Hospital Services Research Articles

Hospitality in Healthcare: Leveraging Employee e-WOM

ABSTRACT Providing hospitality services to patients to enhance their overall healing process has gained importance in the healthcare industry. It is not only just about getting healed but also the experience involved. This entails quality hospitality services in addition to medical services. Given that a happy employee provides better services, the role of job satisfaction of employees providing these services thus becomes important. Drawing from service quality frameworks, this article aims to identify enablers and deterrents of job satisfaction and validate with practitioners pulling out latent aspects that need to be focused on integrating hospitality in healthcare. We explored these aspects using a three-pronged approach. Initially, we identified the key themes influencing job satisfaction by applying data mining techniques to 13,000 employee reviews from companies recognized as Great Place to Work, sourced from Glassdoor. 1 Second, we validated the identified theme from experts through 24 focused group discussions comprising HR practitioners, thereby gaining interesting insights about certain important overlooked aspects. Third, we include literature support for each of the identified themes, stating their importance to the healthcare sector. The study provides a rubric of enablers and deterrents to job satisfaction, which can help the sector enhance employee satisfaction.

Anxiety and Depression among patients with chronic pain

Background: Chronic pain is a pervasive and debilitating state experienced by many individuals across the globe. It produces a wide range of physiological impact which are well documented in literature but the psychological impact which is also equally profound has not received much attention. This study aims to investigate severity of anxiety and depression in patients with chronic pain that contributes to the development of holistic and effective treatment approaches. Materials and Methods: A non-experimental descriptive cross-sectional design was adopted. Non probability purposive sampling was used to recruit a sample of 50 patients with chronic pain attending OPD services in a secondary hospital, Chittoor, Andhra Pradesh. Patients who aged between 20 and 70 years with a chronic pain for at least 3 months were included. Patients with malignant pain were excluded. Hospital Anxiety and Depression Scale (HADS) was used to capture data on anxiety and depression. Results: The mean anxiety score on HADS was 9.2 (SD-3.72) and depression score was 8.48 (SD-3.23). Nearly one third of participants (32%) reported abnormal level of anxiety and 26% had reported abnormal depression. There is no significant association found between level of anxiety and Sociodemographic variables such as age, gender, marital status, type of family, education and occupation. Level of depression showed a significant association with age (p=0.042). Conclusion: Patients with chronic pain experience varying degrees of anxiety and depression. Routine assessment of these attributes would help the healthcare team to plan patient-tailored interventions to manage pain and to prevent anxiety and depression.

Enhancing healthcare operations: a systematic literature review onapproaches for hospital facility layout planning.

The appropriate physical layout of hospital services can help resolve management problems by streamlining the work of medical teams, improving the flow of patients between specific areas and the medical support environment. Nevertheless, the academic literature lacks structured research into how the physical layout of hospitals might be improved. Our study aims to fill this research gap, providing information for researchers and professionals who intend to guide the hospital facility layout planning (HFLP) from the steps and prescribed approaches found in the literature. This study analyzes the current literature status and concerning approaches that support HFLP and identifies their strengths and weaknesses. The literature was classified using the following criteria: approaches for layout generation, approaches for layout evaluation and healthcare facility layout outcomes. The hospital facility layout outcomes achieved for each phase served as a basis for identifying a list of strengths and weaknesses for the hospital layout facility generation and evaluation approaches. Readers can refer to this paper to identify the approach that best fits the desired goal and the HFLP step. This is a contribution to current studies into HFLP, and it provides guidelines for selecting the approach to be utilized based on the desired outcome. The paper describes how to conduct an HFLP and lists the strengths and weaknesses of each approach. The research may be used as a strategy for determining which tool is most suited based on the practitioner's target purpose.

