Large Regional Hospital Research Articles

Machine learning interpretability methods to characterize the importance of hematologic biomarkers in prognosticating patients with suspected infection

ObjectiveTo evaluate the effectiveness of Monocyte Distribution Width (MDW) in predicting sepsis outcomes in emergency department (ED) patients compared to other hematologic parameters and vital signs, and to determine whether routine parameters could substitute MDW in machine learning models. MethodsWe conducted a retrospective analysis of data from 10,229 ED patients admitted to a large regional safety-net hospital in Cleveland, Ohio who had suspected infections and developed sepsis-associated poor outcomes. We developed a new analytical framework consisting of seven data models and an ensemble of high accuracy machine learning (ML) algorithms (accuracy values ranging from 0.83 to 0.90) to predict sepsis-associated poor outcomes (3-day intensive care unit stay or death). Local Interpretable Model-Agnostic Explanation (LIME) and Shapley Additive Value (SHAP) interpretability methods were utilized to assess the contributions of individual hematologic parameters. ResultsThe ML interpretability analysis indicated that the predictive value of MDW is significantly reduced when other hematological parameters and vital signs are considered. The results suggest that complete blood count with differential (CBD-DIFF) alongside vital signs can effectively replace MDW in high accuracy machine learning algorithms for screening poor outcome associated with sepsis. ConclusionMDW, although a newly approved biomarker for sepsis, does not significantly enhance prediction models when combined with routinely available parameters and vital signs. Hospitals, especially those with resource constraints, can rely on existing parameters with high accuracy machine learning models to predict sepsis outcomes effectively, thereby reducing the need for specialized tests like MDW.

Racing to disaster: A 10-year retrospective analysis of pediatric competitive motocross injuries.

In competitive motocross, children as young as 4 years old race in groups on motorized off-road bikes on uneven terrain. We aimed to describe pediatric injuries occurring during an annual week-long certified amateur motocross competition between 2011 and 2021. Secondarily, we compared injury characteristics and medical evaluation by age. This retrospective analysis of injuries sustained by children during an annual motocross competition included children<18 years who received care for an event-related injury within either of the two large regional hospital systems between 2011 and 2021. Data were collected through electronic health record review and analyzed with descriptive statistics. We used chi-square and Fisher exact tests to compare findings by age (young child less than 12 years vs. adolescent 12 years or older). Over the 10-week study period (1week per year for each of 10 years), 286 encounters were made by 278 children. Nearly all children (280/286, 98%) underwent imaging; most had at least one traumatic finding (71.7% of x-rays, 62.4% of computed tomography [CT] scans). Ninety-three children (32.5% of 286) sustained multisystem injuries. Emergency department procedures included one endotracheal intubation, one thoracostomy, 46 closed reductions, and 37 procedural sedations. Twenty-eight children (9.8% of 286) required operative intervention. Overall, 25.5% of children (73/286) were hospitalized and one adolescent died. Adolescents were more likely than young children to undergo CT imaging (40.1%vs. 26.8%, p=0.042) and have multisystem injuries (36.3%vs. 23.2%, p=0.045). There was no difference in hospitalization or operative intervention by age. This comprehensive assessment of injuries sustained by children during competitive motocross demonstrates significant morbidity and mortality. Findings have implications for families who consider participation and health systems in regions where competitions occur.

Prediction of transforaminal epidural injection success in sciatica (POTEISS): a protocol for the development of a multivariable prediction model for outcome after transforaminal epidural steroid injection in patients with lumbar radicular pain due to disc herniation or stenosis

