Physician Resources Research Articles

Exploring Rural Medicine Residency Programs: A Narrative Review.

The challenges of rural medicine are not unknown as access to healthcare is compounded by physician recruitment, specialty care, and resource availability. Rural populations across the USare in a constant struggle for proper medical care and preventive health. Despite research efforts to examine the practice of rural medicine, little has been shared about the role of medical education in overcoming the hurdles of rural medicine. A review of current literature is needed to better understand the current situation in rural medicine and how medical education can aid in addressing the challenges of rural medicine. This review aimed to understand the practice of rural medicine, identify measures taken to address the physician shortage nationally in rural communities, and emphasize the role of rural medicine residency programs and training programs in addressing the current situation. A review of the literature was carried out by searching several electronic databases, which includedPubMed, ScienceDirect, Google Scholar, Directory of Open Access Journals (DOAJ), JSTOR, PsycINFO, ERIC Database (via EBSCOhost), and Academic Search Complete. The search was conducted from January 27, 2022, to February 28, 2022, using Boolean operations and the following terms: rural, family practice, healthcare, residency program, medical resident, graduate medical education, Kansas, and Midwest. There were 23 relevant publications included in this review that explored the role of medical education, physician recruitment, and scope of practice in addressing the struggles of rural medicine. Rural medicine residency programs and targeted training play a crucial role in addressing the physician shortage in underserved areas. Future research should focus on thoroughly understanding rural communities' interactions with the healthcare system and increasing support for medical professionals in rural areas.

A comprehensive evaluation of the service quality of Chinas medical APP based on mobile phones

In light of the rapid advancement of internet-based healthcare and the consequent transformation in medical consultation modalities, an increasing number of individuals, particularly the younger demographic, are opting to seek medical advice or assistance via mobile phones through various online medical platforms or applications. However, the wide range of medical apps with different operational models, varying levels of expertise among resident specialists, and inconsistent quality of medical guidance presents a significant challenge for users in discerning which apps provide accurate and reliable guidance. Consequently, this study aims to comprehensively evaluate the service quality of domestic medical apps from multiple channels and perspectives by utilizing case studies. Rooted in educational materials and diagnostic guidelines for relative diseases, evaluation criteria and a quantitative scoring system are established in this study. The findings are indicated in terms of the accuracy and professionalism of medical consultation services and user experience. This study also proposes that domestic mobile medical apps should enhance their diagnostic quality, expand physician resources, standardize management practices, and strengthen platform infrastructure while developing new functionalities to benefit patients.

Determinants of women’s preferences for surgical versus conservative management for pelvic organ prolapse: a survey-based study from Italy

Background and objectivePelvic organ prolapse (POP) affects 40% of women, with a 12%–19% lifetime surgical risk. Italy showed high practice variation in POP surgery, possibly impacting equity of access to...

The complexity of physician power.

Inequitable variation in physician effort and resource use is revealed.

Risk factors for intensive care unit admission after cesarean hysterectomy for placenta accreta spectrum.

Placenta accreta spectrum (PAS) is a complex disorder of uterine wall disruption with significant morbidity and mortality, particularly at time of delivery. Both physician and physical hospital resource allocation/utilization remains a challenge in PAS cases including intensive care unit (ICU) beds. The primary objective of the present study was to identify preoperative risk factors for ICU admission and create an ICU admission prediction model for patient counseling and resource utilization decision making in an evidence-based manner. This was a case-control study of 145 patients at our PAS referral center undergoing cesarean hysterectomy for PAS. Final confirmation by histopathology was required for inclusion. Patient disposition after surgery (ICU vs post-anesthesia care unit) was our primary outcome and pre-/intra-/postoperative variables were obtained via electronic medical records with an emphasis on the predictive capabilities of the preoperative variables. Uni- and multivariate analysis was performed to identify independent predictive factors for ICU admission. In this large cohort of 145 patients who underwent cesarean hysterectomy for PAS, with histopathologic confirmation, 63 (43%) were admitted to the ICU following delivery. These patients were more likely to be delivered at an earlier gestational age (34 vs 35 weeks, P < 0.001), have had >2 episodes of vaginal bleeding and emergent delivery compared to patients admitted to patients with routine recovery care (44% vs 18.3%, P = 0.009). Uni- and multivariate logistic regression showed an area under the curve of 0.73 (95% CI: [0.63, 0.81], P < 0.001) for prediction of ICU admission with these three variables. Patients with all three predictors had 100% ICU admission rate. Resource prediction, utilization and allocation remains a challenge in PAS management. By identifying patients with preoperative risk factors for ICU admission, not only can patients be counseled but this resource can be requested preoperatively for staffing and utilization purposes.

