High-quality Care Research Articles

Developing the clinical nurse specialist role in Indonesia: increasing high-quality nursing care

Developing the clinical nurse specialist role in Indonesia: increasing high-quality nursing care

Key steps and barriers in the journey of patients with epilepsy through the National Healthcare System in Spain: The EPIPASS qualitative study.

Epilepsy requires continuous medical attention from multiple healthcare specialists, specialized facilities, and community-based care. In Spain, there is no standardized approach to epilepsy care. The aim of this study was to identify the factors impacting on the delivery of high-quality care by exploring key steps and barriers along the patient journey through the Spanish National Healthcare System (NHS). A qualitative study was conducted using opinions and experiences of neurologists, nurses, patients, and caregivers shared in discussion meetings. Using thematic content analyses, relevant aim-focused statements were coded according to prespecified issues in a discussion map (i.e., key steps and barriers), and sub-coded according to emerging issues. Thematic saturation and co-occurrence of key steps/barriers were evaluated to identify the most relevant factors impacting on the delivery of high-quality care. Sixty-five stakeholders took part in discussion meetings (36 neurologists, 10 nurses, 10 patients, and nine caregivers). Six key steps on the patient journey were identified: emergency care, diagnosis, drug therapy, follow-up, referral, and interventional treatment. Of these, follow-up was the most relevant step impacting on the delivery of high-quality patient care, followed by drug therapy and diagnosis. Emergency care was considered a hot-spot step with impact throughout the patient journey. Communication (among HCPs and between HCPs and patients) was a barrier to the delivery of high-quality care at several stages of the patient journey, including drug therapy, follow-up, referral, and interventional treatment. Resource availability was a barrier for diagnosis (especially for confirmation), drug therapy (drug availability), and referral (lack of professionals and specialized centers, and long waiting lists). This is the first study capturing perspectives of four key stakeholders involved in epilepsy care in Spain. We provide an overview of the patient journey through the Spanish NHS and highlight opportunities to improve the delivery of patient-centered care with a chronicity perspective. Patients with epilepsy may require prolonged medical care. In Spain, care is provided by a range of specialist and non-specialist centers. In this study, a team of Spanish neurologists, nurses, patients and caregivers identified barriers that affect the delivery of high-quality care for patients with epilepsy at each stage of their journey through the Spanish NHS. Specific epilepsy training for healthcare providers, appropriate resources for diagnosing and treating patients, and good communication between healthcare workers and patients were identified as important factors in providing high-quality care for patients with epilepsy.

Women ‘s perception on the quality of maternal and newborn care during the COVID-19 pandemic in German-speaking countries: Findings from the IMAgiNE EURO project comparing data from Germany, Switzerland and Austria

ProblemRestrictions during the COVID-19 pandemic compromised maternal and newborn care. BackgroundCountries in the German speaking area share several clinical care guidelines but differed significantly in the strictness of COVID-19 protective measures. AimTo investigate the quality of maternal and newborn care (QMNC) during the COVID-19 pandemic in the German-speaking area and explore associations between the reorganisational changes due to COVID-19 and QMNC, as described with WHO Standards-based Quality Measures. MethodsAs part of the IMAgiNE EURO study (ClinicalTrials.gov: NCT04847336), we conducted an online survey on the QMNC in the German-speaking area, including women who gave birth in Germany, Switzerland, and Austria. Descriptive statistics, Spearman rank correlation coefficient and multivariable quantile regression were used. FindingsOut of a total of 70,721 women accessing the online questionnaire, 1,875 were included (Germany: n = 1,053, Switzerland: n = 494, Austria: n = 328). Significant differences across countries were found in Quality Measures. In Switzerland, women scored Quality Measures more favourable than in Germany and Austria in all four sub-indexes of QMNC. In Austria, Quality Measures gaps in the sub-index ‘Experience of care’ were higher. The sub-index ‘Reorganisational changes due to COVID-19′ correlated weakly to strongly with the other sub-indexes (between r = 0.33 and r = 0.62, p < 0.001 for all correlations). DiscussionMidwives and other health professional should pay particular attention to the provision of respectful, high-quality care. ConclusionTo effectively improve QMNC, further research is essential to monitor the quality of care and develop targeted interventions beyond the COVID-19 pandemic addressing inherent challenges in the organisation and delivery of care.

