Local Team Research Articles

BI17 A novel multidisciplinary clinic for the management of cutaneous T-cell lymphoma

Abstract Mycosis fungoides cutaneous T-cell lymphoma (MF-CTCL) is a rare condition that can present diagnostic difficulty and challenging management as no standard pathway exists. Patients require haematology and dermatology involvement to ensure optimal management, and the British Association of Dermatologists guidelines suggest regional supranetwork skin MDT for the majority of patients. However, this distances patients and local clinicians from the decision-making process. We propose a multidisciplinary model that includes local dermatology and haematology teams with the assistance of a regional expert to evaluate all of a region’s patients with MF-CTCL to ensure appropriate staging and management. On review of our cohort of patients with MF-CTCL, there were 42 patients with only 50% staged. We proposed a day-long multidisciplinary clinic model that enabled all patients with MF-CTCL to attend the dermatology department to receive a teaching session by trained nurses, a 30-minute consultation with a dermatology consultant with direct access to a specialist haematology consultant and a regional cutaneous lymphoma specialist, and access to on-the-day blood tests and diagnostic biopsies if needed. Twenty-six patients attended the clinic; 22 were confirmed to have MF-CTCL, 21 of whom were appropriately staged on the day. Ninety-five per cent of patients said they felt ‘extremely involved and informed’ about their management and treatment decisions after the clinic (vs. 19% preclinic). Ninety-five per cent would recommend the clinic to a family or friend, and 90% would attend a similar clinic in the future. From a clinician perspective, the survey responses showed high value in having repeated exposure to patients with CTCL, understanding the management options for MF-CTCL, face-to-face discussions with the multidisciplinary team (MDT) and longer clinic appointments. In conclusion, we offer this MDT clinic model as an efficient means for delivering patient-centred management and care, continuing education to local referring clinicians and ensuring close working relationships between dermatology and haematology. We propose running this clinic annually to ensure that all patients with MF-CTCL have appropriate investigation, staging and management pathways. The success of the clinic has led the department to adopt this model in other areas such as inflammatory conditions.

PS01 Prevalence of baseline anxiety and depression in patients attending a tertiary virtual acne service

Abstract Evidence suggests that the prevalence of depression and suicide in those with acne is higher than in the general population. There have also been case reports of suicide in patients taking isotretinoin for acne, although there is a lack of evidence to suggest a true causality. We know that many people with acne and acne scars struggle with impacts on emotions, social/daily activities, study, work and relationships. A prospective cohort study was undertaken, including 150 consecutive new patients in our acne clinics from 7 December 2021 to 5 July 2022 as part of a service evaluation. This project was registered with our local research and innovation team. We captured a snapshot of the demographics of our patients, including baseline Generalised Anxiety Disorder Assessments (GAD-7), Patient Health Questionnaires (PHQ-9) and pre-existing mental health problems. Mean age was 26 years (range 17–46). Sixty-four per cent of patients were women and 36% were men. Thirty per cent of patients reported a previous/current mental health problem, the most common being anxiety (19.3%) and depression (18.0%). The most common medications taken previously or currently were sertraline (4.0%) and propranolol (4.0%). Initial PHQ-9 scores ranged from 0 to 29 points: 49.1% had a score of ≥ 5; 29.1% a score of ≥ 10; and 18.2% a score of ≥ 15. As a comparison, in July–August 2021, the prevalence of depression (classified as a PHQ-8 of ≥ 10) was 32% in women and 20% in men aged 16–29 years in the UK. Rates of depression in our patient cohort were therefore similar to those in the general population in this age group. Interestingly, in the general population, 17% of those aged ≥ 16 years experienced depression during this time. This is significantly higher than the prepandemic prevalence rate of 10%. Initial GAD-7 scores in our cohort ranged from 0 to 21 points: 58.7% had a score of ≥ 5; 30.3% a score of ≥ 10; and 11.0% a score of ≥ 15. As a comparison, in September–October 2021, an estimated 28% of those 16–29 years old experienced moderate–severe anxiety in the UK (GAD-7 equivalent to ≥ 10), and the prevalence was higher in women. Anxiety levels were therefore similar in our cohort compared with the general population. The prevalence of anxiety and depression is high in young adults, which has increased with the COVID-19 pandemic, and the prevalence in our acne cohort is similar to that of the general population of a similar age. It remains that those with moderate–severe acne, regardless of what treatment is received, should be screened and monitored for anxiety and depression.

