Deliver Patient Care Research Articles

Redefining the ICP Experience through Online Learning

The Integrated Case Presentation (ICP) provides an introduction to the clinical experience and the importance of evidence-based science to the practice of dentistry. The ICP is part of the Comprehensive Care course at NYU College of Dentistry. The collaboration between the D4 and D3 students in presenting a patient to their peers allows them to form collegial relationships and facilitates a team-based learning philosophy. On entering the clinic, dental students can feel anxious about the responsibility they will have delivering patient care. The ICP allows the D3 novice to be exposed to clinical cases and to establish a relationship with the D4 student, who will then mentor, support, and guide them. The Integrated Case Presentation enhances the students' professional growth by emphasizing the dentist's role as a primary health care provider and a member of the health care team. The initial challenge of presenting the ICP seminars via Zoom has successfully been overcome and accepted by students and faculty.

It's time to 'Build Back Fairer': what can we do to reduce health inequalities in cardiology?

Disparities in cardiovascular morbidity and mortality are among the leading health and social care concerns in the UK. The disruption of the COVID-19 pandemic to health services has further placed cardiovascular care and the respective patient communities at the sharp end, not least in exacerbating existing health inequalities across service interfaces and patients' health outcomes. While the pandemic engenders unprecedented constraints within established cardiology services, it conduces to a unique opportunity to embrace novel transformative approaches within the way we deliver patient care in maintaining best practices during and beyond the crisis. As the first step in navigating toward the 'new norm', a clear recognition of the challenges inherent in cardiovascular health inequalities is critical, primarily in preventing the widening of extant inequalities as cardiology workforces continue to build back fairer. We may consider the challenges through the lens of health services' diverse facets, including the aspects of universality, interconnectivity, adaptability, sustainability, and preventability. This article explores the pertinent challenges and provides a focused narration concerning potential measures to foster equitable and resilient cardiology services that are patient centred in the post-pandemic landscape.

A simplified algorithm for managing hepatitis C infection by leveraging telemedicine

Background: The utilization of alternative modalities to deliver patient care during the coronavirus disease of 2019 (COVID-19) pandemic has catalyzed the widespread adoption and integration of telemedicine into routine practice. These shifts have afforded a pivotal moment to analyze existing guidelines, such as for hepatitis C (HCV), identify opportunities, and streamline algorithms for optimizing disease management in remote settings. Methods and findings: Toward furthering momentum for targeting global HCV elimination, our cross-specialty expert panel collaborated to develop a simplified treatment algorithm for use in telemedicine environments by non-specialist providers (Figure 1). This algorithm includes a framework for delivery of HCV treatment and recommendations for screening, pre-treatment evaluation, on-treatment monitoring, and post-cure follow-up. The use of telemedicine for HCV management is supported by multiple studies demonstrating similar cure rates, measured by sustained virologic response at 12weeks post treatment (SVR12), compared to standard, in-person clinic visits. No laboratory monitoring is necessary for the majority of patients taking pan-genotypic direct-acting antivirals (DAAs), further reinforcing the ease of remote management of HCV treatment. Touchpoints to support medication adherence can be conducted through a variety of technologies, including bidirectional text messaging, electronic portals, and telephone and/or video conferencing. Conclusion: Telemedicine thus offers a critical opportunity to expand identification, link to care, and treat persons living with HCV.

How nurses and midwives engage with patient experience data to inform person‐centred quality and safety improvements

To explore how nurses and midwives engage with patient experience data collected via a mobile health app to inform person-centred practice improvements. A large amount of data is collected in healthcare, yet there is limited evidence outlining how nursing and midwifery staff utilise patient experience data to inform person-centred quality and safety improvements. This study utilised action research, underpinned by Practice Development methodology and has been reported using the SQUIRE 2.0 checklist. Six clinical units (medical short stay, acute medical, surgical, oncology/haematology, day surgery and maternity) in a large health district in Australia engaged in three cycles of data collection using a mobile health app. The app captured patient experience data relating to the person-centred KPIs developed and tested by McCance et al. (2012). Staff used the data to develop and evaluate person-centred practice. A number of improvements in scores and practice occurred through engaging with the data in a cyclical way. All six clinical units saw an improvement in four or more of the KPIs in the patient survey results from cycle one to cycle three, with two clinical units improving in all eight. On average across the six units, there was also an increase in time nurses/midwives were visible to their patients, an increase in clinical documentation reflecting the patients' needs and what was important to them, an increase in positive comments and a decrease in negative comments in patient stories. This study shows that collecting and utilising data from the person-centred KPIs in a collaborative and cyclical way lead to enhanced patient experience and the development and implementation of person-centred quality and safety improvements. Capturing and utilising data that are meaningful to nursing/midwifery teams in a cyclical, action-orientated approach result in person-centred practice improvements that enhance the experience of those that are receiving and delivering patient care.