Healthcare providers' expected barriers and facilitators to the implementation of person-centered long-term follow-up care for childhood cancer survivors: A PanCareFollowUp study.

Childhood cancer survivors face high risks of adverse late health effects. Long-term follow-up care for childhood cancer survivors is crucial to improve their health and quality of life. However, implementation remains a challenge. To support implementation of high-quality long-term follow-up care, we explored expected barriers and facilitators for establishing this follow-up care among healthcare providers from four European clinics. A qualitative study was conducted using four focus groups comprising 30 healthcare providers in total. The semi-structured interview guide was developed based on the Grol and Wensing framework. Data was analyzed following a thematic analysis, combining both inductive and deductive approaches to identify barriers and facilitators across the six levels of Grol and Wensing: innovation, professional, patient, social, organizational and economic and political. Most barriers were identified on the organizational level, including insufficient staff, time, capacity and psychosocial support. Other main barriers included limited knowledge of late effects among healthcare providers outside the long-term follow-up care team, inability of some survivors to complete the survivor questionnaire and financial resources. Main facilitators included motivated healthcare providers and survivors, a skilled hospital team, collaborations with important stakeholders like general practitioners, and psychosocial care facilities, utilization of the international collaboration and reporting long-term follow-up care results to convince hospital managers. This study identified several factors for successful implementation of long-term follow-up care for childhood cancer survivors. Our findings showed that specific attention should be given to knowledge, capacity, and financial issues, along with addressing psychosocial issues of survivors.

Impact of a remote second opinion program on changes in recommended treatment plans for patients with cancer across the U.S.

386 Background: Second opinion consultations are a promising strategy to identify errors in diagnosis and recommend the optimal course of treatment for the patient. Yet, there are several barriers to patients accessing second opinions, including geographic barriers. By bringing high-level care to patients where they live, remote second opinion programs might benefit populations without access to subspecialty cancer centers, including those from underserved communities. While meaningful changes from in-person second opinions have been observed at several institutions, little is known about how often remote second opinions lead to similar improvements in treatment plans. Thus, our objective was to examine the extent to which the Memorial Sloan Kettering Cancer Center (MSK) remote second opinion program led to changes in treatment plans for cancer patients residing across the U.S. Methods: MSK is a high-volume cancer center based in NYC. MSK’s remote second opinion program was developed and rolled out as part of a national cancer benefits solution in 2016. Each second opinion review process is conducted by an MSK subspecialist and enabled by a customized digital platform. The process is asynchronous. To capture subspecialists’ perceptions of the importance of any changes to diagnosis or treatment recommended, we designed and administered a questionnaire starting in December 2023 that subspecialists completed after each case. Here, we report summary findings from the first 100 second opinion cases with complete information from this questionnaire. Results: These 100 case reviews were completed between December 2023 and April 2024. Spanning cancer types, the cases were reviewed by 49 unique subspecialists. There were 17 patients with breast cancer, 9 with colon cancer, 9 with lymphoma, 9 with prostate cancer, 7 with endometrial cancer, 7 with squamous cell carcinoma, 6 with myeloma, 5 with ovarian cancer, and 31 with one of 18 other cancer types. Patients had a mean age of 57 years (median 58) and 61% were female. Patients were from 27 different U.S. states. Of the 100 cases reviewed, subspecialists made a “meaningful change” (expected to affect patient outcomes) in recommended treatment, in 39 cases (39%). These meaningful changes included better prognosis / survival (n=26, 67%), reduced short-term morbidity / quality of life / toxicity (n=17, 44%), or improved long-term morbidity / quality of life / toxicity (n=29, 74%). There was a higher percent of recommended changes for liquid tumor cases compared to solid tumor cases (11/17, 65% for liquid; 28/83, 34% for solid). Conclusions: Findings are crucial for understanding potential opportunities to grow remote second opinion programs to benefit patients. This information is also essential for identifying the most effective strategies to reach underserved communities with geographic access barriers to high-quality subspecialty cancer care.

