Non-clinical Tasks Research Articles

P0569 Inflammatory Bowel Disease nursing helpline trends in a large real-world Australasian cohort: Crohn's Colitis Cure (CCC) data insights program

Abstract Background The chronic nature of Inflammatory Bowel Disease (IBD) necessitates ongoing engagement between the healthcare team and patients with IBD. Dedicated nurse led helplines have been demonstrated to improve access to care, reduce healthcare costs and utilisation, and improves satisfaction. IBD nurses and helplines may not be widely available subject to resourcing. We analysed real world IBD-helpline usage across 10 Australasian sites to determine current trends. Methods Crohn’s Colitis Care (CCCare) is a cloud-based IBD-specific electronic medical record used increasingly in Australasia. The inclusion of a helpline augments the service through enabling encounter related documentation. De-identified data is made available from an associated, clinical quality registry (CQR). Helpline-associated data prospectively entered from September 2023 to September 2024 were analysed. Results In our cohort (n=7,493), 55.8% (n=4,181) had Crohn’s Disease (CD), 41.4% (n=3,101) had Ulcerative colitis (UC) and 2.8% (n=211) had IBD-Unclassified (IBDU). The median age was 42 years (IQR 31–56) and the cohort was evenly distributed in gender (49.0%, n=3,670 male). All patients resided in either Australia (73.1%, n=5,478) or New Zealand (23.6%, n=1,477). Three-quarters (75.2%) lived in metropolitan regions compared to regional/rural areas (24.8%). A total of 10,673 helpline encounters were documented, 75.5% (n=8,078) by email and 24.5%, (n=2,622) by phone. Email remained the predominant modality of communication across all age groups except those under 16. Those receiving advanced therapy (biologic or novel small molecule) formed 60% (n=3876) of the cohort but comprised 81.9% of the helpline utilisation likely reflecting increased complexity associated with their care. The most common reasons for helpline encounters related to administrative tasks (33.3%), medication-related issues (24.0%), and investigations/results (14.3%). Clinical concern and care only formed 14.3% of helpline contact encounters. This was consistent across most age groups, however a greater proportion of encounters were related to clinical concern or care in those under 18 (>30%) and over 80 (>20%). Conclusion IBD helplines play an essential role in augmenting the routine care provided to people with IBD, however it is limited by resource allocation, along with the burden of non-clinical and administrative tasks. Digital delivery of the IBD nursing helpline is utilised preferentially across all demographics in our cohort and signals an opportunity for innovative digital solutions to streamline care, reduce administrative burden, and improve overall patient care and satisfaction. Figure 1. Helpline encounter reasons by age groups.

An Innovative, Collaborative, and Transformative Program to Enhance Off-Campus Clinical Faculty Engagement.

Off-campus (volunteer, community-based) clinical faculty, upon whom medical schools heavily depend, are an integral component of medical education. However, challenges hinder their involvement in medical school governance and other activities, including inadequate communication, lack of recognition, high clinical demands that may preclude teaching, and time-consuming non-clinical tasks. While faculty appointments offer benefits like free CME, access to library resources, and email communications, faculty often prioritize potential contributions to their teaching roles over these benefits. Our medical school launched a new initiative to tackle these issues head-on. We established an Office of Faculty Engagement (OFE) that leverages engagement strategies to enhance communication, broaden access to campus resources, and provide tailored rewards for clinicians. We rebranded volunteer clinical faculty as Off-Campus Faculty (OCF) to foster a more interactive relationship and innovative measures, including personalized welcome emails, a dedicated point of contact for OCF, a user-friendly website, regular orientations, faculty development programs, recognition and appreciation events, and exclusive awards. From August 2021 to December 2023, we contacted 587 OCF members; 85 faculty members experienced improved communication. This innovative approach streamlines and personalizes interactions with OCF, enhances their satisfaction, and represents a transformative opportunity to engage and involve OCF in medical education.

Assessing Corpsmen Training Needs: Enhanced Medical Readiness in the Indo-Pacific for Near Peer.

