Staff Recall Research Articles

When disaster strikes: staff recall and the use of staff recall systems during mass patient influx at Norwegian emergency primary health care centers – a cross-sectional study

BackgroundIn Norway, planning for disasters has been specifically emphasized since the incidents on July 22nd, 2011. Every municipality is now legislated to have a contingency plan that includes plans for staff recall during situations with mass influx of patients. Whether the primary health care services in Norway are prepared for mass influx of patients remains unclear.Aims of the studyThe aims of this study were (1) to assess the experiences of head doctors at emergency primary health care centers (EPHCC) in Norway with mass influx of patients, (2) to explore mass influx and staff recall procedures in use, (3) to assess head doctors’ experiences with staff recall systems, and (4) to assess their perspective on automatized staff recall systems. We also wanted to assess whether there were differences between small and large EPHCCs regarding whether they had plans in place.MethodsThe study had a cross-sectional, multicenter design, using a self-developed questionnaire. The questionnaire was developed utilizing recommendations from the Delphi technique, including an expert group and piloting. A purposive sampling strategy was used, including head doctors from Norwegian EPHCCs (n = 169). Data were analyzed using the Statistical Package for the Social Sciences, and included descriptive statistics, Chi-Square tests and Shapiro-Wilks. Free-text answers were analyzed by content analysis.ResultsA total of 64 head doctors responded to the questionnaire. The results show that 25% of the head doctors had experienced mass influx of patients at their EPHCC. In total 54.7% of Norwegian EPHCCs did not have disaster plans that consider mass influx situations. The majority of EPHCCs plan to recall staff one by one (60.3%) or through Short-Message-Systems (34.4%). Most EPHCCs had available telephone “alarm” lists (81.4%), that are updated regularly (60.9%). However, only 17.2% had plans that consider loss of mobile phone connection or internet. In total, 67,2% of the head doctors reported to have little experience with automatized staff recall systems, and 59,7% reported to have little knowledge about such systems. There were no significant difference between small and large EPHCCs in having plans or not.ConclusionEven though our results show that few EPHCCs experience mass influx of patients, it is important to be prepared when such incidents do occur. Our results indicate that it is still potential for improvement regarding plans for staff recall and implementation of staff recall systems at Norwegian EPHCCs. Involving national disaster medicine experts in the process of generating tools or checklists could aid when constructing disaster plans. Education and implementation of training for mass influx situations at all levels should always be highlighted.

The effect of COVID-19 on intrapartum care: a case review from early in the pandemic

The COVID-19 pandemic has had a marked impact on maternity services in the UK. Those who are pregnant are identified as a higher risk population and there have been significant changes in the structure of antenatal, intrapartum and postnatal care. This case of interest explores a moderate case of SARS-CoV-2 during the intrapartum period in the early stages of the pandemic which was managed by a multidisciplinary approach. The family are well and are now fully recovered. Midwifery accounts recall uncertainties regarding personal protective equipment. Obstetricians recall minimalising patient contact where appropriate and anticipating for obstetric emergencies to reduce delays. Despite challenges, staff recall excellent multidisciplinary team work and the use of technology to facilitate communication between service user and birth partner.

Radiofrequency Identification Track for Tray Optimization: An Instrument Utilization Pilot Study in Surgical Oncology

Surgical instrument tray reduction attempts to minimize intraoperative inefficiency and processing costs. Previous reduction methods relied on trained observers manually recording instrument use (i.e. human ethnography), and surgeon and/or staff recall, which are imprecise and inherently limited. We aimed to determine the feasibility of radiofrequency identification (RFID)-based intraoperative instrument tracking as an effective means of instrument reduction. Instrument trays were tagged with unique RFID tags. A RFID reader tracked instruments passing near RFID antennas during 15 breast operations performed by a single surgeon; ethnography was performed concurrently. Instruments without recorded use were eliminated, and 10 additional cases were performed utilizing the reduced tray. Logistic regression was used to estimate odds of instrument use across cases. Cohen's Kappa estimated agreement between RFID and ethnography. Over 15 cases, 37 unique instruments were used (median 23 instruments/case). A mean 0.64 (median=0, range=0-3) new instruments were added per case; odds of instrument use did not change between cases (OR=1.02, 95%CI 1.00-1.05). Over 15 cases, all instruments marked as used by ethnography were recorded by RFID tracking; 7 RFID-tracked instruments were never recorded by ethnography. Tray size was reduced 40%. None of the 25 eliminated instruments were required in 10 subsequent cases. Cohen's Kappa comparing RFID data and ethnography over all cases was 0.82 (95%CI 0.79-0.86), indicating near perfect agreement between methodologies. Intraoperative RFID instrument tracking is a feasible, data-driven method for surgical tray reduction. Overall, RFID tracking represents a scalable, systematic, and efficient method of optimizing instrument supply across procedures.

