Continuity Of Care For Patients Research Articles

Healthcare data recovery through cloud-based solutions in Ghana: A path forward for developing countries

In the digital age, ensuring effective healthcare data recovery is essential for maintaining patient care continuity and healthcare operations. This study explores the implementation of cloud-based solutions for data recovery in Ghana's healthcare sector, assessing current practices, adoption levels, and associated challenges. A cross-sectional design was used, sampling 300 healthcare IT professionals, administrators, and government officials across five regions. Data were collected via questionnaires and analyzed using descriptive and inferential statistics. Results revealed that 60% of healthcare institutions had adopted cloud-based solutions, with Greater Accra (81.25%) and Ashanti (71.43%) regions showing the highest adoption rates. Teaching hospitals reported a higher adoption (88.89%) compared to district health facilities (47.62%). Participants rated the effectiveness of cloud-based solutions highly, with 41.7% considering them "highly effective." However, key challenges included inadequate infrastructure (55%), lack of trained personnel (40%), and data security concerns (30%). In conclusion, cloud-based solutions are increasingly adopted in Ghana's healthcare sector, offering significant benefits like improved data accessibility (75%) and enhanced security (60%). However, infrastructure and capacity-building efforts are needed to optimize these systems.

AHP SO08 - Weekend physiotherapy pilot for patients on hepatobiliary enhanced recovery pathways: Examining the impact of a 7-day service

Abstract Background Enhanced recovery after surgery (ERAS) is a safe, multi-disciplinary, evidenced-based approach to optimise the perioperative management and outcomes after hepatobiliary (HPB) surgery. Despite the adoption of the ERAS mobilisation protocols to improve recovery time, one limitation is a traditional 5-day service model (Monday-Friday). This can result in an inequality of service provision for those patients operated Thursday or Friday and lead to increased length of stay (LOS) in hospital. Mobilisation across 7 days can ensure improved compliance with ERAS mobilisation protocols, better continuity of care, facilitate improved outcomes and timely discharge from hospital. Method Data was collected pre-introduction of the 7-day physiotherapy service from May-October 2022. During November 2022 – April 2023 a 7-day physiotherapy service was piloted. This service included 1 qualified physiotherapist and 1 non-qualified physiotherapist on Saturday and Sunday. This 7-day service provided continuity of care for patients from intensive care or post-anaesthesia care unit to the ward, facilitating discharges and accelerating return to independence. Data was collected during the 7-day service as well as 6 months post intervention (May 2023-October 2023). Acceptability of the intervention was assessed among the HPB multi-disciplinary team (MDT) using a survey consisting of 5 qualitative questions. Results The table illustrates that a reduction in mean LOS was seen in all 4 HPB surgeries that follow ERAS protocols during the 7-day physiotherapy service. It was also shown that 6-months post intervention (returning to a 5-day service) all 4 HPB ERAS surgeries mean LOS increased. To determine the acceptability of the 7-day physiotherapy service, 22 members of the MDT responded to a survey (5 consultants, 4 physiotherapy staff, 4 sisters, 5 staff nurses, 1 nursing assistant, 2 healthcare assistants). All 22 members of the MDT agreed that a 7-day physiotherapy service was acceptable and improves recovery. Conclusion A 7-day physiotherapy service has shown to reduce mean LOS in comparison to a 5-day physiotherapy service within HPB ERAS pathways. From an MDT perspective the 7-day physiotherapy service was also deemed to be beneficial and improves patient recovery.

Characterizing and Evaluating the Structures of Combined Pediatrics and Medical Genetics and Genomics Residency Programs.

There is limited information on rationale for the current training structure within combined Pediatrics-Medical Genetics and Genomics Residency (MGG) residency programs. This study addresses the benefits and drawbacks of different training structures. Program Directors (PDs) and Associate PDs of combined Pediatrics-MGG residency programs were surveyed to evaluate perceived benefits of different structures and the relative importance of particular pediatric rotations for combined training. Programs varied in terms of how many times a typical resident transitioned between Pediatrics and MGG during training (range 4 to > 9). PDs varied in their opinions of which training structure would be most ideal for training a future Clinical Geneticist within a combined Pediatrics-MGG program. However, the majority of PDs indicated that consecutive training (completing two years of Pediatrics, followed by MGG) would support particular aims of training including continuity of patient care and research productivity. The top six out of twenty pediatric rotations that were ranked as most important in order of importance were neonatal intensive care, development and behavior pediatrics, term newborn, pediatric intensive care, neurology, and inpatient pediatric wards. Particular structures may facilitate distinct aims within training; however, there was not widespread consensus on which program structure would be best. Specific pediatric rotations were highlighted as very important, which could influence future curriculum development.

