Post-implementation Phase Research Articles

Curriculum Innovations: Enhancing Medical Student Neuroscience Training With a Team-Based Learning Curriculum

Background and Problem Statement Neurophobia, the fear of, discomfort with, and dislike of clinical neurology, is frequently due to poor experiences in preclinical neuroscience education among medical providers. We developed, implemented, and assessed a curricular innovation using clinician-educators and team-based learning (TBL) with the goals to demonstrate clinical relevance in neuropathology, enhance student engagement in neuropathology education, and promote direct application of knowledge. Methods and Curriculum Description We identified an underperforming neuropathology curriculum within the second-year medical student neuroscience course at the University of Rochester School of Medicine and Dentistry and implemented a traditional TBL curriculum to deliver this content. In addition, we transitioned to primarily clinician-led lectures in the neuropathology curriculum. We assessed student opinions of the curricular changes though end-of-course feedback, the implementation of a novel survey, and semistructured interviews with students. We assessed outcomes on the course final examination and overall course performance, comparing student performance in the preimplementation phase (year 2020–2021) with that in the postimplementation phase (year 2021–2022) using a 2-sample t test. Results and Assessment Student opinions of the curricular changes were positive on the end-of-course evaluation (79.4% rated TBL as good or excellent) and novel survey (89%–96% of students rated the portions of the curriculum positively). Themes identified in free text responses and through qualitative interviews included an appreciation of the streamlined course content and a sense that the various sessions within the neuropathology curriculum effectively reinforced learning. Student performance on the final examination was similar in the preimplementation vs postimplementation phases (81.2% correct vs 80.3% correct; p = 0.37). Performance on the neuropathology subsection of the final examination was also similar among the 2 cohorts (82.6% correct vs 83.9% correct; p = 0.36). Discussion and Lessons Learned We demonstrate the feasibility and utility of a transition to primarily neurologist and neurosurgeon-led lectures and the implementation of a TBL curriculum within a neuroscience course. While we report data from implementation at a single center, these results have potential relevance to other courses, given our demonstration that TBL is a useful method to deliver neuroscience learning, nonpathologist lecturers can effectively provide neuropathology education, and a small number of educational faculty can be engaged to deliver this material.

Applying Implementation Science Principles to Systematize High-Quality Care for Potentially Significant Imaging Findings

ObjectiveUse principles of implementation science to improve the diagnosis and management of potentially significant imaging findings. MethodsMultidisciplinary stakeholders codified the diagnosis and management of potentially significant imaging findings in eight organs and created a finding tracking management system that was embedded in radiologist workflows and IT systems. Radiologists were trained to use this system. An automated finding tracking management system was created to support consistent high-quality care through care pathway visualizations, increased awareness of specific findings in the electronic medical record, templated notifications, and creation of an electronic safety net. Primary outcome was the rate of quality reviews related to eight targeted imaging findings. Secondary outcome was radiologist use of the finding tracking management tool. ResultsIn the 4 years after implementation, the tool was used to track findings in 7,843 patients who received 10,015 ultrasound, CT, MRI, x-ray, and nuclear medicine examinations that were interpreted by all 34 radiologists. Use of the tool lead to a decrease in related quality reviews (from 8.0% to 0.0%, P < .007). Use of the system increased from 1.7% of examinations in the early implementation phase to 3.1% (+82%, P < .00001) in the postimplementation phase. Each radiologist used the tool on an average of 294.6 unique examinations (SD 404.8). Overall, radiologists currently use the tool approximately 4,000 times per year. DiscussionRadiologists frequently used a finding tracking management system to ensure effective communication and raise awareness of the importance of recommended future follow-up studies. Use of this system was associated with a decrease in the rate of quality review requests in this domain.

Mangrove Reforestation, Protection, and Conservation Initiatives: The Case of Sorsogon Bay Rompeolas, Philippines

Mangrove losses have been observed in several parts of the world including the Philippines despite its explicit directive through Republic Act 8550 or the Philippines Fisheries Code (PHILIPPINES, 1998) in ensuring the conservation, protection, and sustained management of the country’s fishery and aquatic resources. This qualitative research made use of a case study design at Sorsogon Bay Rompeolas through observation, field visits, and interviews to describe and evaluate the milestones and challenges encountered in the mangrove reforestation and protection initiatives among volunteer stakeholders. The study found out that the post-implementation (monitoring) phase of the project was the least participated activity while the project implementation phase was the fully participated activity of the different stakeholders involved in the project. Waste pollution, unsustained participation of residents, and natural calamities are the challenges encountered by the project. The Local Government Units (LGUs) in collaboration with the concerned national authorities may adopt blended infrastructure projects with the environmental protection program in the preservation and enhancement of the current state of the coastal ecosystem for future generations.

