Patient Care Activities Research Articles

Achieving and sustaining reduction in hospital-acquired complications in an Australian local health service

BackgroundReducing the prevalence of hospital-acquired complications (HACs) is paramount for both patient safety and hospital financial performance because of its impact on patient’s recovery and health service delivery by diverting...

Conscientious Objection and the Anesthesiologist: An Ethical Dilemma.

Conscientious objection is a legally protected right of medical professionals to recuse themselves from patient care activities that conflict with their personal values. Anesthesiology is different from most specialties with respect to conscientious objection in that the focus is to facilitate safe, efficient, and successful performance of procedures by others, rather than to perform the treatment in question. This could give rise to a unique, somewhat indirect ethical tension between the application of conscientious objection and potential infringement upon patient autonomy and well-being. While some situations have clear grounds and precedent for conscientious objection (e.g., abortion, or futile procedures), newer procedures, such as gender-affirming surgery and xenotransplantation, may trigger conscientious objection for complex reasons. This review discusses ethical, legal, and practical aspects of conscientious objection; challenges to anesthesia groups, departments, and healthcare organizations when conscientious objection is invoked by anesthesiologists; and strategies to help mitigate the ethical dilemmas.

Burkholderia multivorans Infections Associated with Use of Ice and Water from Ice Machines for Patient Care Activities - Four Hospitals, California and Colorado, 2020-2024.

Ice machines can harbor water-related organisms, and the use of ice or tap water for clinical care activities has been associated with infections in health care settings. During 2021-2022, a total of 23 cases of infection by Burkholderia multivorans (sequence type ST659) were reported at two southern California hospitals and linked to contaminated ice and water from ice machines. In addition to these 23 cases, this report also includes 23 previously unreported cases of B. multivorans ST659 infections that occurred during 2020-2024: 13 at a northern California hospital, eight at a hospital in Colorado, and two additional cases at one of the southern California hospitals. The same brand of ice machine and brands of filters, descaling, and sanitizing products were used by all four hospitals; B. multivorans was isolated from samples collected from ice machines in two of the hospitals. Whole genome sequencing indicated that all clinical and ice machine isolates were highly genetically similar (0-14 single nucleotide variant differences across 81% of the selected reference genome). Recommendations from public health officials to halt the outbreak included avoiding ice and tap water during clinical care activities. An investigation is ongoing to determine possible sources of ice machine contamination. During outbreaks of water-related organisms in health care facilities, health care personnel should consider avoiding the use of tap water, including ice and water from ice machines, for patient care.

Artificial Intelligence And Its Implications In Health Care: A Textual Analysis

This all-inclusive research paper plunges into the transformative nature of artificial intelligence (AI) in healthcare, emphasizing its ability to change patient care and administrative activities. The investigation examines systematically how AI technologies are creating major improvements towards patients’ outcomes and enhanced operational efficiency within the healthcare systems. From diagnostics to personalized treatment plans and administrative tasks, AI is being integrated using sophisticated algorithms in numerous aspects of healthcare delivery. One major focus is improving diagnostic accuracy. AI-backed diagnostic tools such as image recognition software as well as predictive models have outperformed traditional methods in medical condition identification and diagnosis. For instance, artificial intelligence algorithms show exceptional skills in analysing medical images resulting to earlier detection as well as accurate diagnoses of diseases like cancer, cardiovascular conditions among others neurological disorders. These enhancements not only allow for timely intervention but they significantly reduce instances where diagnosis goes wrong hence enhancing patient prognosis while reducing health costs drastically. The ability to customize personalized therapy is yet another essential aspect of AI in healthcare. With such information as genetic data, medical records and lifestyle factors, and other patient information, AI systems can develop individualized treatment plans. It is for this reason that personalization of treatments enhances their efficiency while reducing the risk of any adverse effects as well as ensuring patients’ adherence to prescribed therapies. Besides, it is important to note that AI-driven predictive models are helpful in identifying individuals with a higher probability of developing specific conditions thereby allowing interventions aimed at preventing diseases and bettering overall population health. AI has also transformed administrative tasks within hospitals besides its clinical applications. For example, AI driven automation is now used to streamline scheduling of appointments or billing processes or even storage of patient records which are normally considered routine administrative works. In addition, through these means there is reduced burden on administrative duties for healthcare workers who continue to perform them with increased precision and timeliness. The net effect is that time and resources can be redirected towards more direct patient care thus improving service quality across the board’s entire system

Visualizing Nursing Narratives: An Evaluation of Latent Dirichlet Allocation Topic Modeling for Care Reports.