Abstract 4126893: Feasibility and Acceptability of a Nurse-Pharmacist Post-Discharge Telehealth Model of Care for Heart Failure Patients

Background: Suboptimal medication management is common in patients with heart failure (HF), particularly during transitions-of-care. To date, there are few studies assessing the feasibility of a nurse-pharmacist post-discharge telehealth service for medication optimisation in patients with HF. We performed a feasibility study to determine service uptake and acceptability, and ability to identify medication-related issues for HF patients as they transition from hospital to home. Methods: HF patients were referred to an existing post-discharge telehealth service and offered medication reconciliation and education in addition to their usual care; a service we termed ‘MedRec’ (MR). Primary outcomes were feasibility, measured through recruitment and successful MR completion, and acceptability, measured by an investigator-developed survey. Secondary outcomes were medication-related issues detected during MR. Results: A total of 100 HF patients were offered a post-discharge MR. Mean age of patients was 68.5 ±14.2 years, and mostly male sex (62%). Pharmacist MRs were requested by 80% of patients. In total 62 MRs (77.5%) were performed; 9 patients declined MR during follow-up and an additional 9 patients were uncontactable. Mean time to MR following nurse referral was 10.98 ±9.74 days. Drug-related toxicity or adverse effect presentation was identified in 25 (40.3%) MR recipients at the time of consultation and subsequently required general practitioner follow-up. Medication compliance issues were detected by the pharmacist in 13 (20.9%) patients; forgotten doses being the most common concern. Undertreated medical conditions, such as symptomatic HF and chronic pain, were identified in 12 (19.3%) MR recipients. Medications prescribed without any apparent indication were found in 8 (12.9%) patients. Drug or disease management information was requested by 35 (56.4%) MR recipients. A total of 35 (56.5%) post-MR surveys were successfully completed. All participants who completed a post-MR survey agreed that a post-discharge telehealth MR was an acceptable form of education provision. Engagement with a pharmacist MR was perceived to ease anxiety associated with understanding medication-related changes and empowered greater medication self-management. Conclusions: A post-discharge nurse-pharmacist telehealth service is a feasible and acceptable model of care. Inclusion of a routine MR post-discharge may be an effective means of maintaining continuity of care for HF patients.

The Collaborative Pulse of Healthcare: a critical analysis of Nursing’s Role in a Holistic Approach to Patient Care Across Medical Specialties

This critical analysis explores nursing's pivotal role in fostering a holistic approach to patient care within multidisciplinary healthcare teams. As healthcare becomes increasingly complex, the integration of collaborative practices across specialties is essential for delivering comprehensive and patient-centered care. Nurses, often serving as the main touchpoint for patients, play a crucial role in coordinating care, advocating for patient needs, and bridging communication among healthcare professionals. This study examines the specific contributions of nurses, identifies challenges in inter-professional collaboration, and highlights enablers that support effective teamwork. Findings suggest that nursing collaboration positively impacts patient outcomes, satisfaction, and care continuity, though challenges such as communication barriers and hierarchical structures remain. By enhancing support for collaborative nursing roles, healthcare institutions can achieve improved quality of care and greater efficiency. Recommendations include promoting interdisciplinary training, clarifying team roles, and implementing policy reforms to empower the nursing workforce in holistic patient care.

Evaluate the Differential Effectiveness of the Case Management and Primary Nursing Models in the Implementation of Discharge Planning.