BackgroundTransforaminal epidural injections (TEI) can alleviate symptoms and help to maintain physical functioning and quality of life in patients with lumbar radicular pain. We aim to develop a prediction model for patient outcome after TEI in patients suffering from unilateral lumbar radicular pain due to lumbar disc herniation (LDH) or single-level spinal stenosis (LSS). The secondary aim is to estimate short-term patient outcome differences between LDH and LSS patients, the association between psychological variables and patient outcome, the rate of additional injections, surgery and complications, and to explore the short-term cost-effectiveness of TEI.MethodsThis study is designed as a multi-centre, observational, prospective cohort study in two large regional hospitals in the Netherlands. Patients diagnosed with unilateral lumbar radicular pain secondary to LDH or LSS and congruent with MRI findings, who are referred for TEI along usual care pathways, are eligible for study participation. A total of 388 patients with LDH or LSS will be included. A pre-defined set of demographic, clinical and radiological variables will be used as the predictors in the model. The primary outcome measure is the Numerical Rating Scale (NRS) for leg pain. Secondary outcome measures include back pain, physical functioning, perceived recovery, pain coping strategies, anxiety and depression and use of analgesics and physical therapy. Patients will be evaluated at baseline, 2 weeks and 6 weeks after treatment. NRS leg pain and Likert perceived recovery data will be used as the dependent variables in a generalized linear mixed model for prediction of TEI outcome, with internal validation of performance (explained variation) by bootstrap resampling. Cost-effectiveness for a period of 6 weeks prior to and after treatment will be performed with decision-analytic modelling.DiscussionPatients with severe lumbar radicular pain often request additional treatment when conservative care is insufficient. TEI can offer relief of symptoms. Currently, it is not possible to predict responsiveness to this treatment for individual patients. This study is designed to explore predictors that can differentiate between patients that will and will not have a positive outcome after TEI. This information may support treatment strategies for this patient group.Trial registrationThis study is registered at ClinicalTrials.gov database under registry number NCT04540068 on September 1, 2020.

Reducing personal protective equipment waste in the emergency department of a large regional hospital: codesign informed by system science

BackgroundThis study aimed to bring together health workers from an emergency department (ED) and broader health system changemakers to cocreate a system-oriented understanding of the drivers of single-use personal protective...

The Effects of Displaying the Time Targets of the Manchester Triage System to Emergency Department Personnel: Prospective Crossover Study.

The use of triage systems such as the Manchester Triage System (MTS) is a standard procedure to determine the sequence of treatment in emergency departments (EDs). When using the MTS, time targets for treatment are determined. These are commonly displayed in the ED information system (EDIS) to ED staff. Using measurements as targets has been associated with a decline in meeting those targets. This study investigated the impact of displaying time targets for treatment to physicians on processing times in the ED. We analyzed the effects of displaying time targets to ED staff on waiting times in a prospective crossover study, during the introduction of a new EDIS in a large regional hospital in Germany. The old information system version used a module that showed the time target determined by the MTS, while the new system version used a priority list instead. Evaluation was based on 35,167 routinely collected electronic health records from the preintervention period and 10,655 records from the postintervention period. Electronic health records were extracted from the EDIS, and data were analyzed using descriptive statistics and generalized additive models. We evaluated the effects of the intervention on waiting times and the odds of achieving timely treatment according to the time targets set by the MTS. The average ED length of stay and waiting times increased when the EDIS that did not display time targets was used (average time from admission to treatment: preintervention phase=median 15, IQR 6-39 min; postintervention phase=median 11, IQR 5-23 min). However, severe cases with high acuity (as indicated by the triage score) benefited from lower waiting times (0.15 times as high as in the preintervention period for MTS1, only 0.49 as high for MTS2). Furthermore, these patients were less likely to receive delayed treatment, and we observed reduced odds of late treatment when crowding occurred. Our results suggest that it is beneficial to use a priority list instead of displaying time targets to ED personnel. These time targets may lead to false incentives. Our work highlights that working better is not the same as working faster.

Renal artery occlusion in a young woman - a tale of mysterious thrombosis.