Cost-Effectiveness Analysis of Using Digital Platforms to Alleviate the Gap in Access to Healthcare Services for the Elderly in China

The issue of healthcare access has transcended individual concerns to become a major societal challenge, especially in the context of an aging population. The problem of access to health care has led to a growing healthcare divide. The approach presented in this paper aims to delve into the intricate interplay of social, economic, political, and cultural determinants, the reasons why these factors contribute to the widening disparities in healthcare access experienced by older adults, and the proposed feasible solutions. The implementation of this solution requires a multi-faceted strategy, including an important part - hypothesis-driven experimental research driven by university student volunteers. By proposing hypothetical principles and analyzing data to make a comprehensive economic assessment, this paper aims to propose a pragmatic solution to this pressing problem. Ultimately, we aim to significantly mitigate disparities in healthcare access for older adults, aiming to minimize the impact of the problems of older adults themselves due to the uneven distribution of physician resources, and insufficiently comprehensive government policies.

Emergency physician resource utilization varies by years of experience.

One of the most pivotal decisions an emergency physician (EP) makes is whether to admit or discharge a patient. The emergency department (ED) work-up leading to this decision involves several resource-intensive tests. Previous studies have demonstrated significant differences in EP resource utilization, measured by lab tests, advanced imaging (magnetic resonance imaging [MRI], computed tomography [CT], ultrasound), consultations, and propensity to admit a patient. However, how an EP's years of experience may impact their resource utilization and propensity to admit patients has not been well characterized. This study seeks to better understand how EPs' years of experience, post-residency, relates to their use of advanced imaging and patient disposition. Ten years of ED visits were analyzed for this study from a single, academic tertiary care center in the urban Northeast United States. The primary outcomes were utilization of advanced imaging during the visit (CT, MRI, or formal ultrasound) and whether the patient was admitted. EP years of experience was categorized into 0-2years, 3-5years, 6-8years, 9-11years, and 12 or more years. Patient age, sex, Emergency Severity Index (ESI), and the attending EP's years of experience were collected. The relationship between EP years of experience and each outcome was assessed with a linear mixed model with a random effect for provider and patient age, sex, and ESI as covariates. A total of 460,937 visits seen by 65 EPs were included in the study. Over one-third (37.6%) of visits had an advanced imaging study ordered and nearly half (49.5%) resulted in admission. Compared to visits with EPs with 0-2years of experience, visits with EPs with 3-5 or 6-8years of experience had significantly lower odds of advanced imaging occurring. Visits seen by EPs with more than 2 years of experience had lower odds of admission than visits by EPs with 0-2years of experience. More junior EPs tend to order more advanced imaging studies and have a higher propensity to admit patients. This may be due to less comfort in decision-making without advanced imaging or a lower risk tolerance. Conversely, the additional clinical experience of the most senior EPs, with greater than 9years of experience,likely impacts their resource utilization patterns such that their use of advanced imaging does not significantly differ from the most junior EPs.

Association between physician resource utilization, throughput, and patient experience in the emergency department

