Hospital Staff Research Articles

Understanding responsibility for health inequalities in children’s hospitals in England: a qualitative study with hospital staff

ObjectivesThis study aimed to understand how staff in children’s hospitals view their responsibility to reduce health inequalities for the children and young people who access their services.DesignWe conducted an exploratory...

The Emergency Department Response to Women Experiencing Domestic and Family Violence: Insights from Interviews with Hospital Staff, Service Providers and Community Groups in Australia

The Emergency Department Response to Women Experiencing Domestic and Family Violence: Insights from Interviews with Hospital Staff, Service Providers and Community Groups in Australia

Study some biochemical parameters in patients with Coronary artery disease with and without Type 2 diabetes

Background: Impaired lipid metabolism are well recognized factors for Coronary artery disease (CAD) which is the major reason of mortality and morbidity all over world. The incident of CAD with type 2 diabetes mellitus (T2DM) is growing.
 Aim: The current study aimed to study some biochemical variables (vitamin D3, lipid profile, Insulin, FBG and HbA1C) in patients with diabetes and coronary heart disease and compare them with healthy people.
 Subjects and Methods: The study was conducted in human beings (apparently healthy and patients). It is statistically considered as [case- control study], the voluntaries were divided as following: 40 apparently healthy persons (40 male) were recruited through advertisement among laboratories and hospital staff in the three medical centers previously mentioned and from friends in Baghdad. 40 voluntaries patients with T2DM were taken, of them (40 male) were recruited from the specialized center for endocrinology and diabetes. 55 voluntaries patients who had CAD (55 male), 55 patients who have had T2DM with CAD (55 male).
 Results: the results evaluating the BMI of participant revealed that 16.3% had normal BMI, 55.8% were overweight and 27.9% were obese. 65.3% had vitamin D. insufficiency and 16.8% had vitamin D deficiency. The glycemic control evaluation shows that 37.4% had good glycemic control and 16.8% had poor control and 45.8% had excellent control. All participant had insulin resistance in which 31.6% had early resistance. Otherwise, a statistical significant difference in mean level of BMI, vitamin D, insulin level, HOMA-IR, FBS and HbA1c between the 4 groups. For lipid profile, Control group participant had significant lower total cholesterol level in compare to the other groups. Control group participant had significant lower TG level in compare to the other groups. Control group participant had significant higher HDL in compare in CAD group and CAD with DM group. Control group participant had significant lower LDL in compare in CAD group and CAD with DM group.
 Conclusions: Based on the results of the current study, it was found that there is a strong association between low vitamin D and cardiovascular disease, and it was also found that insulin resistance, which mainly causes type 2 diabetes, has increased health problems in CAD patients. On the other hand, the current study demonstrated that high levels of LDL and cholesterol were closely associated with events and increased risk of CAD.

IJCM_44A: Analysis of Health System and Community Readiness for Adhering to Government Guidelines on Gestational Diabetes Mellitus in India

Background: GDM affects approximately 7% of all pregnant women worldwide. India has one of the highest prevalence of Diabetes Mellitus in the world. In a field study in Tamil Nadu, the prevalence of GDM was 17.8% in the urban, 13.8% in the semi urban and 9.9% in the rural areas. It is estimated that at any given time, approximately 4 million women in India are affected by GDM. Though there is availability of national guidelines, screening and management of GDM is challenging and controversial in India due to conflicting guidelines and treatment protocol. There are huge challenges in GDM management both at the individual and provider level. Objective: To understand the challenges and possible solutions for successfully implementing the GDM program Methodology: Data were collected from both public and private health facilities in two districts of Maharashtra. Self-administered questionnaire, IDIs and FGDs were conducted with medical officers and staff of PHCs, RH, SDH and District Hospital. Thematic analysis was done. Results: There were lack of training to Staff and Doctor of the government and private health system regarding GDM guidelines. Infrastructure was lacking for conducting the OGTT. Staff were not willing to conduct OGT and MNT(Medical nutrition therapy) on regular basis. Conclusion: Improvement in infrastructure, manpower and training of the staff is needed. Training in OGTT and MNT is must for the filed staff. More involvement of private players is needed for better implementation of GoI guidleines.

