Acute Inpatient Care Research Articles

Predictive Factors and the Predictive Scoring System for Falls in Acute Care Inpatients: Retrospective Cohort Study.

Falls in hospitalized patients are a serious problem, resulting in physical injury, secondary complications, impaired activities of daily living, prolonged hospital stays, and increased medical costs. Establishing a fall prediction scoring system to identify patients most likely to fall can help prevent falls among hospitalized patients. This study aimed to identify predictive factors of falls in acute care hospital patients, develop a scoring system, and evaluate its validity. This single-center, retrospective cohort study involved patients aged 20 years or older admitted to Shizuoka General Hospital between April 2019 and September 2020. Demographic data, candidate predictors at admission, and fall occurrence reports were collected from medical records. The outcome was the time from admission to a fall requiring medical resources. Two-thirds of cases were randomly selected as the training set for analysis, and univariable and multivariable Cox regression analyses were used to identify factors affecting fall risk. We scored the fall risk based on the estimated hazard ratios (HRs) and constructed a fall prediction scoring system. The remaining one-third of cases was used as the test set to evaluate the predictive performance of the new scoring system. A total of 13,725 individuals were included. During the study period, 2.4% (326/13,725) of patients experienced a fall. In the training dataset (n=9150), Cox regression analysis identified sex (male: HR 1.60, 95% CI 1.21-2.13), age (65 to <80 years: HR 2.26, 95% CI 1.48-3.44; ≥80 years: HR 2.50, 95% CI 1.60-3.92 vs 20-<65 years), BMI (18.5 to <25 kg/m²: HR 1.36, 95% CI 0.94-1.97; <18.5 kg/m²: HR 1.57, 95% CI 1.01-2.44 vs ≥25 kg/m²), independence degree of daily living for older adults with disabilities (bedriddenness rank A: HR 1.81, 95% CI 1.26-2.60; rank B: HR 2.03, 95% CI 1.31-3.14; rank C: HR 1.23, 95% CI 0.83-1.83 vs rank J), department (internal medicine: HR 1.23, 95% CI 0.92-1.64; emergency department: HR 1.81, 95% CI 1.26-2.60 vs department of surgery), and history of falls within 1 year (yes: HR 1.66, 95% CI 1.21-2.27) as predictors of falls. Using these factors, we developed a fall prediction scoring system categorizing patients into 3 risk groups: low risk (0-4 points), intermediate risk (5-9 points), and high risk (10-15 points). The c-index indicating predictive performance in the test set (n=4575) was 0.733 (95% CI 0.684-0.782). We developed a new fall prediction scoring system for patients admitted to acute care hospitals by identifying predictors of falls in Japan. This system may be useful for preventive interventions in patient populations with a high likelihood of falling in acute care settings.

Point prevalence survey of antibiotics usage in a tertiary care public sector hospital employing WHO methodology.

Background: Antimicrobial resistance (AMR) kills 7 million people annually. WHO recognized AMR as a global threat in 2017 and launched the Point Prevalence Survey (PPS) methodology in 2018. The situation in Pakistan is even worse with an overall prevalence of antibiotic usage of 75 per 100 population. Material and Methods: This cross-sectional survey was conducted on a single day, 25th May 2024, at the Pakistan Institution of Medical Sciences (PIMS), with a sample size of 271 of 822 eligible patients. The PPS team collected the data using a questionnaire based on the WHO PPS methodology. All acute care and ward patients hospitalized at or before 8:00 A.m. were included. Results: A total of 271 patients were included in the survey, 110 (40.60%) were females, and 161 (59.40%) were males. The patients aged&gt; 2 months were 248 (91.50%) and &lt; 2 months were 23 (8.5%). The prevalence of antibiotic use in PIMS was 210 (77.6%). The culture sample sent before the first dose of antibiotic was only in 57 (27.1%) patients. The largest indication was community-acquired infections 40 (55.56%). Blood was the most common form of sample sent 45 (47.36%). The culture positivity rate was 21.05%. Klebsiella Pneumoniae was the most detected organism at 25% followed by Pseudomonas aeruginosa at 15%. The target antibiotic prescriptions were only 13.3%. Ninety percent of the antibiotics were given via parenteral route. Ceftriaxone was the most popular antibiotic used 62(20%). Conclusion: Antibiotics are widely used in our hospital, with the majority being empirical. Most antibiotics are used to treat community-acquired illnesses. Patients whose cultures were sent before their initial antibiotic treatment make up a minor proportion. Keywords: Community-acquired infections, Indication, Culture, Antibiotic consumption, Point prevalence survey, MDROs

