Direct Clinical Care Research Articles

Clinical care ratios for, and tasks undertaken by, allied health professionals: A scoping review of the literature.

With the increasing demand on the global health system and the presence of persistent healthcare disparities, it becomes imperative to utilize the full potential of the healthcare workforce, including allied health professionals (AHPs). To date, no review has mapped the literature on clinical care ratios (CCRs) for AHPs. This information is vital in guiding future work-force planning to address healthcare issues such as understaffed and at capacity hospitals. This scoping review mapped available evidence to offer a comprehensive insight into current AHP CCRs, enabling evidence-based decision-making that ensures optimal care and enhanced system efficiency. The scoping review was undertaken using the 'Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews' (PRISMA-ScR). The search was conducted using Ovid (MEDLINE, Embase, Emcare, PsycINFO), CINAHL, the Cochrane Library, Scopus, PEDro, OTseeker and grey literature. Two reviewers independently screened records, following which data extraction was completed for the included studies. Descriptive synthesis was used to summarize the data. Of the 7670 records identified, 18 studies were included in this review. Whilst there was variability between AHPs on direct clinical time spent with patients, considerable amount of time was also spent on activities beyond direct clinical care. To offset this, literature highlights opportunities for allied health assistants and students to undertake tasks which would free-up AHPs to undertake more direct and higher-level tasks. However, limitations of findings (variability in measurement, lack of coverage of some professions) limits generalisability. While the literature highlights considerable variability in CCRs among different AHP disciplines, it does appear nearly a nearly a third of time spent by AHPs are on tasks that are beyond direct clinical care. Future research could explore new workforce models which would free-up AHPs to undertake more direct and higher-level tasks.

Assessing the frontline competency gap: Emergency care perceptions among nurses in Yemen's conflict zone.

Nursing competencies in armed conflict situations are critical for effective response and recovery. This study explores nurses' perceptions regarding their competencies in armed conflict zones to identify areas of proficiency and those requiring further emphasis in training. This cross-sectional descriptive study adhered to the STROBE reporting guidelines. It used a validated questionnaire examining 47 different competencies for nursing in armed conflict zones, which were subsequently ranked to identify those that were valued most and least. In total, 102 questionnaires were returned (85% response rate). The highest-ranked competencies focused on immediate life-saving interventions and personal safety. In contrast, competencies involving broader disaster management, such as understanding organizational disaster plans, post-death care, and risk identification, ranked lower. This observation may indicate a tendency to prioritize direct clinical care over strategic planning and long-term recovery in disaster nursing education. This study highlights the critical need to strengthen emergency care competencies among nurses working in armed conflict zones in Yemen. Its findings underscore the importance of targeted training programs, particularly in complex trauma management and psychological first aid, to address nurses' self-identified competency gaps. Policy implications include prioritizing resource allocation for emergency care infrastructure, implementing competency-based deployment strategies, and ensuring access to mental health support for nurses in working conflict zones. These actions are essential for building a resilient nursing workforce capable of providing quality care amidst the unique challenges of armed conflict.

Who Uses Pathways Around Care Management?

Clinical pathways are developed by clinicians but used for various purposes in the US health care system. Pathways were designed to result in the best possible clinical and financial outcomes. Real-world care manage­ment involves multiple clinicians, administrators, and other organizations re­sponsible for benefits administration outside of direct clinical care. As a result, there are many different uses for clinical pathways. This pilot study provides a brief literature review on users, uses, and a recent electronic survey to de­termine how users use pathways along with their feedback around their value. Key findings from this limited sample indicate a variety of uses for pathways re­ported primarily by nurses, nursing staff, or practice administration. This prelim­inary effort aids in documenting the value and real-world use of care pathways in the diverse care provider marketplace that plans to be studied in a larger sur­vey with updated questions. This area of clinical pathways remains an important effort to better understand and provide a guide for those working in this grow­ing field of clinical-economic work in the health care system.

Emerging Evidence Supports Broader Definition of Chairside Behavior Guidance and Familial Compliance.