P064: A randomized trial comparing telephone tree, text messaging, and instant messaging app for emergency department staff recall for disaster response

Introduction: A crucial component of a hospital's disaster plan is an efficient staff recall communication method. Many hospitals use a “calling tree” protocol to contact staff members and recall them to work. Alternative staff recall methods have been proposed and explored. Methods: An unannounced, multidisciplinary, randomized emergency department (ED) staff recall drill was conducted at night - when there is the greatest need for back-up personnel and staff is most difficult to reach. The drill was performed on December 14, 2017 at 4:00AM and involved ED staff members from three hospitals which are all part of the McGill University Health Centre (MUHC; Montreal, Quebec, Canada). Three tools were compared: manual phone tree, instant messaging application (IMA), and custom-made hospital Short Message Service (SMS) system. The key outcome measures were proportion of responses at 45 minutes and median response time. Results: One-hundred thirty-two participants were recruited. There were 44 participants in each group after randomization. In the manual phone tree group, 18 (41%) responded within 45 minutes. In the IMA group, 11 participants (25%) responded in the first 45 minutes. In the SMS group, seven participants responded in the first 45 minutes (16%). Manual phone tree was significantly better than SMS with an effect size of 25% (95% confidence interval for effect: 4.6% to 45.0%; P = .018). Conversely, there was no significant difference between manual phone tree and IMA with an effect size of 16% (95% confidence interval for effect: -5.7% to 38.0%; P = .17) There was a statistically significant difference in the median response time between the three groups with the phone tree group presenting the lowest median response time (8.5 minutes; range: 2.0 to 8.5 minutes; P = .000006). Conclusion: Both the phone tree and IMA groups had a significantly higher response rate than the SMS group. There was no significant difference between the proportion of responses at 45 minutes in the phone tree and the IMA arms. This study suggests that an IMA may be a viable alternative to the traditional phone tree method. Limitations of the study include volunteer bias and the fact that there was only one communication drill, which did not allow staff members randomized to the IMA and SMS groups to fully get familiar with the new staff recall methods.

A Randomized Trial Comparing Telephone Tree, Text Messaging, and Instant Messaging App for Emergency Department Staff Recall for Disaster Response.

An unannounced, multidisciplinary, randomized emergency department (ED) staff recall drill was conducted at night - when there is the greatest need for back-up personnel and staff is most difficult to reach. The drill was performed on December 14, 2017 at 4:00am and involved ED staff members from three hospitals which are all part of the McGill University Health Centre (MUHC; Montreal, Quebec, Canada). Three tools were compared: manual phone tree, instant messaging application (IMA), and custom-made hospital Short Message Service (SMS) system. The key outcome measures were proportion of responses at 45 minutes and median response time. One-hundred thirty-two participants were recruited. There were 44 participants in each group after randomization. In the manual phone tree group, 18 (41%) responded within 45 minutes. In the IMA group, 11 participants (25%) responded in the first 45 minutes. In the SMS group, seven participants responded in the first 45 minutes (16%). Manual phone tree was significantly better than SMS with an effect size of 25% (95% confidence interval for effect: 4.6% to 45.0%; P=.018). Conversely, there was no significant difference between manual phone tree and IMA with an effect size of 16% (95% confidence interval for effect: -5.7% to 38.0%; P=.17) There was a statistically significant difference in the median response time between the three groups with the phone tree group presenting the lowest median response time (8.5 minutes; range: 2.0 to 8.5 minutes; P=.000006). Both the phone tree and IMA groups had a significantly higher response rate than the SMS group. There was no significant difference between the proportion of responses at 45 minutes in the phone tree and the IMA arms. This study suggests that an IMA may be a viable alternative to the traditional phone tree method. Limitations of the study include volunteer bias and the fact that there was only one communication drill, which did not allow staff members randomized to the IMA and SMS groups to fully get familiar with the new staff recall methods. HomierV, HamadR, LarocqueJ, ChasséP, KhalilE, FrancJM. A randomized trial comparing telephone tree, text messaging, and instant messaging app for emergency department staff recall for disaster response. Prehosp Disaster Med. 2018;33(5):471-477.

