Staff Time Research Articles

1290-P: Diabetes Provider Perceptions of Barriers and Benefits to Type 1 Diabetes Autoantibody Screening among Patients and Relatives

Background: This study highlights perceived benefits and barriers to type 1 diabetes (T1D) autoantibody screening rates in U.S. endocrinology practices. Methods: Fifty eligible endocrinology providers participated in a 15-question survey distributed via Qualtrics. Participants were recruited from the T1D Exchange Quality Improvement Collaborative. Data was cleaned, sorted, and analyzed. Summary statistics, including frequencies and proportions for categorical variables were evaluated and plotted using bar charts. z Results: Overall, 82% of providers stated interest towards autoantibody screening in their clinics. The following were ranked as benefits of autoantibody screening: opportunity for early diabetes management (90%), enrollment in research projects (84%), clinical guidance and diagnosing abilities (80%), and DKA prevention at diagnosis (76%). Providers identified multiple barriers to autoantibody screening in clinical practice including the associated cost and anxiety for patients, as well as limited staff time and resources (Figures 1, 2). Conclusion: The majority of surveyed providers feel confident recommending autoantibody screening for patients and those at risk for diabetes. However, clinic limitations exist that may affect the feasibility of this in practice. These barriers should be targeted with specific interventions moving forward. Disclosure E.L.Ospelt: None. C.Sullivan: None. S.Majidi: None. I.Lorincz: None. O.Ebekozien: Advisory Panel; Medtronic, Research Support; Eli Lilly and Company, Dexcom, Inc. H.Hardison: None. N.Rioles: None. N.Noor: None. S.Crossen: None. A.Smego: None. G.Aleppo: Advisory Panel; Medscape, Consultant; Bayer Inc., Insulet Corporation, Research Support; Dexcom, Inc., Eli Lilly and Company, Emmes, Insulet Corporation, Fractyl Health, Inc., WellDoc, Speaker's Bureau; Dexcom, Inc. J.Friedman: None. D.Eng: None.

Patient and nursing experience of flash glucose monitoring following kidney transplantation.

Flash glucose monitoring (FGM) is increasingly used for blood glucose assessment due to ease of use and is now subsidized in Australia for blood glucose measurement for patients with Type 1 Diabetes Mellitus. Dysglycaemia is common following kidney transplantation and is associated with worse outcomes and there are data to support the use of FGM post-transplant to better detect and manage changes in blood glucose levels. There is, however, no data on patient or staff perceptions of FGM, or resource implications in this setting. We prospectively evaluated patients and nursing staff experiences of FGM compared to traditional capillary glucose measurement in the immediate post-transplant setting, along with resource utilization, cost of testing, staff time taken to test and accuracy. Twenty-one kidney transplant recipients had a FGM sensor applied in the post-operative period and results compared to capillary blood glucose monitoring (CBGM) measured at least four times a day. Six-hundred-fifty-six glucose measurements were obtained, median per patient of 30 readings (IQR 10). Pearson's correlation between FGM and CBGM readings is 0.95 (p < .001). FGM readings were lower than CBGM by an average of 1.2 mmol/L (SD 0.7). Using a 5-point preference questionnaire (with ratings varying from strongly disagree-strongly agree), both patients and nurses were highly satisfied with the usability and convenience of FGM, with all preferring FGM over CBGM. Average time to perform FGM was 3.6 s versus 64 s for CBGM. In average, cost of FGM was $58 less than traditional testing per patient. FGM is an accurate, convenient and cost-effective tool that may support optimal management of glycaemic control in the post-transplant period.

Information Referral System in the Health System

Information Referral System in the Health System

Using digital technology to promote physical health in mental healthcare: A sequential mixed-methods study of clinicians' views.