Renal artery thrombosis is rare and limited reports exist in the young population. The most common aetiology is thromboembolic disease or abdominal trauma in this population and isolated occurrences are extremely rare. We present the case of an 18-year-old woman with spontaneous unilateral renal artery thrombosis and infarction for whom reperfusion was achieved through endovascular intervention. The aetiology of her thrombosis remains unclear and is under investigation with differential diagnoses being fibromuscular dysplasia, large and medium vessel vasculitis, and thromboembolic causes. To demonstrate the value in attempting salvage of an ischaemic kidney in a young patient with an unexplained spontaneous renal thrombosis. JM is an 18-year-old woman who presented to a large regional tertiary hospital with 3days of right flank pain. She had no infective symptoms and no urinary or bowel changes before admission. She was not pregnant, and her only medication was the oral contraceptive pill commenced 3months prior. A CT angiogram demonstrated right renal artery thrombosis with renal infarction. The kidney was deemed potentially salvageable, and ultrasound defined adequate vessel calibre to access for thrombectomy in the context of a negative coagulopathy screen. The patient underwent thrombolysis, thrombectomy and balloon angioplasty. Intraoperatively, a thin segment of distal stenosis was identified, and angiogram reperfusion was achieved with subsequent improvement in renal function. Renal artery thrombosis in young people is extremely rare and presents a diagnostic and management challenge requiring input from multiple teams including nephrology, rheumatology, paediatrics and vascular surgery. Systemic coagulopathy and vasculitis are differentials against anatomical aetiologies such as fibromuscular dysplasia. Our case adds to the limited literature regarding this in the young population. Renal artery thrombosis with occlusion in young people is very rare and is most often associated with a systemic coagulopathic disorder, such as antiphospholipid syndrome or structural pathology of the renal vasculature such as fibromuscular dysplasia. The work-up of a young female presenting with renal artery thrombosis without any previous medical history screens for a wide range of pathological processes.

Preceptor's experience in supervising undergraduate nursing students in mental health: A qualitative study.

Preceptorship is considered an essential component in undergraduate nursing student's clinical placement, especially those in speciality units such as mental health. During the preceptorship relationship students are granted the opportunity to work alongside experienced nurses in the ward observing their interactions with patients and other professionals. In addition, students are able to build clinical confidence and competence. There is currently a gap in the literature around the preceptorship experience in the mental health clinical environment which warrants further exploration. The aim of this study was to explore the experiences of Registered Nurses precepting undergraduate nursing students during mental health clinical placements. A qualitative, exploratory approach was performed. A total of eight registered nurses working in an acute in-patient mental health unit in a large regional hospital, were recruited and interviewed using a semi-structured interview technique. Thematic analysis was utilised to analyse the data resulting in the development of four overarching themes; (1) Time consuming and additional workload, (2) creating a safe environment, (3) providing and receiving feedback and (4) precepting is not a choice, it is an expectation. The results highlighted that preceptoring students was considered to be an extra workload that required significant time and effort. Preceptors also expressed concerns about student safety, emphasised the importance of feedback and acknowledged preceptorship as an expectation of registered nurses working in mental health. These findings underscore the necessity for further research to delve deeper into the experience of preceptors in mental health settings.

Home nursing and self-administered outpatient parenteral antimicrobial treatment: a comparison of demographics and outcomes from a large regional hospital in Queensland, Australia.

Outpatient parenteral antimicrobial treatment (OPAT) is a safe and effective therapy used in several settings across Australia. As OPAT services expand their inclusion criteria to include complex patient populations, there is an increased need for selecting appropriate patients to receive either healthcare-administered OPAT (H-OPAT) or self-administered OPAT (S-OPAT). To describe patient demographics, diagnosis, microbiology and outcomes of patients treated by H-OPAT and S-OPAT within the Sunshine Coast Hospital and Health Service, Australia. Data on demographics, diagnoses, treatment and outcomes on all patients treated by H-OPAT and S-OPAT from March 2017 to December 2019 were collected retrospectively. One hundred and sixty-five patients (62.26%) were enrolled in H-OPAT and 100 patients (37.74%) in S-OPAT. S-OPAT patients were significantly younger. H-OPAT patients were more comorbid. Bone and joint infections were the most treated infections and were more likely to be treated by S-OPAT. There was no difference in treatment duration, cure and complication rates between S-OPAT and H-OPAT. Longer duration of therapy was associated with more complications. Treatment failure was associated with infections due to multiple organisms, number of comorbidities and treatment of surgical site, skin and soft tissue infections. There were significant differences in demographics between H-OPAT and S-OPAT without any difference in outcomes. Overall failure and complication rates were low. Higher rates of treatment failure were predicted by the diagnosis, number of comorbidities and number of organisms treated.

