Service Line Research Articles

A Learning Health System to Generate and Accelerate Innovation: The HealthPartners Institute

The HealthPartners Institute is a research and education division embedded within HealthPartners — a nonprofit, member-governed integrated health system. The Institute aims to generate and accelerate innovation for the HealthPartners health system, its patients and members, and the communities it serves. It has taken a formal, organized approach to building the necessary capabilities, infrastructures, relationships, and tools to do so. This article outlines an innovative approach by which the HealthPartners Institute created an environment conducive to accelerated system performance. Key components of building this organizational milieu include (1) integration, (2) strategic planning, (3) democratization of knowledge (especially internally generated knowledge), (4) funding, and (5) a capability to listen to diverse perspectives from both within the organization and the community at large. In recent years, based on a 2023 survey of the HealthPartners Senior Strategy team, nearly two thirds of 34 respondents (61%) have seen more connections between their work and the work of the Institute, and just over half (52%) report that the Institute has become more relevant to their work. Notably, care delivery is the area to which respondents (78%) find the Institute brings the most value, followed by our patients (74%), HealthPartners as a whole (70%), and our community (70%). In addition, a series of multiyear federally funded trials involving patients with uncontrolled hypertension collectively represent an example of clinical and financial impact. This collaborative effort involving system division partnerships through the Institute’s core research department and centers of excellence compared usual hypertension care with an intervention that combined home blood pressure telemonitoring and pharmacist-led telephone care and found that the intervention group not only had lowered blood pressure and reduced cardiovascular disease events, but that for every US$1.00 spent the program realized US$1.82 in averted cardiovascular disease event costs. Efforts such as these advance system performance through a closer connection between the Institute and the health system’s strategic multiyear goals, shared leadership among major research portfolios and the care delivery service lines, preprofessional clinical education aligned with workforce needs, systemwide implementation of clinical simulation, aligned and integrated financial operations, and compliance and integrity programs. Based on these experiences and results, the authors present several themes that may support acceleration of progress toward achieving a high-performing learning health system. Future development will include focus on the generation and quantification of value for internal and external stakeholders, strategic alignment of priorities to enhance value, and continued focus on workforce development.

US Hospital Service Availability and New 340B Program Participation

The US 340B Drug Pricing Program enables eligible hospitals to receive substantial discounts on outpatient drugs to improve hospitals' financial sustainability and maintain access to care for patients who have low income and/or are uninsured. However, it is unclear whether hospitals use program savings to subsidize access as intended. To evaluate whether the 340B program is associated with improvements in access to hospital-based services and to test whether the association varies by hospital ownership. Difference-in-differences and cohort analysis from 2010 to 2019. Never and newly participating 340B general, acute, nonfederal hospitals in the US using data from the American Hospital Association's Annual Survey of Hospitals merged with hospital and market characteristics. Data were analyzed from January 1, 2023, to January 31, 2024. New enrollment in 340B between 2012 and 2018. Total number of unprofitable service lines, ie, substance use, psychiatric (inpatient and outpatient), burn clinic, and obstetrics services; and profitable services, ie, cardiac surgery and orthopedic, oncologic, neurologic, and neonatal intensive services. The study sample comprised a total of 2152 hospitals, 1074 newly participating and 1078 not participating in the 340B program. Participating hospitals were more likely than nonparticipating hospitals to be critical access and teaching hospitals, have higher Medicaid shares, and be located in rural areas and in Medicaid expansion states. At public hospitals, participation in the 340B program was associated with a significant increase in total unprofitable services (0.21; 95% CI, 0.04 to 0.38; P = .02) and marginal increases in substance use (5.4 percentage points [pp]; 95% CI, -0.8 pp to 11.6 pp; P = .09) and inpatient psychiatric (6.5 pp; 95% CI, -0.7 pp to 13.7 pp; P = .09) services. Among nonprofit hospitals, there was no significant association between 340B and service offerings (profitable and unprofitable) except for an increase in oncologic services (2.5 pp; 95% CI, 0.0 pp to 5.0 pp; P = .05). The finding of the cohort study indicate that participation in the 340B program was associated with an increase in unprofitable services among newly participating public hospitals. Nonprofit hospitals were largely unaffected. These findings suggest that public hospitals responded to 340B savings by improving patient access, whereas nonprofits did not. This heterogeneous response should be considered when evaluating the eligibility criteria for the 340B program and how it affects social welfare.