Investigating the impact of a multicomponent positive participatory organisational intervention on burnout in New Zealand emergency department staff: a prospective, multisite, before and after, mixed methods study.

The well-being of healthcare workers (HCWs) is critical to providing excellent care. Recent evidence concerns the well-being of emergency department (ED) HCWs in New Zealand, with high levels of burnout found in a 2020 survey. This threat to providing high-quality acute care warrants improvement interventions. The causes of burnout are complex and multifactorial, the solutions are not straightforward. A prospective, multisite, before and after, mixed methods study assessing a multicomponent intervention, adaptable to local context, that targets three organisation levels (the individual, the group and the system levels) and meaningfully involves frontline HCWs may reduce HCW burnout and improve HCW well-being. Individual HCWs will choose from three individual-level psychological interventions and participate in those most appropriate for them. Local champions will decide which group-level intervention their ED will use. The system-level intervention will build capacity and capability for quality improvement (QI) with QI training and the establishment of a Quality Improvement Learning System. This system-level intervention has several important features that may ultimately empower HCWs to contribute to improving the quality of ED healthcare.We will enrol nine EDs, from which there will be at least 900 HCW participants. EDs will be enrolled in three waves from March 2023 to April 2024, with interventions taking place in each ED over 12 months.Methods of assessment will include baseline and repeat survey measures of burnout and well-being. Process evaluation at each ED will provide details of context, the intervention and the fidelity of the implementation. Ethics committee approval was provided, with locality approval at each site.Individual site feedback will be provided to each ED and executive leadership. Dissemination of findings will be through publication in peer-reviewed journals, presentation at national and international scientific meetings and through national healthcare quality bodies. Australia New Zealand Clinical Trials Registry (ACTRN12623000342617).

Prevalence and Risk Factors Associated with Depressive Symptoms Among Healthcare Professionals at a Tertiary Care Hospital in Mogadishu, Somalia: A Cross-Sectional Study.

Depression, a prevalent mental health issue, can significantly impact healthcare workers (HCWs), leading to decreased productivity, increased turnover, and high medical errors. However, there is a dearth of information regarding depression among healthcare professionals in Somalia. Therefore, this study aimed to assess the magnitude and risk factors associated with depressive symptoms among healthcare professionals in Mogadishu, Somalia. A hospital-based cross-sectional study was conducted among HCWs at Erdogan Hospital, in the capital city of Somalia. Data was collected using questionnaires on socio demographic, work-related characteristics and Patient Health Questionnaire-9 (PHQ-9). Bivariate and multivariate logistic regression analyses were conducted to identify variables associated with depressive symptoms. A p-values of 0.05 as a cutoff for a significant association. The prevalence of depressive symptoms among healthcare professionals was 48.9% (95% CI: 45.4-56.9%). In multivariable analysis, being female (AOR = 2.05; 95% CI: 1.17-3.60), being a nurse (AOR = 3.11; 95% CI: 1.14-8.48), unmarried (AOR = 1.83; 95% CI: 1.04-3.21), having insufficient sleep (AOR = 2.61; 95% CI: 1.45-4.70), a family history of mental illness (AOR = 3.31; 95% CI: 1.49-7.36), lack of physical activity (AOR = 2.59; 95% CI: 1.19-5.62), and having low social support (AOR = 3.06; 95% CI: 1.17-7.98) were all associated with increased odds of experiencing depressive symptoms. The study showed that nearly half of healthcare professionals experienced depressive symptoms. The study underscores the importance of efficient screening methods for identifying psychological symptoms in healthcare professionals, which is essential for enhancing their mental health and patient care. Therefore, we recommend that healthcare institutions and policymakers develop and implement screening measures to identify and improve the mental health well-being of HCWs, as well as provide high-quality patient care.

Development of an Emergency Department Safety Checklist through a global consensus process.

