Key Team Members Research Articles

P.069 Development of a streamlined multi-disciplinary care pathway for compression neuropathies

Background: Care for patients with compression neuropathies (carpal tunnel syndrome, ulnar neuropathy) is often fragmented, uncoordinated, and slow. Patients go through multiple steps (neurology consultation, nerve testing, ultrasound, splints, injection, surgical opinion, surgery) with waits between each step. We used a Value-Based Health Care (VBHC) model to develop a multidisciplinary clinic with a novel care pathway. Methods: A Shared Care initiative supported the development of an Integrated Practice Unit (IPU). Key multidisciplinary team members were identified. Participants attended a curated three part VBHC workshop. Process mapping enabled identification of efficiencies. Results: 14 team members participated in the workshops. Condition specific outcome measures were identified (Boston CTS measure, 10-point touch, MRC strength and pain scale) and will be collected longitudinally. Criteria and clinical pathways were developed for mild, moderate, and severe carpal tunnel syndrome. Resource materials for patients and providers were developed. Conclusions: A VBHC framework supported development of a novel clinic for compression neuropathy. Responsibility for the full cycle of care rests with the IPU. Systematically tracking functional outcome measures enables quality improvement. By streamlining the patient journey and substantially reducing wait times between steps, the new care pathway reduces complexity and improve outcomes. Evaluation of impact if this new clinical model is ongoing.

A Dually Certified Nurse Practitioner Role in a Housing First Location

This article sets forth the innovative model of a dually certified primary care/psychiatric mental health nurse practitioner (PC/PMHNP) and elucidates Peplau’s nursing roles (rather than her entire theory) as a foundational component of the treatment in people with complex conditions. The case example presented here describes the care of a person with substance use disorder and complex mental and physical disease processes by a PC/PMHNP in a clinic situated within a permanent supported housing community. Rooted in Peplau’s Theory of Interpersonal Relations, the PC/PMHNP is a key interdisciplinary team member in transforming needed treatment solutions for this challenging population

Abstract WP40: Enhanced Team Communication Improves Door to Device Times

Background: Patients experiencing acute ischemic stroke benefit from early reperfusion. The American Heart Association set a goal for hospitals performing mechanical thrombectomy to achieve ‘door to device’ (DTD) time of less than 90 minutes for 50% of eligible patients. In 2021, only 23% of patients were meeting this time target. These patients require complex care and timely communication between various practitioners. It was noted that these practitioners were working in silos, which resulted in unnecessary delays. The need for enhanced communication was identified as an intervention to improve performance. Methods: Key team members are equipped with a dedicated phone using an artificial intelligence application, which provides an early signal when large vessel occlusion is detected. This allows for earlier mobilization of resources. This is particularly important for emergency department and interventional radiology nurses who are the ones driving transition of care between departments. In addition, the anesthesia department uses closed loop communication to notify the team of their readiness to receive the patient. Lastly, timely debriefs for all practitioners involved in the case provide a forum for constructive, thoughtful feedback about ways to be more efficient. Results: After enhanced communication strategies were implemented in quarter 2 of 2022, DTD times improved to 43% in quarter 3 of 2022, 50% in quarter 4 of 2022, 67% in quarter 1 of 2023 and 75% in quarter 2 of 2023. Conclusions: Providing tools to enhance communication amongst various practitioners has resulted in sustained improvement in DTD times. Future data collection should focus on associating these improved DTD times with long term functional outcomes.

