Department Physicians Research Articles

Video quality of nonalcoholic fatty liver disease on TikTok: A cross-sectional study.

The short-video application TikTok shows great potential for disseminating health information. We assessed the content, sources, and quality of information in videos related to nonalcoholic fatty liver disease (NAFLD) on TikTok. Our study aims to identify upload sources, content, and characteristic information for NAFLD videos on TikTok and further evaluate factors related to video quality. We investigated the top 100 videos related to NAFLD on TikTok and analyzed the upload sources, content, and characteristics of these videos. Evaluate video quality using the DISCERN tool and Global Quality Score (GQS). In addition, the correlation between video quality and video characteristics is further studied. In terms of video sources, the majority of NAFLD videos on TikTok (85/100, 85%) were posted by doctors, ensuring the professionalism of the content, and among the video content, disease knowledge was the most dominant video content, accounting for 57% (57/100) of all videos, and the average DISCERN and GQS scores of all 100 videos were 39.59 (SD 3.31) and 2.99 (SD 0.95), respectively. DISCERN and GQS data show that videos related to NAFLD do not have high-quality scores on TikTok, mainly fair (68/100, 68%) and moderate (49/100, 49%). In general, the quality of NAFLD video information from professional content and professional sources was higher than that of nonprofessional sources and nonprofessional content, the video quality of general surgeons was better than that of other department physicians, and the video quality of junior physicians was better than that of senior physicians. In terms of video correlation, durations, the number of fans, and the total number of works were negatively correlated with DISCERN scores (R < 0, P < .05), while likes, comments, collections, shares, and days since upload were not significantly correlated with DISCERN and GQS scores (P > .05). The medical information on TikTok is not rigorous enough to guide patients to make accurate judgments, platforms should monitor and guide publishers to help promote and disseminate quality content.

Trends in Individual Career Development Awards from National Institutes of Health to Physicians in Departments of Psychiatry (2013-2022).

The authors examined trends of individual career development awards from the National Institutes of Health (NIH) to psychiatry faculty, especially physicians, in comparison to other departments. Data were obtained on 33,392 career development awards from 2013 to 2022. We examined the number of awards each year averaged for 46 non-psychiatry departments, and for departments of psychiatry, the number of awards to all faculty, physicians, and physicians without a PhD. Linear regressions determined whether number of career development awards increased with time and if estimated slopes differed between faculty in non-psychiatry departments and other groups. In departments of psychiatry, 534 faculty received an NIH individual career development award during the 10-year period (534/33,392 or 1.6%), with 118 (22%) to physicians. The number of awards increased significantly over time for other departments and departments of psychiatry (estimated slopes of 3.05 and 2.38, respectively) and did not differ from one another. However, the number of awards to physicians and physicians without a PhD in departments of psychiatry (estimated slopes of 0.51 and - 0.07, respectively) have not increased. This lack of growth in awards for physicians and physicians without a PhD in departments of psychiatry differed significantly in comparison with the increase shown in awards to other departments over time (both p < 0.001). The number of NIH career development awards has increased NIH-wide, and for non-physician faculty but not for physicians in departments of psychiatry. These trends raise concerns for the future of psychiatrists in academic research.

Assessing the knowledge, attitude, and practice of frontline physicians in Egyptian university hospitals regarding pharyngitis and acute rheumatic fever: a cross-sectional study that calls for action

