Lack Of Available Beds Research Articles

Ad Hoc Modifications to a High Dependency Psychiatric Unit for People With Dementia During the COVID-19 Period.

The COVID-19 pandemic led to behavioral exacerbations in people with dementia. Increased hospitalizations and lack of bed availability in specialized dementia wards at a tertiary psychiatric hospital in Singapore resulted in lodging people with dementia in the High Dependency Psychiatric Unit (HDPCU). Customizations to create a dementia-friendly environment at the HDPCU included: (1) environmental modifications to facilitate orientation and engender familiarity; (2) person-centered care to promote attachment, inclusion, identity, occupation, and comfort; (3) risk management for delirium; and (4) training core competencies. Such practical solutions can also be implemented elsewhere to help overcome resource constraints and repurpose services to accommodate increasing populations of people living with dementia.

Original Research: Breaking Through the Bottleneck: Acuity Adaptability in Noncritical Trauma Care.

Achieving efficient throughput of patients is a challenge faced by many hospital systems. Factors that can impede efficient throughput include increased ED use, high surgical volumes, lack of available beds, and the complexities of coordinating multiple patient transfers in response to changing care needs. Traditionally, many hospital inpatient units operate via a fixed acuity model, relying on multiple intrahospital transfers to move patients along the care continuum. In contrast, the acuity-adaptable model allows care to occur in the same room despite fluctuations in clinical condition, removing the need for transfer. This model has been shown to be a safe and cost-effective approach to improving throughput in populations with predictable courses of hospitalization, but has been minimally evaluated in other populations, such as patients hospitalized for traumatic injury. This quality improvement project aimed to evaluate implementation of an acuity-adaptable model on a 20-bed noncritical trauma unit. Specifically, we sought to examine and compare the pre- and postimplementation metrics for throughput efficiency, resource utilization, and nursing quality indicators; and to determine the model's impact on patient transfers for changes in level of care. This was a retrospective, comparative analysis of 1,371 noncritical trauma patients admitted to a level 1 trauma center before and after the implementation of an acuity-adaptable model. Outcomes of interest included throughput efficiency, resource utilization, and quality of nursing care. Inferential statistics were used to compare patients pre- and postimplementation, and logistic regression analyses were performed to determine the impact of the acuity-adaptable model on patient transfers. Postimplementation, the median ED boarding time was reduced by 6.2 hours, patients more often remained in their assigned room following a change in level of care, more progressive care patient days occurred, fall and hospital-acquired pressure injury index rates decreased respectively by 0.9 and 0.3 occurrences per 1,000 patient days, and patients were more often discharged to home. Logistic regression analyses revealed that under the new model, patients were more than nine times more likely to remain in the same room for care after a change in acuity and 81.6% less likely to change rooms after a change in acuity. An increase of over $11,000 in average daily bed charges occurred postimplementation as a result of increased progressive care-level bed capacity. The implementation of an acuity-adaptable model on a dedicated noncritical trauma unit improved throughput efficiency and resource utilization without sacrificing quality of care. As hospitals continue to face increasing demand for services as well as numerous barriers to meeting such demand, leaders remain challenged to find innovative ways to optimize operational efficiency and resource utilization while ensuring delivery of high-quality care. The findings of this study demonstrate the value of the acuity-adaptable model in achieving these goals in a noncritical trauma care population.

Impact of COVID-19 on common non-elective general surgery diagnoses.