Soft Skills: The Work of Communication and Persuasion Among Nurse Navigators in Hospital at Home Programs.

To assess the role of soft skills in the work of Hospital at Home (HaH) nurse navigators. In HaH programs that employ them, nurse navigators are often responsible for identifying, assessing, referring, and educating potential HaH patients. The experiences of these navigators have gone understudied. Researchers conducted semistructured interviews and observations with nurse navigators (n = 7) who collectively cover 14 North Carolina-based HaH sites. Navigators were asked to keep diaries of responses to directed questions. In their capacity as navigators, interviewees said they served several roles: intermediaries between hospital and HaH staff, interpreters of clinical knowledge for patients, and champions of, and educators for, the home-based program. The navigators noted that the interpersonal soft skills of building rapport, clear communication, and gentle persuasion were of the utmost importance in this work. The job descriptions of nurse navigators in HaH programs should fully reflect the breadth of their responsibilities, including time performing soft skilled labor. Also, training for these roles should include techniques to develop and refine these skills.

Changes in psychosocial distress and the number and types of problems reported by patients with cancer when routine screening is integrated within cancer services

Abstract Background: The impact of patient-reported outcome measures on patient outcomes in longitudinal clinical studies is poorly understood. This observational study explored longitudinal changes in distress and problems reported by cancer patients screened and managed in accordance with a clinical pathway for anxiety and depression (ADAPT CP), implemented over 12 months. Methods: Patients reported distress using the Distress Thermometer and indicated reasons for distress using the 39-item Problem List across five domains: practical, social, emotional, spiritual/religious, and physical. Repeat screening occurred on average 3 monthly (quarterly). Results: Six hundred sixty patients from 10 participating services completed 1,256 screening events over 12 months, reporting 8,645 problems. On average, more emotional (27–34%) and physical (19–22%) issues were reported across all quarters than practical (7–9%) and social (8–9%) issues. Distress and emotional, physical, practical, and social problems reduced from initial to follow-up screens, although the decrease in emotional problems over time was not significantly different than that of the other problems. Worry, fatigue, sleep difficulties, health of family members, and insurance/finances were more persistent problems. Conclusions: Although distress and the change in the number of emotional concerns over time did not differ from other problems, rescreening is recommended within oncology settings to allow patients to indicate new or persistent problems and hospital staff to monitor and assess needs. Emotional concerns are high in oncology patients, suggesting the need for the prioritization of psychosocial care. These problems can persist over time due to their clinically challenging nature or because access to, or implementation of, evidence-based interventions are not yet widespread.

IJCM_204A: A qualitative research to identify the barriers and facilitating factors in the utilization of healthcare services by a Particularly Vulnerable Tribal Group (PVTG) in Udupi District

Background: Udupi district hosts two major Particularly Vulnerable Tribal Groups (PVTG) namely Malaikudiya and Koraga. Koraga tribes are declining in number and deprived of availability of healthcare services and accessibility to healthcare facilities. There are a lot of barriers such as lack of awareness and social stigma amalgamate the existing conditions of Koraga tribes in Udupi district. Research studies pertaining to this problem has been seldom done. Objective: We aim to explore the barriers and facilitating factors in accessing healthcare services by a Particularly Vulnerable Tribal Group (PVTG) in Udupi district. Methodology: We conducted qualitative research through 8 in-depth interviews with AMOs from PHC and CHC, ITDP staff and NGO workers, and 3 focus group discussions with community health nurses, ASHA workers, and Koraga community leaders from Udupi district. We explored the major facilitators and barriers that influence the utilization of health care services by the PVTG. Results: On the beneficiaries’ point of view, lack of awareness, distance to health facilities, poor public transportation, perceived negative behavior of hospital staff, lack of infrastructure, unwelcoming neighbourhood approaches, and economic instability were the main barriers to utilizing healthcare facilities. On the stakeholders (providers) point of view, availability of healthcare facilities, government policies and schemes and NGO activities are the facilitating factors. Conclusion: Our study highlights the barriers to utilizing health facilities; these are not always driven by factors linked to the PVTG members’ socio- economic status but also depend significantly on the quality of the health services and other contextual factors. Although the government has made efforts to improve the rural healthcare system through national-level programs, our qualitative study shows that there are a number of barriers which lessens the effectiveness of the programs to enhance the utilization of healthcare facilities by the PVTG in the study area.