Impact of COVID-19 pandemic on acute stroke care in a tertiary stroke centre

The aim of this study was to evaluate how COVID-19 affected acute stroke care and outcome in patients with acute ischemic or hemorrhagic stroke. We performed a retrospective analysis on patients who were admitted with acute ischemic (AIS) or hemorrhagic (ICH) stroke from September 2020 to May 2021 with and without COVID-19. We recorded demographic and clinical data, imaging parameters, functional outcome and mortality at one year. Beside descriptive statistics we performed χ2-probe, Mann-Witney U-test, Student t-probe and multivariate testing. We found a 29%-reduction in the number of AIS cases during the pandemic. The number of the large vessel occlusions /LVOs/ (N = 83, 41.7%), from them 37 (17.7%) had mechanical thrombectomy (MT), was higher than before the COVID-19 period (p = 0.02 and p = 0.001, respectively). From all patients needing acute revascularization therapy (N = 137) 118 patients received it, among them 20 (16.9%) had COVID-19. Those positive for COVID-19 were more likely to have a higher median NIHSS score at baseline and at 24 h (p = 0.02 and p = 0.03, respectively). They also had a lower rate of favourable outcome at discharge (15% vs. 41.8%; p = 0.024) and at three months (25% vs. 52%, p = 0.02), longer median hospitalization (p < 0.0001), and a higher mortality rate (52% vs. 25%; p = 0.03). The incidence of symptomatic intracerebral hemorrhage (sICH) did not differ between the groups. Regarding the ICH patients, NIHSS score at 24 h (p = 0.036), mortality at 3 months (p = 0.004) and at one year (p = 0.00) were higher in the COVID-19 group. We concluded that the pandemic resulted fewer admission due to AIS with an increased number of LVOs and MTs. AIS patients with concomitant SARS-CoV-2 infection have more severe strokes and unfavorable long term outcome. The risk of sICH was not increased in COVID-19 positive patients therefore reperfusion therapies appear to be safe and beneficial for some individuals. Patients with ICH and comorbid COVID-19 have a very poor prognosis.

A qualitative analysis of healthcare professionals’ experiences with an internet-based emotion regulation intervention added to acute psychiatric inpatient care

BackgroundHealthcare professionals play an important role in successfully implementing digital interventions in routine mental healthcare settings. While a larger body of research has focused on the experiences of mental healthcare professionals with the combination of digital interventions and face-to-face outpatient treatment, comparatively little is known about their experiences with digital interventions combined with inpatient treatment. This is especially true for acute psychiatric inpatient care, where studies on the implementation of digital interventions are more rare. The current study aimed to investigate healthcare professionals’ experiences with an internet-based emotion regulation intervention added to acute psychiatric inpatient treatment.MethodsPhysicians, nurses, psychologists, social workers, and occupational therapists from three acute inpatient wards (n = 20) were interviewed regarding their experiences. A thematic analysis approach was used to analyze the interview data.ResultsThe following themes and corresponding subthemes were identified: lack of experience (few or no previous experiences, no expectations, few points of contact), the intervention as a contemporary complement (positive expectations, necessary and contemporary, positive effects on therapeutic work and patients, characteristics of the internet-based program), concerns about fit for acute psychiatric inpatient care (fit for acute psychiatric inpatients, doubts about implementation), the human factor as essential for implementation (the team makes or breaks it, guidance is key, patient characteristics), and requirements for implementation beyond the human factor (integration into existing treatment structure, resources, changes to the internet-based program, timing).ConclusionsWhile healthcare professionals reported few points of contact with the intervention, they saw it as a contemporary complement to acute psychiatric inpatient care with benefits for therapeutic work and patients. The findings further suggest that specific concerns regarding the fit for acute psychiatric inpatient care remain and that human factors such as support from the ward team, human guidance during the intervention and being mindful of specific patient characteristics are considered important for implementation. Moreover, factors such as integration of the intervention into the ward program, resource availability and the timing of the intervention during a patient’s individual stay should be considered for successful implementation.Trial registrationClinicaltrials.gov, NCT04990674, 04/08/2021.