This study aims to compare the effectiveness of the case management model and the primary nursing care model by focusing on hospital stay length, readmission, follow-up resource utilisation and survival. To improve patient continuity of care, a discharge planning team has been established at the hospital to implement the service concept of long-term medical care. The team works with a multidisciplinary medical team to provide case management, which ensures high-quality patient care. Retrospective case-control study. This study collected data from the medical record information system database and the Ministry of Health and Welfare's care service management information system to explore medical and follow-up care utilisation of patients discharged between 2017 and 2018. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines, with the checklist used to ensure transparent and complete reporting of the methodology and results. To ensure comparability between the case management model group and the primary nursing model group, propensity score matching was used. After matching, 660 individuals from the case management model group and 2876 individuals from the primary nursing model group were selected for further analysis. In this study, patients were primarily involved in the research as participants, providing data through their medical records for analysis. However, no direct involvement from the public or patients was used in the planning or design stages of the research. The study found that factors such as activities of daily living (ADL) score ≤ 60 points, catheterisation, poor chronic disease control and inadequate primary caregiver capacity can lead to longer hospitalisations. Males and patients with catheters have a higher risk of readmission within 30 days, and men, those aged ≥ 75 years, those with ADL score ≤ 60, catheterisation, pressure sores or unclean wounds, financial problems, insufficient primary caregiver capacity and those readmitted within 14 days after discharge had significantly increased mortality after discharge. Although the case management model group had higher hospitalisation days, they had lower readmission rates and higher survival rates than the primary nursing model group. Early consultation with the case manager for discharge planning can help patients to continue to receive care and utilise relevant resources after returning home. Identifying and addressing patient-specific factors can significantly improve patient outcomes by reducing hospitalizations and readmissions, and lowering mortality rates. The case management model is more effective than the primary nursing care model in reducing readmission rates and increasing survival rates. Early consultation with case managers for discharge planning is crucial to ensuring patient care continuity and resource utilization.

Moving towards the use of artificial intelligence in pain management.

While the development of artificial intelligence (AI) technologies in medicine has been significant, their application to acute and chronic pain management has not been well characterized. This systematic review aims to provide an overview of the current state of AI in acute and chronic pain management. This review was registered with PROSPERO (ID# CRD42022307017), the international registry for systematic reviews. The search strategy was prepared by a librarian and run in four electronic databases (Embase, Medline, Central, and Web of Science). Collected articles were screened by two reviewers. Included studies described the use of AI for acute and chronic pain management. From the 17,601 records identified in the initial search, 197 were included in this review. Identified applications of AI were described for treatment planning as well as treatment delivery. Described uses include prediction of pain, forecasting of individualized responses to treatment, treatment regimen tailoring, image-guidance for procedural interventions and self-management tools. Multiple domains of AI were used including machine learning, computer vision, fuzzy logic, natural language processing and expert systems. There is growing literature regarding applications of AI for pain management, and their clinical use holds potential for improving patient outcomes. However, multiple barriers to their clinical integration remain including lack validation of such applications in diverse patient populations, missing infrastructure to support these tools and limited provider understanding of AI. This review characterizes current applications of AI for pain management and discusses barriers to their clinical integration. Our findings support continuing efforts directed towards establishing comprehensive systems that integrate AI throughout the patient care continuum.

Managing no-shows in healthcare: insights from an urban Health District in Northern Italy

Abstract Background Non-attendance at healthcare appointments, known as no-show, poses significant challenges to healthcare systems, disrupting patient care continuity, exacerbating waiting times, and straining resources. Addressing this issue is crucial for optimizing health care delivery and containing costs. This study explores the phenomenon of patient no-shows and aims to identify factors associated in a densely populated healthcare district in Turin, Northern Italy. Methods Data were extracted from the healthcare management system covering outpatient care appointments in the health district in 2022 and 2023. The analysis included various patient and service-related variables. Missing information on key variables were managed with listwise deletion. Descriptive statistics provided an overview of missed appointment rates, while multivariate analysis explored various patient and service-related variables. Results A 5.1% (n = 6198) no-show rate was observed out of 120,405 records. The total cost incurred due to missed appointment fees amounted to €127,244. Several factors were associated with a significantly increased likelihood of no-show (p < 0.05), including initial visit (OR = 1.11), deferred priority (OR = 1.22), non-exempt status from healthcare co-payments (OR = 1.36), exemption based on income (OR = 1.82), age under 18 (OR = 2.46) and under 65 (OR = 2.32), male gender (OR = 1.17), residency outside the Piedmont Region (OR = 1.31) and outside Italy (OR = 2.46), and longer waiting time (OR = 1.01). Conclusions This study sheds light on the widespread issue of patient no-shows and its economic implications. It provides clear direction for implementing tailored interventions in healthcare settings. As a response to these findings, a telephone recall project was launched. Its efficacy will be evaluated in subsequent assessments to determine if it can effectively alleviate the burden of no-shows, thus enhancing healthcare efficiency and ensuring continuity of care for patients. Key messages • The no-show phenomenon has important implications both organizationally and economically. • The magnitude and major determinants of patient no-shows must be recognized to guide the deployment of tailored interventions in a real-world setting.

