Availability Of Staff Research Articles

Community health needs in Ukraine in the war context

Abstract The full-scale russia's invasion in Ukraine caused the migration of people, partially destroyed the medical infrastructure, disrupted access to services, so there is a need to connect people tocare. The e-tools allow to monitor the capacities of the healthcare system and utilization of services. However, there is insufficient data on the population's needs. The CHNA was conducted in March-May 2023 in 16 communities across 8 regions of Ukraine. It was based on the adapted methodology of the Philadelphia Healthcare Federation and applied the following research methods: statistical analysis of the operating PHC facilities, availability of medical staff, and current gaps in service delivery; structured survey of the community residents; FGDs with community decision makers and residents; in-depth interviews with heads of PHC facilities. The assessment results demonstrated limited access to healthcare services in remote settlements, and thus the need to develop new formats of healthcare provision. The study showed a difference in the perception of PHC services accessibility between decision makers and the population. The biggest need identified was for MHPSS services for IDPs and local residents. CHNA is critical to inform programming. To improve access to essential services, the USAID Public Health System Recovery & Resilience project will support new approaches to PHC service delivery, including through mobile teams and task shifting to expand the role of nurses. To increase availability of MHPSS services, the project builds the capacity of the workforce and supports the delivery of evidence-based interventions such as mhGAP, CETA, Selfhelp+, CBT. Key messages • The developed CHNA is an effective tool for decision-makers to understand the main gaps in the availability of health services and to develop targeted interventions, especially in times of war. • Community-based MHPSS interventions are critical in time of war.

Improving the quality of translation for patients with language barriers

Abstract Background Patients with language barriers have worse health outcomes. To promote equitable care, efforts must be made to ensure effective communication with patients, specifically by using professional impartial translation services. Aims To build upon previous cycles to promote the use of professional impartial translation. Methods A multi-centre quality improvement project in the Acute Medicine Departments of Bart's Health Trust Hospitals in East London. Patients with language barriers were identified; methods of translation were analysed; and interventions to improve access to professional translation were introduced. Professional impartial translation was defined as use of either a member of staff or interpreter. Results The first three cycles were completed at the Royal London Hospital. Interventions included the dissemination of information to staff members and also the provision of Bengali interpreters on the ward. This improved the number of patients receiving professional impartial translation from 5% to 20%. Further cycles at Newham Hospitals were then undertaken. The initial intervention included the provision of a portable language line device providing 24hour access to professional translation via telephone or video. Despite this, <20% of patient received professional impartial translation, with >50% still receiving translation via a family member instead. Following departmental teaching sessions on the project, this improved significantly with 35.7% having in person and 33.3% having telephone professional translation. Lessons Translation is commonly provided by family members who are often seen as natural advocates for patients; however they may lack impartiality and may be selective in their translation. Impartial professional translation is essential in delivering equitable care. Improved access to translation services alone was not enough, with significant increases in impartial professional translation only being seen after education on its benefits. Key messages • Education of staff and easy access to translation services improve their use. • However, further research is needed to identify why family members are still chosen over professional services.

Adoption of a multicomponent intervention to improve HPV vaccination in France: a mixed methods study

