Duration Of Encounters Research Articles

Impact of Legal Guardian Absence on Research Enrollment in the PICU.

To identify the frequency of which a legal guardian is at the bedside of children admitted to the PICU that are eligible for research studies. A prospective, observational study. Three tertiary Canadian PICUs. Two hundred one patients were admitted to the PICU between September 2021 and March 2023 (site 1), from March 2019 to March 2020 and March 2022 to March 2023 (site 2), and from March 2019 to March 2020 and July 2020 to November 2021 (site 3). None. At each center, the duration of consent encounters was recorded for patients eligible for research by documenting the length of each attempt (min). The frequency of parental presence at bedside and the ability for a guardian to make a decision were also recorded. Thirty-five percent of patients eligible for research did not have a legal guardian at the bedside on the first attempted consent encounter. Twenty-three percent of approached patients were not enrolled due to an inability for a consent decision to be made by the child's legal guardian or an inability to contact the guardian before discharge. The absence of legal guardians in the PICU poses a barrier to the enrollment of critically ill children in pertinent research studies and suggests that a model of deferred consent or implied consent would aid in the future of critical care research.

Outpatient mastectomy is a safe surgical option for patients treated in a rural Appalachian tertiary facility

IntroductionThe feasibility of the outpatient mastectomy in a rural setting is poorly characterized. The aim of this study is to analyze the efficacy and safety of an outpatient mastectomy program in our tertiary care facility treating rural Appalachian patients. MethodsWe performed a single-institution, retrospective review of all women with breast cancer older than 18 years of age treated with mastectomy with or without immediate alloplastic breast reconstruction at JW Ruby Memorial Hospital from 2019 to 2022. Our primary objective was to determine the 30, 60, and 90-day readmission rates and complications. Our secondary objective analyzed perioperative pain control variables that contribute to appropriate discharge. ResultsWe identified thirty-two women between 2019–2022 who underwent same-day mastectomy at JW Ruby Memorial Hospital in Morgantown, West Virginia. Overall readmission rates at 30- 60- and 90-days were 3.1% (n = 1), 9.4% (n = 3) and 9.4% (n = 3), respectively. Two patients were admitted for reasons unrelated to surgery. The patient in the 30-day readmission group required washout for hematoma due to perioperative apixaban making the overall surgical readmission rate 3.1% (n = 1). Preoperatively, 90.6% (n = 29) of women received a local anesthetic block by the anesthesia provider. The mean milligram morphine equivalents received for the duration of the hospital encounter was 15.9 (STD = 10.1). ConclusionOutpatient mastectomy is a safe and effective option for eligible patients in rural settings. Careful patient selection and a multidisciplinary team should assess the individual circumstances to determine if outpatient mastectomy is appropriate.

Abstract PO1-09-07: Outpatient mastectomy is a safe surgical option for patients treated in a rural Appalachian tertiary facility

