Registration Staff Research Articles

Improving Screening for Social Determinants of Health in an Outpatient Complex Care Clinic.

Families of children with medical complexity (CMC) may face challenges related to Social Determinants of Health (SDoH). Although standardized SDoH screening has been implemented in numerous medical settings, there has been limited study of screening among CMC. Our global aim is to improve access to institutional and community resources for families of CMC with identified needs. Here, we aimed to establish SDoH screening for families in our outpatient Complex Care Center and attain a screening rate of 80%. A multidisciplinary team in our clinic used quality improvement methods to implement and study an expanded SDoH screen, which included 3 questions specific to the needs of CMC (ie, emergency planning, social support, and medical equipment concerns). Interventions, informed and refined by 5 key drivers, were tested over a 12-month period. A statistical process control chart tracked key outcome and process measures over time. SDoH screening sustained a mean of 80% after implementation during the study period. Incorporating registration staff in screen distribution was our most impactful intervention. At least 1 SDoH concern was identified on 56% of screens; concerns specific to CMC and mental health were most frequently reported. A total of 309 responses to positive screens were reported in total. Successful implementation of an expanded, tailored SDoH screen revealed a multitude of social needs specific to families of CMC that otherwise may not have been recognized. Our team continues to develop and distribute resources to address identified needs.

Improving symptom screening rates for patients with head and neck cancer.

e23246 Background: Effective symptom management in cancer care relies on regular and accurate reporting using validated patient-reported outcome measures (PROMs), such as the Edmonton Symptom Assessment System (ESAS). The ESAS measures nine common cancer symptoms, rating them on a scale from 0 to 10 to improve monitoring and communication regarding patient symptoms and prevent adverse outcomes such as emergency department visits. There is a need to enhance completion rates to ensure that head and neck cancer (HNC) symptoms are effectively addressed. High completion rates provide valuable data for cancer centers and clinicians to intervene early and support patients through their cancer journey. This makes it an important target for quality improvement (QI) with wide-ranging implications for patient outcomes and care quality. Our objectives were to: Investigate underlying reasons for poor ESAS completion rates. Lay the groundwork for strategic interventions aimed at bolstering symptom screening among HNC patients. Methods: This was a QI project targeting the HNC patient population at a regional cancer centre (RCC). Our approach included stakeholder engagement meetings alongside the expertise of QI specialists. Comprehensive data collection was conducted to analyze symptom screening rates and identify potential barriers to ESAS completion. We tracked ESAS completion on weekly HNC clinic days from 2022-2023 via manual and automated chart abstraction. Patient, staff, and volunteer interviews, along with direct clinic observations, provided data for Ishikawa diagrams, facilitating a root cause analysis. Results: We identified a marked decline in ESAS completion rates, steadily decreasing from an average of 29.4% during the 2022-2023 fiscal year to an average of 7.6% between April-November 2023, with rates dropping as low as 3.3% in September 2023. Root cause analysis pinpointed several barriers to ESAS completion, including the transition from paper-based assessments used during the pandemic to electronic formats, low patient awareness of the purpose of symptom screening, perceived lack of value in screening by patients and staff, and the absence of direct guidance from staff in helping patients complete their ESAS. Variable communication practices and inconsistencies in registration staff directing patients to kiosks was also observed. Improving infrastructure and support for volunteer services was identified as a potential solution, which may optimize their effectiveness in symptom screening roles. Conclusions: The project has laid the foundation for targeted QI interventions aimed at improving ESAS screening adherence. By addressing the identified barriers, this work endeavors to re-engage patients in active symptom reporting and to integrate this critical aspect of care into the daily routine of the outpatient hospital setting, thereby enhancing the overall management of HNC symptoms.