Intravenous Pump Flow Accuracy: A Systematic Review.

Intravenous pumps (IVPs) deliver IV medications to millions of acute care patients each year and result in many adverse events reported to the US Food and Drug Administration (FDA). Although the use of IVPs has improved overall safety, there are still high rates of error that risk the safety of all patients, especially those of advanced age and those suffering from critical illness. Most of the documented errors are based on clinician reports, although there is reason to believe that errors due to flow rate inaccuracy go undetected and unreported. The purpose of this systematic literature review was to explore literature regarding flow rate accuracy for IVPs used in US acute care medicine. The systematic review was conducted by searching PubMed, CINHAL, and Web of Science. Articles chosen were from any year, written in the English language, and had content pertaining to the use of IVPs and key concepts of interest. Concepts discussed throughout the literature are relevant to the IVPs used for patient care, including outlet pressure, intake pressure, dead volume, and pump setup. This review provides a conceptual overview of what is known about this technology but reveals a gap in knowledge related to actual IVP clinical accuracy.

Exploring Clinician Barriers and Enablers in Referring Patients to a Virtual Hospital for Acute Care

Background: Virtual hospitals offer a promising solution to alleviate pressures on traditional healthcare systems by providing acute care in patients' homes. Despite the implementation of a virtual hospital model in South Australia, referral rates remain below expectations. Aim: To explore clinician attitudes, beliefs, barriers, and enablers influencing referrals to a virtual hospital for acute care. Methods: A qualitative exploratory study was conducted using semi-structured interviews with nine clinicians who had experience referring patients to the virtual hospital. Data were analysed thematically using a grounded theory approach. Results: Four key themes emerged: (1) Complexity of the healthcare ecosystem leading to duplication and navigation challenges; (2) Ambiguity in patient selection criteria causing uncertainty in referrals; (3) Higher social complexity and non-medical care needs acting as barriers; (4) Interoperability issues and the need for effective change management. Conclusions: Addressing the identified barriers through refining referral pathways, clarifying eligibility criteria, enhancing support for patients with complex needs, and improving system interoperability could increase referral rates to the virtual hospital. Engaging clinicians in the co-design of virtual care models is essential for successful implementation.

Examining Systemic and Interpersonal Bias in Violence Risk Assessments of Patients in Acute Psychiatric Care.

The assessment and management of inpatient risk for violence in acute psychiatric care are challenges that introduce the potential for bias. This study aimed to examine inequities based on social determinants of health (SDoH) (e.g., race-ethnicity, gender, or mode of admission to acute care) that may lead to unfair assessment of psychiatric patients. The authors analyzed electronic health records of 7,424 acute care patients across 12,650 stays (2016-2022) at a large Canadian psychiatric hospital. Risk ratios (RRs) were calculated by SDoH for staff assessments of high risk (perceived risk), for violent incidents (actual risk), and for potentially biased risk assessment (particularly when a patient was assessed as high risk but did not become violent). In univariate analyses, patients assessed as high risk who did not become violent were more likely to be male than female and to be Black, Indigenous, or Middle Eastern than White. When RRs were mutually adjusted for all variables, the associations for gender and race-ethnicity were attenuated or were no longer statistically significant. Associations with potentially biased risks that remained significant included most psychiatric diagnoses (vs. a depressive or anxiety disorder), supportive or unstable housing (vs. owning a home), and admission by police (vs. self-admission; RR=2.14, 95% CI=1.92-2.40). Systemic factors, such as admission by police and housing status, and having severe mental illness were the primary drivers of observed inequities in risk assessments of patients from racial-ethnic minority groups. Addressing these systemic factors might be key to improving acute psychiatric care.

