Senior Medical Staff Research Articles

FP6.7 - Assessing knowledge and effective utilisation of incentive spirometer across surgical floor

Abstract Aim to assess the level of knowledge of healthcare workers providing incentive spirometer and instruction provided to patient. Methods Snapshot audit between 25&28/05/23 assessing the knowledge and practice using two for patient and staff questionnaires. Inclusions criteria were all adult patients in surgical wards, all healthcare staff. Exclusion criteria were patients who did not receive a spirometer and patients or staff who were not willing to participate in the study. Results 75% of staff provided incentive spirometers, 84% of them never received formal education or training in the use of incentive spirometer. Only one staff member (1.85%) answered all the questions correctly. 83% of patients were not given the correct instructions and approximately 16% were instructed to exhale. Implemented Changes A video created with e-link; explaining the use of incentive spirometer. Training of medical and nursing staff by presenting the project in our local departmental meeting, the results and poster emailed to health professionals. A new patient leaflet was created containing clear instructions, the video link, and a table to record their usage. Random sampling showed significant improvement. The Second cycle will be conducted at beginning of the new year and the results will be presented at the conference Conclusion The lack of training led to incorrect instructions being given to patients. This could lead to false reassurance to the senior medical staff, by assuming that patients are using spirometers correctly which could delay recovery and discharge. Simple training has resulted in significant increase in knowledge and correct use of a spirometer. Checking the staff knowledge is recommended, especially in common daily practice

General physicians' perspectives on SGLT2 inhibitors for heart failure.

Sodium-glucose cotransporter-2 inhibitors (SGLT2is) are novel agents for heart failure (HF) and are now recommended in guidelines. Understanding general physicians' perspectives can help to optimise utilisation of this new medication. To understand the clinical concerns and barriers from general physicians about prescribing SGLT2is in a general medicine cohort. A questionnaire exploring clinicians' experience, comfort level and barriers to prescribing SGLT2is in patients with HF, incorporating two clinical scenarios, was disseminated to Internal Medicine Society of Australia and New Zealand members over a 2-month period. Ninety-eight participants responded to the questionnaire (10.8% response rate). Most respondents (66.3%) were senior medical staff. Most participants worked in metropolitan settings (64.3%) and in public hospital settings (83.7%). For HF with reduced ejection fraction, 23.5% of participants reported prescribing SGLT2is frequently (defined as prescribing SGLT2is frequently over 75% of occasions). For HF with preserved ejection fraction, 57.1% of participants reported prescribing SGLT2is less than 25% of the time. Almost half of the participants (44%) expressed a high level of familiarity with therapeutic knowledge of SGLT2is, while 47% indicated high familiarity with potential side effects. Patient complexity, cost of medications and discontinuity of care were identified as important barriers. Euglycemic diabetic ketoacidosis was the side effect that caused the most hesitancy to prescribe SGLT2is in 48% of the respondents. General physicians in Australia and Aotearoa New Zealand are familiar with the therapeutic knowledge and side effects of SGLT2is. Patient complexity, medication cost and discontinuity of care were significant barriers to the use of SGLT2isfor HF among general physicians.

Improving Healthcare Quality and Clinical Outcomes for Persons with Dementia in the Sub-Acute Hospital Through Person-Centered Care Practice.

Person-centered care is considered beneficial for persons with dementia. To evaluate the impact of a person-centered knowledge translation intervention on the quality of healthcare and outcomes for persons with dementia. Over nine months, sub-acute hospital nursing, allied health, and medical staff (n = 90) participated in online and/or face-to-face person-centered education and were supported by senior nursing, allied health, and medical staff champions (n = 8) to implement person-centered healthcare. The quality of healthcare service, ward climate and care delivery were evaluated pre/post study intervention. In the week following hospital admission (Time 1) and week of discharge (Time 3), agitation incidence (co-primary outcome) was assessed in participants with dementia (n = 80). Participant delirium (co-primary outcome), accidents/injuries, psychotropic medicines, length of stay, readmission and discharge destination (secondary outcomes) were compared with a retrospective group (n = 77) matched on demographics, cognition and function in activities of daily living. Improvements occurred post-intervention in service quality by 17.5% (p = 0.369, phi = 0.08), ward climate by 18.1% (p = 0.291, phi = 0.08), and care quality by 50% (p = 0.000, phi = 0.37). Participant agitation did not change from Time 1 to Time 3 (p = 0.223). Relative to the retrospective group, significant reductions occurred in participant delirium (p = 0.000, phi = 0.73), incidents/injuries (p = 0.000, phi = 0.99), psychotropic medicine use (p = 0.030, phi = 0.09), and hospital readmissions within 30 days (p = 0.002, phi = 0.25), but not in discharge to home (p = 0.171). When person-centered healthcare knowledge is translated through staff education and practice support, persons with dementia can experience improved healthcare services and clinical outcomes, while healthcare services can benefit through reductions in unplanned service use.