Abstract Background HPV vaccine coverage (VC) in France has always been lower than in most high-income countries. As part of the PrevHPV project, we developed and evaluated a school-based multicomponent intervention to improve HPV VC among French adolescents. We assessed the adoption of the PrevHPV intervention among secondary schools and its associated factors. Methods We carried out a pragmatic cluster randomized controlled trial (April 2021-June 2022) in 14/25 French school districts. The cluster was the municipality. Municipalities were eligible if there was only one secondary school and most inhabitants aged 11-14 years attended this school. We then contacted the head of the school to ask him/her to participate in the study. Based on the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework, we described municipalities’ exclusions, schools participation and associated factors (Chi2, t-tests). We also used qualitative data from six focus groups with participating school staff to explore facilitators and barriers to adoption at the school level. Results Compared to non-eligible municipalities (n = 2658), eligible ones (n = 1205) were smaller, less urban and deprived, with lower accessibility to general practitioners. Out of 346 randomly selected municipalities, 91 (26%) accepted to participate. Participating schools were smaller and located in more deprived municipalities than non-participating ones. During the trial, 31/91 (34%) schools discontinued intervention; we did not identify any characteristic associated with discontinuation. Qualitative data showed that several contextual factors can influence adoption at the school-level: human resources (school staff availability, turnover and attitudes towards vaccination, especially for school nurses); material (e.g. computer equipment) and financial resources; parents’ attitudes towards vaccination. Conclusions These results can guide policy making on school-based HPV vaccine promotion in France and Europe. Key messages • The PrevHPV project is supported by the French health authorities and conducted by a multidisciplinary consortium to tackle a long-lasting public health concern in France. • Should the intervention prove effective, these results are expected to help stakeholders scale-up the school-based PrevHPV intervention in France and other European countries.

Courtroom workgroup dynamics and implementation of Three Strikes reform

AbstractIn 2012, California's voters passed a ballot initiative that scaled back the state's “Three Strikes” sentencing law and permitted certain individuals who were serving 25‐to‐life prison terms to petition for resentencing and potentially release. Using analysis of original qualitative interview data supplemented with court administrative records, this study examines how characteristics of courtroom workgroup members; their intergroup dynamics; political, professional, and administrative considerations; and allocated resources were perceived by court officials to facilitate or impede the implementation of this reform in county courts. Availability of staff and budget was associated with a higher proportion of completed case dispositions in the first 2 years of implementation, but resources were not the only factor associated with timely case processing. Courtroom actors' seniority, experience, and professional security facilitated agreement on processes, schedules, and other details. Small, stable, close‐knit groups established routine procedures and developed expertise more quickly, but could not always avoid bottlenecks or delays. Less stable workgroups had higher rates of denial of petitions for resentencing. Positions toward Proposition 36 shaped by political, professional, or other priorities were perceived to influence some elected DAs' positions and line prosecutors' behavior, manifesting in cooperation, opposition, or mixed messages.

Cultural safety in telehealth consultations with Indigenous people: A scoping review of global literature.

Telehealth has become increasingly routine within healthcare and has potential to reduce barriers to care, including for Indigenous populations. However, it is crucial for practitioners to first ensure that their telehealth practice is culturally safe. This review aims to describe the attributes of culturally safe telehealth consultations for Indigenous people as well as strategies that could promote cultural safety. A scoping review was conducted on key features of cultural safety in telehealth for Indigenous people using the Johanna Briggs Institute (JBI) guidelines and PRISMA-ScR checklist. Five electronic databases were searched, and additional literature was identified through handsearching. A total of 649 articles were screened resulting in 17 articles included in the review. The central themes related to the provision of culturally safe telehealth refer to attributes of the practitioner: cultural and community knowledge, communication skills and the building and maintenance of patient-provider relationships. These practitioner attributes are modified and shaped by external environmental factors: technology, the availability of support staff and the telehealth setting. This review identified practitioner-led features which enhance cultural safety but also recognised the structural factors that can contribute, both positively and negatively, to the cultural safety of a telehealth interaction. For some individuals, telehealth is not a comfortable or acceptable form of care. However, if strategies are undertaken to make telehealth more culturally safe, it has the potential to increase opportunities for access to care and thus contribute towards reducing health inequalities faced by Indigenous peoples.

COVID-19 Related Facilitators and Barriers to In-Person Learning for Children With Intellectual and Development Disabilities: A Follow-Up.