The increasing volume of unstructured textual data in healthcare, particularly in nursing care reports, presents both challenges and opportunities for enhancing patient care and operational efficiency. This study explores the application of Latent Dirichlet Allocation (LDA) topic modeling to analyze free-text nursing narratives from inpatient stays in three different clinics, aiming to uncover the latent thematic structures within. Utilizing the R programming environment and the visualization tool LDAvis, we identified three main themes: "Patient Well-being," "Patient Mobility and Care Activities," and "Treatment and Pain Management," the latter combining two closely related but initially distinct topics due to their overlapping content. Our findings demonstrate the potential of LDA topic modeling in extracting meaningful insights from nursing narratives, which could inform patient care strategies and healthcare practices. However, the study also highlights significant challenges associated with the method, including the sensitivity to parameter settings, the lack of updates for key software packages, and concerns about reproducibility. These issues highlight the need for meticulous parameter validation and the exploration of alternative text analysis methodologies for future research. By addressing these methodological challenges and emphasizing the importance of comparative method analysis, this study contributes to the advancement of text analytics in healthcare. It opens avenues for further research aimed at developing more robust, efficient, and accessible tools for analyzing free-text data, thereby enhancing the ability of healthcare professionals to use unstructured data to improve decision making and patient outcomes.

A Snapshot of Introductory Pharmacy Practice Experience Program Characteristics

ObjectiveTo provide schools and colleges of pharmacy a snapshot of Introductory Pharmacy Practice Experience (IPPE) program characteristics to generate and share ideas for IPPE program modifications to improve student learning outcomes and comply with Standards 2025. MethodsA 41-item electronic survey was distributed to 140 Accreditation Council for Pharmacy Education fully accredited schools and colleges of pharmacy in 2023. IPPE program characteristics such as structure, learning activities, assessments, and requirements were described. ResultsEighty-seven programs participated in the survey (62.1% response rate). Notable findings included 64.4% of programs starting IPPEs during the first professional year, 78.6% did not count simulation hours toward Accreditation Council for Pharmacy Education hour requirements, 24.1% incorporated patient care electives, over 90% incorporated various patient care activities, 40.2% exceeded a 2:1 student-to-preceptor ratio, 15.7% incorporated layered learning, 50.0% incorporated interprofessional education, 57.5% used summative assessment rubrics based on Entrustable Professional Activities, and 77.0% used pass/fail grading. ConclusionOwing to evolving accreditation standards, the study provided valuable information about the current state of IPPEs. The study results included examples and components that programs can use to ensure that they comply with Standards 2025.

Defining the Landscape of Educational Experiences in Transplant Infectious Diseases: A National Survey of Infectious Diseases Fellows in the United States.

Transplant infectious diseases (TID) is a growing area of expertise within infectious diseases (ID), but TID training is not standardized. Previous surveys of fellows identified opportunities to improve TID education resources but did not explore didactic, clinical, and nonclinical experiences comprehensively. The American Society of Transplantation ID Community of Practice surveyed adult and pediatric fellows in US-based general ID or dedicated TID training programs to explore their didactic exposure, clinical experiences, and non-direct patient care activities in TID. A total of 234 fellows initiated the survey, and 195 (83%) (190 general ID and 19 TID fellows, including 125 adult, 76 pediatric, and 8 combined adult-pediatric fellows) completed the entire survey. More than half of the fellows described receiving no formal curricular content on most foundational topics in transplant medicine. Almost all respondents (>90%) had some inpatient TID experience, but for >60% of fellows this was <12 weeks annually. Clinical exposure varied by fellow and patient type-in an average month rotating on an inpatient TID service, more than half of adult fellows had evaluated ≥10 kidney, liver, or hematopoietic stem cell transplant recipients but <10 heart, lung, pancreas, or intestinal recipients; pediatric fellows saw <10 of all patient types. Nearly half (46%) of general ID fellows had not spent any time in the dedicated TID clinic at their program. Few fellows had participated in protocol development, organ selection meetings, or donor evaluations. This survey highlights important gaps in TID training. Given the increasing need for TID specialists, updated curricula and educational resources are needed.