Abstract Background The feasibility of the outpatient mastectomy in a rural setting is poorly characterized. Centers treating rural patient populations have unique challenges. Limited access to resources and distance to facilities that can care for post-surgical patients are two such challenges. The aim of this study is to analyze the efficacy and safety of an outpatient mastectomy program in our tertiary care facility treating rural Appalachian patients. Methods We performed a single-institution retrospective review of all patients with breast cancer over 18 years of age who underwent a mastectomy with or without immediate alloplastic breast reconstruction at JW Ruby Memorial Hospital from 2019-2022. Our primary objective was to determine the 30, 60, and 90-day readmission rates. Our secondary objective included an analysis of perioperative pain control variables to develop an enhanced recovery protocol. Data collected included age, ethnicity, prognostic factors, stage at diagnosis, surgical treatment, opioid and non-opioid based treatments pre- and postoperatively by milligram morphine equivalents (MMEs), comorbidities as analyzed by the Charlson comorbidity index (CCI) variables, and distance from the tertiary hospital. Results We identified thirty-two women between 2019-2022 who underwent same-day mastectomy at JW Ruby Memorial Hospital in Morgantown, West Virginia. The mean age was 55.4 years. The mean distance to the hospital was 22.1 miles with a maximum distance of 111 miles (SEM = 3.90). The mean CCI score was 2.9 (SEM = 0.51). Overall readmission rates at 30- 60- and 90-days were 6.3% (n = 2), 3.1% (n = 1) and 0%, respectively. One woman was readmitted eight days postoperatively from a unilateral mastectomy and sentinel lymph node biopsy without reconstruction for an expanding hematoma of the chest after resuming anticoagulation on postoperative day three. The other two patients were admitted for unrelated surgical reasons. Thus, readmission related to surgical complications alone was 3.1% (n = 1). Preoperatively, 90.6% (n = 29) of women received a local anesthetic block by the anesthesia provider. Neither a preoperative nor intraoperative block was given to the remaining three. Bilateral mastectomies occurred in 21.9% (n = 7) of women and 78.1% (n = 25) underwent unilateral mastectomy. Of these 32 women, 25.0% (n = 8) underwent immediate staged reconstruction with tissue expanders. There were no direct-to-implant reconstructions in this population. There were twenty-six sentinel lymph node biopsies and four axillary dissections performed. The mean MMEs received for the duration of the hospital encounter was 132 (SEM = 23.4). An enhanced recovery after surgery protocol was not used. Discussion Outpatient mastectomy is a safe and effective option for eligible patients living in rural settings. Factors such as the type of mastectomy, reconstruction, the patient's overall health status, and the availability of support at home can impact the feasibility of this approach. Careful patient selection and a multidisciplinary team including the patient, surgeon, and anesthesiologist should carefully assess the individual’s circumstances to determine if outpatient mastectomy is appropriate. Implementation of enhanced recovery after surgery protocols will be further investigated and guided by this study. Citation Format: Gregory Stimac, Kristin Lupinacci, Michael Cowher, Hannah Hazard-Jenkins. Outpatient mastectomy is a safe surgical option for patients treated in a rural Appalachian tertiary facility [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-09-07.

The association of prehospital systemic corticosteroids with emergency department and in-hospital outcomes for patients with asthma exacerbations.

Timely administration of systemic corticosteroids is a cornerstone of asthma exacerbation treatment, yet little is known regarding potential benefits of prehospital administration by emergency medical services (EMS) clinicians. We examined factors associated with prehospital corticosteroid administration with hospitalization and hospital length of stay (LOS). We performed a retrospective study of EMS encounters for patients 2-50 years of age with suspected asthma exacerbation from a national data set. We evaluated factors associated with systemic corticosteroid administration using generalized estimating equations. We performed propensity matching based on service level, age, encounter duration, vital signs, and treatments to evaluate the association of prehospital corticosteroid administration with hospitalization and LOS using weighted logistic regression. We evaluated the association of prehospital corticosteroid administration with admission using Bayesian models. Of 15,834 encounters, 4731 (29.9%) received prehospital systemic corticosteroids. Administration of corticosteroids was associated with older age; sex; urbanicity; advanced life support provider; vital sign instability; increasing doses of albuterol; and provision of ipratropium bromide, magnesium, epinephrine, and supplementary oxygen. Within the matched sample, prehospital corticosteroids were not associated with hospitalization (odds ratio [OR] 0.86, 95% confidence interval [CI] 0.73-1.01) or LOS (multiplier 0.76, 95% CI 0.56-1.05). Administration of corticosteroids was associated with lower odds of admission and shorter LOS in longer EMS encounters (>34 min), lower admission odds in patients with documented wheezing, and shorter LOS among patients treated with albuterol. In a Bayesian model with noninformative priors, the OR for admission among encounters given corticosteroids was 0.86 (95% credible interval 0.77-0.96). Prehospital systemic corticosteroid administration was not associated with hospitalization or LOS in the overall cohort of asthma patients treated by EMS, though they had a lower probability of admission within Bayesian models. Improved outcomes were noted among subgroups of longer EMS encounters, documented wheezing, and receipt of albuterol.

Patient Time Spent With Professional Medical Interpreters and the Care Experiences of Patients With Limited English Proficiency.