Students with intellectual and developmental disabilities (IDD) and the staff who support them were largely in-person during the 2021-2022 school year, despite their continued vulnerability to infection with SARS-CoV-2. This qualitative study aimed to understand continued perceptions of weekly SARS-CoV-2 screening testing of students and staff amidst increased availability of vaccinations. Twenty-three focus groups were held with school staff and parents of children with IDD to examine the perceptions of COVID-19 during the 2021-2022 school year. Responses were analyzed using a directed thematic content analysis approach. Four principal themes were identified: strengths and opportunities of school- and district-level mitigation policies; experience at school with the return to in-person learning; facilitators and barriers to participation in SARS-CoV-2 screening testing; and perceptions of SARS-CoV-2 testing in light of vaccine availability. Despite the increased availability of vaccines, school staff and families agreed that saliva-based SARS-CoV-2 screening testing helped increase comfort with in-person learning as long as the virus was present in the community. To keep children with IDD in school during the pandemic, families found SARS-CoV-2 screening testing important. Clearly communicating school policies and mitigation strategies facilitated peace of mind and confidence in the school district.

Perspectives on Assessing the Flexibility of Hospitals for Crisis Mode Operations: Lessons From the COVID-19 Pandemic in the Netherlands.

The COVID-19 pandemic placed healthcare design at the heart of the crisis. Hospitals faced challenges such as rapidly increasing their intensive care unit capacity, enabling physical distancing measures, quickly converting to telehealth and telework practices, and above all, keeping patients and staff safe. Improving flexibility in hospital facility design and adaptability of hospital operations to function in "crisis mode" can be seen as ways of future-proofing for pandemics. In a design brief, flexibility is typically mentioned as an important target. Meanwhile, robustness of technical infrastructure is called for, and standardization at unit level with single-occupancy inpatient accommodation may be considered a way to enhance flexibility and adaptability in dealing with a surge in infectious patients. To future-proof facility design with pandemic preparedness and resilience in mind, this study evaluated what kinds of interventions were taken in Dutch hospital facilities and what perspectives need to be considered when hospitals operate in crisis mode. We have collected data from facility and estate professionals from 30 Dutch hospitals. Using a practice-based approach, in-depth interviewing helped uncover and compare successful operational strategies and design elements that provided the flexibility needed in the early stages of the recent crisis. As we looked at existing facilities and alterations made to allow hospitals to operate during the COVID-19 pandemic, we discovered that staff availability and adaptability were deemed crucial. We add the perspective of staff as an essential factor to be considered when future-proofing hospital facility desigr crisis mode operation.

Service Level Characteristics of Rural Palliative Care for People with Chronic Disease.

Despite clear benefit from palliative care in end-stage chronic, non-malignant disease, access for rural patients is often limited due to workforce gaps and geographical barriers. This study aimed to understand existing rural service structures regarding the availability and provision of palliative care for people with chronic conditions. A cross-sectional online survey was distributed by email to rural health service leaders. Nominal and categorical data were analyzed descriptively, with free-text questions on barriers and facilitators in chronic disease analyzed using qualitative content analysis. Of 42 (61.7%) health services, most were public (88.1%) and operated in acute (19, 45.2%) or community (16, 38.1%) settings. A total of 17 (41.5%) reported an on-site specialist palliative care team, primarily nurses (19, 59.5%). Nearly all services (41, 95.3%) reported off-site specialist palliative care access, including: established external relationships (38, 92.7%); visiting consultancy (26, 63.4%); and telehealth (18, 43.9%). Perceived barriers in chronic disease included: lack of specific referral pathways (18; 62.1%); negative patient expectations (18; 62.1%); and availability of trained staff (17; 58.6%). Structures identified to support palliative care in chronic disease included: increased staff/funding (20, 75.0%); formalized referral pathways (n=18, 64.3%); professional development (16, 57.1%); and community health promotion (14, 50%). Palliative care service structure and capacity varies across rural areas, and relies on a complex, at times ad hoc, network of onsite and external supports. Services for people with chronic, non-malignant disease are sparse and largely unknown, with a call for the development of specific referral pathways to improve patient care.

Prep-for-Labor: Overview of FIGO's labor and delivery triage bundles of care to optimize maternal and newborn outcomes.