Health Status of Nonemergency Patients in the Emergency Department Using the EQ-5D.

Emergency department (ED) overcrowding is influenced by several factors including the hospital's capacity, staff, patient discharges, and community resources. The number of annual ED visits has increased, with patients' medical needs exceeding emergency capacity, resulting in a widespread concern about emergency room overcrowding. Nonemergency patients tend to use large amounts of emergency medical resources, which is one reason for ED overcrowding. Most patients consider their medical cases urgent, whereas medical professionals consider many cases to be nonemergency. Only a few studies have examined self-rated health among nonemergency patients. This cross-sectional study was conducted in the ED of a tertiary hospital in China using the European Quality of Life Five-Dimensional Questionnaire to investigate the health status of nonemergency patients. Among the 545 respondents, 246 (45.14%) self-assessed their health as excellent, 186 (34.13%) as very good, 70 (12.84%) as good, 32 (5.87%) as average, and 11 (2.02%) as poor. Problems related to pain/discomfort were reported by 317 (58.17%) participants, 214 (39.27%) responded that they had problems related to daily activities, 212 (38.90%) responded that they felt anxious or depressed, 211 (38.35%) responded that they had problems related to self-care, and some or extreme problems related to mobility were stated by 193 people (35.41%). Nonemergency patients generally reported good health. Pain/discomfort was the most significant factor affecting the health of nonemergency patients, followed by limitation of daily activities. The duration of illness onset and self-rated health status were common factors influencing the health status of nonemergency patients. This trial is registered with ChiCTR1900023578.

Facial Sentimental Analysis in Hospitals

Abstract: In today's rapidly evolving healthcare landscape,the focus on patient satisfaction and well-being has become crucial. A positive experience plays an important role in aiding the recovery of the patient. A significant factor contributing to a positive patient experience is the quality care and the emotionalsupport they receive during their hospital stay. Traditional methods of measuring patient satisfaction often rely on surveys and feedback forms, which can be subjective, time-consuming, and potentially biased. To address these limitations, this abstract proposes a novel approach: the integration of facial sentiment analysis as a real-time tool for assessing patient emotions and satisfaction levels. This abstract introduces an approach to enhance patient satisfaction and well-being in healthcare settings. By integrating facial sentiment analysis, we propose a realtime method to objectively evaluate patient emotions and treatment satisfaction. Through advanced computer vision, this approach detects and interprets facial expressions of patients inhospitals, offering insights into care effectiveness, dedication of hospital staff, and efficiency of the treatment. The system generates a "Happiness and Satisfaction Index," aiding healthcare stakeholders in making informed improvements as well and it works as a review metric for the customers who wouldlike to visit their hospital.

Analysis of Factors that Influence Compliance in Complete Administration of BPJS Participant Patients at The Banten Girang Puskesmas Outpatient Registration Place