Behavior management as a set of clinical techniques to induce desirable clinical treatment and subsequent compliance behaviors in children and families varies internationally based on professional training, access to care, health literacy, and societal norms. This report proposes non-typical diagnostic considerations of additional inherent behavioral conditions and familial and social qualifiers that may help predict success both at the chairside and in compliance with home self-care behaviors to reduce caries susceptibility. A review of the medical and dental literature provides ample support for the consideration of changing characteristics of both the patient and the environment. The current recommendations for choice of behavior guidance in direct clinical care, as used in the USA, often fall short of efficacy for a variety of reasons including the provider limitations, the extent and difficulty of treatment, and most recently appreciated, the complexity of negative childhood experiences, subclinical behavioral disorders, and immutable negative determinants of health outside the dental setting affecting interaction with health professionals. These same factors, such as family dysfunction and societal stresses, also impact compliance with out-of-clinic preventive efforts that many oral health care providers rely upon to help mitigate treatment limitations in reaching children. There are also behavioral elements of compliance and attitudes toward health that dentists need to recognize. A broader, more inclusive concept of behavior guidance to include factors beyond those typically associated with a dental patient affecting treatment and compliance with preventive behaviors may be beneficial. Every population and patient will have differing characteristics and require individualized care.

Taking one step further: five equity principles for hospitals to increase their value as anchor institutions

Hospitals have the potential to create value beyond the direct clinical care that they provide through tackling the social determinants of health as an 'anchor institution': shifting the way in which they employ staff; procure goods and services; use their physical and environmental resources and assets; and partner with others. However, the societal value of this work is not automatically or accidentally created, it must be intentionally designed and delivered, particularly if it is to tackle inequities. This article proposes five equity principles for healthcare leaders to consider in their hospitals' anchor institution work. There have already been important shifts from the 'traditional way' of conceiving of a hospital's role in the community, but going 'one step further' could help to maximise the equity impact.

A systematic review of the use of FHIR to support clinical research, public health and medical education

PurposeThis systematic review aimed to identify and categorize applications using Fast Healthcare Interoperability Resources (FHIR) to support activities outside of direct healthcare provision.Design/methodology/approachA systematic electronic search was performed, and 53 studies were included after the selection process.FindingsThe results show that FHIR is being used to support (1) clinical research (i.e. clinical research based on interventional trials, data interoperability to support clinical research and advanced communication services to support clinical research), (2) public health and (3) medical education. Despite the FHIR potential to support activities outside of direct healthcare provision, some barriers were identified, namely difficulties translating the proposed applications to clinical environments or FHIR technical issues that require further developments.Originality/valueThis study provided a broad review of how FHIR is being applied in clinical activities outside of direct clinical care and identified three major domains, that is, clinical research, public health and medical education, being the first and most representative in terms of number of publications.

Exploring Motivating Factors for Pursuing Radiation Oncology: A Comparative Analysis of Medical Students and Residents.

Purpose Increasing medical student (MS) interest in radiation oncology (RO) is important to meet the rising demand for radiation oncologists. Understanding the factors that drive MS to pursue RO is crucial. This study compares motivating factors between MS and RO residents to inform interventions to increase recruitment and sustained interest in the specialty. Methods Data from two similar studies investigating factors motivating MS and residents to pursue RO were analyzed. The first study surveyed Canadian RO residents to characterize enablers when applying for RO residency. The second study analyzed application essays from MS applying to an RO studentship. A mixed methods approach was used to compare themes ("career aspects,""prior exposure," and "personal experiences") between the datasets. Results Qualitative analysis demonstrated that both MS and residents identified "career aspects" as the most common theme facilitating interest in RO careers. "Multidisciplinary work" and "direct clinical contact and patient care" were prominent sub-themes. MS emphasized "serious illness and palliative care" and "advanced technology,"while residents prioritized RO as a "rewarding career.""Prior exposure,"particularly through shadowing/observerships, was more important for MS than residents who valued clinical experiences. Practical career considerations including "mentorship" and "career satisfaction and lifestyle" were significant motivators for residents. Conclusion MS value content-based aspects of RO and emphasize shadowing. In contrast, RO residents prioritize lifestyle-based considerations. These differences highlight the opportunity for intervention throughout medical training to sustain interest in RO and facilitate applications to RO residency programs.