Background and Importance: Emergency department (ED) care is complex, involving multifaceted factors such as patient volume, provider experience, throughput metrics, and patient-provider interactions. While some studies have explored relationships between these parameters, there is still much to understand about the nuances in ED care. Objective: Our study aimed to analyze the statistical relationships between admission rates, Press Ganey (PG) scores, and various throughput/resource utilization variables in the ED. These variables include imaging and lab ordering rates, door-to-doctor (D2D) success rate, disposition times for specific patient acuities, and elopement or discharge against medical advice (AMA) rates. Design: A retrospective cohort study was conducted using data from eight emergency facilities within the Valley Health System. Settings and Participants: Data from six community hospital EDs and two freestanding emergency departments (FEDs) in the Valley Health System, spanning August 1, 2020, to July 31, 2021, were examined. The analysis involved 99 physicians and approximately 200,000 adult patients. Outcome Measures and Analysis: Correlations between admission rates, PG scores, and various ED metrics were examined using the Jamovi software. Separate analyses were conducted based on facility type using ANOVAs. Main Results: Our findings revealed several significant correlations. There was a positive correlation between lab ordering and admission rates, while D2D success rates showed a negative correlation with admission rates. Additionally, there was a positive association between D2D success rates and quick dispositioning of lower acuity patients. Patient satisfaction (PG score) was negatively correlated with admission, AMA, and D2D success rates, whereas it positively correlated with lab ordering rates. Conclusion: This study identifies significant relationships among ED throughput, resource utilization, and patient satisfaction metrics. These findings can guide further research to understand the patient experience better, optimize resource utilization, and improve overall ED efficiency.

Association between physician resource utilization, throughput, and patient experience in the emergency department

Association between physician resource utilization, throughput, and patient experience in the emergency department

Primary Care Physicians in Nova Scotia: Are They Where They Need To Be?

Purpose: Accessible primary health care (PHC) is a key area of interest for policy and research as accessible PHC is associated with better health outcomes and lower health system costs. A critical dimension of accessible PHC is an adequate supply of family physicians (FPs) or general practitioners (GPs). Our study sought to analyze the geographic distribution of FP/GPs practicing in Nova Scotia (NS) and to provide an in-depth analysis of the distribution of FP/GPs in relation to population PHC needs. Methods: Using data from the College of Physicians &amp; Surgeons of Nova Scotia’s registry and 2019 annual license renewal survey, we provide a descriptive analysis of physician distribution, demographics and practice structure characteristics across the four Nova Scotia Health management zones (Central, Eastern, Northern, Western) for the population of FP/GPs practicing in NS in 2019. Additionally, we provided a descriptive analysis of PHC demand indicators and population demographics derived from the Canadian Institute for Health Information, the Canadian Community Health Survey, and the Canadian Census. These population PHC need indicators include hospitalization rates for ambulatory care sensitive conditions (ACSC), perceived health, the Canadian Index of Multiple Deprivation (CIMD), and the percentage of the population aged 65 and over across Nova Scotia Health management zones. Results: FP/GPs practising outside the Central zone are less numerous, older, and more likely to be male and international medical graduates. FP/GPs practicing outside the Central zone are more likely to have solo practices, practice in rural areas and not provide care through technology. Additionally, there is a greater potential demand for PHC outside of the Central zone, indicated by lower physician-to-100,000 population ratios, higher rates of hospitalizations for ACSC, a larger percentage of individuals living in rural areas, aged 65 and over, rating their health as fair or poor, and in the most deprived quintile of the situational vulnerability and economic dependency dimensions of the CIMD. Conclusions: These findings indicate a geographic maldistribution of physicians across NS and potential gaps in access to FP/GPs compared to population health needs across Nova Scotia Health management zones. The findings have implications for targeted physician resources planning and policy.

Access and quality of healthcare in China: Rural and urban disparities

While China is nearing its goal of universal coverage, with its large population and the history of urban and rural distinction, disparities in access and quality of healthcare between cities and countries still exist, becoming the underlying problems in the current Chinese healthcare system. Disparities are mainly rooted in the different statutory insurance schemes provided by the government, which have been improving for years of effort, and the household registration -- Hukou system. Access to better-quality hospitals is limited in rural areas because of the lack of secondary and tertiary hospitals that can provide more comprehensive and specialist services to patients. Physician resources are also outflowing into bigger cities as rural areas have significant shortages in physician density and fall short in physician training. Of countries with similar problems, Norway has a high index of quality and healthcare with a maldistribution of healthcare resources and has decreased the inequality or disparity gap by implementing educational programs for medical students and emphasizing primary care. Brazil has the same problems of urban-rural disparities but is better at implementing initiatives to change the situation, such as the use of family health teams and community health workers. In this review, the author analyses the possible causes of healthcare disparity between rural and urban areas in China, compares the policies of other countries with similar conditions, and provides some solutions to decrease the gaps between rural and urban medical insurance services.