Naval operations rely on Corpsmen to provide combat casualty and primary care services to the fleet, including the Fleet Marine Force. The United States faces new conflict challenges with near-peer adversaries in the modern geo-political climate. Corpsmen will likely require new skills to care for patients in anti-access/area-denial regions and transport patients across expansive maritime environments. To help them adapt to these new challenges, we evaluated the need for Corpsmen curriculum reform at the III Marine Expeditionary Force (MEF). This model begins with a general needs assessment to target gaps between the current and ideal approaches identified by the stakeholders. We identified 4 primary stakeholders within the Fleet Marine Force community: Marine Commanders (Society), Marines receiving treatment (Patients), Corpsmen providing care (Health Care Workers), and medical providers supervising Corpsmen (Medical Educators). We invited all ranks from III MEF to participate. The participants were interviewed in a mixture of focus groups and individual interviews in conversational and open-ended discussions. Transcripts of these discussions were analyzed and inductively coded using principles of grounded theory to identify prevailing themes that connected across interviews. The study was exempted by the Institutional Review Board at Naval Medical Center San Diego and Headquarters Marine Corps. The study involved 47 participants, including all stakeholders in III MEF and ranks from E1 through general officers. Through interviews and focus groups, 4 key themes emerged regarding Corpsmen's education: "Training," "Tasking," "Performance," and "Impact". "Training" discussions covered formal education, including gaps in basic training and the applicability of skills in civilian settings. "Tasking" examined daily responsibilities and equipment needs, such as teaching roles and first-responder care. "Performance" highlighted the quality of care and challenges in maintaining skills amid non-clinical tasks. Lastly, "Impact" assessed Corpsmen's influence on mission success and job satisfaction, revealing positive and negative perceptions among participants regarding their role and career prospects. The discussion emphasizes the importance of contextual factors in developing a Corpsmen-based curriculum, focusing on themes such as Training, Performance, and Impact. Tasking highlights critical areas for curriculum development, especially in educating Corpsmen as Educators, Leaders, and First-responder Caregivers. Gaps in training were identified, particularly in Non-trauma and First-responder Care, impacting Corpsmen's ability to handle diseases and injuries independently. Drawing parallels with Community Health Worker and Physician Extender (PE) education paradigms, we suggest adapting existing models to meet Corpsmen's needs. The discussion also delves into the history of employing PEs and developing training programs within the Naval Service. We propose a combination of Community Health Worker and PE-based education to enhance Corpsmen's competency and job satisfaction while facilitating their transition to civilian health care. Standardized curricula and training programs could improve skill transferability and readiness for Corpsmen in both military and civilian settings.

Decision region analysis for generalizability of artificial intelligence models: estimating model generalizability in the case of cross-reactivity and population shift.

Understanding an artificial intelligence (AI) model's ability to generalize to its target population is critical to ensuring the safe and effective usage of AI in medical devices. A traditional generalizability assessment relies on the availability of large, diverse datasets, which are difficult to obtain in many medical imaging applications. We present an approach for enhanced generalizability assessment by examining the decision space beyond the available testing data distribution. Vicinal distributions of virtual samples are generated by interpolating between triplets of test images. The generated virtual samples leverage the characteristics already in the test set, increasing the sample diversity while remaining close to the AI model's data manifold. We demonstrate the generalizability assessment approach on the non-clinical tasks of classifying patient sex, race, COVID status, and age group from chest x-rays. Decision region composition analysis for generalizability indicated that a disproportionately large portion of the decision space belonged to a single "preferred" class for each task, despite comparable performance on the evaluation dataset. Evaluation using cross-reactivity and population shift strategies indicated a tendency to overpredict samples as belonging to the preferred class (e.g., COVID negative) for patients whose subgroup was not represented in the model development data. An analysis of an AI model's decision space has the potential to provide insight into model generalizability. Our approach uses the analysis of composition of the decision space to obtain an improved assessment of model generalizability in the case of limited test data.

Implementation and Evaluation of a Trainee Orientation Manual in an Intensive Care Unit Rotation.

