Staff Utilization Research Articles

Uvođenje novog fleksibilnog sistema planiranja ljudskih resursa zasnovano na digitalnom blizaničkom pristupu - studija slučaja

Digital twin technology has become one of the key directions of intelligent manufacturing with a strong relationship to product lifecycle management. It contributes to increasing efficiency and flexibility in solving highly complex problems in constantly changing conditions. However, many circumstances make the real implementation of effective scenarios generated by simulation software tools difficult. One of them are rigid working schedules that complicate flexible human resources planning in accordance with optimal production and logistics plans. This article aims to examine the role of the digital factory twin in advanced human resources planning. Using the case study method, a solution for better coordination of internal logistics processes and utilization of logistics staff based on discrete-event simulation is presented. Several scenarios were tested and results showed the inevitability of using flexible working schedules for maximum utilization of logistics staff. The purpose of this study is not only to show one special case of one company, but to emphasize the potential of these software tools to achieve long-term synergies in coordinating logistics, production and human resources management activities. As a result of this study, an extended physical-digitalphysical loop model is presented. This extension consists in adding the second loop including communication with HR portal.

Increasing the efficiency of automation in shipbuilding and ship-repairing by building a control system using lean manufacturing principles

Shipbuilding companies often suffer from long production cycles, low staff utilisation and an unbalanced production line. To solve these problems, a lean shipbuilding regime is used which involves work breakdowns, production plans and virtual flow operations that combine lean production with modern information management technology in shipbuilding. Production planning manages all the production activities of a shipbuilding facility. Production plans are achieved just-in-time through intelligent organisation, reducing loss of staff and time. A virtual flow operation is then carried out, achieving high efficiency in flow production and high flexibility in production. By implementing a lean shipbuilding regime based on task package planning and its production system, the ship's production cycle is reduced, the number of workers is reduced, but the level of production balance is increased.

Assessment of emergency department staff awareness, access and utilisation of advance care directives and goals of care: A cross-sectional survey

BackgroundEmergency department staff awareness, access and implementation of advance care directives and goals of care documents and the related patient consent processes are important but not well understood. MethodsA cross-sectional survey using purposive sampling was undertaken at a tertiary hospital’s Emergency Department from 15th March to 26th April 2021. Participants were recruited through online platforms. Pre-validated questionnaires were distributed by email or as QR codes on bulletin boards. Data collected included staff: demographics, knowledge, access and implementation of advance care directives and goals of care documentation. ResultsOne hundred thirty-four (28%) of 476 targeted participants responded with nursing forming largest group. Results showed that previous attendance of advance care planning education was low at 20%. Familiarity with advance care directive documentations was only 19% while with goals of care document was average. 61 (48%) respondents reported ease of accessing electronic documents and 21 (19%) reported feeling very comfortable discussing and setting goals of care with patients (p = <0.01). ConclusionsStaff awareness of advance care directive was poor, while awareness of goals of care was average. There was no association between advance care directives awareness and staff age group, gender, length of: - professional practice, practice at the study site.

The art of delegation: integration of the veterinary nursing assistant into New Zealand veterinary practice

Background: In 2016 veterinary nursing assistants (VNAs) were introduced as an additional tier to New Zealand veterinary practice. Aim: This study explores the utilisation of VNAs in New Zealand veterinary practices to ascertain the impact of an additional staffing layer to patient outcomes, workload management and staff wellness. Method: Through focus groups and semi-structured interviews with 30 participants, three themes emerged allowing evaluation of the Allied Veterinary Professionals Regulatory Council (AVPRC) Scope of Practice (SP) (AVPRC, 2020) and development of delegation guidelines (DG). Results: Analysis identified weak processes in delegation. The practice-based perspectives of VNA staff utilisation supports the AVPRC SP. Conclusion: Effective communication of the SP and DG for veterinary practice utilisation could contribute to reducing workload pressure. Additionally, individual practice staff discussions regarding own and colleague job expectations, along with review of contractual job descriptions, could further evolution of multi-tiered practices leading to improved patient outcomes, team wellness and business success.

Staff and Facility Utilization in Direct Patient Transfer to the Comprehensive Stroke Center: Testing a Real-Time Location System for Automatic Patient Pathway Characterization.