Assessment of Patient Care Activities and Readiness for Advanced Pharmacy Practice Experiences in Revised Third-Year Introductory Pharmacy Practice Experiences

ObjectiveTo quantify the impact of a revised third-year (P3) introductory pharmacy practice experience (IPPE) curriculum on student opportunities for direct patient care and to evaluate student and preceptor perceptions of advanced pharmacy practice experience (APPE) readiness. MethodsAn intentional, structured curriculum redesign shifted 50 IPPE hours from each of the first- and second-years into the P3 year. A survey was developed and administered to students in the graduating classes of 2023 (original curriculum) and 2024 (revised curriculum) at the end of their first APPE rotation. The survey quantified the frequency of patient care activities completed during P3 IPPEs and assessed student perceptions of the effectiveness of P3 IPPEs in preparation for APPEs. At the conclusion of the first APPE, preceptors answered a single question assessing student APPE readiness. ResultsA total of 213/226 (94%) students responded to the optional survey. A significantly higher proportion of students in the 2024 cohort had the opportunity to complete several direct patient care activities compared to the 2023 cohort in community, institutional, and elective IPPEs. Additionally, the 2024 cohort was provided with greater access to the electronic health record (EHR). Although the 2024 cohort had higher perceived APPE readiness in areas of navigating the EHR and administering vaccines, student- and preceptor-perceived overall APPE readiness was similar between the 2 cohorts. ConclusionTransferring more IPPE hours into the last didactic year can increase student opportunities for direct patient care while promoting APPE readiness. Activity quantification could be used by other pharmacy programs to optimize IPPEs.

SmartDetector: Automatic and vision-based approach to point-light display generation for human action perception.

Over the past four decades, point-light displays (PLD) have been integrated into psychology and psychophysics, providing a valuable means to probe human perceptual skills. Leveraging the inherent kinematic information and controllable display parameters, researchers have utilized this technique to examine the mechanisms involved in learning and rehabilitation. However, classical PLD generation methods (e.g., motion capture) are difficult to apply for behavior analysis in real-world situations, such as patient care or sports activities. Therefore, there is a demand for automated and affordable tools that enable efficient and real-world-compatible generation of PLDs for psychological research. In this paper, we propose SmartDetector, a new artificial intelligence (AI)-based tool for automatic PLD creation from RGB videos. To evaluate humans' perceptual skills for processing PLD building with SmartDetector, 126 participants were randomly assigned to recognition, discrimination, or detection tasks. Results demonstrated that, irrespective of the task, PLDs generated by SmartDetector exhibited commendable perceptual performance in terms of accuracy and response times compared to literature findings. Moreover, to enhance usability and broaden accessibility, we developed an intuitive web interface for our method, making it available to a wider audience. The resulting application is available at https://plavimop.prd.fr/index.php/en/automatic-creation-pld . SmartDetector offers interesting possibilities for using PLD in research and makes the use of PLD more accessible for nonacademic applications.

Intensive care unit nursing workload estimation in smart hospitals

PurposeThe objectives of the proposed model are: aiding nursing staff in documentation tasks, which can be onerous and stressful; and helping management by offering an estimate of the nursing workload, which can be considered for administrative purposes, such as staff scheduling.Design/methodology/approachAn exploratory-descriptive study was conducted in order to identify, investigate, and describe the problem of documenting nursing activities and workload estimation in an intensive care unit. Technological solutions were explored, and models were proposed to address these issues.FindingsCross-dataset experiments were performed, and the model was able to offer an adequate estimate of the nursing workload. The results suggest that continuous retraining is essential for maintaining high accuracy. While the proposed model was considered in the context of an adult ICU, it can be adapted to other contexts, such as elderly care.Research limitations/implicationsWhile the proposed solution seems promising, further research is required, such as deploying this system in an ICU and facing challenges in the areas of computer security, medical ethics, and patient data privacy. More patients’ variables could also be collected to improve the workload estimates.Originality/valueNursing workload assessment is critical to improve the cost-benefit ratio in health care, offer high-quality patient care, and reduce unnecessary expenses, and this process is usually manual. An automated device can automatically document the amount of time spent in patient care activities in a more transparent, efficient, and accurate manner, freeing staff for more urgent activities and keeping management better informed about day-to-day nursing operations.