Towards Lean Manufacturing in Developing Countries: Research Gaps and Directions in Tanzania

In the current knowledge-driven economy, many industries across the globe are forced to adopt manufacturing technologies such as lean manufacturing to remain competitive in the globalized world. Despite the increase in lean manufacturing implementations, the adoption rate in Tanzania is very low and estimated to be 8 percent. Likewise, the sustainability of lean manufacturing tools and practices is still questionable, which shows the need to develop lean maturity models. To date, several lean maturity models have been developed but there is a lack of maturity models that consider different levels of manufacturing industries. The study presented in this paper focused on the pre-implementation, implementation, and post-implementation phases of lean manufacturing. To achieve this aim, a systematic literature review and social network analysis using VOS viewer 1.6.18 were conducted. The literature was obtained from four academic databases: Emerald, Elsevier, Springer, and Taylor and Francis. The search covered the period from 2010 to 2022. Of the 100 publications analyzed on lean manufacturing, only 1 percent is from low-income developing countries and 5 percent of publications from Africa. The study has identified that there are few numbers of research publications on lean manufacturing in Africa and low and lower-middle-income developing countries in general, as a result there is a low rate of implementation of lean manufacturing in low and lower-middle-income developing countries. It is recommended that more studies on the drivers and barriers, critical success factors, and lean assessment be conducted in developing countries.

Identifying individuals’ perceptions, attitudes, preferences, and concerns of shared autonomous vehicles: During- and post-implementation evidence

Shared autonomous vehicles (SAVs) have the potential to improve the efficiency, mobility, safety, and affordability of transportation systems; however, consumers will determine whether they can be successfully integrated into the current systems. This study aims to identify the perceptions, attitudes, preferences, and concerns of those who have and have not taken advantage of the AV technology by sharing the results of a self-driving technology demonstration in Arlington, Texas. A two-step approach was employed for this study: (a) quantitative analysis of a self-reported survey of SAV users and non-users who experienced SAVs on the road, and (b) a qualitative study of interviews conducted during the post-implementation phase of the project. The results from an ordinal logistic regression of a self-reported survey showed that the ease of using SAVs because of not having to worry about parking is positively associated with individuals' willingness to use them in the future. In contrast, concerns about possible confusion arising between human drivers and SAVs on the street decrease willingness to use SAVs. A qualitative analysis of interviews conducted on this subject indicated that waiting time, pick-up and drop-off locations, and the ability to make tight turns in intersections are the three major concerns. Potential riders anticipate that SAVs will be more cost-efficient, safer, and environmentally friendly than owner-operated vehicles. This study provides insights into the perceptions and attitudes of SAV users and non-users and identifies strategies for successfully integrating an SAV service with an existing on-demand ridesharing service, thereby enhancing future acceptance of the technology.

Hospital-acquired skin lesions in the neonatal intensive care unit: A retrospective analysis of temporal trends and quality improvement strategies

PurposeSkin lesions in neonatal population are an emerging problem deserving attention from health care professionals. The purpose of this study is to retrospectively assess the incidence of hospital-acquired skin lesions during a 6-year period and to describe the characteristics of infants who developed them. Design and methodsThis was a retrospective observational study conducted in a university-tertiary care center between 2015 and 2020. A descriptive analysis of the observed skin lesions is presented according to 2 time periods: 1) the implementation phase of a quality improvement program (2015–2019) and 2) the postimplementation phase (2020). ResultsOur findings showed an apparent increase in the incidence of all reported skin lesions throughout the study period. Pressure injuries were the most frequently reported skin lesions showing an increasing incidence over time which, however, was paralleled by a reduction in their severity. Among pressure injuries, device-related injuries were the most commonly observed (56.6% and 62.5% in the two periods, respectively) with nasal continuous positive airway pressure-related injuries accounting for 71.7% and 56.0% of lesions, respectively, and mainly affecting the nose root. The occipital area was the most frequently involved site in cases of conventional pressure injuries. ConclusionInfants admitted to Neonatal Intensive Care Units may be at high risk of developing skin lesions. The adoption of appropriate preventative as well as treatment interventions could be effective in reducing the severity of pressure injuries. Practice implicationsThe implementation of quality improvement strategies may contribute to prevent skin injuries or lead to their early detection.

