Inpatient Areas Research Articles

The Need for a New Approach to MCI Readiness in the Era of Emergency Department and Hospital Crowding.

Emergency department (ED) visit volumes have increased since 2007, with crowding in the United States reaching its highest levels in 2022. During this same period, mass casualty incidents (MCIs) have increased dramatically, both in frequency and severity, across the United States. Resuscitation of trauma patients is a time-sensitive process that requires immediate patient assessment by coordinated clinical teams in order to successfully diagnose and manage life-threatening injuries. To make resuscitation spaces immediately available for incoming patients, typical MCI plans call for rapidly relocating ED patients from their rooms into hallways or transferring them to open inpatient areas. With current levels of crowding, however, such alternate care spaces are often already in use and traditional MCI plans are increasingly unrealistic. With ED crowding worsening and the frequency of MCIs rising, there is a worrisome risk that EDs could fail in their efforts to save patients due to insufficient resources and spaces to meet the demands of critically injured patients. Hospitals must use innovative, novel response strategies to ensure sufficient patient care spaces in a short timeframe to save the most lives possible. In this commentary, we describe the use of buffer zones to help EDs mobilize an effective response to MCIs in the current context of severe hospital crowding.

End of Life Care, It’s a Journey

Abstract Background The Hospice Friendly Hospital (HFH) approach was adopted by an urban academic hospital in 2010 which involved the roll out of the Final Journeys Workshops. in 2019 a review of nursing and healthcare attendant’s (HCA) education and training within geriatric department, alongside patient feedback, identified the need for greater focus to be made on End-of-Life Care. In 2022, it was then decided by the department’s Assistant Director of Nursing that the Final Journeys Workshops was a mandatory requirement for the nursing and HCA staff working in the geriatric inpatient areas. Methods Results Workshops are ongoing with nine having been completed so far. As of April 2024, 34 HCA’s and 70 nurses have now completed the workshop within the directorate. Oral feedback received from the 2023’s attendees highlighted the need for a more interprofessional approach so it was decided that the workshop would be offered to all staff who are working in older person’s services from 2024. Since then, 8 members of staff outside nursing and HCA roles attended the workshop. This had a positive impact on the learning experience but also solidifies that much needed multi-disciplinary approach to EOLC. Conclusion At the end of each session, attendees were asked to complete an evaluation. Post reviewing these evaluations the following themes emerged: By having our geriatric directorate facilitators, we can create more awareness surrounding the culture and practices of EOLC for the older person thus improve the quality of EOLC within the directorate in line with HFH approach.

The handling of hazardous medications by nurses and midwives: A retrospective cohort study

BackgroundOccupational exposure of healthcare workers to hazardous medications can be potentially harmful. Hazardous medications can be carcinogenic, developmentally toxic, reproductively toxic, genotoxic and/or toxic to organs at low doses. These hazardous medications can be used in many healthcare settings, but published research of occupational exposure has focused almost exclusively on cancer services. AimTo identify the healthcare settings where nurses and midwives are responsible for the administration of hazardous medications. MethodA retrospective cohort study was undertaken of all medication administration events occurring during a two-week period at a public metropolitan health service in 2023. All medication administration events from six hospital sites were identified using the electronic (Oracle Health-Cerner-Millennium®) and paper (Chemotherapy Chart) medication administration records. From all of the medications administered, the subset of medications classified as hazardous were identified based on the Victorian Therapeutics Advisory Group Framework for Handling of Hazardous Medicines (2021) and other guidelines. Poisson regression modelling was used to explore associations between the number of hazardous medications and the healthcare area where they were administered (p < 0.001). ResultsOf the 121,567 administration events, 6054 (5.0 %) involved hazardous medications. The healthcare areas with the highest rate of hazardous medication administration events, as a proportion of all medication administration events, were outpatient cancer service (301/695, 43.3 %), birth suite (13/86, 15.1 %) and mental health (404/4011, 10.1 %) areas. During the two-week period, 6054 hazardous medication administration events occurred, involving 117 different medications. The greatest number of these events took place in the medical (1729/6054, 28.6 %) and geriatric (1579/6054, 26.1 %) inpatient healthcare areas. A total of 1258 nurses and midwives were directly involved in either administering, or checking and witnessing the administration of hazardous medications to 996 patients (25.2 % of the total 3958 patients). Most hazardous medications administered to patients were in an oral dosage form (5426/6054, 89.6 %). ConclusionHazardous medications were administered in all healthcare areas, with the exception of endoscopy services. Nurses and midwives were at risk of occupational exposure from hazardous medications.