Enhancing Tuberculosis Care in Madhya Pradesh Through Public-Private Partnerships: An Evaluation of the Patient Provider Support Agency (PPSA) Model

BackgroundThe quality of care that patients receive in the private sector has been reported to be poor. Madhya Pradesh began adopting the PPSA model in September 2020, initially covering 44 districts. By April 2022, the state achieved 100% coverage, becoming the first state in the country to implement PPSA across all 52 districts. Although PPSA is now operational in every district, health indicators in the private sector have shown little improvement, and notifications from the private sector remain significantly below the annual targets The patient provider support agency (PPSA) pilot program has demonstrated newer strategies for private sector engagement to be able to deliver significant outcomes. the study explores the strengths and limitations of the private sector engagement model from the healthcare providers’ perspective MethodsThis was a mixed–methods study in which both quantitative and qualitative data were simultaneously collected. Quantitative data collection (using routinely collected programmatic data) is supported by qualitative data collection (in-depth interviews).This study was conducted to study the impact of the PPSA service implementation model on notification status, patient care activities and outcomes through record review among all 52 districts of Madhya Pradesh between October 2020- December 2022 as well as to explore the strengths and limitations of the PPSA model from the healthcare providers’ perspectives using a mixed-methods approach. ResultThere was a increase in the number of TB patients notified in the private sector (62%), number of patients receiving benefits of the Nikshay Poshan Yojna through Direct Bank Transfer (91%), number of patients tested for Human Immunodeficiency Virus (100%), Diabetes, and universal drug susceptibility testing (25%), as well as successful treatment outcomes in the post-PPSA period as compared to the pre-PPSA period. Seventeen in-depth interviews of health care providers from the public (n=8) and private sector (n=9) highlighted the operational challenges and solutions to implementation of the PPSA. Inadequate Human resource, poor coordination with NTEP Staff, poor mapping of PP’s, mobile based counselling & limited home visit to TB patients were the perceived challenges and regular support to the private health facilities and MIS data, trainings and hand-holding, supportive supervision from the State, and strict need based tendering policies were few of the suggestions to improve the PPSA model were some of the solutions. ConclusionThe implementation of the Patient Provider Support Agency (PPSA) model in Madhya Pradesh has not only improved notification rates and successful treatment outcomes but also strengthened the overall engagement of private healthcare providers in TB management. Enhanced collaboration, regular facility mapping, and sustained educational efforts have led to a more robust approach to TB care that extends across both public and private sectors. While challenges such as funding inconsistencies and service delivery fluctuations highlight areas for further improvement, the overall success of the PPSA model in Madhya Pradesh provides a promising framework for other regions aiming to enhance TB care through public-private partnerships. Future efforts should focus on addressing the identified gaps and scaling up these successful practices to ensure high-quality care for all TB patients, irrespective of where they seek treatment.

Investigation of Healthcare-Associated Infection Risks from Ice: Summary of CDC Consultations 2016-2023

Background: Nonsterile ice is frequently used in healthcare settings for a wide array of patient care activities and clinical procedures. However, this ice can harbor pathogenic organisms which can threaten patient safety and cause outbreaks. We sought to characterize recent Centers for Disease Control and Prevention (CDC) consultations involving ice leading to healthcare-associated infections (HAIs). Methods: We reviewed internal CDC records from the Division of Healthcare Quality Promotion (DHQP) to identify investigations of outbreaks and potential outbreaks involving the use of ice in healthcare facilities. We searched records from January 1, 2016, through November 30, 2023, for keywords related to ice. We excluded consultations in which ice was not thought to be a potential transmission pathway as well as those in which only sterile ice products (e.g., saline slush) were investigated. Results: We identified 45 consultations for ice-related investigations, involving a total of 533 patients. Nontuberculous mycobacteria were the most frequently implicated organisms, appearing in 40% (n=18) of investigations. Eighty-four percent (n=38) of investigations occurred in acute care hospitals. The most frequently implicated hospital settings were intensive care units (13%, n=6), operating rooms (13%, n=6), and bronchoscopy suites (13%, n=6). We identified a variety of plausible exposure pathways, including direct ingestion of ice by patients, use of ice during the bronchoscopy procedure, use of nonsterile ice in heater-cooler devices during cardiothoracic surgery, and the use of ice to chill saline for respiratory care. Environmental sampling directly of ice machines was performed in 62% of investigations (n=28) and nonsterile ice from these machines was sampled in 9% of investigations (n=4). Among those investigations in which ice machines were sampled, the organism implicated in the outbreak was isolated in 54% of investigations (n=15). Among those investigations in which ice itself was sampled, the organism implicated in the outbreak was isolated in 75% of investigations (n=3). These organisms included Mycobacterium mucogenicum, Burkholderia multivorans, and Acanthamoeba spp. Conclusions: The use of nonsterile ice during clinical care is a potential source of pathogens that cause patient infections and HAI outbreaks. Healthcare personnel should be aware of the risk posed by nonsterile ice and consider avoiding its use, especially when caring for patients who are critically ill or immunocompromised. Healthcare facilities should ensure regular cleaning and disinfection of ice machines to decrease their microbial burden. When HAI outbreaks involving water-associated organisms are identified, nonsterile ice should be considered as a potential mode of transmission.