Efektifitas Aplikasi Pendaftaran Rawat Jalan Si Palui Terhadap Produktivitas Petugas Registrasi UPT Puskesmas Martapura 1 Kabupaten Banjar

The quality of service based on the outpatient registration application has been implemented by the Martapura 1 Health Center since 2019 and this is a technological innovation developed to simplify health services at the health center. So the operation of the Palui outpatient registration application should be carried out as closely as possible by the registration officer. However, in fact, the officers who act as admins controlling the operation of the application are deemed not to have the qualifications, one of which is that all non-medical recording officers, their responsiveness and concern for the operation of the Si Palui outpatient registration application are considered to be less than optimal. The aim of this research is to find out more deeply about the effectiveness of the Si Palui outpatient registration application on the productivity of UPT registration officers at Martapura 1 Health Center, Banjar Regency. This research is descriptive research with a qualitative approach. The number of samples was 4 people consisting of the Head of Medical Records and Outpatient Registration Staff. The results of the research are that the effectiveness of the outpatient registration application at Palui UPT Puskesmas Martapura 1 in terms of the aspects of achieving goals, integration and adaptation is included in the fulfilled category because it makes it easier for people to register for outpatient care. The productivity of registration officers on average falls into the High Productivity category of UPT Puskesmas Martapura 1. In conclusion, there is a link between the effectiveness of the Si Palui outpatient registration application and the productivity of UPT registration officers at Puskesmas Martapura 1.

Improving Sexual Orientation and Gender Identity Documentation at an NCI-Designated Comprehensive Cancer Center

To increase the rate of sexual orientation and gender identity (SOGI) patient data collection in healthcare software for new patients at a NCI-Designated Comprehensive Cancer Center, via targeted identification of Advanced Practice Providers (APP), development of novel SOGI collection workflows, creation of a real-time SOGI data dashboard, and tailored training utilizing existing High Reliability Organization (HRO) huddles in order to measure, analyze, and improve the quality of care, safety, and patient experiences for Sexual and Gender Minority (SGM) patients. Prior to interventions, project leadership (PL) and data analytics staff obtained SOGI baseline data, while cancer center clinical leadership, registration, and administrative staff identified APPs as the most appropriate staff to collect patient SOGI data. Intervention 1: PL met with Disease Management Groups (DMG)/HRO leads of thoracic medical oncology to identify a practice-level APP champion. PL and the APP champion scripted language for multiple scenarios when asking SOGI questions, and served as a resource for additional practice APPs. PL provided SGM-focused training during HRO huddles, which included how to ask and document SOGI, and significance of asking SOGI information. SOGI data completion rate was tracked on a HRO scorecard. This intervention was replicated across additional DMG/HROs during the study period. Intervention 2: Breast surgical oncology completed Intervention 1 and added SOGI questions to their new patient-facing intake form, allowing patients to self-identify. PL and data analytics team provided continuous feedback to DMG/HRO leads on provider-level completion rates and additional education as needed. At the end of the Interventions, there were 9 LGBTQ+ Knowledge and Awareness HRO training sessions completed resulting in over 300 unique individuals receiving advanced SOGI documentation education. For intervention 1, there were 12,322 new patients asked their SOGI information, which was a greater than 300% increase in SOGI documentation (baseline completion rate for sexual orientation and gender identity was 17% and 21%, respectively, which improved to 77% and 84%). For intervention 2, there were 3,217 new patients asked their SOGI information, which was a greater than 400% increase (baseline completion rate for sexual orientation and gender identity was 13% and 16%, respectively, which improved to 81% and 81%). Together, patient self-reporting quickly increased data completion rates from baseline, comparable to clinical sites from Intervention 1, and may decrease the burden of APPs collecting SOGI history; however, clinical review of questions is important and may further increase SOGI data completion. Leadership buy-in, site champions, and active data monitoring are essential to measurable change. Together, improved SOGI data completion will allow for improved equitable cancer care and increased assessment of SGM cancer disparities.

Online Diagnostic Lab Reporting System

The project “ONLINE DIAGNOSTIC LAB REPORTING SYSTEM” is to develop web application to computerize the Management of a Diagnostic System which is user friendly simple, fast, and cost-effective. It deals with the collection of patient’s information, diagnosis details, etc. Traditionally, it was done manually. The main function of the system is register and store patient details and staff details and retrieve these details as and when required, and also to manipulate these details meaningfully. System input contains patient details, diagnosis details, while system output is to get these details on to the screen. The Online Diagnostic Lab Reporting System can be entered using a username and password. It is accessible by every level of user according to their role. Every user can view the data that they are accessible. Only that user can add data into the database who has editing permission. The data can be retrieved easily. The data are well protected for personal use and makes the data processing very fast.