Reducing Preventable Bleeding Visits and Institutional Factor Costs for Patients with Bleeding Disorders with a Prospective Quality Improvement Project

Providing optimal care to patients with bleeding disorders requires specialized physician, laboratory, pharmacy, nursing, and institutional resources best achieved at Hemophilia Treatment Centers (HTCs). Current systems for managing the care of a resource intensive patient population may be suboptimal. We observed frequent bleeding related hospitalizations and emergency room (ER) visits in patients with bleeding disorders treated at our HTC that could have been potentially prevented by changes in outpatient care delivery. We initiated a prospective quality improvement (QI) project to improve care delivery and to reduce preventable bleeding related hospitalizations and ER visits for adult patients treated at our HTC. The interventions targeted patient-level and systems-level factors contributing to preventable visits, and barriers to care in our patient population. We compared preventable bleeding related hospitalizations and ER visits, institutional factor cost, use of prophylaxis in severe hemophilia, primary care physician attainment, and patient electronic portal enrollment before and after the QI intervention. In our population of adult patients with bleeding disorders (N=88), the intervention significantly reduced the primary outcome of preventable bleeding hospitalization or ER visit (P=0.0082, Figure), and reduced such visits by 85.4%, meeting the pre-specified criteria for success. Institutional factor acquisition costs to treat preventable bleeding were reduced by 94.5%, from $11,800 to $640 per patient per year; a projected savings of $982,088 yearly. Use of factor prophylaxis in patients with severe hemophilia increased from 58.8% to 100%, attainment of a primary care physician increased from 69.4% to 86.4%, and use of the electronic patient portal increased from 53.2% to 83%; all secondary outcomes met pre-specified criteria of success and were statistically significant. HTC clinic visit attendance was low at 55.2%. The majority of patients (71.6%) had at least one outpatient urgent episode (mean 0.72 episode per year), and 93% had non-urgent management (mean 9.3 episodes per year) occurring outside of a clinic visit. These data demonstrate that concerted outpatient management of patients with bleeding disorders with a quality improvement framework can reduce preventable hospitalization and ER visits. Decreased inpatient utilization resulted in substantial reductions in factor costs at the health system level. The clinical effort required to achieve these results was substantial, and required frequent provider engagement outside of regular clinic visits. The HTC can improve patient outcomes and reduce institutional costs from preventable bleeding episodes by supporting a collaborative quality improvement process led by physician, nursing, and laboratory coagulation experts.

Using Discrete-Event Simulation to Balance Staff Allocation and Patient Flow between Clinic and Surgery

We consider the problem of system-level balanced scheduling in a pediatric hospital setting. A hospital clinic has a queue for patients needing care. After being seen in clinic, many require follow-up surgery, for which they also wait in a queue. The rate-limiting factor is physician availability for both clinic visits and surgical cases. Although much existing work has been done to optimize clinic appointments, as well as to optimize surgical appointments, this novel approach models the entire patient journey at the system level, through both clinic and surgery, to optimize the total patient experience. A discrete-event simulation model of the system was built based on historic patient encounter data and validated. The system model was then optimized to determine the best allocation of physician resources across the system to minimize total patient wait time using machine learning. The results were then compared to baseline.

Evolution of community health workers: the fourth stage.

