Multiple Healthcare Professionals Research Articles

Daily Integrated Care Conferences to Reduce Length of Hospital Stay for Patients With Chronic Obstructive Pulmonary Disease.

Inefficiencies in care coordination-specifically, the lack of an effective method of communication among multiple health care professionals-often leads to an unnecessary increase in length of hospital stay. To determine whether daily integrated care conferences (ICCs) would significantly reduce the length of stay for patients with chronic obstructive pulmonary disease (COPD) exacerbation. Patients with COPD exacerbation were selected for the study using electronic medical records from 2 osteopathic community hospitals located in northeastern Ohio. One hospital used daily ICCs and the other hospital did not use daily ICCs. The average length of stay for patients at each hospital was retrospectively investigated. A total of 1683 patients with COPD exacerbation were selected. The mean (SD) length of stay in the hospital with daily ICCs was 3.37 (2.89) days compared with 5.55 (3.99) days in the hospital without daily ICCs (P<.0001). At the hospital with daily ICCs, patients aged 40 to 69 years had a 67% shorter hospital stay and patients aged 70 to 99 years or older had a 36% shorter length of stay compared with patients at the hospital without daily ICCs. Daily integrated care conferences significantly reduced the length of stay for patients with COPD exacerbation at an osteopathic community-based hospital. Implementing daily ICCs may make current health care services and coordinated care more efficient, resulting in decreased costs and length of stay for patients with COPD exacerbation.

Patient Perspective on Hereditary Transthyretin-Mediated (hATTR) Amyloidosis: A Qualitative Review

Background Hereditary transthyretin-mediated (hATTR) amyloidosis is a rare, inherited, rapidly progressive, life-threatening disease. It is caused by a mutation in the transthyretin (TTR) gene that results in misfolded TTR proteins that accumulate as amyloid fibrils in multiple tissues, including the nerves, heart, and gastrointestinal (GI) tract. Due to the multisystem nature of the disease, patients with hATTR amyloidosis often see multiple physicians, nurses, and other health care professionals (HCPs) in a variety of specialties from the onset of symptoms to eventual diagnosis and long-term care. hATTR amyloidosis has an aggressive course with rapid disease progression leading to deteriorating quality of life (QOL) and loss of function. The resulting burden of these symptoms can affect patients' ability to perform activities of daily living (ADLs), increase dependence on caregivers, and increase healthcare utilization. Objectives Clinical aspects of the symptoms that patients experience have been described, but there has been minimal portrayal of the disease from the patient perspective. This abstract provides a summary of the most meaningful symptoms of hATTR amyloidosis and the resulting disease burden from the patient perspective. Methods A targeted literature search of peer-reviewed publications was conducted to identify patient descriptions of hATTR amyloidosis. Due to the limited availability of such publications, the search was broadened to include other sources such as reports developed by patient advocacy organizations. Key data and patient descriptions were tabulated and organized by construct. Results Fourteen sources met the eligibility criteria of the literature search and were included in this analysis. Patients described the significant, life-altering consequences of hATTR amyloidosis and how related symptoms resulted in a substantial impact on physical and mental health. Frequent symptoms included neuropathy (e.g., nerve pain, numbness in hands and feet, falling), GI-related symptoms (e.g., diarrhea, nausea, vomiting), cardiac-related symptoms (e.g., heart palpitations, weak heart, cardiomyopathy), and autonomic dysfunction (e.g., difficulty standing, incontinence, orthostatic hypotension). These symptoms impacted QOL and overall functioning, affecting mobility, ADLs, and independence. hATTR amyloidosis also required frequent medical care, putting substantial strain on finances, ability to work, relationships, and emotional health. Conclusions hATTR amyloidosis is a progressive, life-threatening disease that causes damage to multiple organs. These data highlight the debilitating nature of hATTR amyloidosis, as described by the patients. Patients experienced a myriad of symptoms that worsened over time, resulting in difficulties with everyday activities, loss of freedom, increased reliance on others for care, and increased amount of time spent in hospitals. Patients also reported the disease can place substantial strain on relationships, as well as creating a significant psychosocial and financial burden. Therefore, it is crucial for physicians, nurses, and other HCPs to understand the clinical manifestations of hATTR amyloidosis and work collaboratively to diagnose and treat this disease.

A behavioural approach to specifying interventions: what insights can be gained for the reporting and implementation of interventions to reduce antibiotic use in hospitals?