Healthcare Value Chain and the Impact of Analytics &amp; BI

This study aims to investigate how the existing healthcare value chain system has significantly been impacted as a result of the increasing adoption and implementation of analytics and business intelligence (A&amp;BI) capabilities. Given the increasing interest and investment in A&amp;BI, it is important to have a good understanding of what A&amp;BI capabilities healthcare organizations are utilizing to enhance value. Based on extensive search of the literature and a follow-up case study of a large regional hospital, it was found that the existing healthcare value chain (HCVC) framework is outdated and no longer effective. We therefore revised and updated the existing framework to meet the current needs of modern healthcare practices. Moreover, A&amp;BI applications currently being deployed in healthcare organizations were identified and mapped onto the revised framework. The study contributes by illustrating how healthcare organizations currently utilize or should be using A&amp;BI capabilities to enable them close the quality gaps.

Implementation Evaluation of an Early Notification Care Bundle for Patients with Hip Fracture (eHIP)

Introduction: Hip fracture in older adults results in significant mortality and is one of the costliest fall-related injuries. The Australian Commission for Quality and Safety in Health Care hip fracture clinical care standards consolidate the best available evidence for managing this patient group; however, uptake is variable. The aim of this study was to evaluate the implementation and effectiveness of a multidisciplinary early activation mechanism and bundle of care (eHIP) on patient and health service outcomes. Methods: This controlled pre- and post-test study was conducted from June 2019–June 2021 at a large regional hospital in Australia. We hypothesised that eHIP would result in at least 50% of hip fracture patients receiving six or more components of the ACSQHC Hip Fracture Clinical Care Standard. Secondary outcomes include hospital-acquired complication rates and acute treatment costs. Results: There were 565 cases included for analysis. After implementation of eHIP (the post-period), 88% of patients received a correct activation of the eHIP pathway, sustained over 12 months. The proportion of patients receiving the primary outcome of six or more components increased from 36% to 49%. Care at presentation (pain and cognitive assessment) increased by 23%, and unrestricted mobilisation within 24 h improved by 10%. Prescription of appropriate analgesia improved 10-fold (5.2–57%), and patients receiving the gold standard fascia iliaca block increased from 68% to 88%. Acute treatment costs did not significantly change. Discussion/Conclusion: eHIP, a hip fracture care program incorporating evidence-based behaviour change theory, resulted in sustained improvements to patient care as recommended by the ACSQHC Hip Fracture Clinical Care Standard.

Application of Machine Learning Techniques to Development of Emergency Medical Rapid Triage Prediction Models in Acute Care.

Given the critical and complex features of medical emergencies, it is essential to develop models that enable prompt and suitable clinical decision-making based on considerable information. Emergency nurses are responsible for categorizing and prioritizing injuries and illnesses on the frontlines of the emergency room. This study aims to create an Emergency Medical Rapid Triage and Prediction Assistance model using electronic medical records and machine learning techniques. Patient information was retrieved from the emergency department of a large regional teaching hospital in Taiwan, and five supervised learning techniques were used to construct classification models for predicting critical outcomes. Of these models, the model using logistic regression had superior prediction performance, with an F1 score of 0.861 and an area under the receiver operating characteristic curve of 0.855. The Emergency Medical Rapid Triage and Prediction Assistance model demonstrated superior performance in predicting intensive care and hospitalization outcomes compared with the Taiwan Triage and Acuity Scale and three clinical early warning tools. The proposed model has the potential to assist emergency nurses in executing challenging triage assessments and emergency teams in treating critically ill patients promptly, leading to improved clinical care and efficient utilization of medical resources.

Reduction in Feeding Problems and Impact on Family Following a 12-Week Interdisciplinary Group Feeding Intervention for Children With Feeding Problems and Their Caregivers

Caregivers and their children with clinical levels of feeding problems participated in Picnic Group, an outpatient interdisciplinary family group treatment program for children with feeding disorders and their caregivers at a large regional pediatric hospital. The manualized treatment is based on an interdisciplinary systematic approach that draws from sensory integration, communication, and cognitive behavioral strategies (e.g., classical conditioning, systematic desensitization, communication of automatic thoughts) to increase pleasurable interactions with food over a 12-week period and includes caregiver and child intervention components. Escape extinction techniques such as nonremoval of the spoon were not used in treatment. Caregivers completed measures focused on their children’s feeding behaviors and family strain at baseline and at the end of the 12-week intervention. Wilcoxon signed-rank tests compared measures between baseline and the end of treatment. Results indicated that at the 12th week, caregivers generally reported one less feeding problem, fewer specific types of eating and mealtime problematic behaviors, and decreased impact of feeding problems on the family. Children were able to work up a hierarchy of food interactions with more foods per group session than at the first session. Caregivers of children with a developmental diagnosis showed the most decrease in caregiver strain. Outpatient interdisciplinary group treatment can decrease feeding problems and caregiver strain in families with children with feeding disorders.