The recognition and negotiation of class-based barriers to progression and inclusion in accounting professional services firms

Drawing on interviews with accountants working at professional services firms (PSFs) in the UK, we explore how reflexivity enables accountants to recognise and negotiate class-based barriers to progression and inclusion. We identify a range of reflexive practices (including conversations with colleagues and clients, observations, mentoring, mulling over, and imagining) and show how these interact with habitus to structure the individual (mis)recognition of class-based barriers in the workplace. We find that reflexivity can engender an awareness of ‘difference’ and sense of inferiority relative to others, primarily for those from less privileged backgrounds. We provide evidence of the enabling role of reflexive practices which lead to purposive action for negotiating class-based barriers. However, we also find that reflexivity can lead to idiosyncratic strategies which support assimilation to (rather than challenging) existing practices in the accounting field. We find contradictory accounts of the effects of class, where class is recognised as a barrier, yet individuals are thought to progress through merit. We explain this tension through the limitations of reflexivity, restricted opportunities for reflexivity, and misrecognition of the effects of class in a seemingly meritocratic system. We provide examples of enduring and unrecognised class-based inequalities in accounting PSFs, including team composition and work allocation, class-segmented service lines, and the long-term consequences for those from less privileged backgrounds of having to work harder to ‘reach the same level’. Our findings suggest that PSFs must facilitate ‘difficult’ conversations aimed at breaking the culture of silence around class.

TAILR (Nursing-Sensitive Events and Their Association With Individual Nurse Staffing Levels) Project: Protocol for an International Longitudinal Multicenter Study.

Nursing-sensitive events (NSEs) are common, accounting for up to 77% of adverse events in hospitalized patients (eg, fall-related harm, pressure ulcers, and health care-associated infections). NSEs lead to adverse patient outcomes and impose an economic burden on hospitals due to increased medical costs through a prolonged hospital stay and additional medical procedures. To reduce NSEs and ensure high-quality nursing care, appropriate nurse staffing levels are needed. Although the link between nurse staffing and NSEs has been described in many studies, appropriate nurse staffing levels are lacking. Existing studies describe constant staffing exposure at the unit or hospital level without assessing patient-level exposure to nurse staffing during the hospital stay. Few studies have assessed nurse staffing and patient outcomes using a single-center longitudinal design, with limited generalizability. There is a need for multicenter longitudinal studies with improved potential for generalizing the association between individual nurse staffing levels and NSEs. This study aimed (1) to determine the prevalence, preventability, type, and severity of NSEs; (2) to describe individual patient-level nurse staffing exposure across hospitals; (3) to assess the effect of nurse staffing on NSEs in patients; and (4) to identify thresholds of safe nurse staffing levels and test them against NSEs in hospitalized patients. This international multicenter study uses a longitudinal and observational research design; it involves 4 countries (Switzerland, Sweden, Germany, and Iran), with participation from 14 hospitals and 61 medical, surgery, and mixed units. The 16-week observation period will collect NSEs using systematic retrospective record reviews. A total of 3680 patient admissions will be reviewed, with 60 randomly selected admissions per unit. To be included, patients must have been hospitalized for at least 48 hours. Nurse staffing data (ie, the number of nurses and their education level) will be collected daily for each shift to assess the association between NSEs and individual nurse staffing levels. Additionally, hospital data (ie, type, teaching status, and ownership) and unit data (ie, service line and number of beds) will be collected. As of January 2024, the verification process for the plausibility and comprehensibility of patients' and nurse staffing data is underway across all 4 countries. Data analyses are planned to be completed by spring 2024, with the first results expected to be published in late 2024. This study will provide comprehensive information on NSEs, including their prevalence, preventability, type, and severity, across countries. Moreover, it seeks to enhance understanding of NSE mechanisms and the potential impact of nurse staffing on these events. We will evaluate within- and between-hospital variability to identify productive strategies to ensure safe nurse staffing levels, thereby reducing NSEs in hospitalized patients. The TAILR (Nursing-Sensitive Events and Their Association With Individual Nurse Staffing Levels) study will focus on the optimization of scarce staffing resources. DERR1-10.2196/56262.