BackgroundReducing unnecessary antibiotic exposure is a key strategy in reducing the development and selection of antibiotic-resistant bacteria. Hospital antimicrobial stewardship (AMS) interventions are inherently complex, often requiring multiple healthcare professionals to change multiple behaviours at multiple timepoints along the care pathway. Inaction can arise when roles and responsibilities are unclear. A behavioural perspective can offer insights to maximize the chances of successful implementation.ObjectivesTo apply a behavioural framework [the Target Action Context Timing Actors (TACTA) framework] to existing evidence about hospital AMS interventions to specify which key behavioural aspects of interventions are detailed.MethodsRandomized controlled trials (RCTs) and interrupted time series (ITS) studies with a focus on reducing unnecessary exposure to antibiotics were identified from the most recent Cochrane review of interventions to improve hospital AMS. The TACTA framework was applied to published intervention reports to assess the extent to which key details were reported about what behaviour should be performed, who is responsible for doing it and when, where, how often and with whom it should be performed.ResultsThe included studies (n = 45; 31 RCTs and 14 ITS studies with 49 outcome measures) reported what should be done, where and to whom. However, key details were missing about who should act (45%) and when (22%). Specification of who should act was missing in 79% of 15 interventions to reduce duration of treatment in continuing-care wards.ConclusionsThe lack of precise specification within AMS interventions limits the generalizability and reproducibility of evidence, hampering efforts to implement AMS interventions in practice.

Patient and physician perceptions of lung cancer care in a multidisciplinary clinic model.

Lung cancer (lc) is a complex disease requiring coordination of multiple health care professionals. A recently implemented lc multidisciplinary clinic (mdc) at Kingston Health Sciences Centre, an academic tertiary care hospital, improved timeliness of oncology assessment and treatment. This study describes patient, caregiver, and physician experiences in the mdc. We qualitatively studied patient, caregiver, and physician experiences in a traditional siloed care model and in the mdc model. We used purposive sampling to conduct semi-structured interviews with patients and caregivers who received care in one of the models and with physicians who worked in both models. Thematic design by open coding in the ATLAS.ti software application (ATLAS.ti Scientific Software Development, Berlin, Germany) was used to analyze the data. Participation by 6 of 72 identified patients from the traditional model and 6 of 40 identified patients from the mdc model was obtained. Of 9 physicians who provided care in both models, 8 were interviewed (2 respirologists, 2 medical oncologists, 4 radiation oncologists). Four themes emerged: communication and collaboration, efficiency, quality of care, and effect on patient outcomes. Patients in both models had positive impressions of their care. Patients in the mdc frequently reported convenience and a positive effect of family presence at appointments. Physicians reported that the mdc improved communication and collegiality, clinic efficiency, patient outcomes and satisfaction, and consistency of information provided to patients. Physicians identified lack of clinic space as an area for mdc improvement. This qualitative study found that a lc mdc facilitated patient communication and physician collaboration, improved quality of care, and had a perceived positive effect on patient outcomes.

Inter-rater reliability in performance status assessment among healthcare professionals: an updated systematic review and meta-analysis.

Survival prediction for patients with incurable malignancies is invaluable information during end-of-life discussions, as it helps the healthcare team to appropriately recommend treatment options and consider hospice enrolment. Assessment of performance status may differ between different healthcare professionals (HCPs), which could have implications in predicting prognosis. The aim of this systematic review and meta-analysis is to update a prior systematic review with recent articles, as well as conduct a meta-analysis to quantitatively compare performance status scores. A literature search was carried out in Ovid MEDLINE, Embase, and Cochrane Central Register of Controlled Trials, from the earliest date until the first week of August 2019. Studies were included if they reported on (1) Karnofsky Performance Status (KPS), Eastern Cooperative Oncology Group (ECOG) Performance Status, and/or Palliative Performance Scale (PPS) and (2) assessment of performance status by multiple HCPs for the same patient sets. The concordance statistics (Kappa, Krippendorff's alpha, Kendall correlation, Spearman rank correlation, Pearson correlation) were extracted into a summary table for narrative review, and Pearson correlation coefficients were calculated for each study and meta-analyzed with a random effects analysis model. Analyses were conducted using Comprehensive Meta-Analysis (Version 3) by Biostat. Fourteen articles were included, with a cumulative sample size of 2808 patients. The Pearson correlation coefficient was 0.787 (95% CI: 0.661, 0.870) for KPS, 0.749 (95% CI: 0.716, 0.779) for PPS, and 0.705 (95% CI: 0.536, 0.819) for ECOG. Four studies compared different tools head-to-head; KPS was favored in three studies. The quality of evidence was moderate, as determined by the GRADE tool. The meta-analysis's Pearson correlation coefficient ranged from 0.705 to 0.787; there is notable correlation of performance status scores, with no one tool statistically superior to others. KPS is, however, descriptively better and favored in head-to-head trials. Future studies could now examine the accuracy of KPS assessment in prognostication and focus on model-building around KPS.