Hypnosis in the operating room: are anesthesiology teams interested and well-informed?

BackgroundHypnosis can be a beneficial complementary anesthesia technique for a variety of surgical procedures. Despite favorable scientific evidence, hypnosis is still rarely used in the operating room. Obstacles to implementation could be a lack of interest or training, misconceptions, as well as limited knowledge amongst anesthesiology teams. Hence, this study aimed to assess the interest, training, beliefs, and knowledge about hypnosis in the operating room staff.DesignA questionnaire with 21-items, based on a prior survey, was set up on an online platform. The medical and nursing anesthesiology staff of four Swiss academic and large regional hospitals (N = 754) were invited to participate anonymously through e-mails sent by their hierarchy. Results were analyzed quantitatively.ResultsBetween June, 2020 and August, 2021 353 answers were collected (47% response rate). Most (92%) were aware that hypnosis needs specific training, with 14% trained. A large majority of the untrained staff wished to enroll for conversational hypnosis training. There was a strong agreement for hypnosis playing a role in anesthesia. Nevertheless, many of these professionals believed that hypnosis has a limited field of action (53%) or that it would be too time consuming (33%). The reduction of misconceptions was based more on exposure to hypnosis than on training.ConclusionOverall, anesthesia providers’ attitude was in favor of using hypnosis in the operating room. Misconceptions such as a prolongation of the procedure, alteration of consent, lack of acceptability for patients, and limited indications were identified as potential barriers. These deserve to be challenged through proper dissemination of the recent scientific literature and exposure to practice.

A System Perspective on Implementation and Usage of the Da Vinci Technology at a Large Norwegian Regional Hospital’

The aim of this research paper is to identify advantages and barriers to implementation and usage of robotic-assisted surgery (RAS), specifically the Da Vinci robot, at a larger regional hospital in Norway and from a multiple stakeholder perspective. The identified advantages and barriers are connected to the socio-technical system framework SEIPS, thereby establishing a broader contextual system perspective on RAS implementation and usage. Our findings both align and extend upon existing human factors and ergonomics (HFE) knowledge on RAS in the operating room. In terms of specific future directions, we believe that a pressing concern for both management and current HFE research involving RAS implementation and usage relates to exploring and accounting for the close connections between the organization itself and the external stakeholders that exert a considerable influence on the internal work system and processes and the ability to achieve cost-efficiency and safety levels. We further conclude that the SEIPS framework can be a powerful tool in drawing or eliciting the larger contextual picture of RAS implementation and usage, and we encourage further HFE research to explore its application in different contexts to improve the current knowledge base.

Audit of clinical follow-up and complications after acute pulmonary embolism in an Australian Metropolitan Health Service.

We explored post-pulmonary embolism (post-PE) follow-up at a large Australian regional city hospital health service. Over a 12-month period, we identified 195 (49% male) patients with a median age of 62 years. Post-PE follow-up was not organised for 23 patients and delayed for seven patients. Post-PE complication occurred in 21% of all patients reviewed in the clinic after discharge. Follow-up imaging was arranged in 28% of patients. To deliver high-quality care, we recommend implementing a local post-PE follow-up pathway, which balances individual physician preference with available resources and expert recommendations.

Improving Access to Diagnostic Evaluations for Developmental Disabilities Through an Initial Assessment Model.

