Hospital-based Healthcare Providers Research Articles

Structural Factors Contributing to Compassion Fatigue, Burnout, and Secondary Traumatic Stress Among Hospital-Based Healthcare Professionals During the COVID-19 Pandemic.

High levels of burnout among healthcare providers (HCPs) have been a widely documented phenomenon, which have been exacerbated during the COVID-19 pandemic. In the United States, qualitative studies that are inclusive of HCPs in diverse professional roles have been limited. Therefore, we utilized a qualitative-quantitative design to examine professional quality of life in terms of compassion fatigue, burnout, and secondary traumatic stress among hospital-based HCPs, including social workers, hospitalists, residents, and palliative care team members during COVID-19. HCPs (n = 26) participated in virtual semi-structured focus groups or individual interviews and online surveys (n = 30) including the Professional Quality of Life (ProQOL) Scale. While ProQOL scores indicated low levels of compassion fatigue, burnout, and secondary traumatic stress, thematic analysis of our qualitative data included rich descriptions of compassion fatigue, burnout, and secondary traumatic stress. Safety concerns and value misalignment characterized structural stressors perceived to contribute to HCP compassion fatigue, burnout, and secondary traumatic stress. The discrepancy between our qualitative and quantitative findings may be indication that modifications to current screenings are warranted. These findings also suggest a need to identify and implement structural and policy changes that increase HCPs' physical and emotional safety and promote better alignment of institutional interests with HCP values.

Hospitalists' Perspective of Inpatient Care for Patients with Sickle Cell Disease and Areas for Improvement

Background Acute painful vasoocclusive episodes (VOEs) are the most common reason for hospitalization for adults with sickle cell disease (SCD) and significant predictors of mortality. The facilitators and barriers to providing quality care for adults with SCD in the inpatient setting are largely unknown. We aimed to explore inpatient SCD delivery models in the US, including access (or lack thereof) to quality care and sickle cell disease expertise. Methods We conducted a multi-site rapid qualitative research study in order to evaluate a construct informed by literature review and clinical experience: variability between hospitals in the characteristics on models of inpatient SCD care delivery. We used virtual focus groups of practicing hospitalists in partnership with the Hospital Medicine Reengineering Network from across the United States. We developed an interview guide with open-ended questions and prompts through an iterative process to explore how inpatient SCD care is currently delivered in US hospitals with a focus on how these models of care delivery affect hospitalist practice (Figure). The open-ended questions explored topics ranging from hospitalists' training and experienceto the design of the health care system. Trained facilitators conducted four semi-structured focus groups with 11 hospitalists and one patient and family advisory council member. The facilitators took observation notes. Moderators summarized their group's overall findings for report to the larger group, serving as an opportunity for member checking and pattern identification. The focus groups lasted 35 minutes and report-out summaries lasted an additional 15 minutes. Recordings were de-identified and transcribed. We used rapid qualitative methods to explore perspectives of hospital-based healthcare providers including: having facilitators with expertise in the content area, collecting and analyzing data via multiple team members, and using templated summaries for each focus group question. Group summaries and transcripts were analyzed with thematic coding by two independent coders with feedback from the focus group moderators. Results Participants were from 12 adult university-based or university-affiliated hospitals. All hospitalists had experience taking care of hospitalized patients with SCD during their career, but many described how a change in practice location resulted in only seeing 1-2 patients with SCD per year. Hospitalists described a range of inpatient SCD care models from no specific model to a specific cohorted unit with associated providers. Participants unanimously expressed having provider and unit continuity of SCD care, and having accessible SCD expertise, as an ideal state. Individualized care plans were cited as a helpful tool for inpatient SCD care, but there were considerable challenges to their routine use. Primary themes are presented in the Table with explanations and correlative illustrative quotes. Discussion and Future Directions Hospitalists described wide variation in inpatient SCD care models. More inpatient SCD care support and infrastructure like individualized care plans were more commonly referenced by those hospitalists whose patients had access to a sickle cell center or SCD expert. We are using these data to inform a national survey to further describe and understand inpatient SCD care, if and how care plans are used, and determine next steps for improving inpatient SCD care quality.