Personalized action plans for patients with multiple chronic diseases in Andalusia

Abstract Issue/problem Complex chronic patients (CCPs) present multiple chronic conditions and complex healthcare needs. Comprehensive care by multiple healthcare professionals at different settings is required to improve their outcomes. This challenge is faced by the Andalusian Public Health System (APHS), responsible for the provision of healthcare and public health services to the entire Andalusian population (8.5 million inhabitants). Description of the problem Almost 250000 CCPs have been identified within the APHS in 2018. The very complex ones (4%) utilise up to 30% of primary care and hospital resources. The Comprehensive Healthcare Plan for Patients with Chronic Diseases was launched in 2012 to ensure the comprehensive care for these patients with a multidisciplinary response. Together with the Integrated Care Process Healthcare for Multimorbidity Patients, set the scene for implementing integrated healthcare with coordination of professional services and/or centres over time, helping to decrease clinical variability and improve quality of care. Results Since 2016, Personalized Action Plans (PAPs) were introduced as key-elements to provide a holistic care coordinated at primary healthcare, including: taking patient’s individual needs, preferences and own resources as a starting point for their evaluation and the development their PAPs,involving of patient’s informal caregivers,involving all relevant care levels and health disciplines,ensuring the multidisciplinary care with a coordinating team. Lessons PAPs are a key element in the healthcare process for CCPs, and the assessment of its implementation in Andalusia is contributing to generate evidence within the Joint Action on Chronic Diseases (CHRODIS+, www.chrodis.eu). Key messages PAPs implementation and assessment are crucial to better address CCPs health needs, facilitating a patient-centred healthcare approach, and contributing to a European model of care. Involving patient, family carers together with the professional team facilitates achieving better healthcare outcomes.

Snap shot: Achieving better care through a one-page personal health profile.

Children with intellectual disabilities (IDs) can have complex health conditions that require intense and ongoing care management by multiple healthcare professionals (HCPs). Families often experience frustrations and challenges sharing necessary information about their children's unique emotional and communicative needs with HCPs. In turn, these needs are often poorly documented and shared with other HCPs. This contributes to compromised care and frustrations for families and HCPs. We conducted a qualitative study using focus groups to examine how 10 parents and 3 HCPs experienced provision of care for children with ID, as well as their suggestions for developing a one-page personal health profile (PHP) to improve communication. Parents suggested including behavioural descriptors rather than diagnoses. All participants believed a one-page PHP that was child and parent led would be very helpful and would improve communication between HCPs, parents and children leading to effective and supportive care.

An approach to multidisciplinary team development in cardiothoracic theatres utilising video reflexive ethnography

Introduction Safety in healthcare is predicated on excellent teamwork, this is particularly the case in cardiothoracic theatres where the complex interplay of multiple healthcare professionals is required to deliver successful patient outcomes. Improvements in healthcare habitually focus on the scientific basis of our interventions, evidence-based medicine and randomised control trials (RCTs), however these fail to consider the impact of a high functioning team on delivery of intended outcomes.1 Team development in healthcare is often neglected, despite its connection to patient safety.2 At best, organisations offer sporadic simulation training, however this falls short of the depth of training offered in other industries. Methods We present here a novel approach to the development of clinical expertise. Video reflexive ethnography (VRE) is a powerful tool utilising video to present a fresh perspective of in situ practice to participants.3 The potential for VRE lies in the rich descriptive power of video, and its ability to challenge participants to view their practice with fresh eyes. This results in exposure of tacit behaviour, development of shared understanding across a team and challenge to damaging hierarchy and inequalities.4 We recorded a multidisciplinary team engaged in cardiac surgery requiring cardio-pulmonary bypass. Short clips were selected and edited with a focus on interdisciplinary communication The edited clips were used in a facilitated reflexivity session where the whole multidisciplinary team engaged in reflexive discussion. Results The reflexivity session explored: i) Communication: Differences between surgeon/anaesthetist communication, versus surgeon/perfusionist. There are shared visual guides for the anaesthetic/surgical relationship, but our perfusionists cannot visualise the surgical field and surgeons have no visual cue for blood volume available to return to the circuit, both instead rely on verbal communication. This risks break down under unusual circumstances e.g. unanticipated complications or unfamiliar teams. ii) Hierarchy: Examples surfaced during the reflexivity session, such issues have frequently been shown to have negative consequences.2 The VRE process offered a safe space to explore, challenge and flatten these hierarchies. Discussion Having demonstrated the power of the technique within our department our ongoing work will focus on the integration of this process into the normal working of the team.