Antibiotic de-escalation in pneumonia with pharmacist education and ordering of methicillin-resistant Staphylococcus aureus nasal swabs

IntroductionWhen methicillin-resistant Staphylococcus aureus (MRSA) is the causative pathogen in pneumonia, in-hospital mortality rate is approximately 31.2%. However, the occurrence of MRSA pneumonia is uncommon, with a reported incidence of...

Improving medication safety in a paediatric hospital: a mixed-methods evaluation of a newly implemented computerised provider order entry system

ObjectivesComputerised provider order entry (CPOE) systems have been implemented around the world as a solution to reduce ordering and transcription errors. However, previous literature documented many challenges to attain this...

Effect of apneic oxygenation with intubation to reduce severe desaturation and adverse tracheal intubation-associated events in critically ill children

BackgroundDetermine if apneic oxygenation (AO) delivered via nasal cannula during the apneic phase of tracheal intubation (TI), reduces adverse TI-associated events (TIAEs) in children.MethodsAO was implemented across 14 pediatric intensive care units as a quality improvement intervention during 2016–2020. Implementation consisted of an intubation safety checklist, leadership endorsement, local champion, and data feedback to frontline clinicians. Standardized oxygen flow via nasal cannula for AO was as follows: 5 L/min for infants (< 1 year), 10 L/min for young children (1–7 years), and 15 L/min for older children (≥ 8 years). Outcomes were the occurrence of adverse TIAEs (primary) and hypoxemia (SpO2 < 80%, secondary).ResultsOf 6549 TIs during the study period, 2554 (39.0%) occurred during the pre-implementation phase and 3995 (61.0%) during post-implementation phase. AO utilization increased from 23 to 68%, p < 0.001. AO was utilized less often when intubating infants, those with a primary cardiac diagnosis or difficult airway features, and patient intubated due to respiratory or neurological failure or shock. Conversely, AO was used more often in TIs done for procedures and those assisted by video laryngoscopy. AO utilization was associated with a lower incidence of adverse TIAEs (AO 10.5% vs. without AO 13.5%, p < 0.001), aOR 0.75 (95% CI 0.58–0.98, p = 0.03) after adjusting for site clustering (primary analysis). However, after further adjusting for patient and provider characteristics (secondary analysis), AO utilization was not independently associated with the occurrence of adverse TIAEs: aOR 0.90, 95% CI 0.72–1.12, p = 0.33 and the occurrence of hypoxemia was not different: AO 14.2% versus without AO 15.2%, p = 0.43.ConclusionWhile AO use was associated with a lower occurrence of adverse TIAEs in children who required TI in the pediatric ICU after accounting for site-level clustering, this result may be explained by differences in patient, provider, and practice factors.Trial Registration Trial not registered.

Waitlist mortality in pediatric liver transplantation: The goal is zero.

Waitlist mortality in pediatric liver transplantation: The goal is zero.

Waitlist mortality of young patients with biliary atresia: Impact of allocation policy and living donor liver transplantation.

Patients with biliary atresia (BA) below 2 years of age in need of a transplantation largely rely on partial grafts from deceased donors (deceased donor liver transplantation [DDLT]) or living donors (living donor liver transplantation [LDLT]). Because of high waitlist mortality in especially young patients with BA, the Eurotransplant Liver Intestine Advisory Committee (ELIAC) has further prioritized patients with BA listed before their second birthday for allocation of a deceased donor liver since 2014. We evaluated whether this Eurotransplant (ET) allocation prioritization changed the waitlist mortality of young patients with BA. We used a pre-post cohort study design with the implementation of the new allocation rule between the two periods. Participants were patients with BA younger than 2 years who were listed for liver transplantation in the ET database between 2001 and 2018. Competing risk analyses were performed to assess waitlist mortality in the first 2 years after listing. We analyzed a total of 1055 patients with BA, of which 882 had been listed in the preimplementation phase (PRE) and 173 in the postimplementation phase (POST). Waitlist mortality decreased from 6.7% in PRE to 2.3% in POST ( p = 0.03). Interestingly, the proportion of young patients with BA undergoing DDLT decreased from 32% to 18% after ET allocation prioritization ( p = 0.001), whereas LDLT increased from 55% to 74% ( p = 0.001). The proportional increase in LDLT decreased the median waitlist duration of transplanted patients from 1.5 months in PRE to 0.85 months in POST ( p = 0.003). Since 2014, waitlist mortality in young patients with BA has strongly decreased in the ET region. Rather than associated with prioritized allocation of deceased donor organs, the decreased waitlist mortality was related to a higher proportion of patients undergoing LDLT.

