Staff Need Research Articles

An Optimization Model for Scheduling Additional Medical Personnel During a Pandemic

The most severe and pervasive problems in modern healthcare systems occur during epidemics and pandemics. One of these problems is the reassignment and the rescheduling of the medical staff during the days of the critical weeks with a high number of infected patients, which, at the same time, amplifies the need for hiring additional medical staff. In this paper we are addressing the problem of the number of additional nurses that must be hired as part time workers, with the following objective: to satisfy the minimum number of nurses needed during the days of the critical weeks, while keeping the hospital costs as low as possible. The solution of this problem is obtained by a schedule of the additional personal based on four, partially overlapping shifts, which gave a reduction of the initial costs. It can be applied in any organization that is in need for additional staff, regardless of the reason.

Effects of the “ICU Support” team meeting concept on patient-centered and staff-centered outcomes: study protocol for a randomized controlled multicenter study

BackgroundProviding optimal care for critically ill patients is an extremely important but also highly demanding task, both emotionally and physically. The “ICU Support” team meeting concept aims to support intensive care unit (ICU) teams by promoting interprofessional communication, peer support, and patient safety by providing a structure for daily team meetings. This protocol describes a study to explore the effectiveness of “ICU Support” for patient- and staff-centered outcomes.MethodsICU Support will be implemented at nine university hospitals located in Germany, following a two-arm randomized parallel group design with an intervention and a control condition and three data collection periods. In the intervention arm, leading ICU personnel (physicians and nurses) will be trained in ICU Support and implement the ICU Support elements into the daily work routine of their units upon completion of data collection period T0 (baseline). In the control arm, ICU Support will not be implemented until the completion of the data collection period T1 (1 month after study start). Until then, the regular daily schedule of the ICU teams will be maintained. The final data collection period (T2) will take place 4 months after the start of the study. Primary outcomes include the number of intensive care complications per patient during their ICU stay during T1 and the sick-related absence of ICU staff during T1. Secondary outcomes include, among others, the average severity of intensive care complications per patient and employee self-reported data regarding their teamwork and patient safety behaviors.DiscussionThe need for healthy and well-trained ICU staff is omnipresent; thus, structured and evidence-based interventions aimed at supporting ICU teams and facilitating patient safety are required. This multicenter study aims to explore the effectiveness of ICU Support for patient- and staff-centered outcomes. The insights derived from this study have the potential to significantly improve ICU patient safety, staff communication, and connectedness and decrease sickness-related expenses and social costs associated with high work demands among ICU staff.Trial registrationGerman Clinical Trials Register DRKS00028642. Registered on 4 April 2022.

Training of Digital Data Management for Academic Services

In order to get the characteristics of excellent service, the academic services at Sahid University Surakarta carried out by academic staff need to be improved through a training. This training was held with the aim of improving the competence and ability of academic staff in utilizing digital technology and improving office application skills to improve the quality of academic services. The method of service applied is the method of mentoring. Participants are trained directly and assisted in carrying out their work. The results of this community service activity are an increase in participants' understanding and skills in utilizing digital technology to support academic services, the ability of participants to successfully install and configure computer devices needed to support academic services, and awareness of the importance of improving skills in managing digital technology can increase the efficiency and effectiveness of academic services.

Validating blood microsampling for per- and polyfluoroalkyl substances quantification in whole blood