The intensive care unit (ICU) rotation places trainees in a fast-paced, high-intensity environment that requires complex patient care and multidisciplinary coordination. Trainees seek continuous medical knowledge acquisition while tasked with learning ICU-specific workflows, procedures, and policies. The unfamiliarity with rotation logistics and administrative roles and expectations could hinder the ICU rotation learning experience. A lack of standardization and material for trainee orientation to administrative ICU tasks and workflows could affect the trainee's rotation performance and overall learner satisfaction. We evaluated the implementation of an ICU trainee manual to provide trainees with a source of orientation for rotation logistics and nonclinical ICU tasks. We assessd its impact on content retention, learners' satisfaction with the manual, and overall ICU rotation experience. We designed an observational, prospective cohort study that included all trainees scheduled to rotate in the ICU during the 2020-2021 academic year. The ICU manual was delivered electronically and was available throughout the academic year. Trainees received a survey before their first ICU rotation (pretest) and 6 months after their first ICU rotation (retest) to assess content retention, trainees' perception of the ICU manual, and overall rotation satisfaction. A total of 95 trainees completed the pretest survey, and 61 completed the retest survey. The target cohort response rate for each survey was 100%. Pretest scores were higher than the matched retest scores (41 of 48 [interquartile range, 37-44] vs. 38 of 48 [34-41]; P < 0.001). The median ICU manual satisfaction score was 32 of 40 (26-36.5). We found positive correlations between ICU manual trainee satisfaction score and the retest score (r[59] = 0.320; P = 0.01) and ICU rotation trainee satisfaction level (r[59] = 0.909; P < 0.001). Implementing an ICU manual to orient trainees to their ICU clinical rotation was well received and showed continued retention of orientation content. Higher ICU rotation trainee satisfaction levels were related to a positive perception of the ICU manual.

The Staffing Crisis and Burnout in Academic Radiology: Insights from a Survey Study in Korea

ObjectiveAcademic radiology is essential for advancing medical knowledge, improving patient care, and leading professional organizations. Any shortage of academic faculty affects the ability to provide quality education in radiology, conduct research, and advance the field. In this study, we aimed to identify contributors to the challenges faced by academic radiology in Korea and compare the work burden, career satisfaction, and burnout between academic radiology and private practice. MethodsA Google survey of members of the Korean Society of Radiology, conducted between August 19, 2022 and August 31, 2022, attracted responses from 642 radiologists, including 511 board-certified radiologists and 131 radiologist trainees. The survey assessed career satisfaction, burnout, and reasons for working in academia and frustrations with an academic career. ResultsOf the responding academic radiologists, 53% were located in Seoul, and of the responding private practice radiologists, 71% were located in regions outside Seoul. The reported volume of image readings per month (CT and/or MRI) was higher for academic radiologists than for private practice radiologists, but no significant difference in the time taken to complete the readings was evident between the two groups. Compared with private practice radiologists, academic radiologists required more time for education, clinical conferences, and additional nonclinical tasks. Lower scores for career satisfaction and higher scores for burnout were reported by academic radiologists, compared with private practice radiologists. DiscussionThe field of academic radiology in Korea faces challenges because of a faculty shortage. To prevent the collapse of education in radiology, interventions must address the identified contributors to this shortage, while increasing career satisfaction and reducing burnout among academic radiologists.

Letter: The Urgency of Neurosurgical Leadership in the Era of Artificial Intelligence.

Letter: The Urgency of Neurosurgical Leadership in the Era of Artificial Intelligence.

A Current State Assessment on Nursing Work Activities: An Observational Study.

Nationwide nursing shortages have led to higher patient-to-nurse ratios, nursing burnout, and decreased quality of care. Staffing challenges and nursing burnout were becoming growing concerns and success was contingent upon efficient use of existing resources. Direct observation current state assessment was completed on medical-surgical specialty units to better understand work activities of registered nurses (RNs) and unlicensed assistive personnel (UAPs). RNs spent more time performing indirect care (eg, documentation) than direct patient care. Interruptions and problems consumed 17.4% and 5.6% of their time, respectively. UAPs performed more direct patient care but had a higher proportion of downtime. RNs underdelegated nonclinical tasks. Direct observation current state assessment offers a better understanding of workflow and workload inefficiencies. This information is critical to provide informed, evidence-based recommendations to develop future patient care models with more capacity to deliver high-quality care with greater efficiency and lessen nursing burden and burnout during the nursing shortage crisis.

Implementation of an integrated ambulatory care pharmacist collaborative care workflow model in specialty clinics in a large academic health system.