Clinical benefits of modifying the evening light environment in an acute psychiatric unit: A single-centre, two-arm, parallel-group, pragmatic effectiveness randomised controlled trial.

The impact of light exposure on mental health is increasingly recognised. Modifying inpatient evening light exposure may be a low-intensity intervention for mental disorders, but few randomised controlled trials (RCTs) exist. We report a large-scale pragmatic effectiveness RCT exploring whether individuals with acute psychiatric illnesses experience additional benefits from admission to an inpatient ward where changes in the evening light exposure are integrated into the therapeutic environment. From 10/25/2018 to 03/29/2019, and 10/01/2019 to 11/15/2019, all adults (≥18 years of age) admitted for acute inpatient psychiatric care in Trondheim, Norway, were randomly allocated to a ward with a blue-depleted evening light environment or a ward with a standard light environment. Baseline and outcome data for individuals who provided deferred informed consent were used. The primary outcome measure was the mean duration of admission in days per individual. Secondary outcomes were estimated mean differences in key clinical outcomes: Improvement during admission (The Clinical Global Impressions Scale-Improvement, CGI-I) and illness severity at discharge (CGI-S), aggressive behaviour during admission (Broset Violence Checklist, BVC), violent incidents (Staff Observation Aggression Scale-Revised, SOAS-R), side effects and patient satisfaction, probabilities of suicidality, need for supervision due to suicidality, and change from involuntary to voluntary admission. The Intent to Treat sample comprised 476 individuals (mean age 37 (standard deviation (SD) 13.3); 193 (41%) were male, 283 (59%) were female). There were no differences in the mean duration of admission (7.1 days for inpatients exposed to the blue-depleted evening light environment versus 6.7 days for patients exposed to the standard evening light environment; estimated mean difference: 0.4 days (95% confidence interval (CI) [-0.9, 1.9]; p = 0.523). Inpatients exposed to the blue-depleted evening light showed higher improvement during admission (CGI-I difference 0.28 (95% CI [0.02, 0.54]; p = 0.035), Number Needed to Treat for clinically meaningful improvement (NNT): 12); lower illness severity at discharge (CGI-S difference -0.18 (95% CI [-0.34, -0.02]; p = 0.029), NNT for mild severity at discharge: 7); and lower levels of aggressive behaviour (difference in BVC predicted serious events per 100 days: -2.98 (95% CI [-4.98, -0.99]; p = 0.003), NNT: 9). There were no differences in other secondary outcomes. The nature of this study meant it was impossible to blind patients or clinical staff to the lighting condition. Modifying the evening light environment in acute psychiatric hospitals according to chronobiological principles does not change duration of admissions but can have clinically significant benefits without increasing side effects, reducing patient satisfaction or requiring additional clinical staff. Clinicaltrials.gov NCT03788993; 2018 (CRISTIN ID 602154).

Examining the potential of an internet-based emotion regulation intervention added to acute psychiatric inpatient care: results from a randomized controlled pilot trial.

The feasibility and the preliminary effectiveness of an internet-based emotion regulation intervention added to acute psychiatric inpatient care were assessed with a randomized controlled pilot trial. Sixty patients were allocated in a 1:1 ratio to the intervention group or treatment as usual (TAU). Feasibility was evaluated via patient satisfaction, system usability, and program usage. The primary outcome was symptom severity (Brief-Syptom-Inventory-18-GSI), secondary outcomes included two emotion regulation measures. Assessments occurred at baseline, after four weeks (T1), eight weeks (T2), and patient discharge. Satisfaction scores (CSQ-8: M = 2.97, SD = 0.64) and usability ratings (SUS: M = 69.89, SD = 10.34) were positive. Program usage was low, with only 12 of 30 patients completing at least 50 % of the program. In the ITT-analysis, no significant group-by-time interaction effects were found for symptom severity or emotion regulation. Descriptively, effect sizes favored the intervention for symptom severity at T1 (d = 0.16) and T2 (d = 0.12) and favored TAU for the emotion regulation parameters at both time points. Thus, while the internet-based program showed good usability and satisfaction, it did not significantly impact symptom severity or emotion regulation. Future research should examine how to enhance program use in this treatment context.