Health insurance in Indonesia is one of the rights that every citizen must have. Whenplanning a visit to the Community Health Center, patients hope to receive appropriatetreatment with humane, effective and efficient services, because everyone has theright to obtain safe, quality and affordable health services. In order to achieve a goodservice process, detailed work procedures are required and must be carried out andobeyed by all staff in the hospital, both medical and non-medical staff includinghospital service users, to be orderly and cooperative with each other. This study aimsto determine the analysis of factors that influence compliance in the completeness ofpatient administration for BPJS participants at the Banten Girang Community HealthCenter outpatient registration site in 2023. The research design used is an analyticaltype of research with a cross sectional approach. The population in this study was2,524 people and the sample used was 97 respondents. The sampling technique in thisstudy used accidental sampling technique. The results of this study indicate that thereare still 22 BPJS participating patients who do not comply with administrativerequirements (27.8%) at the Banten Girang Community Health Center outpatientregistration site in 2023. The factor that influences compliance with administrativerequirements for BPJS participating patients is knowledge (OR= 4.705; 95% CI: 1.471-15.045), education level (OR= 7.785; 95% CI: 2.510-24.149), source of information(OR= 4.796; 95% CI: 1.541-14.930). The most dominant factor contributing tocompliance in the complete administration of BPJS patient patients with a p-value of0.000 (OR= 7.785; 95% CI: 2.510-24.149). It is hoped that the results of this researchcan become study material for the Community Health Center to provide socializationor information regarding the administrative completeness of BPJS participants usingmethods that are easy to understand, so that they can increase the knowledge of BPJSparticipant patients.

What’s the preferences of medical staff for providing health education service? – A discrete choice experiment in Beijing, China

ObjectiveTo quantify medical staff preferences for providing health education service in hospitals. MethodsThis study took medical staff in the department of internal medicine of hospitals in Beijing, China as the research subjects, and designed a discrete choice experiment (DCE) to investigate the health education service provision preferences of them. Through various methods, 8 attributes and corresponding levels were determined. An online survey was conducted among the medical staff of the sample hospitals from May to June 2023. Participants’ preferences were analyzed using conditional logit and mixed logit models. ResultsFinally, 831 respondents completed the questionnaire, among which 600 cases passed the consistency test. All the attributes included in this study had an impact on medical staff’ health education service preferences (P < 0.001). The most important one with the greatest impact on the health education service delivery behavior of the respondents was "department working atmosphere-encouraging health education" (β = 4.062, P < 0.001). ConclusionIn this study, the departmental work atmosphere and performance bonuses emerged as crucial factors influencing the engagement of medical staff in health education work. Practical implicationsHospitals should prioritize measures to improve the health education working atmosphere in departments to increase the enthusiasm of medical staff to provide services.

Phlebotomy- A gateway to laboratory diagnostics

Objective: To assess the knowledge, practice and attitude about venipuncture amongst Nursing staff of a tertiary care hospital. Material and Methods: This questionnaire-based survey was done at Rawal General and dental hospital, Islamabad, from January to April 2022. The Questionnaire was developed as per the CLSI H3-A6 and WHO‘s venipuncture guidelines. It was distributed to nursing staff by hand. Most were filled inside the classes in front of the teacher. Results: The frequency of correct responses in the knowledge section varied from 4(4.6%) about the number of tube inversions to 79(90.8%) about wearing of gloves before taking a sample while 47(54%) selected the correct option of identifying a patient. Regarding the standard phlebotomy protocols, the response was quite low which was 26(29.9%), 18(20.7%) and 8(9.2%) about the correct angle of needle insertion, what to inspect of the supplies and the location of applying the tourniquet respectively. Recapping with two hands is still done by 13% and 79% still put the sample by holding tube in the other hand. In spite of all this 66% still think that one can learn venipuncture by practicing the techniques without going through a proper course. Conclusion: Nursing staff in Rawal General and dental hospital is not fully aware about basic laboratory protocols and their importance. This unawareness can lead to generation of erroneous lab reports. Formal education, training with summative assessments should be a part of the curriculum of nursing courses followed by rigorous implementation monitoring. Keywords: Awareness, Nurses, Phlebotomy, Venipuncture, Sample