More time spent with interpreters may support clinician-patient communication for patients with limited English proficiency (LEP), especially when interpreter support before and after clinical encounters is considered. We assessed whether more time spent with interpreters is associated with better patient-reported experiences of clinician-patient communication and interpreter support among patients with LEP. Patients with LEP (n = 338) were surveyed about their experiences with both the clinician and interpreter. Duration of interpreter support during the encounter (in min) and auxiliary time spent before and after encounters supporting patients (in min) were documented by interpreters. Multivariable linear regression models were estimated to assess the association of the time duration of interpreter support and patient experiences of (1) clinician-patient communication, and (2) interpreter support, controlling for patient and encounter characteristics. The average encounter duration was 47.7 min (standard deviation, SD = 25.1), the average auxiliary time was 43.8 min (SD = 16.4), and the average total interpreter time was 91.1 min (SD = 28.6). LEP patients reported better experiences of interpreter support with a mean score of 97.4 out of 100 (SD = 6.99) compared to clinician-patient communication, with a mean score of 93.7 out of 100 (SD = 14.1). In adjusted analyses, total patient time spent with an interpreter was associated with better patient experiences of clinician-patient communication (β = 7.23, P < .01) when auxiliary time spent by interpreters supporting patients before and after the encounter was considered, but not when only the encounter time was considered. Longer duration of time spent with an interpreter was associated with better clinician-patient communication for patients with LEP when time spent with an interpreter before and after the clinician encounter is considered. Policymakers should consider reimbursing health care organizations for time interpreters spend providing patient navigation and other support beyond clinical encounters.

Medication reconciliation by community pharmacists: an essential contribution to ensure continuity of care with regard to medications at hospital discharge.

Background: Collaboration and communication between hospital and ambulatory care is crucial to ensure continuity of care with regard to medications. However, electronic platforms to facilitate seamless care are often deficient and/or insufficiently integrated. Different Belgian chronic care projects (i.e. regional projects with support of the National Institute for Health and Disability Insurance to enhance integrated care) have therefore decided to implement the ‘green envelope’ as a way to transfer the therapy plan of the patient at discharge to the community pharmacy. The green envelope also contains the prescriptions for the patient, as well as an information letter for the pharmacist, including a QR-code to an online platform where the characteristics of the medication reconciliation, as performed by the community pharmacist, can be registered. The aim of this study was to analyze the findings registered by the pharmacists, as to have a clear idea on their contribution to continuity of care with regard to medications.&#x0D; Methods: A descriptive analysis was performed on the data registered by the community pharmacist during / after medication reconciliation.&#x0D; Results: In total, 1807 online surveys were completed by community pharmacists. The mean duration of the patient encounter in the pharmacy, which in more than three quarter of the cases took place on the day of discharge or the day thereafter, was 12,8 minutes (SD 6,933). Over 63% of patients discharged from hospital were aged +75; 52.4% was female. In about 68% of cases, another person than the patient presented him/herself at the pharmacy.&#x0D; About 74% of the patients had not visited the GP before presenting at the pharmacy; only 24% of patients had a planned appointment with the GP.&#x0D; In about 19% of the cases, the pharmacist discovered at least one medication discrepancy. Most frequently it concerned omitted medication, i.e. medication that was taken by the patient before admission, and for which it was unclear for the patient and pharmacist whether it had been stopped intentionally or not.&#x0D; The pharmacist noted in about 11% of cases at least one drug-related problem, mostly related to the choice or use of the drug. With regard to the choice of drug, it mostly concerned a lack of re-substitution to the molecule used by the patient at home; problems related to the use of the drug mostly referred to incorrect dosing or frequency, or incorrect way of administration.&#x0D; In about 15% of cases, the pharmacist contacted another HCP, mostly the GP. On the level of the patient, the intervention mostly consisted of extensive counselling.&#x0D; The final therapy plan was in less than 60% shared with other HCPs. Problems with the platforms used, and lack of collaboration, were mentioned as the most important reasons for not sharing.&#x0D; Conclusion: Our results show that pharmacists discover a relatively high number of medication discrepancies and drug related problems while performing medication reconciliation at discharge. Their alertness, engagement to contact other HCPs and talk to the patients and their relatives undoubtedly contribute to a safe transfer of patients from the hospital to home.&#x0D;

Supporting complex oncology workflows with telemedicine.