The perspective of patients with early rheumatoid arthritis on the journey from symptom onset until referral to a rheumatologist.

ObjectiveTimely treatment of patients with early RA (ERA) favours a beneficial disease outcome. However, individuals often delay their contact with a health-care professional (HCP) after ERA-related symptom onset. The aim of this study was to investigate the perspective of patients on the journey of a patient from RA symptom onset until referral to a specialist.MethodsA subgroup of patients with ERA from the Care in ERA (CareRA) trial were interviewed retrospectively to discuss their initial ERA-related experiences preceding diagnosis, using a bespoke assessment form. The first section of the form focused on initial symptoms and help-seeking behaviour by the patients. The second part probed the actions of the HCPs consulted. Additional notes derived from the patient stories were analysed thematically.ResultsAmong 94 patients, pain (97%), swelling (73%) and stiffness (52%), typically in multiple joints, were reported as initial ERA symptoms. The general practitioner (GP) was generally the first HCP to be contacted (87%). Frequently reported reasons to visit an HCP were intense pain (90.4%) and difficulties in performing daily activities (69%). In 44.1% of patients, the HCP suspected ERA at the first visit. Approximately 25% of patients needed more than five visits before detection of ERA. GPs mainly referred patients to rheumatologists (71%). Thematic analysis uncovered that multiple HCPs were often involved in the journey to RA detection and referral.ConclusionPain is the most commonly reported initial symptom of ERA and the main reason to visit an HCP, usually a GP. These GPs play a pivotal role in early detection and correct referral. Furthermore, the journey of a patient seems complex, often with multiple HCPs being involved.

Implementation of wide-scale pharmacogenetic testing in primary care.

The convergence of translational genomics and biomedical informatics has changed healthcare delivery. Institutional consortia have begun implementing lab testing and decision support for drug-gene interactions. Aggregate datasets are now revealing the impact of clinical decision support for drug-gene interactions. Given the pleiotropic nature of pharmacogenes, interdisciplinary teams and robust clinical decision support tools must exist within an informatics framework built to be flexible and capable of cross-talk between clinical specialties. Navigation of the challenges presented with the implementation of five steps to build a genetics program infrastructure requires the expertise of multiple healthcare professionals. Ultimately, this manuscript describes our efforts to place pharmacogenomics in the hands of the primary care provider integrating this information into a patient's healthcare over their lifetime.

Will Adding Fibrotic Score to the GAP Score Help Predict Patient Survival?

Will Adding Fibrotic Score to the GAP Score Help Predict Patient Survival?

Pharmacy-supported interventions at transitions of care: an umbrella review.