Update burn surgery: overview of current multidisciplinary treatment concepts

Abstract The treatment of severe burn injuries is an essential part of plastic-reconstructive surgery. Severe burned patients are treated in burn centers, which have highly specialized technical and personnel equipment. In addition to clear recommendations for prehospital management, intensive care therapy is usually required for extensive burn wounds. Shock therapy in burns primarily involves balanced fluid resuscitation according to hemodynamic monitoring, vasopressor support, pain management, temperature regulation, oxygen therapy, and comprehensive supportive care to stabilize the patient’s condition. Surgical treatment is still based on wound debridement and the gold standard of autologous split-thickness skin grafting. Besides skin transplantation, surgical management of burns may also involve the application of various topical therapies to promote wound healing, reduce pain, and prevent infection. These therapies may include antimicrobial dressings, skin substitutes, growth factors, or specialized wound care products. Once the acute treatment has been completed, multidisciplinary rehabilitation treatment takes place, which begins in the acute hospital and continues in the outpatient and inpatient rehabilitation areas. Surgical treatment of the secondary complications of burns and scars is also an important component of burn care. Comprehensive knowledge of the various components and players involved in the care of severely burned patients is, therefore, required in order to achieve the best possible outcome for the patient.

A Pain in the Pilot.

Multi-agency guidelines recommend use of a functional pain assessment tool as an objective assessment of pain, rather than relying on a subjective verbal rating scale. This project was created to address issues managing Patients' pain in inpatient settings. The project aimed to answer: 'How can we adopt the use of a Functional Pain Assessment into our clinical practice, optimising its effectiveness for ALL patient groups in our inpatient ward areas?' Output from multi-disciplinary working group: two electronic documents were created - Pain Assessment Tool and Pain Observations Chart: for staff to document routine pain observations. Five wards participated in the pilot study, with training/support provided. Result: Staff and patients preferred the new approach, compared to previous pain documentation method. However, documentation compliance was not as good as expected. Pilot proved the concept, documents are effective in pain management, but more education and support is needed to embed cultural shift.

A Calculated Risk: Evaluation of QTc Drug-Drug Interaction (DDI) Clinical Decision Support (CDS) Alerts and Performance of the Tisdale Risk Score Calculator.

A risk factor for a potentially fatal ventricular arrhythmia Torsade de Pointes is a prolongation in the heart rate-corrected QT interval (QTc) ≥ 500milliseconds (ms) or an increase of ≥60ms from a patient's baseline value, which can cause sudden cardiac death. The Tisdale risk score calculator uses clinical variables to predict which hospitalized patients are at the highest risk for QTc prolongation. To determine the rate of overridden QTc drug-drug interaction (DDI)-related clinical decision support (CDS) alerts per patient admission and the prevalence by Tisdale risk score category of these overridden alerts. Secondary outcome was to determine the rate of drug-induced QTc prolongation (diQTP) associated with overrides. Our organization's enterprise data warehouse was used to retrospectively access QTc DDI alerts presented for patients aged ≥18years who were admitted to Brigham and Women's Hospital during 2022. The QTc DDI CDS alerts were included if shown to a physician, fellow, resident, physician assistant, or nurse practitioner when entering the order in inpatient areas for patients with a length of stay of at least 2days. Variables collected for the Tisdale calculator included age, sex, whether patient was on a loop diuretic, potassium level, admission QTc value, admitting diagnosis of acute myocardial infarction, sepsis, or heart failure, and number of QTc-prolonging drugs given to the patient. A total of 2649 patients with 3033 patient admissions had 18,432 QTc DDI alerts presented that were overridden. An average of 3 unique QTc DDI alerts were presented per patient admission and the alerts were overridden an average of 6 times per patient admission. Overall, 6% of patient admissions were low risk (score ≤ 6), 64% moderate risk (score 7-10), and 30% high risk (score ≥ 11) of QTc prolongation. The most common QTc DDI alerts overridden resulting in an diQTP were quetiapine and propofol (11%) and amiodarone and haloperidol (7%). The diQTP occurred in 883 of patient admissions (29%) and was more frequent in those with higher risk score, with 46% of patient admissions with diQTP in high risk, 23% in moderate risk, and 8% in low risk. Use of the Tisdale calculator to assess patient-specific risk of QT prolongation combined with CDS may improve overall alert quality and acceptance rate, which may decrease the diQTP rate.