This study aimed to evaluate a novel model of care to improve access to diagnostic evaluations for autism spectrum disorder and/or developmental delays for school-age children. An "initial assessment" (IA) model for children aged 7 to 9 years was implemented at a large regional pediatric hospital. Referral patterns and the number of patients evaluated with the IA model were obtained through the electronic health record (EHR). Referral patterns from the EHR were checked against clinician surveys. Total IA volume had a strong negative association with school-age WL volume ( r (22) = -0.92, p < 0.001), indicating that as IA volume increased, the WL volume declined. Evaluation of referral patterns after IAs revealed that approximately 1 in 3 children seen for IA did not require further evaluation and could be immediately removed from the WL. Results indicate that implementation of a novel IA model was strongly associated with a decrease in WL volume for neurodevelopmental evaluations of school-age children. These findings support a "right-fit" approach to optimize clinical resources and improve access to neurodevelopmental evaluations.

MP02-08 CATHETER ASSOCIATED MUCOSAL PRESSURE INJURIES (CAMPI): A NOVEL STUDY DEFINING THE IMPACT OF LONG TERM URETHRAL CATHETERS

You have accessJournal of UrologyCME1 Apr 2023MP02-08 CATHETER ASSOCIATED MUCOSAL PRESSURE INJURIES (CAMPI): A NOVEL STUDY DEFINING THE IMPACT OF LONG TERM URETHRAL CATHETERS Kandice Keogh, Devang Desai, and Hannah Flynn Kandice KeoghKandice Keogh More articles by this author , Devang DesaiDevang Desai More articles by this author , and Hannah FlynnHannah Flynn More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003213.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Indwelling urethral catheters (IDC) are common in surgical practice. Given their widespread use, it is tempting to dismiss IDCs as benign drainage tubes. However, a significant complication is erosion of the urethra and surrounding soft tissues resulting in a pressure injury. We coined the term Catheter-Associated Mucosal Pressure Injury (CAMPI) for this form of iatrogenic hypospadias. Active treatment for CAMPI can be invasive with significant side effect profiles, emphasizing the importance of prevention in these patients. To date, there has been little research into CAMPI. Existing publications are either isolated case reportsor small case series. This study explored the prevalence and risk factors of CAMPI in adults with long-term IDCs in regional Australia. METHODS: A multi-centre cross-sectional study was undertaken at two large regional hospitals. The cohort was comprised of 200 adults with an IDC in-situ for >4 weeks between January 2019 to June 2021. Data was collected via a voluntary questionnaire and review of medical records. A novel grading system based on existing hypospadias classification was developed (Image 1). RESULTS: Overall prevalence of CAMPI was 9% (17/200). The mean IDC duration in patients with CAMPI was 39 weeks (9.7 months). The shortest time between IDC insertion and CAMPI detection was only 2 weeks. Prevalence was higher in males (16/169, 10%) compared to females (1/31, 3%). In males, the grades of CAMPI were meatal (7/17, 41%), glanular (3/17, 18%), coronal (4/17, 23%), subcoronal (1/17, 6%), distal penile shaft (1/17, 6%) and mid-penile shaft (1/17, 6%). The female case involved erosion of the urethral orifice during a long hospital admission. Over two-thirds of adults with a CAMPI had an IDC >16Fr (13/18, 72%). Latex IDCs were more common than silicone IDCs in both groups (78% non-CAMPI vs 67% CAMPI, p=0.49). Poor mobility (36% non-CAMPI vs 72% CAMPI, p=0.01), community managed IDCs (26% non-CAMPI vs 50% CAMPI, p=0.03), and congestive cardiac failure (9% non-CAMPI vs 28% CAMPI, p=0.02) were associated with CAMPI formation. CONCLUSIONS: CAMPI is a prevalent complication of long-term IDCs and prevention is key. Catheter securement, hygiene and care must be prioritised by all clinicians who insert, manage and change IDCs. Source of Funding: Nil Funding © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e13 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kandice Keogh More articles by this author Devang Desai More articles by this author Hannah Flynn More articles by this author Expand All Advertisement PDF downloadLoading ...

Impacts of a dispersed unit structure on allied health professionals' experiences in an Australian public hospital setting.