Microsampling allows the collection of blood samples using a method which is inexpensive, simple and minimally-invasive, without the need for specially-trained medical staff. Analysis of whole blood provides a more holistic understanding of per- and polyfluoroalkyl substances (PFAS) body burden. Capillary action microsamplers (Trajan hemaPEN®) allow the controlled collection of whole blood as dried blood spots (DBS) (four 2.74 µL ± 5 %). The quantification of 75 PFAS from DBS was evaluated by comparing five common extraction techniques. Spiked blood (5 ng/mL PFAS) was extracted by protein precipitation (centrifuged; filtered), acid-base liquid-liquid extraction, trypsin protease digestion, and weak anion exchange (WAX) solid-phase extraction with analysis by high-performance liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS). Filtered protein precipitation was the most effective extraction method, recovering 72 of the 75 PFAS within 70 to 130 % with method reporting limit (MRL) for PFOS of 0.17 ng/L and ranging between 0.05 ng/mL and 0.34 ng/mL for all other PFAS. The optimised method was applied to human blood samples to examine Inter- (n = 7) and intra-day (n = 5) PFAS blood levels in one individual. Sixteen PFAS were detected with an overall Σ16PFAS mean = 6.3 (range = 5.7–7.0) ng/mL and perfluorooctane sulfonate (branched and linear isomers, ΣPFOS) = 3.3 (2.8–3.7) ng/mL being the dominant PFAS present. To the authors knowledge, this minimally invasive self-sampling protocol is the most extensive method for PFAS in blood reported and could be a useful tool for large scale human biomonitoring studies.

Leaving it at the gate: A phenomenological exploration of resilience in mental health nursing staff in a high-secure personality disorder unit.

This study reports a qualitative phenomenological investigation of resilience in nursing staff working in a high-secure personality disorder service. Interviews were carried out with six nursing staff, and these captured the richness and complexity of the lived experience of nursing staff. Four superordinate themes emerged from the analysis: Management of emotions: participants showed an awareness that their job is about giving care to patients who may present with very challenging behaviours. The care that they offered was conceptualized as something that needed to be provided in a measured way, with boundaries. A clear distinction was drawn between 'caring personally' for patients, and 'providing care'. Teamwork: teamwork was cited as a major influencing factor by all participants. This was seen as directly impacting the smooth running of the ward, and therefore on the well-being of nursing staff, but also of patients. Understanding: nursing staff were acutely aware that they were working in an environment where everyday interactions would be open to intense scrutiny and possible misinterpretation by patients. Work-life balance: All the participants spoke of making a conscious effort to have a separate work and home life, which was influenced by a number of factors. The article has discussed the themes of managing emotion, team understanding and work-life balance, illustrating how each contributes to the resilience of nursing staff in this challenging environment. New insights - applicable in both national and international contexts - have been produced. In secure environments, mental health nursing staff need organizational support and assistance to develop ways of managing difficult experiences with patients, systems that promote recovery, and educational and supervisory support to help understand and process the effects on them. This article provides evidence to support the work of managers and clinicians in these environments. No Patient or Public Contribution.

“It’s starting to weigh on me”: Exploring the Experiences and Support Needs of Harm Reduction Staff in Connecticut using the Social-Ecological Model

BackgroundThe experiences and perceived support needs of harm reduction workers in the USA have been understudied. While previous research has explored staff burnout and role-related stress, there is a research gap around potential supports for staff wellbeing and individual longevity in their roles. This is especially critical given the growing overdose crisis and the need for sustainable harm reduction programming. Thus, we sought to describe the experiences of harm reduction staff and identify the perceived support that could empower harm reduction staff to successfully navigate their roles.MethodsPurposive sampling methods were used to recruit harm reduction staff working in Connecticut. Seventeen semi-structured, one-on-one interviews were conducted between December 2022 and March 2023. Participants were asked about their experiences with role-related stressors and supports. Informed by the Social-Ecological Model, transcripts were coded using both inductive and deductive codes, and themes were developed using thematic analysis approaches.ResultsStudy participants described their experiences working in harm reduction and the numerous ways they already are or could be receiving support in their roles. These experiences were organized into eight themes according to the levels of the Social-Ecological Model. At the individual level, participants explained that support could help them navigate the variability of the physical environment, boundary setting, and self-care. Relationships between clients and co-workers were both identified as means of support at the interpersonal level, helping participants navigate difficult situations and feelings of stress. At the organizational level, study participants explained how they look to their organization to provide sufficient support by way of training, staffing, compensation, and benefits. Additionally, participants stressed the importance of having supervisors who valued their work and provided emotional support. Lastly, at the community level, participants discussed how support was needed to help them navigate complex systems while working with a stigmatized population in an often-stigmatized field.ConclusionsTo best support harm reduction staff in their day-to-day roles, our findings underscore the need for support on multiple levels. Future research could explore how the provision of support to harm reduction staff impacts not only staff perceptions of support but also the success of clients accessing harm reduction services.