Factors Impacting the Behavioral Intention to Use Social Media for Knowledge Sharing: Insights from Disaster Relief Practitioners

Aim/Purpose: The primary purpose of this study is to investigate the factors that impact the behavioral intention to use social media (SM) for knowledge sharing (KS) in the disaster relief (DR) context. Background: With the continuing growth of SM for KS in the DR environment, disaster relief organizations across the globe have started to realize its importance in streamlining their processes in the post-implementation phase. However, SM-based KS depends on the willingness of members to share their knowledge with others, which is affected by several technological, social, and organizational factors. Methodology: A survey was conducted in Somalia to gather primary data from DR practitioners, using purposive sampling as the technique. The survey collected 214 valid responses, which were then analyzed with the PLS-SEM approach. Contribution: The study contributes to an understanding of the real-life hurdles faced by disaster relief organizations by expanding on the C-TAM-TPB model with the inclusion of top management support, organizational rewards, enjoyment in helping others, knowledge self-efficacy, and interpersonal trust factors. Additionally, it provides useful recommendations to managers of disaster relief organizations on the key factors to consider. Findings: The findings recorded that perceived usefulness, ease of use, top management support, enjoyment in helping others, knowledge self-efficacy, and interpersonal trust were critical factors in determining behavioral intention (BI) to use SM-based KS in the DR context. Furthermore, the mediator variables were attitude, subjective norms, and perceived behavioral control. Recommendations for Practitioners: Based on the research findings, it was determined that management should create different discussion forums among the disaster relief teams to ensure the long-term use of SM-based KS within DR organizations. They should also become involved in the discussions for disaster-related knowledge such as food supplies, shelter, or medical relief that disaster victims need. Disaster relief managers should consider effective and adequate training to enhance individual knowledge and self-efficacy since a lack of training may increase barriers and difficulties in using SM for KS during a DR process. Recommendation for Researchers: The conceptual model, further empirically investigated, can be employed by other developing countries in fostering acceptance of SM for KS during disaster relief operations. Impact on Society: Disaster relief operations can be facilitated using social media by considering the challenges DR practitioners face during emergencies. Future Research: In generalizing this study’s findings, other national or global disaster relief organizations should consider, when applying and testing, the research instruments and proposed model. The researchers may extend this study by collecting data from managers or administrators since they are different types of users of the SM-based KS system.

Post-realization phase of an interior green wall: A case study

One of the popular modern ways to bring greenery back into interiors are interior green walls, which are also known as vertical gardens. Along with the increase in awareness of green walls, their technical solutions are also increasing and their innovation is progressing rapidly. In recent years, green walls have rapidly moved from the simplest walls with the need for mechanical service to maintenance-free walls connected to the digital environment using various sensors. The contribution is focused on the inputs of monitoring in the post-implementation phase of the interior green wall located on the premises of the Technical University in Košice. The goal of the monitoring is to define the inputs for the transition to digitized maintenance of the green wall. The article analyses of the inputs of 3-month monitoring of a green wall with simple manual maintenance. At the end of the paper, the requirements for setting up a digital device ensuring suitable conditions for the sustainability of green construction are specified.

Effectiveness Of Multifaceted Care Bundle Approach To Reduce Device Associated Infection (Dai) In Critical Care Unit (Ccu) In A Multi Specialty Hospital, Mangaluru