Recent years have seen innovation in 'mHealth' tools and health apps for the management/promotion of physical health and fitness across the general population. However, there is limited research on how this could be applied to mental healthcare. Therefore, we examined mental healthcare professionals' current uses and perceived roles of digital lifestyle interventions for promoting healthy lifestyles, physical health and fitness in youth mental healthcare. A sequential, mixed-methods design was used, consisting of a quantitative online survey, followed by qualitative in-depth interviews. A total of 127 mental healthcare professionals participated in the online survey. Participants had limited mHealth experience, and the majority agreed that further training would be beneficial. Thirteen mental healthcare professionals were interviewed. Five themes were generated (i) digital technology's ability to enhance the physical healthcare; (ii) Conditions for the acceptability of apps; (iii) Limitations on staff capability and time; (iv) Motivation as the principal barrier; and (v) Practicalities around receiving lifestyle data. Systematic integration of data produced novel insights around: (i) staff involvement and needs; (ii) ideal focus and content of digital lifestyle interventions; and (iii) barriers towards implementation (including mental healthcare professionals own limited experience using digital lifestyle interventions, which aligned with the appeal of formal training). Overall, digital lifestyle interventions were positively received by mental healthcare professionals, particularly for health behaviour-tracking and mHealth support for exercise and nutrition. Practical suggestions for facilitating their uptake/implementation to improve availability of physical health interventions in mental healthcare are presented.

Measurement Strategies for The Joint Commission Health Care Disparities Standard: Defining Hospital-Based Requirements—Part 1

Measurement Strategies for The Joint Commission Health Care Disparities Standard: Defining Hospital-Based Requirements—Part 1

#5171 MODIFIED, NON-INVASIVE, TUNNELLED CATHETER REPOSITION (NTCR), SIMPLE AND SAFE TO RESTORE FUNCTION OF CENTRAL TUNNELLED CATHETER FOR HAEMODIALYSIS

Abstract Background and Aims Still many end stage kidney disease (ESKD) patients are dialysed using central tunnelled catheters (CTC) as vascular access. Catheter thrombosis and is a dominant, non-infectious CTC complication. There are a number protocols established, to resolve the problem, all are not always effective, time as well as cost consuming. Method The modified maneuver of non-invasive tunnelled catheter reposition (mNTCR) was introduced and studied, to obtain an immediate haemodialysis start, in case of CTC dysfunction. The NTCR is based on gentle movements of CTC or its part, with CTC lines flushing which resulted with quick CTC's tip reposition. The study was a continuation of previously published with modification including mandatory CTC lines flushing and locking lines with antithrombotic agent after the dialysis session. Results A number of 205 mNTCR were performed in 110 patients with CTC. Effective blood flow CTC was obtained after 115 procedures (56%), partial function followed 73 procedures (35,6%), and 17 attempts (8%) failed. Over 90% interventions improved a CTC patency allowing start of effective haemodialysis. The procedure could be successfully repeated with similar effect after the first, and the second attempt (28 vs 22 hemodialyses performed respectively). In the group of 50 elderly patients (median age 74 years) with CTC as the only vascular access, mNTCR was successful in 31 patients allowing dialysis continuation for median period 54 months. The mNTCR is safe as minor complications were observed after 5,1% of all procedures. Conclusion The novel mNTCR manoeuvre was safe and effective in a majority cases of CTC dysfunction. It permitted immediate dialysis without time consuming fibrinolytic agents usage protocols before the dialysis session, saving costs and nursing staff time.

Video Calls as a Replacement for Family Visits During Lockdowns in Aged Care: Interview Study With Family Members.

Lockdowns have been used to prevent the spread of transmissible illnesses such as influenza, norovirus, and COVID-19 in care homes. However, lockdowns deny care home residents supplemental care and the socioemotional enrichment that comes from seeing family members. Video calling has the potential to enable ongoing contact between residents and family members during lockdowns. However, video calls can be considered by some as a poor substitute for in-person visits. It is important to understand family members' experiences with video calling during lockdowns to ensure the effective use of this technology in the future. This study aimed to understand how family members use video calls to communicate with relatives living in aged care during lockdowns. We focused on experiences during the COVID-19 pandemic, which involved extensive lockdowns in aged care homes. We conducted semistructured interviews with 18 adults who had been using video calls with relatives living in aged care during pandemic lockdowns. The interviews focused on how participants had been using video calls, what benefits they gained from video-based interactions, and what challenges they encountered when using the technology. We analyzed the data using the 6-phase reflexive approach to thematic analysis by Braun and Clarke. We developed 4 themes through our analysis. Theme 1 interprets video calling as a medium for the continuation of care during lockdowns. Using video calls, family members were able to provide social enrichment for residents and engaged in health monitoring to uphold residents' welfare. Theme 2 highlights how video calling extended care by supporting frequent contact, transmitting nonverbal cues that were essential for communication, and negating the need for face masks. Theme 3 interprets organizational issues such as the lack of technology and staff time as impediments to the continuation of familial care through video. Finally, theme 4 highlights the need for 2-way communication, interpreting residents' unfamiliarity with video calling and their health conditions as further barriers to the continuation of care. This study suggests that, during restrictions arising from the COVID-19 pandemic, video calls became a medium for enabling family members to continue participating in the care of their relatives. The use of video calls to continue care illustrates their value for families during times of mandatory lockdown and supports the use of video to complement face-to-face visits at other times. However, better support is needed for video calling in aged care homes. This study also revealed a need for video calling systems that are designed for the aged care context.