A survey exploring the practices of smoking cessation support among hospital-based healthcare providers

BackgroundHospital visits constitute a ‘window of opportunity’ for initiating smoking cessation attempts, and healthcare providers (HCPs) play an important role in supporting patients to stop smoking. Yet, the current practices of supporting smoking cessation in the hospital setting are largely unexplored. The aim of this study was to explore practices of smoking cessation support among hospital-based HCPs.MethodsHCPs working in a large hospital in the secondary care sector completed an online, cross-sectional survey, including sociodemographic and work-related factors as well as 21 questions assessing practices of smoking cessation support based on the “five As” framework. Descriptive statistics were computed, and predictors of HCPs giving patients advice to stop smoking were explored using logistic regression analysis.ResultsAll employees (N = 3998) in the hospital received a survey link; 1645 (41.1%) HCPs with daily patient contact completed the survey. Smoking cessation support in the hospital setting was limited with regard to assessment of smoking; providing information and advice; planning and referral for further support; and follow-up on smoking cessation attempts. Almost half (44.8%) of participating HCPs with daily patient contact never or rarely advise their patients to stop smoking. Physicians were more likely than nurses to advice patients to stop smoking, and HCPs in outpatient clinics were more likely to give advice than inpatient clinic HCPs.ConclusionSmoking cessation support is very limited in the hospital-based healthcare setting. This is problematic, as hospital visits can be windows of opportunity to help patients change their health behaviour. An intensified focus on the implementation of hospital-based smoking cessation support is needed.

"Loved ones are not 'visitors' in a patient's life"-The importance of including loved ones in the patient's hospital stay: An international Twitter study of #HospitalsTalkToLovedOnes in times of COVID-19.

Hospitals are institutions whose primary task is to treat patients. Family-centered care, which considers loved ones as equal partners in patient care, has been gaining recognition in the adult care setting. Our aim was to record experiences of and opinions on communication between hospital-based healthcare providers and patients' loved ones, related but not limited to the rigorous mitigation measures implemented during the COVID-19 pandemic. The Twitter profile @HospitalsTalkTo and hashtag #HospitalsTalkToLovedOnes were created to interact with the Twitter public between 7 June 2021 and 7 February 2022. Conversations surrounding #HospitalsTalkToLovedOnes were extracted and subjected to natural language processing analysis using term frequency and Markov chain analysis. Qualitative thematic analysis was performed on the 10% most interacted tweets and of tweets mentioning "COVID" from a personal experience-based subset. We collected 4412 unique tweets made or interacted by 7040 Twitter users from 142 different countries. The most frequent words were patient, hospital, care, family, loved and communication. Thematic analysis revealed the importance of communication between patients, patients' loved ones and hospitals; showed that patients and their loved ones need support during a patient's hospital journey; and that pediatric care should be the gold standard for adult care. Visitation restrictions due to COVID-19 are just one barrier to communication, others are a lack of phone signal, no space or time for asking questions, and a complex medical system. We formulate 3 recommendations to improve the inclusion of loved ones into the patient's hospital stay. "Loved ones are not 'visitors' in a patient's life". Irrespective of COVID-19, patient's loved ones need to be included during the patient's hospital journey. Transparent communication and patient empowerment increase patient safety and improve the hospital experience for both the patients and their loved ones. Our findings underline the need for the concept of family-centered care to finally be implemented in adult nursing clinical practice.

Acute Pain Management Pearls: A Focused Review for the Hospital Clinician

Acute pain management is a challenging area encountered by inpatient clinicians every day. While patient care is increasingly complex and costly in this realm, the availability of applicable specialists is waning. This narrative review seeks to support diverse hospital-based healthcare providers in refining and updating their acute pain management knowledge base through clinical pearls and point-of-care resources. Practical guidance is provided for the design and adjustment of inpatient multimodal analgesic regimens, including conventional and burgeoning non-opioid and opioid therapies. The importance of customized care plans for patients with preexisting opioid tolerance, chronic pain, or opioid use disorder is emphasized, and current recommendations for inpatient management of associated chronic therapies are discussed. References to best available guidelines and literature are offered for further exploration. Improved clinician attention and more developed skill sets related to acute pain management could significantly benefit hospitalized patient outcomes and healthcare resource utilization.