Assessment of the Need for Staff of Public Libraries of the Subjects of the Russian Federation

The monitoring of the staffing needs of public libraries of the constituent entities of the Russian Federation, conducted by the Russian State Library, shows the dynamics of the regional library policy and allows us to determine the vectors of development of the human resources potential of libraries in the near future.The staffing needs of public libraries of the constituent entities of the Russian Federation — participants of the monitoring, their size and professional structure are different and are mainly conditioned by the size of the regional library network, the level of staffing in the region and the professional composition of library staff. These factors directly determine the indicators of staffing needs of libraries in the near future.The needs for library specialists with higher profile education prevail in relation to other professional groups. However, the absolute indicator of these needs does not exceed half of the regions’ staffing needs and accounts for 43.07 percent of their total number. At the same time, the average value of the relative indicator of the regions’ needs in library specialists with higher profile education is only 29.7 staff units.The need for library specialists with secondary non-core and core additional education remains high. Based on the requests of libraries, their number should be increased by 5.76 percent of the available number.The regional comparative-correlation analysis of the need for library specialists revealed that there is a great need for specialists with higher profile education in a number of constituent entities of the Russian Federation, which have specialised universities that train bachelors and masters in “Library and Information Activities” (Republic of Tatarstan — 77 specialists, Altai Krai — 87, Krasnodar Krai — 174, Samara Oblast — 127). Perhaps, the high demand is due to the low availability of specialists with higher profile education in libraries in these regions (on average — 33.21%).The monitoring data indicate an increased need of public libraries for IT specialists: it amounts to 11.65% of the total staffing needs of the constituent entities of the Russian Federation. Based on the stated needs, the number of IT-specialists should be increased by 30.42%. At the same time, the need for IT specialists with higher profile education significantly exceeds the need for specialists with secondary profile education: 71.45% to 19.35% respectively.The needs of libraries in specialists of other professions are relatively small and occupy 8.43 percent of their total staffing needs. Of these, 71.65 percent are specialists with higher professional education.

Reducing time toxicity: Impact of a fast-track infusion pathway on overall wait-times and patient satisfaction at a large safety-net health system.

386 Background: Time toxicity is an emerging concept focusing on the impact of cancer care beyond traditionally measured outcomes: the time spent towards receiving care. Although the inherent complexity of cancer care can pose a challenge to improve time toxicity, addressing system and workflow inefficiencies through process improvement is an effective mitigation strategy. Here we present the impact of a fast-track infusion pathway on the wait-times and patient satisfaction at a large safety-net system. Methods: Parkland Health (PH) is the safety-net system for Dallas County, TX. The PH oncology infusion center supports cancer disciplines and other subspecialties. Factors such as timely patient arrivals, preference for coupled visits and same-day lab draws, and heterogeneity of treatments (medicine specialties vs. oncology) significantly impact wait times. In July 2022, a multidisciplinary team was formed to reduce wait times at the infusion center, including members who had previously participated in the ASCO Quality Training Program (QTP). This report is focused on developing a fast-track pathway for patients with injections or <30-minute infusions. Patients with coupled appointments and same-day lab draws were eligible for fast-track. Wait times were calculated from the time patients were checked in at the front desk to the first medication administered. A dedicated team (RN and MA) and separate waiting areas/infusion bays were designated for fast-track patients. Fast-track patients were surveyed for satisfaction. Results: Baseline infusion volume for the 3 months prior to fast-track implementation was 106 patients per day with average wait time of 167 minutes. In the seven-month period after fast-track implementation, average daily fast-track and main infusion center combined volume was 115. The first PDSA cycle was focused on improving workflows and communication with pharmacy. In the second PDSA cycle, the fast-track infusions were moved to another area to infusion chairs to better patient flow. In May 2023, average volumes and wait times for fast-track and main infusion were 28/80 minutes and 87/107 minutes, respectively. This represents a 40% decrease in wait time for fast-track and 36% for main infusion. In our survey, 89% of fast-track patients reported their wait time to be shorter and 92% rated their experience good or excellent. Conclusions: Implementing and optimizing a separate process for short treatments reduced the wait times for both the short infusions (fast-track) as well as long infusions (main infusion) without a need for additional staff, infusion chairs, or space. The observed decrease in main infusion wait-time is likely the result of decongestion of their process by moving some of the volume to fast-track. We hope to further decrease our wait-times through additional PDSA cycles and leveraging process improvement methodology.