Childbirth is an intense event in which decisions may need to be made in seconds to guarantee the health of both mother and newborn. Despite health systems and care approaches varying widely according to real-life scenarios, availability of facilities, beliefs, resources, staff, and geography, among others, optimal outcomes should be ensured worldwide. Triaging low-risk pregnancies from high-risk pregnancies is the first step to ensure proper allocation of resources. From this need, we developed FIGO's Prep-For-Labor triage methods, a series of 2-minute labor and delivery bundles of care, with special regard given to low- and middle-income countries and rural settings. Around 80% of women, once properly triaged, can pursue vaginal delivery with minimal intervention, while those at risk can either be managed on site or transferred promptly to an advanced care site. FIGO's bundles of care and good practice recommendations for labor and delivery and immediate newborn triage cover four clinical scenarios: (1) preterm labor; (2) induced or spontaneous labor at term; (3) cesarean delivery; and (4) newborn care. From rapid triage of the mother (low vs high risk) to the list of required equipment, description of skilled staff, and coordination of resources, the recommendations for care are introduced across these four areas in this overview article. Implementing the proposed management steps described in each summary can improve maternal and neonatal outcomes.

Benefits and challenges of living in extra care housing: perspectives of people living with dementia

PurposeThe purpose of this paper is to present the views of people living with dementia in extra care housing (ECH). This is a model of housing with care and support aiming to support older people, including those with dementia, to live independently. Previous research identifies benefits but is predominantly derived from third-party accounts, with the voices of those living with dementia in ECH significantly absent.Design/methodology/approachThis study adopted a qualitative approach conducting 100 interviews across 8 ECH schemes in England. Over half of the interviews were conducted with people living with dementia and their families with the remainder involving staff and commissioners.FindingsFindings suggest there are a range of benefits including owning your own home, having a safe, age friendly location with flexible support, social interaction and continuing to live as a couple. Challenges included availability of staff, flexible resourcing, loneliness and the advancing symptoms of dementia.Research limitations/implicationsDespite efforts to create an inclusive, diverse sample, the participants were all White British. Participants involved were identified by gatekeepers, which may present some bias in the selection.Practical implicationsWhilst ECH offers benefits to people living with dementia, addressing the challenges is essential for effective dementia care. Improving staff training, promoting person-centred care and fostering an inclusive community are critical for enhancing residents’ well-being and quality of life.Originality/valueThis paper explored the lived experiences of residents and family members, providing new insight into the advantages and disadvantages of ECH for people living with dementia.

Integrative medical group visits for patients with chronic pain: results of a pilot single-site hybrid implementation-effectiveness feasibility study.

Approximately 20% of adults in the United States experience chronic pain. Integrative Medical Group Visit (IMGV) offers an innovative approach to chronic pain management through training in mindfulness, nutrition, and other mind-body techniques combined with peer support. To date, there are no studies on IMGV implementation, despite its promise as a feasible non-pharmacological intervention for chronic pain management. In this study, we assessed the feasibility of implementing IMGV and assessing its effectiveness for chronic pain. Implementation Mapping was used to develop and evaluate implementation strategies for IMGV. Strategies included disseminating educational materials, conducting ongoing training, and conducting educational meetings. IMGV was delivered by three healthcare providers: an allopathic physician, registered yoga teacher, and naturopathic physician. The effectiveness of IMGV on patient health outcomes was assessed through qualitative interviews and a Patient-Reported Outcomes Scale (PROMIS-29). Provider perspectives of acceptability, appropriateness, and feasibility were assessed through periodic reflections (group interviews reflecting on the process of implementation) and field notes. Paired t-tests were used to assess changes between scores at baseline and post intervention. Qualitative data were coded by three experienced qualitative researchers using thematic content analysis. Of the initial 16 patients enrolled in research, 12 completed at least two sessions of the IMGV. Other than fatigue, there was no statistically significant difference between the pre- and post-scores. Patients reported high satisfaction with IMGV, noting the development of new skills for self-care and the supportive community of peers. Themes from patient interviews and periodic reflections included the feasibility of virtual delivery, patient perspectives on acceptability, provider perspectives of feasibility and acceptability, ease of recruitment, complexity of referral and scheduling process, balancing medical check-in with group engagement, and nursing staff availability. IMGV was feasible, acceptable, and effective from the perspectives of patients and providers. Although statistically significant differences were not observed for most PROMIS measures, qualitative results suggested that participants experienced increased social support and increased pain coping skills. Providers found implementation strategies effective, except for engaging nurses, due to staff being overwhelmed from the pandemic. Lessons learned from this pilot study can inform future research on implementation of IMGV.