Improving Mobility in Acute Care Patients with a Mobility Technician: A Quality Improvement Pilot Project

Improving Mobility in Acute Care Patients with a Mobility Technician: A Quality Improvement Pilot Project

Effects of early exposure to palliative care on end-of-life outcomes in patients with cancer in a community setting

ObjectiveAlthough prior studies show that exposure to early outpatient palliative care (OPC) versus no exposure is associated with improved outcomes at the end of life (EoL) for patients with cancer,...

Концепция периоперационного риска: обзор литературы

INTRODUCTION: Perioperative risk refers to the likelihood of adverse events occurring during and after surgery. For the purpose of defining and classifying adverse events and predicting them, a comprehensive search of Pubmed and Lens.org was made according to the author expert opinion. OBSERVATIONS: Traditionally, two main types of postoperative adverse events have been investigated: complications and mortality. However, over the past decade, there has been a growing trend to expand the range of adverse events analyzed, from intraoperative critical events and the quality of recovery from anesthesia to the development of intensive care syndrome, assessing quality of life, disability, and survival over time. An important aspect associated with adverse events and outcomes is the provision of additional resources for a long-term stay for patients with acute respiratory viral infections and inpatient care after discharge, among other things. The review formulates its own concept of perioperative risk, based on a critical analysis of literature, with an emphasis on the need to create an ideal tool, such as a calculator, that must undergo external validation. This tool should include available, modifiable variables, and accurately determine the full range of adverse events and outcomes during the intra- and early postoperative periods, as well as delayed events. The concept shall also focus on identifying and characterizing patients with a high risk of perioperative complications.

Abstract Su603: Out-of-hospital cardiac arrest presenting with ST-segment elevation myocardial infarction: Real world assessment and treatment

Background: Coronary artery disease is a common cause of out-of-hospital cardiac arrest (OHCA). Early recognition myocardial infarction (MI) and initiating appropriate therapy has been shown to improve outcomes in OHCA. While early coronary intervention is part of guidelines-based care, the implementation of these recommendation in actual US practice remains poorly described. Objectives: This study aims to characterize patients presenting with OHCA and MI in a cohort from 4 hospitals, to assess care of these patients in actual practice. Methods: We employed a database of OHCA patients admitted to four hospitals within the University of Pennsylvania Hospital System between 01/2019-12/2023. For this study, we included all patients that were diagnosed with STEMI during emergency department evaluation, and collected demographic, arrest, coronary angiographic, and ECG data from electronic health records. SAS was used for statistical analysis. Results: A total of 43 MI cases were included; mean age was 60.6±11.8 y, 65% male, mean BMI 30.0±6.3, 58.1% African American, 27.9% White or Caucasian, and 16.3% had a medical history of myocardial infarction. 74.4% were witnessed, and 44.2% received bystander CPR[BA1]. Initial shockable rhythm was present in 34.9%. 38 survived to hospital admission, and 9 were discharged alive. The first obtained 12-lead ECG (median time to ECG: 13min, (IQR: 3.5-26.5)) found that ST-segment elevations were present in 88.4%, ST-segment depressions in 44.2%, T-wave inversions in 4.7%, QT prolongation in 9.3%, and wide QRS in 18.6%. Sinus rhythm was most common (41.9%), followed by junctional rhythm (9.3%). Left and right bundle branch blocks (4.3% and 7%, respectively) and AV block (7%) were recorded. Coronary angiography (median time to angiography: 1.95hr (IQR: 1.3-4.2)) was performed in 29 patients and revealed that left anterior descending artery (28.6%) was the most common location for a culprit lesion, followed by the right coronary artery (21.4%), and left circumflex artery (10.7%). Notably, in 21.4% of cases, no culprit lesion was identified. 13 patients underwent angioplasty with stent, 4 received balloon angioplasty, and 1 underwent aspiration thrombectomy. Conclusion: This study highlights important attributes of OHCA patients presenting with MI. This paves the way for larger studies comparing ECG and coronary angiography findings between MI and control populations to help identify and improve acute care for OHCA MI patients.

Treatment Quality or Hotel Quality - What Determines more Rehab Satisfaction and Subjective Treatment Success in Psychosomatic Rehabilitation?

