Enhance Patient Experience Research Articles

Value-Based Care: An Executive Briefing

In today’s challenging health care environment, the paradigm shift from volume to value requires nurse leaders to develop enhanced skills to transform health care in 2020. Key drivers for success include: igniting innovation and change; embracing data and analytics; and launching new care delivery models that soar beyond organizational boundaries. Value-based care is here to stay, and nursing must be the catalyst for change. Equipped with new skills and the knowledge of CMS Pay for Performance programs, nurse leaders will design the future health care landscape.

Virtual volunteers: the importance of restructuring medical volunteering during the COVID-19 pandemic

Healthcare systems have postponed medical volunteering services in response to the COVID-19 pandemic. However, much of the aid provided by these volunteers is crucial to patient care and hospital functioning...

P64 Implementation of a paediatric outpatient parenteral antibiotic therapy (p-OPAT) service at a specialist children’s hospital

AimThe aim of this project is to optimise patient care, enhance patient experience, improve antimicrobial stewardship and assist patient flow through the hospital.MethodData collection was conducted one day a week over five consecutive weeks. All eligible wards were visited. Patient medication charts were inspected to see if intravenous antimicrobials were prescribed and a patient - specific data collection form was then completed. All the patients that met the eligibility criteria to be put forward for OPAT referral were then considered from a clinical perspective by a paediatric consultant as to their suitability for OPAT or IVOST and discharge. If the patient was deemed suitable for an OPAT discharge or IVOST and discharge a decision was made as to what antimicrobials they would theoretically have been on when discharged home. The number of potential bed days saved was calculated as the number of days between the patients review by the consultant (ie the day of data collection) and the date of their discharge prescription from that episode of care.The following was examinedpercentage of patients with identified pathogenspercentage of patients that had received input from the ID teampercentage of patients that had received input from microbiologythe prevalence of antimicrobials prescribedthe location of the patient’s home residencepatient/parent willingness to go home on OPAT.The data for patient numbers and bed day savings was then extrapolated to 52 weeks in order to be indicative of one year.ResultsOver the five days, 66 patients were identified that met the exclusion criteria to be referred for OPAT or IVOST. After clinical consideration the consultant deemed 4 patients to be suitable for OPAT and 19 for IVOST and discharge which generated a potential bed day saving of 38 bed days. This was comprised of 17 days through providing IVAs via OPAT and 21 days from timelier IVOST and discharge of patients. Extrapolated to be representative of one year, this would be a bed saving to the Trust of 1, 976 bed days.ConclusionThe potential has been identified for the hospital to make considerable bed day savings through the investment in an extended antimicrobial stewardship programme and establishment of a paediatric OPAT service. A business case has been submitted to the hospital board for consideration, with the hope that the service will be funded for a six month probationary period in order to assess its impact over the winter months, when demand for beds and pressures on PICU and theatres are highest.ReferencesPatel S, et al. 2015. Good practice recommendations for paediatric outpatient parenteral antibiotic therapy (p-OPAT) in the UK: a consensus statement. Journal of Antimicrobial Chemotherapy2015;702:360–373.Carter B, et al. Delivery, setting and outcomes of paediatric outpatient parenteral antimicrobial therapy (OPAT): a scoping review. BMJ Open, 2018;8:e021603.Hodgson KA, et al. The use, appropriateness and outcomes of outpatient parenteral antimicrobial therapy. Archives of Disease in Childhood, 2016:10:886–893.Knackstedt ED, et al. Outpatient parenteral antimicrobial therapy in pediatrics: an opportunity to expand antimicrobial stewardship. Infection Control & Hospital „Epidemiology 2015:36:222–224.