Introduction: Starting reperfusion therapies as early as possible in acute ischemic strokes are of utmost importance to improve outcomes. The Comprehensive Stroke Centers (CSCs) can use surveys, shadowing personnel or perform journal analysis to improve logistics, which can be labor intensive, lack accuracy, and disturb the staff by requiring manual intervention. The aim of this study was to measure transport times, facility usage, and patient–staff colocalization with an automated real-time location system (RTLS).Patients and Methods: We tested IR detection of patient wristbands and staff badges in parallel with a period when the triage of stroke patients was changed from admission to the emergency room (ER) to direct admission to neuroradiology.Results: In total, 281 patients were enrolled. In 242/281 (86%) of cases, stroke patient logistics could be detected. Consistent patient–staff colocalizations were detected in 177/281 (63%) of cases. Bypassing the ER led to a significant decrease in median time neurologists spent with patients (from 15 to 9 min), but to an increase of the time nurses spent with patients (from 13 to 22 min; p = 0.036). Ischemic stroke patients used the most staff time (median 25 min) compared to hemorrhagic stroke patients (median 13 min) and stroke mimics (median 15 min).Discussion: Time spent with patients increased for nurses, but decreased for neurologists after direct triage to the CSC. While lower in-hospital transport times were detected, time spent in neuroradiology (CT room and waiting) remained unchanged.Conclusion: The RTLS could be used to measure the timestamps in stroke pathways and assist in staff allocation.

System of Parametric Modelling and Assessing the Production Staff Utilisation as a Basis for Aggregate Production Planning

The requirement to achieve effective solutions in the shortest possible time in the manufacturing environment is essential, and it can be solved only by effective production planning methods. The scientific problem is that traditional methods for creating and assessing the production plans are insufficient for the future and it is necessary to look for new alternatives. The planners in the framework of designing the production layouts and subsequent capacity planning of the employees are missing the information, methods and tools for making clear decisions. The production costs in general and especially the costs for the workforce create a large part of the operating costs in many manufacturing enterprises. The scientific goal of the article is to present a design of the system for parametric modelling and assessing the working utilisation of the production staff intended for reducing costs. The described solution is based on object-oriented analysis and contains a methodology of planning and controlling the production process in the industrial environment. The designed methodology was used for developing a planning module of project software and was shown through a case study in a company dealing with the production of automotive components. Effective modelling of the digital copy of the manufacturing system in the software environment is one of the most difficult and important steps for developing reliable information systems for planning and inspection in the industry. The methodology’s results in a company are that the solution can be used as a basis for the aggregate production planning that brings savings and efficiency increases. The research results can be used in any company with strictly defined working positions, working activities, and limiting conditions.