Staff Recall Travel Time for ST Elevation Myocardial Infarction Impacted by Traffic Congestion and Distance: A Digitally Integrated Map Software Study.

Recent evidence suggests hospitals fail to meet guideline specified time to percutaneous coronary intervention (PCI) for a proportion of ST elevation myocardial infarction (STEMI) presentations. Implicit in achieving this time is the rapid assembly of crucial catheter laboratory staff. As a proof-of-concept, we set out to create regional maps that graphically show the impact of traffic congestion and distance to destination on staff recall travel times for STEMI, thereby producing a resource that could be used by staff to improve reperfusion time for STEMI. Travel times for staff recalled to one inner and one outer metropolitan hospital at midnight, 6 p.m., and 7 a.m. were estimated using Google Maps Application Programming Interface. Computer modeling predictions were overlaid on metropolitan maps showing color coded staff recall travel times for STEMI, occurring within non-peak and peak hour traffic congestion times. Inner metropolitan hospital staff recall travel times were more affected by traffic congestion compared with outer metropolitan times, and the latter was more affected by distance. The estimated mean travel times to hospital during peak hour were greater than midnight travel times by 13.4 min to the inner and 6.0 min to the outer metropolitan hospital at 6 p.m. (p < 0.001). At 7 a.m., the mean difference was 9.5 min to the inner and 3.6 min to the outer metropolitan hospital (p < 0.001). Only 45% of inner metropolitan staff were predicted to arrive within 30 min at 6 p.m. compared with 100% at midnight (p < 0.001), and 56% of outer metropolitan staff at 6 p.m. (p = 0.021). Our results show that integration of map software with traffic congestion data, distance to destination and travel time can predict optimal residence of staff when on-call for PCI.

Identification of Australian Aboriginal and Torres Strait Islander Cancer Patients in the Primary Health Care Setting.

Aboriginal and Torres Strait Islander Australians have poorer cancer outcomes and experience 30% higher mortality rates compared to non-Indigenous Australians. Primary health care (PHC) services are increasingly being recognized as pivotal in improving Indigenous cancer patient outcomes. It is currently unknown whether patient information systems and practices in PHC settings accurately record Indigenous and cancer status. Being able to identify Indigenous cancer patients accessing services in PHC settings is the first step in improving outcomes. Aboriginal Medical Centres, mainstream (non-Indigenous specific), and government-operated centers in Queensland were contacted and data were collected by telephone during the period from 2014 to 2016. Participants were asked to (i) identify the number of patients diagnosed with cancer attending the service in the previous year; (ii) identify the Indigenous status of these patients and if this information was available; and (iii) advise how this information was obtained. Ten primary health care centers (PHCCs) across Queensland participated in this study. Four centers were located in regional areas, three in remote areas and three in major cities. All participating centers reported ability to identify Indigenous cancer patients attending their service and utilizing electronic Patient Care Information Systems (PCIS) to manage their records; however, not all centers were able to identify Indigenous cancer patients in this way. Indigenous cancer patients were identified by PHCCs using PCIS (n = 8), searching paper records (n = 1), and combination of PCIS and staff recall (n = 1). Six different types of PCIS were being utilized by participating centers. There was no standardized way to identify Indigenous cancer patients across centers. Health service information systems, search functions and capacities of systems, and staff skill in extracting data using PCIS varied between centers. It is crucial to be able to easily identify Indigenous cancer patients accessing health services in the PHC setting to monitor progress, improve and evaluate care, and ultimately improve Indigenous cancer outcomes. It is also important for PHC staff to receive adequate training and support to utilize PCISs efficiently and effectively.