Collaborating for longleaf pine: A case study

Since the mid 1990′s collaborative landscape management, involving varied land users and interest groups, has increased substantially but the utilization of this practice on private land has been sparsely studied. Alongside this increase in collaborative landscape management, there has been an increase in attention on longleaf pine restoration. Once spanning over 93 million acres in the southeastern United States, these trees were reduced to an estimated 3% of their historic range. In response, in 2009, 22 government agencies and independent organizations formed America’s Longleaf Restoration Initiative. The initiative functions in part through local implementation teams, established throughout the range and focused on private as well as public land. To learn more about collaboration and private land, we studied one of the teams, the Sewee Longleaf Conservation Cooperative, in South Carolina.Drawing on the Advocacy Coalition Framework, a well-established model for analysing policy structures and change, we conducted a series of semi-structured interviews with partner organizations to analyze the group’s functions and the frames through which stakeholders view the coalition, their role, and the mission. We found that it has successfully made itself into the policy subsystem for the area and a venue that encompasses all relevant stakeholders. The stakeholders frame longleaf restoration as a positive, at least a secondary belief, and there is minimal conflict surrounding core beliefs. These stakeholders see the collaboration as positive, laud the group’s ability to facilitate access to resources, and utilize the relationship to establish connections, broaden outreach, and develop policy. But while this is a successful collaboration, its successes may be challenged by future events from outside the policy subsystem

Hip Spica Table: A Technical Note.

Hip spica is a widely used treatment modality in the management of various paediatric orthopaedic conditions. A standardized hip spica table is not universally available and various centerres have devised their own designs. In collaboration with the local engineering team, we have designed a light weight yet sturdy, economical and portable hip spica table. Components of the spica table and their measurements are described. Technique of mounting and unmounting the patient off the table has been discussed. We have applied the hip spica using the current design in 141 children between 2009 and 2023. The same table has been used for the children aged 6 months to 10 years. We have not experienced any table breakage during spica application. The acrylic sheet was changed only once during the study period due to attrition. Our design has been used successfully at our center for more than 14 years. It is simple, economical, portable and durable. It can be used in dedicated pediatric orthopedic centers and can be carried easily to the field hospitals. The online version contains supplementary material available at 10.1007/s43465-023-00935-1.

Building rural community disaster resilience in developing countries: insights from a Chinese NGO's Safe Rural Community Program.

As rural areas in developing countries are generally more vulnerable to disasters triggered by natural hazards than urban areas, it has become critical to strengthen rural community disaster resilience (CDR) to reduce the disaster risks. Using follow-up interviews, surveys, and secondary data, this study reviewed the "Safe Rural Community" (SRC) program implemented by One Foundation, a Chinese civilian NGO, after the 2013 Lushan earthquake in China. The study focused on five main key resilience elements; networks, infrastructure, institutions, capabilities, and culture. It was found that the SRC program successfully developed standardized, systematic, interrelated, and practical activities, such as local volunteer rescue teams, emergency supplies, disaster reduction training, community emergency plans, and regular emergency rescue drills. Third-party evaluations and a 2022 Lushan earthquake test revealed that this NGO-led, community-based, and team-oriented program had been effective. The SRC program in Lushan, therefore, provides some guidance on the development of effective CDR programs in rural communities in developing countries.

Advancing positive social determinants of health through collective impact and the 100% New Mexico Model

BackgroundCommunities across the U.S. and globally confront the challenge of transforming negative social determinants of health (SDOH) into positive ones. To address this complex social problem, the collective impact (CI) approach has promise but has been critiqued for insufficiently challenging structural inequities. Research applying CI to SDOH is limited. This mixed-methods study examined early adoption of CI in the 100% New Mexico initiative that aims to address SDOH population-wide in a state with strong cultural identity and assets but also persistent socio-economic inequality.MethodsA web-based survey, interviews and focus groups were conducted with initiative participants in June and July 2021. Survey participants rated agreement on a 4-point scale with six items assessing CI foundation adapted from the Collective Impact Community Assessment Scale. Interviews and focus groups centered on motivation to engage, progress achieved in model components, CI core conditions, and contextual factors influencing experiences. Surveys were analyzed using descriptive means and proportions. Qualitative data were analyzed using thematic analysis and an inductive approach followed by stratified analyses and co-interpretation of emergent findings with model developers.ResultsFifty-eight participants completed the survey, and 21 individuals participated in interviews (n = 12) and two focus groups (n = 9). Survey mean scores were highest related to initiative buy-in and commitment, and lower related to shared ownership, having multiple perspectives and voices involved, and adequate resources. Qualitative results showed that the framework’s cross-sector emphasis helped motivate participation. Participants embraced the focus on leveraging existing community assets that is characteristic of CI and the current framework. Counties implemented effective engagement and visibility strategies including mural projects and book clubs. Participants expressed communication challenges across county sector teams which influenced feelings of accountability and ownership. Participants did not report challenges lacking relevant, available, and timely data or tension between funder-driven and community-driven desired outcomes, in contrast with previous CI research.ConclusionMultiple foundational conditions of CI were supported in 100% New Mexico, including evidence for support of the common agenda addressing SDOH, shared measurement framework, and mutually reinforcing activities. Study results suggest that efforts to launch CI to address SDOH, which is by nature multi-sector, should include robust strategies to address communication needs of local teams. The use of community-administered surveys to identify gaps in SDOH resource access contributed to ownership and a sense of collective efficacy that may portend sustainability; however, relying on volunteers in the absence of other resources extensively also threatens sustainability.