BackgroundDuring the COVID-19 pandemic, public health and hospital policies were enacted to decrease virus transmission and increase hospital capacity. Our aim was to understand the association between COVID-19 positivity rates and patient presentation with EGS diagnoses during the COVID pandemic compared to historical controls.MethodsIn this cohort study, we identified patients ≥ 18 years who presented to an urgent care, freestanding ED, or acute care hospital in a regional health system with selected EGS diagnoses during the pandemic (March 17, 2020 to February 17, 2021) and compared them to a pre-pandemic cohort (March 17, 2019 to February 17, 2020). Outcomes of interest were number of EGS-related visits per month, length of stay (LOS), 30-day mortality and 30-day readmission.ResultsThere were 7908 patients in the pre-pandemic and 6771 in the pandemic cohort. The most common diagnoses in both were diverticulitis (29.6%), small bowel obstruction (28.8%), and appendicitis (20.8%). The lowest relative volume of EGS patients was seen in the first two months of the pandemic period (29% and 40% decrease). A higher percentage of patients were managed at a freestanding ED (9.6% vs. 8.1%) and patients who were admitted were more likely to be managed at a smaller hospital during the pandemic. Rates of surgical intervention were not different. There was no difference in use of ICU, ventilator requirement, or LOS. Higher 30-day readmission and lower 30-day mortality were seen in the pandemic cohort.ConclusionsIn the setting of the COVID pandemic, there was a decrease in visits with EGS diagnoses. The increase in visits managed at freestanding ED may reflect resources dedicated to supporting outpatient non-operative management and lack of bed availability during COVID surges. There was no evidence of a rebound in EGS case volume or substantial increase in severity of disease after a surge declined.

Barriers and Enablers to Early Identification, Referral and Access to Geriatric Rehabilitation Post-Hip Fracture: A Theory-Based Descriptive Qualitative Study.

BackgroundGeriatric hip fracture patients often experience gaps in care including variability in the timing and the choice of an appropriate setting for rehabilitation following hip fracture surgery. Many guidelines recommend standardized processes, including timely access of no later than day 6 to rehabilitation services. A pathway for early identification, referral and access to geriatric rehabilitation post-hip fracture was created to facilitate the implementation. The study aimed to describe the barriers and enablers prior to the implementation of this pathway.MethodsWe conducted a qualitative descriptive study consisting of semi-structured interviews with geriatric hip fracture patients (n = 8), caregivers (n = 1), administrators (n = 12) and clinicians (n = 17) in 2 orthopaedics units and a geriatric rehabilitation service. Responses were analysed using a systematic approach, and overarching themes describing the barriers and enablers were identified.ResultsThe clinicians’ and administrators’ top barriers to implementation of the pathway were competing demands (n = 24); lack of bed availability, community resources and funding (n = 19); and the need for extended hours and increased staff (n = 16). The top 3 enablers were clear communication with patients (n = 27), awareness of the benefits of geriatric rehabilitation (n = 24) and the need for education and resources to properly use the pathway (n = 15). Common barriers among patients and caregivers included lack of care coordination, overcoming some of their own specific challenges during their transition, gaps in the information they received before discharge, not knowing what questions to ask and lack of resources. Despite these barriers, patients were generally pleased with their transition from the hospital to geriatric rehabilitation.ConclusionWe identified and described key barriers and enablers to early identification, referral and access to geriatric rehabilitation post-hip fracture. These influencing factors provide a basis for the development of a standardized pathway aimed at improving access to rehabilitative care for geriatric hip fracture patients.

A Quality Improvement Approach to Early Patient Discharge.

Introduction:Lack of bed availability is a common problem in our pediatric unit, as in many hospitals. To address this issue, we instituted a quality improvement (QI) initiative involving collaborative nurse–physician rounding. This intervention has been shown to expedite discharge, improve patient care, and increase bed availability in other settings.Methods:By utilizing PDCA (Plan, Do, Check, Act) processes, we created two improvement initiatives, “Increasing Patient Discharge Before 12 pm” and “Midnight Rounds with Discharge Focus.” Senior resident and faculty physicians rounded on discharge-ready patients before teaching rounds, and by 10 am, placed discharge orders to allow for a 12 pm discharge. A night team consisting of senior residents and nurses conducted “Midnight Rounds” and identified potential discharges for the morning team. The project aimed to increase patient discharges before 12 pm from a June–November 2018 baseline of 15%–20% by June 2019.Results:Patient discharge percentage before 12 pm increased from 15% to 21% (P < 0.01) by June 2019, and as a result, bed availability increased by 16% (P < 0.01).Conclusions:QI methodology clarified the root causes of limited bed availability. Understanding the existing discharge process allowed for QI initiatives to develop a consistent and sustainable discharge process. Patient discharge percentages before 12 pm increased by 40%, and bed availability increased by 16% after QI implementations.