The Challenge of Employee Retention in Medical Practices across the United States: An Exploratory Investigation Into the Relationship between Operational Succession Planning and Employee Turnover.

Employee turnover is a growing challenge for health-care providers delivering patient care today. US population demographics are shifting as the population ages, which leaves the field of health care poised to lose key leaders and employees to retirement at a time when patient care has grown more complex. This means health care will lose its core of key employees at a time when skilled leadership and specialized knowledge is most needed and directly impacts health care's ability to deliver quality care. Operational succession planning (OSP) may be one solution to manage this looming challenge in health care, as the process identifies and develops the next generation of leadership. Thus, this exploratory national study used a quantitative and cross-sectional design to examine the relationship between OSP and employee turnover. Demographic and 10-point Likert scale data were collected from n = 66 medical practices, using an online survey instrument. Data were analyzed using various descriptive and inferential statistical methods. Distribution (frequency and chi-square) analyses of the study sample, one-way analysis of variance (ANOVA), and regression analyses were performed across seven demographic characteristics of the medical practices: Specialty, Ownership Structure, Number of full-time equivalent (FTE) Physicians, Number of FTE Clinical Employees, Number of FTE Nonclinical Employees, Number of FTE Employees Left Position, and Region. Study results provided statistically significant evidence to support the relationship between OSP and employee turnover, highlighting that OSP was associated with lower employee turnover. The finding suggests that OSP can serve as an effective mechanism for increasing employee retention.

The Next Era of Biomedical Research

The Next Era of Biomedical Research

Developing best practices for PPE Portraits across 25 sites: a systematic assessment of\xa0implementation and spread of adaptations using FRAME

BackgroundAdaptation, a form of modification that aims to improve an intervention’s acceptability and sustainability in each context, is essential to successful implementation in some settings. Due to the COVID-19 pandemic, clinicians have rapidly adapted how they deliver patient care. PPE Portraits are a form of adaptation, whereby health workers affix a postcard size portrait of themselves to the front of their personal protective equipment (PPE) to foster human connection during COVID-19.MethodsWe used the expanded framework for reporting adaptations and modifications to evidence-based interventions (FRAME) method to better understand the reasoning behind and results of each adaptation. We hypothesized that using the FRAME in conjunction with design-thinking would lead to emerging best practices and that we would find adaptation similarities across sites. Throughout multiple implementations across 25 institutions, we piloted, tracked, and analyzed adaptations using FRAME and design thinking. For each adaptation, we assessed the stage of implementation, whether the change was planned, decision makers involved, level of delivery impacted, fidelity to original intervention, and the goal and reasoning for adaptation. We added three crucial components to the FRAME: original purpose of the adaptation, unintended consequences, and alternative adaptations.ResultsWhen implementing PPE Portraits across settings, from a local assisted living center’s memory unit to a pediatric emergency department, several requests for adaptations arose during early development stages before implementation. Adaptations primarily related to (1) provider convenience and comfort, (2) patient populations, and (3) scale. Providers preferred smaller portraits and rounded (rather than square) laminated edges that could potentially injure a patient. Affixing the portrait with a magnet was rejected given the potential choking hazard the magnetic strip presented for children. Other adaptations, related to ease of dissemination, included slowing the process down during early development and providing buttons, which could be produced easily at scale.ConclusionsThe FRAME was used to curate the reasoning for each adaptation and to inform future dissemination. We look forward to utilizing FRAME including our additions and design thinking, to build out a range of PPE Portrait best practices with accompanying costs and benefits.