Implementation of Australia’s primary human papillomavirus (HPV) cervical screening program: The STakeholders Opinions of Renewal Implementation and Experiences Study

In this study, we aimed to document stakeholders’ experiences of implementing Australia’s renewed National Cervical Screening Program. In December 2017, the program changed from 2nd yearly cytology for 20–69 year olds to 5 yearly human papillomavirus (HPV) screening for women 25–74 years. We undertook semi-structured interviews with key stakeholders including government, program administrators, register staff, clinicians and health care workers, non-government organisations, professional bodies, and pathology laboratories from across Australia between Nov 2018 - Aug 2019. Response rate to emailed invitations was 49/85 (58%). We used Proctor et al’s (2011) implementation outcomes framework to guide our questions and thematic analysis. We found that stakeholders were evenly divided over whether implementation was successful. There was strong support for change, but concern over aspects of the implementation. There was some frustration related to the delayed start, timeliness of communication and education, shortcomings in change management, lack of inclusion of Aboriginal and Torres Strait Islander people in planning and implementation, failure to make self-collection widely available, and delays in the National Cancer Screening Register. Barriers centred around a perceived failure to appreciate the enormity of the change and register build, and consequent failure to resource, project manage and communicate effectively. Facilitators included the good will and dedication of stakeholders, strong evidence base for change and the support of jurisdictions during the delay. We documented substantial implementation challenges, offering learnings for other countries transitioning to HPV screening. Sufficient planning, significant and transparent engagement and communication with stakeholders, and change management are critical.

Kualitas Pelayanan Pendaftaran Rawat Jalan Pasien Jaminan Kesehatan Nasional di Rumah Sakit Royal Progress

The hospital is one of the health facilities where it organizes health efforts that deal with medical problems for the recovery and maintenance of health needed for its users. It is necessary to know the quality of outpatient registration services for National Health Insurance patients. To determine the effect of Input (HR, Technology Facilities) and processes (Professional and expertise, attitude, Behavior, Situation Control, Problem Solving, Ease of achievement and adjustment, Reliability and trust) that will produce quality in outpatient registration services at Royal Hospital Progress especially for patients using the National Health Insurance. sampling non-probability sampling. The sampling technique was purposive sampling. Human Resources, there is a shortage of service officers, in terms of internet speed technology and the lack of bridging of SIMRS with the JKN web is one of the factors that affect quality in terms of speed of service, in terms of the process where the ease of achieving and adjusting services has not been achieved because of the patient's waiting time when registering until data verification gets SEP still above 15 minutes. In other factors, namely Facilities, Professional and expertise, Attitude, Behavior, Control of the situation, Problem solving, Reliability and trust showed positive results. The quality of Outpatient Registration Services at the Royal Progress hospital illustrates good and satisfying service for patients including a very adequate waiting room, disabled toilets and elevators which are very much needed for patients. Registration staff are very professional in doing their jobs. Also described in the attitude of friendly and always smiling officers in receiving patients who come for treatment at Royal Progress Hospital, the very high empathy given by registration officers to patients who need help and the fast response received by patients when patients experience difficulties in administration This is what makes Royal Progress Hospital provide excellent service even though there is still a shortage of both human resources and networks, but in general the services provided to JKN patients are quite good

Evaluating Drivers of the Patient Experience Triangle: Stress, Anxiety, and Frustration.

Patient experience is a widely used indicator for assessing the quality-of-care process during a patient's journey in hospital. However, the literature rarely discusses three components: patient stress, anxiety, and frustration. Furthermore, little is known about what drives each component during hospital visits. In order to explore this, we utilized data from a patient experience survey, including patient- and provider-related determinants, that was administered at a local hospital in Abu Dhabi, UAE. A machine-learning-based random forest (RF) algorithm, along with its embedded importance analysis function feature, was used to explore and rank the drivers of patient stress, anxiety, and frustration throughout two stages of the patient journey: registration and consultation. The attribute 'age' was identified as the primary patient-related determinant driving patient stress, anxiety, and frustration throughout the registration and consultation stages. In the registration stage, 'total time taken for registration' was the key driver of patient stress, whereas 'courtesy demonstrated by the registration staff in meeting your needs' was the key driver of anxiety and frustration. In the consultation step, 'waiting time to see the doctor/physician' was the key driver of both patient stress and frustration, whereas 'the doctor/physician was able to explain your symptoms using language that was easy to understand' was the main driver of anxiety. The RF algorithm provided valuable insights, showing the relative importance of factors affecting patient stress, anxiety, and frustration throughout the registration and consultation stages. Healthcare managers can utilize and allocate resources to improve the overall patient experience during hospital visits based on the importance of patient- and provider-related determinants.