BackgroundAcute rheumatic fever (ARF) and rheumatic heart disease (RHD) remain major public health issues. Although the primary and secondary prevention of RHD through appropriate management of bacterial pharyngitis and ARF are well-described in the literature, few studies address the knowledge, attitude, and practice (KAP) of developing countries. We aimed to evaluate the KAP of the frontline physicians in Egyptian university hospitals regarding pharyngitis and ARF.MethodsWe employed a cross-sectional design between September 1st, 2022, and January 31st, 2023 using a self-administered questionnaire in 21 Egyptian universities. The questionnaire was developed based on previous studies and recent guidelines and included four domains: sociodemographic data, knowledge, attitude, and practice regarding pharyngitis and ARF. We utilized both online (Google Forms) and paper surveys. Frontline physicians, including interns, residents, and assistant lecturers, were conveniently invited to participate. Furthermore, with the help of participating phycisians in recruiting their colleagues, we utilized the snowball method. Data were analyzed using IBM SPSS version 27 software.ResultsThe final analysis included 629 participants, of whom 372 (59.1%) were males and 257 (40.9%) had direct contact with ARF patients. Most participants (61.5%) had a fair knowledge level while 69.5% had a fair level of practice regarding ARF and pharyngitis. Higher satisfactory knowledge levels were noted regarding pharyngitis (17.1% vs. 11.3%; p-value: 0.036) and ARF (26.8% vs. 18%; p-value: 0.008) among physicians dealing directly with ARF cases compared to physicians in departments not dealing directly with ARF cases. Physicians in Cairo region universities had significantly higher levels of satisfactory knowledge about ARF compared to Delta and Upper Egypt region universities (p = 0.014). Delta region universities showed significantly lower levels of practice compared to Cairo and Upper Egypt region universities (p = 0.027). The most frequently recognized barriers against health promotion were low socioeconomic status (90.3%) and lack of adequate public education (85.8%).ConclusionsDespite the fair knowledge and practice levels towards bacterial pharyngitis and ARF among participants, many gaps were still identified that might contribute to RHD prevalence. Educational interventions should be implemented by updating the local guidelines in Egypt for diagnosis and management based on the most recent guidelines.

Application of the combination of CBL teaching method and SEGUE framework to improve the doctor-patient communication skills of resident physicians in otolaryngology department

BackgroundTo explore the feasibility and effectiveness of applying CBL teaching method and SEGUE Framework in the doctor-patient communication skills of resident physicians in the department of otolaryngology.MethodsThis is an observational study to compare the score changes in doctor-patient communication skills of 120 resident physicians, before and after using CBL combined SEGUE Framework teaching method. The effects of gender, age, grade, educational background and marital status on SEGUE score were analyzed.ResultsThrough the combined application of CBL teaching method and SEGUE Framework, the SEGUE score of 120 resident physicians was significantly improved. There was no significant difference in SEGUE score among different sex and marital status of resident physicians. SEGUE score is positively correlated with age; Different grades and educational backgrounds have significant effects on SEGUE score.ConclusionThe combination of CBL teaching method and SEGUE Framework is feasible and effective in the education program of doctor-patient communication skills for resident physicians in the department of otolaryngology, and worthy of popularization and application in other medical specialties.

Group peer mentoring to improve faculty connections and enhance mentoring networks.

Difficulty finding mentors and forging connections in academic departments can be challenging and became even more so when the COVID-19 pandemic reduced opportunities for informal networking. Even as restrictions on in-person meetings eased, many faculty preferred meetings to remain virtual. Because some of the most powerful predictors of faculty vitality are positive professional relationships and feelings of inclusion and belonging to an institution, attending to faculty needs in this area is important to mitigate undesired lingering consequences. We created structured peer mentoring groups for our department's physicians and psychologists that meet virtually. Groups span career stages, academic appointments and clinical interests. The purpose was to establish a deeper culture of mentoring, increase feelings of connection to a supportive community within the department, facilitate career planning and enhance the development of skills necessary in academic medicine such as teaching skills, scholarly productivity and personal wellness. A survey conducted after the first year of the programme was completed by 70% of eligible faculty (31/45). Ninety-six percent felt the programme had created an inclusive and appreciative culture, 86% met faculty members they had never met before and 79% sought mentoring advice from a colleague they would not usually have interacted with in that manner. All participants appreciated hearing their colleagues' perspectives on topics they do not typically discuss. Departmentally based group peer mentoring that spans career stages and interests can facilitate faculty connections and enhance a supportive culture of mentorship.