Implementation of a Mentoring Program for Mentee-Mentor Satisfaction: A Longitudinal Pilot Study

IntroductionMentoring is a unique educational workplace relationship that can support both the mentee and mentor’s skill, knowledge, social, and emotional needs. The primary aim of this longitudinal pilot study was to implement a formal mentoring program to assess its effect on mentee and mentor satisfaction.MethodsData was collected from two hospitals in New South Wales, Australia in late 2018 and early 2019. Junior doctors (mentees) and senior medical staff (mentors) were asked to complete pre-, mid-, and oost-program surveys, with questions relevant to mentee-mentor satisfaction, interactions, and participation. Mixed-effects ordinal logistic regression models were used to assess the program effect on mentee-mentor satisfaction, while Fishers’ exact test was used to evaluate mentee-mentor interactions and participation.ResultsAlthough there was evidence of upwards trends in the proportion of mentees and mentors who reported their satisfaction in the program as excellent and rated their work satisfaction as being very influenced by the program, both trends were statistically non-significant. While our study was likely underpowered, high participation rates provide promising evidence of the program’s acceptability and feasibility.ConclusionThough not reaching statistical significance, study results suggest that the implementation of a mentoring program has the potential to increase satisfaction levels among its participants, be they mentees or mentors. It is recommended that future studies recruit larger samples thereby having sufficient statistical power. Furthermore, causality should be explored in more detail through a multi-site randomized controlled trial design.

EDUCATION OF NURSES IN THE INSTITUTIONS OF BOSNIA AND HERZEGOVINA

Background: In times of daily change, it is necessary to turn to the progress of the nursing profession, precisely through permanent learning in programs of continuous education and training. The aim of this work was to show the levels of education of nurses in the areas of Republika Srpska, Bosnia and Herzegovina. Secondary and higher medical schools, some of which grew into health faculties, played a significant role in organizing quality health care in Bosnia and Herzegovina. For a long time, secondary and senior medical staff could not be educated in B&H due to the lack of educational institutions, but also due to the lack of teaching staff. Until 2002, nurses in B&H acquired knowledge through secondary and higher education (two years). At the B&H level, the establishment of nursing studies was started in Sarajevo (2002), Tuzla (2005/2006), Zenica (2005), Bihać (2006), Mostar (2008), and then in Foca, Banja Luka and Prijedor (2007). Also, master’s and doctoral studies for nurses are organized in Bosnia and Herzegovina. There are no specializations for nurses in the education system in Bosnia and Herzegovina. Respecting the Directives of the European Council, in which the processes and norms of the education of nurses are precisely defined, some countries have equalized the competencies and levels of education of nurses. Changing nursing reform requires professional recognition in society and the entire healthcare system. Education partially follows the practice in terms of degree recognition. There is no Chamber of Nurses in the Republic of Srpska. In numerous institutions, internal and external education for nurses is organized. The Federation has a Chamber for nurses, and after passing a professional exam and registration in the Register of Chamber members, a request for a license is submitted with the documentation prescribed by the Rulebook on the License Issuance Procedure. The independent and interdependent work of nurses is in a highly interactive relationship and constitutes a unique field of nursing practice that must be understood and nurtured to maintain and develop a professional nursing identity. Therefore, it can be said that the purpose and goal of the nursing education strategy are pragmatic and visionary, and excellence can only be achieved through education. Conclusion: To raise the reputation and state of the nursing profession, it is necessary to define the scope of work and set clear boundaries between the competencies of nurses of different levels of education at the level of the whole of Bosnia and Herzegovina. Part of the strategic plan for the further development of the nursing profession should also be the promotion of the profession in the media and means of public information.