Optimising staff utilisation in rural animal veterinary practice in Aotearoa/New Zealand

Utilisation of veterinary professional staff in rural animal veterinary practice has long been anecdotally reported as poor in Aotearoa / New Zealand. Evidence shows that skill utilisation is poor, and this is likely impacted by the low ratios of non-veterinarian staff to each veterinarian in rural animal veterinary practice. This participative action research utilised focus groups with a range of staff practising in rural animal veterinary practice in Aotearoa / New Zealand, who self-selected as having experience with excellent utilisation. Participants were asked to imagine what a future with excellent utilisation in rural animal veterinary practice in Aotearoa / New Zealand would look like. This research clarifies role definitions of a veterinarian, rural animal veterinary technician and rural animal healthcare assistant, and documents examples of task allocation in an interprofessional team. The participants identified that the outcomes of achieving appropriate utilisation are likely to be beneficial to individuals, the team, animals, clients, and the business profitability, however, a significant number of barriers were identified that may prevent implementation of appropriate utilisation. These included a disconnect between the current rural animal veterinary technician qualifications and the requirement from veterinary clinical practice for specific skills, rather than a full qualification; the current veterinary training pathway not setting up veterinarians to be consultants; lack of regulation of allied veterinary professionals; current skills in the team; lack of trust in technicians from veterinarians; perception of client expectations that a vet will attend; willingness of veterinarians to relinquish control; lack of availability of technical staff; the requirement for veterinarians to provide 27/4 after-hours service; and the risk of technicians leaving after being trained up to go out on their own. Whilst overcoming some of these barriers requires industryled solutions, many can be resolved immediately within individual teams. Therefore, there is no need to wait for industry change to begin creating veterinary teams with excellent utilisation within individual rural animal veterinary practices.

Captive breeding of European freshwater mussels as a conservation tool: A review

Abstract Freshwater mussels are declining throughout their range. Their important ecological functions along with insufficient levels of natural recruitment have prompted captive breeding for population augmentation and questions about the usefulness and applicability of such measures. This article reviews the current state of captive breeding and rearing programmes for freshwater mussels in Europe. It considers the various species, strategies, and techniques of propagation, as well as the different levels of effort required according to rearing method, highlighting the key factors of success. Within the last 30 years, 46 breeding activities in 16 European countries have been reported, mainly of Margaritifera margaritifera and Unio crassus. Some facilities propagate species that are in a very critical situation, such as Pseudunio auricularius, Unio mancus, and Unio ravoisieri, or multiple species concurrently. In some streams, the number of released captive‐bred mussels already exceeds the size of the remaining natural population. Rearing efforts range from highly intensive laboratory incubation to lower intensity methods using in‐river mussel cages or silos. Most breeding efforts are funded by national and EU LIFE(+) grants, are well documented, and consider the genetic integrity of the propagated mussels. Limited long‐term funding perspectives, the availability of experienced staff, water quality, and feeding/survival during early life stages are seen as the most important challenges. Successful captive breeding programmes need to be combined with restoration of the habitats into which the mussels are released. This work will benefit from an evidence‐based approach, knowledge exchange among facilities, and an overall breeding strategy comprising multiple countries and conservation units.

Staff-rated ability to provide post-diagnosis support for patients with mild cognitive impairment and related factors.