Observed rates of surgical instrument errors point to visualization tasks as being a critically vulnerable point in sterile processing and a significant cause of lost chargeable OR minutes

BackgroundThe reporting of surgical instrument errors historically relies on cumbersome, non-automated, human-dependent, data entry into a computer database that is not integrated into the electronic medical record. The limitations of these reporting systems make it difficult to accurately estimate the negative impact of surgical instrument errors on operating room efficiencies. We set out to determine the impact of surgical instrument errors on a two-hospital healthcare campus using independent observers trained in the identification of Surgical Instrument Errors.MethodsThis study was conducted in the 7 pediatric ORs at an academic healthcare campus. Direct observations were conducted over the summer of 2021 in the 7 pediatric ORs by 24 trained student observers during elective OR days. Surgical service line, error type, case type (inpatient or outpatient), and associated length of delay were recorded.ResultsThere were 236 observed errors affecting 147 individual surgical cases. The three most common errors were Missing+ (n = 160), Broken/poorly functioning instruments (n = 44), and Tray+ (n = 13). Errors arising from failures in visualization (i.e. inspection, identification, function) accounted for 88.6% of all errors (Missing+/Broken/Bioburden). Significantly more inpatient cases (42.73%) had errors than outpatient cases (22.32%) (p = 0.0129). For cases in which data was collected on whether an error caused a delay (103), over 50% of both IP and OP cases experienced a delay. The average length of delays per case was 10.16 min. The annual lost charges in dollars for surgical instrument associated delays in chargeable minutes was estimated to be between $6,751,058.06 and $9,421,590.11.ConclusionsThese data indicate that elimination of surgical instrument errors should be a major target of waste reduction. Most observed errors (88.6%) have to do with failures in the visualization required to identify, determine functionality, detect the presence of bioburden, and assemble instruments into the correct trays. To reduce these errors and associated waste, technological advances in instrument identification, inspection, and assembly will need to be made and applied to the process of sterile processing.

Leveraging data to support health equity in an integrated delivery and finance system.

To accelerate healthcare transformation and advance health equity, scientists in learning health systems (LHSs) require ready access to integrated, comprehensive data that includes information on social determinants of health (SDOH). We describe how an integrated delivery and finance system leveraged its learning ecosystem to advance health equity through (a) a cross-sector initiative to integrate healthcare and human services data for better meeting clients' holistic needs and (b) a system-level initiative to collect and use patient-reported SDOH data for connecting patients to needed resources. Through these initiatives, we strengthened our health system's capacity to meet diverse patient needs, address health disparities, and improve health outcomes. By sharing and integrating healthcare and human services data, we identified 281 000 Shared Services Clients and enhanced care management for 100 adult Medicaid/Special Needs Plan members. Over a 1-year period, we screened 9173 (37%) patients across UPMC's Women's Health Services Line and connected over 700 individuals to social services and supports. Opportunities exist for LHSs to improve, expand, and sustain their innovative data practices. As learnings continue to emerge, LHSs will be well positioned to accelerate healthcare transformation and advance health equity.

Modeling Copper Alloy Corrosion in Underground Service Line Components

Key TakeawaysIt's important for the water industry to determine which corrosion tests are suitable to evaluate potential alloys for service line components buried underground.Two dezincification tests were effective at correlating to field experience.Electrochemical corrosion tests using “low‐ and high‐corrosive” synthetic soil with neutral pH were not generally effective in predicting field experience.

Identifying alternative stops for first and last-mile urban travel planning

Urban travelers today are seeking increasingly more information to plan their optimal trip, based on additional factors other than scheduled departure times. Still, some route planning applications provide a simple approach with a few parameter settings (e.g. to minimize travel time between two specific places at a certain time) and without any multimodal solutions. Our approach provides travelers with a set of non-dominated nearby stops that presents a number of traveler preferences in an easily comprehensible and quickly calculable manner. We display first and last-mile stops that fall on a Pareto front based on multiple criteria such as travel time, number of transfers, and frequency of service. Our algorithm combines stop and route-based information to quickly present the traveler with numerous nearby quality options for their itinerary decision making. We expand this algorithm to include multimodal itineraries with the incorporation of free-floating scooters to investigate the change in stop and itinerary characteristics. We then analyze the results on the star-shaped public transportation network of Göttingen, Germany, to show what advantages stops on the Pareto front have as well as demonstrate the increased effect on frequency and service lines when incorporating a broadened multimodal approach.