Barriers and facilitators to supporting Canadian autistic postsecondary students: Experiences of accessible learning staff and administrators

BackgroundSpecific supports like social skills training, support groups, and mentorship programs can improve autistic postsecondary students’ chances of success. To improve inclusion practices, it is vital to understand the experiences of key staff and administrators who support autistic students during their postsecondary education. This mixed-methods study provides insight into the scope, strengths, and weaknesses of autism-specific services among Canadian universities from the perspective of university staff and administrators associated with accessibility services. MethodThirty-six staff and administrators (N = 36) from publicly-funded Canadian universities responded to an online survey, and eight participated in a follow-up semi-structured interview. Descriptive statistics and reflexive thematic analysis were conducted. ResultsHalf of the participants endorsed having support for autistic students; the most common being for transition to university. Main obstacles to providing autism-specific supports included a need for more funding, knowledgeable staff, and institutional support. In the interviews, participants reported a strong desire to support autistic students; however, noted several barriers, including under-resourced challenges faced by staff and limitations to funding. ConclusionsFindings highlight financial and practical challenges to supporting autistic students on postsecondary campuses. We advocate for the implementation and evaluation of wrap-around services for autistic students to enhance their success and promote social inclusion. Achieving this will require changes at all levels of the university system, including leadership and policy decisions involving autistic advocates’ perspectives.

Exploring methods and tools for estimating and measuring medical staff shortages

Abstract Background Healthcare systems face major challenges due to shortages in the healthcare workforce (HWF). In order to effectively plan for the future, it is critical to forecast the HWF needs. This study aimed to identify, map, and synthesize the tools, methods, and procedures for measuring medical staff deficits in Europe. Methods The study was performed in accordance with the Arksey and O'Malley scoping review methodology. The authors searched 4 scientific databases: Medline via PubMed, EMBASE, Web of Science, Cochrane Library, as well as manually, by searching for relevant reports. The results were analyzed using both qualitative and quantitative methods. The final searches were conducted until October 2022. Results The study included 38 publications published between 2002 and 2022. Among included publications, 25 were empirical studies, 6 theoretical papers, 5 reports, 1 a literature review, and 1 a guidebook. The majority of the publications estimated or measured shortages of physicians (14/38) and nurses and midwives (7/38), or the HWF generally (10/38). A variety of methods was used, including projections, estimations, predictions, simulation models, and surveys, which utilized tools such as special computer software or customized indicators, such as the Workload Indicators of Staffing Need method. HWF shortages were estimated at both national and regional levels, often based on demand, supply, and/or need. Conclusions While these methods and tools provide valuable insights, they may not always be suitable for the needs of a country or a medical facility. The problem of shortages in the health service is growing and its effects are already being felt, while data on the extent of medical staff shortages are usually outdated and underestimated, which highlights the need for further development, testing and implementation of validated methods. Key messages • Improvement of tools for measuring HWF shortages should be an integral part of HWF planning. • Validated methods and tools are needed to measure, estimate, and prepare forecasts of HWF shortages.