Loss of patient centeredness in interpreter-mediated primary care visits

ObjectivesTo explore consequences of interpreter mediation of visit communication on patient centered dialogue and patient satisfaction with interpreter listening. MethodsFifty-five professionally interpreted primary care visits were coded using the Roter Interaction Analysis System (RIAS). Two corresponding quantitative measures of patient-centered dialogue were calculated as ratios of psycho-emotional to biomedical statements based on (1) patient and clinician expressed codes and (2) interpreter conveyed codes. Multilevel models examined consequences of interpreter mediation on patient-centered dialogue and patient ratings of interpreter listening. ResultsStudy participants included 27 Cantonese, 17 Mandarin and 11 Spanish-speaking primary care patients and 31 of their clinicians. Overall, clinicians expressed 2.26 times more statements and patients expressed 1.74 times more statements than interpreters conveyed. Interpreters conveyed significantly less patient-centered dialogue than expressed by patients and clinicians. All differences were evident within each study language. Interpreter conveyed patient centered dialogue positively predicted patient ratings of interpreter listening (B = 0.817; p < .007). ConclusionsThe level of interpreter-conveyed patient-centered dialogue was both substantially lower than that expressed by patients and clinicians and a positive predictor of patient satisfaction with interpreter listening. Practice implicationsFuller interpretation of patient-centered dialogue may enhance patient experience with interpreters and thereby increase care quality.

Nursing leadership during COVID-19: Enhancing patient, family and workforce experience

The global COVID-19 pandemic has challenged nurse leaders in ways that one could not imagine six months ago. Along with ongoing priorities of providing high quality, cost-effective and safe care, nurse leaders are also committed to creating environments that support excellence in patient and family experience. This article will provide exemplars of how nurse leaders used decisive decision-making, adapted to novel situations and issues, ensured reliable and safe delivery of care and engaged patients, families and their workforce to create excellent experiences of care during the pandemic. Throughout this crisis, nurse leaders have learned how to grapple with quick and often uncertain decision-making, adapted ways to engage patient and family amidst new care situations and operational policies, delivered care reliably with ever changing metrics and measures and created environments to support and bring smiles to nurses and other health care staff. New opportunities to care for and positively engage patients and families have emerged.

Synthesizing Multiple Stakeholder Perspectives on Using Virtual Reality to Improve the Periprocedural Experience in Children and Adolescents: Survey Study.

BackgroundVirtual reality (VR) technology is a powerful tool for augmenting patient experience in pediatric settings. Incorporating the needs and values of stakeholders in the design of VR apps in health care can contribute to better outcomes and meaningful experiences for patients.ObjectiveWe used a multiperspective approach to investigate how VR apps can be designed to improve the periprocedural experiences of children and adolescents, particularly those with severe anxiety.MethodsThis study included a focus group (n=4) and a survey (n=56) of clinicians. Semistructured interviews were conducted with children and adolescents in an immunization clinic (n=3) and perioperative setting (n=65) and with parents and carers in an immunization clinic (n=3) and perioperative setting (n=35).ResultsQualitative data were examined to determine the experience and psychological needs and intervention and design strategies that may contribute to better experiences for children in three age groups (4-7, 8-11, and 12-17 years). Quantitative data were used to identify areas of priority for future VR interventions.ConclusionsWe propose a set of ten design considerations for the creation of future VR experiences for pediatric patients. Enhancing patient experience may be achieved by combining multiple VR solutions through a holistic approach considering the roles of clinicians and carers and the temporality of the patient’s experience. These situations require personalized solutions to fulfill the needs of pediatric patients before and during the medical procedure. In particular, communication should be placed at the center of preprocedure solutions, while emotional goals can be embedded into a procedure-focused VR app to help patients shift their focus in a meaningful way to build skills to manage their anxiety.

Preparing the clinicians of tomorrow: Weaving integrated care across doctor of nursing practice education

In today’s changing landscape of health care, integrated health care is essential for best patient outcomes. The number of people with psychiatric conditions in the United States today is staggering, but only half of these people will receive treatment for their condition. By effectively integrating psychiatric and primary health care patients can be connected to appropriate and necessary services that meet the Triple Aim of enhancing patient experience of care while achieving population health goals in a cost-effective manner. Incorporating integrated health care experiences in a DNP program can position future practice leaders to take on these challenges. Guided by DNP essentials and the National Organization of Nurse Practitioner Faculty competencies, integrated health care concepts were weaved across the DNP curriculum. Including robust academic experiences treating mental health conditions in primary care and integrated settings can increase the confidence and effectiveness of clinicians who identify, manage, and refer patients with mental health concerns. Increasing the number of doctorally prepared nurses who are educated in integrated health care helps improve clinical outcomes while transforming the health care landscape.