The Current State of Neonatal Neurodevelopmental Follow-up Programs in North America: A Children's Hospitals Neonatal Consortium Report.

This study aimed to determine neonatal neurodevelopmental follow-up (NDFU) practices across academic centers. This study was a cross-sectional survey that addressed center-specific neonatal NDFU practices within the Children's Hospitals Neonatal Consortium (CHNC). Survey response rate was 76%, and 97% of respondents had a formal NDFU program. Programs were commonly staffed by neonatologists (80%), physical therapists (77%), and nurse practitioners (74%). Median gestational age at birth identified for follow-up was ≤32 weeks (range 26-36). Median duration was 3 years (range 2-18). Ninety-seven percent of sites used Bayley Scales of Infant and Toddler Development, but instruments used varied across ages. Scores were recorded in discrete electronic data fields at 43% of sites. Social determinants of health data were collected by 63%. Care coordination and telehealth services were not universally available. NDFU clinics are almost universal within CHNC centers. Commonalities and variances in practice highlight opportunities for data sharing and development of best practices. · Neonatal NDFU clinics help transition high-risk infants home.. · Interdisciplinary neonatal intensive care unit follow-up brings together previously separated outpatient service lines.. · This study reviews the current state of neonatal NDFU in North America..

IDENTIFYING BARRIERS IN PUBLIC SECTOR DIGITAL TRANSFORMATION: A CASE STUDY IN INDONESIA CITY OFFICE FOR POPULATION ADMINISTRATION AND CIVIL REGISTRATION (COPACR) CONTEXT

Purpose: This paper presents a case study of the Surabaya City Office for Population Administration and Civil Registration (COPACR), which is currently undergoing digitization and digital transformation across all its civil registration service lines. This research identifies internal and external barriers relevant to digital transformation in the context of Surabaya COPACR. Theoretical Framework: This study combines qualitative and quantitative methods to identify internal and external barriers relevant to the implementation of digital transformation in the COPACR sector. The barriers are validated through Focus Group Discussions (FGDs) applying the Analytic Hierarchy Process (AHP) and Expert Choice tools. Priority barriers are determined based on the highest relevance weight values from the perspectives of Top Management and Field Officers. Design/Methodology/Approach: This research adopts an action research methodology, leveraging the researcher's position within the system to directly intervene and facilitate change. A mixed-method approach is employed, combining qualitative and quantitative methodologies. Twenty literature sources are utilized to identify internal and external barriers within public sectors to adopt digital transformation. A total of 63 barriers (33 internal and 30 external) are categorized and their relevance tested through Focus Group Discussions (FGDs). Barrier priorities are selected using the Analytic Hierarchy Process (AHP) method and expert choice tools. Findings: The Surabaya COPACR in developing countries exhibits characteristics such as low employee motivation, inadequate officer competency, rigid bureaucratic structures, and limited innovation. With these conditions, the internal priorities for adopting digital transformation in Surabaya COPACR include lack of political support, traditional bureaucracy, organizational complexity, and lack of competency. External barriers include inflexible regulations, bureaucracy, lack of data standardization, and inadequate funding allocation. Research, Practical & Social Implications: This research contributes theoretical insights into internal and external priority barriers that need to be considered to adopt digital transformation in the COPACR context of developing countries. The identified barriers can serve as references for public sectors with similar organizational characteristics in developing countries to design strategies for adopting digital transformation effectively. Originality/Value: This study identifies internal and external barriers to digital transformation in the Surabaya COPACR context, involving assessments from both strategic (Top Management) and technical (Field Officer) perspectives.