Positive Francisella tularensis meningitis outcome despite delayed identification: a case report

Francisella tularensis is a Gram-negative bacteria, that may cause a zoonotic disease, tularemia. Here, we describe a patient case, where a previously healthy young woman in Northern Finland contacted health care because of fever and headache. Due to the symptoms and lack of further diagnostic tools in primary health care, she was transferred to University Hospital (UH) where ampicillin and ceftriaxone was given empirically. A cerebrospinal fluid sample (CSF) was drawn showing small Gram-negative rods that grew on chocolate agar after 2 days of incubation. Matrix-assisted laser-desorption-ionization time of-flight (Maldi-tof) did not provide identification, but the bacteria was interpreted as sensitive to ciprofloxacin and the treatment was changed to ciprofloxacin. During the time the patient was infected, there were several positive tularemia samples found in the area. Therefore, an in house tularemia nucleic acid method (PCR) was used on the bacterial culture. Additionally, 16S rDNA sequencing was performed and these methods identified the bacteria as F. tularensis. Fortunately, the patient recovered completely with ciprofloxacin and was discharged without any complications. Our case underlines the need to understand the limits of specific diagnostic methods, such as Maldi-tof, used in clinical laboratory settings. It also highlights the need of both clinicians and laboratory staff to be aware of the many clinical presentations of tularemia when working in an endemic area.

Supporting the “hallway residents”: a qualitative descriptive study of staff perspectives on implementing the Namaste Care intervention in long-term care

BackgroundLong-term care (LTC) settings are becoming home to an increasing number of people living with advanced or late-stage dementia. Residents living with advanced dementia represent some of society’s most vulnerable and socially excluded populations and are thus at an increased risk of social isolation. A multisensory intervention tailored to this population, Namaste Care, has been developed to improve quality of life for residents living with advanced dementia in LTC homes. To date, limited research has explored the perspectives of staff in implementing the Namaste Care program with an emphasis on social inclusion of residents in Canadian LTC homes. This study aimed to describe the perspectives of LTC staff on the implementation facilitators and barriers of Namaste Care as a program to support the social inclusion of residents living with advanced dementia.MethodsUsing a qualitative descriptive design, semi-structured interviews (n = 12) and focus groups (n = 6) were conducted in two LTC homes in Southern Ontario, Canada, over a 6-month period. Convenience sampling was used to recruit LTC home staff from the two participating sites. Thematic analysis was used to analyze data.ResultsLTC staff (n = 46) emphasized the program’s ability to recognize the unique needs of residents with advanced dementia, and also stated its potential to facilitate meaningful connections between families and residents, as well as foster care partnerships between staff and families. Findings indicated staff also perceived numerous facilitators and barriers to Namaste Care. In particular, providing staff with dedicated time for Namaste Care and implementing volunteer and family participation in the program were seen as facilitators, whereas the initial perception of the need for extra staff to deliver Namaste Care and identifying times in the day where Namaste Care was feasible for residents, families, and staff, were seen as barriers.ConclusionsLTC staff recognized the need for formalized programs like Namaste Care to address the biopsychosocial needs of residents with advanced dementia and offer positive care partnership opportunities between staff and family members. Although staffing constraints remain the largest barrier to effective implementation, staff valued the program and made suggestions to build LTC home capacity for Namaste Care.

Evolution and characteristics of speech and language therapist services in a high complexity Chilean hospital according to monthly statistical records (REM)

Introduction: speech and language therapist services has been extensively described. However, in Chile the evolution and characteristics of these services at hospital level and especially during the last years (pre and post COVID-19) are unknown. The exploration of these data could contribute to the development of strategies and decision making at the local level. Objective: to determine the evolution and characteristics of speech and language therapist services between the years 2015-2022 in a Chilean high complexity hospital. Methods: by means of a quantitative, transectional and descriptive design, 96 databases corresponding to the Monthly Statistical Records (REM) between January 2015 and December 2022 were reviewed. The variables analyzed were: number of initial and intermediate evaluations, hospital rehabilitation sessions, home rehabilitation and procedures-activities performed. Results: an oscillating increase in the number of speech and language therapist services performed between 2015-2022 was observed. Preference is given to hospital rehabilitation sessions (95,626 services) followed by initial evaluations (11,550). By specific area, the highest number of benefits was obtained by swallowing rehabilitation (22,594), while individual and group auditory rehabilitation only presented 7 and 11 records respectively. Conclusions: the analysis of the REM exhibits an incremental evolution of the registry of speech and language therapist services, especially since the last three years (2020 onwards), this despite the fluctuations observed during the previous years (2015-2019). This increase would be directly related to the increase in the hiring of professionals, improvement of supplies and equipment, incorporation of the speech therapist to pathologies with explicit health guarantees (GES) and the need for professional staffing due to the COVID-19 contingency

Nursing Personnel Workload and Staffing Need for Rural Hospitals of Darjeeling District, India: Assessment by Application of Workload Indicators of Staffing Need Tool (World Health Organization).