In Case You Haven't Heard…

Findings from a survey of 1,000 patients, ages 18 to 65 or older, about their virtual care experiences during the COVID‐19 pandemic published in the Patient Perspectives on Virtual Care report found that nearly three‐quarters of respondents engaged in their first virtual care visit ever during the initial surge of COVID‐19 cases in the United States. Over 75% were very or completely satisfied with their virtual care experiences. However, the results also suggest that health care organizations have an opportunity to enhance patient experience, acquisition and retention by making virtual care scheduling and follow‐up more seamless, The Associated Press reported June 24. The survey examined patients' experiences accessing virtual care, their sentiment around the visits themselves and their demand for virtual care in the future. Not only did the majority of respondents rate their experiences with virtual care positively, but 50% also indicated they would be willing to switch providers to have virtual visits on a regular basis. Kyruus, an organization that helps health systems match patients with the right providers, engaged Wakefield Research to conduct the survey between February and May of 2020.

Using Long Short-Term Memory (LSTM) Neural Networks to Predict Emergency Department Wait Time.

Emergency Department (ED) overcrowding is a major global healthcare issue. Many research studies have been conducted to predict ED wait time using various machine learning prediction models to enhance patient experience and improve care efficiency and resource allocation. In this paper, we used Long Short-Term Memory (LSTM) recurrent neural networks to build a model to predict ED wait time in the next 2 hours using a randomly generated patient timestamp dataset of a typical patient hospital journey. Compared with Linear Regression model, the average mean absolute error for the LSTM model is decreased by 9.7% (3 minutes) (p < 0.01). The LSTM model statistically outperforms the LR model, however, both models could be practically useful in ED wait time prediction.

Understanding Reasons for Treatment Discontinuation, Attitudes and Education Needs Among People Who Discontinue Type2 Diabetes Treatment: Results from an Online Patient Survey in the USA and UK.

IntroductionType 2 diabetes mellitus (T2DM) requires long-term treatment to achieve and maintain glycaemic control; however, up to 50% of people with T2DM discontinue treatment by 1 year. It is therefore important to understand the patient perspective of therapeutic adherence and persistence.MethodsAn online questionnaire was presented to people with T2DM in the USA and UK on PatientLive®, a platform of Carenity, an online patient community. Those who discontinued at least one T2DM treatment within the last 6 months answered open-ended questions aimed to assess the reasons for discontinuation, how discontinuation could have been prevented, and what would have improved the experience with the discontinued treatment. Thematic qualitative analysis was performed on respondents’ answers to these questions.ResultsOral antidiabetics were the most commonly discontinued treatments (93/161), followed by insulin (40/161) and glucagon-like peptide 1 receptor agonists (13/161). Main reasons for treatment discontinuation overall were side effects (57/161), mostly gastrointestinal side effects and weight gain. The second most reported reason was drug efficacy issues (42/161). Key factors stated to prevent discontinuation were an improved care pathway (45/161) and more efficacious treatments with fewer side effects (41/161). In the USA, treatment cost played an important role in discontinuation (14/89) and discontinuation prevention (12/89). More information about T2DM and associated treatments (56/161), help with T2DM management (24/161), and increased and informative patient–physician interaction (12/161) would have been helpful for many respondents in both countries, while some patients noted that no additional information would have been useful to improve their understanding and experience with their T2DM treatment (64/161).ConclusionsThese results emphasise the need for focused medical education and improved communication to enhance patient experience and prevent treatment discontinuation. Understanding of attributes preferred by people with T2DM can help improve therapeutic adherence and outcomes with current medications, and guide development of future therapies.