A qualitative study exploring hospital-based team dynamics in discharge planning for patients experiencing delayed care transitions in Ontario, Canada

BackgroundIn attempt to improve continuity of patient care and reduce length of stay, hospitals have placed an increased focus on reducing delayed discharges through discharge planning. Several benefits and challenges to team-based approaches for discharge planning have been identified. Despite this, professional hierarchies and power dynamics are common challenges experienced by healthcare providers who are trying to work as a team when dealing with delayed discharges. The objective of this study was to explore what was working well with formal care team-based discharge processes, as well as challenges experienced, in order to outline how teams can function to better support transitions for patients experiencing a delayed discharge. MethodsWe conducted a descriptive qualitative study with hospital-based healthcare providers, managers and organizational leaders who had experience with delayed discharges. Participants were recruited from two diverse health regions in Ontario, Canada. In-depth, semi-structured interviews were conducted in-person, by telephone or teleconference between December 2019 and October 2020. All interviews were recorded and transcribed. A codebook was developed by the research team and applied to all transcripts. Data were analyzed inductively, as well as deductively through directed content analysis.ResultsWe organized our findings into three main categories – (1) collaboration with physicians makes a difference; (2) leadership should meaningfully engage with frontline providers and (3) partnerships across sectors are critical. Regular physician engagement, as equal members of the team, was recommended to improve consistent communication, relationship building between providers, accessibility, and in-person communication. Participants highlighted the need for a dedicated senior leader who ensured members of the team were treated as equals and advocated for the team. Improved partnerships across sectors included the enhanced integration of community-based providers into discharge planning by placing more focus on collaborative practice, combined discharge planning meetings, and having embedded and physically accessible care coordinators in the hospital.ConclusionsTeam-based approaches for delayed discharge can offer benefits. However, to optimize how teams function in supporting these processes, it is important to consistently collaborate with physicians, ensure senior leadership engage with and seek feedback from frontline providers through co-design, and actively integrate the community sector in discharge planning.

Severe vision impairment and blindness in hospitalized patients: a retrospective nationwide study

BackgroundOutcomes among hospitalized patients with severe vision impairment or blindness have not been extensively explored. This study sought to determine clinical and resource utilization outcomes in patients with severe vision impairment/blindness (SVI/B). Because obesity is very common among those who are hospitalized, we also sought to understand its impact among patients with SVI/B.MethodsWe conducted a retrospective study using the National Inpatient Sample for the year 2017; hospitalized adults with and without SVI/B were compared. In addition, for all patients with SVI/B, we compared those with and without obesity. Multiple logistic regression and linear analysis were used to evaluate mortality, disposition, length of stay, and hospital charges; the analyses were adjusted for multiple variables including age, sex, and race.Results30,420,907 adults were hospitalized, of whom 37,200 had SVI/B. Patients with SVI/B were older (mean age ± SEM: 66.4 ± 0.24 vs. 57.9 ± 0.09 years, p < 0.01), less likely to be female (50 % vs. 57.7 %, p < 0.01), more frequently insured by Medicare (75.7 % vs. 49.2 %, p < 0.01), and had more comorbidities (Charlson comorbidity score ≥ 3: 53.2 % vs. 27.8 %, p < 0.01). Patients with SVI/B had a higher in-hospital mortality rate (3.9 % vs. 2.2 %; p < 0.01), and had lower odds to be discharged home after hospital discharge (adjusted Odds Ratio {aOR} =0.54, [Confidence Interval (CI) 0.51–0.58]; p < 0.01) compared to those without SVI/B. Hospital charges were not significantly different (adjusted Mean Difference {aMD} = $247 CI [-$2,474-2,929]; p = 0.85) but length of stay was longer (aMD = 0.5 days CI [0.3–0.7]; p < 0.01) for those with SVI/B. Patients with vision impariment who were also obese had higher total hospital charges compared to those without obesity (mean difference: $9,821 [CI $1,375-$18,268]; p = 0.02).ConclusionsPatients admitted to American hospitals in 2017 who had SVI/B had worse clinical outcomes and greater resources utilization than those without SVI/B. Hospital-based healthcare providers who understand that those with SVI/B may be at risk for worse outcomes may be optimally positioned to help them to receive the best possible care.