Abstract C070: REAL variance in genomic testing by sex, age, race, ethnicity, and language: PROFILE database 7/2011 - 1/2022

Abstract Background: Lack of representation in genomic databases limits the generalizability of study findings, predictive models, and therapeutics. In cancer, the development of nearly 75% of cancer drugs have been informed by genomic data,1 yet there is persistent lack of diversity of genomic testing databases that inform clinical trials and lead to drug approval.2,3 The PROFILE project at Dana-Farber Cancer Institute (DFCI) is available to all adult cancer patients, offering free genomic testing for inclusion in their genomic database. Herein, we describe the enrollment ratios in PROFILE delineated by demographic group and cancer type. Methods: We conducted a cross-sectional analysis of the prevalence of PROFILE enrollment 7/8/2011 – 1/1/2022. Over this time period 177,788. Enrollment processes vary in each DFCI disease center, but all solid tumor patients are meant to be approached for enrollment around the time of their first visit. The electronic health record was queried to identify demographics, which are collected by registration staff at intake. Queried demographics included gender, age (<70/≥70 years old), race, ethnicity, marital status, English proficiency, and primary language; cancer type was also queried. Prevalence was calculated from the number of patients enrolled each year and the total patients for that year. The association between PROFILE enrollment and demographic groups were determined with χ2 tests. Results: Across DFCI, 41% of adult patients are enrolled in PROFILE (73,730 enrolled). Enrollment was most common in the following groups (% of DFCI population, % of enrolled): female (57, 54), younger (78, 79), white (90, 93), non-Hispanic (97, 98), married (68, 70), English proficient (96, 98), hematologic malignancy (20, 18). Differences were statisticially significant for each category (p-value <0.0001). Conclusion: This data suggests that, despite the universal availability of genomic testing for DFCI patients, disparities still result in underenrollment of certain groups, particularly by race and English proficiency. Ongoing projects at DFCI aim to increase enrollment with decision-making support through a patient navigator and informational video among key patient groups, including older adults, racial minorities, Latinx, and limited English proficient. 1. Marquart J, Chen EY, Prasad V. Estimation of the percentage of US patients with cancer who benefit from genome-driven oncology. JAMA oncology. 2018;4(8):1093-1098. 2. Guerrero S, López-Cortés A, Indacochea A, et al. Analysis of racial/ethnic representation in select basic and applied cancer research studies. Scientific reports. 2018;8(1):1-8. 3. Zavala VA, Bracci PM, Carethers JM, et al. Cancer health disparities in racial/ethnic minorities in the United States. British journal of cancer. 2021;124(2):315-332. Citation Format: Nadine Jackson McCleary, Ellana K. Haakenstad, Bridget Neville, Arrien A. Bertram, Wendy Loeser, Joseph Grider, Andea Kruse, Alissa Gentile, Olga Kozyreva, Pedro Sanz-Altamira, Christopher Lathan, Michael J. Hassett, Ethan Cerami, Annette S. Kim, Marios Giannakis, R. Coleman Lindsley, Neal I. Lindeman, William C. Hahn, Janina Longtine, Barrett Rollins, Levi Garraway, Bruce E. Johnson. REAL variance in genomic testing by sex, age, race, ethnicity, and language: PROFILE database 7/2011 - 1/2022 [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr C070.