Proactive interventions for patients with mild cognitive impairment (MCI) are required. We aimed to determine the staff-rated ability to provide post-diagnosis support for patients with MCI at a medical centre for dementia and the related factors. We conducted a web-based survey on post-diagnosis support for patients with MCI among healthcare personnel, such as mental health social workers and public health nurses (hereafter referred to as 'staff'), in consultation and support roles at medical centres for dementia nationwide. The latent characteristic value for 'staff's self-rated ability to provide post-diagnosis support to patients with MCI', which was estimated using the one-parameter logistic model of item response theory, was used as the dependent variable. Multivariate linear regression analysis was used to examine the factors associated with the dependent variable. We conducted the study at 482 medical centres for dementia. We received responses from 162 participants, 158 of which were valid. We applied item response theory to 45 staff-rated items regarding post-diagnosis support for patients with MCI and found that item difficulty ranged from -2.56 to 1.02; 40 items had negative values and were deemed relatively easy. The staff-rated ability to provide post-diagnosis support was significantly higher for 'The role in assisting patients with MCI is clear' (P < 0.005), 'A reasonable number of personnel is available to assist immediately after MCI diagnosis' (P = 0.001), and 'Collaboration with family physician available immediately after MCI diagnosis' (P < 0.001). The results of this study showed that staff rated their ability to provide post-diagnosis support for patients with MCI as relatively easy. The staff-rated ability to provide post-diagnosis support to patients with MCI may be enhanced by increased availability of staff immediately after MCI diagnosis, clarification of staff roles, and collaboration with family doctors.

Evaluation of awareness and factors determining satisfaction among tuberculosis patients regarding RNTCP services in a western district of Uttar Pradesh: a cross sectional study

Background: With the help of ‘Revised National Tuberculosis Control Program’ (RNTCP), India has envisioned to end Tuberculosis (TB) five years ahead of the targets set by SDG which was by 2030. Regular evaluation is necessary for every programme to keep the programme in track and to identify the existing lacunae. Therefore, this study was planned to assess the awareness of TB patients regarding RNTCP along with identifying the factors which determine satisfaction of TB patients. Methods: A community-based cross sectional study was conducted on patients seeking treatment at district tuberculosis centre and DOTs centres of district. The data were collected using a close-ended, pretested and pre-validated questionnaire. Results: The mean score for awareness regarding TB among 205 study participants was 5.76±1.88 with level of awareness being poor, average and good in 41%, 31% and 28% of the study participants respectively. The mean satisfaction score was 9.47±1.02 and the services were perceived as good, average and poor by 56%, 39% and 5% of the study population respectively. Majority of the participants were unsatisfied due to the untimely distribution of the money provided under Nikshay Poshan Yojna (31.7%). The reasons for satisfaction among majority of the participants was the availability of staff at DOTS Centre (87.3%). A significant correlation was observed between satisfaction score and awareness score (r2=0.033, p=0.01). Conclusions: The overall awareness and satisfaction about RNTCP services was good among TB patients with a greater satisfaction among people with high awareness.