Emergency departments (EDs) are at high risk for medical errors. Checklist implementation programs have been associated with improved patient outcomes in other high-risk clinical settings and when used to address specific aspects of ED care. The aim of this study was to develop an ED Safety Checklist with broad applicability across different international ED settings. Athree-round modified Delphi consensus processwasconductedwith a multidisciplinary and multinational panel of experts in emergency medicine and patient safety. Initial checklist items were identified through a systematic review of the literature. Each item was evaluated for inclusion in the final checklist during two rounds of web-based surveys and an online consensus meeting. Agreement for inclusion was defined a priori with a threshold of 80% combined agreement. Eighty panel members from 34 countries across all seven world regions participated in the study, with comparable representation from low- and middle-income and high-income countries. The final checklist contains 86 items divided into: (1) a general ED Safety Checklist focused on diagnostic evaluation, patient reassessment, and disposition and (2) five domain-specific ED Safety Checklists focused on handoff, invasive procedures, triage, treatment prescription, and treatment administration. The checklist includes key clinical tasks to prevent medical errors, as well as items to improve communication among ED team members and with patients and their families. This novel ED Safety Checklist defines the essential elements of high-quality ED care and has the potential to ensure their consistent implementation worldwide.

Health Workers Perception On The Key Drivers Of Maternal Mortality

Maternal mortality remains a critical public health issue, particularly in low- and middle-income countries. Health workers play a pivotal role in addressing this challenge, offering insights into the key drivers of maternal deaths. This study explores the perceptions of healthcare workers on the systemic, socioeconomic, cultural, and healthcare-related factors contributing to maternal mortality. Health workers identify systemic barriers, including understaffing, lack of resources, inadequate training, and inefficient referral systems, as significant contributors. Cultural and religious influences also impact maternal care, with societal norms often discouraging women from seeking professional healthcare. Additionally, socioeconomic factors like poverty, illiteracy, and unemployment further exacerbate the problem, limiting access to quality maternal care. Health workers’ insights are crucial in designing effective interventions, emphasizing the need for improved training, better healthcare infrastructure, and community engagement to address cultural barriers. This study highlights the importance of empowering healthcare professionals to deliver high-quality maternal care, suggesting that systemic reforms, including enhanced emergency obstetric care and better access to medical supplies, are essential for reducing maternal mortality rates. Understanding these perspectives can inform policies and programs aimed at improving maternal health outcomes, particularly in resource-limited settings

Center Related Variation in Hospitalization Cost for Patients Undergoing Percutaneous Left Atrial Appendage Occlusion

BackgroundThe commercial use of percutaneous LAAO with the Watchman device is increasing in the United States. The purpose of this study was to evaluate center related variation in total hospital costs for Watchman device implantation and identify factors associated with high hospital costs at a national level. MethodsAll adults undergoing elective LAAO with Watchman were identified in the 2016 to 2018 National Inpatient Database. Mixed models were used to evaluate the impact of center on total hospital costs adjusting for patient and center characteristics, and length of stay. ResultsA total of 30,175 patients underwent Watchman device implantation at a median cost of $24,500 and demonstrated significant variability across admissions (inter-decile range, $13,900-37,000). Nearly 13% of the variability in patient-level costs was related to the center performing the procedure rather than patient factors. Higher volume centers had lower total costs and demonstrated lesser total cost variation. Centers with low procedural volume, occurrence of procedural complications, congestive heart failure, and length of stay were independent predictors of a high-cost hospitalization. Though complications were associated with increased expenditure, they did not explain the observed cost variation related to the center. ConclusionA significant proportion of variation in total hospital cost was attributable to the center performing the procedure. Addressing variability of Watchman-related costs is necessary to achieve high-quality value-based care.

Journey towards equity: Unveiling the relationship between patient travel distance and social vulnerability among patients with cancer.