Fair and generous pay for veterinary professions

The Veterinary NurseVol. 12, No. 8 EditorialFree AccessFair and generous pay for veterinary professionsJennifer HamlinJennifer HamlinConsultant Editor, The Veterinary NurseSearch for more papers by this authorJennifer HamlinPublished Online:25 Oct 2021https://doi.org/10.12968/vetn.2021.12.8.347AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail Veterinary nursing census data around the world reveal a common trend; we are underpaid compared with most other qualified occupations, and we are underutilised compared with the skills we gained in our professional qualifications. The implications of chronic low pay of veterinary professionals are extensive, reaching all aspects of the sector from operational efficiencies, and public service, to clinical effectiveness, and animal welfare. Despite the reasons and issues that need to be resolved, one thing is for certain, we need to pay our veterinary nurses fairly and in line with our level of professionalism, credentials, and responsibility.There is extensive research looking at operational efficiencies in sectors that have low wages. Some trends in this research show dramatic consequences to wellbeing, performance, and creativity when people are underpaid. Mental and physical health suffers; cognitive functions are impacted, with decreased creativity, and efficiency. Evidence shows a 13 point drop in IQ when there is a daily struggle to make ends meet. Workers struggle to pay the bills, their health suffers, their performance declines, and consequently they don't get utilised, promoted, or empowered to take on advanced roles. The flow-on effects of this process to the workforce includes low productivity, decreased profits, decreased confidence in employees, poor organisational culture, and high staff turnover. Low wages are both a cause and effect of designing for mediocrity. It's a vicious cycle.When people feel valued, they add value — this is supported in psychology and behavioural economics. Efficiency wage theory outlines how employees who are paid fairly and generously are more productive, employee satisfaction and retention metrics score higher, and profits go up because employees are more focused, motivated, valued and take pride in what they do. Employees are driven by a desire to offer value for money, and the company benefits by attracting high quality recruits, and by having healthier employees.What does all of this mean to an average veterinary clinic? Practices must determine what the extra effort from workers, and the boost in productivity, is worth to the business. This is the maximum that can sustainably go toward wages. If this amount is low, it is worth determining ways to simplify systems to improve efficiency, measure areas of inefficiency including optimal staff utilisation. Employers can consider value-based healthcare strategies, such as systems and processes to measure service cost and health outcomes; development of patient-centred care, as opposed to supply-driven care; measurement and transparency of outcomes, including patient, performance, and service quality outcomes.Generous pay is most effective when linked with organisational culture that sees each worker as a whole person worth investing in. This translates to investments in economic strategy, emotional literacy, and employee wages. As a sector, we need to upskill in these areas if we hope to get out of this vicious cycle.While most of us entered the profession to care for animals, we are not just bystanders to evolution of our profession, we are part of it. Veterinary nurses can lead in this space, by gathering the economic and behavioural scientific evidence, building emotional literacy skills, and developing capabilities in building a strong organisational culture. By developing awareness of financial acumen, profits, and risks we build capability to influence our profession's strategic vision. If we don't lead it, who will? FiguresReferencesRelatedDetails 2 October 2021Volume 12Issue 8ISSN (print): 2044-0065ISSN (online): 2052-2959 Metrics Downloaded 47 times History Published online 25 October 2021 Published in print 2 October 2021 Information© MA Healthcare LimitedPDF download

Effective Collaboration Towards Positive Perioperative Outcomes for the Cardiac Surgery Patient in the Preoperative Phase of Care

<h3>Background Information</h3> The pre-procedure clinic in our academic medical center provides preoperative evaluation and surgical preparation for patients. Nurses in the clinic care for complex patients and support multiple surgical specialties, including cardiac surgery. Workflows related to this subset of patients, specifically identification of blood type and antibodies, presented a particular challenge for the clinic and cardiac surgery patients were not always ready for the operating room (OR) on the day of surgery. There was a negative impact on on-time first case starts (OTFS), cardiac surgery staff utilization, and, most importantly, patient satisfaction when delays occurred the morning of surgery due to positive antibodies and the need for additional work up to prepare blood availability for surgery. <h3>Objectives of Project</h3> The project aims were to: 1) provide an efficient outpatient pre-operative 30-day blood band process in the pre-procedure evaluation clinic for the adult cardiac surgery patient as partners in care with the cardiac surgery service and 2) establish a mutually beneficial work flow between perioperative services and cardiac surgery staff to minimize downstream OR delays. <h3>Process of Implementation</h3> A consultative group guided perioperative services leadership to improve internal processes. Collaboration with the cardiac surgery clinic and patient administrative services staff was crucial for project success. The project team developed and implemented a cardiac surgery internal workflow for preoperative management and the team revised outpatient registration workflows. All patient care technicians in the pre-procedure evaluation clinic received education for preoperative 30-day blood band lab procurement and associated form storage. <h3>Statement of Successful Practice</h3> This poster illustrates that there had been an upward trend in meeting the divisional OTFS goal of ≥ 75%. As of 10/31/19, ≥ 80% of cardiac surgery first cases started on time as compared to only 55% of cases started on time in July 2019. <h3>Implications for Advancing the Practice of Perianesthesia Nursing</h3> Perinanesthesia nurses can improve the care of their patients by employing performance innovation concepts to break down barriers to ensure multidisciplinary success. By engaging multiple perioperative disciplines, providers, and members of the patient care delivery team, both patient care and organizational goals can be met. The option of 30 day blood bands is expanding to other surgical services to avoid delays the morning of surgery.

Quality, Safety, and Standards Organizations COVID-19 Impact Assessment: Lessons Learned and Compelling Needs.