Federated intelligence of anomaly detection agent in IoTMD-enabled Diabetes Management Control System

Implantable internet of things medical devices (IoTMD) has drawn a disruptive transformation in the healthcare domain. It has improved the services of healthcare providers in delivering patient care. Even better, it has supported individuals that are suffering from a chronic condition in self-managing their condition. Patients diagnosed with diabetes are the leading beneficiaries of IoTMD, assisting them in maintaining their sugar level at a normal range. However, the security defense of these systems against potential cyberthreats is currently underdeveloped. Such threats must not be ignored as they can put the lives of the patients in danger. Thus, this paper proposes deep learning (DL)-based anomaly detection system composed of estimation and classification models applied to a subdomain in healthcare systems referred to as Diabetes Management Control System (DMCS). The estimation model was used to forecast the glucose level of patients at each evaluation time step, whereas the classification model is intended to detect anomalous data points. This paper implements convolutional neural network (CNN) and multilayer perceptron (MLP) algorithms for comparison purposes. Moreover, considering that the dataset contains sensitive physiological information of the patients, this paper implements the independent learning (IL) and federated learning (FL) methods to maintain user data privacy. Furthermore, the post-quantization compression technique was also applied to convert models into their lightweight version, overcoming the computationally demanding processes of DL. Based on the experiment results, the FL method showed a higher recall rate (> = 98.69%) than the IL method (< = 97.87%). Additionally, the FL-aided CNN-based anomaly detection system performs better than the MLP-based approach. The former achieved an average recall rate of 99.24%, whereas the latter only attained 98.69%. Without loss of recall value, the inference latency of the models was tremendously reduced from more than 300 ms to less than two milliseconds when the original models were converted to their lightweight version.

Conceptions of clinical learning among stakeholders involved in undergraduate nursing education: a phenomenographic study

BackgroundTo prepare nursing students to become critical, autonomous members of the workforce, an agreement among stakeholders on how this can be achieved in the clinical setting is needed. However, a critical discussion of the clinical learning process in relation to actual and desirable outcomes is lacking in the nursing education literature. This study aimed to map conceptions of the desired process and outcomes of clinical learning among stakeholders involved in undergraduate clinical nursing education.MethodsTwenty-five semi-structured interviews about their understanding of clinical learning were conducted with nursing students, supervisors, clinical educators and higher education institute professionals involved in clinical nursing education in a Dutch academic medical center. Data were analyzed using a phenomenographic approach.ResultsFour conceptions were identified: clinical learning as a process to 1) meet curricular demands, 2) learn to deliberately deliver patient care, 3) learn to deliver patient care within the larger (healthcare) context, and 4) become a continuously developing professional. Conceptions 3 and 4 represented a broader, more inclusive perspective on clinical learning than conception 1 and 2. Conceptions were distinguished by five dimensions: role of guidelines from the school; learning opportunities, focus of supervisor; focus of reflection; desirable outcomes of clinical learning.ConclusionsThose directly involved in clinical learning in nursing may have qualitatively different understandings of its desired nature and outcomes. Two patterns across conceptions could be discerned: a) a shift in focus from learning as following standards, to following an individualized learning trajectory and b) a shift in focus from increasing patient load, to understanding oneself and the patient within the healthcare context. To prepare nursing students for the future workforce, a flexible, social form of self-regulated learning is warranted, as well as an understanding of one’s own role within the healthcare system and a critical attitude towards healthcare. Schools and hospitals should collaborate to integrate these values in the curriculum. The current study adds different ways of applying self-regulated learning as a relevant dimension in understanding clinical learning to the literature. Through the phenomenographic approach we identified conceptions that can be a basis for training and policy development.