Peri-operative care of transgender and gender-diverse individuals: guidance for clinicians and departments.

The objective of this document is to guide best practice to ensure the safety and dignity of transgender and gender-diverse people in the peri-operative period. While transgender and gender-diverse people may have specific health needs in relation to gender dysphoria, their health requirements go beyond their gender identity. Most doctors will provide care to someone who is transgender or gender-diverse at some stage in their career. It is therefore important that all anaesthetists are educated on specific considerations when caring for these patients. A working party was assembled consisting of individuals with experience in direct clinical care of the relevant patient group, those who have expertise in endocrinology and gender-affirming hormones, educators on the topic of transgender and gender-diverse healthcare, and authors of both cisgender and transgender identities. After discussion among the working party, targeted searches of literature were undertaken. The authors initially came up with a list of over 25 recommendations which was subsequently revised to a list of 15 recommendations after further review by the working party. These included airway assessment and management; management of hormonal therapy; relevant issues in obstetric anaesthesia; and hospital infrastructure and processes. This document provides the first guidance produced to advise on best practice to ensure the safety and dignity of trans and gender-diverse individuals in the peri-operative period.

The Role of Midwives in US Perinatal Palliative Care: A Scoping Review.

Perinatal palliative care (PPC) is a rapidly growing and essential reproductive health care option for pregnant persons with a diagnosed life-limiting fetal condition who continue their pregnancy. The provision of PPC is within the scope of basic midwifery competencies, and midwives are well-positioned to make unique and valuable contributions to interprofessional PPC teams. However, little is known about midwives' past or current involvement in PPC in the United States. This scoping review of the literature investigated what is known about the role of midwives in PPC in the United States. Multiple databases of published literature were used for this review: PubMed, CINAHL, Embase, Web of Science, ProQuest, Google Scholar, and relevant citations from identified studies. All types of English language publications addressing midwives' involvement in PPC in the United States were included, without any limitations on publication date. The role and contributions of midwives in PPC is not well represented in existing literature. Of the 259 results identified, 7 publications met criteria for inclusion. These included 5 case reports, one quantitative research article, and one conference abstract. Midwives are involved in PPC through the provision of direct clinical care (including antepartum, intrapartum, postpartum, neonatal, bereavement, postmortem, and follow-up care) and care planning and coordination as part of an interprofessional team. Despite midwives being uniquely positioned to provide holistic, family-centered, and person-centered care in situations of pregnancy with life-limiting fetal conditions, there is limited literature about their involvement in PPC in the United States. PPC should be incorporated into midwifery education and training programs. Midwives should play a central role in shaping future research and policies to ensure the accessibility and quality of PPC.

Factors Influencing Data Quality in Electronic Health Record Systems in 50 Health Facilities in Rwanda and the Role of Clinical Alerts: Cross-Sectional Observational Study.