A Second Look at Chelation Therapy During COVID-19 as A Viable Option for Treating Cardiac Endothelial Dysfunction

Across the United States and the world, COVID-19 has altered the manner patients are treated and admitted to the hospital. Through this pandemic, bed space has been allocated for the massive on-rush of patients requiring acute assistance with ventilations and survival. There has been a 60% reduction in nonemergent surgeries being postponed due to lack of available beds, due to precautions for COVID exposure, and due to decreased staff available for non-COVID patients [1-3,].

583 Impacting the Length of Stay of Burn Patients in the Emergency Department

Abstract Introduction Burn patients represent a challenging patient population and require early interventions. Advance Burn Life Support classes have been developed to guide first responders with assessing and treating burn patients in the pre-hospital setting. In the emergency department (ED) patients may experience hypothermia, delayed resuscitation, inadequate pain control, and delayed wound cares. Methods ED length of stay (LOS) was retrospectively reviewed for burn patient who met trauma activation criteria from 2013–2018. Patients were categorized based on ED disposition to burn stepdown, burn unit intensive care (BICU), or directly to the burn operating room (OR). Patients who died in the ED or were discharged home were excluded. In 2019, guidelines for burn activations, responses, and consults were developed to mirror the activation criteria for a Level 1 trauma institution. ED nurses and physicians were educated on burn assessment, wound care, and the new triage guidelines with emphasis on the importance of early transfer out of the ED. Results Prior to the change in burn activation guidelines, rapid transfer of burn patients out of the ED had not been emphasized. Of the 144 patients examined, ED LOS was 5.4 hours for those going to burn stepdown, 4.3 hours for BICU, and 3.7 hours for those who went directly to the burn OR. Several barriers to early transfer out of the ED were identified including lack of bed availability, lack of cleaning staff on nights and weekends, difficult lateral transfers of non-burn patients out of the Burn Unit, and a lack of education on the importance of early interventions by nursing staff. Since the implementation of the guidelines, there has been an improvement in LOS for BICU patients, but the goal of less than one hour in the ED has not yet been achieved. Conclusions Unacceptable ED LOS for burn patients were identified, triage guidelines were developed, and education was provided to staff. Guidelines and education, in conjunction with emphasizing the importance of having available beds in the Burn Unit, have led to a decrease in ED length of stay. Ongoing education and process improvement are key for rapid transfer of burn patients out of the ED. Applicability of Research to Practice Burn Centers can improve patient accounts by identifying areas that put burn patients at risk. Implementation of protocols can lead to process improvement and lead to better patient outcomes.

Self-Reported Knowledge Levels of Critical Care Nurses in Managing Neuroemergencies: A Survey Based Study

Abstract INTRODUCTION Neurocritical care has become increasingly subspecialized. However, due to a lack of bed availability in neurocritical care units (NCCUs), sometimes patients may need to be boarded in other intensive care units (ICUs). Several academic centers do not have access to dedicated NCCUs. We hypothesized that general ICU and postanesthesia care unit (PACU) nurses may not feel as comfortable managing neurocritical care patients. In this survey-based quality improvement (QI) study, we explored the self-reported knowledge of ICU and PACU nurses at a comprehensive stroke center in recognizing and managing some common neurological emergencies such as stroke, status epilepticus, and raised intracranial pressure. METHODS We engaged the nursing managers of 8 units in this QI project, which included medical, surgical, neurocritical care, cardiac and cardiothoracic units as well as PACU and interventional radiology units. Using institutional RedCap, anonymized surveys were sent to the nurses in January 2019. We collected information on demographic and critical care work experience. All participants answered questions on a Likert-type scale based on their knowledge of several common neurological emergencies. RESULTS A total of 240 nurses (199 females, 41 males) participated in the survey. Out of which, 112 (58%) had been working in an ICU for 3 yr or longer. Their self-reported level of knowledge in managing neurological emergencies have been summarized below. More than half the participants did not feel comfortable managing patients with EVDs, ICH, SAH, raised intracranial pressure, and TBI and traumatic spine injury patients. More than 70% of nurses were not satisfied with their current level of training to deal with neuroemergency and supported the need for dedicated training/study time. CONCLUSION ICU and PACU nurses report gaps in knowledge in recognizing and managing common neuroemergencies. With an increasing cohorting of patients in subspecialized units, it is important to provide ongoing education to ICU and PACU nurses to help them maintain fundamental neurocritical knowledge.