521 Background: Telemedicine is now foundational in health care, including oncology. Cancer care is complex and requires an integrated care model that involves multiple participants. The use of telemedicine in oncology requires careful consideration of workflows and patients’ needs. Our team reviewed existing telemedicine technology options, but none fit the needs of ongoing, complex cancer care delivery. We describe the development and implementation of a home-grown telemedicine system to support complex oncology workflows in an efficient and scalable manner at a high-volume specialty cancer center. Methods: Using an internally developed application, MSK Telemedicine, we created a technology-enabled workflow that mimicked the positive aspects of an in-person interaction for the patient, the clinician, and administrative staff. The patient (i) can invite friends and family to the visit, (ii) are notified when the clinician is running late, (iii) can join the visit without downloading special software, (iv) can receive visit reminders based on their preferences, (v) can engage with the telemedicine platform in multiple languages (vi) have translators join the call, (vi) provide research consents and participate in clinical trials virtually, and (vii) have multiple clinicians join the virtual visit. We assessed telemedicine volume, duration of the remote encounter, patient satisfaction and help desk measures from August 1, 2021 to May 31, 2023. Patients could provide feedback immediately after the visit using star ratings on a scale of 1-5, 5 being the highest score. After the first telemedicine visit using MSK Telemedicine, patients also had the opportunity to answer a comprehensive patient satisfaction questionnaire. Results: Telemedicine represented 28% of the outpatient visit volume. During the study period, the platform supported a total of 483,499 visits with 67% including more than 2 people. Clinicians requested translator services for 1,289 of visits (Nov 2022 – May 2023) and 25,411 reminders were sent in languages other than English. Patients provided 5,635 research consents. The overall patient satisfaction was 4.84 (n=53,902). Patients reported high ease of use (4.83), audio quality (4.83) and video quality (4.84). 90% of patients would recommend telemedicine to other patients and 91% would have another telemedicine visit with their provider (n=29,804). Over 96% of telemedicine calls lasted over 3 minutes, a proxy to identify successful visits. Since the implementation of the platform, the monthly number of patient calls to the help desk decreased significantly (from 1,691 in March 2022 to 585 in March 2023). Conclusions: The MSK Telemedicine system is an example of a high performing system that is successfully meeting the unique and complex needs of cancer care delivery while providing a seamless patient experience. Future research is underway to evaluate the impact of this system on additional patient and provider outcomes.

Does the duration of ambulatory consultations affect the quality of healthcare? A systematic review

BackgroundThe objective is to examine and synthesise the best available experimental evidence about the effect of ambulatory consultation duration on quality of healthcare.MethodsWe included experimental studies manipulating the length of...

Characterization of superspreaders movement in a bidirectional corridor using a social force model.

During infectious disease outbreaks, some infected individuals may spread the disease widely and amplify risks in the community. People whose daily activities bring them in close proximity to many others can unknowingly become superspreaders. The use of contact tracking based on social networks, GPS, or mobile tracking data can help to identify superspreaders and break the chain of transmission. We propose a model that aims at providing insight into risk factors of superspreading events. Here, we use a social force model to estimate the superspreading potential of individuals walking in a bidirectional corridor. First, we applied the model to identify parameters that favor exposure to an infectious person in scattered crowds. We find that low walking speed and high body mass both increase the expected number of close exposures. Panic events exacerbate the risks while social distancing reduces both the number and duration of close encounters. Further, in dense crowds, pedestrians interact more and cannot easily maintain the social distance between them. The number of exposures increases with the density of person in the corridor. The study of movements reveals that individuals walking toward the center of the corridor tend to rotate and zigzag more than those walking along the edges, and thus have higher risks of superspreading. The corridor model can be applied to designing risk reduction measures for specific high volume venues, including transit stations, stadiums, and schools.

Marine bird mass mortality events as an indicator of the impacts of ocean warming

The frequency and severity of marine heatwaves (MHWs), an emergent property of global warming, has led to large-scale disruptions to marine ecosystems. As upper trophic species, marine birds reflect shifts in trophic structure and stability; therefore, a sharp increase in marine bird mortality is a clear signal of ecosystem impact. In this study, we analyzed 29 yr (1993-2021) of beached bird monitoring data (~90000 surveys) to identify marine bird mortality events throughout the Northeast Pacific and Alaska, USA, and examined linkages to ocean-climate variability. Mortality events were documented throughout the study period, but massive events (&gt;500 km in extent, &gt;10 carcasses km-1) occurred infrequently (n = 5), with an unprecedented sequence from 2014-2019. Event characteristics, including encounter rate (carcasses km-1), duration, and spatial extent, were positively related to prior-year averaged sea surface temperature anomaly, with event magnitude (product of encounter rate, extent, and duration) displaying a step-like transition, increasing 5-fold between +0°C and +1°C above baseline (1981-2010) temperatures. Mortality events occurred more frequently following MHWs, and a common sequence of mortality events (at 1-6 and 10-16 mo after heatwave onset) was observed in the California Current large marine ecosystem following 3 prolonged MHW events. Following the second wave of mortality at 10-16 mo after MHW onset, a consistent 16 mo period of depressed carcass encounter rates ensued. Given continued global warming, our results point to more frequent large-scale mortality events and the potential for a new lower carrying capacity for marine birds in the Northeast Pacific.