Change in Medical Sharps Injury Characteristics During the COVID-19 Pandemic

Aim: Knowledge about the change in the frequency and characteristics of medical sharps injuries during the Coronavirus Disease–2019 (COVID-19) pandemic is very limited. This study aimed to compare the characteristics of medical sharps injuries experienced by healthcare staff before and during the COVID-19 pandemic. Material and Method: A total of 304 cases of medical sharps injuries suffered by hospital staff in our hospital between 2014 and 2022 were included in the study. Data regarding these accidents were obtained from accident files in the hospital archive. Results: The mean age of the staff exposed to the accident was 30.2±10.7 (range: 15-50) years, and 227 (74.7%) were women. During the pandemic, a 34.6% decrease was detected in the annual mean number of medical sharps injuries compared to before the pandemic. In cases during the pandemic, the annual mean rate of interns who had an accident decreased significantly compared to before the pandemic (43.7% vs. 18.8%), while the mean rate of nurses increased significantly (31.9% vs. 53.2%)(p&amp;lt;0.001), and the annual mean needle tip rate decreased significantly (83.0% vs. 68.0%)(p=0.035). Conclusion: The findings of the present study showed that there was a significant decrease in the number of medical sharps accidents during the pandemic compared to the pre-pandemic period, that the rate of nurses who were exposed to accidents increased significantly during this period, that there was a significant decrease in the rate of needle stick-related accidents, that there was a significant decrease in the accident rate in surgical wards and a significant increase in intensive care units.

Impact of Off-Hour Admission on In-Hospital Outcomes for Patients With Stroke Receiving Reperfusion Therapy in China.

The structure and staffing of hospitals greatly impact patient outcomes, with frequent changes occurring during nights and weekends. This retrospective cohort study assessed the impact of admission timing on in-hospital management and outcomes for patients with stroke receiving reperfusion therapy in China using data from a nationwide registry. Data from patients receiving reperfusion therapy were extracted from the Chinese Stroke Center Alliance. Hospital admission time was categorized according to day/evening versus night and weekday versus weekend. Primary outcomes were in-hospital death or discharge against medical advice, hemorrhage transformation, early neurological deterioration, and major adverse cardiovascular events. Logistic regression was performed to compare in-hospital management performance and outcomes based on admission time categories. Overall, 42 381 patients received recombinant tissue-type plasminogen activator (r-tPA) therapy, and 5224 underwent endovascular treatment (EVT). Patients admitted during nighttime had a higher probability of receiving r-tPA therapy within 4.5 hours from onset or undergoing EVT within 6 hours from onset compared with those admitted during day/evening hours (adjusted odds ratio, 1.04 [95% CI, 1.01-1.08]; P=0.021; adjusted odds ratio, 1.72 [95% CI, 1.59-1.86]; P<0.001, respectively). However, no significant difference was observed between weekend and weekday admissions for either treatment. No notable differences were noted between weekends and weekdays or nighttime and daytime periods in door-to-needle time for r-tPA or door-to-puncture time for EVT initiation. Furthermore, weekend or nighttime admission did not have a significant effect on the primary outcomes of r-tPA therapy or EVT. Nevertheless, in patients undergoing EVT, a higher incidence of pneumonia was observed among those admitted at night compared with those admitted during day/evening hours (adjusted odds ratio, 1.22 [95% CI, 1.05-1.42]; P=0.011). Patients admitted at nighttime were more likely to receive r-tPA therapy or EVT within the time window recommended in the guidelines. However, patients receiving EVT admitted at night had an increased risk of pneumonia.

Investigating Between Patient Safety Culture, Organizational Climate, and A Positive Workplace on Reporting of Patient Safety Incidents in Hospital

Many patient safety incidents (PSIs) begin the hospital's safety system establishment, which is oriented toward patient safety. The importance of PSI reporting is of particular concern to WHO. Therefore, comprehensive guidance exists on designing, implementing, and applying good PSI reporting. This research is a non-experimental design using SEM analysis techniques, and it is processed using the SMARTPLSv3 application. This study aims to determine the effect of patient safety culture (X1), organizational climate (X2), and a positive environment (X3) on motivation to report PSI (Y1). The research sample was the X Semarang Hospital staff, with 200 respondents. The results showed that the Patient Safety Rate at X Semarang Hospital was in a suitable category of 54%, even though the number of PSI reported was in the low category. The SEM analysis result indicated that the construct of the X1 and X2 variables after modification was valid and reliable. Moreover, there was a positive and significant effect of X1 and X2 on Y1 with an effect size of 0.042 (small) and 0.490 (large). However, X2 did not have a significant influence on Y1. The hierarchy culture implemented in X Hospital didn't affect motivation for the reporting of patient safety incidents (PSI). It even tends to have an indirect negative influence through a supportive environment variable.