Sistem Informasi Penerimaan Peserta Didik Baru UPT SPNF SKB Belitung Menggunakan Metode Rapid Application Development Berbasis Web

UPT SPNF SKB Belitung is a non-formal school under the education office located in Belitung Regency. UPT SPNF SKB Belitung has 3 equivalence education packages, namely packages A, B, and C. The system for accepting new prospective students is still being carried out conventionally , namely prospective students must come directly to the UPT SPNF SKB Belitung office to register, As a result, it is less efficient in the use of time, distance, cost and energy. To convey registration information, banners are still being distributed in certain locations, as a result, the delivery is still not comprehensive. The process of inputting registration data for new prospective students is done manually so that problems occur such as difficulty in reading the handwriting of prospective new students, errors in inputting prospective student data and can result in the scattering of important documents for prospective new students. With the construction of this system, it can make it easier for registration staff and new students to carry out the registration process and processing student registration data. The method used to build website for UPT SPNF SKB Belitung is the RAD (Rapid Application Development) method.testing Black box is used to conduct testing on this system, the results of these tests are the system runs without any problems, all the features contained in the system function properly and are in accordance with user needs. With this system, it can make it easier for prospective new students to find information and register without having to come directly to the UPT SPNF SKB Belitung office and make it easier for admins as administrative staff to verify registration data online and process registration report data for prospective new students.

Waiting Time and Patient Satisfaction in a Subspecialty Eye Hospital Using a Mobile Data Collection Kit: Pre-Post Quality Improvement Intervention.

Waiting time can considerably increase the cost to both the clinic and the patient and be a major predictor of the satisfaction of eye care users. Efficient management of waiting time remains as a challenge in hospitals. Waiting time management will become even more crucial in the postpandemic era. A key consideration when improving waiting time is the involvement of eye care users. This study aimed at improving patient waiting time and satisfaction through the use of Plan-Do-Study-Act (PDSA) quality improvement cycles. The objectives of this study were to determine the waiting time and patient satisfaction, measure the association between waiting time and patient satisfaction, and determine the effectiveness of the PDSA model in improving waiting time and satisfaction. This was a pre-post quality improvement study among patients aged 19 to 80 years, who are consulting with the Magrabi International Council of Ophthalmology Cameroon Eye Institute. We used PDSA cycles to conduct improvement audits of waiting time and satisfaction over 6 weeks. A data collection app known as Open Data Kit (Get ODK Inc) was used for real-time tracking of waiting, service, and idling times at each service point. Participants were also asked whether they were satisfied with the waiting time at the point of exit. Data from 51% (25/49) preintervention participants and 49% (24/49) postintervention participants were analyzed using Stata 14 at .05 significance level. An unpaired 2-tailed t test was used to assess the statistical significance of the observed differences in times before and after the intervention. Logistic regression was used to examine the association between satisfaction and waiting time. In total, 49 participants were recruited with mean age of 49 (SD 15.7) years. The preintervention mean waiting, service, and idling times were 450 (SD 96.6), 112 (SD 47), and 338 (SD 98.1) minutes, respectively. There was no significant association between patient waiting time and satisfaction (odds ratio 1, 95% CI 0.99-1; P=.37; χ23=0.4). The use of PDSA led to 15% (66 minutes/450 minutes) improvement in waiting time (t47=2; P=.05) and nonsignificant increase in patient satisfaction from 32% (8/25) to 33% (8/24; z=0.1; P=.92). Use of PDSA led to a borderline statistically significant reduction of 66 minutes in waiting time over 6 weeks and an insignificant improvement in satisfaction, suggesting that quality improvement efforts at the clinic have to be made over a considerable period to be able to produce significant changes. The study provides a good basis for standardizing the cycle (consultation) time at the clinic. We recommend shortening the patient pathway and implementing other measures including a phasic appointment system, automated patient time monitoring, robust ticketing, patient pathway supervision, standard triaging, task shifting, physician consultation planning, patient education, and additional registration staff.

PENGARUH KEADILAN ORGANISASIONAL DAN KETERLIBATAN KERJA TERHADAP KOMITMEN ORGANISASI PADA PEGAWAI DINAS KEPENDUDUKAN DAN PENCATATAN SIPIL KABUPATEN KERINCI