Comparison of perinatal hospital services of women living in Roma settlements in Slovenia

Abstract Background Women living in Roma settlements in Slovenia had worse perinatal health indicators comparing with women from the rest of population. They gave more births in younger age and used fewer preventive services and later in pregnancy. Roma children had higher chances to be born earlier and with lower birth weight. We explored the differences in provided hospital services between pregnant Roma and the rest of female population in Slovenia. Methods We identified the female inhabitants of Roma settlements from the national registry of population and separated from the rest of the population data. Health indicators were provided from the national health register - Perinatal Information System for the years from 2018 to 2022. The frequency statistics, ANOVA and comparison of column proportion tests were used (p-value<0.005, 95% CI) to compare the differences in categories of services in those two groups. Results Statistically significant differences were found in several hospital services comparing treatments of pregnant females from Roma settlements comparing to the rest of female population. Women from Roma settlements had higher ratio of gynecologic history without remarks, fewer treatments and less prevention investigations in prenatal period and higher ratio of natural start of delivery. In addition, by Roma females was used less medication during delivery, less episiotomies and fewer caesarean section were performed. Conclusions There are significant differences in provision of hospital services between female inhabitants of Roma settlements and the rest of population. Some of them could be explained by younger average age of delivery in Roma, but additional research would bring more light in possible impact of socio-economic and cultural determinants on both the use and provision of health services. Key messages • There are differences in provided health services between Roma women and the rest of female population. In depth research of prenatal and hospital services would bring additional explanations. • Considering the health inequalities which start by birth, targeted and tailored actions to improve health of Roma women and their new-borns are appropriate and necessary.

Healthcare utilization in general practice and hospitals preceding a diagnosis of systemic sclerosis: a nationwide registry study.

Irreversible tissue damage is frequently present at the time of diagnosis in systemic sclerosis (SSc), which calls for earlier diagnosis. This study estimated healthcare utilization three years before the diagnosis of SSc. We conducted a population-based cohort study using data from Danish national registries. Incident patients diagnosed with SSc between January 1, 2005, and December 31, 2018, were matched by age and gender with 10 references without SSc. The date of diagnosis was the index date. We estimated quarterly rates and adjusted incidence rate ratios (IRRs) with 95% confidence intervals (CI) of healthcare utilization in the three years preceding the diagnosis for patients with SSc and their references. A total of 1,650 SSc patients (1,255 women and 395 men) and 16 500 non-SSc references were included. The mean age was 58 years (interquartile range 48-68). Three years before diagnosis, patients with SSc had more contacts with general practice (IRRwomen= 1.43 [95% CI: 1.33; 1.53], IRRmen= 1.47 [95% CI: 1.26; 1.71]) and hospitals (IRRwomen= 1.86 [95% CI: 1.62; 2.14], IRRmen= 2.70 [95% CI: 2.04; 3.58]) compared with their references. In the last three months before diagnosis, patients with SSc had significantly more contacts with general practice (IRRwomen= 2.30 [95% CI: 2.16; 2.44], IRRmen= 2.98 [95% CI: 2.64; 3.35]) and hospitals (IRRwomen= 5.62 [95% CI: 5.08; 6.20], IRRmen= 9.53 [95% CI: 7.81; 11.63]). The higher use of healthcare services in general practice and hospitals in the three years before diagnosis suggests an opportunity to facilitate earlier diagnosis and treatment of SSc.

Impact of COVID-19 on cardiology and neurology services in a peripheral hospital in Northern Israel

Abstract Background The indirect impact of COVID-19 pandemic on clinical services remains incompletely described in secondary care hospitals outside major urban centers. We compared clinical outcomes before and during the pandemic in a disrupted service (Neurology) and a non-disrupted one (Cardiology) in a peripheral hospital in Israel, using Cerebral Vascular Accident (CVA) and ST-elevation myocardial infarction (STEMI) as clinical indicators, respectively. Methods We compared demographics, treatment and outcomes from CVA and STEMI patients who attended Ziv Medical Center, Israel, during the pandemic (15/3/2020-15/4/2022) and before (1/1/2018-14/3/2020), Using chi-square, t-test and Wilcoxon-Mann-Whitney tests. Results 1029 CVA and 497 STEMI patients were included. Those who arrived during the pandemic were demographically comparable to those arriving before. Compared to pre-pandemic, intra-pandemic median time for CVA patients from arrival to imaging was longer (23 vs. 19 minutes, p = 0.001). However, timing from arrival to tissue Plasminogen Activator administration was similar (49 vs. 45 min, p = 0.61). The likelihood of transfer to another hospital was higher (20.3% vs. 14.4% p = 0.01) and median length of stay (LOS) was shorter (3 vs. 4 days, p < 0.05). Among STEMI patients, median time from arrival to percutaneous coronary intervention during the pandemic was shorter than before (45 vs. 50 minutes p = 0.02) and median ejection fraction at discharge was higher (50% vs. 45% p = 0.02). Mean LOS was shorter (3.86 vs. 4.48 p = 0.01), and unplanned re-admission to the ED was less frequent (7.8% vs. 14.6% p = 0.01). No significant changes in mortality were observed. Conclusions Our data shows no major negative impact of the COVID-19 pandemic on CVA and STEMI outcomes, and possibly improved care in the less disrupted department. Follow-up qualitative studies with neurology and cardiology staff already in action to comprehend how quality of care was maintained during the crises. Key messages • In peripheral setting, COVID-19 hadn’t negatively impact Neurology or Cardiology acute clinical outcomes. • The consequences of maintaining clinical performance when working under adverse conditions requires further research.