The Influence of Psychological Capital and Affective Commitment on Organizational Citizenship Behavior of Hospital Staff

Organizational Citizenship Behavior (OCB) is important to apply to hospital staff. This research aims to determine the simultaneous and partial influence of psychological capital and affective commitment on OCB. Respondents were 196 officers from two hospitals in Indonesia. The sampling method uses stratified random sampling. The data analysis method uses multiple linear regression. Data was processed with the help of Jamovi 2.3.28 software. The research results found that psychological capital and affective commitment had a significant positive effect on OCB both partially and simultaneously. Hospital management can increase the voluntary behavior of its staff in working beyond formal rules by increasing psychological capital such as self-efficacy, hope, optimism, resilience. Factors that increase affective commitment also need to be implemented so that officers' OCB increases, followed by better service provided. Future researchers can limit the study population to certain areas and combine private and government hospitals to obtain greater generalization. Future researchers can add other variables such as work motivation and job satisfaction to the simultaneous and partial effects.

AmBisome® Formulations for Pediatrics: Stability, Cytotoxicity, and Cost-Effectiveness Studies.

Liposomal amphotericin B (Ambisome®) is the gold standard for the treatment and prevention of fungal infections both in the adult and pediatric populations. The lyophilized dosage form has to be reconstituted and diluted by hospital staff, but its management can be challenging due to the spontaneous tendency of amphotericin B to form aggregates with different biological activity. In this study, the colloidal stability of the liposomes and the chemical stability of amphotericin B were investigated over time at storage conditions. Three liposomal formulations of amphotericin B at 4.0 mg/mL, 2.0 mg/mL, and 0.2 mg/mL were prepared and assayed for changes regarding the dimensional distribution, zeta potential, drug aggregation state, and onset of by-products. Our analyses highlighted that the most diluted formulation, kept at room temperature, showed the greatest changes in the aggregation state of the drug and accordingly the highest cytotoxicity. These findings are clinically relevant since the lower dosages are addressed to the more vulnerable patients. Therefore, the centralization of the dilution of AmBisome® at the pharmacy is of fundamental importance for assuring patient safety, and at the same time for reducing medication waste, as we demonstrated using the cost-saving analysis of drug expense per therapy carried out at the G. Gaslini children hospital.

Exploring hospital resilience protective or risk factors: lessons for future disaster response efforts.

Hospital resilience is essential in responding to disasters, but current research focuses mainly on frameworks and models rather than the protection of resilience and analysis of risk factors during public health emergencies. This study aims to examine the development of resilience in Chinese frontline hospitals during the initial COVID-19 outbreak in 2020, providing insights for future disaster response efforts. We conducted interviews with 26 hospital staff members who were involved in the initial response to the COVID-19 outbreak in China. We used a semi-structured interview approach and employed purposive sampling and snowball sampling techniques. The interview outline was guided by the 'Action Framework' proposed by the World Health Organization (WHO) for responding to infectious disease emergencies. This framework includes dimensions such as command, surveillance, risk communication, medical response, and public health response. We analyzed the collected data using Colaizzi's seven-step data analysis method and the template analysis method. WHO's 'action framework' effectively highlights the factors that contribute to hospital resilience. While medical response, including the availability of materials and facilities, the use of information technology, and the capacity for infectious disease diagnosis and treatment, remains crucial, other important aspects include awareness and beliefs about infections, treatment experience, interdisciplinary collaboration, and more. Additionally, it is essential to establish an intelligent command system, foster trusting partnerships between teams, improve monitoring capabilities for infectious disease agents, enhance risk communication through information synchronization and transparency, strengthen infection control planning, and improve environmental disinfection capabilities for effective public health emergency response. These contradictions significantly impact the enhancement of hospital resilience in dealing with major infectious disease outbreaks. In responding to sudden major infectious diseases, hospitals play a vital role within the healthcare system. Enhancing hospital resilience involves more than just improving treatment capabilities. It also requires effective command coordination at the hospital level, infection control planning, and the deployment of intelligent equipment. Additionally, planning for effective communication and coordination between hospitals, communities, and the national healthcare system can further enhance hospital resilience.