Medical student deployment to a single metropolitan hospital during the COVID-19 pandemic: A mixed methods analysis.

To explore student and staff satisfaction with the use of medical students as a surge workforce during the COVID-19 pandemic. We conducted a mixed methods analysis of staff and student experiences with the medical student workforce at a single metropolitan ED over an 8-month period between December 2021 and July 2022, using an online survey tool. Students were invited to complete the survey fortnightly, whereas senior medical and nursing staff were invited weekly. There was a 32% response rate for surveys sent to medical student assistants (MSAs) and 18% and 15% for medical and nursing staff, respectively. Most students felt well prepared and supported in the role and would recommend it to other students. They reported that the role allowed them to gain experience and confidence within the ED, especially after much of their learning had moved online throughout the pandemic. Senior nurses and doctors found MSAs to be useful members of the team, largely through their assistance with task completion. Both staff and students recommended a more comprehensive orientation, changes to the supervision model and increased clarity in the students' scope of practice. The results of the present study provide insight into the use of medical students as an emergency surge workforce. Responses from medical students and staff suggested that the project was beneficial for both groups as well as for overall departmental performance. These findings are likely to be translatable beyond the COVID-19 pandemic setting.

Editorial introductions.

Editorial introductions.

Current Fertility Knowledge of Senior High School Students, Infertile Patients, and Medical Staff at an Infertility Clinic in Japan

Background: In a survey on fertility knowledge published in 2013 (Cardiff Fertility Knowledge Scale [CFKS]), Japan ranked 78th among 79 countries. This finding encouraged the Japanese government to revise the curriculum for sex education in 2015. The present study was conducted to assess the current fertility knowledge of senior high school students, infertile patients, and medical staff at an infertility clinic in Japan. Methods: A cross-sectional study of 899 senior high school students (average age 16.8 years), 461 infertile female patients (36.9 years), and 127 medical staff at our infertility clinic (33.1 years) was performed between July 2020 and January 2021. The questionnaire included 13 items from CFKS and our 12 original items on fertility and infertility treatments. Results: The positive response rates of senior high school students, infertile female patients, and medical staff were 69.4, 86.9, and 86.5% for CFKS, respectively, and were similar for all 25 items. The positive response rate was higher in all three groups than in the surveys conducted in 2013 (36.0%) and 2015 (44.4%) in Japan. Conclusions: Although sex education may have improved these scores, other resources (media and social media) may also be responsible for this increase.

Survey of hospital practitioners: common understanding of cardiopulmonary resuscitation definition and outcomes.

Cardiopulmonary resuscitation (CPR) is internationally defined as chest compressions and rescue breaths, and is a subset of resuscitation. First used for out-of-hospital cardiac arrest, CPR is now frequently used for in-hospital cardiac arrest (IHCA) with different causes and outcomes. This paper aims to describe clinical understanding of the role of in-hospital CPR and perceived outcomes for IHCA. An online survey of a secondary care staff involved in resuscitation was conducted, focussing on definitions of CPR, features of do-not-attempt-CPR conversations with patients and clinical case scenarios. Data were analysed using a simple descriptive approach. Of 652 responses, 500 were complete and used for analysis. Two hundred eleven respondents were senior medical staff covering acute medical disciplines. Ninety-one percent of respondents agreed or strongly agreed that defibrillation is part of CPR, and 96% believed CPR for IHCA included defibrillation. Responses to clinical scenarios were dissonant, with nearly half of respondents demonstrating a pattern of underestimating survival and subsequently showing a desire to offer CPR in similar scenarios with poor outcomes. This was unaffected by seniority and level of resuscitation training. The common use of CPR in hospital reflects the broader definition of resuscitation. Recapturing the CPR definition for clinicians and patients as only chest compressions and rescue breaths may allow clinicians to better discuss individualised resuscitation care to aide meaningful shared decision-making around patient deterioration. This may involve reframing current in-hospital algorithms and uncoupling CPR from wider resuscitative measures.

Variation in clinical practice guidelines for use of palivizumab in preventing severe respiratory syncytial viral (RSV) disease in high-risk infants.