Bedside Nurse Documentation Practices: At the Patient Bedside or Not?

High-quality care requires precise and timely provider documentation. Hospitals have used technology to document patient care within both the inpatient and outpatient areas and long-term care facilities. Research has demonstrated, by revealing a reduction in medical errors, that there has been a worldwide improvement in our community health and welfare since the implementation and utilization of documenting patient care electronically. Although electronic documentation has proven to be an improvement in patient record keeping, the most efficient location in which this documentation is to occur remains a question. At the location where this project took place, only the ICU had computers within the patient rooms for documentation purposes. This project evaluated bedside nurses' opinions related to the efficiency of documentation practices compounded by the location where documentation took place. The options were at the patient's bedside, on a workstation on wheels, or at the nursing station. Surveys were provided to bedside nursing staff both before and after computers were installed in patients' rooms in surgical and medical/surgical nursing units at a Veteran Affairs Medical Center located in the Northeastern region of the United States. The results of this project inconclusively answer the question posed: "Which mode of entry do nurses feel is more efficient to document patient care, on a computer in the patient room, at the nurses' station, or on a workstation on wheels?" Innovative strategies should be explored to develop a user-friendly design for computers located within the patient rooms for patient documentation.

Intensive care unit admission criteria: a scoping review.

Effectively identifying deteriorated patients is vital to the development and validation of automated systems designed to predict clinical deterioration. Existing outcome measures used for this purpose have significant limitations. Published criteria for admission to high acuity inpatient areas may represent markers of patient deterioration and could inform the development of alternate outcome measures. In this scoping review, we aimed to characterise published criteria for admission of adult inpatients to high acuity inpatient areas including intensive care units. A secondary aim was to identify variables that are extractable from electronic health records (EHRs). Electronic databases PubMed and ProQuest EBook Central were searched to identify papers published from 1999 to date of search. We included publications which described prescriptive criteria for admission of adult inpatients to a clinical area with a higher level of care than a general hospital ward. Data was extracted from each publication using a standardised data-charting form. Admission criteria characteristics were summarised and cross-tabulated for each criterion by population group. Five domains were identified: diagnosis-based criteria, clinical parameter criteria, organ-support criteria, organ-monitoring criteria and patient baseline criteria. Six clinical parameter-based criteria and five needs-based criteria were frequently proposed and represent variables extractable from EHRs. Thresholds for objective clinical parameter criteria varied across publications, and by disease subgroup, and universal cut-offs for criteria could not be elucidated. This study identified multiple criteria which may represent markers of deterioration. Many of the criteria are extractable from the EHR, making them potential candidates for future automated systems. Variability in admission criteria and associated thresholds across the literature suggests clinical deterioration is a heterogeneous phenomenon which may resist being defined as a single entity via a consensus-driven process.

The association between midwifery staffing and reported harmful incidents: a cross-sectional analysis of routinely collected data