Prevention of Pediatric Respiratory Syncytial Virus Lower Respiratory Tract Illness: Perspectives for the Next Decade.

The landscape of infant bronchiolitis and viral pneumonia may be altered by preventive interventions against respiratory syncytial virus under evaluation today. Pediatric wards in 2018 in developing countries may differ from those attended by future generation pediatricians who may not witness the packed emergency rooms, lack of available beds, or emergency situations that all physicians caring for children with RSV experience every year. In this review, we describe and discuss different prevention strategies under evaluation to protect pediatric patients. Then, we outline a number of potential challenges, benefits, and concerns that may result from successful interventions after licensure.

A force de mal dire, le public va forcément mal entendre ! :

In 2014, the lack of beds for asylum seekers in Switzerland captured media headlines. To explain this housing crisis, authorities mentioned that there were an increasing number of asylum seekers, and the rising numbers were repeated on a loop by journalists. The opening of civic protection shelters, situated underground, is, with some rare exceptions, the only short-term solution considered by the cantons in Western Switzerland. Yet, in 2014, and despite the critical international geopolitical situation, in Switzerland there had not be such an « explosive » or « extraordinary » increase of asylum seekers, if one compares it to their arrival in previous years. As a consequence, if cantons struggle to find aboveground shelters, other reasons for the housing shortage must be put forward. I demonstrate that the lack of beds is due to contextual and structural factors, and especially to the fact that an increasing number of asylum seekers have the right to stay and to establish themselves in Switzerland, considering the asylum law. Why do authorities and media not propose this analysis? I formulate the hypothesis that this is due to the fact that the rhetoric of invasion, considered a « myth » by de Haas (de Haas, 2008), is integrated in the belief system. The rhetoric of invasion is a knowledge distortion that creates misunderstanding (Lazar, 2005) and is used to justify emergency politics, especially in the field of asylum seekers’ housing. The belief system is so socially anchored that it prevents journalists to investigate the real reasons of the lack of available beds for asylum seekers.

Association of early emergency calls before patient collapse with survival from out-of-hospital cardiac arrests

Reducing time from acceptance to intensive care unit arrival Donna K. Berner, John A. Terrell, Sharill L. Bernhard, Lorraine S. Layton, Joseph L. Nates The University of Texas MD Anderson Cancer Center, Houston, TX, USA Background/Purpose: The lack of bed availability leads to patient care delays and increases complications and patient dissatisfaction. As part of our institutional continuous performance improvement goals, we aimed to improve our intensive care unit (ICU) admission process by gaining a better understanding of the process through the use of industrial engineering tools. Methods: We investigated all nonoperative admissions to the ICU from May 21, 2014, to December 31, 2014 (n = 929). Using standard industrial engineering techniques, process flow maps, Ishikawa diagrams, and plan-do-study-act (PDSA) cycles, key quality indicators affecting the admission process were prospectively collected and validated against the ICU database. The study database consisted of time of referral, acceptance, ICU arrival time, referral service, and location and reason for delay in transport. Results: Patients pulled to ICUby the code teamor the rapid response team (RRT) arrived statistically significantly faster than patients pushed to ICU from the referral location (27 vs 71minutes, P b .001). Patientwith delayed transport took 4 times as long to arrive as code and RRT patients and twice as long to arrive as nondelayed patients (105 vs 60 vs 26 minutes 1-way ANOVA, P b .0001). Conclusions: The use of the pulling technique was significantly more effective than the pushing technique in the ICU admission process. In busy units, a dedicated ICU driven transport team could lead to more efficient and time-sensitive ICU critically ill patient admission. This team would work in parallel to the rapid response or code team for a more efficient ICU admission process.