Front Cover: Piano‐Stool Ruthenium N‐Heterocyclic Carbene Complexes for gem‐Specific Catalytic Dimerization of Terminal Alkynes (Eur. J. Inorg. Chem. 21/2023)

The Front Cover shows [RuClCp*(NHC)] complexes of varying wingtip groups playing a baseball game, the NHC Cup Final. The complex bearing the bulkiest NHC ligand is seen batting with a LiHMDS “base”-ball bat, illustrating the crucial role of the LiHMDS base in the catalytic reaction. The batter hits the incoming phenylacetylene pitch towards the outer field for a homerun, yielding the geminal-enyne product with 100 % selectivity, which is displayed on the score board. The complexes of less bulky NHC ligands are on the opposing team, as they are not able to selectively yield the geminal-enynes. The 25 °C temperature on the weather display board shows the mild reaction conditions, while the CN Tower outside the baseball field in the background is the landmark of Toronto, where this research was conducted. The blue-white “outfit” of the batter corresponds to the Toronto local team colors. More information can be found in the Research Article by D. Song and co-workers.

Steering the Titanic: One tertiary care children's hospital's experience navigating safe sleep for hospitalized infants

BackgroundSudden Unexpected Infant Death (SUID) is the leading cause of death in infants 1 month to 1 year of age in the United States. Despite extensive efforts in research and public education, rates of sleep-related infant death have plateaued since the late-1990s, largely due to unsafe sleep practices and environments. Local problemA multidisciplinary team assessed our institution's compliance with its own infant safe sleep policy. Data was collected on infant sleep practices, nurses' knowledge and training on the hospital policy, and teaching practices for parents and caregivers of hospitalized infants. Zero crib environments from our baseline observation met all the American Academy of Pediatrics recommendations for infant safe sleep. MethodsA comprehensive safe sleep program was implemented in a large pediatric hospital system. The purpose of this quality improvement project was to improve compliance with safe sleep practice from 0% to 80%, documentation of infant sleep position and environment every shift from 0% to 90%, and documentation of caregiver education from 12% to 90% within 24 months. InterventionsInterventions included revision of hospital policy, staff education, family education, environmental modifications, creation of a safe sleep taskforce, and electronic health record modifications. ResultsDocumented compliance with infant safe sleep interventions at the bedside improved from 0% to 88%, while documentation of family safe sleep education improved from 12% to 97% during the study period. ConclusionsA multifaceted, multidisciplinary approach can lead to significant improvements in infant safe sleep practices and education in a large tertiary care children's hospital system.

#6018 SODIUM-GLUCOSE CO-TRANSPORTER-2 INHIBITOR USE IN THE MANAGEMENT OF PATIENTS WITH CHRONIC KIDNEY DISEASE AND TYPE 2 DIABETES MELLITUS