Association between the number of individuals injured in a traumatic event and posttraumatic stress disorder among hospitalized trauma patients.

Posttraumatic stress disorder (PTSD) often occurs following mass casualty events, yet the connection between the number of individuals injured in an event and PTSD risk in smaller-scale events (i.e., involving one or several injured persons)remains unclear. We conducted a registries-based study cross-referencing three databases across the continuum of care for military trauma patients hospitalized for traumatic injuries. The study population was categorized into three groups based on the number of injured individuals involved (i.e., single injured person, two to four [2-4] injured people, and five or more [≥ 5] injured people), and PTSD prevalence was assessed using long-term disability claim diagnoses. Overall, 4,030 military personnel were included (age at injury: Mdn = 20 years), and 18.3% were subsequently diagnosed with PTSD, with the highest prevalence in events involving ≥ 5 injured individuals (35.8%). Regression analyses adjusted for potential confounders revealed that being injured in an event with 2-4 injured persons, OR = 1.68, 95% CI [1.31, 2.15], or ≥ 5 injured persons, OR = 2.36, 95% CI [1.79, 3.13], was associated with increased odds of developing PTSD compared to being the sole injured person. The findings suggest a direct association between the number of injured individuals in an event and PTSD prevalence among traumatic injury survivors. The results underscore the importance of early diagnosis and interventions to prevent PTSD in individuals injured in multicasualty and mass casualty events.

24 Community provider perspectives on an autism learning health network: A qualitative study

Abstract Background Although autism is highly prevalent, no single care centre has a sufficient number of patients to produce generalizable knowledge; this slows the pace of quality improvement research. Learning health networks (LHNs) offer a promising solution to improve the quality and efficiency of healthcare by integrating clinical and research data. The Autism Care Network (ACNet) is an LHN composed of 20 clinics across the United States and Canada dedicated to developing the most effective approach to care for children with autism. In Canada, the majority of autistic patients receive a majority of their ongoing care in the community. Therefore, to make meaningful improvements in the continuum of care for patients and their families, it is essential that the ACNet be extended to include community physicians. Objectives The primary objectives were to (1) understand the current data collection practices, learning needs, clinic capacity, areas of improvement, and overall interest of community physicians in participating in a LHN and (2) identify community physicians’ perspectives on the benefits and disadvantages of participating in a LHN and ways in which their engagement in a LHN can be supported. Design/Methods In-depth semi-structured interviews were conducted participants who were purposively sampled from community providers who had previously participated in autism-focused educational programming. The interview guide was developed by the three ACNet sites based on experience with LHNs and working with community physicians. Data were analyzed using an interpretative phenomenological analysis approach with a social constructivist paradigm. Results Analysis of 29 interviews identified 5 primary themes: (1) “Navigating Administrative Challenges,” which highlighted the lack of time, resources, and administrative capacity in the community; (2) “Improving Data Collection Practices”, which emphasized the barriers to consistently collecting information from patients and families; (3) “Increasing Provider Confidence and Competence,” which explored the challenges of navigating the everchanging landscape of community autism care; (4) “Breaking Down Silos”, which focused on fragmented care and the lack of communication between allied health resources, diagnostic hubs, and community physicians; and (5) “Systemic and Societal Barriers to Achieving Best Practices,” which explored the systemic barriers that impact autism care for physicians and families. Conclusion This study provides an understanding of the experiences of community physicians regarding the challenges of community-based autism care. LHNs have the potential to address several of the issues highlighted by community physicians in autism care. Additionally, LHNs can play an important role in improving community care in fields beyond autism.

Challenges faced by internally displaced diabetes patients in managing their health during a conflict: a qualitative study

BackgroundThis study examines the experiences of diabetic patients who were displaced during the Israel–Hamas conflict, highlighting the substantial challenges they face in managing their health under these circumstances.MethodsA qualitative-phenomenological approach was employed, focusing on the experiences of 14 individuals with diabetes who were displaced during the conflict. Data were collected through semi-structured interviews and subsequently subjected to content analysis.ResultsThree central themes emerged: (1) “I left without clothes and medications”: Participants described the chaotic evacuation process and the difficulty in maintaining diabetes care without their supplies. (2) “Dual coping”: Participants struggled with managing their diabetes while adapting to new, temporary living conditions that disrupted their care routines. (3) Seeking inner resilience while drawing strength from external support: This theme reflected the importance of internal resilience and support from family, friends, and healthcare professionals in coping with health management and displacement challenges.ConclusionsThe study underscores the significant challenges diabetes patients face during conflict evacuation, including disruptions in their routine care, heightened psychological stress, and the essential role of support systems. These findings underscore the need for emergency preparedness plans to ensure continuity of care for patients with chronic conditions during crises.