Device-associated infections (DAI) can cause major medical and economic sequelae. Multifaceted care bundle is considered as an important part of routine nursing activity, not only as a measures DAI prevention, but as a crucial treatment with a profound effect on the patients general health.&#x0D; Objectives&#x0D; &#x0D; To measure the Device associated infection status of CLABSI, CAUTI, and VAP in pre implementation phase according to HAI surveillance guidelines.&#x0D; To determine the compliance status of health care workers of care bundles on prevention and care of device associated infections in CCU in Phase III.&#x0D; To evaluate the effectiveness of multifaceted care bundle approach on device associated infections status of CLABSI, CAUTI, &amp; VAP in CCU&#x0D; To find the risk of DAI in patients in the Post implementation phase (Phase III)&#x0D; &#x0D; Methods: An experimental approach was adopted to study the effectiveness of multifaceted care bundle approach to reduce device associated infection (DAI) in critical care unit (CCU) in a multispecialty hospital, Mangaluru. Universal sampling technique was adopted to select the 472 sample retrospectively (MRD and HIC records of DAI patients of critically care units) and 409 samples as prospectively (current critically ill patients) then implementation of bundle was done and post implementation evaluation done.&#x0D; Results: While comparing pre and post implementation phases, it is found that there was reduction in CAUTI rate /1000 catheter days and CLASBI rate/1000 central line days from Phase I to phase III and increase in VAP rate /1000 ventilator days from Phase I to phase III. Increase in device utilization ratio of CAUTI and CLASBI from Phase I to III and reduction in VAP device utilization ratio from Phase I to III, also observed that during pre-implementation phase, the VAP rate, CLABSI rate and CAUTI rate for all the ICU’s taken together were 134.37/1000 ventilator days, 412/1000 central line days, and 332.92/1000 urinary catheter days, respectively. However, during the post implementation the rates reduced into 133.92, 287.98, and 242 per 1000 device days respectively. There was a month wise decreasing trend of VAP rate, CLABSI rate, and CAUTI rate during the study period.&#x0D; In males CAUTI, CLABSI AND VAP rates were reported highest in the both Phases (I and III) and CAUTI, CLABSI and VAP difference in both Phases was not statistically significant according to age and gender (p=0.500) .Highest number of CAUTI was reported in Phase I compared to Phase III .Total number of device days were more (352) for CAUTI whereas 340 ventilator days for VAP, 292 central line days in the Phase I. While comparing both Phases significant difference was found in CAUTI (0.0017) CLASBI (0.002) and VAP (0.0016 ).&#x0D; Conclusion: From the findings of the study it can concluded that multifaceted care bundle significantly reduced DAIs in critically ill patients

359. The Clinical Utility of the GenMark Dx ePlex® Fungal Blood Culture Identification Panel

Abstract Background The GenMark ePlex® Fungal Blood Culture Identification (BCID) Panel utilizes electrowetting technology to detect 15 most common causes of fungemia. Rapid identification of fungal species and innate resistance patterns enable improved antifungal stewardship. Methods In this prospective study, aliquots of the initial diagnostic blood culture bottle with fungal organisms detected on Gram Stain (n=61) received standard of care (SOC) fungal identification in two study periods. MALDI-TOF MS was utilized in both phases. BCID-FP results were not reported to treating clinicians during the pre-implementation phase. After 35 isolates, BCID-FP results became part of the SOC for all bloodstream infections (implementation phase) with results available to providers. Chart reviews were performed to assess risk factors for candidemia and evaluate the potential then actual impact of the BCID-FP on the time to organism identification, treatment, and patient outcomes. Results A total of 61 patients were included in the final analysis, 35 in the pre-implementation phase and 26 in the post-implementation phase (Table 1). C. albicans was most common, followed by C. glabrata and C. parapsilosis. The cohort includes two cases of Cryptococcus as well as two rare yeasts unable to be identified by BCID-FP and requiring the state lab identification (Table 2). Overall outcomes and differences between groups are seen in Table 3. The BCID-FP identified species 1.4 days faster compared to SOC methods across all patients, 1.12 days in the pre-implementation phase vs. 1.81 days in the post-implementation phase. In 32 patients (52%), the BCID-FP allowed for an earlier change in antifungal therapy for species with known low risk of fluconazole resistance. Conclusion The BCID-FP enabled earlier fungal identification compared to SOC identification. Earlier identification allows for earlier antifungal stewardship as well as better empiric therapy for non-Candida­ fungal pathogens. Empiric therapy rates were low with high mortality rates, indicative of an ongoing need for improving the care of patients with fungemia. Disclosures Todd P. McCarty, MD, GenMark Dx: Grant/Research Support|GenMark Dx: Honoraria Sixto M. Leal, Jr., MD, PhD, GenMark Dx: Grant/Research Support|GenMark Dx: Honoraria.