Uniformity and compliance with clinical practice guidelines (CPGs) for use of palivizumab in preventing severe respiratory syncytial viral infection in Australian high-risk infants remain unclear. An online survey was conducted across the Australian and New Zealand Neonatal Network (ANZNN) to determine clinical practices around palivizumab. A literature search was also performed to identify and compare national and international guidelines. A total of 65 of 422 ANZNN members completed the survey. Respondents included 61 senior medical staff of consultants/staff specialists (78%) and four nursing staff (6%). According to the survey, infants most likely to be recommended palivizumab included preterm infants born <29 weeks gestational age (GA) (30%), children with chronic lung diseases (CLDs) born <32 weeks GA (40%), and with hemodynamically significant heart disease (35%). Many of the respondents (53%) stated that CPGs for palivizumab were developed locally. Literature search identified 20 guidelines (10 international and 10 domestic); 16 (80%) recommended palivizumab use in preterm infants, 16 (80%) recommended use in infants with CLD, 17 (85%) in congenital heart disease and 6 (30%) in bronchopulmonary dysplasia (BPD). Eight (40%) guidelines provided specific recommendations for immunocompromised infants. Canada, Western Australia, and American Academy of Paediatrics provided recommendations for Indigenous children. Frequency and dosage of palivizumab was universal across all CPGs. None of the international guidelines obtained were from low- or middle-income countries. Standardization of CPGs may improve clinical decision making around use of palivizumab in high-risk infants.

Underreporting of occupational blood and body fluid exposure in French university hospitals in 2017.

Occupational blood and body fluid exposures (OBBFEs) are one of the biological risks run by health professionals, especially in hospitals. The objectives of this study were to assess the occurrence and reporting of occupational blood and body fluid exposures (OBBFEs) in university hospital medical staff and to investigate factors associated to declared OBBFE and factors associated to reported OBBFE. A self-administered questionnaire has been e-mailed to all junior and senior medical staff in four university hospital centers in one administrative region of France in 2017. 292 of the 1,228 respondents declared at least one OBBFE. More than two-thirds (70.2%) were under-reporters and more than half (53.8%) non-reporters. Younger subjects, surgical specialties and other associated work accidents were risk factors for OBBFE. Considering the reporting procedure too complex was a risk factor for underreporting. Underreporting by hospital medical staff was a persistent phenomenon, with a high rate. The OBBFE reporting procedure needs rethinking.

Management of paediatric acute severe behavioural disturbance in emergency departments across Australia: A PREDICT survey of senior medical staff.

Acute severe behavioural disturbance (ASBD) is a condition seen with increasing frequency in EDs. It poses a significant risk to the patient and those around them. Little is known about the epidemiology or most effective management in the paediatric population. The aim of the present study is to clarify the practice of senior emergency doctors in Australia when managing paediatric ASBD. The present study was a voluntary electronic questionnaire distributed to and undertaken by senior medical staff in EDs affiliated with the Paediatric Research in Emergency Departments International Collaborative (PREDICT) network. Respondents reported on exposure to and confidence in managing paediatric ASBD and their current practices. A total of 227 (33%) clinicians completed the survey between February and May 2020. Most clinicians were caring for at least two young people with ASBD each week (72%), felt confident regarding the majority of components of management and referred to local clinical practice guidelines (69%). Agitation/sedation rating scales were seldom used (19%). There was a significant variation in self-reported management practices. The choice of whether to use medication at all, the medication chosen and route of administration all varied greatly. Respondents were more willing to provide parenteral medication to young people reported as having recreational drug intoxication (84%) than those with neurodevelopment disorders (65%) when the same degree of agitation was reported. Within Australia, there is considerable variation in paediatric ASBD practice, in particular regarding medication provision. Further prospective research is required to inform best clinical practice.

245 A PILOT STUDY EVALUATING USE AND ACCEPTABILITY OF A NATIONAL AUDIT TOOL AND MANUAL FOR PSYCHOTROPIC MEDICATIONS IN RESIDENTIAL CARE