The institutional presence of music therapists in aphasia therapy in Hungary

Numerous international studies have reported on the relevance of music therapy for aphasia, but music-based therapy for the rehabilitation of acquired language and speech disorders is not common in the clinical practice of Hungary. The aim of our study is to provide insights into the composition of professional teams involved in aphasia care in active neurology and stroke wards and rehabilitation departments in Hungarian hospitals, with a special focus on the presence of music therapists. We are looking for the answer to why the employment of music therapists in hospitals is so low in our country. For our research, we selected the relevant institutions and departments from a list of hospitals on the website of the National Directorate General for Hospitals. Data were then collected from the websites of the hospital departments, supplemented or clarified with information from the head of department's physicians where necessary. None of the active neurology and stroke wards employ a music therapist. Two of the rehabilitation wards have a total of 4 music therapists. The low number of trained professionals in music therapy for aphasia is due to financial reasons, lack of professionals and lack of professional demand. Our research shows that music therapy is deeply underrepresented in the field of aphasia rehabilitation in Hungarian hospitals. The reasons for this are quite diverse and their elimination would require effective intervention in many areas. Orv Hetil. 2023; 164(19): 747-752.

Pediatric pain knowledge and attitudes among health care professionals-A National Danish Survey.

To explore and compare Danish health-care professionals' attitudes and knowledge towards pain management of children. The cross-sectional study was carried out using the Pediatric Pain Knowledge and Attitudes Questionnaire. The questionnaire was distributed to all health care professionals caring for children in three hospital settings, including nurses and physicians in departments of pediatric, emergency, and anesthesia and medical laboratory technologists. The study was conducted in 2020 and 765 health care professionals participated. Within the six main categories included in the questionnaire, there were significant differences between nurses and physicians in three subcategories: view on the care of children in pain, using drugs to relieve pain, and the four mandatories. Comparing nurses with medical laboratory technicians, there were significant differences in the subcategory "view on the care of children in pain." Comparing types of clinical departments, there were significant differences in the subcategories' view on the care of children in pain, using drugs to relieve pain, and the four mandatories. Overall, we found that the participating health professionals did not have a uniform understanding of pain management and therefore might treat children differently. The present study highlights the need to align health care professionals' knowledge regarding pain assessment and management of children, as well as the need to develop and test interventions that support the use of knowledge in practice.

Teen Advisory Council Survey's Factors Associated With Self-Harming Thoughts.

BackgroundThe evaluation of teens with self-harming thoughts (SHT) is a high-stakes task for physicians in community and emergency department (ED) settings. The lived experience of adolescents with stress and SHT provides an important source of insight for mental health professionals who evaluate and treat teens A snapshot of the lived experience of teens in northwest Louisiana was captured by the Step Forward Teen Advisory Council (TAC) in 2019. The TAC surveyed peers with the goal of identifying common stressors experienced by local teens in order to inform policy and practices in the local school system. The identification of stressors is a critical step in addressing SHT as adolescents who experience life stressors are at increased risk for self-harming thoughts (SHT), a known precursor to self-harm and suicide. Assessing youth for life stressors is a critical element of suicide prevention.MethodsLocal teens queried 5,070 peers attending Caddo Parish schools to better understand the stressors faced by high school students in Northwest Louisiana using a student developed survey. Results were presented to peers at a virtual summit where teens developed action items to reduce stress and presented findings to local leaders. Their efforts ultimately lead to increased supports for students in local schools.ResultsOver half of the teens surveyed reported stressors that negatively impacted their physical or emotional well-being. Students endorsing self-harming thoughts reported an average of 7.82 stressors as compared to 3.47 in peers without SHT. Teens with stressors at both home and school were more likely to experience SHT than teens with stressors in a single location.ConclusionThe Gen Z students who developed the TAC Survey identified stress as a major concern for teens in Northwest Louisiana. The TAC Survey data aligns local experience with established data regarding the association between stress, depression and SHT. Second, the results highlight the importance of diving deep to identify all stressors when assessing the risk of self-harm. Finally, the lived experience of local teens with SHT provides critical information for professionals to better understand risk for SHT and suicide in our region and beyond.