2182-PUB: Feasibility of Extended Calibration Intervals with a Long-Term, Implantable CGM System

Background: Continuous Glucose Monitoring (CGM) technology has improved glycemia in people with diabetes. However, user burden including frequent calibration, and reinsertion of short-term devices limits adoption of this technology. Aim: Our objective was to retrospectively analyze CGM data from a fully implanted prototype sensor to assess feasibility of an extended calibration interval. Methods: The Eclipse® ICGM® System was surgically inserted in the lower abdomen, superficial to the rectus muscle sheath (Figure 1) in 6 adults with T1 diabetes, Mean (SD) age 42(12) years; 33% Females, HbA1c 7.1% (1.2)%/54(13) mmol/mol. For 6 months participants self-monitored blood glucose 4 times/day and wore a Dexcom G5 CGM. In addition, monthly clinic visits include meal-tests with frequent sampling YSI plasma glucose for paired analyses. Analyses of investigational device CGM data was retrospective against benchmark measurements. Results: There were no device associated adverse events. Data from three participants demonstrate intervals of 30, 48 and 85 days between calibrations without impacting overall performance. Preliminary measures show clinically relevant accuracy of &amp;gt;95 % within the A+B ranges. Conclusion: Interim data supports extended interval calibration for the fully implanted prototype Eclipse® ICGM® System which holds promise of CGM with fewer device interactions and enhanced patient experience. Disclosure P. Gupta: Employee; Self; GlySens Incorporated. A. Butler: Employee; Self; GlySens Incorporated. K. Bertsch: None. H. Jones: None. M.H. Lee: Research Support; Self; Medtronic. Speaker’s Bureau; Self; AstraZeneca, Medtronic. V.R. Obeyesekere: None. S.L. Martha: None. A. Jenkins: Advisory Panel; Self; Abbott, Medtronic. Research Support; Self; Abbott, GlySens Incorporated, Medtronic, Sanofi-Aventis. D.N. ONeal: None.

2232-PUB: Reasons for Treatment Discontinuation in Type 2 Diabetes (T2D): Results from an Online Patient Survey in the UK and U.S.

T2D is a chronic condition that requires long-term treatment to achieve and maintain glycemic control. However, up to 50% of people with T2D discontinue treatment by 1 year. To better understand why this occurs, an online questionnaire was presented to people with T2D in the UK (n=72) and U.S. (n=89) on the PatientLive® platform of Carenity, a global online patient community. For those who discontinued at least one of their T2D treatments within the last 6 months, open-ended questions aimed to assess the reasons why, how it could have been prevented, and what would have improved the experience with the discontinued treatment. Thematic qualitative analysis was performed on respondents’ answers to these open-ended questions. Overall, oral antidiabetics were the most commonly discontinued treatment type (93/161), followed by insulin (40/161) and other injectable antidiabetics (13/161). The most common reasons for treatment discontinuation were side effects (57/161), mostly gastrointestinal side effects and weight gain. Drug efficacy issues were the second most reported reason (42/161). In the U.S., cost of treatment played an important role (14/89). For the respondents, key factors to prevent discontinuation would have been an improved care pathway (45/161) and more efficacious treatments with fewer side effects (41/161). In the U.S., a lower price was also noted as an improvement factor (12/89). More information about T2D and associated treatments (56/161), help on how to manage T2D (24/161), and better informing of doctors of patients’ needs (12/161) would have been helpful for many respondents in both the UK and U.S. Notably, however, many respondents confirmed that they were sufficiently informed (64/161). These results emphasize the need for focused education and improved communication to enhance patient experience and prevent treatment discontinuation, and highlight the importance of therapies with attributes preferred by people with T2D that better fit their needs. Disclosure A. Roborel de Climens: Employee; Self; Sanofi. E. Pain: Consultant; Self; Sanofi. A.H. Boss: Employee; Self; Sanofi. Stock/Shareholder; Self; Novo Nordisk Inc., Sanofi. A. Shaunik: None. Funding Sanofi

Advancing evidence-based healthcare facility design: a systematic literature review.