Comprehensive primary care is a key component of any good health system. Designers need to incorporate the Starfield requirements of (i) a defined population, (ii) comprehensive range, (iii) continuity of services, and (iv) easy accessibility, as well as address several related issues. They also need to keep in mind that the classical British GP model, because of the severe challenges of physician availability, is all but infeasible for most developing countries. There is, therefore, an urgent need for them to find a new approach which offers comparable, possibly even superior, outcomes. The next evolutionary stage of the traditional Community health worker (CHW) model may well offer them one such approach. We suggest that there are potentially four stages in the evolution of the CHW - the health messenger, the physician extender, the focused provider, and the comprehensive provider. In the latter two stages, the physician becomes much more of an adjunct figure, unlike in the first two, where the physician is at the center. We examine the comprehensive provider stage (stage 4) with the help of programs that have attempted to explore this stage, using Qualitative Comparative Analysis (QCA) developed by Ragin. Starting with the 4 Starfield principles, we first arrive at 17 potential characteristics that could be important. Based on a careful reading of the six programs, we then attempt to determine the characteristics that apply to each program. Using this data, we look across all the programs to ascertain which of these characteristics are important to the success of these six programs. Using a truth table, we then compare the programs which have more than 80% of the characteristics with those that have fewer than 80%, to identify characteristics that distinguish between them. Using these methods, we analyse two global programs and four Indian ones. Our analysis suggests that the global Alaskan and Iranian, and the Indian Dvara Health and Swasthya Swaraj programs incorporate more than 80% (> 14) of the 17 characteristics. Of these 17, there are 6 foundational characteristics that are present in all the six stage 4 programs discussed in this study. These include (i) close supervision of the CHW; (ii) care coordination for treatment not directly provided by the CHW; (iii) defined referral pathways to be used to guide referrals; (iv) medication management which closes the loop with patients on all the medicines that they need both immediately and on an ongoing basis (the only characteristic which needs engagement with a licensed physician); (v) proactive care: which ensures adherence to treatment plans; and (vi) cost-effectiveness in the use of scarce physician and financial resources. When comparing between programs, we find that the five essential added elements of a high-performance stage 4 program are (i) the full empanelment of a defined population; (ii) their comprehensive assessment, (iii) risk stratification so that the focus can be on the high-risk individuals, (iv) the use of carefully defined care protocols, and (v) the use of cultural wisdom both to learn from the community and to work with them to persuade them to adhere to treatment regimens.

AP-453071-5 SHOCKED BY EFFICIENCY: PATIENTS RECEIVE QUALITY CARE IN AN ALLIED PROFESSIONAL CARDIOVERSION PROGRAM THAT ALLEVIATES LAYERS OF SYSTEMIC STRAIN

Performance of electrical cardioversion (CV) for atrial fibrillation (AF) by allied professionals (APs) can reduce physician resource utilization and may be associated with greater efficiency without compromising patient safety. To demonstrate that a cardioversion service overseen and performed by APs is associated with improved efficiency and reduced physician utilization while maintaining patient safety. In July 2020, we initiated a protocol whereby electrophysiology APs were trained, privileged, and credentialed to independently perform CVs at our institution. Each AP performed ten supervised CVs and subsequently proceeded independently with periprocedural documentation, CV performance, coordination of care, and patient education for those referred to the program. An analysis was performed assessing a cohort of patients (randomly selected from 2018-2022) to compare the average patient length of stay and adverse events under the EP AP service vs the EP/Cardiologist service. Since the initiation of the AP CV protocol (from July 2020 to November 2022), there were 422 CVs performed by an AP out of 1,048 total CVs. A chart review was performed assessing a random cohort of 104 CVs from 2018-2022: 52 (50%) by APs and 52 (50%) by MDs. The average length of stay in the procedure suite for AP CV was 90.8±26.3min vs 114.1±33.5min when performed by a physician, representing a time savings of 23.3min per patient (p <0.01). In addition, the time from outpatient elective CV order to time of CV was 18.4±11.8 days for APs vs 19.4±12.5 days for physicians. There were no adverse events in any of the AP CVs. The APs involved in the CV service universally felt that this independent activity improved job satisfaction. Independent performance of CVs by APs is significantly more time efficient without compromise in patient safety. Additional benefits to the EP AP CV service include improved scheduling availability, easier coordination with anesthesia services, offloading of physician workload, and increased AP job satisfaction.

Cost consequences of task-shifting intravitreal injections from physicians to nurses in a tertiary hospital in Norway