Electronic health records (EHRs) play an increasingly important role in delivering HIV care in low- and middle-income countries. The data collected are used for direct clinical care, quality improvement, program monitoring, public health interventions, and research. Despite widespread EHR use for HIV care in African countries, challenges remain, especially in collecting high-quality data. We aimed to assess data completeness, accuracy, and timeliness compared to paper-based records, and factors influencing data quality in a large-scale EHR deployment in Rwanda. We randomly selected 50 health facilities (HFs) using OpenMRS, an EHR system that supports HIV care in Rwanda, and performed a data quality evaluation. All HFs were part of a larger randomized controlled trial, with 25 HFs receiving an enhanced EHR with clinical decision support systems. Trained data collectors visited the 50 HFs to collect 28 variables from the paper charts and the EHR system using the Open Data Kit app. We measured data completeness, timeliness, and the degree of matching of the data in paper and EHR records, and calculated concordance scores. Factors potentially affecting data quality were drawn from a previous survey of users in the 50 HFs. We randomly selected 3467 patient records, reviewing both paper and EHR copies (194,152 total data items). Data completeness was >85% threshold for all data elements except viral load (VL) results, second-line, and third-line drug regimens. Matching scores for data values were close to or >85% threshold, except for dates, particularly for drug pickups and VL. The mean data concordance was 10.2 (SD 1.28) for 15 (68%) variables. HF and user factors (eg, years of EHR use, technology experience, EHR availability and uptime, and intervention status) were tested for correlation with data quality measures. EHR system availability and uptime was positively correlated with concordance, whereas users' experience with technology was negatively correlated with concordance. The alerts for missing VL results implemented at 11 intervention HFs showed clear evidence of improving timeliness and completeness of initially low matching of VL results in the EHRs and paper records (11.9%-26.7%; P<.001). Similar effects were seen on the completeness of the recording of medication pickups (18.7%-32.6%; P<.001). The EHR records in the 50 HFs generally had high levels of completeness except for VL results. Matching results were close to or >85% threshold for nondate variables. Higher EHR stability and uptime, and alerts for entering VL both strongly improved data quality. Most data were considered fit for purpose, but more regular data quality assessments, training, and technical improvements in EHR forms, data reports, and alerts are recommended. The application of quality improvement techniques described in this study should benefit a wide range of HFs and data uses for clinical care, public health, and disease surveillance.

Administrative Time Expectations for Residency Core Faculty: A CERA Study.

Academic family medicine (FM) physicians aim to balance competing needs of providing clinical care with nonclinical duties of program administration, formal education, and scholarly activity. FM residency is unique in its scope of practice, clinical settings, and training priorities, which may differ between university-based and community-based programs. In both types of programs, these competing needs are a source of faculty dissatisfaction and burnout. We performed this study to explore the allocation of nonclinical administrative full-time equivalents (FTE) for FM residency core faculty members. Reported nonclinical administrative FTE time allocation is equivalent between university/medical school-based and community-based programs. The ideal proportion of FTE distribution identified by DCs had greater amounts of direct clinical care compared to greater emphasis on precepting time identified by PDs. DCs and PDs agreed that administrative time should be used for advising residents, curriculum development and delivery, and evaluation of resident performance. Barriers to allocating additional administrative time for DCs included loss of revenue and pressure by hospital-level leadership. PDs responded that the need for clinical supervision of residents was most significant. We performed our research through a cross-sectional survey of FM department chairs (DC) and residency program directors (PD) conducted by the Council of Academic Family Medicine Educational Research Alliance. We used descriptive statistics to characterize the data and Pearson's χ2 tests to evaluate bivariate relationships. DCs and PDs offer a similar ideal picture of core responsibilities, though subtle differences remain. These differences should be considered for the next revision of the Accreditation Council for Graduate Medical Education minimum program standards to best meet the needs of all FM programs.

Medics as influencers: a historical analysis of British Army military medical exercises in Kenya over two decades

IntroductionAnnual British Army medical training exercises have run in Kenya since the early 1990s, initially with a dual purpose—to deliver the Kenyan Extended Programme of Immunisation (in remote locations) and...

The hospital costs of high emergency department pediatric readiness.

We estimate annual hospital expenditures to achieve high emergency department (ED) pediatric readiness (HPR), that is, weighted Pediatric Readiness Score (wPRS)≥88 (0-100 scale) across EDs with different pediatric volumes of children, overall and after accounting for current levels of readiness. We calculated the annual hospital costs of HPR based on two components: (1) ED pediatric equipment and supplies and (2) labor costs required for a Pediatric Emergency Care Coordinator (PECC) to perform pediatric readiness tasks. Data sources to generate labor cost estimates included: 2021 national salary information from U.S. Bureau of Labor Statistics, detailed patient and readiness data from 983 EDs in 11 states, the 2021 National Pediatric Readiness Project assessment; a national PECC survey; and a regional PECC survey. Data sources for equipment and supply costs included: purchasing costs from seven healthcare organizations and equipment usage per ED pediatric volume. We excluded costs of day-to-day ED operations (ie, direct clinical care and routine ED supplies). The total annual hospital costs for HPR ranged from $77,712 (95% CI 54,719-100,694) for low volume EDs to $279,134 (95% CI 196,487-362,179) for very high volume EDs; equipment costs accounted for 0.9-5.0% of expenses. The total annual cost-per-patient ranged from $3/child (95% CI 2-4/child) to $222/child (95% CI 156-288/child). After accounting for current readiness levels, the cost to reach HPR ranged from $23,775 among low volume EDs to $145,521 among high volume EDs, with costs per patient of $4/child to $48/child. Annual hospital costs for HPR are modest, particularly when considered per child.