Variation in foraging activity influences area-restricted search behaviour by bottlenose dolphins.

Area-restricted search (ARS) behaviour is commonly used to characterize spatio-temporal variation in foraging activity of predators, but evidence of the drivers underlying this behaviour in marine systems is sparse. Advances in underwater sound recording techniques and automated processing of acoustic data now provide opportunities to investigate these questions where species use different vocalizations when encountering prey. Here, we used passive acoustics to investigate drivers of ARS behaviour in a population of dolphins and determined if residency in key foraging areas increased following encounters with prey. Analyses were based on two independent proxies of foraging: echolocation buzzes (widely used as foraging proxies) and bray calls (vocalizations linked to salmon predation attempts). Echolocation buzzes were extracted from echolocation data loggers and bray calls from broadband recordings by a convolutional neural network. We found a strong positive relationship between the duration of encounters and the frequency of both foraging proxies, supporting the theory that bottlenose dolphins engage in ARS behaviour in response to higher prey encounter rates. This study provides empirical evidence for one driver of ARS behaviour and demonstrates the potential for applying passive acoustic monitoring in combination with deep learning-based techniques to investigate the behaviour of vocal animals.

Temporal novelty detection and multiple timescale integration drive Drosophila orientation dynamics in temporally diverse olfactory environments.

To survive, insects must effectively navigate odor plumes to their source. In natural plumes, turbulent winds break up smooth odor regions into disconnected patches, so navigators encounter brief bursts of odor interrupted by bouts of clean air. The timing of these encounters plays a critical role in navigation, determining the direction, rate, and magnitude of insects' orientation and speed dynamics. Disambiguating the specific role of odor timing from other cues, such as spatial structure, is challenging due to natural correlations between plumes' temporal and spatial features. Here, we use optogenetics to isolate temporal features of odor signals, examining how the frequency and duration of odor encounters shape the navigational decisions of freely-walking Drosophila. We find that fly angular velocity depends on signal frequency and intermittency-the fraction of time signal can be detected-but not directly on durations. Rather than switching strategies when signal statistics change, flies smoothly transition between signal regimes, by combining an odor offset response with a frequency-dependent novelty-like response. In the latter, flies are more likely to turn in response to each odor hit only when the hits are sparse. Finally, the upwind bias of individual turns relies on a filtering scheme with two distinct timescales, allowing rapid and sustained responses in a variety of signal statistics. A quantitative model incorporating these ingredients recapitulates fly orientation dynamics across a wide range of environments and shows that temporal novelty detection, when combined with odor motion detection, enhances odor plume navigation.

Dealing with sexually transmitted infections in private pharmacies in Morocco

Context: Sexually transmitted infections continue to be a health problem in many countries. The management of these infections requires the mobilization of all health actors. Aims: To evaluate the management of sexually transmitted infections at private pharmacies in a Moroccan city. Methods: The simulated patient technique was used. Thirty-six pharmacies were visited to determine how cases of vaginal discharge syndrome and genital ulceration were managed in practice. Results: Rural (18) and urban (18) pharmacies were surveyed. The pharmacies visited were often of moderate (58.3%) to low (27.8%) activity and the activity of the pharmacy was significantly different (p=0.045) during the visit for vaginal discharge or genital ulceration. The duration of visits was less than five minutes in the majority of cases (91.7%). The nature of the syndrome vary significantly affected encounter duration (p=0.000). The proposition of medication to the simulated patient was carried out by 75% of the pharmacists/vendors (X = 3.36; σ = 0.860) and the type of syndrome very significantly affected the proposed management (p=0.009). The average prescription price was 298.32 dirhams per visit (σ = 39.353). None of the cases of genital ulceration or vaginal discharge were offered treatment that perfectly matched the protocol used by the Moroccan Ministry of Health. Conclusions: In the face of microbial resistance to antibiotics, sexually transmitted infections must be managed in the best conditions. In the future, studying the knowledge of these actors and proposing training on treatment protocols for sexually transmitted infections could contribute to the fight against these infections in this city.