BackgroundIndependent inquiries have identified that appropriate staffing in maternity units is key to enabling quality care and minimising harm, but optimal staffing levels can be difficult to achieve when there is a shortage of midwives. The services provided and how they are staffed (total staffing, skill-mix and deployment) have been changing, and the effects of workforce changes on care quality and outcomes have not been assessed. This study aims to explore the association between daily midwifery staffing levels and the rate of reported harmful incidents affecting mothers and babies.MethodsWe conducted a cross-sectional analysis of daily reports of clinical incidents in maternity inpatient areas matched with inpatient staffing levels for three maternity services in England, using data from April 2015 to February 2020. Incidents resulting in harm to mothers or babies was the primary outcome measure. Staffing levels were calculated from daily staffing rosters, quantified in Hours Per Patient Day (HPPD) for midwives and maternity assistants. Understaffing was defined as staffing below the mean for the service. A negative binomial hierarchical model was used to assess the relationship between exposure to low staffing and reported incidents involving harm.ResultsThe sample covered 106,904 maternal admissions over 46 months. The rate of harmful incidents in each of the three services ranged from 2.1 to 3.0 per 100 admissions across the study period. Understaffing by registered midwives was associated with an 11% increase in harmful incidents (adjusted IRR 1.110, 95% CI 1.002,1.229). Understaffing by maternity assistants was not associated with an increase in harmful incidents (adjusted IRR 0.919, 95% 0.813,1.039). Analysis of specific types of incidents showed no statistically significant associations, but most of the point estimates were in the direction of increased incidents when services were understaffed.Conclusion When there is understaffing by registered midwives, more harmful incidents are reported but understaffing by maternity assistants is not associated with higher risk of harms. Adequate registered midwife staffing levels are crucial for maintaining safety. Changes in the profile of maternity service workforces need to be carefully scrutinised to prevent mothers and babies being put at risk of avoidable harm.

Patients’ preferences, feelings, and benefits on Music-Based Intervention: A Pilot Study in COVID-19 Hospitalization

Introduction: COVID-19 patients survive in isolation with stringent measures of infection containment, leading to anxiety, fear, stress, loneliness, and depression. Music is recognized as useful to promote multiple health outcomes, including anxiolytic effects, pain-relieving, and relaxing effects that favour well-being and social interaction in healthcare settings. Objective: This study aimed to determine the impact of a pre-recorded music-based intervention on the music perception in hospitalized COVID-19 patients. Music appreciation, evoked emotions, and self-reported effects were explored and compared before and after music-based intervention, also considering the gender of the patients. Methods: This prospective study consisted of a pre-recorded music-based intervention administered to 272 patients hospitalized for COVID-19 by piping the music into rooms of inpatient medical area. Pre-recorded musical pieces of were selected by a music therapist considering specific formal and parametric characteristics, with the purposes of distraction, entertainment, relaxation, and emotional support. The patients’ opinions were collected using an ad hoc self-report questionnaire and a short data survey that followed the Consolidated Framework for Implementation Research (CFIR) guidelines. Results: Music resulted to be the preferred entertainment activity during hospitalization by 84.6% of patients, with 96.6% of them expecting a positive effect and a very high grade of usefulness attributed to music before hospitalization and even higher afterwards. The music intervention significantly changed the patients’ perception of music from everyday life to hospitalization (p&lt;0.0001). It proved successful in evoking pleasure and fun, which raised from 18.4% of everyday life to 41.1% during hospitalization. The usefulness of listening music to alleviate unpleasant feelings including anxiety, fear, loneliness, and low mood in COVID-19 disease, had a significant increase from 22.5% to 60.0% after the music intervention. Conclusion: Music-based intervention, directed according to reference frameworks, provides self-reported social and emotional support in hospitalized patients for COVID-19.

Ultrasound-Enhancing Agent and IV Administration in Cardiac Sonography: How Sonographers Play a Key Role in Positively Affecting Key Performance Indicators

As the health system in the United States continuously searches for ways to reduce costs and improve the health care experience, cardiac sonographers are uniquely positioned to add to this initiative. Tasked with providing high-quality imaging studies in outpatient and inpatient areas, the scope of practice for sonographers continues to evolve. To ensure quality imaging, ultrasound-enhancing agents (UEAs) are needed in patients with suboptimal images to improve delineation of left ventricular endocardial borders. This process involves intravenous (IV) access and occurs in both patients in ambulatory clinics and hospitals. Historically, health care professionals delegated to perform these duties have been nursing, radiology, and nuclear medicine staff. Because these professionals have their own job responsibilities, the potential to complete a transthoracic echocardiogram (TTE) with UEA, in a timely fashion, may be compromised. Expanding the practice of cardiac sonographers to include these duties should be supported to facilitate uninterrupted patient care, efficiency, and stakeholder satisfaction.