Integrating connected autonomous shuttle buses as an alternative for public transport – A simulation-based study

The concept of connected autonomous shuttles is gaining recognition for its potential to revolutionize traditional public transport by offering a safer and more consistent travel experience. Despite technological advancements facilitating their integration into current traffic systems, research in this area is still exploratory, with public acceptance and trust in autonomous technology posing significant challenges. This paper contributes to the field by validating the benefits of deploying connected autonomous shuttles and examining their impact on ridership via an immersive experience. We introduce a VR-enabled co-simulation strategy to analyze the effects of replacing a traditional bus service line with connected shuttles in Melbourne, Australia. Our case study results reveal that while autonomous shuttles can reduce travel time because of optimized vehicle motion, their traffic efficiency is affected by fleet size, with the optimal fleet size identified as four in the study area. Furthermore, we observed a mismatch between participants’ stated intentions and actual boarding behavior, indicating that the attractive appearance of this novel mobility mode may not necessarily enhance ridership. Our work offers an alternative approach to simulation studies in futuristic public transportation and complement existing literature in the field.

Modeling the Failures and Decommissioning of Water Mains and Water Service Lines with Time-Dependent Factors

Modeling the Failures and Decommissioning of Water Mains and Water Service Lines with Time-Dependent Factors

Identifying drivers of cost in pediatric liver transplantation.

Understanding the economics of pediatric liver transplantation (LT) is central to high-value care initiatives. We examined cost and resource utilization in pediatric LT nationally to identify drivers of cost and hospital factors associated with greater total cost of care. We reviewed 3295 children (<21y) receiving an LT from 2010 to 2020 in the Pediatric Health Information System to study cost, both per LT and service line, and associated mortality, complications, and resource utilization. To facilitate comparisons, patients were stratified into high-cost, intermediate-cost, or low-cost tertiles based on LT cost. The median cost per LT was $150,836 [IQR $104,481-$250,129], with marked variance in cost within and between hospital tertiles. High-cost hospitals (HCHs) cared for more patients with the highest severity of illness and mortality risk levels (67% and 29%, respectively), compared to intermediate-cost (60%, 21%; p <0.001) and low-cost (51%, 16%; p <0.001) hospitals. Patients at HCHs experienced a higher prevalence of mechanical ventilation, total parental nutrition use, renal comorbidities, and surgical complications than other tertiles. Clinical (27.5%), laboratory (15.1%), and pharmacy (11.9%) service lines contributed most to the total cost. Renal comorbidities ($69,563) and total parental nutrition use ($33,192) were large, independent contributors to total cost, irrespective of the cost tertile ( p <0.001). There exists a significant variation in pediatric LT cost, with HCHs caring for more patients with higher illness acuity and resource needs. Studies are needed to examine drivers of cost and associated outcomes more granularly, with the goal of defining value and standardizing care. Such efforts may uniquely benefit the sicker patients requiring the strategic resources located within HCHs to achieve the best outcomes.

Eredienste vertoon die geestelike stand van die NG Kerk

Worship services display the spiritual stand of the Dutch Reformed Church. In theological and clerical circles, it is accepted that the content of church services in Dutch Reformed Church (DRC) congregations shows its spiritual state as a church, or the basic convictions of its Christian faith. From their General Synod as the broadest assembly in this church, stipulations of the DRC Church Order, as well as other resolutions about church services, are accepted to be implemented by congregations. From personal experiences during visits to congregations, the author came to the conclusion that there are tendencies in these church services that are no longer in accordance with its church order and the viewpoints of its General Synod, regarding church services. These tendencies lead to a derailing of the biblical lines of church services. It also indicates a lack of loyalty in this regard, by ministers of the DRC. What it boils down to, is that church services indicate the spiritual stand of the DRC.Contribution: This article shows that church services show the spiritual approach and practice of churches. It states a principle for Reformed churches, and its critique on the Dutch Reformed Church aims at a reformation. The article stresses that the integration of the confessions of a church, as well as the understanding of the church, reflects in the services.