Building Career Pathways for Cancer Nurses: Ensuring Cancer Nursing's Future

Objectives: It is well established that cancer nurses and Advanced Practice Nurses (APN) are critical to the delivery of high-quality, accessible, safe and affordable cancer care globally. Specialised cancer nurses and APNs with a strong foundation in the pillars of nursing practice (clinical, leadership, education, and research) are essential to optimise patient outcomes, create increased cost-efficiencies through innovative models of care delivery, and can further leverage interprofessional collaboration in cancer care. To address the existing shortcomings in cancer control, Australian cancer nurses, including APNs, and cancer nurses and APNs globally, need an evidence-informed consensus drive framework to harmonize clinical, educational and career pathways leading to specialization, advanced practice, promotion, and equitable and accessible education. Methods: Critical perspective. Results: Scoping work has begun to build on the 2009 seminal Australian EdCaN framework, with ambitions to develop a contemporary practice and career framework for all cancer nurses which details clear pathways to specialised and APN roles inclusive of navigating to and through direct clinical care, research, academia, education and management or executive leadership. Conclusions: A revised framework that is cognisant of the changing landscape of contemporary cancer care, and the growing diversity of nursing roles is needed to address the imminent nursing workforce crisis. Implications for Nursing Practice: The revised framework may support the implementation of the newly released Australian Cancer Plan and provide a career pathway model that may be adopted internationally, including in low and middle income countries.

Assessment of health care workers preparedness to epidemics: A case of Ebola virus disease preparedness in private hospitals in Kampala, Uganda.

Unrecognized Ebola Virus Disease (EVD) can lead to multiple chains of transmissions if the first caretakers are not trained and prepared. This study aimed to assess healthcare workers (HCWs) preparedness in private hospitals located in Kampala, to detect, respond and prevent EVD. A descriptive cross-sectional study was carried out among HCWs in direct clinical care provision in four private hospitals, and in one Ebola Treatment Unit (ETU) using a self-administered questionnaire from March to June 2020. 222 HCWs agreed to participate aged from 19 to 64 years and with 6 months to 38 years of practice where most were nurses (44%). 3/5 hospitals did not have written protocols on EVD case management, and only one (ETU) had an exclusive emergency team. 59% were not sure whether contact tracing was taking place. Private hospitals were not included in EVD trainings organized by the Ministry of Health (MoH). In addition, HCWs in private hospitals were not empowered by the MoH to take part in EVD case management. Despite these shortcomings, only 66% of HCWs showed an interest to be immunized. Knowledge about potential Ebola vaccines was generally poor. In Kampala, Uganda, establishment of a more comprehensive preparedness and response strategy for EVD outbreaks is imperative for HCWs in private facilities, including a wide vaccination educational program on Ebola vaccination. The findings from this study if addressed will likely improve the preparedness and management of future Ebola outbreaks in Uganda.

Assessing Priorities in a Statewide Cardiovascular and Diabetes Health Collaborative Based on the Results of a Needs Assessment: Cross-Sectional Survey Study.