Guidance on health promoting and climate-friendly hospitals and health services

Abstract The negative impacts of climate change on health and the healthcare system are becoming increasingly evident. The healthcare sector, which accounts for nearly seven percent of Austria’s CO2 emissions, contributes to the exacerbation of climate change on one hand, but is also affected by its consequences on the other. To meet these challenges, it is necessary for healthcare facilities to both adopt climate-protective measures and adapt to the changed conditions. A project launched in 2023, supported by the Austrian Health Promotion Agenda and in cooperation with the Austrian Network of Health Promoting Hospitals and Health Services, has shown that there is a need for support in implementing climate protection measures in healthcare facilities. In response, the WHO Collaborating Centre for Health Promotion in Hospitals and Healthcare, located at the Competence Centre for Health Promotion and Healthcare at the Austrian National Public Health Institute, will work on the development of standards based on international models to support healthcare facilities in the introduction of climate-friendly practices until 2026. The methodology of the project includes the analysis of existing quality criteria and instruments, as well as a modified Delphi process with two rounds of online questionnaires directed at an international panel of experts. After each round, exchange meetings with a smaller group from the panel take place to achieve consensus. Based on the research findings and the Delphi consultations, a draft of standards and an implementation manual will be created. These drafts will be piloted in various healthcare facilities in Austria and other countries to assess their practicability and effectiveness. Following the pilot tests, the standards and the manual will be revised to integrate the practical insights gained. At the time of the conference, the initial results of the Delphi process will be presented, providing insights for the further development of the standards. Key messages • Integrating climate-friendly practices into all aspects of healthcare can reduce its environmental impact, improve health outcomes, and contribute to the broader sustainable development goals. • Climate-friendly approaches yield significant health, economic, and social co-benefits.

Towards integration of care in Portugal: Expansion of a new management model for the NHS

Abstract Introduction In 1999, the first Local Health Unit (LHU) was created in the Northern region of Portugal to improve management, share resources and integrate care. The LHU integrated a National Health Service (NHS) hospital and primary healthcare (PHC) services located within the same geographic area and became responsible for public health activities and the provision of care. Over the next few years, 7 LHUs were created, the last one in 2012. In 2024, the government expanded this model to the entire territory, creating 39 LHUs. This research analyses the objectives, characteristics and expected outcomes of the scale-up of LHUs. Methods This study utilised a mixed methods approach based on the 6 Ps - Problem, People (policy stakeholders), Process (policy development), Price tag (Resource allocation), Paper (policies, laws, regulations), Programmes (policy implementation); and the political, social and economic setting of the Policy Circle Framework. Findings A 2015 assessment revealed that LHUs did not differ from non-LHUs in terms of access, waiting times, clinical excellency, patient safety or patient centeredness. The degree of integration of care in LHUs seemed lower compared with non-LHUs. However, there was no systematic evaluation of the creation of the first LHU. Despite this, the government announced the intention to expand LHUs to the entire national territory, which culminated with the creation of 39 LHUs in 2024 to deliver integrated care, with an emphasis on the proximity and continuity of health services and promotion. Conclusions Despite the existing knowledge gap on the impacts of LHUs in health outcomes and management efficiency, LHUs can provide opportunities to advance integrated and patient-centred care and develop strategies for managing scarce resources, including the health workforce. Nevertheless, the integration of hospitals and PHC can threaten the centrality of primary health care both in terms of delivery of care and resource allocation.