Abstract Background Psychotropic medications are frequently prescribed for long-term care residents, even though the risks frequently outweigh the benefits. A draft tool was developed for self-audit of the appropriateness of psychotropic medications prescribed for non-cognitive symptoms for people with dementia in Residential-Care Facilities (RCF). Prior to national use, the audit tool, audit manual and training required piloting. Methods The case notes of ten residents with dementia were selected at random within a single RCF. A set of notes were audited by professional staff after online (pre-recorded) audit training, with subsequent feedback by the auditors on the process via focus groups/individual interviews. A second set of notes were then audited, with feedback via a brief survey. Results All auditors (7 nurses, 4 doctors, and 4 therapists) gave feedback via a focus group(n=4) or 1:1 interviews; 7 also completed the second-round survey. The pre-audit online training was welcomed but some auditors required additional support during the audit, especially if inexperienced or if there was a gap between training and audit performance. Improvement suggestions for the audit manual included shortening it; adding a glossary of terms, and additional information for decisions on the appropriateness of “as needed” (PRN) medications. Auditors reported difficulties with reading handwriting, locating information in the chart, and determining if a medication was newly or previously prescribed on occasion (due to inconsistencies with prescribing documentation). Conclusion Overall, the feedback was positive; all reported that the audit was relevant to their practice, and the manual and online training were useful. Future audits could be facilitated by electronic prescriptions, protected time to complete audits, and site audit leads (senior nursing or medical staff who are familiar with the residents, the audit topic, and with performing the audit). Inexperienced auditors should have, in addition to a training session, a supported auditing session.

Research activities in general medicine: a scoping survey by the Internal Medicine Society of Australia and New Zealand.

BackgroundIn developing an effective framework for a collaborative research network (RN) that supports members involved in research, the Internal Medicine Society of Australia and New Zealand (IMSANZ) required a better understanding of the current level of research activity and engagement by general physicians, and factors influencing such engagement.AimsTo explore the current research landscape amongst general physicians in Australia and Aotearoa New Zealand.MethodsA questionnaire exploring research participation, scope, research enablers and barriers was disseminated to IMSANZ members over a 3‐month period. Core functions of IMSANZ‐RN, research priorities, potential solutions to perceived barriers and required level of support were also evaluated.ResultsA total of 82 members, mostly senior medical staff (74.4%), responded to the survey (11.8% response rate). More than 70% were involved in impactful research across multiple disciplines, encompassing a wide range of research themes and topics. However, there is limited support and resources available to conduct research, with most projects being self‐instigated and self‐funded. There is overwhelming support to increasing the profile of research in general medicine through the establishment of IMSANZ‐RN, whose principal purposes, as identified by respondents, are to foster collaboration, promote research, provide research education and training, and share information among general physicians. Quality improvement studies (56.1%) and clinical trials (41.5%) were also identified as priority research types.ConclusionsThis study has profiled the constraints faced by general physicians in conducting high‐quality collaborative research and provides insights into what is needed to support greater research engagement, through development of a discipline‐specific clinical RN.

Implementation of the 'PicNic' handover huddle: A quality improvement project to improve the transition of infants between paediatric and neonatal intensive care units.

Thorough handover and effective communication are crucial to the transfer of clinical information between different intensive care units. Following a sentinel patient safety event, an improvement project was initiated to reduce patient safety risks associated with the transfer of complex patients between the neonatal and paediatric intensive care. A handover tool was implemented over a 4-month period, guiding handover through means of a handover huddle. The tool ensured a full ISBAR (Introduction, Situation, Background, Assessment, Response) handover, with a specified attendance register. It acknowledged specific safety points inclusive of outstanding investigations, procedural history and medication transcription. Post implementation, huddle checklist sheets were audited for compliance and a staff satisfaction survey was conducted. Thirty-nine handovers took place during this trial period, of which 69% were captured in the huddle process. Senior medical and nursing staff attendance was greater than 95% throughout the process, and 100% of huddles attended to a full ISBAR handover. Sixty staff satisfaction survey responses were received, 90% of which identified the process to improve the safety of patient handover. Responses also identified safety issues such as discontinuity of medication transcription between the units, and inappropriate patient transfers occurring outside of working hours. Qualitative feedback highlighted how the tool improved interdepartmental educational and collaboration opportunities. The 'PicNic' huddle effectively facilitated a standardised handover between paediatric and neonatal intensive care. It also recognised the importance of interdepartmental collaboration and education surrounding culturally different clinical practices. Further improvement cycles continue to progress the tool and initiate a digital format for ongoing use.

Early detection and treatment of acute illness in medical patients with novel software: a prospective quality improvement initiative

ObjectiveAn ageing population and rising healthcare costs place healthcare systems at risk of failure. Our goal was to develop a technology that would identify illness early, initiate action and therein...