722: POKE PLAN: A QI INITIATIVE TO REDUCE PAIN AND ANXIETY IN PEDIATRIC PATIENTS WITH NEEDLE INSERTIONS

Introduction: Adequate control of pain and anxiety during intravenous cannula (IV) placement improves patient satisfaction and reduces medical traumatic stress in children. We aimed to improve the overall experience of needle sticks in children by implementing a year-long multidisciplinary quality improvement project (“The Poke Plan”). Our primary aim was to increase the involvement of child life and use of pediatric pain mitigation strategies by 60% in all hospitalized children. Our secondary aim was to improve patient and parental satisfaction. Methods: A multidisciplinary team was assembled to improve our screening process for difficult IV access in patients on admission and the development of a poke plan pathway. 9 PDSA cycles focused on extensive nursing education, improved documentation, easy access to local pain medication, family involvement and feedback with child life, and weekly updates. Our process measure was the use of poke plan pathway. Balancing measures included increased workload for PIV placement experts. Results: During the study period, 773 patient charts were reviewed (78 pre-intervention [12/20 -04/21] and 695 post-intervention [04/21-07/22]). Compliance with the pain mitigation and distraction strategies increased from 16 – 20% in preintervention phase to > 60% in post implementation phase. The utilization of expert staff increased from 2% to 6%. HCAHPS scores for pain control improved from an average of 73.78% in 2020 to 82.6% in 2021/2022. Process stability of pain mitigation strategies was measured using a control chart. During the first 4 PDSA cycles, there was a significant shift above the center line which was transiently sustained (p=0.001). These cycles included nursing education, ultrasound training, and implementation of a poke plan algorithm. There was then a downward trend back below the center line. Further strategies included weekly huddles and a competition between the units to encourage poke plan usage. Another significant trend upward was observed (p=0.002) following resident education, update of the order sets, and EMR integration. Conclusions: Standardized poke plan pathway including early evaluation, timely team communication, proper preparation and targeted approach can lead to reduction in discomfort with IV access with better patient satisfaction.

Development and implementation of a laboratory monitoring dashboard to reduce treatment gaps in inflammatory bowel disease.

Patients receiving biologic therapy for inflammatory bowel disease (IBD) require routine laboratory monitoring to ensure the safety and efficacy of therapy. The purpose of this quality improvement project was to evaluate the implementation of a dashboard to prevent treatment gaps by prospectively identifying patients with IBD and outdated laboratory results receiving biologics. We performed a pre/post analysis of dashboard implementation to assess the number of patients with overdue laboratory work resulting in treatment gaps. The dashboard combined data from the electronic health record (EHR) and pharmacy claims database to identify patients on a biologic with laboratory tests (white blood cell count, liver transaminases, C-reactive protein, and erythrocyte sedimentation rate) completed 5 or more months ago and/or a tuberculosis screen completed 11 or more months ago. After implementation, specialty pharmacists reviewed the dashboard and communicated via EHR if a new prescription and laboratory tests were needed. Messages were sent 4 weeks in advance of the next refill-eligible date. Mixed methods were used for analysis of qualitative data, including surveys, and quantitative data, assessing treatment gap length. A total of 40 patients who had outdated laboratory values and required a new prescription (15 before dashboard implementation and 25 after implementation) were included in the analysis. The frequency of a treatment gap decreased from 80% (n = 12) in the preimplementation phase to 32% (n = 8) in the postimplementation phase. The median gap length was shorter after dashboard implementation, decreasing from 21 days (range, 3-97 days) to 11 days (range, 2-23 days). Utilization of a quality measures dashboard decreased treatment gaps in patients with IBD receiving biologic therapy. Integrated specialty pharmacists are uniquely positioned to monitor adherence to laboratory monitoring parameters for patients on biologics.

Understanding Clinician's Experiences with Implementation of a Younger Onset Dementia Telehealth Service.

The successful implementation of telehealth services depends largely on clinician acceptance of telehealth as a viable healthcare option and their adoption of telehealth methods into their clinical practice. While growing research supports the feasibility of telehealth services, no research has evaluated clinicians' experiences during the implementation of a younger onset dementia telehealth service. Semi-structured group interviews were conducted with 7 metropolitan (hub) clinicians and 16 rural (spoke) clinicians during the pre-and post-implementation phases of a novel Younger onset dementia (YOD) telehealth service. Reflexive thematic analysis identified five themes at pre-implementation: clinical need, previous experiences and views, potential telehealth barriers, solutions to potential telehealth barriers, and potential clinical outcomes. At post-implementation, nine themes were identified: clinical need, clinical relationships, concerns about the future of rural healthcare, clinical practice and resourcing factors, patient suitability, difficulties with technology, service quality, the way forward, and the impact of COVID-19. Most clinicians held positive views regarding the service, particularly the ability to provide more options to rural-dwelling patients. However, some concerns about threats to rural healthcare and the validity of telehealth assessments remained. Overall, this study has identified service implementation barriers and facilitators and contributes to the long-term sustainability of current and future telehealth YOD services.