Evaluating a Novel Prehospital Emergency Trauma Care Assessment Tool (PETCAT) for Low- and Middle-Income Countries in Sierra Leone.

WHO recommends training lay first responders (LFRs) as the first step toward formal emergency medical services development, yet no tool exists to evaluate LFR programs. We developed Prehospital Emergency Trauma Care Assessment Tool (PETCAT), a seven-question survey administered to first-line hospital-based healthcare providers, to independently assess LFR prehospital intervention frequency and quality. PETCAT surveys were administered one month pre-LFR program launch (June 2019) in Makeni, Sierra Leone and again 14months post-launch (August 2020). Using a difference-in-differences approach, PETCAT was also administered in a control city (Kenema) with no LFR training intervention during the study period at the same intervals to control for secular trends. PETCAT measured change in both the experimental and control locations. Cronbach's alpha, point bi-serial correlation, and inter-rater reliability using Cohen's Kappa assessed PETCAT reliability. PETCAT administration to 90 first-line, hospital-based healthcare providers found baseline prehospital intervention were rare in Makeni and Kenema prior to LFR program launch (1.2/10 vs. 1.8/10). Fourteen months post-LFR program implementation, PETCAT demonstrated prehospital interventions increased in Makeni with LFRs (5.2/10, p < 0.0001) and not in Kenema (1.2/10) by an adjusted difference of + 4.6 points/10 (p < 0.0001) ("never/rarely" to "half the time"), indicating negligible change due to secular trends. PETCAT demonstrated high reliability (Cronbach's α = 0.93, Cohen's K = 0.62). PETCAT measures changes in rates of prehospital care delivery by LFRs in a resource-limited African setting and may serve as a robust tool for independent EMS quality assessment.

How hospital-based health care providers perceive clinical librarian services: a qualitative review protocol.

The objective of the review is to evaluate how health care providers working in hospitals perceive clinical librarian services. Clinical librarianship programs existed as early as 1971; however, there is a lack of evidence on their effectiveness in impacting health care outcomes. Studies report primarily on programs supporting medicine, although these programs also support other health care providers. In order to affect outcomes, particularly those focused on patient-centered, evidence-based care, clinical librarians need insight into how hospital health care providers perceive clinical librarian services. The review will consider studies that include any health care provider who works within a hospital, including surgical, clinical, and inpatient units. Studies that focus on qualitative data about clinical librarian services, published from 1971 onward, will be eligible for inclusion. The primary databases to be searched are PubMed, CINAHL, Embase, PsycINFO, Library Literature & Information Science, LISTA (Library, Information Science & Technology Abstracts), and Web of Science. Studies will be selected based on their assessment against the inclusion criteria by two independent reviewers. Eligible studies will be critically appraised for methodological quality. Data will be extracted using a standardized tool, and findings pooled and synthesized using a meta-aggregation approach.