Component analyses for effectiveness of compressions and ventilations in bystander cardiopulmonary resuscitation

Reducing time from acceptance to intensive care unit arrival Donna K. Berner, John A. Terrell, Sharill L. Bernhard, Lorraine S. Layton, Joseph L. Nates The University of Texas MD Anderson Cancer Center, Houston, TX, USA Background/Purpose: The lack of bed availability leads to patient care delays and increases complications and patient dissatisfaction. As part of our institutional continuous performance improvement goals, we aimed to improve our intensive care unit (ICU) admission process by gaining a better understanding of the process through the use of industrial engineering tools. Methods: We investigated all nonoperative admissions to the ICU from May 21, 2014, to December 31, 2014 (n = 929). Using standard industrial engineering techniques, process flow maps, Ishikawa diagrams, and plan-do-study-act (PDSA) cycles, key quality indicators affecting the admission process were prospectively collected and validated against the ICU database. The study database consisted of time of referral, acceptance, ICU arrival time, referral service, and location and reason for delay in transport. Results: Patients pulled to ICUby the code teamor the rapid response team (RRT) arrived statistically significantly faster than patients pushed to ICU from the referral location (27 vs 71minutes, P b .001). Patientwith delayed transport took 4 times as long to arrive as code and RRT patients and twice as long to arrive as nondelayed patients (105 vs 60 vs 26 minutes 1-way ANOVA, P b .0001). Conclusions: The use of the pulling technique was significantly more effective than the pushing technique in the ICU admission process. In busy units, a dedicated ICU driven transport team could lead to more efficient and time-sensitive ICU critically ill patient admission. This team would work in parallel to the rapid response or code team for a more efficient ICU admission process.

The effect of new emergency program on patient length of stay in a teaching hospital emergency department of Tehran.

Background and Aim:Ideally, the period of patients admitting in the Emergency Department (ED) should not exceed 6 hours. Prolonged of the patients admitting time affects the ED overcrowding, quality of patient care and patient satisfaction. To evaluate the efficacy of new programs and suggest new strategies to reduce the overcrowding in a typical overcrowded ED of general teaching hospital in Tehran city.Materials and Methods:In this descriptive case study, charts of patients held over 24 hours, in Imam Hossein Hospital affiliated to the Shaheed Beheshti Medical University, were reviewed from April 21rd on August 23rd, 2008.Results:Of 15,477 patients, 151 (1%) have been held in the ED over 24 hours. Reasons for this long-stay included:lack of available bed in Intensive Care Unit (ICU) (125 patients), lack of available bed in related wards (18 patients), poor final decision — making by physician (eight patient)Conclusion:Long-term stay of patients in ED of teaching hospital is a major problem. The most frequent cause is a limitation of inpatient beds. The long stay time had not been affected by paraclinic procedures, multispecialities involvement or the lack of obvious diagnosis. The following solution is proposed: (1) creation of a holding unit, (2) active inter-facility transfer and (3) governing admittance of patients who need ICU care to related wards.

Optimal Timing of Transfer Out of the Intensive Care Unit

Little other than subjective judgment is available to help clinicians determine when a patient should be transferred out of the intensive care unit. To assess whether remaining in the intensive care unit longer than judged to be medically necessary is associated with increased 30-day mortality. This prospective, observational cohort study was performed in a 13-bed, closed-model, adult medical intensive care unit of a county-owned, university-affiliated hospital that often has difficulty transferring patients to general care areas because of a lack of available beds. Analysis included all 2401 survivors of intensive care from the study period. Delay in discharge from the intensive care unit was defined as time elapsed between the request for transfer and the actual transfer. Logistic regression was used to assess the association of discharge delay with 30-day mortality, adjusting for demographics, comorbid conditions, type and severity of acute illness, care limitations in the unit, and other potential confounding variables. Nonlinear relationships with continuous variables were modeled with restricted cubic splines. Overall, 30-day mortality was 10.1%. Mean discharge delay was 9.6 (SD, 11.7) hours; 9.9% had a discharge delay exceeding 24 hours. The relationship of 30-day mortality to discharge delay was statistically significant and U-shaped, with the nadir at 20 hours. These data indicate an optimal time window for patients to leave the intensive care unit, with increased mortality not only if they leave earlier but also if they leave later than this optimal timing.