Ambulatory care and specialty pharmacy practices are rapidly growing in tandem with the accelerated development of advanced therapies for complex disease states. A coordinated and standardized interprofessional team-based approach is critical to providing high-quality care to specialty patients on complex, expensive, and high-risk therapies. Yale New Haven Health System dedicated resources to the creation of a medication management clinic under a unique care model that integrates ambulatory care pharmacists within specialty clinics who coordinate with centralized specialty pharmacists. The new care model workflow encompasses ambulatory care pharmacists, specialty pharmacists, ambulatory care pharmacy technicians, specialty pharmacy liaisons, clinicians, and clinic support staff. The strategies employed to design, implement, and optimize this workflow to meet the increasing demand for pharmacy support in specialty care is discussed. The workflow incorporated key activities from highly diverse existing specialty pharmacy, ambulatory care pharmacy, and specialty clinic practices. Standard processes were developed for patient identification, referral placement, visit scheduling, encounter documentation, medication fulfillment, and clinical follow-up. Resources were created or optimized to support successful implementation, including an electronic pharmacy referral, specialty collaborative practice agreements to facilitate pharmacist-led comprehensive medication management, and a standardized note template. Communication strategies were developed to facilitate feedback and process updates. Enhancements focused on eliminating documentation redundancies and delegating nonclinical tasks to a dedicated ambulatory care pharmacy technician. The workflow was implemented in 5 ambulatory rheumatology, digestive health, and infectious diseases clinics. Pharmacists utilized this workflow to complete 1,237 patient visits, serving 550 individual patients over 11 months. This initiative created a standard workflow to support an interdisciplinary standard of specialty patient care that is robust to accommodate planned expansion. This workflow implementation approach can serve as a road map for other healthcare systems with integrated specialty and ambulatory pharmacy departments undertaking similar models for specialty patient management.

Does a youth intern programme strengthen HIV service delivery in South Africa? An interrupted time-series analysis.

Since 2018, Youth Health Africa (YHA) has placed unemployed young adults at health facilities across South Africa in 1-year non-clinical internships to support HIV services. While YHA is primarily designed to improve employment prospects for youth, it also strives to strengthen the health system. Hundreds of YHA interns have been placed in programme (e.g. HIV testing and counselling) or administrative (e.g. data and filing) roles, but their impact on HIV service delivery has not been evaluated. Using routinely collected data from October 2017 to March 2020, we conducted an interrupted time-series analysis to explore the impact of YHA on HIV testing, treatment initiation and retention in care. We analysed data from facilities in Gauteng and North West where interns were placed between November 2018 and October 2019. We used linear regression, accounting for facility-level clustering and time correlation, to compare trends before and after interns were placed for seven HIV service indicators covering HIV testing, treatment initiation and retention in care. Outcomes were measured monthly at each facility. Time was measured as months since the first interns were placed at each facility. We conducted three secondary analyses per indicator, stratified by intern role, number of interns and region. Based on 207 facilities hosting 604 interns, YHA interns at facilities were associated with significant improvements in monthly trends for numbers of people tested for HIV, newly initiated on treatment and retained in care (i.e. loss to follow-up, tested for viral load [VL] and virally suppressed). We found no difference in trends for the number of people newly diagnosed with HIV or the number initiating treatment within 14 days of diagnosis. Changes in HIV testing, overall treatment initiation and VL testing/suppression were most pronounced where there were programme interns and a higher number of interns; change in loss to follow-up was greatest where there were administrative interns. Placing interns in facilities to support non-clinical tasks may improve HIV service delivery by contributing to improved HIV testing, treatment initiation and retention in care. Using youth interns as lay health workers may be an impactful strategy to strengthen the HIV response while supporting youth employment.

Burnout: A Call to Action From the AUA Workforce Workgroup.