Estimated Childhood Lead Exposure From Drinking Water in Chicago

There is no level of lead in drinking water considered to be safe, yet lead service lines are still commonly used in water systems across the US. To identify the extent of lead-contaminated drinking water in Chicago, Illinois, and model its impact on children younger than 6 years. For this cross-sectional study, a retrospective assessment was performed of lead exposure based on household tests collected from January 2016 to September 2023. Tests were obtained from households in Chicago that registered for a free self-administered testing service for lead exposure. Machine learning and microsimulation were used to estimate citywide childhood lead exposure. Lead-contaminated drinking water, measured in parts per billion. Number of children younger than 6 years exposed to lead-contaminated water. A total of 38 385 household lead tests were collected. An estimated 68% (95% uncertainty interval, 66%-69%) of children younger than 6 years were exposed to lead-contaminated water, corresponding to 129 000 children (95% uncertainty interval, 128 000-131 000 children). Ten-percentage-point increases in block-level Black and Hispanic populations were associated with 3% (95% CI, 2%-3%) and 6% (95% CI, 5%-7%) decreases in odds of being tested for lead and 4% (95% CI, 3%-6%) and 11% (95% CI, 10%-13%) increases in having lead-contaminated drinking water, respectively. These findings indicate that childhood lead exposure is widespread in Chicago, and racial inequities are present in both testing rates and exposure levels. Machine learning may assist in preliminary screening for lead exposure, and efforts to remediate the effects of environmental racism should involve improving outreach for and access to lead testing services.

The Effects of the Flint water crisis on the educational outcomes of school-age children.

In 2014, the municipal water source in Flint, Michigan was switched, causing lead from aging pipes to leach into the city's drinking water. While lead exposure in Flint children increased modestly on average, some children were exposed to high lead levels. Surveys of Flint residents show the water crisis was also associated with increased levels of stress, anxiety, and depression. We use Michigan's administrative education data and utilize synthetic control methods to examine the impact of the crisis on Flint's school-age children. We find decreases in math achievement and increases in special needs classification, even among children living in homes with copper (rather than lead) water service lines. Low socioeconomic status students and younger students experienced the largest effects on math achievement, and boys experienced the largest effects on special needs classification. Our results point toward the broad negative effects of the crisis on children and suggest that existing estimates may substantially underestimate the overall societal cost of the crisis.

Characteristics and academic career outcomes of Godina Fellowship recipients

The American Society for Reconstructive Microsurgery (ASRM) sponsors the Godina Fellowship to expand the careers of talented early career microsurgeons. This study characterizes the scholarly impact and academic career outcomes of Godina Fellows. The ASRM provided a list of Godina Fellows since program inception (1993 – 2020). An Internet based search obtained demographic, academic pedigree, and scholarly impact metrics. Curriculum vitae were reviewed to characterize future career outcomes including academic leadership positions. Of the 28 Godina Fellows, most were men (96%) and from the United States (61%). The average age of selection was 44 ​± ​4 years. Training pedigrees consisted primarily of plastic surgery residency training (93%) followed by orthopedic surgery (3%) and otolaryngology (3%). 32% completed reconstructive microsurgery fellowship training, 25% completed hand fellowship training, and 32% had no sub-specialty fellowship training. A minority of Fellows had a PhD (32%) and Master's Degree (14%). The average h-index was 33 ​± ​11 resulting from 160 ​± ​90 peer-reviewed manuscripts cited 3998 ​± ​2516 times. At the time of selection, Godina fellows had an average of 65 ​± ​42 peer-reviewed manuscripts. Most selected academic careers (79%), including 43% serving as chief of a sub-specialty service line (25%) or chair of a division or department (18%). Godina Fellowship recipients make important contributions to the field of reconstructive microsurgery through research impact and leadership at academic departments.

Bacterial communities of planktonic bacteria and mature biofilm in service lines and premise plumbing of a Megacity: Composition, Diversity, and influencing factors