Comparative Analysis of Educational Approaches: Unveiling Strengths across Attributes

Design plays a pivotal role in the successful development of any interactive learning environment (ILE). Furthermore, in the realm of technology-enhanced learning (TEL), the design process necessitates contributions from a wide array of expertise areas. Therefore, individuals engaged in tool development must directly confront the design challenge from multiple standpoints. This article aims to present a comprehensive analysis of current research that centers on the utilization of various approaches as a means of enhancing technology-driven learning environments. The objective is to investigate how much of its instructional promise is genuinely put into practical implementation. The review exclusively considers empirical studies that have been published in peer-reviewed scholarly journals, focusing specifically on the application of diverse approaches as educational environments. Over the past ten years, the methodology of design-based research has proven its potential in both the research and design aspects of technology-enhanced learning environments (TELEs). This article delineates and characterizes design-based research, outlining its significance in the development of technology-enhanced learning environments (TELEs). It also introduces principles for the integration of design-based research into TELEs, and deliberates on the forthcoming challenges associated with this approach. The introduction of technology-enhanced learning (TEL) techniques has transformed the allocation of the most crucial resource in the education system: the time of educators and learners. Although new technology holds the promise of increased personalization and efficiency, the impact on staff time must be meticulously analyzed. Without careful consideration, TEL methods might escalate expenses without proportionate advantages. The paper evaluates various methods of comparing teaching time costs between TEL and traditional approaches. The conclusion suggests that cost-benefit modeling conducted within the institution provides the most accurate means of comprehending how educators can leverage technology to attain the level of efficiency that renders personalization economically viable. Options explored include Interactive Online Courses, Virtual Reality Classrooms, Gamified Learning Platforms, Personalized Learning AI, and Collaborative Social Learning. Assessment criteria encompass Learning Effectiveness, Engagement, Adaptability, Skill Transfer, Cost, Accessibility, User Experience, and Data Privacy. The examination serves as a foundation for establishing prerequisites tailored to a forward-looking cost-benefit framework. The process commences with strategic decisions aimed at realizing the advantages of Technology-Enhanced Learning (TEL). These decisions, in turn, inform the identification of probable essential expenditures, thus delineating the inherent "benefits-oriented cost model." A key benefit of this approach is that it empowers innovators to strategically plan and comprehend the dynamic between anticipated educational gains and potential teaching expenses.

MRI and the Critical Care Patient: Clinical, Operational, and Financial Challenges.

Neuroimaging in conjunction with a neurologic examination has become a valuable resource for today's intensive care unit (ICU) physicians. Imaging provides critical information during the assessment and ongoing neuromonitoring of patients for toxic-metabolic or structural injury of the brain. A patient's condition can change rapidly, and interventions may require imaging. When making this determination, the benefit must be weighed against possible risks associated with intrahospital transport. The patient's condition is assessed to decide if they are stable enough to leave the ICU for an extended period. Intrahospital transport risks include adverse events related to the physical nature of the transport, the change in the environment, or relocating equipment used to monitor the patient. Adverse events can be categorized as minor (e.g., clinical decompensation) or major (e.g., requiring immediate intervention) and may occur in preparation or during transport. Regardless of the type of event experienced, any intervention during transport impacts the patient and may lead to delayed treatment and disruption of critical care. This review summarizes the commentary on the current literature on the associated risks and provides insight into the costs as well as provider experiences. Approximately, one-third of patients who are transported from the ICU to an imaging suite may experience an adverse event. This creates an additional risk for extending a patient's stay in the ICU. The delay in obtaining imaging can negatively impact the patient's treatment plan and affect long-term outcomes as increased disability or mortality. Disruption of ICU therapy can decrease respiratory function after the patient returns from transport. Because of the complex care team needed for patient transport, the staff time alone can cost $200 or more. New technologies and advancements are needed to reduce patient risk and improve safety.