The stark reality of the COVID-19 pandemic challenged the very systems established to ensure the nation’s safety and quality. The pandemic resurfaced long-endemic challenges within the health care quality and standards ecosystem and identified novel challenges that cannot be ignored. This paper examines: 1. the health care quality and standards ecosystem pre-pandemic; 2. vulnerabilities in quality and standards organizations exposed by COVID-19; 3. quality and standards organizations’ responses during the pandemic; 4. opportunities to improve the national response to improving quality and safety overall with a particular focus on readiness in the case of disasters, pandemics, or other national emergencies; 5. sector-wide policy, regulatory, and legal changes that might be transformative; and 6. priorities moving forward. The quality and safety focus of the American health care system has a long history, dating back to the 19th and early 20th centuries. Quality of care is generally understood as providing the right care for the right person at the right time—every time. Several seminal laws and publications over the last 60 years have shaped the current quality landscape in profound ways and have been cataloged in numerous publications [1,2,3,4]. These publications generally point to several landmark occurrences that have shaped the evolution of quality measurement, improvement activities, and safety standards over the years. The evolution has centered around four main levers (see Figure 1): Open in a separate window FIGURE 1 Key Levers for Care Quality and Safety 1. survey, certification, and accreditation of facilities, laboratories, health plans, and providers; 2. quality measurement, incentives, and payment reforms; 3. public ratings of providers and facilities; and 4. quality improvement learning and action networks. Survey, Certification, and Accreditation The role of government in establishing quality and safety standards for the health care system became prominent with the implementation of the 1965 Medicare legislation, in which Congress explicitly tied payment to the achievement of minimum health and safety standards, commonly known as conditions of participation (CoPs). Initially, the CoPs focused on medical staff qualifications, nursing services, and utilization review, but have since evolved to include minimum standards for various other important safety issues, including infection control, emergency preparedness, quality assurance, performance improvement, and medication management. States also established health and safety requirements for facility licensure. State standards for health and safety must, at a minimum, align with the CoPs but may go above and beyond the federal requirements. While the state government and federal surveyors perform inspections for many facilities (primarily nursing homes), the Centers for Medicare and Medicaid Services (CMS) has approved several national accreditation organizations (AOs) to perform survey functions [5]. One of the largest AOs is the Joint Commission. Founded in 1951, the “Joint Commission accreditation can be earned by many types of health care organizations, including hospitals, doctor’s [sic] offices, nursing homes, office-based surgery centers, behavioral health treatment facilities, and providers of home care services” [65]. In 1990, the National Committee for Quality Assurance (NCQA) was established as a nonprofit organization that accredits quality programs for health plans, physicians, and other providers. NCQA developed the first set of standards for health plan quality using a set of evidence-based requirements and measurements.

Mixed integer linear programming problem for personnel multi-day shift scheduling: A case study in an Iran hospital

The application of mathematical and systematic models and approaches to health is on the rise. In this study, a mixed-integer linear programming problem with cost (staff payroll) objective function is proposed to determine homogeneous personnel shift scheduling so that the constraints of the number of personnel per shift are met. The purpose of this study is to optimize the scheduling of personnel with the same skills to minimize variable hospital costs. In a hospital, homogeneous personnel might be skilled nurses who can work in the same departments or service staff of the departments. First, a mathematical model is proposed for scheduling as a linear problem and solved using Lingo software. By analyzing the results for a personnel working time period in Pasargad Hospital in Tehran (Iran), it is found that while optimizing the utilization of the skilled staff within departments, the variable costs (payroll) related to the department for that specified period (month), which includes overtime, overnight and holidays, are reduced by around 10 percent.

Information on Domestic staff utilisation and household crimes

Hiring of domestic staff and its effect on households’ crime has been an issues of great concern in Nigeria. This study is sets to investigate the correlates between domestic staff utilisation and crimes such as kidnapping, stealing and rape. Blocked opportunity theory and structural functionalism theory were adopted. Cross-sectional survey design was used while data was generated view questionnaire. A total sample of 330 respondents were selected from households in Southern Senatorial District of Cross River State, Nigeria. Information retrieved were coded and subjected to statistical analysis. Outcome revealed a significant relationship between the hiring of domestic staff and household crimes (such as kidnapping, stealing and rape). It was recommended among others that house helps should be passably screened through proper employment procedures before they are employed as domestic staff.

