consults > 2 hours in duration occurred in 22% of pre-implementation vs. 0% of post-implementation visits (P < 0.001). Similarly, the proportion of visits requiring < 1 hour was 16% pre- vs. 34% post-implementation (P < 0.001). Patients spent significantly less time in the waiting room (14 vs. 5 min; P < 0.001) despite no significant differences in the proportion of patients arriving early, on-time, or late. Overall, wait times at each step in the visit process were reduced by 55-70% (Table 1).PFA can be used to identify clinical inefficiencies and optimize workflows in radiation oncology. Utilizing this patient-centric model reduced waiting times and total consult duration, which may improve patient satisfaction, decrease staff burnout, and provide a framework for financial savings through innovative staffing models. Efforts are currently underway to expand this process across all sections within our department.