Changes in Patient Experiences of Hospital Care During the COVID-19 Pandemic

It is important to assess how the COVID-19 pandemic was adversely associated with patients' care experiences. To describe differences in 2020 to 2021 patient experiences from what would have been expected from prepandemic (2018-2019) trends and assess correlates of changes across hospitals. This cohort study compared 2020 to 2021 data with 2018 to 2019 data from 3 900 887 HCAHPS respondents discharged from 3381 HCAHPS-participating US hospitals. The data were analyzed from 2022 to 2023. The primary outcome was an HCAHPS summary score (HCAHPS-SS), which averaged 10 HCAHPS measures. The primary analysis estimated whether HCAHPS scores from patients discharged from 2020 to 2021 differed from scores that would be expected based on quarterly and linear trends from 2018 to 2019 discharges. Secondary analyses stratified hospitals by prepandemic overall star ratings and staffing levels. Of the 3 900 887 HCAHPS 2020 to 2021 respondents, 59% were age 65 years or older, and 35% (11%) were in the surgical (maternity) service lines. Compared with trends expected based on prepandemic (2018-2019) data, HCAHPS-SS was 1.2 percentage points (pp) lower for quarter (Q) 2/2020 discharges and -1.9 to -2.0 pp for Q3/2020 to Q1/2021, which then declined to -3.6 pp by Q4/2021. The most affected measures (Q4/2021) were staff responsiveness (-5.6 pp) and cleanliness (-4.9 pp); the least affected were discharge information (-1.6 pp) and quietness (-1.8 pp). Overall rating and hospital recommendation measures initially exhibited smaller-than-average decreases, but then fell as much as the more specific experience measures by Q2/2021. Quietness did not decline until Q2/2021. The HCAHPS-SS fell most for hospitals with the lowest prepandemic staffing levels; hospitals with bottom-quartile staffing showed the largest decrements, whereas top-quartile hospitals showed smaller decrements in most quarters. Hospitals with better overall prepandemic quality showed consistently smaller HCAHPS-SS drops, with effects for 5-star hospitals about 25% smaller than for 1-star and 2-star hospitals. The results of this cohort study of HCAHPS-participating hospitals found that patient experience scores declined during 2020 to 2021. By Q4/2021, the HCAHPS-SS was 3.6 pp lower than would have been expected, a medium effect size. The most affected measures (staff responsiveness and cleanliness) showed large effect sizes, possibly reflecting high illness-associated hospital workforce absenteeism. Hospitals that were lower performing and less staffed prepandemic may have been less resilient to reduced staff availability and other pandemic-associated challenges. However, by Q4/2021, even prepandemic high-performing hospitals had similar declines.

P27 Dermatology team huddle

Abstract When I started working in the BRI Dermatology department, I noticed that team morale appeared to have been impacted by the COVID-19 pandemic, and also that the department was not running as efficiently as it could be. To improve departmental efficiency, team-working and staff wellbeing following the COVID-19 pandemic, I surveyed staff to assess their thoughts on departmental efficiency, team-working and a daily team ‘Huddle’. I presented my findings in a departmental meeting, following which a daily team Huddle was initiated. All team members were invited. I created a Huddle proforma which included a checklist troubleshooting issues likely to arise in the day, a moment for a wellbeing ‘check-in’ and a celebration of staff achievement. The Huddle team leader rotated daily. After 6 months, I re-surveyed staff: 92% strongly agreed/agreed that patient care was delivered efficiently (60% pre-Huddle, P = 0.01); 96% of staff strongly agreed/agreed that the team worked well together (71% pre-Huddle, P = 0.03); 62% strongly agreed/agreed that the department was running smoothly/efficiently (33% pre-Huddle, P = 0.08). Staff strongly agreed that the Huddle had improved their wellbeing. Nonclinicians felt more confident to approach the on-call Registrar and Consultant. Respondents observed nonclinical staff were less likely to attend. The Huddle allowed staff to share information/concerns. Rotating the Huddle lead helped break down hierarchical barriers. Celebrating achievements boosted team morale and helped members feel valued. Recommendations include encouraging administrative/reception staff to attend and to set up virtual access for staff who work from home.

Nurse Practitioner Employment in Relation to Nursing Staff Turnover and Resident Care Outcomes in US Nursing Homes