EMBRACING CULTURE AND DESIGNING AN INTERGENERATIONAL TRAINING PROGRAM TO SUPPORT LATINE ELDERS

Abstract Although there have been efforts to promote health equity and increase representational diversity in research, there is a gap in our understanding on how to integrate cultural considerations into the intervention design process. Dementia caregiving interventions too frequently lack prioritization and integration of community-directed and culturally appropriate inputs during intervention planning. Consequently, intervention fit among racial and ethnic populations is sometimes culturally incongruent and intervention acceptability in community settings is weakened. We conducted a formative analysis drawing from research team member memos, document review, World Cafes with Latine community residents, and group interviews with Latine organizational staff to understand the intervention development process of an intergenerational dementia training program to support elders within the Latine community. The design process integrated iterative periods of listening through data gathering, informing by applying learned information to the developing program, and affirming through validation. Our analysis demonstrates the need for a broad range of skills and capacity to facilitate effective intervention design (language mastery among key research team members, program design skills, listening, relationship building).

A Clinical Audit of Orthopaedic Clinical Documentation of Acute Ankle Fractures: A Quality Improvement Project.

Background Orthopaedic ankle fractures are common injuries that require careful assessment, management, and documentation to ensure optimal patient outcomes. Proper documentation plays a critical role in facilitating communication among healthcare professionals, ensuring accurate diagnosis, treatment planning, and monitoring patient progress. Moreover, it is essential for medico-legal purposes and quality improvement initiatives. This article presents a comprehensive clinical audit aimed at evaluating the quality of orthopaedic ankle fracture documentation within a healthcare setting. The aim of this project was to assess the quality and accuracy of ankle fracture documentation within a single centreagainst the audit standards set by the British Orthopaedic Association (BOA) and the National Institute for Health and Care Excellence (NICE). Methods The study was a closed-loop audit utilising both retrospective and prospective analysis of ankle fracture clerking documentation performed by members of the trauma and orthopaedics team. Two audit cycles were completed in total; the first cycle was carried out in January 2020 where data were collected retrospectively from all orthopaedic admissions of ankle fractures. This was then re-audited against the BOA and NICE guidelines and presented to the local clinical governance meeting. A targeted educational intervention was then implemented with the goal of educating and reinforcing to key team members the documentation standards and the importance of accurate clerking documentation. The second cycle was carried out during July 2020 prospectively. All data were collected and collated with a total of nine data parameters analysed. Patients were included if they were skeletally mature and presented with closed malleolar and syndesmotic ankle injuries. Excluded patients were those who presented with open fractures, pilon fractures, and/or were skeletally immature. Data were then re-presented at the clinical governance meeting. Results A total of 23 patients were identified in the initial audit cycle and 22 patients in re-audit. On admission, it was found that 86% of patients presenting with ankle fractures had adequate documentation of their injury mechanism, which subsequently improved to 100% following the intervention. Similarly, there was a 71% improvement in precise documentation of clinical findings of ankle fractures. There was a marked improvement in the consistency of examination findings as well, with over 30% improvement in the rate of documentation for sensation status, skin integrity, circulation, and motor function. Results also revealed a 71% improvement in the documentation rates of vascular examinations where a Doppler ultrasound was used or pulses named in the documentation. Conclusion Through a targeted educational scheme focussing on the proposed documentation guidelines, we noted a significant improvement in documentation standards and accuracy of ankle fractures in the trauma and orthopaedic department. With ongoing educational input and reinforcement, team members can be supported to maintain a high level of documentation that meets all available standards, which will ultimately lead to improved patient care.