Abstract Background and Aims Sodium-glucose co-transporter-2 (SGLT-2) inhibitors were initially developed for the management of type 2 diabetes mellitus (T2DM). Results from large placebo-controlled clinical outcome trials have now highlighted efficacy of SGLT-2 inhibitors in reducing the risk of CKD progression [1,2]. NICE CKD guidelines now recommend use of SGLT-2 inhibitors alongside standard of care in those patients with T2DM [3]. This has subsequently extended SGLT-2 inhibitor licensing highlighting the importance of wider multi-disciplinary team practise awareness. The aim of this audit was to assess the level of implementation of updated NICE guidelines in patients under a specialist CKD clinic in Birmingham. Method A database of renal diabetics under a specialist CKD clinic in May 2022 was generated via the trust electronic patient record system. Patients with a recorded diagnosis of T2DM and estimated glomerular filtration rate (eGFR) >25ml/min (current UK regulatory licensing for SGLT-2 inhibitor use) were included. Parameters of renal function (urine albumin: creatinine ratio (uACR) and eGFR) as well as medication histories were retrospectively collected for 158 patients and analysed using descriptive statistics. Results Results demonstrated 19% (n = 43) of 143 patients with an accessible drug history were prescribed an SGLT-2 inhibitor. Less than half (44%) of those prescribed standard of care (ACEI/ARB) with a uACR >30 mg/mmol (n = 34) were prescribed an SGLT-2 inhibitor as per NICE recommendations. The prescribing of SGLT-2 inhibitors in patients at different stages of CKD was noted except in those with eGFR <30 ml/min. Conclusion Results suggest a number of patients with T2DM are not prescribed an SGLT-2 inhibitor as per NICE recommendations for CKD management. Whilst considering sample size limitation as well as possible contraindications relevant to SGLT-2 inhibitor treatment, these findings may reflect the recent update to NICE guidelines and delayed dissemination of information between multi-disciplinary teams around extended SGLT-2 inhibitor licensing. Glycaemic control is less effective in later stages of CKD however, trials have demonstrated the independent role of SGLT-2 inhibitors in reducing the risk of CKD progression irrespective of their attenuated ability to lower glucose in reduced kidney function [1,2]. It is imperative patients not currently prescribed an SGLT-2 inhibitor are reviewed for treatment eligibility and any contraindications. Results of this study were fed back to the local renal and diabetes team with the recommendation for development of clear guidelines for use of SGLT-2 inhibitors in all eligible patients in order to achieve maximum healthcare benefits. In addition, there are ongoing discussions with primary care regarding review of their use of SGLT-2 inhibitors.

OTHR-01. SUCCESSFUL DEVELOPMENT OF A LOCAL-REGIONAL POST-MORTEM BRAIN TUMOR DONATION PROGRAM

Abstract Patient tumor tissue is vital to development of therapeutic interventions in the setting of refractory CNS tumors. Patients and families who participate in tumor donation (TD) report meaning making and improved bereavement outcomes. Provider discomfort is a significant barrier to autopsy participation. Families who are not approached for tumor donation report distress or a feeling of a missed opportunity. Our center developed a process to offer all patients who died from their disease the option to participate in TD as a standard of care. Discussions around TD are best done in the context of a multidisciplinary team well known to the patient and family lead by the treating oncologist. Opportunities to discuss TD present themselves at predictable time points in the disease trajectory: day one talk, treatment discussion, time of recurrence, clinical deterioration, advance care planning discussions, end of life, and immediately-post mortem. Our practice is in the setting of a free-standing children’s hospital. We are not a phase one site. In 2022 seven patients in our neuro-oncology program died from progressive disease. Seven of seven chose to participate in TD. We partnered with a regional phase one center and SWIFTY foundation to coordinate logistics and enrollment. All tumor procurements occurred off site at the funeral home selected by each family. To facilitate family comfort with TD a local team member was present at the time of harvest and kept family updated in process in real time via phone call at the following time points: time of harvest, completion of harvest, tissue arrival at research site. Future directions include offering structured post-mortem visits with families to review research findings with primary treating oncologist in conjunction with the research team and conducting prospective studies with bereaved families to better understand the impact of TD on bereavement.

Implementing interprofessional video consultations with general practitioners and psychiatrists in correctional facilities in Germany: results from a mixed-methods study

BackgroundAdequate health care in correctional facilities is often limited by staff shortage, which entails time-consuming consultations with physicians outside of these facilities. Video consultations (VC) have been implemented in many different health care settings and may also be useful in correctional facilities. As part of a pilot project, synchronous VC were implemented in five correctional facilities in Germany in June 2018. The aim of this study was to describe the implementation process from the providers’ perspective and to identify factors promoting or inhibiting the implementation process of VC with a focus on interprofessional collaboration between nursing staff and telemedicine physicians.MethodsAs part of the mixed-methods evaluation of the pilot project, site visits to the five correctional facilities were carried out. Nursing staff from the five correctional facilities (n=49) and telemedicine physicians (n=10) were asked to participate in interviews and a questionnaire survey. Interviews were analyzed using qualitative content analysis and questionnaires were evaluated using descriptive statistical methods. The results from both data sources were integrated and discussed in the framework of Normalization Process Theory.ResultsInterviews were conducted with 24.5% (n=12) of nursing staff and 20.0% (n=2) of telemedicine physicians, while questionnaires were returned by 22.5% (n=11) of nursing staff and 33.3% (n=3) of telemedicine physicians. VC with general practitioners and psychiatrists were perceived as an additional support during times when physicians were absent from the correctional facilities. Allocating telemedicine physicians to specific correctional facilities might further improve interprofessional collaboration with nursing staff during VC. Inhibiting factors comprised the lack of integrating nursing staff into the implementation process, increased workload, insufficient training and the implementation of VC at an inconvenient time.ConclusionsTo summarize, VC are a promising supplement to face-to-face health care in correctional facilities despite several limitations. These might be compensated by improving interprofessional cooperation and by integrating telemedicine physicians into local health care teams.