\u201cHow can I do more?\u201d Cultural awareness training for hospital-based healthcare providers working with high Aboriginal caseload

BackgroundAboriginal cultural awareness training aims to build a culturally responsive workforce, however research has found the training has limited impact on the health professional’s ability to provide culturally safe care. This study examined cultural awareness training feedback from healthcare professionals working with high Aboriginal patient caseloads in the Top End of the Northern Territory of Australia. The aim of the research was to assess the perception of training and the potential for expansion to better meet workforce needs.MethodsAudit and qualitative thematic analysis of cultural awareness training evaluation forms completed by course participants between March and October 2018. Course participants ranked seven teaching domains using five-point Likert scales (maximum summary score 35 points) and provided free-text feedback. Data were analysed using the Framework Method and assessed against Kirkpatrick’s training evaluation model. Cultural safety and decolonising philosophies shaped the approach.Results621 participants attended 27 ACAP sessions during the study period. Evaluation forms were completed by 596 (96%). The mean overall assessment score provided was 34/35 points (standard deviation 1.0, range 31-35) indicating high levels of participant satisfaction. Analysis of 683 free text comments found participants wanted more cultural education, designed and delivered by local people, which provides an opportunity to consciously explore both Aboriginal and non-Aboriginal cultures (including self-reflection). Regarding the expansion of cultural education, four major areas requiring specific attention were identified: communication, kinship, history and professional relevance. A strength of this training was the authentic personal stories shared by local Aboriginal cultural educators, reflecting community experiences and attitudes. Criticism of the current model included that too much information was delivered in one day.ConclusionsHealthcare providers found cultural awareness training to be an invaluable entry point. Cultural education which elevates the Aboriginal health user’s experience and provides health professionals with an opportunity for critical self-reflection and practical solutions for common cross-cultural clinical encounters may improve the delivery of culturally safe care. We conclude that revised models of cultural education should be developed, tested and evaluated. This requires institutional support, and recognition that cultural education can contribute to addressing systemic racism.

Funeral Experience in South Korea: A Phenomenological Study.

Few studies of death preparation in South Korea are available. This article describes South Koreans' experiences of death and a funeral in a hospital setting to improve health care providers' ability to care for dying patients and their family. Using Colaizzi's phenomenological method, we conducted semistructured interviews with 40 South Koreans who had lost a family member in a hospital setting. Participants' statements were classified into 12 themes, 5 theme clusters, and 3 categories: (a) vagueness of funeral culture, (b) distortion of meaning in funeral culture, and (c) the need to prepare for death and process grief. Our findings are relevant to hospital-based health care providers who care for dying patients and their family. Targeted educational information could help health care providers better serve patients and family. Policy changes could improve quality of care by allowing health care providers to transition with the family from hospital units to a hospital-based funeral setting.

New Paradigms of Extended Thromboprophylaxis in Medically Ill Patients.

Extended thromboprophylaxis given to medically ill patients for up to 45 days following an acute hospitalization remains an emerging topic among many hospital-based health care providers. Recent advancements in the field of extended thromboprophylaxis using risk stratification and careful patient selection criteria have led to an improved safety profile of direct oral anticoagulants (DOACs) and established net clinical benefit when given to key patient subgroups at high risk of venous thromboembolism (VTE) and low risk of bleeding. The Food and Drug Administration (FDA) has now approved the DOACs betrixaban and rivaroxaban for both in-hospital and extended thromboprophylaxis in medically ill patients in these key subgroups, which represents more than one-quarter of hospitalized medically ill patients. This has potential to significantly reduce VTE-related morbidity and mortality for these patients. Emerging data also supports reductions in the risk of arterial thromboembolism in medically ill patients with extended thromboprophylaxis post-hospital discharge using DOACs. This article aims to review the most recent concepts of predicting and preventing VTE and to discuss emerging paradigms of extended thromboprophylaxis in hospitalized medically ill patients utilizing an individualized, risk-adapted approach.