Color scheme: Implementation Evidence-Based Design for Palliative Care and Hospice Building

The number of patients suffering from cancer has increased 27.8% per 1000 population from 2013 to 2018 and most of cancer patients come from Jakarta. Based on interviews with health workers and cancer patients, it can be concluded that there are problems in terms of space requirements and space design in current palliative care and hospice care facilities. This study uses a qualitative method. The data used for this study came from interviews as part of the Evidence-based Design (EBD) process, which was then analyzed using coding techniques and precedent analysis to draw conclusions. It was found that color is an element that can influence human health, the preference for color by cancer patients in Indonesia is in line with the color preference for hospice buildings and cancer health facilities in western countries, and it was also found that cancer patients need a communal area, consultation area, therapy area, spiritual area, and in-patient area. Each of these areas requires a different color scheme.

Provider & nursing perspectives on the "panculture": opportunities for innovative diagnostic stewardship interventions.

To examine practices of providers and nursing staff in evaluating febrile patients and identify drivers of excessive diagnostic testing. Prospective multiple-choice surveys. Inpatient areas and the Emergency Department at Rhode Island Hospital (RIH) in Providence, RI. We conducted two surveys focused on the evaluation of febrile inpatients at RIH. One survey was of providers trained in internal medicine, surgery, pediatrics, emergency medicine, and neurology; the other survey was of nursing staff (registered nurses and certified nursing assistants), in inpatient areas and the emergency department. 70 providers (9%) and 178 nursing staff (12%) completed the surveys. 64% of providers (n = 43) reported "always" or "often" ordering full fever workups and 67% of providers (n = 47) reported "always" or "often" physically evaluating febrile patients. Nurses were less likely than providers to report that providers "always" or "often" physically evaluate febrile patients (n = 80, 45%; P < 0.01) and more likely to report providers "always" or "often" order full fever workups (n = 135, 76%; P = 0.04). 71% of providers (n = 50) reported "always" or "often" receiving written handoffs. 86% of providers (n = 60) reported handoffs are "always" or "often" accurate; however, only 17% of providers responded these were "always" accurate. 77% of providers (n = 54) reported "always" or "often" following handoff instructions to obtain a full fever workup for febrile patients, regardless of clinical status. Responses differed significantly by unit type and provider specialty and position. This study elucidates drivers of inefficient and excessive utilization of diagnostic studies and identifies targets for diagnostic stewardship interventions.

The impact of whole of patient nursing assessment frameworks on hospital inpatients: A scoping literature review.

A comprehensive patient assessment is essential for safe patient care. Patient assessment frameworks for nurses are generally restricted to patients who already have altered vital signs and are at risk of deterioration, or to specific risks or body systems such as falls, pressure injury and the Glasgow Coma Score. Comprehensive and structured evidence-based nursing assessment frameworks that consider the whole patient and extend beyond vital signs, specific risks and single systems are not routinely used in inpatient settings but are important to establish early risks for patient deterioration. The aim of this review was to identify nursing assessment tools or frameworks used to holistically assess hospitalized patients and to identify the impact of these tools on patient and health service outcomes. A scoping literature review was conducted. Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index of Nursing and Allied Health Literature (CINAHL), ProQuest Dissertations and Thesis, Embase and Scopus were databases used in the search. The initial search was conducted in August 2021 and repeated in November 2022. No date parameters were set. The Participants, Concept, Context (PCC) framework was used to guide the development of the research question and consolidate inclusion and exclusion criteria. The PRISMA-ScR Checklist Item was followed to ensure a methodologically sound checklist was used. Ten primary research studies evaluating six nursing assessment frameworks were included. Of the five nursing assessment frameworks, none were explicitly designed for general ward nursing, but rather the emergency department or specific patient cohorts, such as oncology. Four studies reported on reliability and/or validity; two reported on patient outcomes and four on staff satisfaction. Evidence-based nursing patient assessment frameworks for use in general inpatient wards are lacking. Existing assessment tools are largely designed for specific patient cohorts, specific body systems or the already deteriorating patient. A framework to enable a structured approach to patient assessment in this environment is needed for patient safety, consistency in assessment, nursing staff enablement and confidence to escalate care. Routine systematic nursing assessment could also aid timely patient escalation. What problem did the study address? This study addresses the lack of evidence-based nursing assessment frameworks for use in hospitalized patients. The impact of this is that it highlights the need for an evidence-based, whole of patient assessment framework for use by nurses for patients admitted to a ward environment. What were the main findings? This review identified limited comprehensive, patient assessment frameworks for use in general ward inpatient areas. Those identified were not validated for this patient cohort and are aimed at patients already deteriorating. Where and on whom will the research have an impact? This review has the potential to impact future research and patient care. It highlights that most research is focussed on processes to detect and escalate care for the already deteriorating patient. There is a need for an evidence-based routine nursing assessment framework for patients admitted to a ward environment to promote positive patient outcomes and prevent deterioration. This review contributes to existing knowledge of nursing patient assessment frameworks, yet it also highlights several gaps. Currently, there are no known, validated, holistic, structured nursing patient assessment frameworks for use in general ward inpatient settings. However, areas that do use such assessment frameworks (e.g. the emergency department) have shown positive patient outcomes and staff usability. Hospitalized ward patients would benefit from routine, structured nursing assessments targeting positive patient outcomes prior to the onset of deterioration.