Guiding principles for effective collaborative implementation strategies for multisite hospital improvement initiatives: a mixed-method realist evaluation of collaborative strategies used in four multisite initiatives at public hospitals in New South Wales, Australia

ObjectiveLarge-scale, multisite hospital improvement initiatives can advance high-quality care for patients. Implementation support is key to adoption of change in this context. Strategies that foster collaboration within local teams, across...

Network-enabled rapid growth of a US-based remote asynchronous oncology subspecialist case review service.

e13507 Background: AccessHope (AH) is a company that provides remote subspecialist insight on cancer care for patients via an asynchronous model of review of medical records followed by a detailed assessment of current and potential future management options sent to the patient’s local oncologist. This summary characterizes the rapid and ongoing scaling and growth as demand for this service has expanded and as AccessHope has transitioned from a single site to a geographically diverse US-based network of National Cancer Institute-designated comprehensive cancer centers (NCI-CCCs) as foundational partners. Methods: Cases were identified based on a trigger list of high complexity cancers or by request for case review by participating patients with cancer. Using descriptive statistics, we assessed measures of eligible patient, completed case volumes, and number of unique expert reviewers over time; the distribution of cancer types; the extent of concordance between care outlined by the local care team and that recommended by the reviewing expert; and potential cost savings from recommended changes. Results: From 1/2019-9/2022, the number of sponsor organizations and eligible “covered lives” increased by 1462% and 393% respectively; case volume increased from 42 to 525 cases/quarter over this interval. The most common cancer diagnoses were gastrointestinal (30%), hematologic/lymphoid (18%), lung (14%), and breast (12%). While reviewers recommended an alternative treatment in 29% of cases and agreed overall with current management in 71%, only 4% agreed and had no proposed refinements associated with anticipated evidence-based improvements. Recommendations leading to cost savings if adopted were identified in 16.1% of cases, translating to projected cost savings of $13,008/patient. Conclusions: After initially demonstrating the feasibility of completing a rapid turnaround of cases of lung cancer either patient-initiated for review or prospectively triggered by diagnosis and stage, this program of asynchronous second opinions has grown from a single institution to a network of five NCI-CCCs around the US. Demand for this service has rapidly escalated, so that AH has been able to provide input and support to local oncologists for many-fold more physicians and patients over the past few years.

A novel program to address acute food insecurity among patients with cancer in Philadelphia.

e18739 Background: Acute food insecurity (FI) is a significant yet poorly understood social risk factor facing cancer patients, with a prevalence greater than that of the general U.S. population. FI poses a particular risk for cancer patients, as FI-induced malnutrition is associated with fatigue, stress, depression, and a weakened immunological response to infection. Legacy of Hope is a non-profit organization based in Philadelphia, PA providing emergency support to cancer patients in financial distress. Partnering with local grocery stores to supply the food and local police districts to deliver the groceries, Legacy of Hope receives patient referrals from social workers at cancer centers in Philadelphia to identify patients and families in need. Cancer patients can receive one or more bi-weekly grocery deliveries until their acute FI needs are addressed. Legacy of Hope documents and tracks metrics associated with the patients who are served by the program. Beginning in 2023 is direct participant evaluation of the program, assessing outcomes in acute anxiety, quality of life, and acute FI. Methods: Legacy of Hope receives ongoing referrals from oncology social workers about cancer patients in need. Legacy of Hope documents the cancer diagnosis, age, race/ethnicity, and gender of the cancer patient as well as the size of the household and the number of children living in the house. Additionally, a participant evaluation survey collects data via an online survey at two time points: first, at the time of their grocery delivery and second, two weeks after the delivery. The survey uses validated measures (FACT-G7) to assess changes in quality of life and anxiety, as well as acute FI, over the two-week time period. Standard statistics, including a paired t-test, will evaluate the changes in the outcome measures of interest. Results: Legacy of Hope has served more than 1600 cancer patients representing more than 2000 food deliveries. About half (52.2%) were female and 58% were African American. The mean age was 60 years old. Breast cancer was the most common diagnosis (18%), followed by lung (8%) and colorectal cancer (5%), although almost all cancers are represented in the database. One in five patients (21%) lived alone, but most (45%) had between 2 and 3 persons in their household. Children were present in the home 21% of the time. Data for the participant evaluation survey will be available in Spring 2023. Conclusions: Acute FI is prevalent and devastating for cancer patients, although few resources exist within cancer centers to adequately address it. Legacy of Hope fills this gap through a novel program that leverages sustainable and trusted partnerships with local food distributors, civic organizations, and oncology social work teams at cancer centers throughout the Greater Philadelphia region.