BackgroundAnti-vascular endothelial growth factor is a medicine administered intravitreally by an injection to maintain visual acuity in patients with a variety of retinal diseases. The demand for this treatment has grown considerably in the westernized world the last two decades and will continue to increase due to an aging population. Because of the high volume, injections seize enormous resources and represent high costs for both hospitals and society. Task-shifting of injections from physicians to nurses may be a means to reduce such costs, however the magnitude of possible savings has been poorly investigated. To this end we investigated changes in the hospital costs per injection, six-year cost projections of physician- versus nurse-administered injections for a Norwegian tertiary hospital and we compared the societal costs per patient per year.MethodsPatients (n = 318) were randomized to either physician- or nurse administered injections, and data were prospectively collected. Hospital costs per injection were calculated as the sum of training costs, personnel time and running expenses. The number of injections for the years 2014 – 21 from a Norwegian tertiary hospital was combined with age group specific injection prevalence and population projections to calculate cost projections for 2022 – 27. Societal costs per patient were calculated as the sum of hospital costs, transport costs for patients, caregivers’ use of time, costs of ophthalmology consultations and community-based homecare.ResultsThe hospital costs per injection were 5.5 € higher for physicians compared to nurses (281.6 € versus 276.1 €). Cost projections estimated an annual hospital saving of task-shifting of 48 921 € for 2022 – 27. Societal costs per patient did not differ significantly between the two groups (mean 4988 € vs 5418 €, p = 0.398).ConclusionTask-shifting of injections from physicians to nurses can reduce hospital costs and increase the flexibility of physician resources. The annual savings are modest, but increased demand for injections might increase future cost savings. To achieve future savings for society, organizing ophthalmology consultations and injections on the same day to reduce the number of visits might be a solution.Trial registrationClinicalTrials.gov NCT02359149 (09/02/2015).

Report card on access to rural health care in Canada.

Canadians living in rural communities continue to experience challenges in accessing rural health care. The Rural Road Map for Action (RRM) was developed in February 2017 and provides a guiding framework for a coordinated, pan-Canadian approach to physician rural work force planning and improved access to rural health care. The Rural Road Map Implementation Committee (RRMIC) was formed in February 2018 to support the implementation of the RRM. The RRMIC was co-sponsored by the College of Family Physicians of Canada and the Society of Rural Physicians of Canada and had a broad membership that deliberately crossed sectors supporting the RRM's social accountability vision. In April 2021, the \"Rural Road Map: Report Card on Access to HealthCare in Rural Canada\" was discussed at a Society of Rural Physicians of Canada national forum. Next steps included: focusing on equitable access to rural health care service delivery; enhancing rural physician resource planning including national medical licensure and the adoption of more effective strategies for rural physician recruitment and retention; improving access to rural specialty care; supporting the work of the National Consortium on Indigenous Medical Education; and developing metrics as useful tools to facilitate change in rural health care, social accountability in medical education and provisions for supporting the delivery of virtual health care. Collaborative partnerships and commitments from all key stakeholders will be critical to addressing national and regional health work force needs. No one sector alone can fix the inequitable health care realities of people living in rural communities in Canada.

CHILDSTAR: CHIldren Living With Diabetes See and Thrive with AI Review.

Artificial intelligence (AI) appears capable of detecting diabetic retinopathy (DR) with a high degree of accuracy in adults; however, there are few studies in children and young adults. Children and young adults (3-26 years) with type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) were screened at the Dhaka BIRDEM-2 hospital, Bangladesh. All gradable fundus images were uploaded to Cybersight AI for interpretation. Two main outcomes were considered at a patient level: 1) Any DR, defined as mild non-proliferative diabetic retinopathy (NPDR or more severe; and 2) Referable DR, defined as moderate NPDR or more severe. Diagnostic test performance comparing Orbis International's Cybersight AI with the reference standard, a fully qualified optometrist certified in DR grading, was assessed using the Matthews correlation coefficient (MCC), area under the receiver operating characteristic curve (AUC-ROC), area under the precision-recall curve (AUC-PR), sensitivity, specificity, positive and negative predictive values. Among 1274 participants (53.1% female, mean age 16.7 years), 19.4% (n = 247) had any DR according to AI. For referable DR, 2.35% (n = 30) were detected by AI. The sensitivity and specificity of AI for any DR were 75.5% (CI 69.7-81.3%) and 91.8% (CI 90.2-93.5%) respectively, and for referable DR, these values were 84.2% (CI 67.8-100%) and 98.9% (CI 98.3%-99.5%). The MCC, AUC-ROC and the AUC-PR for referable DR were 63.4, 91.2 and 76.2% respectively. AI was most successful in accurately classifying younger children with shorter duration of diabetes. Cybersight AI accurately detected any DR and referable DR among children and young adults, despite its algorithms having been trained on adults. The observed high specificity is particularly important to avoid over-referral in low-resource settings. AI may be an effective tool to reduce demands on scarce physician resources for the care of children with diabetes in low-resource settings.