Evaluation of Automated Alert and Activation of Medical Emergency Team in Head and Neck Cancer Patients Using Early Warning Score at Tertiary Level Hospital in North India.

Improved patient safety for those undergoing treatment of head and neck cancers depends on prompt identification of warning indicators from severely critical patients and appropriate treatment. As a result, many hospitals all around the world have implemented quick response techniques, including medical emergency teams (MET), which have systems and personnel that are highly trained to deal with patients who are deteriorating. Nowadays, automated activation and alert programs are also being discussed. To compare the patient outcomes in two conditions: one before the application of the automated MET alert and activation program and the other after the application of the automated MET alert and an activation programwas used. There was an examination of clinical data on MET-managed patients before and after the computerized alert and activation approach was put in place. The study comprised all adult head and neck cancer patients who were treated by the MET between March 1, 2017, and December 31, 2021. The physiologic abnormalities of the patient at the moment of the MET initiation were recorded as causes for MET activation when the MET was alerted by the computerized alert, and activation system.From activation through deactivation, the MET intervention lasted. Hospital mortality served as the study's primary outcome. The duration of stay at the hospital and unscheduled ICU hospitalizations were secondary outcomes. Medical records from hospitals were examined retrospectively to get information on clinical outcomes. The percentage of unplanned admissions in ICU was greater in the pre-implementation stage (22.34%) as compared to that in the post-implementation stage (13.56%) (p value<0.001). The duration of stay of patients at the hospital also got reduced in the post-implementation phase (13.23 ±1.47 days) as compared to the pre-implementation stage (24,76± 1.12 days) (p<0.001). The median time of derangement of activation of MET was greater in the pre-implementation stage (62 minutes) as compared to the post-implementation stage (34 minutes) (p-value <0.001). The most common complications leading to MET activation in a pre-implementation phase were neurological and respiratory complications. On the other hand, overall deterioration was the most common cause of MET activation. The mortality rate of patients in the pre-implementation stage was 36.23% as compared to 22.12% in the post-implementation stage (p<0.001). The hospital experienced improved clinical outcomes with the adoption of an automated alarm and activation system using a cumulative weighted scoring methodology, which significantly reduced the time from disruption to MET activation.

Long-term alterations of ERP systems: lasting through relinquishment and regeneration

PurposeThis paper highlights how technical devices last in organizations. Instead of focusing on the usual implementation or short-term post-implementation phases, this study aims to explore what happens to established technical devices.Design/methodology/approachThe authors build on a 10-year in-depth longitudinal case study examining a CRM package, a type of Enterprise Resource Planning system specialized in customer relationship management, in a door-drop advertising company. This case is based mainly on 35 interviews and four weeks of non-participant observation, made over three different periods.FindingsDrawing on the literature on drift and maintenance, this study investigates two tensions foregrounding lasting: one regarding the degree of human intervention on the technical device (object being maintained vs object maintaining itself) and one regarding the relationship to the initial expectations towards the technical device (relinquishment of certain hopes vs regeneration of interests). This case combines these tensions and allows to highlight four alterations in the CRM system to show how apparently stable devices keep on changing.Social implicationsIn a time of resource exhaustion, it is important to reflect upon our relationships to information technology and their modalities of lasting. By stressing that uses emerge from relinquishment and reduction, the authors wish to help organizations move towards more sustainable engagement with their technical devices in the long run.Originality/valueLasting is not just a matter of being maintained in a context of threat but also builds upon the capacities of a technical device to maintain itself. The self-alteration dynamics that the authors come up with, shedding and ramification, offer a dedramatized interpretation of maintenance that complements studies on institutional maintenance. The results also contribute to studies on technological drift. The authors stress that drifts are triggered by ties that run out, in particular, discontinuation of maintenance in the system. The durability of technical devices in organizations thus does not consist in always more uses or functionalities, but is also made of reductions and relinquishment.