EXPERIENTAL INTERPROFESSIONAL SIMULATION-BASED EDUCATION IMPROVES KNOWLEDGE, PERCIEVED PROFICIENCY AND VALUE IN COLLABORATIVE CRITICAL CARE

TOPIC: Education, Research, and Quality Improvement TYPE: Original Investigations PURPOSE: Interprofessional care teams are the pillars of intensive care units (ICUs) where severity of illness is high and care requires unique knowledge, skills and experience. Despite this model, programs rarely integrate different professions in training. ICU rotations present unique challenges, especially the rapid recognition of clinical deterioration. Many trainees are expected to have working knowledge of these without previously setting foot in an ICU. Simulation provides "hands-on" practice in a safe environment and also allows for the integration of teamwork into knowledge and skill training. Our study is important as it assesses the impact of this much needed interprofessional training in a novel but practical ICU simulation. We assessed the impact on knowledge, skills, comfort level with providing ICU care in a collaborative approach following participation in a simulation experience designed to educate and provide opportunities to lead, make decisions, and manage crises in critical patients. METHODS: This pilot study was designed as a mixed method study in a simulated environment where all participants took part in a three-hour immersive interprofessional learning. They completed a pre-survey followed by simulations meant to represent skills critical to the ICU setting in multi-disciplinary groups. Learners rotated through different stations such as the Ventilator knowledge hub where they received an overview of respiratory physiology, and ventilator mechanics. This was followed by a Ventilator simulation and using "VentiSim" software. They were also educated about the different oxygen delivery devices. They then partook in ultrasound-guided central line placement on a mannequin, cardiac rhythm recognition, and simulated Megacode using high fidelity simulators. A post survey was completed for assessment of knowledge, skills, and comfort level of participants. A three-tiered approach to debriefing was implemented for all participants. RESULTS: There were 74 participants of which 48% were medical residents, 19% nursing students, 16% medical students, 10% respiratory therapy students, 5% pharmacy trainees. Paired t-test was used to analyze the knowledge, and skills data which showed significant improvement with P-value < 0.0001(95% CI 1.16 to 2.20). Based on the Post-intervention survey, 99% agreed that it was worth their time to attend the session. 96% believed their ability to deliver patient care improved, 80% felt their anxiety reduced about rotating in ICU. During debriefing an overwhelming majority of learners commented how much they appreciated, “getting to interact with other professions”. There was strong feedback that we needed to conduct more workshops. CONCLUSIONS: Our novel ICU simulation workshop provided a statistically significant improvement in the knowledge base and understanding of common ICU procedures and concepts in a multidisciplinary team of healthcare trainees. It was evident during debriefing that participants appreciated the importance of an interprofessional, collaborative approach to critical care during their training. CLINICAL IMPLICATIONS: We will continue to refine our educational tool to bridge the gap in learning and collaboration. Although implementing such a detailed workshop was challenging, we feel it is essential for learning critical care skills in a safe environment and also to prioritize teamwork and communication in the ICU setting. DISCLOSURES: No relevant relationships by Nalini Kalanadhabhatta, source=Web Response No relevant relationships by Rajesh Kunadharaju, source=Web Response No relevant relationships by Archana Mishra, source=Web Response No relevant relationships by Alexander Pomakov, source=Web Response No relevant relationships by Raj Thapar, source=Web Response

The Optimizing Care Model: Final findings of a novel community pharmacy practice model to enhance patient care delivery using technician product verification

BackgroundThe community pharmacy represents a convenient health care access point for patients and is increasingly used to deliver direct patient care services; however, several barriers exist that hinder widespread patient service implementation and scalability. Such barriers include scope of practice restrictions, a dearth of sustainable payment models, lack of pharmacist capacity given other responsibilities, and workflow models developed for dispensing medications rather than clinical care. In an effort to overcome the lack of pharmacist time and capacity, further task delegation to pharmacy technicians has been suggested. ObjectivesThe primary objective of this study was to present the final outcomes of the Optimizing Care Model’s impact. The model’s impact on pharmacist patient care, workday composition, and rates of product selection errors not identified during final product verification are reported. MethodsThe Optimizing Care Model is an innovative approach to community pharmacy practice aiming to foster a new patient-centered care delivery model that expands clinical service delivery and fosters collaboration across health care settings through task delegation, primarily through technician product verification (TPV). To investigate the impact of its sustained implementation, a quasi-experimental, 1-group pretest-posttest design was used. Outcomes assessed included medication errors, clinical activities, and workday composition. ResultsSix chain and 3 independent pharmacies completed the final, continuation phase of the study. Overall pharmacist time spent delivering patient care services increased significantly upon implementation of the Optimizing Care Model (21% vs. 43%; P < 0.05), whereas pharmacist time spent performing dispensing-related activities decreased significantly (67% vs. 37%; P < 0.05). Total undetected error rates were significantly less in the Optimizing Care Model phase compared with the traditional model (0.05% vs. 0.01%; P < 0.001). ConclusionThis study presented the final results of a 2-year assessment of the Optimizing Care Model. Results reaffirmed initial published findings that the model and its use of TPV increase the array and frequency of direct patient care services rendered while resulting in lower undetected error rates. Final project results of the Optimizing Care Model demonstrate increased clinical service delivery versus the traditional model, while also improving patient safety with lower rates of undetected dispensing errors within the Optimizing Care Model. The Optimizing Care Model continues to show promise as a future practice model for community pharmacies.