Hospital out-lying through lack of beds and its impact on care and patient outcome

BackgroundWhen medical wards become saturated, the common practice is to resort to outlying patients in another ward until a bed becomes free.ObjectivesCompare the quality of care provided for inpatients who are outlying (O) in inappropriate wards because of lack of vacant beds in appropriate specialty wards to the care given to non outlying (NO) patients.MethodsWe propose a matched-pair cluster study. The exposed group consisted of inpatients that were outliers in inappropriate wards because of lack of available beds. Non-exposed subjects (the control group) were those patients who were hospitalized in the ward that corresponded to the reason for their admission. Each patient of the exposed group was matched to a specific control subject. The principal objective was to prospectively measure differences in the length of hospital stays, the secondary objectives were to assess mortality, rate of re-admission at 28 days, and rate of transfer into intensive care.Results238 were included in the NO group, 245 in the O group. More patients in the O group (86% vs 76%) were transferred into a ward with prescription completed. O patients remained in hospital for 8 days [4-15] vs 7 days [4-13] for NO patients (p = 0.04). 124 (52%) of the NO patients received heparin-based thromboembolic prevention during their stay in hospital vs 104 (42%) of the O patient group (p = 0.03). 66 (27%) O patients were re-admitted to hospital within 28 days vs 40 (17%) NO patients (p = 0.008).ConclusionO patients had a worse prognosis than NO patients.

Is There a Starling Curve for Intensive Care?

Large differences exist in the provision of ICU beds worldwide, with a complicated mix of risks and benefits to the population of having either too few or too many beds. Having too few beds can result in delayed admission of patients to the ICU or no admission at all, with either scenario potentially increasing mortality. Potential societal benefits of having few beds include lower costs for health care and less futile intensive care at the end of life. With added ICU beds for a population, mortality benefit should accrue, but there is still the question of whether the addition of beds always means that more lives will be saved or whether there is a point at which no additional mortality benefit is gained. With an abundance of ICU beds may come the possibility of increasing harm in the forms of unnecessary costs, poor quality of deaths (ie, excessively intensive), and iatrogenic complications. The possibility of harm may be likened to the concept of falling off a Starling curve, which is traditionally used to describe worsening heart function when overfilling occurs. This commentary examines the possible implications of having too few or too many ICU beds and proposes the concept of a family of Starling curves as a way to conceptualize the balance of societal benefits and harms associated with different availability of ICU beds for a population.

Bottlenecks in the Emergency Department: the psychiatric clinicians' perspective

ObjectiveTo ask psychiatric clinicians for their perspectives on the rate-limiting steps (RLS) in patient care in the Emergency Department (ED) and to compare them to the patient's actual length of stay. MethodProspective cohort study of clinicians' perspectives on the RLS among 1092 adult ED patients. Medical records were abstracted for ED time and other data. ResultsClinicians identified five RLS: limited availability of staff, limited availability of beds after discharge, need for clinical stability, need for additional history and patient's financial issues. The last RLS was the only one not associated with increased wait times in the ED. There were significant differences in the patterns of RLS by trainee status and hospital. For example, significantly higher proportions of trainees reported that RLS in patient care were due to the need for clinical stability and additional history and lack of bed availability. In contrast, non-trainee clinicians were more likely to cite problems with the availability of ED staff as an RLS. ConclusionsMost of the RLS in patient care identified by clinicians were associated with actual increases in ED wait time for their patients. Next steps include asking clinicians for possible solutions to the delays their patients experience.

Abstract 3670: Lean Manufacturing Process Improvement Methods Accelerate and Simplify Transfer of Patients to a Comprehensive Stroke Center