The limited published evidence relating to the experiences and outcomes of a unit dispersement model is generally more negative than positive from an allied health perspective. The perceptions of allied health managers and leaders after the transition to a unit dispersement structure were explored in this study. The objectives were to review the impacts of this type of structure and the factors for health care organizations to consider before incorporating allied health professions into a clinical matrix structure. A qualitative study was conducted in a large regional multisite public hospital and health service located in Australia. Semistructured interviews and focus groups were conducted with 30 allied health frontline managers and leaders. Four negative impacts on the work experience of allied health professionals in a dispersement structure were identified through data analysis as: a negative impact on service delivery to patients, a detrimental effect on professional identity, reduced ability of allied health managers and leaders to do their role effectively, and a negative impact on morale, culture, and emotional well-being. Several key factors for public hospitals to consider before embarking on an organizational structure that includes allied health professionals were identified. The impacts of the unit dispersement structure on allied health professionals working within the organization under study were generally negative and did not deliver on the desired objectives. The findings reinforce the unique requirements pertaining to allied health professionals for optimal functioning. The learnings have implications for administrators in health care organizations embarking on organizational change that incorporates allied health professions in certain settings. The findings recommend that health care organizations consider several important factors before they introduce any structural change that would affect the delivery of allied health services.

Exploring avoidable presentations from residential aged care facilities to the emergency department of a large regional Australian hospital.

The study aimed at determining the factors that contributed to older people presenting from residential aged care facilities (RACFs) to the emergency department (ED) of a regional Victorian hospital located in MM3 regional area. Appropriateness of transfer was assessed based on predefined criteria, and associated costs for each presentation were calculated. The study carried out a retrospective review of records between July and December 2021. Data were extracted in a MS Excel spreadsheet and transferred to STATA 15.0 for analysis. Large regional health service in Victoria. Residential aged care facilities residents presenting to the ED. Was transfer appropriate or avoidable, costs associated with avoidable transfer, characteristics of the patient and circumstances relating to presentation to hospital. A total of 448 presentations were recorded, and 85% of residents were >75 years of age. More than 60% of presentations occurred during weekends or after hours, with the most common reason being falls (31.9%). Over half (55.6%) of all presentations were avoidable which incurred a cost of $777 200 in 6 months. In multiple logistic regression, higher ED presentations were observed in residents with no prior GP assessment (OR: 1.47, 95% CI: 1.02-2.11). Necessary interventions such as preventing falls and increasing primary care access along with improving the quality of advance care directives (ACD) may reduce RACF transfers to the regional ED. To the best of our knowledge, this is the first paper of this kind that provides new data from an Australian rural and regional perspective and adds value to the growing body of knowledge in the intersection of aged care and acute emergency care.

Craig Driver &amp; Ross Warren (architects) will present examples of an innovative waymaking (wayfinding) concept from a current development in Norwich, UK

AbstractA new interpretation of the normalised “Wayfinding” design task offers the opportunity to become an important element of the larger clinical and architectural project for a new “core” expansion of a large regional psychiatric hospital in the South-East of the UK. We call this new approach Waymaking, as it goes beyond signage, leveraging our deep-set knowledge and understanding of the entire project at all scales.Waymaking at the Rivers Centre for Mental Health (Rivers) begins with the exploration of movement narratives into and around its larger site. It turns a classic design task into a design opportunity on all scales, starting with an urban design and planning perspective, through to the architectural and landscape design decisions outside of the building and into the specific on-ward atmospheres in a manner integrated with the detail interior design decisions of colour, built-in-furniture and others.Rivers has been carefully composed out of existing structures as well as smaller new-build and extension buildings. These are all set within a large, sloping site of noteworthy natural beauty. As such, Rivers can well be understood as a hillside village or campus of health - rather than as a traditional “hospital.” As a health village, Rivers provides spatial sequencing as the landscape design directly introduces a series of smaller, more human scale spaces built and natural all of which together aid in orientation and identity across the site. This will help support the daily use of the buildings by all stakeholders.This strategy has been “baked-in“ to the architectural design as well, strategically distributed retreat/recovery spaces allow for space for de-escalation or relaxation. These can be found in the form of regular niches in the hallways and “porch” entrance spaces, usually with built-in benches and bespoke lighting elements. In addition to creating orientation affordances, these also provide opportunities for neurodivergent persons (ie. ASD, learning disabilities, etc.) to better understand and master independent movement around the Centre.Disclosure of InterestNone Declared