The Workload Indicators of Staffing Need (WISN) human resource planning and management tool developed by Shipp (1998) and popularized by the World Health Organization gives health managers a way to analyze and calculate correct staffing levels in health facilities. This study aimed to assess the current workload and staffing need of staff nurses for rural hospitals in Darjeeling district, West Bengal. Primary data were collected by interviews with nursing personnel using a semi-structured interview schedule. Secondary data were obtained from available records at the rural hospitals. Workload components were established for health service activities, support activities, and additional activities. Staffing needs based on workload was calculated after adjusting allowance multiplier. WISN findings highlighted varying degrees of health worker shortages and inequities in their distribution at different health facilities. WISN ratio indicated that the work pressure of health staff was highest at Kharibari RH (0.45), followed by Naxalbari RH (0.54). About 43% of nurses' time was occupied with support activities, instead of nursing care. WISN method can help policy-makers in optimizing utilization of existing human resources. There is a need to adopt flexible health workforce planning and recruitment policy to manage the patient load and disease burden.

Medical demography at stroke centers: Current situation in France

IntroductionFollowing the 2010–2014 French national stroke action plan, the number of stroke center (SC) has gradually increased in France, allowing a homogeneous coverage and access to neurovascular care in organized and territorially defined structures. However, operational difficulties within SCs have been progressively reported over the last few years. The objective of this study was to identify the medical staff shortages in SC that may contribute to these difficulties. MethodsA survey on the medical staffing level as of January 1, 2021 was sent to all French SC managers. Specific questions related on vacancies, need of interim medical staff, and participation in out-of-hour healthcare services. ResultsAmong the 139 SC managers contacted, 122 (88%) filled in the questionnaire. Analysis of the data showed that over 879 physician positions opened, 163 (18.5%) remained vacant for a mean of two years, and that in 51 SCs (41.9%), more than two positions were unfilled. In 13 of these 51 SCs, the out-of-hour healthcare services relied on less than four practitioners, defining a critical situation, and three other SCs had to close temporarily (2) or permanently (1). Moreover, 39.2% of SCs with at least one vacancy used interim physicians, for a median period of 12.5 weeks/year (IQR 5–18). ConclusionThis study highlights the significant medical staff shortage in French SCs. In the absence of urgent measures, more SCs will close, jeopardizing the regional network and access to care for stroke patients.

An Assessment of Knowledge, Attitude, and Practice of Medical Professionals on Factors Related to Antimicrobial Resistance in Three (3) Selected University Teaching Hospital Complexes in Sierra Leone: A Cross-Sectional Analytic Study

Although the growing increase of AMR is a major problem everywhere, developing nations like Sierra Leone are particularly at higher risk because of their limited resources to combat the problem. Medical Professionals are recognized as important determinants of antimicrobial abuse. To evaluate factors related to antimicrobial resistance patterns, a cross-sectional study was undertaken among 376 Medical Professionals. Doctors, nurses, pharmacists, laboratory Personnel and community health officer from three Sierra Leone University Teaching Hospital Complexes in Sierra Leone, formed the study population. KAP dimensions were assessed, and differences between groups were investigated, using descriptive statistics tests. The study highlighted the socio-demographic factors of health professionals (age, gender, profession, qualification, and years of experience) that were associated with antibiotic resistance training (p < 0.05). In the area of attitude towards antibiotics, 54% (203) and 72.9% (274) of study participants recommended that pharmacy staff be at their workstations to deliver services and dispense antibiotics prescribed by authorized prescribers as recommended by the Ministry of Health. Out of the total survey participants, 54.5% suggested antibiotics for laboratory-confirmed diseases. To prevent antibiotic resistance, 72.9% of survey participants advised patients to finish antibiotics. This study revealed the need for pharmacy staff to always be available to provide services and dispense antibiotics. Healthcare professionals must be monitored to combat AMR. More research is needed to understand and improve antibiotic stewardship practices in Sierra Leone. Keywords: Antibiotic, Attitude, Knowledge, Practice, Resistance.