Rehab satisfaction and treatment success are firmly anchored in the German Pension Insurance's quality assurance program as quality criteria for medical rehab. In the field of psychosomatic rehab, there are hardly any studies in which the relative importance of treatment- and hotel-related characteristics for the prediction of these criteria has been investigated. In a secondary analysis, anonymous survey data from 25 psychosomatic rehab clinics/specialist departments were analyzed. The sample comprises around 50,000 inpatient rehabilitants from 2018-2022. The surveys were conducted using a largely standardized questionnaire for the purpose of internal quality assurance. The extent to which the two outcome criteria can be predicted from 14 predictors (assessments of partial performance areas) and from a heuristic model with three blocks of variables (KV=control variables, RB=rehabilitation treatment, HL=hotel services) was examined using regression analysis. All 14 predictors correlate significantly with both criteria and can explain a total of around 67% (rehab satisfaction) resp. 40% (treatment success). In stepwise regressions, the predictors "psychotherapeutic care" and "preparing for the time after rehab" contribute most to the prediction of the criteria. Hierarchical regressions show that the incremental share of the RB block in the prediction of both criteria, i. e. the share that can be attributed with certainty to the rehab treatment variables, is many times greater than that of the hotel services. The hierarchical regression analyses support earlier findings that characteristics of the actual rehab care (e. g. good psychotherapeutic support) play a much greater role for the rehabilitants with regard to both outcome criteria than hotel -related features. There is much to suggest that these findings are also valid for inpatient psychosomatic acute care.

Obstacles in "Time to Spine": Challenges for the Timely Delivery of Acute Surgical Care for Patients with Traumatic and Non-Traumatic Spinal Cord Injury.

Over the past three decades, advancements in our understanding of the pathophysiology of spinal cord injury (SCI) have underscored the critical importance of early treatment for both traumatic and non-traumatic cases. Early surgical intervention significantly improves outcomes by limiting the extent of secondary damage. Despite numerous studies highlighting the superior outcomes associated with early decompression surgery for patients with SCIs, hospital reviews reveal that less than 60% of patients undergo surgical decompression within 24 h of injury. This occurs despite consensus among physicians regarding the benefits of early surgery. Therefore, it is important to highlight the multifactorial causes of this knowledge to action discordance. This review aims to elucidate the administrative, logistical, and technical challenges that hinder timely access to surgery for SCIs.

Care Quality and Outcomes of Ischemic Stroke in Patients With Premorbid Dementia: Get With The Guidelines-Stroke Registry.

Patients with premorbid dementia have been generally excluded from trials of stroke therapies, and their dementia diagnosis may affect the care received. There are few data on the quality of stroke care and outcomes in these patients. We compared the quality of care and outcomes for acute ischemic stroke patients with versus without premorbid dementia using national data from the Get With The Guidelines-Stroke registry between July 1, 2020, and December 31, 2021. Process outcomes included receiving intravenous thrombolysis, endovascular thrombectomy, and additional national quality measures. Clinical outcomes included ambulatory status at discharge, discharge destination, and mortality. The analyses were adjusted for patient and hospital characteristics. Among 609 350 patients with acute ischemic stroke, 29 751 of 546 407 (5.4%) had documented prestroke dementia (median age, 84 [interquartile range, 78-89]; 62.8% female). Patients with versus without premorbid dementia were more likely to arrive via emergency medical services (70.5% versus 46.8%) and had more severe strokes (median National Institutes of Health Stroke Scale score, 7 [interquartile range, 3-15] versus 3 [interquartile range, 1-8]). They were less likely to be admitted to a comprehensive stroke center (17.9% versus 22.7%; P<0.0001), to receive intravenous thrombolysis (9.6% versus 11.1%; adjusted odds ratio [aOR], 0.91 [95% CI, 0.87-0.95]) or endovascular thrombectomy (4.5% versus 7.4%; aOR, 0.62 [95% CI, 0.56-0.68]), attain each of the Get With The Guidelines-Stroke Achievement Measures and Quality Measures, or attain defect-free stroke care (92.0% versus 95.0%; aOR, 0.75 [95% CI, 0.71-0.78]). Patients with premorbid dementia had longer door-to-needle times (adjusted difference, 3.17 minutes [95% CI, 1.34-5.01]), lower odds of being discharged home (43.8% versus 60.1%; aOR, 0.96 [95% CI, 0.93-1.00]), and higher odds of being nonambulatory at discharge (25.8% versus 9.3%; aOR, 1.62 [95% CI, 1.54-1.69]), and of in-hospital mortality or hospice admission (23.3% versus 8.6%; aOR, 1.38 [95% CI, 1.32-1.43]). Symptomatic intracranial hemorrhage after intravenous thrombolysis/endovascular thrombectomy did not differ (5.3% versus 3.7%; aOR, 1.13 [95% CI, 0.97-1.31]). Patients with premorbid dementia experienced slightly poorer quality of stroke care across multiple measures, were less likely to receive acute stroke interventions, and had worse poststroke outcomes than patients without dementia in a large nationwide registry. Our findings underscore the need for concerted efforts to further improve care quality and outcomes in this population.