Mental health service users' experiences of telehealth interventions facilitated during the COVID-19 pandemic and their relevance to nursing: An integrative review.

INTRODUCTION: The Covid-19 pandemic saw the swift implementation of physical and social distancing that impacted the way in which mental health services were facilitated. Consequently, telehealth/e-health interventions are increasing in use. This integrative review aims to explore existing literature regarding mental health service users' experiences of telehealth interventions facilitated through the COVID-19 pandemic, to determine the visibility of nursing involvement in the facilitation of telehealth interventions and to use these experiences to inform nursing practice. A methodical search of eight (n = 8) academic databases was undertaken using CINAHL, SCOPUS, EMBASE, PsycINFO, Web of Science, Cochrane, MEDLINE and Academic Search Complete between January 2020 and January 2022. A total of 5133 papers were screened by title and abstract of which (n = 77) progressed for full-text screening. Five (n = 5) papers met the inclusion criteria for this review and results were mapped onto the four meta-paradigms of nursing: person; where the findings discuss the acceptability of telehealth interventions; environment; where the findings highlight barriers and facilitators to the use of telehealth interventions; health; where the findings discuss staff time and logistical issues relating to telehealth interventions and nursing; where the findings centre around the therapeutic relationship. This review highlights there is a paucity of direct evidence relating to nursing involvement in the facilitation of telehealth interventions. However, there are benefits to the use of telehealth interventions that include increased access to services, less perceived stigma and increased engagement which are relevant to nursing practice. A lack of individual contact and concerns relating to infrastructure indicates a fondness for face-to-face interventions remains high. There is a need for further research on the role of the nurse in the facilitation of telehealth interventions, specific interventions used and outcomes of such interventions.

Evaluation of awake prone positioning effectiveness in moderate to severe COVID-19

Evidence mainly from high income countries suggests that lying in the prone position may be beneficial in patients with COVID-19 even if they are not receiving invasive ventilation. Studies indicate that increased duration of prone position may be associated with improved outcomes, but achieving this requires additional staff time and resources. Our study aims to support prolonged (≥ 8hours/day) awake prone positioning in patients with moderate to severe COVID-19 disease in Vietnam. We use a specialist team to support prone positioning of patients and wearable devices to assist monitoring vital signs and prone position and an electronic data registry to capture routine clinical data.

Should AEDs Become More Common in Nursing Homes?