Understanding cause of stillbirth: a prospective observational multi-country study from sub-Saharan Africa

BackgroundEvery year, an estimated 2.6 million stillbirths occur worldwide, with up to 98% occurring in low- and middle-income countries (LMIC). There is a paucity of primary data on cause of stillbirth from LMIC, and particularly from sub-Saharan Africa to inform effective interventions. This study aimed to identify the cause of stillbirths in low- and middle-income settings and compare methods of assessment.MethodsThis was a prospective, observational study in 12 hospitals in Kenya, Malawi, Sierra Leone and Zimbabwe. Stillbirths (28 weeks or more) were reviewed to assign the cause of death by healthcare providers, an expert panel and by using computer-based algorithms. Agreement between the three methods was compared using Kappa (κ) analysis. Cause of stillbirth and level of agreement between the methods used to assign cause of death.ResultsOne thousand five hundred sixty-three stillbirths were studied. The stillbirth rate (per 1000 births) was 20.3 in Malawi, 34.7 in Zimbabwe, 38.8 in Kenya and 118.1 in Sierra Leone. Half (50.7%) of all stillbirths occurred during the intrapartum period.Cause of death (range) overall varied by method of assessment and included: asphyxia (18.5–37.4%), placental disorders (8.4–15.1%), maternal hypertensive disorders (5.1–13.6%), infections (4.3–9.0%), cord problems (3.3–6.5%), and ruptured uterus due to obstructed labour (2.6–6.1%). Cause of stillbirth was unknown in 17.9–26.0% of cases.Moderate agreement was observed for cause of stillbirth as assigned by the expert panel and by hospital-based healthcare providers who conducted perinatal death review (κ = 0.69; p < 0.0005). There was only minimal agreement between expert panel review or healthcare provider review and computer-based algorithms (κ = 0.34; 0.31 respectively p < 0.0005).ConclusionsFor the majority of stillbirths, an underlying likely cause of death could be determined despite limited diagnostic capacity. In these settings, more diagnostic information is, however, needed to establish a more specific cause of death for the majority of stillbirths. Existing computer-based algorithms used to assign cause of death require revision.

The effect of eye images and a social norms message on healthcare provider hand hygiene adherence.

Depictions of eye images and messages encouraging compliance with social norms have successfully motivated behavioral change in a variety of experimental and applied settings. We studied the effect of these 2 visual cues on hand hygiene adherence in a cohort of hospital-based healthcare providers participating in an electronic monitoring and feedback program. Prospective, quasi-experimental study utilizing an interrupted time-series design. Intervention placards depicting an image of eyes, a social norms message, or a control placard were placed near soap and alcohol-based hand-rub dispensers on 2 hospital units. Placards were alternated every 10 days. Hand hygiene opportunities and adherence rates were assessed electronically via the CenTrak Hand Hygiene Compliance Solution. A total of 166 nurses and certified nursing assistants (74 on a medical-surgical unit and 92 on a progressive care unit) were monitored electronically over the 4-month study period. In total, 184,172 electronic observations were collected (110,903 on a medical-surgical unit and 73,269 on a progressive care unit). The median daily number of electronic observations was 1,471 (interquartile range, 1,337-1,584). The preintervention baseline hand hygiene adherence rate was 70%. No statistically significant increase in hand hygiene adherence was observed as a result of either intervention. Displaying eye images or a social norms message in the hospital environment did not result in measurable improvements in HH adherence in a cohort of healthcare providers participating in an electronic monitoring and feedback program.

Healthcare Providers’ Roles in Decision Making About Tracheostomy for Children with Medical Complexity (S768)