Veteran Patient Perceptions of a Universal Gloving Intervention for Healthcare-Associated Infection Prevention: A Qualitative Study

BackgroundUniversal gloving by healthcare workers (HCW) for all patient care activities (beyond isolation and standard precautions) has been proposed to reduce healthcare-associated infection transmission, but patient perceptions of this approach are unclear. We interviewed patients who experienced a universal gloving intervention by HCW within Veterans Affairs inpatient acute care units to understand their perceptions of universal gloving. MethodsWe conducted interviews with 15 across five Veterans Affairs (VA) hospitals. We used a rapid qualitative inquiry approach to analyze interview transcripts and identified patient perceptions of universal gloving regarding patient knowledge, patient experience, and HCW practice. ResultsPatients were highly supportive of healthcare workers’ use of universal gloving, noting potential benefits for infection prevention, patient and healthcare worker safety, and patient feelings of well-being and care. Patients also communicated support of universal gloving in the context of the COVID-19 pandemic. DiscussionUniversal gloving by healthcare workers may support patients’ feelings of safe and positive healthcare delivery. ConclusionsPatients’ positive perception of gloving may facilitate universal gloving as an infection prevention and control strategy.

2.F. Scientific session: Challenges in healthcare architectures

Abstract The Workshop titled “Challenges in healthcare architectures” - proposed and developed by the three EUPHA Section: Urban Public Health (URB), Public Mental Health (MEN) and Environmental Health (ENV) - is aimed to foster the dialogue between designers (architects and urban planners), Public Health experts (operators, professionals and epidemiologists), general/sanitary Directors of healthcare facilities and medical staff, to establish a multidisciplinary approach for understanding together how to create and manage the healthcare facilities of the future. According to the main Conference topic “Sailing the waves of European public health: exploring a sea of innovation”, the workshop mainly addresses both the “Health care services and systems” and the “Health workforce, practice and training” EPH24 conference topics. The Workshops purpose is to explore the concept for the hospital of the future, that should be resilient to changes and capable of protecting different users’ health and tackle the transforming social, economic, environmental and epidemiological needs of the context in which they are located. As in many other spheres and economic activities, the pandemic accelerated the processes of innovation and digitization that had somehow already been activated. The healthcare issue, the use of smart devices for a dialogue between the healthcare professionals and the pervasive use of apps to monitor certain health parameters, are just some of the megatrends that were being observed and which have now necessarily entered into everyday life. In the same way, the hospital, which in the face of this gradual process of dematerialization and relocation of ‘softer’ clinical-diagnostic activities, reaffirms itself as a center of the highest specialty for the treatment and care of acute patients, for high-level clinical and experimental re-search, for diagnostics and more complex operations. At the same time, and finally, the hospital is inserted in a territorial healthcare facilities network, that should be planned, designed, and managed. The workshop program includes inputs which they argue current experiences, emerging practices and scientific outcomes related to the hospital design, planning and management sphere, coming from four different European countries. From designing to managing practices, in “Hospital Design and planning in the line of Foresight of Health Needs” and in “Sustainability in the Next Generation Hospital”. From digitalization in national resilience experiences, in “Digital Health Spaces in the City of Lisbon. The Role of Digitalization in linking Boundaryless Hospitals and Smart Health Cities” to novel approaches for specific disease, in “Building bridges: mobile mental health care units in four European countries”. Key messages • Explore the “hospital of the future” concept, resilient to changes, capable of protecting users’ health, and to tackle the transforming social, economic, environmental and epidemiological needs. • Establish a multidisciplinary and territorial approach, for understanding together how to create and manage the healthcare network of the future.