Automated external defibrillators, or AEDs, to manage cardiac arrest have become standard in many community settings. This was evident when first responders had to perform cardiopulmonary resuscitation (CPR) and use an AED on Buffalo Bills safety Damar Hamlin, who went into cardiac arrest on the football field in January. By contrast, AEDs are not standard in nursing homes. Nursing facilities that participate in Medicare and Medicaid must be able to provide basic life support (BLS), including CPR, in emergency situations, but they are not required to have AEDs on-site, and the extent of AED use is unknown. It may be time to re-evaluate CPR procedures among residents, says Rebecca Elon, MD, MPH, CMD, an associate professor at Johns Hopkins University School of Medicine. Previously, studies suggested that performing CPR on nursing home residents who experience cardiac arrest is futile, given that the likelihood of survival lessens as individuals age. One study, for instance, found that over a 13-year period, survival 30 days after CPR was performed was 6.7% among individuals aged 70 to 79, dropping to 4.4% among those aged 80 to 89 and 2.4% among those aged 90 and older (Resuscitation 2015;94:28–32). Studies also have found poorer outcomes in individuals who have comorbidities, even when an AED was used. However, Dr. Elon points out, many of those studies are more than a decade old. The most recent study dates to 2006, and none of the individuals in that study received CPR with an AED. Indeed, in four U.S. cities only 6.7% of nursing homes had AEDs, and 10% had manual defibrillators, as reported by another study that same year (J Am Med Direc Assoc 2006;7:413–415). When cardiac arrest occurs, the rate of survival diminishes by about 10% for every minute between the arrest and initiation of CPR, and the risk of prolonged brain damage increases due to cerebral hypoxia. However, recent studies have shown that outcomes have improved when someone witnesses the cardiac arrest and performs CPR using an AED. For example, a 2018 study in Denmark found that between 2001 and 2014, the overall survival in a limited cohort went from 1.7% to 7.7% when a bystander witnessed the cardiac arrest, performed CPR, and used an AED while awaiting emergency medical services (Resuscitation 2018;125:90–98). A German study of nursing facilities in 2020 found that among 2,900 CPR attempts over a seven-year period, only 118 patients (4.4%) were alive when they later left the hospital; 64 of those individuals (2.2% of the total) had a favorable cerebral performance (Dtsch Arztebl Int 2020;117:757–763). The researchers also found that in 64% of those cases the nursing staff did not attempt to resuscitate the resident but instead waited for the arrival of emergency personnel. Besides clinical outcomes, there are other considerations when deciding whether AEDs should be standard in nursing homes, such as staff time, especially considering shortages, and cost effectiveness. “Despite these various potential concerns, providing AEDs for nursing facility staff to utilize in the BLS/CPR protocols might prove to be an important quality-improvement intervention and risk-management tool for nursing facilities,” Dr. Elon writes. Source: Elon RD. Cardiac Resuscitation Procedures in US Nursing Facilities: Time to Reevaluate the Standard of Care? [published online: February 28, 2023]. J Am Med Dir Assoc. DOI: https://doi.org/10.1016/j.jamda.2023.01.029. Jeffrey S. Eisenberg, a freelance writer in the Philadelphia area, compiled this listing.

Enhancing patient clinical streamlining (EPACS) pilot in the breast medicine service at memorial sloan kettering cancer center.

e18759 Background: Breast cancer patients at specialty cancer hospitals have a 10% lower risk of death in the first year vs those at community hospitals, where 77% of cancer patients are treated. However, there are barriers to seeking and following up care at the former. One intervention shown to favor continuity and reduce time to treatment has been ‘enhancing patient clinical streamlining’ (EPACS), which coordinates patient record-collection, care, expectations and therapy from initial contact. Methods: In this quality improvement project, we implemented EPACS in the breast outpatient service at a specialty cancer hospital. In lieu of the traditional sequence of nursing then doctors' visit followed by coordination of workup and subsequent therapy, EPACS involved an initial nursing visit followed by a telephone call from a provider (registered nurse, RN or advanced practitioner, APP) used to collect medical records/data, clarify patient expectations, and coordinate workup. Patients were then reviewed by MDs and treatment decisions were made. Phone calls were made to a subgroup of patients to assess satisfaction; and participating providers completed questionnaires regarding their experience of the pathway implementation. Results: The EPACS pilot was run at 8 clinics in parallel. In total 156 of 377 eligible patients (41.4%) were telephoned in a 6 month period. RN telephone calls lasted 15-60 minutes; while 82% of APP calls lasted &gt; 60 minutes. 66 of these 156 (42.3%) were questioned on a separate phone call on their experience. Patient and MD satisfaction with EPACS was universally high: patients consistently reported that they felt better prepared and connected to their team after the calls. The majority of MDs felt that EPACS saved them time and increased overall efficiency. RN and APP responses were more mixed, with some feeling that calls were lengthy and overly broad in scope. Notably, only 19% of eligible patients were contacted prior to RN and practice-associated APP visits; vs 74% by per-diem APPs; hinting at time limitations. Cancellation and no-show rates were unchanged vs pre-EPACS, as were patient time in clinic; and time to first chemotherapy from first visit. There was no objective harm to patients with EPACS vs without. Conclusions: Although EPACS implementation in a busy breast outpatient service did not replicate prior findings of increased patient retention or reduced time to treatment; it did result in objective significant improvement in patient experience as judged by patient-reported metrics. Patients felt prepared, involved, and heard, though partially at the cost of staff time and workflow. Future work might aim to lighten the data-gathering aspects of the EPACS framework and focus instead on patient ideas, concerns and expectations, capitalizing on the observed benefits while limiting negative impact on time management experienced by some providers.