•Identify the roles of physicians and non-physician clinicians in the decision-making process about tracheostomy for children with medical complexity.•Identify barriers faced by healthcare providers when guiding caregivers in decision making about tracheostomy for children with medical complexity.•Identify potential solutions to improve the tracheostomy decision-making process for children with medical complexity. Children with medical complexity (CMC) receive life-sustaining treatments (LST) for survival. Guiding caregivers about LST is an important aspect of pediatric palliative care. Describe healthcare providers’ roles in the tracheostomy decision-making process for CMC. This qualitative study was conducted in a tertiary care children’s hospital in North Carolina between February and October 2015. Five focus groups of 33 hospital-based healthcare providers that included hospitalists, pediatric intensivists, neonatologists, pulmonologists, otorhinolaryngologists, nurses, social workers, care coordinator, and respiratory, speech and physical therapist were conducted. Focus groups were audio-recorded and transcribed verbatim. We used ATLAS.ti software to code and manage qualitative data. Recurrent themes were identified. Theme 1. Physicians considered many child-level factors when recommending tracheostomy: underlying condition, survival, risk of recurrent hospitalizations, and neurological impairment. Recommending tracheostomy for CMC with limited survival, perceived poor functioning and quality of life, and progressive conditions was morally and ethically difficult for clinicians. Theme 2. Clinicians considered caregivers’ ability to provide complex care at home when recommending tracheostomy. Barriers to decision making were caregivers’ lack of understanding of the severity of child’s condition, benefits/ futility of tracheostomy, and the effect of tracheostomy on long-term care of CMC, and the influence of social media. Theme 3. Physician variability in tracheostomy recommendation was an impediment to guiding caregivers. Physicians attributed this variability to clinical uncertainty and lack of outcomes data about the effect of tracheostomy. Theme 4. Palliative care services were helpful to clinicians in the decision-making process. Bedside nurses, had information about and trusting relationship with caregivers, that were important. Physicians’ engagement of non-physician clinicians in daily rounds, and provider and family meetings were potential strategies to improve the decision-making process. Healthcare providers play an important role in guiding caregivers in the decision-making process about tracheostomy for CMC.

Abstract TP356: Advanced Stroke Life Support® Course Significantly Improves Knowledge of Stroke Diagnosis and Management for Prehospital and Hospital-Based Providers

Introduction: Comprehensive stroke education is necessary for rapid and effective diagnosis and treatment of stroke victims, especially in the prehospital and emergency department settings. Early acute stroke recognition and appropriate treatment lead to improved patient outcomes. Prehospital and hospital-based health care providers can make the difference between the opportunity for recovery, or a life of long-term disability, and even death. Advanced Stroke Life Support (ASLS®) is a one-day, evidence-based stroke course consisting of didactic lectures and interactive instruction. The sessions include video-based cases where the learners diagnose and develop a management plan for patients with strokes or stroke mimics; skills sessions where learners examine standardized patients who simulate major stroke syndromes; and an interactive game as a course summary. The purpose of this study is to evaluate the ASLS® course’s impact on knowledge of stroke diagnosis and management among prehospital and hospital-based providers. Methods: The ASLS® course was delivered to prehospital and hospital-based providers throughout the United States. All instructors were trained in a train-the-trainer program administered by the ASLS® home site faculty. A total of 9,678 prehospital and hospital-based personnel participated in the course between November 19, 2014 and May 31, 2017. Outcomes were measured using previously validated 25-item written pre-course and post-course assessments. Results: A total of 9,678 participants were included in statistical analyses. Using IBM SPSS Statistics, v.24, paired sample t-tests were performed on the data. Learners demonstrated a statistically significant increase in knowledge from pre- to post-course assessment, from a pre-course mean of 64.4% to a mean of 89.1% at post-course assessment (p &lt; .001). Statistically significant increases in knowledge also occurred within both learner groups, with performance for prehospital learners rising from 63.8% to 90% (p &lt; .001). Hospital-based learners improved from 64.8% to 88.6% (p &lt; .001). Conclusions: Prehospital and hospital-based providers who participated in the ASLS® one-day course significantly improved their knowledge of stroke diagnosis and management.

A Step Toward Workplace Obesity Prevention: Evaluation of Weight Management Program for Hospital-based Health Care Providers

Background: Obesity is a worldwide problem. Healthy workplace and lifestyle are crucial in preventing obesity. A workplace weight management program could create a culture of health and facilitate weight control among health care providers. The present study aims to describe and evaluate the health outcomes of the interaction of professional practice and organizational infrastructure. Method: The hospital-based weight management program was an eight-week pilot randomized controlled study for obese health care providers. The primary outcomes were body weight and body mass index. The secondary outcomes included serum fasting glucose, fasting cholesterol, triglyceride, high- and low-density lipoprotein, body fat percentage, body mass, and quality of life. The RE-AIM framework was used to examine the intervention’s reach, effectiveness, adoption, implementation and maintenance at individual and organizational levels. Results: The program successfully attained the target population. Health care providers demonstrated short-term weight loss and decreased serum fasting cholesterol level after completing the program. The excellent retention rate (95%) of the study suggested that the participants were well-engaged in self-weight management. The program was implemented with adequate resource and support from the health organization. The organization may consider continuing the program in view of its long-term benefits to health care providers. Conclusion: Supportive organizational structure and culture enhanced professional practice and improved the health outcomes of the hospital-based weight management program participants.