The Ohio Cardiovascular and Diabetes Health Collaborative (Cardi-OH) unites general and subspecialty medical staff at the 7 medical schools in Ohio with community and public health partnerships to improve cardiovascular and diabetes health outcomes and eliminate disparities in Ohio's Medicaid population. Although statewide collaboratives exist to address health improvements, few deploy needs assessments to inform their work. Cardi-OH conducts an annual needs assessment to identify high-priority clinical topics, screening practices, policy changes for home monitoring devices and referrals, and preferences for the dissemination and implementation of evidence-based best practices. The results of the statewide needs assessment could also be used by others interested in disseminating best practices to primary care teams. A cross-sectional survey was distributed electronically via REDCap (Research Electronic Data Capture; Vanderbilt University) to both Cardi-OH grant-funded and non-grant-funded members (ie, people who have engaged with Cardi-OH but are not funded by the grant). In total, 88% (103/117) of Cardi-OH grant-funded members and 8.14% (98/1204) of non-grant-funded members completed the needs assessment survey. Of these, 51.5% (53/103) of Cardi-OH grant-funded members and 47% (46/98) of non-grant-funded members provided direct clinical care. The top cardiovascular medicine and diabetes clinical topics for Cardi-OH grant-funded members (clinical and nonclinical) were lifestyle prescriptions (50/103, 48.5%), atypical diabetes (38/103, 36.9%), COVID-19 and cardiovascular disease (CVD; 38/103, 36.9%), and mental health and CVD (38/103, 36.9%). For non-grant-funded members, the top topics were lifestyle prescriptions (53/98, 54%), mental health and CVD (39/98, 40%), alcohol and CVD (27/98, 28%), and cardiovascular complications (27/98, 28%). Regarding social determinants of health, Cardi-OH grant-funded members prioritized 3 topics: weight bias and stigma (44/103, 42.7%), family-focused interventions (40/103, 38.8%), and adverse childhood events (37/103, 35.9%). Non-grant-funded members' choices were family-focused interventions (51/98, 52%), implicit bias (43/98, 44%), and adverse childhood events (39/98, 40%). Assessment of other risk factors for CVD and diabetes across grant- and non-grant-funded members revealed screening for social determinants of health in approximately 50% of patients in each practice, whereas some frequency of depression and substance abuse screening occurred in 80% to 90% of the patients. Access to best practice home monitoring devices was challenging, with 30% (16/53) and 41% (19/46) of clinical grant-funded and non-grant-funded members reporting challenges in obtaining home blood pressure monitoring devices and 68% (36/53) and 43% (20/46) reporting challenges with continuous glucose monitors. Cardi-OH grant- and non-grant-funded members shared the following high-priority topics: lifestyle prescriptions, CVD and mental health, family-focused interventions, alcohol and CVD, and adverse childhood experiences. Identifying high-priority educational topics and preferred delivery modalities for evidence-based materials is essential for ensuring that the dissemination of resources is practical and useful for providers.

Public and patient perspectives on the use of clinical and administrative health data to identify and contact people at risk of future illness-The case of chronic kidney disease.

For decades, researchers have used linkable administrative health data for evaluating the health care system, subject to local privacy legislation. In Ontario, Canada, the relevant privacy legislation permits some organizations (prescribed entities) to conduct this kind of research but is silent on their ability to identify and contact individuals in those datasets. Following consultation with the Office of the Information and Privacy Commissioner of Ontario, we developed a pilot study to identify and contact by mail a sample of people at high risk for kidney failure within the next 2 years, based on laboratory and administrative data from provincial datasets held by ICES, to ensure they receive needed kidney care. Before proceeding, we conducted six focus groups to understand the acceptability to the public and people living with chronic kidney disease of direct mail outreach to people at high risk of developing kidney failure. While virtually all participants indicated they would likely participate in the study, most felt strongly that the message should come directly from their primary care provider or whoever ordered the laboratory tests, rather than from an unknown organization. If this is not possible, they felt the health care provider should be made aware of the concern related to their kidney health. Most agreed that, if health authorities could identify people at high risk of a treatable life-threatening illness if caught early enough, there is a social responsibility to notify people. While privacy laws allow for free flow of health information among health care providers who provide direct clinical care, the proposed case-finding and outreach falls outside that model. Enabling this kind of information flow will require greater clarity in existing laws or revisions to these laws. This also requires adequate notification and culture change for health care providers and the public around information uses and flows.