We hypothesize burnout has failed to improve and certain demographics may be disproportionately affected. The AUA Workforce Workgroup examined work from the annual AUA Census over the past several years. Particular to this study, relevant burnout-related data were examined from the past 5 years. In 2021, 36.7% of urologists reported burnout compared to 36.2% in 2016. Burnout in men decreased from 36.3% to 35.2%, but increased in women from 35.3% to 49.2%. When examined by age, the largest increases in burnout were seen in those <45 years old, increasing from 37.9% to 44.8%, followed by 45-54 years old, increasing from 43.4% to 44.6%. When asked about the effect of COVID-19 on burnout, 54% of urologists didn't feel COVID-19 impacted burnout. Beyond burnout, only 25.0% of men and 4.6% of women reported no conflict between work and personal responsibilities, while 25.7% of men and 44.7% of women resolved these conflicts in favor of work or were unable to resolve them. Of respondents, 22.5% of men and 37.1% of women were "dissatisfied" with work-life balance. Similarly, 33.6% of men reported their work schedule does not leave enough time for personal/family life, compared to 57.5% of women. Overall, urologists have higher burnout now when compared to 2016. The gender discrepancy has vastly widened with women experiencing burnout at an increased rate of 14% compared to 2016, while burnout in men decreased by 1%. Burnout has increased the most in those <45 years old. Further action is needed to substantiate the causes of burnout.

Providing culturally competent and universal health care in the Peruvian Amazon: The role of medical authority

Peru's Ministry of Health promotes the provision of culturally competent and universal health care. To do so they have implemented policies aimed at addressing indigenous peoples' social, geographic, and financial barriers to health care as well as cultural gaps between them and (bio)medical providers. While scholars argued that these policies have fallen short, their explanations have ignored the role that medical providers' professional authority plays in implementing these policies. This study examined how medical providers aim to provide culturally competent care and facilitate patients' use of medical services while protecting their professional authority. This includes preserving control over their space of work and their capacity to legitimately diagnose, treat, and prognosticate medical problems. Ethnographic observations and 50 interviews conducted between May 2017 and February 2018 show that to facilitate the provision of culturally competent and universal health care, medical providers engaged in non-clinical tasks, trespassed bureaucratic rules, tolerated and integrated the use of traditional medicine, and expanded the time and place of their practice. To advance these strategies, medical providers sacrificed aspects of their social authority (e.g., their autonomy over their work) and their cultural authority (e.g., their ability to define treatment). However, providers also asserted aspects of their professional authority such as the ability to give patients instructions and advice and control over the use of traditional medicine. The latter had the potential of deterring some women from having institutional births, thus reproducing some of the constraints that indigenous people face in accessing health care.

Medical Professionals’ Administrative Burdens- A Less Talked About Issue

The modern-day clinical practice extends a step furtherthan traditional patient care that focuses primarily on clinical issues. It requires additional administrative responsibilities, and documentation. Physicians often get overwhelmed with the non-clinical tasks expected of them, adding to their existing burden of providing clinical care to a high volume of patients.&#x0D; Viable solutions to alleviate the burdens discussed in this article include equipping physicians with necessary administrative skills by providing them adequate software training, making virtual scribe services more uniform and easily accessible, and developing artificial intelligence and advanced voice-gesture-based interfaces. In addition, insurance companies and regulators should consider implementing changes that are physician friendly.&#x0D; The extensive administrative tasks that physicians handle on a day-to-day basis lead to an increased risk of burnout and a sense of dissatisfaction among health providers as they struggle to divide time between patient care and office work.

Analisis Pelaksanaan Telehealth di Rumah sakit selama pandemi covid-19 di Indonesia : Literature review

Telehealth is the provision of a variety of clinical and non-clinical services, and technology to people in remote locations using information telecommunication technology (ICT). Utilization of telehealth services can reduce the likelihood of transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Health care professionals can take on more clinical and nonclinical tasks from home. Therefore, telehealth protects the health of patients and healthcare professionals 15. Telehealth also provides low-risk critical medical care to patients with non-COVID-19 conditions, and recognizes those who may require further clinical assessment and consultation. This review aims to analyze the implementation of telehealth in hospitals during the covid-19 pandemic in Indonesia. In the initial search stage, 22 articles were found, and 4 articles were found that matched. From the 4 articles, it was concluded that Telemedicine is much interested in and contributes positively to the world of health, can minimize the risk of transmission of COVID-19 so that it is a solution to prevent all forms of direct physical contact, provide continuous care to the community, and ultimately reduce morbidity and mortality from COVID-19 outbreak. However, the government's role is very large in the sustainability of digital telehealth in the world of health Dengue infection is the fastest-spreading viral infectious disease in the world. In recent years, there has been an increase in reported neurological findings associated with dengue infection. In dengue endemic areas, the most common neurological complication is dengue encephalopathy.