Background and Purpose: Acute therapies offered at comprehensive stroke centers require the rapid transfer of stroke patients from outlying hospitals. Here, we describe the application of Lean manufacturing process improvement methods to stroke care in order to accelerate the transfer of patients from outlying hospitals. Methods: A multidisciplinary team of Stroke Neurologists, Vascular Neurosurgeons, ED Physician, Call Center staff and Lean Performance Management Engineers critically evaluated the chain of events required to accept a patient for transfer from outlying hospitals. Barriers and inefficiencies were identified in a “current state” Value Stream Map (VSM). A “future state” VSM created a new process for stroke patient transfer by overcoming the identified barriers and was implemented in March, 2011. Metrics were prospectively collected for a 4-month period prior to (7/1/10-10/30/10) and after implementation of the “future state” VSM (3/1/11-6/30/11), and included: mean time from call start to physician acceptance, percent of calls resulting in acceptance of patients within 15 minutes, total number of patients accepted within 15 minutes over 4 months, and total number of calls. Student’s T-test was used to compare means, while Chi-square test was used to compare ratios. Results: Identified barriers to rapid acceptance of patients included: 1) inefficient distribution of cases between services (neurology vs. neurosurgery); 2) calls frequently transferred from one physician to another on other services; and 3) lack of available beds resulting in acceptance delays. To overcome these inefficiencies, a new process was created with the following changes: 1) alternating call coverage shared between neurology and neurosurgery; 2) immediate acceptance of the patient with behind the scenes patient allocation to appropriate service; 3) direct involvement of patient placement services in transfer process. Mean time to acceptance decreased significantly from 14 min prior to new protocol implementation to 9 minutes (p&lt; 0.03). The total number patients accepted within 15 minutes increased from 186 to 307 during this 4-month period. Percent accepted within 15 minutes also increased from 73% to 92% (p&lt;0.0002). In addition, the rate of patient calls (#calls/month) increased after new protocol implementation (see table ). Conclusions: Lean manufacturing process improvement tools are effective in designing hospital and physician work flow to help improve stroke care. Such practices require a collaborative approach including all parties involved in the process.

NP008 “LOOK, LISTEN and FEEL” What can the bedside nurse do to prevent vascular related complications post Percutaneous Coronary Intervention?

There is a need for review and updates for all clinicians involved in the care of Percutaneous Coronary Intervention (PCI) patients because of rapid technological advances in PCI therapy. Traditionally, post PCI patients were monitored in critical care units however, with shortened hospital stays, budgetary restraints, and a lack of available beds, post PCI care has shifted to nurses within the community hospitals. Following evaluation of a learning needs assessment survey which was distributed to the community hospitals within the Champlain Local Health Integrated Network (LHIN), it was determined that there was a gap in the learning needs for nurses caring for patients with vascular related complications post femoral PCI. The objective of this education project, is to provide the necessary information to help nurses develop the critical thinking and clinical judgement necessary to monitor for potential vascular related complications. This information would be delivered in the form of a pocket size laminated algorithm card in accordance with Best Practice Guidelines for the care of PCI patients to prevent vascular related complications. The algorithm would provide the clincal staff nurse with guidelines, and an increased knowledge base around the potential vascular related complications associated with PCI, and what actions to take should they occur. This resource will facilitate knowledge transfer and improve the quality of patient care by standardizing practices among all clinical staff nurses within the Champlain LHIN, reducing vascular related complications and improving patient outcomes.

Infection control and antibiotic stewardship practices reported by south-eastern Mediterranean hospitals collaborating in the ARMed project

The prevalence of multiply resistant organisms (MROs) reported from south-eastern Mediterranean hospitals highlights the need to identify possible contributory factors to help design control interventions. This was investigated through a structured questionnaire, which examined infection control and antibiotic stewardship practices in hospitals participating or collaborating with the Antibiotic Resistance SurveilLance & Control in the Mediterranean Region (ARMed) project. A total of 45 hospitals (78.9% of invited institutions) responded to the questionnaire; 60% indicated that they faced periods of overcrowding when available bed complement was insufficient to cope with hospital admissions and 62% reported difficulties in isolating patients with MROs due to lack of available beds. Most hospitals relied mainly on washing to achieve hand hygiene, whether by non-medicated or disinfectant soaps. Dependence on solid bars of soap (28.9%) and cloth towels (37.8%) were among the problems identified as well as inconvenient distances of sinks from patient beds (66.6%). Alcohol hand rub was the predominant hand hygiene product in only 7% of hospitals. Programmes for better antibiotic use were mostly limited in scope; 33.3% reported having antibiotic prescribing guidelines and 53.3% of hospitals fed back resistance rates to prescribers. Auditing of antibiotic consumption, whether institution- or unit-based, was carried out in 37.8% of responding hospitals. Multi-faceted approaches aimed at improving isolation of patients with MROs, increasing the emphasis on hand hygiene by encouraging greater use of alcohol hand rubs and introducing effective antibiotic stewardship programmes should be encouraged in south-eastern Mediterranean hospitals.