Strategy for scheduled downtime of hospital information system utilizing third-party applications

BackgroundThe widespread adoption of Hospital Information Systems (HIS) has brought significant benefits in healthcare quality and workflow efficiency. However, downtimes for system maintenance are inevitable and pose a considerable challenge to continuous patient care. Existing strategies, including manual prescription methods, are no longer effective due to increasing reliance on digital systems.MethodThis study implemented two main strategies to mitigate the impact of scheduled downtimes. First, we created an “Emergency query program” that switches to a read-only backup server during downtimes, allowing clinicians to view essential patient data. Second, an “Emergency prescription system” was developed based on the Microsoft Power Platform and integrated into Microsoft Teams. This allows clinicians to perform digital prescriptions even during downtimes.ResultsDuring a planned 90-minute downtime, 282 users accessed the Emergency Prescription System, resulting in 22 prescriptions from various departments. Average times for prescription confirmation and completion were 8 min and 3 s, and 18 min and 40 s, respectively. A post-downtime evaluation revealed high user satisfaction.ConclusionEssential maintenance-induced HIS downtimes are inherently disruptive to patient care process. Our deployment of an emergency query program and a Microsoft Teams-integrated emergency prescription system demonstrated robust care continuity during HIS downtime.

Empowering Wellness: A Comprehensive Narrative Review of Cancer Prehabilitation from Treatment Onset to Surveillance.

Cancer prehabilitation, defined as a process occurring between cancer diagnosis and the onset of acute treatment, is highlighted for its ability to enhance physical and mental health results while decreasing overall healthcare costs. This summary introduces the concept of cancer prehabilitation and emphasises the crucial role of oncology nurses in rehabilitation care. The cancer treatment plan of prehabilitation requires timely and efficient assessment across the care continuum, focusing on enhancing outcomes at every stage of cancer. The battle with cancer involves three different assessments with distinct goals: i) prehabilitation evaluation before treatment, ii) early post-treatment evaluations of rehabilitation and iii) final evaluations of health promotion. Analyses and treatments for significant side effects or complications associated with the treatment specifically for prehabilitation are recommended. The roles of coordination, counseling, preparing for discharge and teaching are outlined as integral components of a cancer nurse's responsibilities in the prevention of cancer. A literature search from March 2016 to June 2023 was conducted using the keywords 'neoplasms,' 'cancer,' 'prehabilitation,' 'continuum of care,' 'care continuum,' 'patient care continuity,' 'epidemiology,' 'therapeutics,' 'health,' 'prevention and control' and 'guidelines as topic.' The findings suggest that care coordinators or navigators for cancer should be educated to assess the physical and psychological status of patients once a cancer diagnosis is confirmed, particularly for those awaiting surgery at home. To enhance their competence in prehabilitation care, oncology nurses are encouraged to gain knowledge of certain tumours' outcomes and cancer-related treatments. Additionally, improving the ability to evaluate patients' functional status and emotional distress is crucial for oncology nurses involved in cancer prehabilitation.

Requesting Relatives' Consent for Intensive Care for Organ Donation: An Empirical Analysis of Spanish Transplant Coordinators' Practices.

Intensive care to facilitate organ donation (ICOD) involves the initiation or continuation of intensive care for patients with devastating brain injury for donation purposes. In the Spanish system, relatives undergo an early interview to request consent for this procedure. If they consent, a waiting time is agreed upon in the expectation that death by neurological criteria occurs and donation after brain death takes place. Otherwise, relatives can decide on donation after circulatory determination of death or withdrawal of life support. This study analyzes how Spanish transplant coordinators interact with relatives in early interviews and follow-ups on potential donation pathways. Semistructured interviews were conducted with a random stratified sample of 23 Spanish transplant coordination teams to explore strategies, practices, and perceptions of ICOD consent requests. The interviews were recorded, transcribed, and analyzed using content analysis. Previous coordination with other units and information retrieval regarding patient and relatives' situations is crucial. The development of early interviews includes an introduction to the family, identification of decision makers, empathizing with relatives and offering condolences, reaffirming the fatal prognosis, explaining the possibility of donating based on the patient's will, confirming the family's understanding and resolving doubts, and ensuring comfort and assessing family needs. Approaching families to obtain ICOD consent is a regular practice for Spanish coordination teams. It involves a highly professional and diversified set of strategies based on establishing a support relationship for relatives. Our study provides strategies that serve as a reference for obtaining ICOD consent from families in other settings.