Sândi Vocálico Externo no Português Vernacular Santomense / External Vocalic Sandhi in Santomean Popular Portuguese

This paper describes three processes of external vowel sandhi — degemination (DG), elision (EL), and diphthongization (DT) — in São Tomé Vernacular Portuguese (PST). All three processes are found in PST: 32% DG; 36% EL; 52.5% DT. Working with six Santomean informants, we analyzed a corpus of 113 sentences with vowel encounters in word boundaries (V#V). Then, we measured the duration of vowel encounters or the single resulting vowel when the encounter was undone. Factors such as the nature of the prosodic boundaries (phonological word, phonological phrase, and intonational phrase), prosodic stress (lexical and phonological word), and vowel quality are crucial to implementing sandhi processes. However, they occur in different prosodic settings: diphthongization occurs between intonation phrases (IP+IP) as long as their boundary is not limited by a pause. In contrast, elision and degemination occur in phonological word boundaries (ω + ω) and phonological phrase boundaries (ϕ + ϕ). The prominence of the phonological phrase was the preponderant factor in preventing all processes, blocking degemination whenever phonological phrase stress matches with a stressed second vowel. For elision and diphthongization, sandhi was blocked when two stressed vowels co-occurred with the stress of a phonological phrase.

Parker Solar Probe Encounters the Leg of a Coronal Mass Ejection at 14 Solar Radii

We use Parker Solar Probe (PSP) observations to report the first direct measurements of the particle and field environments while crossing the leg of a coronal mass ejection (CME) very close to the Sun (∼14 Rs). An analysis that combines imaging from 1 au and PSP with a CME model, predicts an encounter time and duration that correspond to an unusual, complete dropout in low-energy solar energetic ions from H–Fe, observed by the Integrated Science Investigation of the Sun (IS⊙IS). The surrounding regions are populated with low-intensity protons and heavy ions from 10s to 100 keV, typical of some quiet times close in to the Sun. In contrast, the magnetic field and solar wind plasma show no similarly abrupt changes at the boundaries of the dropout. Together, the IS⊙IS energetic particle observations, combined with remote sensing of the CME and a dearth of other “typical” CME signatures, indicate that this CME leg is significantly different from the magnetic and plasma structure normally assumed for CMEs near the Sun and observed in interplanetary CMEs farther out in the solar wind. The dropout in low-energy energetic ions may be due to the cooling of suprathermal ions at the base of the CME leg flux tube, owing to the rapid outward expansion during the release of the CME.

Review of Patient Outcomes After Referral to OT Embedded Within a Primary Care Practice.

Context: Interprofessional teams can reduce workload of primary care providers (PCP). Currently, there is no standardization regarding which professionals should be on the team. We completed a 2 year pilot imbedding an occupational therapist (OT) within a family medicine team. Our initial findings showed significant satisfaction among PCPs. This current study further analyses the outcomes from this pilot. Objective: To examine the treatment plans and corresponding outcomes for all patients that were seen by an OT in order to assess the impact on patients of integrating OT into a primary care setting. Study Design: We performed a retrospective chart review of all adult patients that were referred to OT during an office visit over a period of 23 months. Setting: Department of Family Medicine, Mayo Clinic AZ. Population: Consecutive patients 18 yrs or older referred to OT by a PCP within the designated family medicine clinic between 01/02/2020 and 11/30/2021. Intervention: A novel pilot program imbedding OT within a family medicine team was initiated in January 2020. Patients are referred to an embedded OT during an office visit with their PCP. Whenever possible, a warm hand-off was performed to facilitate the referral. Results: Total of 776 patients were referred to OT. 64.1% were female. Mean age 62.9 years. Insurance: 46% Medicare, 46.4% commercial. 7.2% both. Mean encounter duration: 35.17 minutes. Patients were referred for a variety of diagnoses including balance and movement disorders, musculoskeletal pain, dizziness /vertigo and neuropathy. A majority of patients, 84.21%, reported either partial (30.24%) or complete (54%) improvement. Only 2.9% did not improve, while 12.9% were lost to follow up. 59.7% of patients required a one time treatment, 40.1% were referred for further treatment outside the department (OT or PT). Conclusions: Imbedding OT within a primary care team resulted in partial or complete improvement of symptoms in 84.21% of patients with a variety of diagnoses. A majority of patients required only 1 treatment. Both Medicare and commercial insurance plans were successfully billed for OT services. Learning Objectives: OT imbedded within a primary care team can result in efficient and successful treatment of a wide variety of patient complaints. OT services embedded within a primary care team are reimbursable by Medicare and commercial insurance plans. Research Category: Original research Study Design: Retrospective chart review.