Background Medication discrepancies arising at care transitions are prevalent and are linked with adverse drug events and increased healthcare utilization. Evidence is lacking about which pharmacy-supported interventions at care transitions are most effective for both the patient and the healthcare system. Aim of the review To invesitigatethe content and effect of pharmacy-supported interventions at transitions of care. Method The PubMed, Ovid/Medline and Cochrane Database of Systematic Reviews databases were used. The search was limited to systematic reviews and meta-analyses published in English up to May 2018. Included reviews investigated any intervention related to medication therapy performed by pharmacists or multiple healthcare professionals, including a pharmacist, at transition points in any healthcare setting. Reviews were excluded if interventions were not clearly defined or were not performed at care transitions or were not related to medications. A quality assessment was performed using the PRISMA guidelines. The data extracted included general characteristics, methodology, point of transition, pharmacy-supported interventions and outcomes. For systematic reviews, narrative conclusions were extracted. For meta analyses, reported relative risks or odds ratios were extracted along with the 95% confidence intervals. Results Nine systematic reviews and 5 meta-analyses reporting 162 studies were included. The interventions analysed included medication reconciliation (7 reviews) and composite interventions (7 reviews). Six studies reviewed interventions performed by pharmacists alone, while 8 studies explored interventions by different healthcare professionals, including a pharmacist. A positive effect on either medication discrepancies or (potential) ADEs was observed in all reviews. Mixed effects were observed for hospitalizations rates (9 reviews) and costs (4 reviews), regardless of the intervention applied. Mixed effects were also observed for both medication reconciliation and composite interventions on the number of emergency department visit. Interventions showed no significant effect on mortality (4 reviews). The quality of the reviews showed significant variability. Conclusion Pharmacy-supported interventions at transitions of care are heterogeneous and potentially improve medication safety, but show no significant effect on mortality. The effect on healthcare utilization and costs is inconclusive.

Digitizing a Face-to-Face Group Fatigue Management Program: Exploring the Views of People With Multiple Sclerosis and Health Care Professionals Via Consultation Groups and Interviews.

BackgroundFatigue is one of the most common and debilitating symptoms of multiple sclerosis (MS) and is the main reason why people with MS stop working early. The MS Society in the United Kingdom funded a randomized controlled trial of FACETS—a face-to-face group-based fatigue management program for people with multiple sclerosis (pwMS)—developed by members of the research team. Given the favorable trial results and to help with implementation, the MS Society supported the design and printing of the FACETS manual and materials and the national delivery of FACETS training courses (designed by the research team) for health care professionals (HCPs). By 2015 more than 1500 pwMS had received the FACETS program, but it is not available in all areas and a face-to-face format may not be suitable for, or appeal to, everyone. For these reasons, the MS Society funded a consultation to explore an alternative Web-based model of service delivery.ObjectiveThe aim of this study was to gather views about a Web-based model of service delivery from HCPs who had delivered FACETS and from pwMS who had attended FACETS.MethodsTelephone consultations were undertaken with FACETS-trained HCPs who had experience of delivering FACETS (n=8). Three face-to-face consultation groups were held with pwMS who had attended the FACETS program: London (n=4), Liverpool (n=4), and Bristol (n=7). The interviews and consultation groups were digitally recorded and transcribed. A thematic analysis was undertaken to identify key themes. Toward the end of the study, a roundtable meeting was held to discuss outcomes from the consultation with representatives from the MS Society, HCPs, and pwMS.ResultsKey challenges and opportunities of designing and delivering an integrated Web-based version of FACETS and maintaining user engagement were identified across 7 themes (delivery, online delivery, design, group, engagement, interactivity, and HCP relationships). Particularly of interest were themes related to replicating the group dynamics and the lack of high-quality solutions that would support the FACETS’ weekly homework tasks and symptom monitoring and management.ConclusionsA minimum viable Web-based version of FACETS was suggested as the best starting point for a phased implementation, enabling a solution that could then be added to over time. It was also proposed that a separate study should look to create a free stand-alone digital toolkit focusing on the homework elements of FACETS. This study has commenced with a first version of the toolkit in development involving pwMS throughout the design and build stages to ensure a user-centered solution.

Development of a national minimum data set to monitor deceased organ donation performance in Canada

PurposeDeceased donation data requires standardization to enable accurate interprovincial and international comparisons of deceased donation performance. In Canada, most provincial organ donation organizations (ODOs) have developed different processes and infrastructures for referring potential donors and subsequent data collection. This has led to differing definitions of the performance measures used for each step in the donation process, from potential donor identification to consent to transplantation. The Deceased Donation Data Working Group (DDDWG), comprised of representatives from ODOs across Canada, was therefore convened by Canadian Blood Services to develop a national, comprehensive, standardized deceased donation minimum data set.MethodsThe DDDWG’s scope encompassed considering all potential deceased organ donation data elements, including operational and performance data collected along the deceased donor pathway from donation potential to donation and disposition of organs. An environmental scan was conducted of other existing deceased donation registries from the Canadian and the international community. The DDDWG then engaged in regular face-to-face meetings and teleconferences to develop recommendations for the minimum data set that would satisfy key considerations, including the impact on existing ODO data collection processes, financial impact on stakeholders, the clinical and operational needs of multiple healthcare professionals involved in the deceased donation pathway, and availability of other existing national data sets that could be leveraged to reduce data collection burden.ResultsThe key deceased donation data elements identified by the DDDWG are contained in an inverted pyramid framework that was derived from similar work conducted in other countries.ConclusionThe DDDWG developed recommendations for proposed definitions and data sources that should be adopted nationally to guide the collection of deceased donation data. The ultimate purpose of the final minimum data set is to harmonize and standardize donation data definitions in Canada and align with international standards; inform the development of operational and clinical practice standards at the provincial and national levels; develop a framework for deceased donation performance measures; and advance the science of deceased donation.