Quality and sustainability of Ethiopia's national surgical indicators.

In 2015, the Ethiopian Federal Ministry of Health (FMOH) developed the Saving Lives through Safe Surgery (SaLTS) initiative to improve national surgical care. Previous work led to development and implementation of 15 surgical key performance indicators (KPIs) to standardize surgical data practices. The objective of this project is to investigate current practices of KPI data collection and assess quality to improve data management and strengthen surgical systems. The first portion of the study documented the surgical data collection process including methods, instruments, and effectiveness at 10 hospitals across 2 regions in Ethiopia. Secondly, data for KPIs of focus [1. Surgical Volume, 2. Perioperative Mortality Rate (POMR), 3. Adverse Anesthetic Outcome (AAO), 4. Surgical Site Infection (SSI), and 5. Safe Surgery Checklist (SSC) Utilization] were compared between registries, KPI reporting forms, and the DHIS2 (district health information system) electronic database for a 6-month period (January-June 2022). Quality was assessed based on data completeness and consistency. The data collection process involved hospital staff recording data elements in registries, quality officers calculating KPIs, completing monthly KPI reporting forms, and submitting data into DHIS2 for the national and regional health bureaus. Data quality verifications revealed discrepancies in consistency at all hospitals, ranging from 1-3 indicators. For all hospitals, average monthly surgical volume was 57 cases, POMR was 0.38% (13/3399), inpatient SSI rate was 0.79% (27/3399), AAO rate was 0.15% (5/3399), and mean SSC utilization monthly was 93% (100% median). Half of the hospitals had incomplete data within the registries, ranging from 2-5 indicators. AAO, SSC, and SSI were commonly missing data in registries. Non-standardized KPI reporting forms contributed significantly to the findings. Facilitators to quality data collection included continued use of registries from previous interventions and use of a separate logbook to document specific KPIs. Delayed rollout of these indicators in each region contributed to issues in data quality. Barriers involved variable indicator recording from different personnel, data collection tools that generate false positives (i.e. completeness of SSC defined as paper form filled out prior to patient discharge) or missing data because of reporting time period (i.e. monthly SSI may miss infections outside of one month), inadequate data elements in registries, and lack of standardized monthly KPI reporting forms. As the FMOH introduces new indicators and changes, we recommend continuous and consistent quality checks and data capacity building, including the use of routinely generated health information for quality improvement projects at the department level.

The Rhetoric and Reality of Choice and Autonomy When Older People Are Discharged from Community Hospital at the End-of-Life in England: A Constructivist Grounded Theory Study

There has been an increasing acknowledgement in the UK of the importance of recognising frailty as a condition that leaves older people vulnerable to dramatic, sudden changes in health triggered by seemingly small events. In policy, the approach to managing frailty is often an emphasis on staying well with limited consideration to frailty as an end-of-life phase. Meanwhile, discharge from hospital continues to be complex. Overstretched acute hospitals are juxtaposed with community and social services that struggle to keep up with the demand of those being discharged and the labelling of older people as “bed blockers” at the centre of delayed discharges. This paper reports a study underpinned by constructivist grounded theory methodology, with the aim of exploring the experiences and perceptions of stakeholders. Semistructured interviews were conducted with 57 participants including patients, their informal carer(s), community hospital staff, community health professionals, and care home managers. The core category of “the drive to discharge conveyor belt” was derived from data analysis. A significant finding of this study was that of the carer, their burden, and their intrinsic role in facilitating discharge, filling in gaps in services, coordinating services, and enabling the patient to stay at home, with little consideration of their choices or autonomy. The “drive to discharge” impacts older people, their informal carers, and health professional. This study suggests how they may be supported, through an ethical lens.