Collaborating for success: empowering medical professionals through interprofessional education

Interprofessional education (IPE) refers to training activities to foster collaborative learning among students from different healthcare professions with the intention to augment the quality of patient care activities. Interprofessional education has been linked with significant impact and accounts for significant benefits that it adds to patient care, healthcare professionals, and even the healthcare delivery system as a whole. Medical institutions that are planning to introduce interprofessional education within their settings must adopt a structured framework to ensure effective delivery of IPE that can train students to develop the required set of skills and competencies that are essential for patient-centered practice. A wide range of challenges has been identified that can impact the implementation of effective IPE in a medical college. There is an immense need to overcome these challenges to facilitate IPE by creating an enabling environment that supports interprofessional collaboration. In conclusion, interprofessional education has a special place in the medical education delivery, as it has the potential to encourage collaborative practice, patient-centered care, and effective teamwork among different types of healthcare professionals. Thus, it is the need of the hour that each medical institution should explore opportunities for interdisciplinary learning and adequately prepare their students for the complexities of modern healthcare.

Elevating competency-based education in baccalaureate nursing: A simulation integration project

Simulation offers a mechanism for scaffolded learning in a safe environment and affords opportunities for students to integrate nursing knowledge, skills, and behaviors into patient care activities. Faculty applied a structured change model and utilized simulation theory and the AACN Essentials framework for competency-based education to integrate simulation across the pre-licensure curriculum at a large school of nursing. A series of clinical learning activities were implemented including one revised scenario, a computer-based simulation adapted from an existing manikin-based activity, and a multi-patient simulation developed by modifying three textbook publisher simulation resources. Students were provided with opportunities to develop competencies across multiple Essentials domains, and congruence between course and simulation objectives was achieved. The purpose of this article is to describe the processes and outcomes of a faculty-driven effort to advance competency-based education in baccalaureate nursing curricula.

Impact of a multi-disciplinary team-based care model for patients living with diabetes on health outcomes: a mixed-methods study

BackgroundIndividuals facing socioeconomic hardship experience higher than average rates of chronic disease, such as diabetes, with less access to evidence-based treatment. One solution to address these inequities is a team-based care (TBC) model, defined as one in which at least two providers work collaboratively with a patient and their caregiver(s) to make healthcare decisions. This paper seeks to describe the implementation of a TBC model within a safety-net healthcare setting and determine the extent to which it can be an effective, patient-centered approach to treating individuals with diabetes.MethodsSemi-structured interviews were conducted with staff (n = 15) and patients (n = 18). Clinical data were extracted from the electronic medical record of patients (n = 1,599) seen at a safety-net health system in Chicago, Illinois, United States. The mixed methods study was guided by implementation science and participatory research principles. Staff interviews were 60 min and covered patient care activities, work flow, perceived patient experience, and facilitators/barriers to care coordination. Patient interviews were 60 min and covered satisfaction, attitudes about diabetes management, quality of life, and technology. Patient interviews were co-analyzed by research staff and members of a patient advisory committee. Clinical data were collected at an index visit, two years prior and at one-year follow up (n = 1,599).ResultsFour themes emerged from the interviews: (1) patients perceived the TBC model to be patient centered and of high quality; (2) technology can be an innovative tool, but barriers exist; (3) diabetes management is a complex process; and (4) staff communication enhances care coordination, but misinterpreting roles reduces care coordination. From pre-enrollment to the follow-up period, we found a statistically significant increase in missed visits, decrease in hemoglobin A1c (HbA1c), decrease in body mass index, and decrease in the percent of patients with high blood pressure. We found that each medical visit during the follow-up period was associated with an HbA1c decrease of 0.26 points.ConclusionsA TBC model is a patient-centered approach to providing care to patients with complex health needs, such as diabetes, patients were satisfied with the care they were receiving, and the model was associated with an improvement in clinical outcomes.