Abstract 19115: In-situ Resuscitation Training in Cardiology Procedural Suites

Background: Critical Care Advanced Resuscitation Training (CC-ART) prepares critical care teams for emergency situations through training that occurs in a simulated clinical space. Simulated environments do not always accurately mirror the actual clinical environments. Simulations conducted in the actual clinical environment, also known as in-situ simulation, may overcome some of these challenges. Goal: To explored the impact of in situ, ART simulation in a Cardiac Catheterization Lab (CCL) and an Electrophysiology Lab (EPL) on the staff’s experience, confidence, and communication skills. Method: Key leadership and educator team members collaborated on the in-situ simulation set up. Coordination with Simulation Center and Central Supply Department was completed to arrange for delivery of high-fidelity manikins and training crash cart to the site. A team of physicians and nurse educators created CCL and EPL scenarios for the simulations and wrote a simulation evaluation survey for CCL and EPL nurses and technologists who attended. Results: . Simulations were run by both critical care anesthesiologist and clinical nurse educator. Pre-simulation and post-simulation surveys were collected immediately prior to and after the in-situ simulation. 38 staff completed pre and post surveys. Pre-simulation, 50.00% of staff strongly agreed that they were confident in their ability to care for a decompensated patient based on the prior CC-ART training versus, post-simulation, 84.21% strongly agreed. Pre-simulation, 26.32% strongly agreed that the simulation center training was similar to their actual work experience versus post-simulation, 78.95% agreed the in-situ simulation matched their actual work experience. Pre-simulation, 52.63% strongly agreed that they were confident in their ability to communicate their needs during emergencies or code blue situations versus post-simulation 86.84% agreed. Conclusion: This quality improvement project highlights the effectiveness of in situ resuscitation simulation in improving healthcare professionals' confidence, training realism, and communication skills . Analysis of patient outcomes is needed to determine the effectiveness and duration of impact of in situ training for clinical practice.

The Development and Implementation of a School-Based Dental Sealant Program for Hawaii Public Schools.

School-based dental sealant programs are noted to increase sealant uptake among children, especially those from low-income families and those living in rural and underserved areas. However, nationally school-based dental sealant programs are substantially underutilized. This paper describes a partnership approach to a school-based dental sealant program for Title 1 public schools in Hawaii. The Hawaii Keiki: Healthy and Ready to Learn program partnered with the Hawaii Dental Service to develop and implement an interprofessional, school-based sealant program (SBSP). This article describes the development of key factors, such as partnerships, an interprofessional team, team roles, policies, and marketing tools to optimize program success. The SBSP has completed over 3 academic years of implementation in Hawaii public schools. In its initial year (school year [SY] 2019-2020), which presented challenges due to the COVID-19 pandemic, it served 6 schools (106 students screened) on 1 island. It expanded to 14 schools on 1 island (193 students screened) in its second year (SY 2020-2021), 28 schools on 3 islands (653 students screened) in its third year (SY 2021-2022), and during the Fall of the fourth year, the program reached 50 schools on 3 islands (1821 students screened) and is projected to reach over 70 schools by the end of SY 2022-2023. Taking advantage of strategic partnerships and key interprofessional team members, a school-based dental sealant program can help to improve the oral health of children in public schools by helping to decrease barriers to care.

SNMMI Clinical Trials Network Research Series for Technologists: Imaging Contract Research Organizations, Nuclear Medicine Technologists, and the Role They Play in Medical Imaging Research.

Clinical imaging research is a fast-growing, complex, and integral part of drug and therapy discovery and development. Research sponsors rely on outside vendors to manage their trials and deliver results they hope will demonstrate the efficacy of their product. Specialized vendors known as imaging contract research organizations have teams of highly trained and specialized professionals who lend their expertise to all aspects of imaging research management, of which nuclear medicine technologists are key team members. This article is part of the Clinical Trials Network Research Series for Technologists and will help provide an overview of an imaging research study from initiation to data delivery and the roles that nuclear medicine technologists and other imaging professionals play.

Gathering and disseminating lessons learned in construction companies to support knowledge management

The importance of knowledge management (KM) in the Architecture, Engineering, and Construction (AEC) industry has risen with the improvement of information and communication technologies. However, the construction industry still struggles to capture and disseminate lessons learned. The present research explores this issue by using interviews and an online questionnaire, to provide updated information on lesson-learned procedures and their challenges in United States (US) construction companies. To do this, the authors have gathered industry professionals’ perceptions about lessons learned and methods used in their companies for harnessing and disseminating the knowledge generated by them. Our findings indicate that post-project evaluations are frequently conducted, utilize a two-step approach (review of materials followed by meetings), and are mainly organized by project managers. Most often, only key project team members are present in meetings to create a safe environment for discussion. Moreover, our findings echo previous research on the dissemination and reuse of lessons learned, indicating that these procedures are scattered and, most of the time, the information is not effectively reutilized. This suggests that US construction companies still need to revisit how information from lessons learned is currently being harnessed, stored, and especially shared (within and between companies) so that information can be effectively transformed into knowledge that can advance the AEC industry's productivity.