L’Hôpital en santé mentale Albert-Prévost : cent ans d’histoire

Si le PAP m’était conté… 2019 a vu s’inscrire dans les annales de l’histoire du Québec les cent ans de l’Hôpital en santé mentale Albert-Prévost, pionnier des soins psychiatriques. Un siècle et une Institution marqués par plusieurs périodes de révolution (tranquille ou non), dont l’expression la plus concrète peut être vue dans les nombreux changements de nom de l’établissement, de sanatorium à hôpital en santé mentale, reflétant un contexte social, politique et surtout administratif fluctuant. Bien que le mandat principal d’Albert-Prévost, celui de soigner les plus vulnérables, demeure encore relativement immuable, il a dû s’adapter à la stable instabilité dans lequel ont évolué et se sont construits le Québec et son système de santé au cours des cent dernières années. Différents acteurs et penseurs s’y sont succédé, d’opinions et d’orientations variées (et parfois conflictuelles), mais unis dans leur désir de protéger l’identité d’Albert-Prévost et d’assurer sa pérennité. Ainsi, malgré les contraintes et pressions extérieures, l’Institution a tenu et continue à tenir moult rôles dans le système de santé québécois : outre le traitement et la réadaptation de patients, il a également contribué à la formation de nombreux psychiatres et professionnels de la santé qui rayonnent maintenant dans tout le Québec. Ce récit se veut une façon de revenir aux origines de cette Institution, ses balbutiements, échecs et réussites, dont la collection forme l’histoire d’un pionnier de la psychiatrie moderne du Québec. De 1919 à aujourd’hui, l’évolution se poursuit.

Healthcare Professionals and In-Flight Medical Emergencies: Resources, Responsibilities, Goals, and Legalities as a Good Samaritan.

Common in-flight emergencies include syncope, respiratory symptoms, nausea/vomiting, cardiac symptoms, and seizures. Flight conditions, such as changes in air pressure and humidity, can exacerbate existing chronic medical conditions. In 2017, US airlines carried 849.3 million passengers. Undoubtedly, there were many requests for in-flight medical assistance. Whenever a medical event occurs, it is standard procedure that an announcement be made by a flight attendant, requesting medical personnel to identify themselves. The 1998 Aviation Medical Assistance Act provides liability protection for a healthcare professional (HCP) acting as a good Samaritan. Nevertheless, HCPs may initially experience trepidation providing care in an aircraft. They may be unaware that a first aid kit, a emergency medical kit, and an automatic external defibrillator are on every plane. Flight crews have been trained in cardiopulmonary resuscitation, and a support system, including a ground-based consultation service, is available to provide radio assistance from an on-call physician. When multiple HCPs volunteer, the most experienced should assume leadership of care. After evaluating the ill passenger, the HCP communicates the assessment to the crew and, when necessary, to the ground-based physician. The goal of in-flight care is to medically stabilize the ill passenger and facilitate the individual's arrival at the scheduled destination for continued medical care. When unable to stabilize the passenger's condition, the decision to divert the plane rests with the flight's captain. Our article helps HCPs to best understand their resources, structured support, liability, and role during an in-flight medical event. With this knowledge of resources, a good Samaritan can confidently attend to an ill airline passenger in flight.

Delivering the Right Formula to the Right Baby at the Right Time

Appropriate nutrition interventions are a key component of neonatal and pediatric care during hospitalization. Safe and accurate preparation of formula and fortified breast milk reduces the risk of infections and promotes growth and development of infants and children. Meeting the goal of delivering the right formula to the right patient at the right time involves several steps and multiple departments and health care professionals. Centralized pediatric feeding rooms (CPFRs) provide a centralized location to control preparation processes under the right conditions. This article describes a systematic approach to improving quality control in a CPFR at a major academic medical center.