Impacts of racism on First Nations patients' emergency care: results of a thematic analysis of healthcare provider interviews in Alberta, Canada

BackgroundFirst Nations people experience racism in society and in the healthcare system. This study aimed to document emergency care providers’ perspectives on care of First Nations patients. First Nations research partner organizations co-led all aspects of the research.MethodsSixteen semi-structured interviews were conducted with Alberta emergency department (ED) physicians and nurses between November 2019 and March 2020.ResultsED providers reported that First Nations patients are exposed to disrespect through tone and body language, experience overt racism, and may be neglected or not taken seriously. They described impacts of racist stereotypes on patient care, and strategies they took as individuals to address patient barriers to care. Recognized barriers to care included communication, resources, access to primary care and the ED environment itself.ConclusionsResults may inform the content of anti-racist and anti-colonial pedagogy that is contextually tailored to ED providers, and inform wider systems efforts to counter racism against First Nations members and settler colonialism within healthcare.

A Pilot Study of the Efficacy and Economical Sustainability of Acute Coronavirus Disease 2019 Patient Management in an Outpatient Setting.

ObjectiveTo report a preliminary experience of outpatient management of patients with Coronavirus disease 2019 (COVID-19) through an innovative approach of healthcare delivery.Patients and MethodsPatients evaluated at the Mild-to-Moderate COVID-19 Outpatient clinics (MMCOs) of San Raffaele University Hospital and Luigi Sacco University Hospital in Milan, Italy, from 1 October 2020 to 31 October 2021 were included. Patients were referred by general practitioners (GPs), Emergency Department (ED) physicians or hospital specialists (HS) in case of moderate COVID-19. A classification and regression tree (CART) model predicting ED referral by MMCO physicians was developed to aid GPs identify those deserving immediate ED admission. Cost-effectiveness analysis was also performed.ResultsA total of 660 patients were included. The majority (70%) was referred by GPs, 21% by the ED and 9% by HS. Patients referred by GPs had more severe disease as assessed by peripheral oxygen saturation (SpO2), ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2), C-reactive protein (CRP) levels and interstitial involvement at lung ultrasound. Among them, 18% were addressed to the ED following MMCO assessment. CART analysis identified three independent predictors, namely home-measured SpO2, age and body mass index (BMI), that robustly divide patients into risk groups of COVID-19 severity. Home-measured SpO2 < 95% and BMI ≥ 33 Kg/m2 defined the high-risk group. The model yielded an accuracy (95% CI) of 83 (77–88)%. Outpatient management of COVID-19 patients allowed the national healthcare system to spare 1,490,422.05 € when compared with inpatient care.ConclusionMild-to-moderate COVID-19 outpatient clinics were effective and sustainable in managing COVID-19 patients and allowed to alleviate pressure on EDs and hospital wards, favoring effort redirection toward non-COVID-19 patients.

Workplace violence toward emergency medicine physicians in the hospitals of Taif city, Saudi Arabia: a cross-sectional survey

BackgroundWorkplace violence against health care workers is an emerging concern in various global health settings and the documentation of physical and verbal attacks against physicians in tertiary hospitals in Saudi Arabia is uncommon. This study aimed to determine the incidence of workplace violence against physicians in the emergency department of selected tertiary hospitals in Taif City, Saudi Arabia from June to July 2021. Associations between the incidence of violence and interventions and type of physicians and years of experience were also investigated.MethodologyUsing a cross-sectional design, a total of 96 physicians were recruited to answer the World Health Organization Questionnaire on Violence against Health Care Workers last June to July 2021.ResultsIt was found out that 75 physicians (78.1%) experienced verbal violence while 14 physicians (14.6%) experienced physical violence. Most of the workplace violence happened within hospital premises (84.4%). Despite having an experience of verbal and physical violence, only 44.8% of the respondents reported the incidents. The most common instigators were patients (55.21%), their relatives (78.00%), external colleagues (9.37%) and staff members (6.25%). Most respondents took no action, or reported the incidence to the police or senior staff member. The incidence of workplace violence and type of physician showed significant association. The number of years of practice in emergency medicine also exhibited statistically significant association with the incidence of verbal attack, frequency of violence, and location of incident.ConclusionThere is high incidence of workplace violence among physicians in tertiary hospitals, and younger physicians with less experience in emergency medicine were the most susceptible to both verbal and physical violence. There is a need to strengthen policies to protect physicians against workplace violence.