945. Development of Antimicrobial Stewardship Programs in Central and South America

Abstract Background There is a need to assess current development of hospital Antimicrobial Stewardship Programs (ASPs) in Latin America. Methods Cross-sectional evaluation of ASPs using a standardized and previously validated self-assessment tool derived from the Centers for Disease Control and Prevention Core Elements of Antibiotic Stewardship (AS). The assessment was deployed to 40 hospitals in Panama, Guatemala, Ecuador, Colombia, and Argentina in 3/2022 through a regional research network. The assessment included 94 questions, with each question including a graded response (meets criteria, partially meets criteria, does not meet criteria, and in some, not applicable). Results 22 public and 16 private hospitals completed the assessment (95% response rate), 10% and 25% of which were small hospitals (&amp;lt; 110 beds), respectively. 82% were academic, and all have an Infection Prevention and Control program/committee. &amp;gt;70% of ASPs have a physician and pharmacist involved, although 65% reported no salary support for AS activities. Only 13% and 29% of AS pharmacists and physicians, respectively, met recommended full-time equivalent/bed ratios; and 76% lacked information and technology (IT) support. 50% indicated the AS committee did not meet regularly, and another 50% reported not including non-AS physicians in the committee. Most hospitals have implemented prior-authorization and post-prescription review and feedback, with much fewer reporting a process to alert of duplicate therapy and use of auto-stops. 89% reported regular access to new antibiotics. While most hospitals monitor antibiotic consumption, few evaluate trends and/or appropriateness of use. Treatment guidelines for most common infections were missing in up to 50% of hospitals, especially in public hospitals. Most respondents indicated their hospitals promote teamwork, and in the vast majority, recommendations from AS are valued. Stratification of results by private and public hospitals in Table. Table:Results of a self-assessment of antimicrobial stewardship activities at the facility level in 38 hospitals in Latin America. Conclusion We found several opportunities for improvement, which differed between private and public hospitals. Common barriers to both settings include access to IT support; better pharmacist and physician resource allocation, education, and monitoring of process and outcomes measures. Disclosures Sara E. Cosgrove, MD, Basilea: Member of Infection Adjudication Committee.

Paramedic Clinical Consults with a Paramedic or Nurse in an EMS Communications Center Compared to Traditional Online Physician Consults

Objectives In many emergency medical services (EMS) systems, a direct medical oversight physician is available to paramedics for mandatory and/or elective consultations. At the time of this study, a clinical support desk (CSD) was being implemented within the medical communications center of a provincial EMS system in addition to the physician resource. The CSD was initially staffed with a registered nurse or an advanced care paramedic. The objective of the current study was to compare CSD “peer to peer” consults versus physician consults with regards to consultation patterns, transport dispositions, and patient safety measures. Methods This retrospective cohort study analyzed 2 months before (September 1 to October 31, 2012) and 2 months after (September 1 to October 31, 2013) implementation of the CSD. In the before period, all clinical consults were fielded by the direct medical oversight physician. In the after period, consults were fielded by the physician, CSD or both. EMS databases were queried, and manual chart review and abstraction of audio recordings were done. Relapses back to EMS within 48 hours of non-transport were measured. Results 1621 consults were included, with 764 consults in the before period and 857 after (p = 0.02). The number of physician consults decreased from 764 before to 464 after (39.2%, p < 0.001), with the CSD taking 325 (37.9%) consults. The CSD was consulted more for police custody and trip destination. The physician was consulted more for cease resuscitation and clinical consults prior to medication administration. Overall non-transport rates were 595/764 before (77.9%), and 646/857 after (75.4%) (p = 0.2). Non-transports were 233/325 (71.7%) via the CSD, 364/464 (78.4%) via the physician, and 49/68 (72.1%) when both were involved (p = 0.07). Rate of relapse to EMS was similar before (25/524, 4.8%) and after (26/568, 4.6%) (p = 0.76), and between CSD (12/216, 5.5%) and physician consults (13/325, 4.0%) in the after period (p = 0.41). Conclusion The introduction of a novel “peer-to-peer” consult program was associated with an increased total number of consults made and reduced call volume for direct medical oversight physicians. There was no change in the patient safety measure studied.