158 Background: Patient travel distance is a significant barrier to accessing high-quality cancer care, impacting patient outcomes. Factors such as geographic location, transportation infrastructure, and socio-economic status contribute to variations in patient travel distance. The relationship between patient travel distance and the area deprivation index (ADI), a measure of socioeconomic disadvantage (based on income, education, employment, and housing quality) and social vulnerability of neighborhoods developed by the Health Resources &amp; Services Administration (HRSA), remains largely unexplored. This abstract seeks to unveil the intricate relationship between patient travel distance and ADI, shedding light on the impact of social vulnerability on cancer care access. Methods: Using patient ZIP code data and practice location data from April 2023 to March 2024, we calculated the straight-line, one-way, patient-clinic travel distance (travel distance). We then derived the ADI for patient ZIP codes using geospatial mapping techniques and compared travel distances by area deprivation vulnerability categories. Results: While analyzing geographic data for 20,000 patients at 5 locations, we observed that 89% of patients traveled 15 miles or less one-way to reach the practice location, with a median travel distance of 5 miles. Median travel distance in miles for patients within 15 miles of each practice location by ADI vulnerability category is provided (Table). Median travel distances between ADI categories were statistically significant (Kruskal Wallis H-test, p &lt;0.001). Patients from the most disadvantaged neighborhoods generally travel longer distances to access cancer care. Conclusions: Patients in socially vulnerable locales generally travel longer distances to access cancer care. By considering the ADI alongside patient travel distance, healthcare providers and policymakers can understand barriers faced by disadvantaged populations and allocate resources to reduce disparities in access to care. Targeted interventions and policies, like improving transportation services/infrastructure, empowering community-based care locations, and expanding telehealth, are necessary to address travel distance disparities for vulnerable populations. The effects of increased travel distance on timely access to care, treatment adherence, health outcomes, finances, caregivers, and patient satisfaction warrant further investigation. Location Site Category Within 15 miles of the practice location % of patients Median travel distance (in miles) by overall ADI vulnerability Highest (8, 9, 10 ADI Rank) Mid High (5, 6, 7 ADI Rank) Low (1, 2, 3, 4 ADI Rank) A Suburban Metro 89.8% 13.5 2.2 4.7 B Suburban Small Town 86.7% 12.5 13.03 8.5 C Suburban Metro 85.1% 14.9 9.4 5.9 D Suburban Metro 90.9% 12.9 9.6 4.7 E Urban Metro 93.6% 12.9 4.8 2.7 ALL 89% 12.5 6.3 5.0

Baseline practice-level financial screening processes and resources among Children’s Oncology Group National Cancer Institute Community Oncology Research Programs (NCORP).

34 Background: Financial toxicity is an increasingly recognized and prevalent adverse effect during cancer treatment. Systematic financial screening is recommended for families of children with cancer, and emerging data support the importance of system-level support and interventions to mitigate financial toxicity. Financial distress is a key, measurable domain of financial toxicity. Methods: To inform interventions for pediatric oncology settings, we are conducting ACCL20N1CD, a Children’s Oncology Group (COG) prospective, multilevel observational study among NCORP practices in the US, to determine the risk and trajectory for financial distress in guardians of children with newly diagnosed acute lymphoblastic leukemia. We analyzed baseline survey data from COG NCORP practices that enrolled at least one parent. Data were collected via REDCap following the practice’s first parent enrollment. We describe practice participation patterns, current approaches to financial screening, and available resources to address identified needs including navigation. Results: Of 50 eligible COG NCORP practices, 40 (80%) activated the study, and 28 (56%) enrolled at least 1 participant and thus, completed the survey. Most (61%) of these practices treated 50-99 new pediatric oncology patients annually; 10 (36%) enrolled at least 5 participants in ACCL20N1CD. Twenty (71%) reported that their practice routinely conducted financial screening in addition to insurance assessment; 15 (75%) of these 20 practices conducted financial screening at more than one timepoint. Social workers were primarily responsible for screening (16/20; 80%). Only three practices (3/28; 11%) used a standardized financial screening tool. Most practices had access to a private foundation/organization (25/28, 89%), institutional support (23/28, 82%), or local referrals to organizations (22/28, 78%) that provided financial support for patients/families. Fewer practices had patient navigators (9/28, 32%), financial navigators (8/28, 28%), or legal advocates (3/28, 11%) available to assist families. Conclusions: Though most COG practices treating children of parents enrolled in 20N1CD conduct financial screening, processes are not standardized, and resources available to address identified needs and potentially mitigate financial toxicity vary. Further, these data represent enrolling sites which may overestimate screening practices within COG NCORP practices. Variations in financial screening procedures and lack of individual-level resources to facilitate screening may impact delivery of equitable high-quality cancer care across NCORP COG practices. Clinical trial information: NCT04928599 .