Practice Diversity and Burn Center Growth: A 10-Year Profile of a State's Only Burn Center.

Growth and sustainability of burn practices can be impaired by irregular patterns of patient presentations, resulting in uneven utilization of facilities and staff. Burn care itself may not engage the full capacities of members of burn care teams. To address these problems, we organized a burn and reconstruction center to provide statewide acute care as Mississippi's only burn unit, to fully integrate reconstructive surgery into management of burn patients, and to diversify practice based on plastic surgery scope of practice. The first 10 years of this unit were reviewed to evaluate the performance of this scheme. Burn admissions to and surgical procedures at this unit between July 2009 and June 2019 were analyzed to quantify acute burn care, secondary reconstructive burn care, and categories of practice growth. The unit admitted 5469 acute burn patients with a mortality rate of 1.49%. Comparing year 10 to year 1 of practice, acute burn admissions increased 58%. Total operations increased 276%. Acute burn procedures increased 176%. Secondary burn procedures increased 405%. Nonburn procedures increased 352%, with the subset of nonburn hand surgery increasing 1062%. Acute burn admissions and procedures increased over this period, but greater growth was seen in secondary burn procedures and nonburn procedures, especially hand cases. Expansion of practice into areas within the overall skill sets of burn team members was an effective growth strategy.

Clinical laboratory services for primary healthcare centers in urban cities: a pilot ACO model of ten primary healthcare centers

BackgroundPrimary healthcare centers (PHC) ensure that patients receive comprehensive care from promotion and prevention to treatment, rehabilitation, and palliative care in a familiar environment. It is designed to provide first-contact, continuous, comprehensive, and coordinated patient care that will help achieve equity in the specialty healthcare system. The healthcare in Saudi Arabia is undergoing transformation to Accountable Care Organizations (ACO) model. In order for the Kingdom of Saudi Arabia (KSA) to achieve its transformational goals in healthcare, the improvement of PHCs’ quality and utilization is crucial. An integral part of this service is the laboratory services.MethodsThis paper presents a pilot model for the laboratory services of PHC's in urban cities. The method was based on the FOCUS-PDCA quality improvement method focusing on the pre-analytical phase of the laboratory testing as well as the Saudi Central Board for Accreditation of Healthcare Institutes (CBAHI) gap analysis and readiness within the ten piloted primary healthcare centers.ResultsThe Gap analysis, revealed in-consistency in the practice, lead to lower the quality of the service, which was seen in the low performance of the chosen key performance indicators (KPI's) (high rejection rates, lower turn-around times (TAT) for test results) and also in the competency of the staff. Following executing the interventions, and by using some of the ACO Laboratory strategies; the KPI rates were improved, and our results exceeded the targets that we have set to reach during the first year. Also introducing the electronic connectivity improved the TAT KPI and made many of the processes leaner.ConclusionsOur results revealed that the centralization of PHC's laboratory service to an accredited reference laboratory and implementing the national accreditation standards improved the testing process and lowered the cost, for the mass majority of the routine laboratory testing. Moreover, the model shed the light on how crucial the pre-analytical phase for laboratory quality improvement process, its effect on cost reduction, and the importance of staff competency and utilization.

Optimization of Patient Flow in Urgent Care Centers Using a Digital Tool for Recording Patient Symptoms and History: Simulation Study.

BackgroundCrowding can negatively affect patient and staff experience, and consequently the performance of health care facilities. Crowding can potentially be eased through streamlining and the reduction of duplication in patient history-taking through the use of a digital symptom-taking app.ObjectiveWe simulated the introduction of a digital symptom-taking app on patient flow. We hypothesized that waiting times and crowding in an urgent care center (UCC) could be reduced, and that this would be more efficient than simply adding more staff.MethodsA discrete-event approach was used to simulate patient flow in a UCC during a 4-hour time frame. The baseline scenario was a small UCC with 2 triage nurses, 2 doctors, 1 treatment/examination nurse, and 1 discharge administrator in service. We simulated 33 scenarios with different staff numbers or different potential time savings through the app. We explored average queue length, waiting time, idle time, and staff utilization for each scenario.ResultsDiscrete-event simulation showed that even a few minutes saved through patient app-based self-history recording during triage could result in significantly increased efficiency. A modest estimated time saving per patient of 2.5 minutes decreased the average patient wait time for triage by 26.17%, whereas a time saving of 5 minutes led to a 54.88% reduction in patient wait times. Alternatively, adding an additional triage nurse was less efficient, as the additional staff were only required at the busiest times.ConclusionsSmall time savings in the history-taking process have potential to result in substantial reductions in total patient waiting time for triage nurses, with likely effects of reduced patient anxiety, staff anxiety, and improved patient care. Patient self-history recording could be carried out at home or in the waiting room via a check-in kiosk or a portable tablet computer. This formative simulation study has potential to impact service provision and approaches to digitalization at scale.