Platform Rhetoric and Fan Labour as the Building Blocks of <em>LEGO Ideas</em>

Platform Rhetoric and Fan Labour as the Building Blocks of <em>LEGO Ideas</em>

Evidence-Based Strategies to Reduce Anxiety in Students With Autism Spectrum Disorder

Students with autism spectrum disorder (ASD) experience anxiety at higher rates than their neurotypical peers, which can negatively impact school performance. Anxiety symptoms for these students can be challenging to identify because they mimic diagnostic characteristics. As key intervention team members, school-based mental health professionals can assist with identifying and addressing anxiety in students with autism. Specific evidence-based strategies for school-based mental health professionals are detailed to support efforts to intervene successfully with students with autism who experience anxiety.

Improving primary care team functioning through evidence based quality improvement: A comparative case study

BackgroundProvision of team-based primary care (PC) is associated with improved care quality, but limited empirical evidence guides practices on how to optimize team functioning. We examined how evidence-based quality improvement (EBQI) was used to change PC team processes. EBQI activities were supported by research-clinical partnerships and included multilevel stakeholder engagement, external facilitation, technical support, formative feedback, QI training, local QI development and across-site collaboration to share proven practices. MethodsWe used a comparative case study in two VA medical centers (Sites A and B) that engaged in EBQI between 2014 and 2016. We analyzed multiple qualitative data sources: baseline and follow-up interviews with key stakeholders and provider team (“teamlet”) members (n = 64), and EBQI meeting notes, reports, and supporting materials. ResultsSite A's QI project entailed engaging in structured daily huddles using a huddle checklist and developing a protocol clarifying team member roles and responsibilities; Site B initiated weekly virtual team meetings that spanned two practice locations. Respondents from both sites perceived these projects as improving team structure and staffing, team communications, role clarity, staff voice and personhood, accountability, and ultimately, overall team functioning over time. ConclusionEBQI enabled local QI teams and other stakeholders to develop and implement innovations to improve PC team processes and characteristics in ways that improved teamlet members’ perceptions of team functioning. ImplicationsEBQI's multi-level approach may empower staff and facilitate innovation by and within teams, making it an effective implementation strategy for addressing unique practice-based challenges and supporting improvements in team functioning across varied clinical settings. Level of evidenceVI.

Framing data witnessing: Airwars and the production of authority in conflict monitoring

Civilian victims of aerial warfare too often go uncounted and unrecognised by the belligerents. Myriad images and video of attacks against Syrian civilians did little to end their suffering, for example. The UK-based not-for-profit Airwars has had tangible impact on civilian harm disclosures and reparations because they have been able to shape such representations in a form that will be recognised by those with the power to enact change. Building on established theories of media witnessing and their extension to what Gray calls ‘data witnessing’, we argue that Airwars reveals the operative role of framing in open-source investigation and the forms of it witnessing it produces. Through interviews with key team members and detailed analysis of Airwars published methodology and other materials, this article shows how open-source investigations broadens the frame for witnessing civilian harm and in doing so generates relational, multi-scalar accounts of state violence that remain open to contestation and confirmation. In doing so, Airwars claims an epistemic authority via its distinctive framing of emergent practices of witnessing that depend upon the assembling of roles, standards, spatialities and techniques.

NICU Parents Desperately Need a "Heather" After Discharge Day.