Implementation of Generative Adversarial Network (GAN) Method for Pneumonia Dataset Augmentation

As a communicable disease, the majority of pneumonia cases are brought on by bacteria or viruses, which cause the lungs' alveoli to swell with fluid or mucus. Pneumonia may arise from this and further making breathing challenging since the lungs' air sacs are unable to contain enough oxygen for the body. Pneumonia may generally be diagnosed clinically (by a physician based on physical symptoms) as well as through a photo chest radiograph, CT scan, and MRI. In this case, the lower cost of a chest radiograph examination making it as one of the most popular medical imaging tests. However, chest radiograph photo readings have a disadvantage, where it takes a long time for medical staff or physicians to identify the patient's illness since it is difficult to detect the condition. Therefore, an identification of chest radiograph imagery into various forms using machine learning becomes one way to address this issue. This research focuses on building a deep neural network model using techniques from the Generative Adversarial Network algorithm. GAN is a category of machine learning techniques using two models to be trained simultaneously, one is a generator model to generated fake data and the other is a discriminator model used to separate the raw data from the real data set images. The dataset used is Chest X-Ray images obtained from repo GitHub and repo Kaggle totaling 5,863 with normal data 1583 images and pneumonia data 4273 imagesThe results showed that the use of the Generative Adevrsarial Network method as augmentation data proved to be more effective in improving the generalization of neural networks, this can be seen from the results the result of the accuracy value obtained is 97%.

Forensic mental health nurses' experiences of rebuilding the therapeutic relationship after an episode of physical restraint in forensic services in Ireland: A qualitative study.

Few studies have explored how forensic mental health nurses can rebuild the therapeutic relationship following an episode of physical restraint in the acute forensic setting. In this study, we aimed to redress this gap in the literature by exploring with forensic mental health nurses the factors that enable or hinder the rebuilding of the therapeutic relationship following an episode of physical restraint. A qualitative study design was used to capture participants' experiences, views and perceptions of the therapeutic relationship following an episode of physical restraint in the acute forensic setting. Data were collected through individual interviews with forensic mental health nurses (n = 10) working in an acute forensic setting. Interviews were audio recorded, and transcribed verbatim and accounts were analysed using thematic analysis. Four themes were identified: 'Building a Recovery Focused Therapeutic Relationship'; 'Authoritarian Role'; 'Inevitable Imbalance'; 'Rebuilding the Therapeutic Relationship'; plus two sub-themes 'Facilitators to rebuilding' and 'Barriers to rebuilding'. Findings suggest that an inevitable imbalance exists in building a recovery-focused therapeutic relationship and at times, is hindered by the authoritarian role of the forensic mental health nurse. Recommendations for changes in clinical practice and in upcoming policies should incorporate a dedicated debrief room and protected time for staff to debrief effectively following restraint. Routine post-restraint-focused clinical supervision would also be beneficial to mental health nursing staff.

Impact of novel insertable cardiac monitoring system on real-world cardiac device clinic workflow

Abstract Funding Acknowledgements Type of funding sources: None. Background Insertable cardiac monitors (ICMs) continually monitor for cardiac arrhythmias, enabling appropriate therapeutic intervention. However, clinic workload to manage ICM patients can be significant. The recent LINQ II ICM system was designed with several features to streamline clinic practice, including remote reprogramming and on-demand data pull capabilities, tablet-based clinician device programmer, smartphone app-based patient monitor, patient management service, and elective data triaging service. Purpose To characterize the impact of the LINQ II ICM system on clinic workload compared to previous ICM systems. Methods A detailed workflow survey was taken by clinicians at 66 unique cardiac device clinics across UK/Ireland. The total number of ICM patients per clinic averaged 563 patients (median = 500). Respondents included cardiac physiologists (94%), cardiac nurses (4%), and physicians (2%). Results Overall, 82.5% of respondents reported that the LINQ II ICM system is more efficient compared to previous ICM workflow, with a total clinic time savings of 9.3 hours/week (Table). Use of a tablet-based device programmer was estimated to save 19.9 minutes per ICM patient during the initial device insertion and activation, while the patient management service saved 30.6 minutes per new patient on monitor set-up and education. Two-thirds (68.6%) of respondents reported that app-based patient monitoring increases efficiency of remote monitoring, attributable to fewer disconnected monitors and reduced patient calls due to information available in the app (e.g., device battery life, data transmission status). The majority (85.7%) felt that remote reprogramming increases efficiency, as remote reprogramming was estimated to save an average 20.0 minutes of staff time compared to an in-clinic reprogramming. More frequent reprogramming of device alerts also led to an average 13.5% reduction in the rate of non-actionable ICM alerts, and overall 43.1% fewer in-person clinic visits. Conclusions New ICM system features appear to streamline the clinic workflow associated with managing ICM patients, freeing up valuable clinician time to devote to patient care activities.