Comparison of hospital treatments of the Roma settlements’ inhabitants in Slovenia

Abstract Background Roma ethnic minority in Slovenia was recognized as a vulnerable group with worse health indicators and significantly shorter life expectancy. The vast majority of Roma population in Slovenia have health insurance. We were investigating the use of hospital services in Roma population according to their age and comparing it with the rest of the population. Methods We determined the inhabitants of Roma settlements from the Slovenian register on residents. The data on hospital treatments used were from Slovenian national register on hospital treatments for the period 2018 to 2022. We compared different ratios according to certain hospital treatments within age categories of patients and co-pared those two groups. The frequency statistics, ANOVA and comparison of column proportion tests were used (p-value<0.005, 95% CI). Results Inhabitants of Roma settlements were more often treating in hospitals that rest of population. If comparing the frequency of hospital treatments between age groups only in Roma population, the percentage of hospital treatments steeply declines with age as well as the number of persons in age groups. The highest percentages and numbers of services are in the youngest age group of 0-15 years, and the lowest in the oldest group (75+). Therefore, significantly higher ratios of hospital treatments were detected in younger then in older age groups. Conclusions Roma children and youngsters (0-15 years old) had the highest rate of hospital treatments and it declined with the age. It was consistent with age pyramid of Roma as young population as well as emphasized care for children in culture. The steady decline rate of hospital treatments with age could be explain with delayed seeking of health care services in adult age and higher premature mortality that leads to smaller adult population. Additional and in-depth research is necessary to explain the root causes of higher premature mortality and use of primary and preventive health services. Key messages • Higher use of hospital treatments was caused by higher morbidity. It is necessary to explore the leading causes of hospital treatments and premature mortality. • It is necessary to explore the use of primary health care service, preventive service and level of health literacy of inhabitants of Roma settlements.

Key requirements for achieving EU-wide programme change

Abstract Issue Across the world, thousands of projects aim for equitable improvement in health for people who are experiencing ongoing avoidable stigma, discrimination and disadvantage however very little change is often achieved. Description of the problem In this presentation we explore key requirements for project-level change to ensure EU-wide programme change is achieved. Results The two most common causes of project failure are a) the innovation is not suitable, needed or wanted (also called theory failure) or b) implementation failure. This presentation shares strategies to mitigate risks of project failure through co-design processes and communication, drawing from 30 years of experience from the entire implementation process from ideation to scale up. These experiences include projects from over 30 countries, including partnerships with the World Health Organization, governments and industry focused on health literacy, self-management, care pathways, workplace health, hospital services redesign, First Nations health and migrant health. Common success factors include balancing top-down needs with co-designed inputs and with previous preferred or good practice (which may have come from controlled trial evidence generated in different contexts). The intervention must co-implemented to serve stakeholder’s needs at all levels, from citizens to decision makers. Lessons The United Nations (UN) and private sector apply system-wide approaches to affect large scale change. This knowledge is valuable for large public health programmes aiming to integrate equity and diversity in project processes to minimize implementation failure.

The effects of a dyadic empowerment-based heart failure management (De-HF) programme on self-care and HRQL : a randomized controlled trial