Review of Clinical Guidelines for Cardiopulmonary Resuscitation.

More than 359,000 out-of-hospital cardiac arrests occur each year in the United States, with a survival rate of only 8% [1]. Improving the chances of meaningful recovery after cardiac arrest depends on a team approach from the community, first responders, emergency medical services, and hospital-based health care providers. The American Heart Association’s term “chain of survival” provides a useful metaphor, with the following 5 “links” in the chain: immediate recognition of cardiac arrest and activation of the emergency response system, early cardiopulmonary resuscitation (CPR) with an emphasis on chest compressions, rapid defibrillation, effective advanced life support, and integrated post–cardiac arrest care. This sidebar highlights features of the American Heart Association (AHA) guidelines for CPR and emergency cardiovascular care (ECC), which were released in 2010 [2]. This article serves as a primer to the much anticipated, updated AHA CPR/ECC guidelines that will be coming out in late 2015.

Strategies for effective goals of care discussions and decision-making: perspectives from a multi-centre survey of Canadian hospital-based healthcare providers.

BackgroundCommunication gaps impact the quality of patient care. Previous research has focused on communication barriers rather than seeking solutions. Our aim was to identify strategies for effective communication and decision-making about goals of care for medical interventions in serious illness, from the perspectives of hospital-based healthcare providers.MethodsA cross-sectional survey composed of closed- and open-ended questions about goals of care communication and decision-making was administered to healthcare providers in 13 centres in six Canadian provinces. We analyzed a portion of the open-ended survey questions, specifically (1) suggestions for overcoming barriers encountered in discussing goals of care, and (2) currently effective practices. Thematic content analysis was used to analyze responses to the open-ended questions.ResultsOf the 1,256 respondents to the larger survey, 468 responded to the open-ended questions (37 %), including 272 of 512 nurses (53 %), 153 of 484 internal medicine trainees (32 %), and 43 of 260 attending physicians (17 %). Responses to each of the two questions were similar, generating a common set of themes and subthemes. Effective strategies and ideas for improving communication and decision-making about goals of care clustered under five themes: patient and family factors, communication between healthcare providers and patients, interprofessional collaboration, education, and resources. Subthemes highlighted core elements of shared decision-making.ConclusionsTranslating our findings into multifaceted interventions that consider patient and family factors, address knowledge gaps, optimize resource utilization, and facilitate communication and collaboration between patients, families and healthcare providers may improve communication and decision-making about goals of care.Electronic supplementary materialThe online version of this article (doi:10.1186/s12904-015-0035-x) contains supplementary material, which is available to authorized users.

Exploring the Phenomenon of Spiritual Care Between Hospital Chaplains and Hospital Based Healthcare Providers

Hospital chaplaincy and spiritual care services are important to patients’ medical care and well-being; however, little is known about healthcare providers’ experiences receiving spiritual support. A phenomenological study examined the shared experience of spiritual care between hospital chaplains and hospital-based healthcare providers (HBHPs). Six distinct themes emerged from the in-depth interviews: Awareness of chaplain availability, chaplains focus on building relationships with providers and staff, chaplains are integrated in varying degrees on certain hospital units, chaplains meet providers’ personal and professional needs, providers appreciate chaplains, and barriers to expanding hospital chaplains’ services. While HBHPs appreciated the care received and were able to provide better patient care as a result, participants reported that administrators may not recognize the true value of the care provided. Implications from this study are applied to hospital chaplaincy clinical, research, and training opportunities.