Antimicrobial Point Prevalence Survey in four Emergency Departments at Manchester University NHS Foundation Trust

Abstract Introduction Antimicrobial Point Prevalence Surveys (PPS) are a recognised tool to facilitate monitoring of compliance to an organisation’s antimicrobial stewardship (AMS) programme.1 Most PPS tools used within secondary care focus on prescribing of antimicrobials for in-patients. At Manchester University NHS Foundation Trust (MFT) PPS are carried out by clinical pharmacists across all inpatient ward areas. Antimicrobials are one of the most prescribed medicines in the emergency department2 (ED) yet, the current MFT PPS tool does not facilitate undertaking PPS in EDs. A new validated outpatient PPS tool3 from the Global Point Prevalence Survey (GPPS) was released earlier this year. Aim To pilot the GPPS outpatient tool in the EDs at MFT to determine the level of compliance with the MFT antimicrobial guidelines within the EDs, estimate the total burden of antimicrobial use and describe types of infections and prescribed antimicrobials within the EDs. Methods Following the GPPS outpatient protocol3 the four emergency departments (3 general EDs, and 1 paediatric ED) at MFT were assessed in a ten-day period during May 2023. Each ED was assessed continuously for a 4-hour timeslot on a weekday morning by an AMS pharmacist who retrieved the data from the EPIC electronic patient record system remotely. All patients who were allocated a room/bedspace on ED within the timeslot were audited, including patients who were not prescribed antimicrobials. Guideline compliance was checked with the MFT antimicrobial guidelines. The online GPPS data collection tool was used, generating a data download into an Excel spreadsheet for analysis. This study was a service evaluation and so did not require ethical approval. Results 180 patients were audited from 4 EDs yielding a total of 41 prescriptions for antimicrobials. 28/180 patients were prescribed one or more antimicrobial, with an overall antimicrobial prescribing rate of 15.5%. Prescribing was higher in the paediatric ED with a rate of 25%. 92.7% (38/41) of antimicrobials were prescribed intravenously (IV). Choice of antimicrobial was compliant in 38/41 (92.7%). Dose was compliant in 40/41 (97.6%). Duration of treatment was compliant in 39/41 (95.1%). Sepsis accounted for 48.8% of indications. 2/41 prescriptions were based on the C Reactive Protein (CRP) biomarker. Discussion/Conclusion Whilst the study was only conducted over a short time period, the findings suggested that overall compliance with the MFT antimicrobial guidelines was very good. The prescribing rate of 15.5% was low in comparison to the recent MFT inpatient PPS which showed a prescribing rate of 30%. There is a high rate of diagnosis of sepsis and prescribing of IV antimicrobials in comparison to orals which may be anticipated in the emergency setting. The GPPS outpatient audit tool provided an opportunity to do a baseline assessment within the EDs across MFT, providing data on prevalence of antimicrobial prescribing and compliance to the MFT guidelines. The GPPS audit tool did not have the utility to review the accuracy of clinical diagnosis of severe infection/sepsis within the ED, or the appropriateness of IV antimicrobial prescribing. Further research should be undertaken to provide assurance on the clinical diagnosis of severe infection and the appropriateness of IV antimicrobial prescribing with the EDs.