Abstract Background The ever-growing epidemiology of heart failure (HF) and its detrimental impacts on patients’ quality of life and healthcare cost urge for effective interventions to ameliorate the modifiable prognostic factors. As substantial evidence suggests ineffective self-care as an important candidate especially for the post-discharge outcomes, various care approaches are developed to optimize this behavioral outcome. However, even family carers are heavily involved in the self-care process, dyadic approach to improve the health outcomes of both interactive partners are least applied in the HF transitional care model. Purpose To evaluate the effects of a dyadic empowerment-based heart failure management program (De-HF) on dyadic health and hospital service utilization outcomes. Methods This double-blind RCT randomized 88 HF patient-carer dyads to receive the De-HF program or a dialectic education program, after hospital discharge. Based on the Theory of Dyadic Illness Management, the 16-week De-HF Program, comprising i) a dyadic assessment, ii) five online empowerment modules and iii) follow-up telecare, integrated explicit strategies (scenario-based training, teach-back and goal-setting) to actively engage the care dyads in collaborative disease management. Figure 1 is the graphical presentation of the De-HF Program. The primary outcome is health-related quality of life (HRQL) of the care dyads. Secondary outcomes include patients’ self-care as well as shared care and perceived control of the dyad. Results The mean age of the HF patients was 76.8 (9.4). The patients were in moderate disease severity [NYHA II/II: 56/44%; mean LVEF = 42.5%]. Figure 2 shows the consort flow diagram. After adjusting the socio-demographic characteristic, two-way analysis of covariance showed that patients in the De-HF program showed significantly greater improvement in patients’ self-care domains [Mean difference in change of score (95% CI): Self-care maintenance = 7.15 (1.82-12.46),Cohen’s d = 0.26, p=0.009; Self-care management = 10.04(3.29-16.79), Cohen’s d=0.65, p=0.004; symptom perception = 15.59 (8.20-22.98), Cohen’s d=0.928, p<0.001] and Minnesota Living with Heart Failure score [Mean different in the change of score (95% CI) = -11.45 (-18.24 - -4.66). Cohen’s d = -0.742, p=0.001]. The patient-carer dyads also have significantly greater improvement in perceived control (p=0.001) and collaborative disease management in terms of joint decision-making (p=0.001) and sense of reciprocity (p=0.026). Conclusion Dyadic science has evolved in self-care research for HF. This trial provides the first evidence to inform the positive effects of a theory-based dyadic transitional care program in improving the collaborative self-care management in a family context and patient health outcome. Longer-term evaluation on the effects of De-HF program on health service utilization outcomes and cost-effectiveness will be followed.The De-HF Managment ProgramThe Consort Flow Diagram

Sociodemographic Patterns of Patients Engaging with an Acute Hospital Alcohol Care Team: An Underused Resource

ABSTRACT Alcohol care teams represent a unique resource to deliver holistic care for those presenting to acute hospital services with alcohol-related ill-health. However, most existing data regarding the characteristics of individuals engaging with alcohol support services concern those involved with community services. We reviewed the sociodemographic and alcohol-use characteristics of patients presenting to the Sandwell and West-Birmingham NHS Trust Alcohol Care team between 2018 and 2023. Patients engaging with Alcohol Care Teams in hospitals represent a population of significant vulnerability, driven by multiple sociodemographic and alcohol-use characteristics. These patients are distinct from those in community service treatment.

Validity of the Johns Hopkins Adjusted Clinical Groups system on the utilisation of healthcare services in Norway: a retrospective cross-sectional study

BackgroundThe Adjusted Clinical Groups (ACG) System is a validated electronic risk stratification system. However, there is a lack of studies on the association between different ACG risk scores and the utilisation of different healthcare services using different sources of input data. The aim of this study was therefore to assess the validity of the association between five different ACG risk scores and the utilisation of a range of different healthcare services using input data from either general practitioners (GPs) or hospitals.MethodsRegistry-based study of all adult inhabitants in four Norwegian municipalities that received somatic healthcare in one year (N = 168 285). The ACG risk scores resource utilisation band, unscaled ACG concurrent risk, unscaled concurrent risk, frailty flag and chronic condition count were calculated using age, sex and diagnosis codes from GPs and a hospital, respectively. Healthcare utilisation covered GP, municipal and hospital services. Areas under the receiver operating curve (AUC) were calculated and compared to the AUC of a model using only age and sex.ResultsUtilisation of all healthcare services increased with increasing scores in the “resource utilisation band” (RUB) and all other investigated ACG risk scores. The risk scores overall distinguished well between levels of utilisation of GP visits (AUC up to 0.84), hospitalisation (AUC up to 0.8) and specialist outpatient visits (AUC up to 0.72), but not out-of-hours GP visits (AUC up to 0.62). The score “unscaled ACG concurrent risk” overall performed best. Risk scores based on data from either GPs or hospitals performed better for the classification of healthcare services in their respective domains. The model based on age and sex performed better for distinguishing between levels of utilisation of municipal services (AUC 0.83–0.90 compared to 0.46–0.79).ConclusionsRisk scores from the ACG system is valid for classifying GP visits, hospitalisation and specialist outpatient visits. It does not outperform simpler models in the classification of utilisation of municipal services such as nursing homes and home services and outpatient emergency care in primary healthcare. The ACG system can be applied in Norway using administrative data from either GPs or hospitals.