Assessment of compliance with national guidelines in genetic testing and tumor profiling in patients diagnosed with pancreatic adenocarcinoma: A retrospective review.

e16260 Background: Pancreatic ductal adenocarcinoma (PDAC) remains one of poor prognosis, portending a 5-year survival rate of 9% when considering all stages. Although the mainstay of treatment of PDAC remains cytotoxic chemotherapy in both the early and advanced stages, recent advances in tumor profiling and germline testing have allowed for the incorporation of poly-ADP-ribose polymerase (PARP) inhibitors, immune checkpoint inhibitors and targeted therapy to be utilized in the maintenance and subsequent-line settings for metastatic PDAC, respectively. We sought to identify our institutional compliance rate in germline testing and tumor profiling in all patients diagnosed with PDAC. Methods: A retrospective review was conducted of all patients diagnosed with PDAC from 2017-2019 at Allegheny General Hospital. Data analysis was completed using IBM SPSS v23. Summary statistics were presented using percentages for categorical variables and medians with interquartile ranges for continuous variables. Results: Out of 171 patients reviewed, 121 received and completed treatment in our institution, and were included in the analysis. Median age was 69 years. 55 patients (45%) were male and 66 (55%) were female. Germline testing was done in 28 patients (23%) and tumor molecular profiling was done in 25 patients (21%). Testing for microsatellite instability was performed in 28 patients (23%). Testing for programmed death-ligand (PD-L1) expression was done in 16 patients (13%). On univariate analysis, family history of malignancy was a predictor for germline testing (OR 5.3; 95% CI 1.4-2.01; p=0.01). No predictors were identified in association with tumor molecular profiling likely due to low sample size. Conclusions: Our analysis reveals an institutional compliance rate of 20-23% in adherence to national guidelines with respect to germline testing and tumor profiling in the management of PDAC. A family history of malignancy demonstrated predictive association with germline testing. Factors which may limit pathological evaluation of microsatellite stability status, assessment of PD-L1 expression and molecular profiling include lack of institutional protocol for reflex histological testing, financial or insurance constraints, and lack of adequate tissue. As part of our Quality improvement project, we identified that incorporation of reflex histological testing based on tumor-type, standardization of tissue biopsy to optimize yield, and utilization of support staff, such as Oncology Navigators, to facilitate scheduling for germline testing may increase compliance rates.

Social Services Involvement in Care Transitions and Admissions in Nursing Homes

ABSTRACT Care transitions (CT) are critical junctures in the healthcare delivery process. Effective transitions reduce the need for subsequent transfers between healthcare settings, including nursing homes. Understanding social services (SS) involvement in these processes in nursing homes is important from a quality and holistic care perspective. Using logistic regression, this study examines structural and relational factors identified with higher involvement of SS in care transitions and admissions. SS directors from 924 nursing homes were evaluated in relation to SS involvement in care transitions and admissions processes. Results suggest the level of SS involvement in care transitions and admissions are associated with structural factors such as size of facility, geographical location, ratio of FTE’s to beds, ownership status, and standalone SS departments, as well as relational factors, including perceptions and utilization of SS staff by facility leadership, coworkers, and family. Additionally, SS staff with higher levels of expertise and with social work degrees are less involved in admissions tasks.

Exploring Factors Contributing to Chronic Obstructive Pulmonary Disease (COPD) Guideline Non-Adherence and Potential Solutions in the Emergency Department: Interdisciplinary Staff Perspective.