Asurvey among physicians in surgery and anesthesiology departments after the first surge of SARS-CoV-2 infections in Germany : Preparing for further challenges ahead.

BackgroundThe SARS-CoV‑2 pandemic has extensively challenged healthcare systems all over the world. Many elective operations were postponed or cancelled, changing priorities and workflows in surgery departments.AimsThe primary aim of this cross-sectional study was to assess the workload and psychosocial burden of surgeons and anesthesiologists, working in German hospitals during the first wave of SARS-CoV‑2 infections in 2020.MethodsQuantitative online survey on the workplace situation including psychosocial and work-related stress factors among resident and board-certified surgeons and anesthesiologists. Physicians in German hospitals across all levels of healthcare were contacted via departments, professional associations and social media posts.ResultsAmong 154 total study participants, 54% of respondents stated a lack of personal protective equipment in their own wards and 56% reported increased staff shortages since the onset of the pandemic. While routine practice was reported as fully resumed in 71% of surgery departments at the time of the survey, work-related dissatisfaction among responding surgeons and anesthesiologists increased from 24% before the pandemic to 36% after the first wave of infections. As a countermeasure, 94% of participants deemed the establishment of action plans to increase pandemic preparedness and strengthening German public health systems a useful measure to respond to current challenges.ConclusionThe aftermath of the first wave of SARS-CoV‑2 infections in Germany has left the surgical staff strained, despite temporarily decreased workloads. Overall, a critical review of the altered conditions is indispensable to identify and promote effective solutions and prudent action plans required to address imminent challenges.

Comparison of emergency department and psychiatry physicians’ views on decision-making capacity cases in the grey zone (eng)

Comparison of emergency department and psychiatry physicians’ views on decision-making capacity cases in the grey zone (eng)

Optimizing Physician’s Requirement in a Tertiary Care Hospital in India Using Erlang’s Method

The study has attempts to use ERLANG method to find out if a change is needed in the existing manpower with respect to physicians in various departments. The methodology involves calculating the time taken by the doctor of a selected department to carry out multiple activities like consultation of patients, performing minor or major surgeries, other procedures as per the requirement of the department by observation, interaction with staff and accessing required information from Hospital Information System for the departments of surgery, General Medicine, Orthopedics and Emergency Medicine.

An Innovative, Nurse-Led Service for Appropriate Management of Psychiatric Emergencies: Initial Findings.

The emergency department (ED) physicians working for the French Service d'Aide Medicale d'Urgence (SAMU) refer about 84% of individuals who contact SAMU for psychiatric problems to the psychiatric ED (PED), compared with only 20% of those calling with other medical emergencies. Physicians' lack of psychiatric knowledge may contribute to the high PED referral rate. The authors created a new psychiatric nurse-led service to improve the identification of psychiatric emergencies and assessed PED referrals and inpatient hospitalization rates before and after the new service commenced. After service implementation, the proportion of PED-referred patients fell from 84% to 38%, and inpatient hospitalization rates for those referred to the PED increased from 27% to 36%.