The Future of Wearable Health Technology: Advancing Continuous Patient Care through Data Management

The Future of Wearable Health Technology: Advancing Continuous Patient Care through Data Management

Exploring the lack of continuity of care in older cancer patients under China's 'integrated health system' reform.

Continuity of care is essential to older patients' health outcomes, especially for those with complex needs. It is a key function of primary healthcare. Despite China's policy efforts to promote continuity of care and an integrated healthcare system, primary healthcare centres (PHCs) are generally very underused. To explore the experience and perception of continuity of care in older cancer patients, and to examine how PHCs play a role in the continuity of care within the healthcare system in China. A qualitative study using semi-structured interviews was conducted in two tertiary hospitals in Nantong city, Jiangsu province, China. A combination of deductive and inductive analysis was conducted thematically. Interviews with 29 patients highlighted three key themes: no guidance for patients in connecting with different levels of doctors, unmet patients' needs under specialist-led follow-up care, and poor coordination and communication across healthcare levels. This study clearly illustrated patients' lack of personal awareness and experience of care continuity, a key issue despite China's drive for an integrated healthcare system. The need for continuity of care at each stage of cancer care is largely unmeasured in the current healthcare system for older patients. PHCs offer benefits which include convenience, less burdened doctors with more time, and lower out-of-pocket payment compared to tertiary hospitals, especially for patients with long-term healthcare needs. However, addressing barriers such as the absence of integrated medical records and unclear roles of PHCs are needed to improve the crucial role of PHCs in continuity of care.

Streamlining documentation in patient electronic medical records: An example of chlamydia consultation shortcuts.

Australian general practitioners encounter a vast array of health issues in their clinical practice. High-quality clinical record keeping is crucial to support continuity of care for patients and decision making for clinicians. Many clinical software programs used in general practice contain shortcut features that allow insertion of pre-stored, editable text into progress notes. These can be used to support documentation of specific health issues. Drawing on our experience within a research project seeking to strengthen chlamydia management in general practice, this article describes the co-design, implementation and use of documentation shortcuts for chlamydia management. Shortcuts are useful as a memory prompt and timesaver for general practice clinicians. It is important that they do not replace clinical acumen and judgement. General practices using our chlamydia management shortcuts found them easy to set up, that they acted as a prompt for best practice chlamydia management and that they integrated well with the general practice workflow.

Getting mammograms shouldn’t be so bumpy: Improving mammogram workflow in VA community care.

345 Background: The interplay between VA-based care and Community Care (CC) has long been important for continuity of patient care, though transitioning care between the two is often fraught with problems. Mammograms ordered at VA San Diego (VASD) are often deferred to Community Care; while this process should be smooth and seamless, it is instead challenging to navigate, with inconsistent rates of completion and results often not relayed to patients leading to delayed/missed diagnoses. We applied extensive QI methodology towards overhauling the VASD Community Care Mammogram workflow to improve rates of CC mammogram completion and results released to patients in a timely manner. Methods: We evaluated the CC mammogram workflow and implemented interventions at VASD from 01/2022-04/2023. An A3 was used for tracking process improvement. Using Lean Six Sigma process improvement strategies, we identified several problematic areas within the CC Mammogram workflow that are prone to errors and can lead to patient safety issues. Weekly meetings/interviews were set up to identify pain points with the primary users to allow for continuous process evaluation and improvement. Primary outcome was the frequency with which a CC mammogram order had mammogram completed and result released to patient within the expected timeframe by VISN 22 metrics (BIRADS 0,3,4,5,6 <7 days and BIRADS 1,2 <14 days to notification). Results: Process mapping of the VASD CC mammogram process revealed significant waste and failure modes. Notably among these was the splintered tracking systems used across multiple users and lack of automated follow-up reminders. Multiple PDSAs involved standardizing workflow by developing an SOP that focused on standardization of tracking orders/results, creating automated task reminders, while also adding backup systems and double-checks. To centralize and standardize the patient tracking process, we repurposed the Coordinated Care Tracking System (CCTS), a VA-based tool that is used for tracking patients in other departments and creating reminders for follow up, while storing patient data in a centralized location. We also redesigned and streamlined the mammogram ordering menu within CPRS. Implementation of the above interventions increased monthly rates of mammograms completed and reported to patients in a timely manner from a median of 67.5% to 100% in all BIRADS groups by 10/2022, and sustained at 100% through 04/2023. Conclusions: Standardization of workflow and incorporation of CCTS software into the CC Mammogram process led to an appreciable improvement in rates of CC mammogram scheduling and timely result notifications. Improved tracking of CC mammogram patients has the potential to prevent unnecessary patient harm. It is worth considering whether CCTS and a similar standardized process should be incorporated into other CC programs, as these issues are not unique to VASD mammograms.