Healthcare facility design is a complex process that brings together diverse stakeholders and ideally aligns operational, environmental, experiential, clinical, and organizational objectives. The challenges inherent in facility design arise from the dynamic and complex nature of healthcare itself, and the growing accountability to the quadruple aims of enhancing patient experience, improving population health, reducing costs, and improving staff work life. Many healthcare systems and design practitioners are adopting an evidence-based approach to facility design, defined broadly as basing decisions about the built environment on credible and rigorous research and linking facility design to quality outcomes. Studies focused on architectural options and concepts in the evidence-based design literature have largely employed observation, surveys, post-occupancy study, space syntax analysis, or have been retrospective in nature. Fewer studies have explored layout optimization frameworks, healthcare layout modeling, applications of artificial intelligence, and layout robustness. These operations research/operations management approaches are highly valuable methods to inform healthcare facility design process in its earliest stages and measure performance in quantitative terms, yet they are currently underutilized. A primary objective of this paper is to begin to bridge this gap. This systematic review summarizes 65 evidence-based research studies related to facility layout and planning concepts published from 2008 through 2018, and categorizes them by methodology, area of focus, typology, and metrics of interest. The review identifies gaps in the existing literature and proposes solutions to advance evidence-based healthcare facility design. This work is the first of its kind to review the facility design literature across the disciplines of evidence-based healthcare design research, healthcare systems engineering, and operations research/operations management. The review suggests areas for future study that will enhance evidence-based healthcare facility designs through the integration of operations research and management science methods.

Efficacy of Point-of-Care for INR Testing Compared to Standard Laboratory Methods at a Tertiary Care Hospital in Saudi Arabia.

Regular testing of the international normalized ratio (INR) is essential for people taking vitamin K antagonists as part of anticoagulation therapy. This study was undertaken to ascertain the efficacy of point-of-care testing (POCT)-INR versus conventional core laboratory testing in terms of result adequacy, waiting-time reduction, and patient satisfaction enhancement at the thrombosis clinic of the outpatient Medical Specialties Department in King Fahad Medical City, Saudi Arabia. The study was conducted prospectively for 6 months (from June 2017 to December 2017) on 182 eligible participants out of 250 entitled patients who were attending the thrombosis clinic for warfarin dose adjustment and who fulfilled all the prerequisites for performing dual testing by fingerstick at the clinic and venipuncture by the core laboratory. The data-capturing template created on Microsoft Excel recorded turnaround times (TATs), clinical concordance of INR result variables by POCT, and laboratory methods. Individual patient experience was recorded to gauge satisfaction rate, and all the data were analyzed statistically. Of 182 patients included in the study, overall good concord was observed between POCT whole blood and laboratory plasma INR results with median bias of 0.07 and 92.3% agreement using acceptability criteria for clinical concordance of Clinical Laboratory Standards Institute (CLSI) 14-A and International Standards Organization (ISO) 17593-2007, respectively. Marked improvement in terms of patient's time spent at the clinic was noted, with substantial reduction from 180 to ∼30 minutes (p < 0.001). Survey questionnaire responses indicated that POCT of INR was highly convenient and enhanced patient experience in terms of shorter wait time, minimal invasive procedures, and immediate result availability (p < 0.001). Predominantly, participants (75.4%) endorsed and expressed a strong preference for the POCT procedure over conventional laboratory testing. Whole blood INR testing for warfarin dose adjustment with validated POCT devices is adequately comparable to the core laboratory results. It also simplifies workflow steps at the thrombosis clinic, enhancing patient experience and convenience via the immediate availability of results, a less invasive procedure, and a marked reduction in waiting time. However, caution is needed with regard to higher INR results (≥4.7), which call for core laboratory confirmation.