In-depth assessment of critical access hospital stewardship program adherence to the CDC Core elements in Iowa and Nebraska

Background: Critical-access hospitals (CAHs) are required to meet the CDC 7 Core Elements of antimicrobial stewardship programs (ASPs). CAHs have lower adherence to the core elements than larger acute-care hospitals, and literature defining which core-element deficiencies exist within CAHs as well as barriers to adherence is lacking. Methods: We evaluated 21 CAH ASPs (5 in Nebraska and 15 in Iowa) that self-identified as potentially deficient in the Core Elements, via self-assessment followed by in-depth interviews with local ASP team members to assess adherence to the CDC Core Elements for ASPs. Core-element compliance was rated as either full (1 point), partial (0.5), or deficient (0), with a maximum score of 7 per ASP. High-priority recommendations to ensure core-element compliance were provided to facilities as written feedback. Self-reported barriers to implementation were thematically categorized. Results: Among the 21 CAH ASPs, none fully met all 7 core elements (range, 2.5–6.5), with a median of 5 full core elements met (Fig. 1). Only 6 ASPs (28.6%) had at least partial adherence to each of the 7 core elements. Action (21 of 21, 100%) and leadership commitment (16 of 21, 76.2%) were the core elements with the highest adherence, and accountability (4 of 21, 19%) and education (9 of 21, 42.9%) were the lowest. The most frequent high-priority recommendations were to provide physician and pharmacist leader ASP training (19 of 21, 90.5%), to track antimicrobial stewardship interventions (12 of 21, 57.1%), and to provide or track educational activities (12 of 21, 57.1%) (Fig. 2). One-third of programs were recommended to establish a physician leader. The most commonly self-identified barriers to establishing and maintaining an ASP were a lack of dedicated resources such as time of personnel (15 of 20, 75%), lack of infectious diseases expertise and training (8 of 20, 40%), and electronic medical record limitations (5 of 20, 25%) (Fig. 3). Conclusions: CAH ASPs demonstrate several critical gaps in achieving adherence to the CDC Core Elements, primarily in training for physician and pharmacist leaders and providing stewardship-focused education. Further resources and training customized to the issues present in CAH ASPs should be developed.Disclosures: None

Implementing a health-system–wide antibiotic stewardship program in ambulatory surgery centers

Background: In 2016, the CDC released the Core Elements of Outpatient Antibiotic Stewardship, which extended the requirements previously released for hospital facilities and nursing homes to the outpatient setting. Several regulatory agencies focused on outpatient antimicrobial use. However, The Joint Commission and the Ambulatory Surgery Center (ASC) Leapfrog Group excluded ambulatory surgery centers from their medication management standards and questions. Due to the public health and patient safety benefits of implementing an antimicrobial stewardship program (ASP) and increasing regulatory interest in the matter, the Hospital Corporation of America (HCA) Ambulatory Surgery Division formally launched a nationwide ASP for its ambulatory surgery centers in March 2021. Methods: HCA is a large healthcare system with 146 ASCs in 16 states in 2021. The structure of the ASCs are local surgery centers with a medical director, a nurse responsible for infection prevention, and a pharmacist at a regional level. The types of surgeries vary based on location and ASC site. In 2019, a multidisciplinary team formed the corporate planning committee. The program was modeled after the CDC Core Elements and The Joint Commission’s requirements for an ASP. Each ASC was asked to build a local ASP team, led by a local physician and a regionally based pharmacist. In addition, a stewardship goal was established to update all preoperative antibiotic surgical-site infection prophylaxis order sets. The corporate committee provided educational resources, including evidence-based guidelines for appropriate antibiotic selection for surgical-site infections. They collected antibiotic cost per case as a baseline metric to track and analyze. Pediatric, ophthalmic, and gastrointestinal endoscopic procedures were excluded from the program. Results: From January 1, 2020, through December 31, 2021, including only centers that were operational during this period and excluding single specialty endoscopy centers, antibiotic cost per case decreased annually from $2.38 to $1.84 (t = 4.157; P < .005), and the postoperative infection rate also declined from 0.370 to 0.304 (t = 2.079; P = .040). Conclusions: Our findings suggest that implementing a health-system–wide outpatient antibiotic stewardship program in the ambulatory surgery center setting is feasible and may contribute to decreased antibiotic cost per case and improved postoperative surgical site infection rates.Disclosures: None

Neurosurgical morbidity in pediatric supratentorial midline low-grade glioma: Results from the German LGG studies.