Remote mental health services: a mixed-methods survey and interview study on the use, value, benefits and challenges of a national video consulting service in NHS Wales, UK

Social distancing laws during the first year of the pandemic, and its unprecedented changes to the National Health Service (NHS) forced a large majority of services, especially mental health teams...

Integration of Doctor of Acupuncture and Oriental Medicine (DAOM) Students in a Trauma Center's Acute Pain Service: In-Person and Remote Training and Patient Care.

Evidence of effectiveness and demand for acupuncture to treat acute pain conditions is growing, as is the need for acupuncturists trained to deliver patient care in a hospital setting. This articles describes collaboration between Bastyr University and Harborview Medical Center to incorporate Doctor of Acupuncture and Oriental Medicine (DAOM) students into a trauma hospital setting. A model was developed to integrate DAOM students into an Anesthesiology Acute Pain Service to provide acupuncture to postoperative inpatients. That in-person model pivoted to remote student education and patient self-care education during the COVID 19 outbreak. A review was conducted of 323 consecutive patients who received acupuncture while they were hospitalized. The review of 323 consecutive patients who received acupuncture for pain during their hospital admission indicated that as few as one acupuncture treatment resulted in clinically significant benefits. No serious complications or safety concerns were reported. Collaboration between academic and clinical programs can provide the structure to integrate acupuncture into hospital settings safely and with benefit to patients and students.

Qatar Health 2021: An online conference to prepare for a mass gathering sporting event while still addressing the pandemic

It feels like yesterday that we wrote the editorial related to the previous issue of the Qatar Health 2020 Conference!. 2020 is clearly a year to remember globally as a challenging one and this probably contributed to time passing so rapidly, keeping everyone so busy caring for patients and conducting research. COVID-19 has had a big impact on all aspects of our lives, from the way we deliver patient care and work, to how we socialize and plan for the future in general. The past year has certainly provided an opportunity for the State of Qatar to demonstrate its resilience, its ability to rapidly adapt to new circumstances, and to find effective solutions to new problems. Although very concerned by the current pandemic, our focus needs to also concentrate on the forthcoming FIFA World Cup in 2022 and every possible health related aspects, to ensure the event is safely hosted for everyone’s enjoyment. This has been clearly reflected in the Qatar Health 2021 conference program and call for abstracts which was organized into four parallel tracks fully hosted online for everyone’s safety. This issue of the Journal of Emergency Medicine, Trauma and Acute Care contains an extensive selection of 38 out of the 94 abstracts that have been accepted for oral or poster presentation during the conference. The abstract themes are summarized in and range from the impact of the pandemic on delivering primary care to Qatar’s preparedness to dealing with hazardous and chemical, biological, radiological and nuclear incidents. Notably 48 (51.06%) of the abstract titles contained the word COVID-19 or pandemic while only 4 abstracts (4.25%) were related to mass gatherings and sporting events. The later topics were primarily covered by multiple invited speakers with the relevant experience and proved to be the most attended conference sessions. It is worth noticing that the event attracted just over of 5,400 delegates and speakers from a total of 40 countries and has received highly positive feedback. We look forward to welcoming everyone again next year as we come closer to the FIFA World Cup 2022, with many more topics, partner organizations, and attendees.

Exoskeletons in Nursing and Healthcare: A Bionic Future.