Experimental burn models for evaluating wound healing agents and its current situation and existing disadvantages: a literature review

BACKGROUND: Burns remain a crucial part of the structure of injuries in Russia and abroad. Therefore, providing high-quality medical care to burn victims is relevant. Despite the large number of proposed solutions to this condition, developments in the field of tissue engineering and medical materials science still lack standardization and consideration of specific features of animal burn models for their testing. Many studies showed minor and major disadvantages from a technical and descriptive point of view. AIM: To analyze and identify the main disadvantages of existing burn models to assess the effect of wound healing agents. MATERIALS AND METHODS: This article examines the search results in the databases Google Scholar and PubMed using the keywords “burns,” “rats,” “animal model,” and “wound healing.” Sixty publications were analyzed. RESULTS: Seven quality criteria for the animal burn model have been determined, which allow obtaining reliable results and reproducing the described experiment: indication of the terms of quarantine and conditions of keeping laboratory animals, detailed description of the technique of applying burn injury, presence of one burn on a laboratory animal, presence of a control biopsy, indication of the absolute value of the initial burn area, presence of surgical treatment of burn wounds, and correct use of formulas for the planimetric assessment of wound healing. CONCLUSIONS: A solution to the problem of creating a standardized model may be a more detailed description of techniques and following the proposed quality criteria.

Identification of complex co-occurring symptom burden in persons with cancer through multisite implementation of health-related social needs assessment in community oncology settings.

306 Background: Health related social needs (HRSN) impact cancer outcomes and patient experience, but their integration into routine cancer care is highly variable. To expand the implementation-centered evidence base for effective HRSN assessments, we studied a scalable HRSN screening tool to identify distress and complex symptom burden in patients with cancer. Methods: We prospectively tracked HRSN screenings (using the National Comprehensive Cancer Network [NCCN] Distress Thermometer [DT]) of patients at varying points during their cancer care between 07/2023-12/2023 at seven multi-site community oncology practices within the US Oncology Network. DT responses were used to evaluate the positive finding rate, types of distress reported, and correlations between distress areas and concerns reported. Results: Overall, 219,720 unique patients with cancer received 269,666 HRSN screenings using the NCCN DT; 27% had a distress score ≥1 and 38.5% reported a concern (of whom, 58.2% reported &gt;1). Co-occurring concerns that were most correlated (Pearson correlation coefficient) were emotional &amp; practical concerns in 49% of screenings, physical &amp; practical 44%, emotional &amp; social 37% and social &amp; practical concerns 36%. Emotional symptoms most frequently reported together were sadness/depression + worry/anxiety 47%, loss of interest + sadness/depression 44%, and loneliness &amp; sadness/depression 38.5%. Regarding complex symptom burden, the physical and psychosocial symptoms that were most correlated were fatigue &amp; sleep 43%, pain &amp; fatigue 40%, pain &amp; sleep 38%, anxiety/worry &amp; fatigue 37%, anxiety/worry &amp; sleep 36%. Fatigue and pain, the two most frequently reported concerns were strongly correlated with emotional and practical concerns like sleep, worry or anxiety, memory or concentration, loss or change of physical abilities, sadness or depression, loss of interest or enjoyment, changes in eating, ability to take care of self, feelings of worthlessness or being a burden, etc. Concerns with the strongest correlations are reported in the table. Conclusions: Distress and its components impact multiple cancer outcomes making their rapid identification and consequent action key to high-quality cancer care. The findings highlight the NCCN DT as a scalable approach to integrate HRSN screening and to identify complex symptom burden in the real-world practice. Co-occurring physical and psychosocial concerns. Concern 1 Concern 2 Correlation r Sadness or depression Worry or anxiety 47.3% 0.5 Loss of interest or enjoyment Sadness or depression 44.3% 0.4 Fatigue Sleep 42.5% 0.4 Pain Fatigue 40.0% 0.4 Loneliness Sadness or depression 38.5% 0.4 Pain Sleep 37.8% 0.4 Worry or anxiety Fatigue 36.7% 0.4 Worry or anxiety Sleep 36.1% 0.4 Taking care of myself Taking care of others 35.9% 0.4