This study aims to find out how the Effect of Organizational Justice and Work Engagement on Organizational Commitment to the Staff of the Population and Civil Registration Office of Kerinci Regency. The technique of collecting data using a questionnaire after testing the validity and reliability. Data analysis techniques are carried out using, multiple linear regression analysis, hypothesis testing, coefficient of determination (R2). The results of this study indicate that: There is a significant effect between Organizational Justice on Organizational Commitment to the Staff of the Population and Civil Registration Office of Kerinci Regency, this is evidenced by t count> t table (3.431> 2.04227). There is a significant influence between Organizational work involvement on Organizational Commitment to the Staff of the Population and Civil Registration Office of Kerinci Regency, this is evidenced by t count> t table (4,192> 2,04227). There is the influence of organizational justice and work involvement affect the organizational commitment of the Department of Population and Civil Registration Staff Kerinci Regency simultaneously, this is evidenced by F count> Ftable (15,049> 3,32). The magnitude of the influence of organizational justice and work involvement on organizational commitment in the Department of Population and Civil Registration staff of Kerinci Regency is 50.1%, while the remaining 48.9% is explained by other causal factors not examined in this study

Improving Data Collection and Abstraction to Assess Health Equity in Trauma Care.

Current trauma registries suffer from inconsistent collection of data needed to assess health equity. To identify barriers/facilitators to collecting accurate equity-related data elements, we assessed perspectives of national stakeholders, Emergency Department (ED) registration, and Trauma Registry staff. We conducted a Delphi process with experts in trauma care systems and key informant interviews and focus groups with ED patient registration and trauma registry staff at a regional Level I trauma center. Topics included data collection process, barriers/facilitators for equity-related data collection, electronic health record (EHR) entry, trauma registry abstraction, and strategies to overcome technology limitations. Responses were qualitatively analyzed and triangulated with observations of ED and trauma registry staff workflow. Expert-identified barriers to consistent data collection included lack of staff investment in changes and lack of national standardization of data elements; facilitators were simplicity, quality improvement checks, and stakeholder investment in modifying existing technology to collect equity elements. ED staff reported experiences with patients reacting suspiciously to queries regarding race and ethnicity. Cultural resonance training, a script to explain equity data collection, and allowing patients to self-report sensitive items using technology were identified as potential facilitators. Trauma registry staff reported lack of discrete fields, and a preference for auto-populated and designated EHR fields. Identified barriers and facilitators of collection and abstraction of equity-related data elements from multiple stakeholders provides a framework for improving data collection. Successful implementation will require standardized definitions, staff training, use of existing technology for patient self-report, and discrete fields for added elements.

Web-Based Land Registration Management System: Iraq/Duhok Case Study

In this era, technology is playing a central role in many areas of human life, but the classical hardcopy-based approaches are still being used for land registration. The Internet-based methods provide excellent facilities for overcoming the drawbacks of handwritten-based style and communication among different government sectors. Nowadays, Information and Communication Technology (ICT) is used to build professional electronic systems as a big step towards the electronic government (E-government) system. One of the most critical sections of the E-government is the E-Land-Registration (ELR). Duhok Land Directorate, together with its sub-directorates, works on a considerable amount of data to process. These directorates suffer from classical hardcopy-based approaches, so building an ELR system will reduce time consumption and paper waste. The improvement of the land registration system will also allow integration with the E-government system. The progress of the land registration will enable communication between the land registration staff on one side and the administration and financial directorates on the other. In this thesis, an efficient ELR system for Duhok land registration is proposed. The services of the database management system cover the Employee Registration Module, Estates Registration Module, Operation Type Module, Estate Owners Module, Estate Status Module, View Information Module, and Login Employee Module. HTML, CSS, PHP, MySQL, JavaScript, jQuery, Ajax, and Bootstrap tools were used for the design and implementation stages of the proposed ELR.

Integrating social determinants of health screening and referral during routine emergency department care: evaluation of reach and implementation challenges