The work environment and hospitalist work well-being and burnout.

Hospital medicine is the largest growing specialty in the United States. It is important to understand factors that are related to burnout and work well-being (WWB), both predictors of workforce retention. To examine the relationship between work environment factors and hospitalist burnout and WWB. An online cross-sectional survey was completed by hospitalists in July-October 2020. Burnout was assessed using the Mini-Z burnout scale and the Abbreviated Maslach Burnout Inventory. WWB was assessed using the Work Well-Being Scale. Work structure variables included hours worked per week, frustration at work, safety level of clinical workload, lack of control over schedule, lack of control over daily work, continuity of patient care, and ability to optimize license. The current desire to practice medicine was also examined. Eight-eight hospitalists participated. There were statistically significant differences between levels of safety of workload (F(2,85) = 9.70, p = <.005), frustration at work (F(2,85) = 12.29, p = <.005), control over schedule (F(2,85) = 3.17, p = .04), control over daily work (F(2,85) = 6.17, p = .003), and desire to practice medicine (F(2,85) = 42.34, p = <.005) with WWB. There were statistically significant associations between the presence of burnout and the safety of workload (χ2 = 8.167, p = .017), frustration at work (χ2 = 15.29, p = .005), control over daily work (χ2 = 12.48, p = .002), and desire to practice medicine (χ2 = 7.12, p = .03). WWB was positively associated with years as a hospitalist (r = .249, p = .02)). Work environment factors are associated with WWB and burnout. Modifiable work environment factors may offer a point of intervention for reducing burnout and enhancing WWB among hospitalists.

Establishment of Registered Advanced Nurse Practitioners (RANP) Gerontology Clinics in Two Ambulatory Day Units

Abstract Background Ireland is experiencing substantial growth in the older population. Data from The Irish Longitudinal Study on Ageing (TILDA) suggests that up to 25% of older people in Ireland are living with frailty while a further 45% are at risk of being pre-frail (Roe L et al, 2017). Frailty in older adults can be a predictor to adverse health outcomes including hospitalization, falls, and increased mortality risk. Ambulatory day units proactively identify older adults at risk of frailty living in the community using a comprehensive geriatric assessment (CGA), potentially reducing adverse outcomes. Methods Plan-Do- Study-Act (PDSA) cycle was used. Waiting lists were reviewed with Consultant Geriatricians for the ambulatory units. Referral pathways for RANP Gerontology Clinics with inclusion and exclusion criteria were developed. RANP clinics were established in 2023 in the ambulatory day units utilising Slaíntecare’s strategy. Referrals were triaged by Consultants Geriatricians resulting in the RANP clinic caseload. Results During 2023, 844 older adults were reviewed in the RANP clinics. This contributed to a reduction in Consultant Geriatricians’ waiting lists and allowed reduced wait times for new Consultant Geriatricians’ referrals. This service also enhanced communication pathways between primary and secondary care settings and became a point of contact for families in crisis, with rapid access review and care planning to avoid unnecessary Emergency Department attendances. Patients attending the RANP clinics, if admitted to hospital, were seen by the RANP during their admission, ensuring continuity of care. Conclusion Overall, establishment of RANP Gerontology clinics resulted in a better streamlined service for the older adult. This service ensures continuity of patient care through a working knowledge of patient cohort and rapid access for those known to the service, potentially avoiding an Emergency Department attendance.