Evaluation of the Time Spent by Anesthetist on Clinical Tasks in the Operating Room.

BackgroundChanges in the health system in Western countries have increased the scope of the daily tasks assigned to physicians', anesthetists included. As already shown in other specialties, increased non-clinical burden reduces the clinical time spent with patients.MethodsThis was a multicenter, prospective, observational study conducted in 6 public and private hospitals in France. The primary endpoint was the evaluation by an external observer of the time spent per day (in minutes) by anesthetists on clinical tasks in the operating room. Secondary endpoints were the time spent per day (in minutes) on non-clinical organizational tasks and the number of task interruptions per hour of work.ResultsBetween October 2017 and April 2018, 54 anesthetists from six hospitals (1 public university hospital, two public general hospitals and three private hospitals) were included. They were followed for 96 days corresponding to 550 hours of work. The proportion of overall clinical time was 62% (58% 95%CI [53; 63] for direct care. The proportion of organizational time was higher in public hospitals (11% in the university hospital (p < 0.001) and 4% in general hospitals (p < 0.01)) compared to private hospitals (1%). The number of task interruptions (1.5/h ± 1.4 in all hospitals) was 4 times higher in the university hospital (2.2/h ± 1.6) compared to private hospitals (0.5/h ± 0.3) (p < 0.05).ConclusionsMost time in the operating room was spent on clinical care with a significant contrast between public and private hospitals for organizational time.

Optimizing radiologist productivity and efficiency: Work smarter, not harder

Radiologists’ personal productivity and efficiency are critically important for both improving patient outcomes and protecting clinician well-being. There are several solutions that individuals can implement to improve personal productivity and efficiency in the radiology workroom. Strategies include understanding the psychology behind productivity, using personal productivity methodologies to accomplish daily tasks, and learning to modulate stress to optimize performance. Institutional infrastructure requirements include a robust departmental commitment to information technology and informatics, including universal log-in systems, internal websites, and dashboards. The workstation itself can be optimized by utilizing hanging protocols, customized keyboard shortcuts, hotkeys, advanced scripts, gaming mice, and other input devices. Personal devices like smartphones can be harnessed to maximize productivity by using online storage applications and radiology-specific applications to augment knowledge. Reading room layouts must be designed to minimize interruptions and workstations must consider ergonomics to prevent fatigue and strain. High-efficiency teams also need to be created to allow radiologists to delegate non-clinical tasks to reduce administrative burdens. Lastly, continued advances in artificial intelligence including the use of smart report templates will lead to substantial gains in radiologists’ productivity and efficiency.

Technology in the emergency department: Using cognitive work analysis to model and design sustainable systems

Emergency Departments (EDs) are highly complex healthcare settings that must be resilient to unpredictable demands. New technologies are regularly introduced into EDs to improve patient care and workflow processes. However, the interaction between social and technical agents can introduce further complexity, making it difficult to identify the factors that influence the dynamic sustainability of interventions. This study aimed to demonstrate how the Cognitive Work Analysis (CWA) Framework can be used to model and design sustainable social-technical ED systems. To identify workspaces, social, technical, and collaboration factors that can be used to design and implement contextually appropriate technologies into the ED, we applied Control Task Analysis (i.e., Contextual Activities Template, CAT), Social Organizational and Cooperation Analysis (SOCA), and Strategies Analysis (StrA) phases from the CWA Framework, developed and validated using data collected during 263 h of observation in a large metropolitan ED. Our models revealed workspaces within the ED that are heavily involved in both clinical and non-clinical tasks for nurses and doctors using a range of technology. Workspaces, technology, and roles that are over- or under- utilized create contextually sensitive opportunities for dispersing work. Application of CWA enables examination of the ongoing, dynamic relationship between technological interventions and context, which can support sustainability and inform future designs.

Nonclinical Time for Family Medicine Residency Faculty: National Survey Results.