Communication of Medication Nonmedical Switching Policies and Procedures by Insurance Companies: Results of an E-Survey

PurposeNonmedical switching is defined as a change in a stable patient's prescribed medication to a clinically distinct, nongeneric alternative for reasons other than lack of clinical response, adverse effects, or poor adherence. Nonmedical switching often results from formulary changes implemented by insurers to lower medication costs. We sought to survey randomly sampled physicians to elicit their opinions regarding insurers' communication about nonmedical switching. MethodsWe performed an online, cross-sectional survey of licensed, practicing physicians who were >2 years but <30 years out of residency and/or fellowship, who practiced in an internal medicine, family medicine, or specialist setting, spent ≥10% of their work time providing direct patient care, and had received at least 1 request for a nonmedical switch for ≥1 patient in the prior 12 months. The survey was fielded from November to December 2018. We report weighted percent responses categorized from 5- or 7-point Likert scale questions. FindingsE-mail invitations were sent to 13,117 randomly sampled physicians, and 1818 opened the e-mail and followed the embedded survey link to participate. Of these, 1010 total physicians (55.5%), 606 primary care and 404 specialists, who treated patients experiencing nonmedical switching in the prior 12 months completed the survey. A few physicians were notified about nonmedical switches by insurers; more frequently physicians learned about them from pharmacies serving their patients. Notification frequently occurred at or after a refill came due. Notification via electronic medical record or insurer letter was less frequent. Few thought that insurers clearly communicated information about alternative medications when a nonmedical switch was required, and most disagreed that insurers provided clear procedures, timelines, and methods to track challenges. Nearly all agreed that insurers should provide supporting documentation or rationale for nonmedical switches and specifics on alternatives. Respondents overwhelmingly agreed that steps to improve communication and physicians' and patients’ ability to navigate nonmedical switches or challenge procedures should be implemented. ImplicationsThis survey of primary care and speciality physicians suggests that physicians believe that insurers’ current level of communication regarding nonmedical switching is suboptimal. Respondents suggested that insurers did not optimally communicate information about alternative medications when a nonmedical switch was required and did not provide clear procedures, timelines, and methods to track challenges. A preponderance of physicians agreed that steps to improve physician-insurer communication to aid in the navigation of nonmedical switch and to challenge procedures should be implemented. If not addressed, these identified nonmedical switch communication issues may have a negative effect on achieving the quadruple aim of enhancing patient experience, improving population health, reducing costs, and improving the work life of health care practitioners and their staff.

Trends in Patient-Centered Care in South West Nigeria: A Holistic Assessment of the Nurses Perception of Primary Healthcare Practice

BACKGROUND: A key dimension of a quality healthcare to patients is patient-centered care approach which is increasingly gaining recognition worldwide. However, this concept is not fully implemented in practice.&#x0D; &#x0D; AIM: The aim of this study is to provide outcomes from assessment of nurses&amp;rsquo; perceptions about patient-centered care and the current trends in Primary Health Care system in South West Nigeria.&#x0D; &#x0D; METHODS: This study employed a qualitative participatory action research study approach and conducted a semi-structured individual interview with thirty-five nurses and four focus group discussions in Osun State South West Nigeria Primary Health Care centres.&#x0D; &#x0D; RESULTS: Primary Health Care (PHC) nurses perceived and described patient-centered care (PCC) as a global approach to improve and enhance nursing care to foster patient participation. The narratives were categorised into two: positive and negative perception. Ten main themes emerged: (I) Attitude of the nurses (ii) Lack of enforcement and implementation, (iii) Experience of the nurses, (iv) Quality-Caring, (v) Effective communication with patient, (vi) Motivated and Proactive healthcare, (vii) Sharpen the form of care, (viii) Outcome and after-effect driven healthcare, (ix) Approved support, and (x) Guarantor of service and motivation.&#x0D; &#x0D; CONCLUSION: Our participatory action research study on the assessment of nurses&amp;rsquo; perception on the utilization of PCC at the PHC for effective and quality healthcare service revealed the importance of nurses&amp;rsquo; role, acceptability of PCC and current nursing care practice at the Primary Health Care (PHC) rural community setting. Nurses as healthcare providers expressed PCC as a common and global approach that would enhance patient experiences and improves the quality of nursing healthcare delivery through integration of PCC and healthcare service at the PHC healthcare system.