Critical care pharmacist perspectives on optimal practice models and prioritization of professional activities: A cross-sectional survey

Abstract Disclaimer In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose Critical care pharmacists (CCPs) are essential members of the multidisciplinary critical care team. Professional activities of the CCP are outlined in a 2020 position paper on critical care pharmacy services. This study looks to characterize CCP perspectives for priorities in optimizing pharmacy practice models and professional activities. Methods This was a cross-sectional survey conducted from July 24 to September 20, 2023. A 41-question survey instrument was developed to assess 7 domains: demographics, CCP resource utilization, patient care, quality improvement, research and scholarship, training and education, and professional development. This voluntary survey was sent to members of the American College of Clinical Pharmacy’s Critical Care Practice and Research Network. The survey was open for a total of 6 weeks. Results There was a response rate of 20.7% (332 of 1,605 invitees), with 66.6% of respondents (n = 221) completing at least 90% of the survey questions. Most respondents were clinical specialists (58.2%) and/or practiced at an academic medical center (58.5%). Direct patient care, quality improvement and medication safety, and teaching and precepting were identified as the CCP activities of highest importance to CCPs. The CCP-to-patient ratios considered ideal were 1:11-15 (selected by 49.8% of respondents) and 1:16-20 (33.9% of respondents). The ideal percentage of time dedicated to direct patient care activities, as identified by survey respondents, was 50% (interquartile range, 40-50). Conclusion These findings highlight the professional activities viewed as having the highest priority by CCPs. Future research is needed to define optimal CCP practice models for the delivery of patient care in real-world settings.

Time and Note Characteristic Effects of an Electronic Health Record Template for Internal Medicine Resident Notes.

Background Inpatient internal medicine (IM) residents spend most of their time on indirect patient care activities such as clinical documentation. Objective We developed optimized electronic health record (EHR) templates for IM resident admission and progress notes, with the objective to reduce note-writing time, shorten note length, and decrease the percentage of progress note text that was copy-forwarded from prior notes. Methods In 2022, a multidisciplinary team created, over an 8-month period, optimized EHR templates for IM resident admission and progress notes. A retrospective analysis was performed to assess differences in resident time spent writing notes, note length in characters, and percentage of progress note text that was copy-forwarded. All 94 residents in the IM residency program had the opportunity to use the novel templates. Results Following implementation of the novel templates, residents spent on average 3.6 minutes less per progress note compared to pre-intervention (P=.008; 95% CI of the difference: 1.1-6.0 minutes). Notes in the post-intervention period were shorter for admission notes (mean reduction of 1041 characters; P<.001; 95% CI of the difference: 448-1634 characters) and progress notes (mean reduction of 764 characters; P<.001; 95% CI of the difference: 103-1426 characters). Progress notes also saw an average 22% decrease of copy-forwarded text (P<.001, 95% CI of the difference: 18.7%-25.4%). Conclusions The optimized note templates led to a reduction in resident progress note-writing time, shortened note length, and a lower percentage of copy-forwarded text.

Measurement of Cost of Boarding in the Emergency Department Using Time-Driven Activity-Based Costing

ObjectiveBoarding admitted patients in Emergency Departments (EDs) is a national crisis that is worsening despite potential financial disadvantages. The objective of this study was to assess costs associated with boarding. MethodsWe conducted a prospective, observational investigation of patients admitted through an ED for management of acute stroke at a large, urban, academic, comprehensive stroke center hospital. We employed Time-Driven Activity-Based Costing methodology to estimate cost for patient care activities during admission and aggregated results to estimate the total cost of boarding versus inpatient care. Primary outcomes were total daily costs per patient for: med/surg boarding, med/surg inpatient care, ICU boarding, and ICU inpatient care. ResultsThe total daily cost of med/surg boarding per acute stroke patient was $1,856 versus $993 for med/surg inpatient care and $2,267 for ICU boarding versus $2,165 for ICU inpatient care. These differences were even greater when accounting for costs associated with traveler nurses. ED nurses spent 293 minutes per day (mean) caring for each med/surg boarder; inpatient nurses spent 313 minutes per day for each med/surg inpatient. ED nurses spent 419 minutes per day caring for each ICU boarder; inpatient nurses spent 787 minutes per day for each ICU inpatient. Neurology attendings and residents spent 25 and 52 minutes per day caring for each med/surg boarder versus 62 minutes and 90 minutes for each med/surg inpatient. ConclusionsUsing advanced cost accounting methods, our investigation provides novel evidence that boarding of admitted patients is financially costly, adding greater urgency for elimination of this practice.