Emerging lessons from experiences at transitions in care among hospitalised patients with cancer with postdischarge frequent emergency department use: a qualitative study using linked clinical and patient-reported interview data from Quebec, Canada

BackgroundWhile teamwork is essential to providing high-quality patient-centred care, challenges in interprofessional collaboration and decision-making in hospital settings are common, especially for patients with cancer. The purpose of this qualitative...

Breaking Barriers and Navigating the Future of Emergency Care

Over the past two decades, the emergency nurse practitioner (ENP) role has significantly enhanced emergency care in the United States. With the increasing complexity of emergency care, ENPs have expanded into nontraditional settings, necessitating regulatory updates to maintain patient safety. The Consensus Model for Advanced Practice Registered Nurse Regulation has influenced ENP practice, yet consistent regulatory recognition is still needed due to the marked evolution in ENP practice. Despite collaborative efforts to prepare the ENP workforce and ensure competency through standardized education, certification, and licensure, recent unethical publications and skewed statistics have threatened the specialty’s progress. Addressing these challenges is crucial for advancing the ENP role and ensuring high-quality emergency care delivery.

Improving the quality and guideline concordance of multidisciplinary gastric cancer care in a safety net hospital.

314 Background: Gastric cancer is a leading cause of cancer death worldwide and disproportionally affects people of East Asian and Latin American ethnicities. This study aimed to implement and evaluate an intervention to improve the quality and guideline concordance of multidisciplinary gastric cancer care at a public safety net hospital, Zuckerberg San Francisco General Hospital (ZSFG). Methods: A quality improvement (QI) intervention was developed and evaluated by pre-post comparison of clinical data. (1) An in-depth chart review of all patients with gastric adenocarcinoma in 2017-2019 (n=17) evaluated concordance with evidence-based guidelines and quality metrics. (2) Multidisciplinary meetings identified barriers to high quality care and established targets for improvement. (3) A clinical algorithm tailored for ZSFG was disseminated to standardize gastric cancer management. (4) A post-intervention chart review was conducted of all patients from 2021-2022 (n=22). (5) Descriptive statistics and pre-post comparison of QI metrics with Chi square and Kruskal Wallis tests were performed. Results: Pre-intervention clinical data and multidisciplinary input identified gaps in care: variation in provider knowledge and practices, rapidly evolving guidelines, limited access to advanced diagnostic modalities, and non-standardized surgical documentation. After implementation of a standardized approach to address these gaps, pre-post improvement was seen in rates of tumor board presentation (36.3% vs. 85.7%, P= 0.033), use of endoscopic ultrasound (9.09% vs. 64.2%, P= 0.017), pre-treatment nodal staging (27.2% vs. 78.5%, P= 0.030), receipt of neoadjuvant chemotherapy (20% vs. 80%, P=0.007 ), documentation of lymphadenectomy type (25% vs. 100%, P= 0.015), and a trend toward reduced time to PET/CT scan (median, 8.5 weeks pre vs 7.1 weeks post, P= 0.268). Conclusions: A QI intervention was successfully implemented to standardize gastric cancer care at ZSFG. Significant improvements were seen in all targeted metrics except time to outside PET scan. Potential confounders affecting pre-post care quality included personnel changes in a small workforce and the COVID-19 pandemic. Nevertheless, our intervention led to sustained improvements in practice patterns. We aim to replicate this success with other malignancies. Category Pre-Intervention Target Post-Intervention P value* Tumor Board% cM0 cases presented 36% (n=11) &gt;90% 86% (n=14) 0.033 Endoscopic ultrasound (EUS)% cM0 cases referred for clinical staging 9% (n=11) &gt;90% 64% (n=14) 0.017 Nodal staging (with EUS or PET) 27% (n=11) N/A 79% (n=14) 0.030 Receipt of neoadjuvant chemotherapy% eligible patients 20% (n=10) &gt;80% 80% (n=10) 0.007 Surgery documentationLymphadenectomy type (i.e., D1 or D2) 25% (n=8) 100% 100% (n=7) 0.015 Time from diagnosis to PET/CT (median) 8.5 wks &lt;5 wks 7.1 wks 0.268 *Chi square test, Kruskal-Wallis test.