10044 Background: Surgical resection is a mainstay of treatment for pediatric low-grade glioma (LGG) within all current therapy algorithms, yet associated morbidity is scarcely reported. As supratentorial midline (SML) interventions are particularly challenging, we investigated the frequency of neurosurgical complications/new impairments aiming to identify their risk factors. Methods: Records were retrospectively analyzed from 318 patients with SML-LGG from successive German multicenter LGG studies, undergoing surgery between May 1998 and June 2020. Results: 537 operations (230 resections, 167 biopsies, 140 non-tumor procedures) were performed in 318 patients (54% male, median age: 7.6 years at diagnosis, 9.5 years at operation, 11% NF1, 42.5% optic pathway glioma). Surgical mortality rate was 0.93%. Applying the Drake classification, postoperative surgical morbidity was observed in 254/537 (47.3%) and medical morbidity in 97/537 (18.1%) patients with a 40.1% 30-day persistence rate for newly developed neurological deficits (65/162). Neuroendocrine impairment affected 53/318 patients (16.7%), visual deterioration 34/318 (10.7%). Postsurgical morbidity was associated with patient age <3 years at operation, tumor volume ≥80cm3, presence of hydrocephalus, complete resection, surgery in centers with less than median reported tumor-related procedures and during the earlier study period between 1998-2006, while the neurosurgical approach, tumor location, NF1 status or previous non-surgical treatment were not. Conclusions: Neurosurgery-associated morbidity was frequent in pediatric patients with SML-LGG undergoing surgery in the German LGG-studies. We identified patient- and institution-associated factors that may increase the risk for complications. We advocate that local multidisciplinary teams consider the planned extent of resection and surgical skills. [Table: see text]

AN ANALYSIS OF A PREOPERATIVE PHYSIOTHERAPY AND OCCUPATIONAL THERAPY LIMB RECONSTRUCTION SERVICE FOR CHILDREN WITH PERTHES’ DISEASE IN THE REPUBLIC OF IRELAND

IntroductionLegg-Calve-Perthes (Perthes Disease) was first recognised by three physicians, Arthur Legg (1874–1939), Jacqui Calve (1875–1954) and George Perthes (1869 – 1927) in 1910. Perthes disease is a rare childhood condition that affects the hip. It occurs when the blood supply to the femoral head is disrupted. Without this blood supply, the bone cells die and avascular necrosis can occur. The Herring classification is used to diagnose the stages of Perthes Disease. It is an important prognostic factor. There are three classifications, Herring A, B and C. Herring A has no involvement of the lateral pillar with no density changes noted on x-ray. Herring B has at least 50% of the lateral pillar height maintained on x-ray. Herring C has less than 50% of the lateral pillar height on x-ray (Herring et al, 1992). Children with Perthes disease require specialist Limb Reconstruction team throughout their treatment journey, this includes Orthopaedic surgery and therapy (Physiotherapy and Occupational Therapy). The National Limb Reconstruction Therapy Team is based at the National Orthopaedic Hospital, Cappagh. The therapy team consists of 1 Clinical Specialist Physiotherapist, 1 Senior Physiotherapist and 1 Senior Occupational Therapist who provide input to this cohort. This study aims to analyse the importance of a comprehensive pre-operative assessment by the therapy team (Physiotherapist and Occupational Therapist) to maximise patient outcomes post operatively.MethodologyThis is a quantitative research study conducted by the National Limb Reconstructive Therapy Service of the National Orthopaedic Hospital in Cappagh, Dublin. The inclusion criteria for this study consisted of:Age – Patient must be part of the Paediatric Service, i.e., under the age of 16.Diagnosis – Patient must have a diagnosis of Perthes Disease with a Herring Classification documented.Application of a Hip Distractor Frame formed part of the patient's surgical management.Surgery was completed by Mr Connor Green.Surgery was completed between January 2021 and December 2022.Patient were required to have their external hip distractor frame removed by December 2022.Exclusion Criteria: Those not meeting the above inclusion criteria. Following the inclusion criteria, a number of cases were identified of which 10 cases were selected at random. A retrospective analysis of these samples was completed. The medical charts were reviewed as well as patient electronic healthcare records. Microsoft Excel was utilised to analyse the data and capture results.ResultsFrom analysing the data, the following results were identified:80% of the sample cohort had a length of stay of 5 days following surgery. There were two outliers due to infection who had a length of stay of 14 days.90% of the sample received a pre-operative Physiotherapy and Occupational Therapy assessment. This assessment included information gathering regarding the child's home and social environment; their functional baseline and anticipated post-operative needs. Standardised and non-standardised assessments were used.88.89% of those who completed a pre-operative assessment required referral to community Occupational Therapy teams for equipment provision (wheelchair, transfer aids) to allow for timely discharge.On average, each patient in the sample required 17 physiotherapy outpatient sessions prior to handover to the community teams.100% of our sample required post operation onward referral for MDT input in the community (Occupational Therapy and Physiotherapy).ConclusionsThe importance of a multi-disciplinary approach towards family and children was highlighted in this study. A comprehensive pre-operative therapy assessment optimizes care for this cohort by preparing them in terms of equipment provisions, local team input and expectations for therapy. The data suggests future Limb Reconstruction team should include Physiotherapy and Occupational Therapy as part of the multi-disciplinary team, in the treatment of children with Perthe's Disease. We suggest an MDT pre-assessment is completed to optimize patient care, reduce length of stay and improve patient satisfaction in the acute hospital setting.