Providing sexual and reproductive health services to migrants in Southern Sweden: a qualitative exploration of healthcare providers’ experiences

BackgroundWhile a large body of research has focused on the challenges experienced by healthcare staff when providing sexual and reproductive health services, little attention has been paid to the ways healthcare providers navigate these challenges. This study examined healthcare providers’ accounts of encounters when providing sexual and reproductive health (SRH) services to migrants in Southern Sweden. It sought to examine challenges and dilemmas experienced by healthcare providers, strategies used to navigate these challenges and dilemmas, and assumptions underlying participants’ accounts.MethodsThe data collection was conducted between September 2020 and March 2021. Qualitative thematic analysis was used to analyze thirty-one interviews with healthcare providers working in youth clinics and women healthcare clinics. The analysis was guided by a conceptual framework combining person-centered care approach, Foucault’s concepts on power/knowledge, and theories to navigate diversity in healthcare setting: cultural competency and cultural humility.ResultsThree themes were identified in the analysis: 1) Between person centeredness and cultural considerations; 2) Knowledge positions and patient involvement; and 3) beyond the dyadic interaction healthcare provider-patient.Some participants understood person-centered care as individualized care where the influence of culture on the encounter should be de-emphasized, whereas others tended to highlight this influence. Many participants viewed the influence of culture as primarily driven by migrants’ cultural backgrounds, and as a source of challenges and dilemmas. Participants’ strategies to navigate these perceived challenges and dilemmas included practicing cultural humility and seeking cultural competency.Knowledge positions also emerged as an important aspect of participants’ accounts of encounters with migrants. Many participants experienced that migrant patients were lacking knowledge about the body and sexuality. This disadvantaged knowledge position affected migrant involvement in care.Additionally, the study shows how participants placed their experiences in a broader organizational and social context. Participants highlighted several organizational challenges to encountering migrants and discussed dilemmas stemming from the interplay between migrants’ structural and individual disadvantages.ConclusionsThe study findings illuminate the complex links between person-centered care and two important dimensions of the encounters with migrants: culture and knowledge positions. They also shed the light on the organizational and structural challenges surrounding these encounters. These findings suggest that multilevel strategies are needed to improve the quality of encounters when providing SRH services to migrants. These strategies could include ensuring universal access to SRH services to migrants, adjusting the encounter duration when interpretation is needed, and providing necessary resources to healthcare providers to build their structural competency.

Abstract 9623: Shared Decision Making for Atrial Fibrillation: An Overview of Seven Studies Within an Encounter - Randomized Trial

Introduction: Shared decision-making (SDM) about anticoagulant treatment in patients with atrial fibrillation (AF) is widely recommended but its effectiveness is unclear. We assessed the extent to which using an SDM tool promotes high-quality SDM. Hypothesis: SDM will improve communication quality, knowledge, and decisional conflict and will translate to improved medication adherence and outcomes. Methods: In this multicentre encounter-randomized trial, we included patients with nonvalvular AF considering starting/reviewing anticoagulation, and their clinicians. We compared usual care with or without ANTICOAGULATION CHOICE, an SDM conversation tool for use during the clinical encounter that presents individualized risk estimates and compares anticoagulation options across patient important issues. Results: We enrolled and video-recorded 922 patient-clinician encounters. So far, our data have shown that participants in both arms reported near-optimal communication quality, knowledge, and decisional conflict (JAMA IM-2020). Patients in intervention-arm estimated their stroke risks more accurately and were more involved in decision-making (JAMA IM-2020), clinicians were more satisfied (JAMA IM-2020), and cost conversation were more common (JAMA NO-2021). Use of the intervention had no effect on treatment decisions, encounter duration (JAMA IM-2020), treatment adherence, clinical outcomes (JAHA-epub) or patient-perceived sense of the care plan (PEC-epub). New analyses have shown that compared to eligible white participants, black participants more frequently did not enrol to the study. Enrolment of Black, indigenous, and people of colour benefited most form including and prioritizing practices most likely to care for them. We found no evidence of contamination (tool use, functional, or learned) between study arms. Conclusions: Use of an SDM tool improved some measures of SDM quality, without affecting treatment decisions and their sensibility, encounter duration, patient adherence, or clinical outcomes. Our results should calibrate expectations as to what could be accomplished by implementing SDM tools about anticoagulation in the care of patients with AF

Characteristics of Emergency Room and Hospital Encounters Resulting From Consumer Home Monitors.