Bringing Patients Out of The Gloom: Examining The Effects of Patient Power and Affect Labeling on Emotional Experience Reflected in Emotional Judgement

ObjectiveNegative emotions are common among patients in medical settings. It is important to investigate impacts of patient power and affect labeling on emotional experience in patients. MethodsBehavioral judgments and event-related potentials (ERPs) were recorded while participants with high or low patient power made emotional judgments (positive, negative) about neutral faces, as well as investigating how affect labeling (affect labeling, viewing) influenced emotional judgments about neutral faces in participants with low patient power. ResultsIndividuals with low patient power made more and faster negative emotion judgements. A larger late positive component (LPC) amplitude was found in negative emotion judgments for individuals with low patient power, a component related to allocation of attentional resources to motivationally salient stimuli. Affect labeling elicit less and slower negative emotion judgments in individuals with low patient power. ConclusionsThese results suggest that low patient power triggers negative emotion, which can be reduced by affect labeling. Practice implicationsThe current findings provide valuable insights into reducing negative emotions in patients, fostering promising targets for training for medical professionals and education for patients aiming to ensure more humanistic and higher-quality care delivery.

Regulation of Artificial Intelligence in India: Difficulties and Factors to be Considered

Artificial Intelligence (AI) is revolutionizing various sectors, particularly healthcare, by improving processes, enhancing efficiency, and driving economic growth. In India, the healthcare system faces significant challenges, including inadequate access to quality care, especially in rural areas, and a severe shortage of skilled medical professionals. Despite having world-class hospitals that bolster medical tourism, India struggles with disparities in healthcare access and affordability. AI has the potential to address these issues by improving access to high-quality care, reducing the burden on healthcare professionals, and enabling personalized treatments on a large scale. The Indian government is actively working to integrate AI into the healthcare system, as demonstrated by initiatives like the National Health Stack and the National Digital Health Blueprint. These policies aim to create a digital infrastructure that facilitates data sharing and supports innovation in the private sector. Additionally, collaborations between government bodies, technology companies, and healthcare providers are accelerating the development and implementation of AI-driven solutions. For example, NITI Aayog's partnerships with Microsoft and Forus Health focus on early disease detection, while the Maharashtra government is working with Wadhwani AI to enhance rural healthcare. These efforts highlight AI's potential to transform India's healthcare system, making it more efficient, accessible, and affordable, ultimately improving public health outcomes and reducing poverty related to healthcare costs.

An Interactive, Case-Based Workshop on the Patient Experience for Internal Medicine Residents.

The technological revolution has narrowed the information gap between physician and patient. This has led to an evolution in medicine from paternalistic to patient-centric, with health care systems now prioritizing patient experience to achieve higher satisfaction scores. Therefore, it is imperative to start early in educating trainees on how to best address the holistic needs of the patient while also delivering high-quality care. We implemented a 1-hour workshop that was repeated weekly over 8 weeks to capture all internal medicine residents in our program. During the workshop, we reviewed the historical evolution of patient care from paternalistic to patient-centered, presented the Hospital Consumer Assessment of Healthcare Providers and Systems survey questions, and discussed evidence-based strategies for physicians to improve their patients' experience utilizing four case-based scenarios. Over the 8-week period, a total of 195 residents participated in the workshop. One hundred thirty-nine residents (71%) completed the pre- and postsession survey. Results demonstrated significant knowledge improvement (p < .001) in all of the topics discussed. Additionally, the majority of residents felt the workshop would be useful in their clinical practice and found the clinical scenarios useful. Given the evolution towards patient-centered care, it is important to take a proactive approach in providing residents with the tools to best address their patients' needs. Early understanding of patient satisfaction surveys and the impacts they have on hospital metrics can help trainees in their careers as practicing physicians.