Does earmarked funding affect the performance of international organisations?

AbstractWhat determines the performance of international organisations (IOs)? We argue that funding structures remain an overlooked driver of IO performance. Over the past decades, donor governments have provided an increasing share of their contributions to IOs in the form of earmarked resources, which provide them with the opportunity to restrict the use of funding to specific themes, sectors, regions, countries or projects. This development has raised concerns about the ability of IOs to perform their duties, given that earmarked funds distort programme priorities away from recipient need and increase transaction costs for IO staff. Beyond qualitative evidence from case studies, concerns about the performance‐related effects of earmarking remain untested in large‐N analysis. Drawing on 64 performance assessments of 32 IOs from 2009 to 2021, undertaken by the Multilateral Organisation Performance Assessment Network, we employ latent factor analysis to extract measures of process performance—the extent to which IOs have rules, procedures and routines in place to plan strategically, manage operations efficiently, liaise with partners effectively, monitor results and promote institutional learning—and outcome performance—the extent to which IOs achieve results that are relevant, efficient and sustainable. Using multivariate regressions, we find that earmarked funding is negatively related to process performance. Our result is robust to alternative model specifications and an instrumental variable design that helps mitigate concerns about endogeneity. These results have important implications for our understanding of IO performance and policy implications for donors of IOs.

A-192 Cause and Departmental Origin of Errors—An Investigation of Questionable Patient Test Results

Abstract Introduction Reliable patient test results are crucial for quality patient care, involving pre-, post- and analytical phases. Questionable Patient test Results (QPRs), either not matching patient clinical presentation or apparent outliers for the patient population, are often encountered. We aimed to investigate the source and nature of possible errors that cause QPRs. Methods 960 QPRs were identified during July-December 2022 at our institution. We examined the nature of the QPRs, the corresponding patient clinical records, the procedures involved in pre-, post- and analytical phases, and quality control systems. Results The QPRs were found to be originated from 31 departments and medical specialty units. Of those, 5 departments/units had >50 QPRs (accounting for 64% of total QPRs) and are listed in the table provided. The table also lists the information on 7 types of errors identified by our analysis. Of all errors, 78% occurred at pre-analytical phase, with the majority of errors occurring during sample collection. Discussion The most common types of errors were either diluted or contaminated samples accounting for 38% and 34%, respectively. Such errors often occur during sample drawing from an existing I.V. access port if not adequately flushed after saline solution infusion (causing sample dilution) or dextrose solution (causing glucose contamination). Many errors were due to samples drawn in the wrong collection tube type. Sample integrity issues included hemolysis, lack of sufficient sample volume, or clotting. For those QPRs that we did not find apparent errors, they were either due to random errors or the results fit the patient’s true medical condition. Conclusions Our findings highlight the importance of pre-analytical quality control measures and the need for regular staff education/training. This study pinpointed the errors that require targeted education materials, as well as the hospital units that would benefit most from this focus on error prevention.

Information on medication abortion provided by family planning clinics in California

ObjectivesTo assess access to abortion pills offered by clinics providing state-funded family planning services in California. MethodsWe attempted to make two scripted calls to a 20% random sample of family planning clinics in California, stratified by county, as “secret shoppers” in 2020 and 2021. ResultsClinic staff responded to 407 calls. Only 50 respondents (12%) reported their clinic offered abortion pills and 23 respondents (6%) accurately indicated to callers that abortion pills were available free to low-income individuals in California. Most (68%) clinics that did not offer abortion pills could not direct callers to a clinic that did offer abortion pills. ConclusionsEfforts are needed to increase the number of clinics providing medication abortion services in California. Clinic staff need training to provide accurate information about medication abortion.

What support do staff need to help them use instant messaging responsibly?

What support do staff need to help them use instant messaging responsibly?