Staff recall in crisis situation

Objectif le but de ce travail etait d’etudier les methodes et les outils utilises par les Samu pour rappeler leurs personnels en cas de situation exceptionnelle.

Mise en place et modalités d’organisation d’un Plan blanc à l’échelle d’un établissement de santé

The disaster plan is a regulatory requirement. Its aim is to adapt the daily organization of a care centre in case of an extraordinary situation while preserving the quality of care for inpatients. It allows to cope either with numerous patients or with any risk endangering the hospital. An institutional procedure should be developed with the creation of a technical pilot committee whose purpose is to prepare an operational document. These guidelines should be often reevaluated according to practices or feedbacks. The procedure describes the disaster plan organization, including the crisis management unit, staff recall, admission of patients in emergency medical unit (triage) and in wards, cancellation of hospitalizations, reception of close relatives, internal and external communication. An annual training with pre-written crisis scenarios must be provided to each professional to master his own unit strategy.

Identification by Primary Care Clinicians of Patients with Obstructive Sleep Apnea: A practice-based research network (PBRN) study

Obstructive sleep apnea (OSA) is a reasonably common disorder that is associated with daytime tiredness and a host of medical conditions. Little is known about how primary care clinicians (PCCs) detect, diagnose, and manage patients who have OSA. We gathered information from 44 randomly selected practices in 5 regional practice-based research networks. This included interviews with PCCs and sleep consultants, medical records abstraction, and patient surveys. Descriptive analyses of the quantitative data were used to describe the prevalence of sleep symptoms, the proportion of primary care patients at high risk for OSA, and the methods used by PCCs to detect and diagnose patients with OSA. More than 90% of adult patients visiting a PCC on any given day are experiencing sleep-related symptoms. Based on their Berlin Questionnaire scores, more than one third are at high risk of having sleep apnea. However, most patients have not discussed their sleep-related symptoms with their PCC, and fewer than one third have sleep-related symptoms documented in their medical records. Very few PCCs routinely screen for OSA, and, despite using billing records, problem lists, clinician and staff recall, and prospective logs enhanced by waiting room posters, PCCs were generally unable to identify 25 patients with OSA in their practices. A substantial proportion of patients who see PCCs regularly are at high risk for OSA. Very few of them are being diagnosed or treated. Clearer guidelines and a systematic approach are needed if this is indeed a problem that should be addressed.

Development of a Staff Recall System for Mass Casualty Incidents Using Cell Phone Text Messaging

To the Editor In January 2010, we implemented a system similar to that described by Epstein et al.1 to send Short Message Service (SMS) messages to staff of our cardiac surgical team to respond to emergency cases. In addition to sending SMS messages to cell phones, our system was also able to send text messages to hospital provided pagers. (Pager provider: Indiana Paging Network, messages sent to <10 digit pager number @ipnpaging.com>). Staff had the option of receiving a SMS message on either their cell phone or their pager. We also had staff reprogram their phones with a loud ring tone instead of the default chirp when a SMS message arrived. Systems such as that described by Epstein et al. and ours have multiple potential points of failure. The SMS message has to go through an e-mail server, through the cell phone carrier's gateway, and then though the cell tower nearest the cell phone subscriber.2 Should a natural disaster occur, for example, an earthquake, it is more than likely that one of these points would fail, causing a failure of the entire process. It is possible to build redundancy into the system by using more than one e-mail server or more than one SMS gateway. However, the final pathway for the SMS message is still the cell tower nearest the subscriber. Therefore, a method using as few failure points as possible is recommended. This would include an Internet-based option such as Voice over Internet Protocol (VoIP) phones, for example, Skype (Skype provides free computer to computer calls; www.skype.com); use of e-mail with both the sender and receiver using the same e-mail server to limit the number of transfers that the transmission has to make; and use of instant messaging (IM). Most new smart phones have Wi-Fi, and even if the cellular network is inoperable, these phones will still be able to send and receive VoIP-based phone calls, e-mail, and IM, provided they have Internet access.3 These systems are less likely to fail during natural disasters because of the in-built redundancy in the Internet network.4 Rather than concatenating the phone number with a code for the carrier (555-123-4567-V*), as is recommended by Epstein et al., and then having to parse this to determine the carrier, an alternate database design methodology5 would create a new field to store the carrier information. Using nonhospital e-mail systems to send recall messages is limited by restrictions placed by the e-mail provider. The e-mail provider that our application uses, Godaddy.com (http://www.godaddy.com) places a limit of 100 total addresses per e-mail message.6 For departments without the technical skills or manpower to develop a fully integrated response system, Google Voice (www.google.com/voice) provides a free phone number with the ability to send SMS messages to cell phones without having to know the cell phone carrier. However, there is a limit of 5 recipients at a time. It also allows the receipt of SMS replies and the ability to forward replies to an e-mail address. Adejare Windokun, MD Department of Anesthesiology Clarian Arnett Hospital Lafayette, Indiana Zumran Hamid, MD Department of Anesthesiology Methodist Hospital Merrillville, Indiana [email protected]