BackgroundDespite the importance of social determinants in health outcomes, little is known about the best practices for screening and referral during clinical encounters. This study aimed to implement universal social needs screening and community service referrals in an academic emergency department (ED), evaluating for feasibility, reach, and stakeholder perspectives.MethodsBetween January 2019 and February 2020, ED registration staff screened patients for social needs using a 10-item, low-literacy, English-Spanish screener on touchscreens that generated automatic referrals to community service outreach specialists and data linkages. The RE-AIM framework, specifically the constructs of reach and adoption, guided the evaluation. Reach was estimated through a number of approaches, completed screenings, and receipt of community service referrals. Adoption was addressed qualitatively via content analysis and qualitative coding techniques from (1) meetings, clinical interactions, and semi-structured interviews with ED staff and (2) an iterative “engagement studio” with an advisory group composed of ED patients representing diverse communities.ResultsOverall, 4608 participants were approached, and 61% completed the screener. The most common reason for non-completion was patient refusal (43%). Forty-seven percent of patients with completed screeners communicated one or more needs, 34% of whom agreed to follow-up by resource specialists. Of the 482 participants referred, 20% were reached by outreach specialists and referred to community agencies. Only 7% of patients completed the full process from screening to community service referral; older, male, non-White, and Hispanic patients were more likely to complete the referral process. Iterative staff (n = 8) observations and interviews demonstrated that, despite instruction for universal screening, patient presentation (e.g., appearance, insurance status) drove screening decisions. The staff communicated discomfort with, and questioned the usefulness of, screening. Patients (n = 10) communicated a desire for improved understanding of their unmet needs, but had concerns about stigmatization and privacy, and communicated how receptivity of screenings and outreach are influenced by the perceived sincerity of screening staff.ConclusionsDespite the limited time and technical barriers, few patients with social needs ultimately received service referrals. Perspectives of staff and patients suggest that social needs screening during clinical encounters should incorporate structure for facilitating patient-staff relatedness and competence, and address patient vulnerability by ensuring universal, private screenings with clear intent.Trial registrationClinicalTrials.gov, NCT04630041.

Ambulatory Perioperative Services Wheels to Wheel

<h3>Background information related to problem identification</h3> Operating Room turnover time or patient Wheels to Wheels (W2W) is the total amount of time necessary to turn over the room from one patient to the next. Wheels Out to Wheels In is defined as the duration between the previous case Out of Room time and the following case In Room time. W2W involves every member of perioperative services including surgeons, anesthesiologists, nurses, surgical scrub technicians, and registration and environmental staff. A delay in one or more areas causes a chain reaction of delays in the whole system. As such, it is necessary to define, measure, analyze, improve, and control the various outliers in the present system for its optimization. The HackensackUMC Ambulatory Perioperative Services' 2019 to 2020 turnover time rate was 27.45 minutes. <h3>Objectives of project</h3> Short- term: To shorten W2W to 23 minutes within 1 year Long- term: To improve patient outcomes, increase case volume, and maximize productivity <h3>Process of implementation</h3> Daily, weekly, monthly audits were conducted to identify compliance issues and improvement opportunities, which were shared to all the stakeholders for guidance, implementation, and control. EPIC Workbench Reports were utilized in data collection and processing. <h3>Statement of the successful practice</h3> Prior to the regular audits and information sharing, there was no coherent visualization for the causes of delay in the W2W process. With the identification of problem areas and accountabilities, delays were minimized and the process completion rate was shortened to 24 minutes. <h3>Implications for advancing the practice of perianesthesia nursing</h3> Using EPIC Workbench Reports and Clarity Reports for audit data processing are significant tools for outlier identification and correction. Professional communication and close collaboration among the stakeholders are keys for the continued quality and rate improvement of the Ambulatory Perioperative Services W2W. Consistent 24/7 implementation of control parameters will lead to improved patient outcomes, increased case volume, and maximum productivity.

Examining the Implementation of the Android Based Outpatient Online Queuing System

This study aims to determine the implementation of the android-based online outpatient queuing system at the UPTD Bali Mandara Eye Hospital. To achieve the research objectives, a qualitative method with a phenomenological approach through in-depth interviews was used. The interviews involved 12 informants consisting of two registration staff, eight patients or users of online queues, the Head of the SIMRS Unit, and the Head of the SIMRS Subdivision and Hospital Reporting as well as triangulation. Based on the results of this study, it can be seen that the use of the online queuing system is still not optimal. It is because there are not many patients who know about the system, and they are not interested in using the online queuing system.

Unheard Victims: Multidisciplinary Incidence and Reporting of Violence in an Emergency Department.