An Assessment of Work Environment Factors Correlating with Burnout Status of Physicians Employed with the Public Hospitals Authority in The Bahamas

Objective To identify the prevalence and factors associated with the Burnout Syndrome in physicians working in the Public Hospitals Authority (PHA), Nassau, Bahamas. Methods A cross-sectional study was done in 2014 utilising a self-administered survey comprising of demographics, general health, work environment, and Maslach Burnout Inventory items to assess burnout among physicians working in nine (9) departments of PHA. The IBM SPSS (v. 20.0 or more current) Statistical Analyses software was used for data analysis. Results The study participants were 153 physicians. Their mean age was 35.84 (± 7.09) years old; median 34.00 (IQR: 31.00, 40.00) years old, 99 (64.7%) were females. No associations were found among these, other socio-demographic variables measured and burnout status. Physicians in the department of Internal Medicine represented 34 (22.2%), Family Medicine 31 (20.3%), Emergency Medicine 30 (19.6%), Paediatrics 21 (13.7%), and physicians in other departments 34 (22.3%). Of the physicians employed under the PHA, 55.7% collectively exhibited burnout. Poor balance of family life, 15 work environment potential stressors and 4 potential stress relievers were found to each be weakly or very weakly related to burnout status. Postgraduate programme year, irregular sleep pattern and lack of appreciation were moderately strong positively related. Logistic regression analysis showed the key predictors of burnout status to be lack of appreciation (OR=1.69, p=.002) and number of years worked post-internship (OR=.94, p=.039). Conclusion: Physician’s sense of appreciation and number of years post internship were clear predictors of burnout.

Hepatitis B Virus Screening Before Cancer Chemotherapy in Taiwan: A Nationwide Population-Based Study.

Background: Reactivation of the hepatitis B virus (HBV) during cancer chemotherapy is a severe and sometimes fatal complication. In 2009, the National Health Insurance (NHI) in Taiwan recommended and reimbursed screening for HBV infection and prophylactic antiviral therapy before cancer chemotherapy. In this study, we determined the HBV screening rate in patients with cancer undergoing chemotherapy in Taiwan.Methods: We retrospectively collected data from the National Health Insurance Research Database on patients who received systemic chemotherapy for solid or hematologic cancers from January 2000 through December 2012. We defined HBV screening based on testing for serum HBsAg within 2 years of the first chemotherapy commencement. We calculated overall and annual HBV screening rates in all patients and subgroups of age, gender, cancer type, hospital level, physician's department, and implementation of NHI reimbursement for HBV screening before cancer chemotherapy.Results: We enrolled 379,639 patients. The overall HBV screening rate was 45.9%. The screening rates were higher in males, those with hematological cancer, those at non-medical centers and medical departments. The HBV screening rates before (2000–2008) and after the implementation of NHI reimbursement (2009–2012) were 38.1 and 57.5%, respectively (p < 0.0001). The most common practice pattern of HBV screening was only HBsAg (64.6%) followed by HBsAg/HBsAb (22.1%), and HBsAg/HBcAb/HBsAb (0.7%) (p < 0.0001). The annual HBV screening rate increased from 31.5 to 66.3% (p < 0.0001). The screening rates of solid and hematological cancers significantly increased by year; however, the trend was greater in solid cancer than in hematological cancer (35.9 and 26.2%, p < 0.0001).Conclusions: The HBV screening rate before cancer chemotherapy was fair but increased over time. These figures improved after implementing a government-based strategy; however, a mandatory hospital-based strategy might improve awareness of HBV screening and starting prophylactic antiviral therapy before cancer chemotherapy.

Abstract P856: Contributors to Internal Primary Stroke Center Transfer Delays: Factors Beyond Stroke Coordinators’ Control

Background: Stroke coordinators often are challenged to transfer patients to higher levels of care, facing internal system, transport, and comprehensive stroke center (CSC) factors that may slow the transfer process. We aimed to understand the internal challenges faced by stroke coordinators at primary stroke centers/acute stroke ready hospitals (PSC/ASRH) in the transfer process. Methods: Six national focus groups with PSC/ASRH staff experienced with stroke transfers were conducted by web conference. Interviews were conducted using pre-scripted open-ended questions; information was recorded and data were transcribed for theme identification. Results: Participants were from Northeast, Mid-Atlantic, Southeast, Midwest, and West Coast USA. Internal PSC/ASRH problems were tied exclusively to physicians: Emergency department (ED) physicians’ lack knowledge of how/when to order advanced imaging; delays initiating telemedicine guidance were common; and, negative attitudes towards stroke emergencies among “tenured” ED physicians were identified. All participants noted that they were compliant with door-to-noncontrast CT and alteplase treatment time metrics, however, radiologists commonly used the full 2-hours allotted for CTA and CTP reads, and many telemedicine neurologists refused to review/interpret advanced imaging choosing to rely on the local general radiologists’ formal interpretation. Conclusions: Major factors contributing to internal PSC/ASRH transfer delays are exclusively physician-based. Physician education, standardized algorithms for advanced imaging selection, more-timely regulatory metrics for advanced imaging interpretation, and improved telemedicine physician expertise and guidance would improve transfer timeliness in these centers.