Development of a Staff Recall System for Mass Casualty Incidents Using Cell Phone Text Messaging

After a mass casualty incident (MCI), rapid mobilization of hospital personnel is required because of an expected surge of victims. Risk assessment of our department's manual phone tree recall system revealed multiple weaknesses that would limit an effective response. Because cell phone use is widespread within the department, we developed and tested a staff recall system, based in our anesthesia information management system (AIMS), using Short Message Service (SMS) text messaging. We sent test text messages to anesthesia staff members' cell phone numbers, determined the distance from their home to the hospital, and stored this information in our AIMS. Latency testing for the time from transmission of SMS test messages from the server to return of an e-mail reply was determined at 2 different times on 2 different dates, 1 of which was a busy holiday weekend, using volunteers within the department. Two unannounced simulated disaster recall drills were conducted, with text messages sent asking for the anticipated time to return to the hospital. A timeline of available staff on site was determined. Reasons for failure to respond to the disaster notification message were tabulated. Latency data were fit by a log-normal distribution with an average of 82 seconds from message transmission to e-mail reply. Replies to the simulated disaster alert were received from approximately 50% of staff, with 16 projecting that they would have been able to be back at the hospital within 30 minutes on both dates. There would have been 21 and 23 staff in-house at 30 minutes, and 32 and 37 staff in-house at 60 minutes on the first and second test date, respectively, including in-house staff. Of the nonresponders to the alert, 48% indicated that their cell phone was not with them or was turned off, whereas 22% missed the message. Our SMS staff recall system is likely to be able to rapidly mobilize sufficient numbers of anesthesia personnel in response to an MCI, but actual performance cannot be predicted with confidence. Using our AIMS as the source for contact information and from which to send messages was simple, inexpensive, and easy to implement. Updating contact information, periodic testing, and analysis of responses to simulated disaster alerts are essential for the effective functioning of such a system. However, maintenance of alternative methods of communication is recommended, because there may be more significant message transmission delays and failures during an actual MCI, and not all staff will receive the text message in a timely fashion.

The benevolent overreaction: nursing assessment and intervention in families coping with seizure disorder.

Boone and Hartman identified the phenomenon of benevolent overreaction to describe the enmeshment seen in parents and their chronically ill children. The cylce of the benevolent overreaction begins with the child's diagnosis with a chronic illness and the subsequent natural protective behaviors of the parents. However, overprotection may become pathologic if these protective behaviors persist and delay or prevent the child's achieving developmental goals. This ego boundary deficit is one of the most frequently seen phenomena in families with chronically ill children. On the Comprehensive Epilepsy Unit this phenomenon was repeatedly observed. The purpose of this investigation was to ascertain the frequency of benevolent overreaction seen on the unit, and to identify the nursing interventions used to address this issue. A chart review was used to identify the frequency of the phenomenon during the past year, the discipline first identifying the phenomenon and nursing interventions applied to the phenomenon. Nursing staff interviews were then conducted, using unit census records of the past year, to identify staff recall of the phenomenon. Nursing staff frequently identified the components of benevolent overreaction in the inpatient population, however, consistent intervention for the phenomenon was less frequently seen. Autonomy, empowerment and self-advocacy for families are goals of the Comprehensive Epilepsy Unit. Consistent application of the nursing process to this phenomenon is vital to providing quality patient care.