0884 User Needs and Preferences for a Smartphone App to Treat Insomnia in Cancer Survivors

Abstract Introduction Cancer patients with insomnia have unique needs and require tailored healthcare interventions. iCANSleep is a mobile health intervention aimed at providing evidence-based insomnia treatment via a smartphone app. As part of a user-centered development process, virtual needs assessment interviews were conducted with cancer survivors who report insomnia to determine the needs and preferences of this patient group for insomnia treatment. Methods 22 cancer survivors from 5 Canadian provinces completed an online survey and participated in a needs assessment interview. Surveys were analyzed using descriptive statistics, while interviews were transcribed and analyzed using thematic analysis. Results 81.8% (18/22) of cancer survivors report that their insomnia started or was exacerbated during the time of their cancer diagnosis and treatment. Of the participants who discussed insomnia with a medical provider, hypnotic medications were prescribed in 64.3% (9/14) of cases. With some exceptions, participants reported strong familiarity with smartphone technology, had experience using apps for health management, and found an insomnia treatment app highly acceptable. Participant-identified facilitators of app use included ease of access, lack of cost, anonymity, empirical basis, and recommendation by local care teams. Smartphone ownership, cumbersome user interface, and limited access to internet were raised as potential challenges of implementation. Additional functionality identified by participants included options to link consumer wearable devices, additional modules to address comorbid conditions such as pain and anxiety, and an anonymous peer support forum. Conclusion Mobile apps hold promise as an avenue for the effective delivery of insomnia treatment; however, treatments must be evidence-based, and apps must be designed for maximum ease of use. Findings provide novel insight into how to best promote uptake and sustained use of mobile health interventions in cancer survivors and will be used to develop functional guidelines. Support (if any) Samlau Kutana is a trainee in the Cancer Research Training Program of the Beatrice Hunter Cancer Research Institute, with funds provided by the Canadian Cancer Society’s JD Irving, Limited – Excellence in Cancer Research Fund. Dr. Sheila Garland is supported by a Canadian Cancer Society Emerging Scholar Award (Survivorship) (grant #707146).

Buprenorphine/naloxone initiation and referral as a quality improvement intervention for patients who live with opioid use disorder: quantitative evaluation of provincial spread to 107 rural and urban Alberta emergency departments

ObjectivesOpioid use disorder is a major public health concern that accounts for a high number of potential years of life lost. Buprenorphine/naloxone is a recommended treatment for opioid use disorder that can be started in the emergency department (ED). We developed an ED-based program to initiate buprenorphine/naloxone for eligible patients who live with opioid use disorder, and to provide unscheduled, next-day follow-up referrals to an opioid use disorder treatment clinic (in person or virtual) for continuing patient care throughout Alberta.MethodsIn this quality improvement initiative, we supported local ED teams to offer buprenorphine/naloxone to eligible patients presenting to the ED with suspected opioid use disorder and refer these patients for follow-up care. Process, outcome, and balancing measures were evaluated over the first 2 years of the initiative (May 15, 2018–May 15, 2020).ResultsThe program was implemented at 107 sites across Alberta during our evaluation period. Buprenorphine/naloxone initiations in the ED increased post-intervention at most sites with baseline data available (11 of 13), and most patients (67%) continued to fill an opioid agonist prescription at 180 days post-ED visit. Of the 572 referrals recorded at clinics, 271 (47%) attended their first follow-up visit. Safety events were reported in ten initiations and were all categorized as no harm to minimal harm.ConclusionsA standardized provincial approach to initiating buprenorphine/naloxone in the ED for patients living with opioid use disorder was spread to 107 sites with dedicated program support staff and adjustment to local contexts. Similar quality improvement approaches may benefit other jurisdictions.