Neonatal therapists are a key team member, especially, when in concert with the medical teams, especially nurses. This column speaks of the challenges the author faced as a parent in the NICU then delves into an interview with Heather Batman, a feeding occupational and neonatal therapist who provides personal and professional insight into how those NICU days and the team members ultimately benefit that infant's long-term outcome.

Salary determination in professional football: empirical evidence from goalkeepers

ABSTRACT Research Question We consider how elite European football clubs use available and measurable performance data to value personnel by focussing on the goalkeeper labour market. We test the determinants of goalkeeper pay and discuss if football clubs effectively separate goalkeeper performances from outfield players. Research Methods Matching an exclusive salary dataset with rich performance measures, we estimate a Mincer-type salary model for a sample of 260 goalkeepers from five European football leagues (Premier League, Ligue 1, Bundesliga 1, Serie A and La Liga). Our dataset covers seven seasons from 2013/14 to 2019/20. Results and Findings We find that clubs use primitive defensive statistics to determine goalkeeper pay. Goalkeepers are paid based on co-production and team outcomes rather than individual workload. Also features of goalkeeper ball distribution positively affect salary - this indicates the importance of goalkeepers to initiating offensive moves. Implications Our evidence suggests that decision-makers within clubs are not optimally decoupling individual performance from team qualities. As such, clubs could improve how they value a key team member. Identifying the failure to use advanced statistics is especially important as forming contracts in this setting is costly.

Risk assessment of failure during transitioning from in-centre to home haemodialysis

BackgroundIntroducing a de-novo home haemodialysis (HHD) program often raises safety concerns as errors could potentially lead to serious adverse events. Despite the complexity of performing haemodialysis at home without the supervision of healthcare staff, HHD has a good safety record. We aim to pre-emptively identify and reduce the risks to our new HHD program by risk assessment and using failure mode and effects analysis (FMEA) to identify potential defects in the design and planning of HHD.MethodsWe performed a general risk assessment of failure during transitioning from in-centre to HHD with a failure mode and effects analysis focused on the highest areas of failure. We collaborated with key team members from a well-established HHD program and one HHD patient. Risk assessment was conducted separately and then through video conference meetings for joint deliberation. We listed all key processes, sub-processes, step and then identified failure mode by scoring based on risk priority numbers. Solutions were then designed to eliminate and mitigate risk.ResultsTransitioning to HHD was found to have the highest risk of failure with 3 main processes and 34 steps. We identified a total of 59 areas with potential failures. The median and mean risk priority number (RPN) scores from failure mode effect analysis were 5 and 38, with the highest RPN related to vascular access at 256. As many failure modes with high RPN scores were related to vascular access, we focussed on FMEA by identifying the risk mitigation strategies and possible solutions in all 9 areas in access-related medical emergencies in a bundled- approach. We discussed, the risk reduction areas of setting up HHD and how to address incidents that occurred and those not preventable.ConclusionsWe developed a safety framework for a de-novo HHD program by performing FMEA in high-risk areas. The involvement of two teams with different clinical experience for HHD allowed us to successfully pre-emptively identify risks and develop solutions.

Parents' experiences of their child's transition from tube to oral feeding during an intensive intervention programme.

Persistent enteral tube feeding beyond the point of medical and/or physical necessity provides important nutrition to a child but may have implications for their development, gastrointestinal tract and quality of life. Tube dependency can affect parent-child relationships and sibling and family dynamics and place additional medical demands upon parents. It is therefore important to transition children from tube to oral eating and drinking as soon as is medically safe to do so. Tube weaning requires a skilled team to support the transition to oral intake; however, access to experienced teams is inconsistent. Without transparent discussions with their treating teams, many parents are left to navigate tube weaning options independently. Fourteen parents were interviewed using semi-structured interviews. We explored the experiences of parents across their child's progression towards oral feeding, from the decision-making process to undertaking an intensive multi-disciplinary tube weaning programme. Thematic analysis of the parents' stories shaped the development of seven themes. Parents were unaware that tube weaning would be required and how that would be facilitated. They expressed a strong belief that their child could learn to eat-if afforded an opportunity. Furthermore, parents are prepared to disengage from current services if they feel they are not respected members of their child's therapeutic team. Three key learnings were identified relating to the need for tube exit plans, parents as key team members and parents as change agents. Parenting a tube-fed child, initiating and engaging in tube weaning, is a stressful and emotional journey. However, by establishing care partnerships, parents are willing to put trust in a process if provided with options and afforded autonomy, empowerment, acknowledgement and relevant support.