Editorial introductions.

Editorial introductions.

Factors that influence and change medical engagement in Australian not for profit hospitals

PurposeThe study aims to assess medical engagement levels at two teaching hospitals and a 500 bed private hospital in two states operated by the same health care provider and to describe individual and organisational factors that influence and change medical engagement.Design/methodology/approachA survey was emailed to all junior and senior medical staff, seeking responses to 30 pre-determined items. The survey used a valid and reliable instrument which provided an overall index of medical engagement. Qualitative data were also collected by including an open ended question.FindingsDoctors (n = 810) working at all sites are in the top 20-40 percentile when compared to Australia and the United Kingdom. Two sites in one state were in the highest relative engagement band with the other being in the high relative range when compared to the (UK) and the medium relative band when compared to sites in Australia. Senior doctors working at all three were less engaged on feeling valued and empowered, when compared to having purpose and direction or working in a collaborative culture. This appears to be related to work satisfaction and whether they feel encouraged to develop their skills and progress their careers. Junior doctors at 1 site are much less engaged than colleagues working at another. Since their formal training pathways are identical the informal training experience appears to be an engagement factor.Originality/valueDespite medical engagement being recognised as crucial, little is known about individual and organisational factors that support doctors to be engaged, particularly for juniors and in the private sector.

APPROACHES TO IMPROVE MANAGEMENT STYLES IN THE PROCESS OF TRAINING LEADERSHIP MEDICAL STAFF AT DIFFERENT LEVELS OF EDUCATION

Abstract. Effective leadership, which is one of the most important functions of the health care system, is impossible without effective leadership.&#x0D; Objective. Exploring the self-perception of own management style among senior medical staff and medical students to determine approaches for their optimization in the direction of improving personal and professional efficiency.&#x0D; Materials and methods. A study was conducted among 76 managers of different levels of management of health care institutions in the Dnipro region (main group) and 74 senior medical students (comparison group). The methodology developed and tested by WHO specialists in the relevant training module on leadership and strategic management was used. A special website https://leader-style.herokuapp.com was created to collect information and obtain results. The results were analyzed using generally accepted statistical approaches using the Jupyter Notebook software (https://jupyter.org/install)&#x0D; Results. Among the dominant management styles among managers of different levels in descending order were: Problem-solving style, Supportive, Resilient and Innovative. Similar patterns are observed among medical students in the frequency of styles, but with a statistically significantly lower frequency (p &lt;0.05) there are Supportive and Problem-solving styles. Regarding the effectiveness of management functions, no differences were found between the groups between Regulating and Adaptive functions, while others had a greater degree of effectiveness in the organizers of health. Managers most effectively use the next functions: Task Management, Creative and Nurturing, the least effective - Regulating and Adaptive.&#x0D; Conclusions. The formation of leadership potential among medical students will in the future increase the effectiveness of the management functions of health care organizers. Defining leading management styles and further developing the necessary skills of managers is the leading way to improve their performance.

Aotearoa New Zealand emergency medicine specialists on the provision of care at or near the end of life: A survey.

The ED is an increasingly important venue for the initiation of palliative care. We sought to characterise the opinions, experience, training and education of ED staff in Aotearoa/New Zealand (NZ) with regard to specific aspects of palliative care in the NZ ED setting. All NZ FACEMs were personally emailed a simple unstructured 16-part survey asking questions about initiating palliative care, goals of care, initiation and availability of advance care plans, frailty screening, availability of palliative expertise, training and education, cultural safety and pastoral care of staff. All EDs were contacted and a link provided for non-FACEM ED staff who wished to participate. Free-text comments were analysed for dominant themes. All NZ EDs had at least one participant. There was a high level of senior medical staff engagement with 60% of NZ FACEMs participating. More than 300 free-text comments from this group were available for theme analysis. A total of 93% of NZ FACEM respondents agree that palliative care should be able to be initiated in the ED. Only 25% of this group knew of training in serious illness conversations in the ED while only 34% felt culturally competent when providing end-of-life care for Māori and their whanau (family). Pastoral care for ED staff appears to be ad hoc. Time and privacy limitations were common themes. There is significant opportunity for quality improvement in the initiation and provision of palliative care from the ED. Attention to how departments provide pastoral care to their staff is needed.