ObjectivesA growing number of nurse practitioners (NPs) are employed in nursing homes (NHs) through various NP staffing mechanisms. The purpose of this study was to examine if having NH-employed NPs was associated with nursing staff turnover and resident care outcomes measured as hospital utilization, infection control citations, and substantiated complaints in NHs in 2021–2022. DesignA cross-sectional, retrospective study. Setting and ParticipantsA total of 13,966 NHs from payroll-based journal (PBJ) and claim-based quality measures published by the Centers for Medicare and Medicaid Services in 2021–2022. MethodsFacilities were identified as having NH-employed NPs if at least 1 employed NP with paid working hours ≥10 per week was reported through the PBJ. We examined if having NH-employed NPs was associated with nursing staff turnover rates, unplanned hospital utilization, infection control citations, and substantiated complaints using doubly robust estimation that combined inverse probability weight representing the NH's likelihood of employing NPs and outcome regression. ResultsApproximately, 2.8% of NHs had employed NPs. Facilities with NH-employed NPs tended to be larger, hospital affiliated, and not for profit with greater medical and nursing staff availability. In addition, a significantly higher proportion of facilities with NH-employed NPs were in metropolitan areas or states with full NP practice independence. We found that facilities with NH-employed NPs had significantly lower registered nurse (adjusted β, −5.40; 95% CI, −9.50 to −1.30) and certified nursing assistant turnover rates (adjusted β, −3.35; 95% CI, −6.29 to −0.40). Facilities with NH-employed NPs also had significantly fewer long-stay resident hospitalizations, infection control citations, and substantial complaints compared with those with no NH-employed NPs. Conclusions and ImplicationsThis study highlights the value of NH-employed NPs to improve registered nurse and certified nursing assistant staff retention and NH resident outcomes. NH stakeholders and policymakers may consider various strategies to incentivize NP employment in NHs such as removing regulatory barriers to NP practice.

ThTP5.12 Assessment of malnutrition and nutritional interventions in patients presenting with acute small bowel obstruction – are we ‘getting it right first time’?

Abstract Aims High levels of morbidity and mortality are associated with small bowel obstruction (SBO), a common general surgical emergency. Assessment of malnutrition and introduction of early nutritional interventions are of paramount importance in the management algorithm of these patients. We audited our practice of managing acute small bowel obstruction at a busy district general hospital comparing our practice against National Audit of Small Bowel Obstruction (NASBO) recommendations. Methods Data were gathered for all patients presenting with bowel obstruction to our Trust between 01/08/2022 and 30/11/2022. In depth review of patient case records was undertaken using electronic patient record systems (e-Track and Evolve). Results 195 patients were admitted with acute bowel obstruction. 68 patients (35%) had acute SBO (M: F; 34:34). 58 (85%) had no documentation of duration for which they had been ‘nil by mouth’ (NBM) prior to hospitalisation. Malnutrition universal screening tool score (MUST score) was completed in 29 (43%) patients. 59% of patients had an emergency computed tomography (CT) which confirmed diagnosis of SBO. 60% of patients were managed non-operatively. On an average, patients were kept ‘NBM’ for two days (range; 1-16 days). Average waiting time for peripherally inserted central catheter (PICC) was 9.6 days. Conclusions Evaluating our practice of managing patients with acute SBO has highlighted multiple areas for improvement to ‘get it right first time’. We have included stakeholders; nursing staff, dieticians, surgeons, junior doctors and vascular access team to implement action plan to optimise management in this cohort of patients in line with NASBO guidelines.

Pain Management in Children Admitted to the Emergency Room: A Narrative Review.

Pain is a biopsychosocial experience characterized by sensory, physiological, cognitive, affective, and behavioral components. Both acute and chronic pain can have short and long-term negative effects. Unfortunately, pain treatment is often inadequate. Guidelines and recommendations for a rational approach to pediatric pain frequently differ, and this may be one of the most important reasons for the poor attention frequently paid to pain treatment in children. This narrative review discusses the present knowledge in this regard. A literature review conducted on papers produced over the last 8 years showed that although in recent years, compared to the past, much progress has been made in the treatment of pain in the context of the pediatric emergency room, there is still a lot to do. There is a need to create guidelines that outline standardized and easy-to-follow pathways for pain recognition and management, which are also flexible enough to take into account differences in different contexts both in terms of drug availability and education of staff as well as of the different complexities of patients. It is essential to guarantee an approach to pain that is as uniform as possible among the pediatric population that limits, as much as possible, the inequalities related to ethnicity and language barriers.