Optimization of the clinical workflow and patient pathway in cardiac monitor implantation and follow-up

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Medtronic Background Clinical evidence supports the use of Insertable Cardiac Monitors (ICMs) to determine the aetiology of recurrent unexplained syncope and cryptogenic stroke. ICMs continuously monitor cardiac arrhythmias, enabling appropriate diagnosis and treatment. A remote follow-up system transfers ICM data to hospital staff for analysis. This creates a significant data-burden for the staff. Purpose To assess the impact of efficiency optimization of the diagnostic patient pathway and clinical workflow for patients eligible for an ICM. Methods We collected patient-level data from all patients that received an ICM at a university hospital in 2018 and 2020 to assess the change in the clinical workflow with one year follow-up time. Pathway improvements included moving the procedure out of the catheterization lab (cath lab), switching to a nurse-led pathway as well as outsourcing part of the remote follow-up workflow to an external monitoring centre. Results The number of implanted ICMs doubled from 74 in 2018 to 159 in 2020. In 2018, all implantations were done by a physician while in 2020, 70 % were done by nurses. In 2018 the operation schedule was 60 min for an ICM, compared to 45 minutes in 2020. The waiting time from referral to implantation was significantly shorter in 2020 (mean=36 days) compared to 2018 (mean=49 days), p=0,008. Implantations done in the cath lab decreased significantly (19 % in 2018; 2 % in 2020). Patients receiving an ICM after syncope increased from 71 to 94 patients. Stroke and transient ischemic attack (TIA) as an implantation indication increased substantially from 2018 to 2020 (2 and 62 patients, respectively). In 2018, nurses analysed all remote transmissions. In 2020 the first line review and triaging of remote transmissions was outsourced to an external monitoring and triaging centre. This external service escalated only 11 % of the transmissions (204 out of 1817) to the clinic for revision. Under the assumption that a nurse uses 11 minutes per transmission as seen in previous studies, this saved 296 hours of nursing time in 2020. The nurse-led implantation in 2020 saved 48 hours of physicians’ time compared to what would have been used by the process in 2018. The shorter procedure scheduling freed up additional 40 hours of nursing time in 2020. Also, time in the cath lab was freed up for other procedures (27 hours per year). The complication rate did not change significantly (2,7 % in 2018 and 3,1 % in 2020, P=0,85). The 1-year diagnostic yield for syncope remained high in 2018 and 2020 with no statistically significant difference (26.8 % vs 20.2 % P=0.32). The diagnostic yield for stroke patients implanted in 2020 was 24.6 %. Conclusions Nurse-led care pathways and the use of an external monitoring and triaging service significantly improved the patient pathways for patients indicated for an ICM. This freed up a significant amount of staff time and resources without compromising the quality of the treatment.

Automation in flow cytometry: Guidelines and review of systems.

Automation in flow cytometry has recently advanced from the partial laboratory automation and robotics islets, to more fully integrated systems. This article reviews three manufacturers' newest sample preparation systems: the Beckman CellMek, the Sysmex PS-10, and the BD FACSDuet. These three instruments are capable of performing many of the manual steps in flow cytometry sample processing (pipetting, staining, lysing, washing, fixing). General description, capabilities, advantages, and disadvantages of each system are compared. Overall, these systems have the potential to become mainstay items in today's busy clinical flow cytometry laboratories, and save a significant amount of hands-on time for laboratory staff.