Abstract P166: The Primary Stroke Center Transfer Experience to Higher Levels of Care: A Qualitative Study

Background: Transfer times from primary stroke centers/acute stroke ready hospitals (PSCs/ASRHs) to higher levels of care have been shown to be excessive in many cases, promoting some to believe that bypass regulations should be instituted. Yet barriers to rapid transfer remain undescribed in the literature. The purpose of this work is to investigate these issues and the locus of control for transfer time delays. Methods: Six national focus groups with PSC/ASRH staff experienced with stroke transfers were conducted by web conference. Interviews were conducted using pre-scripted open-ended questions; information was recorded, and data were transcribed, for theme identification. Results: Participants were from Northeast, Mid-Atlantic, Southeast, Midwest, and West Coast USA. Data were grouped into 3 main categories representing where transfer problems initiated. Themes emerging within the Internal PSC/ASRH Category were exclusively emergency department (ED) physician focused including knowing how/when to use advanced imaging and telemedicine resources. Of note, all participants were compliant with door-to-CT and treatment time metrics. Within the Transport Category , themes included inadequate time-to-response by ground and air ambulances, and specialty transport costs. Within the Internal Comprehensive Stroke Center (CSC) Category , themes included complex communication, overwhelmed systems, and poor guidance on patient selection. Conclusions: While ED physician contributors to transfer delays are within the control of PSCs/ASRHs, more challenging factors to rapid transfer include factors within transport systems and CSCs themselves. Quantification of these factors is warranted to support transfer system redesign with rapid access to care.

Abstract P117: Stroke-Nurse Triage: Effects on Time Metrics at a Regional Stroke Center

Introduction: Optimization of time metrics in the management of acute stroke is a priority. Nurses with special training in stroke management may contribute to enhanced delivery of care. This study analyzes the effects of initiating a nurse-led stroke triage program at a regional stroke center on time metrics of acute stroke. Methods: Registered nurses (RNs) who received specialized stroke training including NIHSS certification were designated to each presenting stroke code at our institution. The stroke RN was responsible for initial assessment, obtaining NIHSS, continued monitoring of the patient, and maintaining timely progression of care. Metrics including time from arrival to assessment by emergency department (ED) physician, assessment by a neurologist, head CT scan, the start of tissue plasminogen activator (tPA) administration, and puncture for mechanical thrombectomy were recorded. In retrospective review, stroke metrics 25 months prior to the start of the triage program (controls) and 23 months after the start of the program (cases) were analyzed. Results: 1,019 patients presented with symptoms of acute stroke during the study duration, with 293 presenting pre-program initiation and 796 presenting post-program initiation. No significant differences during this period were seen for primary outcomes of time from arrival to assessment by ED physician, CT scan, start of tPA administration, or groin puncture. A significant increase in time to assessment by a neurologist was observed (pre-program: 12.24 minutes, post-program: 17.42 minutes, p&lt;0.001). There was no difference before or after the program in Modified Rankin Scale (mRS) scores at discharge. Conclusions: Implementation of the stroke-nurse triage program involved the delegation of tasks previously under the responsibility of ED physicians to the stroke nurses. This delegation did not negatively impact care as determined by the lack of significant difference pre- and post-program for the primary metrics of arrival to CT, arrival to tPA, and arrival to groin puncture. Incorporating specially trained stroke-nurses in acute stroke management may be an appropriate use of personnel without negatively impacting stroke care.