Mortality of patients with implanted pacemaker: Long-term follow-up Data from Czech National Pacemaker Registry (REPACE)

Abstract Aim The aim is the long-term continuous monitoring of patients with an implanted pacemaker (PM) regarding real mortality and morbidity in relation to the standard population without PM, to predict the development of procedures and costs of care in the next ten years. Methodology The analysis is based on data , which are collected within the framework of the National Health Information System and national health registers. The National Register of Reimbursed Health Services – contains data from health insurance companies in both inpatient and outpatient areas, including complete data on reported diagnoses, procedures, treatment and rehospitalizations. Results The analysis is performed on a population sample of 82,791 patients who underwent PM implantation for symptomatic bradycardia with standard indications according to the guidelines. The annual number of PM implantations is steadily increasing slightly (in the years 2010-2019 by an average of 120 cases per year). In 2020, there was a year-on-year decrease of 6%, in connection with the COVID-19 pandemic, increased mortality and the limitation of care provided. The annual share of reimplantations in the total number of performed procedures varies between 24% and 30%. In the years 2010-2021, almost 114 thousand pacemakers were implanted, of which 27.9% were single-chamber, 67.4% were double-chamber , and 4.6% were biventricular. A higher proportion of pacemakers are implanted in men (56.9% vs. 43.1% in women). This share is increasing over time: in 2010, the share of men was 55.3%, in 2021 it will be 57.8%. The average age of a patient at the time of initial pacemaker implantation is 76 years (75 years for men, 77 years for women). From 2010 to 2021, the average age of patients at primary implantation increased by 1 year from 75.3 years to 76.3 years. Patients with primary PM implantation in the years 2010–2021 (N = 82,791) according to the age of the patient at the time of the procedure - the length of survival is evaluated using the Kaplan-Meier method. The patient is monitored from the date of PM primoimplantation until the date of death (Fig. 1). Conclusions Relative survival expresses the rate of survival of patients with an implanted pacemaker compared to the general population. 5-year relative survival is 88.6% (overall survival: 60.6%), 10-year relative survival is 75.9% (overall survival: 32.7%). ( Fig.2) The most common cause of death in people with implanted PM are diseases of the circulatory system (62% of death cases; of which 31% dg. I25 chronic CAD, 6% dg. I50 heart failure, 4% dg. I21 acute MI). This is followed by oncological diseases (13%) and diseases of the respiratory system (7%). The average age of the deceased is 83 ± 8 years. Causes of death vary according to the patient's age at death; with age, the proportion of deaths from diseases of the circulatory system increases, while the proportion of deaths from oncological diseases decreases.Overall survival of patients after PM5-year and 10-year relative survival

Streamlining urgent, same day oncology admissions from an ambulatory clinic and patient safety, patient experience, and team communication.