Consumer home monitors (CHM), which measure vital signs, are popular products marketed to detect airway obstruction and arrhythmia. Yet, they lack evidence of infant death prevention, demonstrate suboptimal accuracy, and may result in false alarms that prompt unnecessary acute care visits. To better understand the hospital utilization and costs of CHM, we characterized emergency department (ED) and hospital encounters associated with CHM use at a children's hospital. We used structured query language to search the free text of all ED and admission notes between January 2013 and December 2019 to identify clinical documentation discussing CHM use. Two physicians independently reviewed the presence of CHM use and categorized encounter characteristics. Evidence of CHM use contributed to the presentation of 36 encounters in a sample of over 300 000 encounters, with nearly half occurring in 2019. The leading discharge diagnoses were viral infection (13, 36%), gastroesophageal reflux (8, 22%) and false positive alarm (6, 17%). Median encounter duration was 20 hours (interquartile range: 3 hours to 2 days; max 10.5 days) and median cost of encounters was $2188 (interquartile range: $255 to $7632; max $84 928). Although the annual rate of CHM-related encounters was low and did not indicate a major public health burden, for individual families who present to the ED or hospital for concerns related to CHMs, there may be important adverse financial and emotional consequences.

Nursing Workflow Change in a COVID-19 Inpatient Unit Following the Deployment of Inpatient Telehealth: Observational Study Using a Real-Time Locating System.

BackgroundThe COVID-19 pandemic prompted widespread implementation of telehealth, including in the inpatient setting, with the goals to reduce potential pathogen exposure events and personal protective equipment (PPE) utilization. Nursing workflow adaptations in these novel environments are of particular interest given the association between nursing time at the bedside and patient safety. Understanding the frequency and duration of nurse-patient encounters following the introduction of a novel telehealth platform in the context of COVID-19 may therefore provide insight into downstream impacts on patient safety, pathogen exposure, and PPE utilization.ObjectiveThe aim of this study was to evaluate changes in nursing workflow relative to prepandemic levels using a real-time locating system (RTLS) following the deployment of inpatient telehealth on a COVID-19 unit.MethodsIn March 2020, telehealth was installed in patient rooms in a COVID-19 unit and on movable carts in 3 comparison units. The existing RTLS captured nurse movement during 1 pre- and 5 postpandemic stages (January-December 2020). Change in direct nurse-patient encounters, time spent in patient rooms per encounter, and total time spent with patients per shift relative to baseline were calculated. Generalized linear models assessed difference-in-differences in outcomes between COVID-19 and comparison units. Telehealth adoption was captured and reported at the unit level.ResultsChange in frequency of encounters and time spent per encounter from baseline differed between the COVID-19 and comparison units at all stages of the pandemic (all P<.001). Frequency of encounters decreased (difference-in-differences range –6.6 to –14.1 encounters) and duration of encounters increased (difference-in-differences range 1.8 to 6.2 minutes) from baseline to a greater extent in the COVID-19 units relative to the comparison units. At most stages of the pandemic, the change in total time nurses spent in patient rooms per patient per shift from baseline did not differ between the COVID-19 and comparison units (all P>.17). The primary COVID-19 unit quickly adopted telehealth technology during the observation period, initiating 15,088 encounters that averaged 6.6 minutes (SD 13.6) each.ConclusionsRTLS movement data suggest that total nursing time at the bedside remained unchanged following the deployment of inpatient telehealth in a COVID-19 unit. Compared to other units with shared mobile telehealth units, the frequency of nurse-patient in-person encounters decreased and the duration lengthened on a COVID-19 unit with in-room telehealth availability, indicating “batched” redistribution of work to maintain total time at bedside relative to prepandemic periods. The simultaneous adoption of telehealth suggests that virtual care was a complement to, rather than a replacement for, in-person care. However, study limitations preclude our ability to draw a causal link between nursing workflow change and telehealth adoption. Thus, further evaluation is needed to determine potential downstream implications on disease transmission, PPE utilization, and patient safety.