Recent changes to the Accreditation Council for Graduate Medical Education (ACGME) requirements eliminated minimum standards for protected nonclinical time for core faculty. Faculty perform many nonclinical tasks to maintain family medicine residencies. The objective of this study is to describe the landscape of nonclinical time for family medicine residency faculty. Program directors at ACGME-accredited family medicine residencies were electronically surveyed in August 2019 to describe nonclinical time of their faculty. Survey information requested included program demographics, the amount of nonclinical time allocated, and the estimated amount of nonclinical time spent per year completing their faculty duties. A total 156 of 635 program directors (24.6%) returned the survey and 58 (9.1%) completed the entire survey for analysis inclusion. An average of 3,394 hours per year, per program were estimated to be spent on nonclinical activities. The greatest amount of time was spent on program administration (39%) and the least amount of time on curriculum development (5%). There was variation in the use of nonphysician faculty to complete these tasks. Allocated faculty time was comparable to estimated time spent performing nonclinical tasks. On average, a 24-resident program devoted 1.9 full-time equivalent faculty salary support to complete nonclinical activities. Family medicine residency faculty spend significant time completing nonclinical tasks required to meet ACGME requirements and need the protected time to complete these necessary tasks. Direct data on the use of faculty nonclinical time is needed to more accurately define its use.

Participation of pharmacy technicians in clinical and patient-centered care practices: A state-wide survey in Nigeria

BackgroundIdentifying the involvement of pharmacy technicians (PTs) in nonclinical and clinical duties will provide insight for improved pharmaceutical services. ObjectivesThis study assessed the involvement of PTs in nonclinical tasks, patient-centered services, and more specialized patient care services and the difference in practice between hospital and community PTs. MethodsA cross-sectional survey was conducted using a 5-point Likert scale, and an analysis of data was performed using IBM SPSS version 21.0 (IBM). Descriptive statistics was done, and P ≤ 0.05 was considered statistically significant. The study was conducted in community and hospital pharmacies in Ogun State, Nigeria, among 100 PTs. Outcome measures were the involvement of PTs in clinical roles and other pharmaceutical care practices. ResultsA total of 73 (73.0%) participated in the study, 45 (61.6%) and 28 (38.4%) practiced in hospital and community pharmacies, respectively. From the 11 listed nonclinical activities, only stocking of medications 61 (83.6%) and processing clients' or patient’s charges 48 (65.8%) were often or very often performed. More than half of the participants often performed each of all 7 listed patient-centered activities, particularly empathy and confidentiality 62 (84.9%), providing information and referrals to patients or clients 56 (76.7%), and identifying patients or clients for counseling 51 (69.9%), respectively. No statistically significant difference was observed between the practice areas (P > 0.05). Only 2 of the 11 listed specialized clinical activities were performed by more than half of the respondents: screening prescriptions for completeness and authenticity 43 (58.9%) and alerting the pharmacist of drug therapy problems 46 (63.0%). Differences in the practice of specialized tasks was statistically significant for consultations (P = 0.002) and resolution of clinical conflict (P = 0.040) between the practice areas. ConclusionStudy participants were less frequently involved in nonclinical activities but often involved in clinical activities. They also participated in specialized clinical tasks at lesser frequencies. Differences were observed between the practice areas in performance of nonclinical and specialized activities. Strategies to fill in the observed gaps should be explored for improved practice.

The scope for adaptive capacity in emergency departments: modelling performance constraints using control task analysis and social organisational cooperation analysis

Patient flow between the emergency department (ED) and hospital wards becomes problematic when bed availability is limited. To better understand the constraints that shape patient flow and everyday work in the ED, we applied Control Task Analysis (i.e. Contextual Activities Template, CAT) and Social Organisational Cooperation Analysis (SOCA) phases from the Cognitive Work Analysis framework to identify ways in which to optimise patient flow. The model and analysis were created through observations in the ED of clinicians (e.g. nurses, doctors), and professional staff (e.g. ward personnel, clerks). The CAT and SOCA-CAT models illustrate workspaces, patient journey phases, and patient volume within the department that are heavily loaded with tasks and human and non-human agents performing these tasks, while others are underutilised. The findings suggest that an ED’s adaptive capacity could be strengthened through the integration of additional human and non-human agents allowing the redistribution of clinical and non-clinical tasks. Practitioner Summary: Workflow in EDs is constrained by uneven geographical distribution of activities, insufficient adaptive support during critical patient journey phases and periods of high patient volume. Adaptive capacity could be strengthened by additional human and non-human agents in combination with a redistribution of tasks, supporting seamless successful structural and behavioural adaptation in ED.