394 Background: The urgent, same-day, admission process for an ambulatory oncology patient is complex. Between January 1, 2021 and November 8, 2022, at least 35 safety reports were filed relating to urgent, same-day admissions yielding a rate of 1.72% of direct admissions resulting in a safety report. Issues included communication breakdowns (e.g. insufficient handoff, insufficient updates on patient condition, incorrect mode of communication which led to delays in care), admissions to incorrect teams, and admissions to locations ill-equipped to manage the patient’s acuity. Another challenge is the ambulatory facility, Dana-Farber Cancer Institute, and the admitting facility, Brigham and Women’s Hospital (BWH), are two different hospitals further complicating the admissions process. The goal was to streamline the urgent, same-day admission process, set expectations for the interdisciplinary teams involved, and determine a process to triage high acuity patients to the emergency department (ED) when warranted. Methods: The interdisciplinary workgroup identified gaps and pain points in the current state process. This collaborative effort led to new, streamlined workflows for key stakeholders in the process. New workflows were created for outpatient nurses, outpatient providers, and inpatient nurses. An important step in the new workflows revolves around establishing the rule that patients will be routed to the ED at 5pm if no bed will become available by clinic closing. This allows the patient to receive care quicker and triages the patient to the inpatient bed queue at an earlier point in the day. These workflows were posted in clinic and inpatient areas, distributed electronically, and presented in multiple team meetings. A new safety report event type, “Admissions from Clinic,” was created in the system to identify issues related to these processes. Results: From the date of implementation of the new workflows to the time of reporting (approximately 2.5 months), there have been 4 safety reports yielding a rate of 1.68% of direct admissions leading to safety reports. Most of these reports pertained to the bed tracking system not functioning properly leading to patients showing up to the inpatient floor before their bed was ready. Overall, the new workflows are functioning efficiently with no increase in the number of patients sent to the ED due to communication of bed availability at 5pm. Conclusions: Interdisciplinary collaboration involving key stakeholders in the direct admissions process from a cancer clinic to the inpatient setting, led to a reduction in safety reports generated regarding communication, patient safety and patient experience. There was no increase in patients being triaged to the ER at the end of the day.

Efficacy and optimal dose of acetic acid to treat colonised burns wounds: protocol for a pilot randomised controlled trial

IntroductionDespite of recent advancement in the burns wound management, burn wound infection (BWI) is still one of the major cause of burns mortality. Patients who survive their burns injury still...

Depression and Suicide Risk Among Nursing Staff at a Honduran National Hospital.

Depression and suicide risk among nursing staff have become increasingly concerning, especially given the demanding nature of their profession. The World Health Organization identifies depression as a primary factor contributing to global disability and suicide deaths. A descriptive, non-experimental, cross-sectional cohort study was conducted, encompassing the eligible personnel (n=82) out of a total of 102 nurses at the Mario Catarino Rivas Hospital in San Pedro Sula, Honduras, from October to November 2022. The study utilized the Okasha assessment tool to gauge the prevalence of suicidal risk and the Beck Depression Inventory-II (BDI-II) instrument to analyze the extent and severity of depression. In addition, the participants completed a demographic survey. Results: The average age of participants was 34.91 years, with a majority (86.6%) being female. In terms of work assignments, 54.9% were employed in the inpatient area. Regarding the mental health of the nursing staff, 78% displayed no or minimal depression, 9.7% presented mild depression, 7.3% showed moderate depression, 4.8% displayed severe depression, and 14.6% exhibited a suicide risk. Young adults had the highest prevalence of all three levels of depression, and the emergency department and inpatient area had the most at-risk individuals for suicidal tendencies. The study offers a comprehensive insight into the demographics, work environment, and mental health of the nursing staff at the Honduran National Hospital. The results highlight the importance of specialized measures and strong support systems to safeguard the mental health of nursing staff.

Hospitalists in Pediatric Oncology/Stem Cell Transplant: Successes and Opportunities.

As hospitalized pediatric patients have grown in number and complexity, and residency structural changes have reduced resident coverage, inpatient care models have changed to include additional providers at the "front line." Hospitalists are increasingly employed in general pediatric units, but in specialized inpatient areas, hospitalist care models are less common. Hospitalist programs in pediatric oncology are few and unique, and thus there are limited data assessing this role. Here we describe the oncology/stem cell transplant hospitalist program at the Children's Hospital of Philadelphia with a survey project to assess the perceptions of physicians in the role. Hospitalists from 2017 to 2019 (n=26) were surveyed to assess nonclinical roles and job satisfaction. With a response rate of 84.6%, all respondents concurred work-life balance, hours, and flexibility are attractive and found the field intellectually stimulating. Most (86.4%) agreed there were significant academic opportunities. The vast majority felt this job was valuable in attaining career and personal goals; 95.5% were happy they accepted this position. As the pediatric oncology/stem cell transplant hospitalist position is a viable, versatile career path providing ample academic opportunities and job satisfaction, the expansion of such a model within our institution and others should be well received.