The influence religiosity as a moderating patient satisfaction and positive word of mouth in Indonesian hospitals

The aim of this study was to fill a gap that is critical to developing strategies to increase positive word of mouth in health settings. Understanding the mediating role of patient satisfaction can provide insight into the areas of hospital service quality that most directly influence patient perception and subsequent recommendations. By forming clearer connections between these variables, healthcare providers can tailor their services to improve patient satisfaction and in turn stimulate positive word of mouth. The moderate role of religiosity can provide insight into whether and how religious beliefs influence patients' likelihood of spreading positive information by word of mouth based on their satisfaction with the healthcare experience. The research method used Causal Explanatory Research with a sample of 297 respondents in hospitals with religious ideology in Indonesia. Data management is done using SEM. Religiosity as a moderator of the relationship between patient satisfaction and positive women shows a C.R value of 6.075 and a significant probability (ρ) of 0.000 is obtained which is smaller than the required significance level of 0.05. Religiosity is able to significantly moderate the influence of Patient Satisfaction on Positive WOM.

'Development and Psychometric Testing of the Lean Management Scale for Nursing Services in Hospitals'.

The aim of this study is to develop a new instrument (The Lean Management Scale for Nursing Services in Hospitals- LMS-N) to evaluate the lean levels of nursing services in hospitals and to evaluate its psychometric properties. A three-phase construct was used to develop this scale and to determine its psychometric properties: (1) creating the item pool, (2) preliminarily evaluating items and (3) evaluating psychometric properties. This methodological study evaluated the scale's face, content and construct validities, internal consistency, and temporal stability. The psychometric properties of the scale were tested with a total of 695 nurses in different sample groups. Data were collected between 18 November 2020 and 15 May 2021. The scale's content validity index was 0.75. According to principal component analysis, the scale included 22 items and five subdimensions, and the total variance was 60.32%. In confirmatory factor analysis, the fit indices were good or acceptable for this construct. Its internal consistency was good or acceptable according to reliability analysis. Test-retest showed that the scale had temporal stability. Lean Management Scale in Nursing Services in Hospitals is a valid and reliable tool that can evaluate the level of leanness of nursing services. It provides a comprehensive evaluation with five subdimensions: management support, visual stock management, work environment layout, preventive notification system and waste detection.

Perceived quality of maternal care and its barriers based on women’s perspective in hospitals of Northwest Ethiopia: a qualitative study

BackgroundThe Sustainable Development Goals (SDGs) in health focus on achieving equity to reduce maternal mortality disparities among subpopulations globally. The goal is to lower the maternal mortality ratio (MMR) to below 70 per 100,000 live births by 2030 for countries with an MMR below 420 in 2010. For those exceeding 420, the target is to keep the MMR below 140 by 2030. This target could not be achieved unless quality maternal health care service is implemented in all health care settings. This study aimed to assess the quality of maternal care and perceived barriers based on women’s perspectives among women who receive delivery services in hospitals of South Gondar Zone, Northwest, Ethiopia.MethodsA phenomenological method was implemented to explore women’s perspectives on quality maternal care and its perceived barriers. An in-depth interview (IDI) was used to collect data using a semi-structured in-depth interview guide. The study was conducted from January 1–30, 2021. All in-depth interview notes were translated into meaningful notes. Then notes were organized by coding texts into meaningful elements using open code version 4.03 software.ResultsThe majority (14 in 20) tried to interpret quality care in terms of respect during procedures, providing family support, and timely care. Some (6 in 20) tried to associate quality care with the competency of care providers, the cleanliness of the procedure, and privacy during care. With regards to perceived barriers to quality care, the majority (15 in 20) of the IDI participants agreed that a high caseload, limited drugs, and administrative problems were barriers to providing quality maternal care.ConclusionParticipants articulate a multifaceted understanding of quality maternal care that encompasses emotional support, accessibility, cleanliness, timely interventions, and respectful treatment. They also identify significant barriers that stem from facility limitations, provider attitudes and knowledge, and administrative inefficiencies. Addressing these barriers is essential for enhancing the quality of maternal health services.