Forecasting the Future Supply of Pediatric Subspecialists in the United States: 2020-2040.

Concerns persist about whether the United States has an adequate supply of pediatric subspecialists and whether they are appropriately distributed across the nation to meet children's health needs. This article describes the data and methods used to develop a workforce projection model that estimates the future supply of 14 pediatric subspecialities certified by the American Board of Pediatrics at the national and US census region and division levels from 2020 to 2040. The 14 subspecialties include adolescent medicine, pediatric cardiology, child abuse pediatrics, pediatric critical care medicine, developmental-behavioral pediatrics, pediatric emergency medicine, pediatric endocrinology, pediatric gastroenterology, pediatric hematology-oncology, pediatric infectious diseases, neonatal-perinatal medicine, pediatric nephrology, pediatric pulmonology, and pediatric rheumatology. Hospital medicine was excluded because of the lack of historical data needed for the model. This study addresses the limitations of prior models that grouped adult and pediatric physician subspecialty workforces together and aggregated pediatric subspecialties. The model projects supply at national and subnational levels while accounting for geographic moves that pediatric subspecialists make after training and during their career. Ten "what if" scenarios included in the model simulate the effect of changes in the number of fellows entering training, the rate at which subspecialists leave the workforce, and changes in hours worked in direct and indirect clinical care. All model projections and scenarios are available on a public, interactive Web site. The model's projections can also be examined with other data to provide insight into the possible future of the pediatric subspecialty workforce and offer data to inform decision-making.

A Proposal of a Student Run Clinic Medical School Elective to Improve Adherence to Postoperative Follow-Up.

Patient nonadherence to healthcare follow-up appointments is an ever-growing problem leading to worsened health outcomes and increased morbidity and mortality. Social factors, namely lack of transportation, are commonly implicated as a cause for the lack of following up. Medical students make up a significant portion of the healthcare team but are mostly viewed as passive learners on clinical rotations and do not receive many active opportunities to engage in direct clinical care. Here, an elective for 4th year medical students where students operate a clinic and work alongside residents to hold virtual surgical follow-up appointments to assess for complications and monitor healing is proposed. This could potentially bypass many of the social barriers that patients face while giving students a more direct role in patient care and a focused educational experience while reducing stress on the physical healthcare clinic system.

Implementing digital devices to maintain family connections during the COVID-19 pandemic: Experience of a large academic urban hospital

IntroductionThe COVID-19 pandemic lockdown imposed drastic measures at hospitals internationally to rapidly pivot their approaches to patient care. Early on when the pandemic was declared, hospitals responded to local public health restrictions by limiting all non-essential visits for their patients. Digital devices allowed Canadians to remain connected with their friends and families during the imposed isolation restrictions. The aim of this clinical perspective is to share the experience with the immediate implementation of digital connections for patients by exploring the impact as well as to describe key learnings from the initiative. Methods150 iPads were distributed to clinical teams for use by patients, for either clinical care or for social connection. An iterative evaluation process, guided by quality improvement methodology, was followed which ensured that any changes to the iPad implementation process were responsive in real time. The evaluation measures included a clinician survey and collection of narratives from patients and clinicians. ResultsAll clinician respondents (n=7) indicated that the iPads were a valuable tool to support patients and families. Narratives from patients indicated that virtual connections brought joy to them especially given that they were isolated from their support systems during the initial days of COVID-19. Key learnings for the Implementation Team were: the importance in maintaining cognitive stimulation as an enabler to recovery for patients; staff members provide support beyond direct clinical care; technology needs to be harnessed to facilitate clinical care; technology should be leveraged to support clinical care; and interprofesssional collaboration of the entire Implementation Team is a key enabler of success. ConclusionSince implementation, iPads have been integrated as a supporting digital tool for both social connections as well as clinical care as a result of the benefits seen during this initiative. The iPads have also been recognized as a tool to complement patient connection and care and currently being expanded as part of services to patients, families and their clinicians.