74.2 Practical Tips for Strengthening Multidisciplinary Teams Working With Youth in Foster Care

Working with youth and family in the child welfare system requires a multidisciplinary team approach to ensure the best outcomes for some of our most vulnerable youth. Often, however, key team members such as social workers and foster caregivers are at particular risk for the impact of secondary trauma, compassion fatigue, and burnout, therefore limiting their capacity. The child and adolescent psychiatrist as a team leader plays a crucial role in strengthening and promoting psychological resiliency among this multidisciplinary team.

How to Better Value EMS Clinicians as Key Care Team Members.

Emergency medical services (EMS) clinicians, including emergency medical technicians and paramedics, are skilled professionals whose expertise is leveraged routinely to meet a wide range of patient needs. Collaborative interdisciplinary care requires mutual understanding, trust, and respect. Yet, among EMS clinicians and in- and out-of-hospital clinicians, these values are too often not expressed in working relationships. This article offers guidance on how to nourish successful partnerships with EMS clinicians and motivate good care.

Patient and researcher experiences of patient engagement in primary care health care research: A participatory qualitative study.

Studies have highlighted common challenges and barriers to patient engagement in research, but most were based on patient partners' or academic researchers' experiences. A better understanding of how both groups differentially experience their partnership could help identify strategies to improve collaboration in patient engagement research. This study aimed to describe and compare patient partners' and academic researchers' experiences in patient engagement research. Based on a participatory approach, a descriptive qualitative study was conducted with patient partners and academic researchers who are involved in the PriCARE research programme in primary health care to examine their experience of patient engagement. Individual semi-structured interviews with patient partners (n = 7) and academic researchers (n = 15) were conducted. Academic researchers' interview verbatims, deidentified patient partners' summaries of their interviews and summaries of meetings with patient partners were analysed using inductive thematic analysis in collaboration with patient partners. Patient partners and academic researchers' experiences with patient engagement are captured within four themes: (1) evolving relationships; (2) creating an environment that fosters patient engagement; (3) striking a balance; and (4) impact and value of patient engagement. Evolving relationships refers to how partnerships grew and improved over time with an acceptance of tensions and willingness to move beyond them, two-way communication and leadership of key team members. Creating an environment that fosters patient engagement requires appropriate structural support, such as clear descriptions of patient partner roles; adequate training for all team members; institutional guidance on patient engagement; regular and appropriate translation services; and financial assistance. For patient partners and academic researchers, striking a balance referred to the challenge of reconciling patient partners' interests and established research practices. Finally, both groups recognized the value and positive impact of patient engagement in the programme in terms of improving the relevance of research and the applicability of results. While patient partners and academic researchers identified similar challenges and strategies, their experiences of patient engagement differed according to their own backgrounds, motivesand expectations. Both patient partners and academic researchers highlighted the importance of finding a balance between providing structure or guidelines for patient engagement, while allowing for flexibility along the way. Patient partners from the PriCARE research programme were involved in the following aspects of the current study: (1) development of the research objectives; (2) planning of the research design; (3) development and validation of data collection tools (i.e., interview guides); (4) production of data (i.e., acted as interviewees); (5) validation of data analysis tools (code book); (6) analysis of qualitative data; and (7) drafting of the manuscript and contributing to other knowledge translation activities, such as conference presentations and the creation of a short animated video.