Is elderspeak communication in simulated hospital dementia care congruent to communication in actual patient care? A mixed-methods pilot study.

Simulation offers a feasible modality to prepare nurses for challenges communicating with patients with dementia. Elderspeak communication is speech that sounds like baby talk and can lead to rejection of care by patients with dementia. However, it is unknown if simulation can be used to capture elderspeak communication in dementia care. The purpose of this mixed-methods study was to determine if simulation accurately captures elderspeak communication by nursing staff in hospital dementia care. A 3-part mixed-methods design in which (1) three dementia care simulations were designed and validated by a panel of experts, (2) communication by nursing staff completing each simulation was quantitatively compared to communication during actual patient care, and (3) views on the realism were explored using within- and across-case coding. Three simulations using different modalities (manikin, role-play, and standardised patient) were designed and validated with eight experts using the Lynn Method. Ten nursing staff were audio-recorded and their communication was coded for elderspeak communication. Results for each simulation were compared using Wilcoxon signed-rank test to recordings taken during actual dementia care encounters. Debriefings were coded for realism and results were converged. The average time using elderspeak during naturalistic care was 29.9% (SD = 20.9%) which did not differ from the average amount of elderspeak used across the three simulations modalities which ranged from 29.1% to 30.4%. Qualitative results suggested a lack of realism with the manikin condition and the nursing staff indicated preference for the simulation with the standardised patient. Communication elicited in the dementia care simulations was congruent to communication produced in actual dementia care but preference was for the standardised patient. Elderspeak communication can be accurately produced in the simulated environment which indicates that simulation is a valid method for person-centred communication training in nursing staff. Simulation offers a feasible modality to prepare nurses for challenges communicating with patients with dementia. Elderspeak communication is speech that sounds like baby talk and can lead to rejection of care by patients with dementia. However, it is unknown if simulation can be used to capture elderspeak communication in dementia care. Elderspeak communication captured in the simulated environment was congruent to communication nursing staff use during actual patient care to hospitalised persons living with dementia. This study empirically identifies that communication is elicited in similar patterns by nursing staff in the simulated environment compared to the naturalistic care environment which demonstrates that simulation can be used as a valid tool for education and research on person-centred communication. STROBE. No Patient or Public Contribution.

A multistep approach and executive summary assessing and addressing workforce satisfaction and retention of the oncology pharmacy workforce

AbstractIntroductionHematology/oncology pharmacists work in various roles in healthcare systems and represent a highly skilled and valuable resource. There remains a significant challenge in the recruitment and retention of these well‐trained pharmacists. We sought to identify key factors and propose solutions to impact the ability to recruit, promote, and retain pharmacists.MethodsAn initial survey in 2021 assessed the status of the oncology pharmacist workforce with regard to job satisfaction and attrition risk. Based on the top 5 factors identified in the Initial Survey, a Follow‐Up Survey was conducted in 2022 to further understand top dissatisfiers in the workplace. To address these factors, an in‐person collaborative workshop was conducted in 2023 with a focus on creating action plans around the practice model, professional development, well‐being, and metrics.ResultsA total of 392 individuals participated in the Follow‐Up Survey. Most were 31–40 years of age (56%), female (70%), Caucasian (78%), and from academic medical centers (68%). Of the 367 individuals who responded to factors contributing to dissatisfaction at work, 51 of the respondents selected all five factors. The most common factor was the practice model (77%), followed by burnout/well‐being (74%), leadership (62%), professional development (56%), and metrics (32%). At the workshop, teams worked collaboratively to review detailed data, evaluate root causes, define a goal future state, and build recommendations for incremental steps to pursue progress in each of these areas.DiscussionUtilizing key information learned from both the Initial and Follow‐Up Survey, the Oncology Pharmacy Workforce Collaborative demonstrated that the key themes are interconnected and institutional support is essential in modernizing practice models, revamping professional development, creating better measures of direct and indirect patient care activities, and ensuring effective support for well‐being.