This editorial summarizes the emergence of bionic technology in the form of exoskeletons and how these wearable robotics are and could be applied in the nursing profession to improve the occupational health of nurses and deliver patient care. The benefits, risks, and limitations of these novel technologies are also briefly discussed.

Telehealth outpatient coronavirus disease 2019 case management at a tertiary hospital in Sydney

Introduction Coronavirus disease 2019 is an acute respiratory illness caused by severe acute respiratory syndrome coronavirus 2. The coronavirus disease 2019 pandemic upended the traditional paradigm of face-to-face provision of healthcare in the Australian context; as such, a telehealth model of active case management was implemented in our public health system, even though there was little supporting data for the safety of delivering patient care remotely to home-isolation patients in the setting of a highly infectious and potentially fatal illness. Methods A retrospective, single-centre, observational cohort study was performed over 6 weeks commencing 12 March 2020, including patients with coronavirus disease 2019 undergoing home isolation and being actively monitored by a coronavirus disease 2019 telephone assessment clinic. Outcomes assessed comprised: duration of active case follow-up, average number of telephone calls per patient, average number of hours managing each patient, treatment required including presentation to the emergency department or admission to hospital, patient characteristics and utilisation of other health services. Results Of 5223 severe acute respiratory syndrome coronavirus 2 tests performed, 170 individuals (3.25%) tested positive. A total of 158 were included: 76 (47.5%) male and median age 31 years (range 18-94). Median symptom duration was 13 days (interquartile range 6, range 2-34). Median length of coronavirus disease 2019 telephone assessment clinic admission was 10 days (interquartile range 7, range 3-32). A total of 1151 telephone patient encounters were undertaken, with a median of six phone calls made to each patient (interquartile range 5, range 1-20). Ten patients required repeat clinic review; all but one returned home. Six presented to emergency department, with three of these being admitted. In total, there were six admissions: one from the clinic, three from the emergency department and two direct from home (bypassing emergency department). Only four of the six admissions (or 2.5% of all patients) required low-flow oxygen therapy; none required high-flow oxygen or assisted ventilation. The remaining 140 patients (88.6%) were safely managed at home without complications. Discussion A telehealth model of care is safe, efficient and cost-effective for the management of mild-to-moderate coronavirus disease-19 and facilitates home isolation, especially of a low-risk population, thus providing reassurance that this model is sound and suitable for ongoing use.

Experiences of nurses amidst giving care to COVID-19 patients in clinical settings in Iraqi Kurdistan: A qualitative descriptive study.

Aim and objectiveWe explored the experiences of nurses who cared for coronavirus disease 2019 patients in Iraqi Kurdistan.BackgroundNurses play a major role in response to pandemics and epidemics in delivering patient care. The experiences of nurses who provided care have significant short and long‐term consequences for individuals, communities, and the nursing profession.MethodsDescriptive qualitative research approach was adopted in this study. We interviewed 12 nurses (22–50 years) who cared for the coronavirus disease 2019 patients in one of the clinical units of two coronavirus disease 2019 hospitals in Iraqi Kurdistan in 2020. Interviews were conducted via phone calls and were analysed using the thematic analysis method. The Consolidated criteria for reporting qualitative research checklist was applied when constructing this paper.ResultsThe nurses had to care for a number of situations during the outbreak of coronavirus disease 2019 in Kurdistan. As people in the public did not believe that there was such a virus, nurses often had to deal with this lack of knowledge and aggression from some patients and their family members. Most nurses changed their preventive behaviours since the coronavirus disease 2019 outbreak at hospital or in public. This was mainly to protect not only themselves but their patients, colleagues, family members and friends. They were cautious about the use of a mask at the hospital and in public. Most nurses experienced fear, stress, anxiety and isolation during this period.ConclusionsThe patients had some concerns about their health and staying at hospitals, and some of them had aggressive behaviours towards nurses at corona hospitals. The public, close friends and relatives of the nurses had a fear of getting the infection by the virus through the nurses. However, the nurses attempted to protect themselves, colleagues and family members, and provide the best care to coronavirus disease 2019 patients. The nurses had a high obligation towards care giving at hospitals.Relevance to clinical practiceThe negative experiences of the nurses regarding the care of coronavirus disease 2019 patients must be considered in clinical settings. Sensitive policy programs must be established to protect nurses from the ostracization and stigmatization of the coronavirus disease 2019 pandemic and to allow them to be able to achieve their professional practices safely.