54 Efficacy of a quality improvement project in paediatric procedural pain management during needle procedures

Abstract Background In paediatric hospital settings, needle procedures significantly contribute to children’s experiences of pain and distress. A structured approach integrating preparation, comfort positions, distraction, relaxation techniques, and topical anesthetics can enhance children’s ability to cope with procedural discomfort. We developed a quality improvement (QI) initiative aiming to alleviate procedural pain and distress through a staggered implementation approach over a 3-year period. Objectives This study aimed to evaluate the impact of the first 2 years of an institutional QI initiative on managing procedural pain and distress in children undergoing needle procedures. The primary objective was to evaluate the use of multimodal strategies to reduce needle-related procedural pain/distress following the QI initiative. The secondary objective was to compare pain scores for needle procedures before and after the QI initiative. Design/Methods This observational study was conducted in a tertiary care university-affiliated paediatric hospital with an ongoing hospital-wide QI initiative aiming to alleviate procedural pain and distress in children undergoing needle procedures. The QI initiative consisted of mandatory sector-by-sector training of healthcare providers (HCP) on procedural pain/distress strategies to increase the use of multimodal pain care. Pain scores were measured during needle procedures (i.e. Numerical Rating Scale (NRS), Faces Pain Scale-R (FPS-R) or the FLACC scales, according to patient age) pre and 3-6 months post implementation of the QI initiative. Scheduled audits were conducted using a standardized questionnaire by a deployment champion nurse during needle procedures to document pain scales and pain/distress strategies used by the HCP during needle procedures in each of the hospital services. Results Throughout the first two implementation years (June 2021-June 2023), 363 audits were conducted on needle procedures for 363 children (Median age 7 yo (0month-18yo□). At this stage, audits took place in 14 different hospital services. The most frequent procedures were IV-line insertions (34%), venous blood draws (27%), and capillary blood sampling (26%). Parental presence and the use of distraction techniques were frequently used (90% and 80% of procedures, respectively). Of the 363 audits, 221 were pre-implementation and 142 post-implementation. Post QI initiative, an increased number of procedures were realized using multimodal strategies (4 or more strategies) to reduce pain/distress (from 60% to 78%). Pain scores were recorded for 203/221 audits pre and 134/142 post with a reduction in severe pain scores (7 or more) from 25% pre to 5% post-implementation. Conclusion The institutional QI initiative demonstrated both an increase in the number of strategies used to prevent pain/distress and a reduction in severe pain scores associated with paediatric needle procedures. This project emphasizes the significance of employing a multifaceted approach to managing procedural pain/distress in children undergoing needle procedures.

62 Outcomes from a randomized controlled trial of a brief virtual group intervention for adolescents with mild to moderate suicidal ideation and their caregivers: The BRAVA study

Abstract Background Building Resilience and Attachment in Vulnerable Adolescents (BRAVA) is a brief virtual group intervention designed for adolescents with mild to moderate suicidal ideation (SI) and their caregivers. The goal of BRAVA is to reduce SI in adolescents and increase family connection. The intervention consists of six independent, 90 minute modules that are delivered in a group setting on a weekly basis. Independent modules allow for rolling admission thereby reducing wait time to start the intervention. The modules include components of Dialectical Behaviour Therapy. Attachment Based Family Therapy, Cognitive Behavioral Therapy, Collaborative Problem Solving and psychoeducation. Adolescents and their parents attend separate groups. Adolescents focus on emotional regulation, coping skills, managing crisis situations and caregivers focus on connecting with their teen, validation and crisis management Objectives This randomized controlled trial (RCT) assessed the efficacy of BRAVA in reducing symptoms of SI, depression and anxiety in adolescents, and improving life stress and competency in caregivers. Design/Methods Ninety-nine eligible youth (13-17.5 years) presenting with mild to moderate SI (rated 1 on the suicide item of HEADS-ED MH screening tool) and their caregivers were recruited from hospital and community services. Families were randomized to BRAVA (n=50) or the control group (n=49). The control group intervention consisted of weekly text messages and the opportunity to join the BRAVA group post-exit assessment). Outcome measures were administered at intake and exit for adolescents (Suicidal Ideation Questionnaire-Junior, SIQ-JR; Revised Children’s Anxiety and Depression Scale, RCADS) and caregivers (Perceived Stress Scale, PSS; Parent Sense of Competency Scale, PSOC). Outcomes were analyzed using repeated measures of multivariable analysis of variance (MANOVA). Results Preliminary analyses showed no significant differences between groups at intake for any demographic or clinical variables. Most adolescents and caregivers completed their exit assessment (nBRAVA=37; nControl=39). Adolescents and caregivers attended a median of six and five groups, respectively. Comparing to the control group, BRAVA was superior in reducing SI (p = 0.05) and depression (p = 0.005) in adolescents and caregiver life stress (p = 0.026). Preliminary MANOVA of adolescent outcomes were significant for time [p <0.01, Effect size (ES) = 0.98] and between groups (p = 0.03, ES = 0.11). Caregiver outcomes were significant for time (p=0.051, ES=0.70). Conclusion This study demonstrates that a brief virtual group intervention can have a significant impact on adolescent SI and depression compared to an enhanced treatment as usual control group. In addition, BRAVA can reduce caregiver perceived stress, helping them view their lives as less unpredictable, uncontrollable and overloaded.