Strategies to use government-funded programme models to achieve the triple aim: A look at New York State’s DSRIP programme

New York State has become a leader in Medicaid reform and the Delivery System Reform Incentive Payments (DSRIP) programme has provided new opportunities for both providers and new healthcare market players to play a stronger role in transitioning to value-based payments (VBP). The lessons learned in New York will be adapted to help with widespread success across the country, particularly in shifting Medicaid to risk-based reimbursement. The DSRIP programme in New York promoted the development of new healthcare organisations to lead and manage the government funding in an effort to achieve cost and quality improvements across the state. These new healthcare organisations are creating long-term sustainable models to advance the programme goals. Sustainability of Medicaid and Medicare continues to be at the forefront of federal and state government health reform. With health reform now poised to be a major 2020 presidential election issue, VBP remains a leading strategy for reducing the total cost of care and meeting the Quadruple Aim of enhancing patient experience, improving population health, reducing costs and improving the work life of healthcare providers.

02: The influence of postoperative environment on patient pain and satisfaction following pelvic reconstructive surgery: A randomized controlled trial

We sought to determine if the addition of music and a natural landscape image to postoperative hospital rooms would result in improved pain and satisfaction scores among patients undergoing pelvic reconstructive surgery. This was an Institutional Review Board approved, randomized controlled trial. Eligible candidates were 18-85 years old, English speaking, and scheduled to undergo native tissue vault suspension for symptomatic pelvic organ prolapse. Exclusions included history of a chronic pain or substance abuse. Subjects were advised the purpose of the study was to assess the impact of changes to the hospital environment on patient experience, but were blinded to their group and intervention details. Changes included a landscape image mounted to the wall, as well as access to a speaker with preprogrammed music selections. The intervention group was instructed to listen to their preferred music for a minimum of two 30-minute sessions postoperatively. The control group had a standard hospital room, without music or landscape. All patient rooms were private. The primary outcome was the Visual Analogue Scale (VAS) for pain on the morning of post-operative day one (POD #1). Secondary outcomes included narcotic use, likelihood to refer family to the same facility, satisfaction with care and the hospital, and perception of a healing environment. We calculated a sample size of 43 subjects per arm in order to detect a difference of 1cm in VAS pain score. One hundred thirty-three subjects were enrolled; primary outcome data was available for 92 (46 per arm). The mean age was 63.8 (SD 9.5) years, median Charlson Comorbidity score was 2 (IQR 0,7), and 94.6% were Caucasian. On POD #1, VAS score for pain was low (24.5 cm, 28 cm), and did not differ between control and intervention respectively (p = 0.566). Total morphine equivalents (p = 0.817) and nursing pain scores (p = 0.774) were also similar. However, the intervention group displayed a higher likelihood to refer family members to the hospital (p = 0.037). At 2 weeks postoperative, the intervention group demonstrated higher satisfaction with their care (p = 0.032), the hospital (p = 0.004), and the healing environment provided during their stay (p = 0.020), than those in standard hospital rooms. In this randomized trial, we demonstrate that music and landscape imagery has a positive impact on postoperative care. This effect was noted to increase by two weeks following surgery. Given the importance of value-based care, interventions such as these should be emphasized in an effort to enhance patient experience, satisfaction and quality scores.

Development and implementation of a novel child life protocol to enhance psychosocial support for pediatric awake craniotomies: technical note.

Awake craniotomies are a crucial tool for identifying eloquent cortex, but significant limitations frequently related to patient tolerance have limited their applicability in pediatric cases. The authors describe a comprehensive, longitudinal protocol developed in collaboration with a certified child life specialist (CCLS) in order to enhance patient experiences and develop resiliency related to the intraoperative portion of cases. This protocol includes preoperative conditioning, intraoperative support, and postoperative positive reinforcement and debriefing. A unique coping plan is developed for each prospective patient. With appropriate support, awake craniotomy may be applicable in a wider array of preadolescent and adolescent patients than has previously been possible. Future prospective studies are needed to validate this approach.

178 - Evolving Trainee Assistant Practitioner role enhances patient experience and lung pathway

178 - Evolving Trainee Assistant Practitioner role enhances patient experience and lung pathway