853-P: Comparing Telemedicine with Conventional Diabetes Care in Assessing Long-Term Outcomes in 451 Patients over 15 Years

Pros and cons of telemedicine (TM) in diabetes have been debated during Covid-19. Diabetes Tele Management System (DTMS®) which include a disease specific EMR, customized targets integrated with remote monitoring capabilities supported 24/7 by a multidisciplinary team has been actively delivering patient care for more than 2 decades. We assessed long-term outcomes in patients adhering to DTMS® for 15 ± 3 years(y) [Treatment group(TG)] compared with those on conventional care[Control Group (CG)]. Patients having a Virtual Consultation(VC) ≥ 1 in 3 months, Physical Visit(PV) ≥ 1 in 3y, and attended group diabetes education ≥ 1 in 3y were included.T2D (n=451, age 62.91 ± 11.64 y, avg. duration of diabetes 8.41 ± 2.78 at baseline) were deidentified and their clinical characteristics were extracted from EMR. DTSQ and Eq-5D were administered to capture treatment satisfaction and QoL respectively. TG demonstrated sustained improvements and maintenance of glycemic and non-glycemic parameters over 15y. Subjects expressed significant level of satisfaction with TM(Table). Judicious use of TM with customized frequency for virtual consultations, counselling and coaching significantly averts the long term complications of diabetes and is superior to conventional care. Nonetheless connectivity issues and economic loss to hospital are among the foremost challenges observed with TM.View largeDownload slideView largeDownload slide DisclosureJ. Kesavadev: None. J. Ajith: None. S. Jothydev: None. A. Shankar: None. G. Krishnan: None. A. David: None. G. Sanal: None. K. Jothydev: None. G. B. Chandran: None. A. Basanth: None. S. T. s. : None.

Virtual health in cancer care: Results from a semi-structured interview-survey of oncology health care providers.

e13618 Background: The COVID-19 pandemic has compelled an increased use of virtual care delivery models in oncology. This study sought to examine the views of oncology health care providers (HCP) in British Columbia on the value and impact of virtual care models in clinical practice. Methods: A semi-structured interview-survey was developed to compare provider practice patterns between May 2019 and May 2020. Questions were designed to determine provider-perceived value and impact of virtual visits on clinical interactions with patients. HCP (including physicians, dentists, and nurse practitioners) at BC Cancer were invited to participate. Responses to the interview questions were de-identified and HCP names were replaced with a study code. Quantitative questions were interpreted with descriptive statistics. Qualitative results were analyzed and iteratively coded by multiple reviewers for emerging themes. Results: Among 531 invited participants, 61 completed the interview-survey and 60 were included in the final analysis. Of those interviewed, 47% were radiation oncologists and 33% were medical oncologists. The remainder of HCP interviewed (n = 12) included functional imaging physicians, general practitioners in oncology, hereditary cancer physicians, nurse practitioners, palliative care physicians, psychiatrists, and surgical oncologists. Most oncology providers (87%) desired the continuation of virtual visits as part of their clinical practice so long as barriers to integration were addressed. Barriers identified included limited access to physical resources, such as hardware (70% responses) and quiet spaces (54% responses), insufficient logistic support such as information technology services (84% responses) and operational workflows (46% responses), the absence of guidelines to select patients for this delivery model (38% responses), and concerns regarding HCP liability, security and privacy (30% responses). Conclusions: Oncology HCP value delivering patient care through virtual means, however, barriers to implementation must be better understood. These data may inform continued use and implementation of virtual care at other oncology centers.

Understanding patient experience in the emergency room using multiple methods

This paper discusses a multi-method approach of gathering data in order to understand how variables within a high stress environment, such as a hospital emergency room, can affect user experience. The challenges facing emergency departments in Alberta can be summarized as a lack of understanding of what happens in an emergency room, inadequate communication between staff and the public, and challenges with the physical design of these departments. Through this study we were able to understand the patient experience and to identify gaps in service, gain insights into issues that are negatively impacting patients and suggests artefacts and processes in order to better deliver patient care.