The meaning of organizational culture and structure for interprofessional collaboration

Abstract In Germany, early neurological rehabilitation (ENR) acts as a link between acute inpatient care and rehabilitation, aiming to restore patients’ ability to rehabilitate amid their complex clinical conditions. Interprofessional cooperation (IPC) is crucial for harmonized treatment due to patients’ vulnerability. An interprofessional team comprising medical, nursing, and various therapy professionals is essential for this purpose. To explore the meaning of organizational culture and structure to IPC, 15 group discussions in 5 clinics were conducted with n = 76 participants. 1. Weekly team meetings are used to coordinate treatment goals and outcomes, but their implementation varies from clinic to clinic. Two types of meetings were identified: those that focus primarily on billing compliance and others that address patients’ long-term perspectives. However, both require additional social service involvement and are not sufficient to adequately address daily tasks, requiring additional IPC coordination. Some clinics have therefore introduced daily meetings to improve the coordination of IPC tasks. 2. Therapy planning and therapist assignment shape IPC and task fulfillment. Three therapy planning methods were observed: centralized, block-based, and flexible, each with different therapist allocation strategies. Centralized planning with flexible allocation leads to appointment pressure and interprofessional communication challenges. Block therapy reduces therapist turnover and promotes better interprofessional coordination in patient care. Flexible therapy planning is conducted through daily interprofessional meetings with shared task allocation and planning leads to a shared understanding. Initial analysis underscores the meaning of organizational structure on interprofessional task fulfillment in ENR, emphasizing the importance of enhancing different cooperation formats which can balance stability and flexibility and integrate social services effectively in patientcare. Key messages • Morning interprofessional meetings on the ward facilitate flexible responses to daily changes in patients’ health conditions and promote interprofessional collaboration. • The consideration of occupational group-specific processes in ward organization is a necessary structural prerequisite for successful interprofessional collaboration.

Missing Medical Data in Neurological Emergency Care Compromise Patient Safety and Healthcare Resources.

Background: Acute care of patients in the emergency department (ED) can be very challenging when patients attend EDs without their important medical information. This is especially problematic for multimorbid patients under polypharmacy. The aim of this study was to assess systematically the frequency and clinical relevance of incomplete medical data upon ED admission. Methods: The study was conducted in the neurological ED of a German tertiary hospital. The availability and accuracy of medical data of all neurological patients in the ED were assessed upon arrival. Treating ED physicians were asked about the acute care of the patients to clarify whether missing data resulted in delays or complications in the emergency treatment. Additionally, doctors responsible for the inpatient care of patients who were admitted to a ward via the ED were questioned about the course of the inpatient stay to monitor how initially missing data might have influenced the hospital stay. Results: Medical data of 27% of the 272 included patients were missing or incomplete upon admission in the ED. The ED physicians had to make additional phone calls to gather information in 57% of these cases (vs. 22% in patients with complete data, p < 0.0001). Delays between 5 and 240 min were documented due to initially missing data. Unnecessary diagnostic procedures (e.g., lumbar puncture) were performed in 5% of these patients, thus compromising patient safety. Even the inpatient stay was complicated by initially missing data, as doctors still had to spend time (between 10 and 180 min) to gain relevant information. Retrospectively, 5% of hospitalizations could have been avoided if all medical information had been available upon ED admission. Conclusions: Missing medical data caused complications and delays in acute as well as inpatient care of patients admitted to the neurological ED. This compromised patient safety and led to a waste of medical resources and valuable time of the responsible medical team. Therefore, a comprehensive, digital data management system is urgently needed to improve patient safety and facilitate efficient patient care in the ED and beyond.