Palliative Care in Neurology: Integrating a Palliative Approach to Amyotrophic Lateral Sclerosis Care

This narrative review examines connections between neurology, specialist palliative care, and an integrated palliative approach to care for people living with neurodegenerative conditions. To illustrate the complexities of including palliative care in the management of neurodegenerative conditions, amyotrophic lateral sclerosis (ALS) is used as a case study. Challenges to co-ordinated ALS care and smooth care transitions between multiple services and healthcare professionals are discussed, including the timing of palliative care delivery in ALS; the education and training needs of healthcare professionals; and misperceptions of palliative care held by healthcare professionals, patients, and families. The benefits of adopting an integrated palliative approach to care for patients, families, and healthcare professionals are clarified. To enhance this, a family perspective is given on experiences of ALS neurology and palliative services, the challenges they faced, and aspects of care that facilitated the patient’s preferences for the time they had left. This review concludes that a palliative approach integrated into the care plan of people with ALS from the time of diagnosis can optimise quality of life by relieving symptoms; providing emotional, psychological, and spiritual support pre-bereavement; minimising barriers to a comfortable end of life; and supporting the family post-bereavement. These outcomes can only be achieved if palliative care knowledge and expertise are extended beyond the domain of specialist palliative care services to include the full scope of health and community-based care. These challenges and potential actions are common for several neurodegenerative pathologies, and recommendations are made for enhancing the training of neurology health professionals within the wider community.

Clinical nurses' experiences and perceptions after the implementation of an interprofessional team intervention: A qualitative study.

To explore clinical nurses' experiences and perceptions following a purposeful interprofessional (IP) team intervention in practice. Despite increasing interest in IP collaborative practice to improve teamwork, nursing outcomes and quality of care, there has been little research that focused on nurses' perspectives of IP collaboration after a purposeful IP team intervention. A qualitative descriptive study using focus group interviews of registered nurses who care for patients with advanced heart failure. This study is part of a larger study that conducted and evaluated a purposeful IP team intervention. Registered nurses (n=10) were invited to participate in three focus groups following the IP team intervention. Data were audio-recorded, transcribed and analysed using a conventional content analysis approach and constant comparative method. We identified six interrelated themes: (a) IP team building, (b) psychological safety and cultural change, (c) efficiency in delivery of care, (d) quality of patient care, (e) job outcomes and (f) team challenges. Notably, participants reported that they could better understand the patient's care plan of the day because every team member was "on the same page at the same time." Registered nurses perceived that they were more satisfied with their job through improved IP team performance, enhanced psychological safety and cultural change, efficient workflow and better quality of patient care. The IP team intervention contributed to enhancing IP team functioning as well as improving registered nurse job satisfaction. To sustain the improved perceptional and behavioural changes, team strategies to improve workflow and communication should be considered. Effective teamwork and communication between multiple healthcare professionals including nurses are the cornerstones to improve care delivery, nursing outcomes and quality of patient care in clinical settings.

Work-based Assessment and Co-production in Postgraduate Medical Training.

Assessment has always been an essential component of postgraduate medical education and for many years focused predominantly on various types of examinations. While examinations of medical knowledge and more recently of clinical skills with standardized patients can assess learner capability in controlled settings and provide a level of assurance for the public, persistent and growing concerns regarding quality of care and patient safety worldwide has raised the importance and need for better work-based assessments. Work-based assessments, when done effectively, can more authentically capture the abilities of learners to actually provide safe, effective, patient-centered care. Furthermore, we have entered the era of interprofessional care where effective teamwork among multiple health care professionals is now paramount. Work-based assessment methods are now essential in an interprofessional healthcare world.To better prepare learners for these newer competencies and the ever-growing complexity of healthcare, many post-graduate medical education systems across the globe have turned to outcomes-based models of education, codified through competency frameworks. This commentary provides a brief overview on key methods of work-based assessment such as direct observation, multisource feedback, patient experience surveys and performance measures that are needed in a competency-based world that places a premium on educational and clinical outcomes. However, the full potential of work-based assessments will only be realized if post-graduate learners play an active role in their own assessment program. This will require a substantial culture change, and culture change only occurs through actions and changed behaviors. Co-production offers a practical and philosophical approach to engaging postgraduate learners to be active, intrinsically motivated agents for their own professional development, help to change learning culture and contribute to improving programmatic assessment in post-graduate training.