IntroductionWorkplace violence in the emergency department (ED) is a serious threat to staff and is likely to go unreported. We sought to identify the incidence of violence among staff at our academic ED over a six-month period.MethodsAn anonymous survey was sent to all ED staff, asking whether respondents had experienced verbal abuse or physical assault over the prior six months and whether they had reported it. Those working in the department <6 months were excluded from analysis. We used chi-squared comparison to analyze the results.ResultsWe analyzed 242 responses. Overall, 208 (86%) respondents indicated being verbally abused in the preceding six months, and 90 (37%) indicated being physically assaulted. Security officers had the highest incidence of verbal abuse (98%), followed by nursing (95%), patient care assistants (PCA) (90%) and clinicians (90%), phlebotomists (75%), care team assistants (73%), registration staff (50%) and electrocardiogram (ECG)/radiology technicians (50%). Security also had the highest incidence of physical assault (73%), followed by nursing (49%), PCAs (30%), clinicians (24%), phlebotomists (17%), and ECG/radiology technicians (13%). A total of 140 (69%) non-security personnel indicated that they never report incidents of violence.ConclusionOur results indicate that violence in the ED affects more than just nurses and doctors. As health systems seek to improve the safety of their employees in violence-prone areas, it is imperative that they direct initiatives to the entire healthcare team as no one group is immune.

Gambaran Stres Kerja Petugas Pendaftaran Rawat Jalan di RSUP Dr. Sardjito Yogyakarta

Occupational stress is recognized as a global health issue that affects all professions, no other profession in the health field i.e. medical record registration section. RSUP Dr. Sardjito Yogyakarta has a total data visit annually on an outpatient registration, which is in 2018 as much as 469813 and in 2019 as many as 518806. The number of visits explained at least the registration staff should serve 200-300 patients every day. Known errors that occur in SIMETRISS also harm the officer because inevitably officers should double job. The Stress of work felt by the officers of the list is often felt muscle tension, feel tense, fast angry, feel anxious, and difficult to concentrate in the work. Stressful work if not resolved will have an impact on activities in the scope or out of work. The research aims to figure out the work stress overview of the registration officers in RSUP Dr. Sardjito Yogyakarta. The collection methods used are interviews. The analysis of the data used in this study is qualitative. The results of the study showed work stress experienced by outpatient registration officers, that is caused by a physical work environment that is less comfortable to cause a lack of concentration by the officers and causes the performance of officers to decline, the conflict between family demands and the demands of agencies such as the use of less time breaks and the presence of a sustained shift, performance demands are done quickly and precisely however support facilities, namely Simetriss still error also raises pressure for the work RSUP Dr. Sardjito Yogyakarta has reduced some problems by conducting effective consultation on outpatient registration officers.

497. Impact of a customized travel and exposure screening tool during the COVID-19 pandemic

BackgroundScreening for communicable diseases at entry to any healthcare setting due to a patient’s travel or exposure history is an important tenet of reducing transmission of pathogens among patients and healthcare providers. We identified multiple screening tools across our enterprise leading to inconsistent documentation by staff and inability to rapidly change screening questions. We aimed to develop a customized screening tool within our electronic health record to address these challenges and provide real-time screening data to our Department of Infection Prevention.MethodsStakeholders from all clinical areas as well as family consultants and registration staff provided input on needs for an optimized screening tool. Process mapping across clinical areas of prior screening tools identified variation in decision support and screening questions for both countries and diseases, and demonstrated lack of clear communication between registration staff and clinical teams. Questions and decision support needed to identify communicable diseases in a waiting room setting were identified with stakeholders. Our informatics team reviewed multiple tool options available in the EHR including a built-in travel module with print groups and best practice alerts, a smartform, and flowsheets.ResultsOur informatics team designed a universal flowsheet with cascading rows that included clinical decision support with travel, exposure, and symptom screening. During the period of peak COVID-19 transmission in our region, an average of 1644 patients were screened daily. Of those, 2.8% screened positive for travel to an area of increased transmission with 14.9% of those who traveled reporting respiratory symptoms. An additional 4.1% of total patients screened positive for exposure to COVID-19, while 7.7% reported respiratory symptoms. Nine real-time updates to locations of increased disease transmission and symptoms have been made.Customized travel and exposure screening flowsheet cascade ConclusionUtilizing a custom-built flowsheet model in our EHR permitted real time changes to screening to support appropriate use of infection prevention measures. Customizable travel and exposure screening is critical for identification of patients with concern for COVID-19 and other emerging pathogens.Disclosures All Authors: No reported disclosures