Data envelopment analysis to evaluate the efficiency of tobacco treatment programs in the NCI Moonshot Cancer Center Cessation Initiative

BackgroundThe Cancer Center Cessation Initiative (C3I) is a National Cancer Institute (NCI) Cancer Moonshot Program that supports NCI-designated cancer centers developing tobacco treatment programs for oncology patients who smoke. C3I-funded centers implement evidence-based programs that offer various smoking cessation treatment components (e.g., counseling, Quitline referrals, access to medications). While evaluation of implementation outcomes in C3I is guided by evaluation of reach and effectiveness (via RE-AIM), little is known about technical efficiency—i.e., how inputs (e.g., program costs, staff time) influence implementation outcomes (e.g., reach, effectiveness). This study demonstrates the application of data envelopment analysis (DEA) as an implementation science tool to evaluate technical efficiency of C3I programs and advance prioritization of implementation resources.MethodsDEA is a linear programming technique widely used in economics and engineering for assessing relative performance of production units. Using data from 16 C3I-funded centers reported in 2020, we applied input-oriented DEA to model technical efficiency (i.e., proportion of observed outcomes to benchmarked outcomes for given input levels). The primary models used the constant returns-to-scale specification and featured cost-per-participant, total full-time equivalent (FTE) effort, and tobacco treatment specialist effort as model inputs and reach and effectiveness (quit rates) as outcomes.ResultsIn the DEA model featuring cost-per-participant (input) and reach/effectiveness (outcomes), average constant returns-to-scale technical efficiency was 25.66 (SD = 24.56). When stratified by program characteristics, technical efficiency was higher among programs in cohort 1 (M = 29.15, SD = 28.65, n = 11) vs. cohort 2 (M = 17.99, SD = 10.16, n = 5), with point-of-care (M = 33.90, SD = 28.63, n = 9) vs. no point-of-care services (M = 15.59, SD = 14.31, n = 7), larger (M = 33.63, SD = 30.38, n = 8) vs. smaller center size (M = 17.70, SD = 15.00, n = 8), and higher (M = 29.65, SD = 30.99, n = 8) vs. lower smoking prevalence (M = 21.67, SD = 17.21, n = 8).ConclusionMost C3I programs assessed were technically inefficient relative to the most efficient center benchmark and may be improved by optimizing the use of inputs (e.g., cost-per-participant) relative to program outcomes (e.g., reach, effectiveness). This study demonstrates the appropriateness and feasibility of using DEA to evaluate the relative performance of evidence-based programs.

Emergency Department-Based HIV Testing Services and Self-Testing Programs: A Qualitative Study of Healthcare Providers and Patients in Kenya

Introduction:Young people in Sub-Saharan Africa, especially males, have been insufficiently engaged in HIV Testing Services (HTS). In Kenya, these persons are often treated in emergency departments (EDs) for injuries, a healthcare interaction where HTS including HIV self-testing (HIVST) could be leveraged. There is, however, limited data from stakeholders on ED-HTS which impedes programmatic advancement.Method:A qualitative study was completed to understand facilitators and challenges for ED-HTS and HIVST delivery in Kenya (12/2021-03/2022). Data were collected via 28 in-depth patient interviews (14 males and 14 females) who had been treated in the Kenyatta National Hospital (KNH) ED and through seven focus-group discussions conducted with 49 ED healthcare personnel (nurses, doctors, HIV testing counselors, and administrators). Transcripts were double-coded and thematically analyzed with Dedoose™ software using a parallel inductive and deductive approach to capture both a priori and emergent themes.Results:Patients and providers viewed ED-HTS as a beneficial provision that was facilitated by engaged staff, education, perceived high HIV risk, and confidentiality. However, ED-HTS was limited by burdens on staff time and material resources, lacking systems integration, and patient illness severity. Facilitators of ED-HIVST delivery were perceived to have greater autonomy and confidentiality as well as lower health resource utilization. Challenges for ED-HIVST identified included patients’ concerns about HIVST accuracy and psychological stress, as well as providers’ concerns for loss to follow up and inability to complete confirmatory testing.Conclusion:ED stakeholders are receptive to HTS and HIVST provisions. This data provides insight into the patient, provider, and systems aspects that can be leveraged in ED-based HTS to enhance program impacts via intervention functions in the forms of education, care integration, resource scaling, and solidified post-self-testing follow-up mechanisms.