Although simulated studies have provided valuable knowledge regarding the communities of planktonic bacteria and biofilms, the lack of systematic field studies have hampered the understanding of microbiology in real-world service lines and premise plumbing. In this study, the bacterial communities of water and biofilm were explored, with a special focus on the lifetime development of biofilm communities and their key influencing factors. The 16S rRNA gene sequencing results showed that both the planktonic bacteria and biofilm were dominated by Proteobacteria. Among the 15,084 observed amplicon sequence variants (ASVs), the 33 core ASVs covered 72.8 %, while the 12 shared core ASVs accounted for 62.2 % of the total sequences. Remarkably, it was found that the species richness and diversity of biofilm communities correlated with pipe age. The relative abundance of ASV2 (f_Sphingomonadaceae) was lower for pipe ages 40–50 years (7.9 %) than for pipe ages 10–20 years (59.3 %), while the relative abundance of ASV10 (f_Hyphomonadaceae) was higher for pipe ages 40–50 years (19.5 %) than its presence at pipe ages 20–30 years (1.9 %). The community of the premise plumbing biofilm had significantly higher species richness and diversity than that of the service line, while the steel-plastics composite pipe interior lined with polyethylene (S-PE) harbored significantly more diverse biofilm than the galvanized steel pipes (S-Zn). Interestingly, S-PE was enriched with ASV27 (g_Mycobacterium), while S-Zn pipes were enriched with ASV13 (g_Pseudomonas). Moreover, the network analysis showed that five rare ASVs, not core ASVs, were keystone members in biofilm communities, indicating the importance of rare members in the function and stability of biofilm communities. This manuscript provides novel insights into real-world service lines and premise plumbing microbiology, regarding lifetime dynamics (pipe age 10–50 years), and the influences of pipe types (premise plumbing vs. service line) and pipe materials (S-Zn vs. S-PE).

How SWAT Changed the Conversation: Implementation of a Discharge SWAT Team Improves Morale and Facilitates Communication During the COVID-19 Pandemic.

Hospital overcrowding and delays in discharge are serious issues in the modern health care landscape and can lead to poor patient outcomes and health care personnel (HCP) burnout. The goal of this project was to develop a collaborative forum where HCP representing the entire spectrum of the inpatient care team, including case management team members, could connect to discuss challenges and barriers to patient discharge. The following describes the development, implementation, and outcomes of the discharge SWAT (Solutions, Wins, Actions, and Tactics) team, which is a 30-min virtual daily meeting where discussion is primarily centered around challenges in discharging individual patients and addressing case manager needs. The primary aim of SWAT meetings is fostering a positive atmosphere to address barriers to discharge while prioritizing patient care and outcomes. This study was conducted in a 40-hospital academic health system in the United States. SWAT meetings were first implemented at a representative flagship facility in a health system. HCP at this first facility were surveyed to assess satisfaction with SWAT meetings. SWAT meetings then were implemented at the majority of facilities in a 40-hospital academic health system. During SWAT implementation, average inpatient length of stay (LOS) and patient care transitions were monitored for participating and nonparticipating service lines. Among surveyed HCP, the majority view SWAT meetings favorably and reported that it was a valuable use of their time and positively impacted their work in the patient discharge space. Nonprovider and case management staff in particular valued the SWAT meetings and found them beneficial. LOS remained stable for patients under the care of participating providers, despite the upheaval of the ongoing COVID-19 pandemic, and the research team also observed a positive impact of SWAT meetings on appropriate inpatient care transitions.

AUDIT OF COVID-19 WARD PERFORMANCE AND PRACTICE IN THE COVID-19 PANDEMIC: FUTURE DIRECTIONS FOR UNDERSTANDING: A RETROSPECTIVE STUDY

A retrospective study was conducted to assess the trend of the COVID-19 pandemic in the COVID Ward emergency and COVID Ward treatment departments of the Department of COVID Ward at POF Hospital Wah Cantt from January 2021 to January 2022. Data on every patient admitted to the COVID Ward department over a year was gathered retroactively. The following demographic factors were recorded: diagnosis, COVID-19 work-up, admission specialization, and COVID-19 ward vs. conservative therapy. In total, there were 156 patients, with 108 being primarily men (70.4%). Of these patients, 90 (72%) were admitted via the clinic, and 124 (46%) were admitted in May. One hundred five patients (62.8%) had a COVID-19 PCR, 135 had a chest x-ray (90.2%), and 56 patients (31.4%) had a chest HRCT. The orthopedic COVID Ward was the most common department for operational interventions, with 88.4% of patients undergoing operative care, despite the general COVID Ward being the busiest service line with 89 total patient admissions (43.1%). The study found that the existing local protocols for patient flow and COVID-19 crisis management are effective and practical. Hospitals should be prepared to redirect their resources to high-volume specialties like orthopaedics and general COVID Wards after the later COVID-19 waves. Arteriovenous fistula formation is a simple yet crucial technique that should only be discontinued in the event of a labor shortage.