04 Care for adolescents with substance use: A national survey of paediatric hospitals

Abstract Background Substance use is a recognized Paediatric health care issue. More than 9 in 10 individuals receiving treatment for substance use disorders report that their first use of substances occurred by young adulthood. The Canadian Institute for Health Information reported that 5% of hospital stays among Canadian youth in 2017-2018 were related to harmful substance use. In a study of youth with a first-time emergency department visit for a mental health problem between 2010 and 2014, most visits were due to substance related disorders. Despite this, little is known about practices relating to substance use in children's hospitals. Objectives 1. To describe how adolescents who present to Paediatric hospitals with substance use disorders or substance-related health issues are identified, assessed, and treated. 2. To identify best-practices that can inform national standards of care. Design/Methods An online questionnaire was utilized to obtain information on: 1. Clinical practices in the emergency department, inpatient services and ICU; 2. Hospital policies and practice guidelines; and 3. Hospital and community programs and resources. Recruitment emails were sent to hospital leaders (CEO or equivalent) at all 13 Paediatric hospitals. Leaders were asked to identify one individual to complete the survey on behalf of their hospital with input from relevant stakeholders in the various clinical areas. The survey was developed iteratively by a national group of 9 adolescent medicine clinicians and 2 Paediatric trainees. The survey was piloted at a single Paediatric hospital and refined. The survey was administered via RedCap technology. Results Survey response rate was 70% (9/13 hospitals). The mean number of contributors to each survey was 9 (range of 1-35). Overall, few hospitals utilized best practices consistently. There was inconsistency in the use of validated screening tools, use of clinical practice guidelines for monitoring and ongoing care and prescribing of nicotine replacement therapy and opioid agonist therapy. These inconsistencies were noted within each clinical setting (emergency department, inpatient services, and ICU), across services in each hospital, and between hospitals. With respect to hospital services, 5/9 had some type of consult team related to substance use (e.g., adolescent medicine), 4/9 had specialized substance use outpatient services, and 2/9 offered partial hospitalization/day treatment for patients with substance use issues. Local community-based substance use resources were identified as insufficient to address needs by 8/9 hospitals. Conclusion Inconsistencies in the care of adolescents with substance use disorders or substance-related health issues highlights the need for national guidelines for Paediatric hospital-based assessment and care, and enhanced coordination between services and systems of care for this patient population.

From Plate to Planet: A Systematic Review and Meta-Analysis on Strategies to Reduce Plate Food Waste at Food Services

Annually, over 931 million tons of plate food waste is generated in food services, affecting various aspects of sustainability. Therefore, this review aims to evaluate the most effective strategies or actions to reduce plate food waste. A systematic review and meta-analysis were conducted following a PROSPERO-registered protocol [#CRD42024501971], searching multiple databases and gray literature until August 2024. Studies evaluating strategies and actions against waste in various food services [restaurants, institutional services in hospitals, childcare centers, schools, universities, or businesses] were included, with no language, location, or date restrictions. The risk of bias was assessed using JBI tools. A random-effects meta-analysis was performed in R (version 4.2.1), with subgroup analyses based on intervention type, food service type, meal type, management, and distribution systems. Of the 6070 studies, 18 were included in the narrative synthesis and 6 in the meta-analysis. The most effective strategies or actions targeted clients (vs. employees), meals on plates (vs. trays), school canteens (vs. other services), self-managed establishments (vs. outsourced), and à la carte services (vs. self-service). In this sense, strategies focusing on clients, plate-served meals, school canteens, self-management, and à la carte services are more effective in reducing food waste. Further actions are needed in other areas like customers, trays, different kitchen types, outsourced services, and self-service menus.