PurposeAcute exacerbations of chronic obstructive pulmonary disease (COPD) have a significant and prolonged impact on health-related quality of life, patient outcomes, and escalation of pulmonary function decline. COPD-X guidelines published in 2003 subsist to facilitate a shift from the emphasis on pharmacological treatment to a more holistic multi-disciplinary interventions approach. Despite the existing comprehensive recommendations, readmission rates have increased in the last decade. Evidence to date has reported sub-optimal COPD guidelines adherence in emergency departments. This qualitative study explored contributing factors to interdisciplinary staff non-adherence and utilisation of COPD-X guidelines in a major Southern Queensland Emergency Department.MethodsSemi-structured qualitative interviews with interdisciplinary staff were conducted in an emergency department. A purposive sample of doctors, nurses, physiotherapists, pharmacist and a social worker were recruited. Interviews were digitally recorded, de-identified and transcribed verbatim. Data analysis followed a coding process against the Theoretical Domains Framework (TDF) to examine implementation barriers and potential solutions. Identified factors affecting non-adherence and underutilisation of guidelines were then mapped to the capability, opportunity, motivation, behaviour model (COM-B) and behaviour change wheel (BCW) to inform future implementation recommendations.ResultsProminent barriers influencing the clinical uptake of COPD guidelines were identified using TDF analysis and included knowledge, professional role clarity, clinical behaviour regulation, memory, attention, and decision process, beliefs about departmental capabilities, environmental context and resources. Potential interventions included education, training, staffing, funding and time-efficient digitalised referrals and systems management reminders to prevent COPD readmissions, remissions and improve patient health-related quality of life.ConclusionImplementation strategies such as electronic interdisciplinary COPD proforma that facilitates a multimodal approach with appropriate patient/staff resources and referrals prior to discharge from an ED require further exploration. Greater clarity around which components of the COPD X guidelines must be applied in ED settings needs to stem from future research.

Prediction of Prolonged Intensive Care Unit Length of Stay Following Cardiac Surgery

Intensive care unit (ICU) costs comprise a significant proportion of the total inpatient charges for cardiac surgery. No reliable method for predicting intensive care unit length of stay following cardiac surgery exists, making appropriate staffing and resource allocation challenging. We sought to develop a predictive model to anticipate prolonged ICU length of stay (LOS). All patients undergoing coronary artery bypass grafting (CABG) and/or valve surgery with a Society of Thoracic Surgeons (STS) predicted risk score were evaluated from an institutional STS database. Models were developed using 2014-2017 data; validation used 2018-2019 data. Prolonged ICU LOS was defined as requiring ICU care for at least three days postoperatively. Predictive models were created using lasso regression and relative utility compared. A total of 3283 patients were included with 1669 (50.8%) undergoing isolated CABG. Overall, 32% of patients had prolonged ICU LOS. Patients with comorbid conditions including severe COPD (53% vs 29%, P < 0.001), recent pneumonia (46% vs 31%, P < 0.001), dialysis-dependent renal failure (57% vs 31%, P < 0.001) or reoperative status (41% vs 31%, P < 0.001) were more likely to experience prolonged ICU stays. A prediction model utilizing preoperative and intraoperative variables correctly predicted prolonged ICU stay 76% of the time. A preoperative variable-only model exhibited 74% prediction accuracy. Excellent prediction of prolonged ICU stay can be achieved using STS data. Moreover, there is limited loss of predictive ability when restricting models to preoperative variables. This novel model can be applied to aid patient counseling, resource allocation, and staff utilization.

An exploration of the landscape of fundamental movement skills and strength development in UK professional football academies

The purpose of this study was to investigate the landscape of Fundamental Movement Skills (FMS) and strength development in professional football (soccer) academies in the UK. To achieve this, we interviewed 16 participants, whose primary responsibility was the physical development of youth players from a variety of Elite Player Performance Plan (EPPP) categorised academies. Following abductive analysis, we identified that whilst all participants acknowledged the importance of FMS and strength development for young football players, there was variance across EPPP categories relating to: (a) the time dedicated to developing FMS and strength; (b) the number, level of qualification, and utilisation of staff; and (c) the integration of the evidence informed practice into programme design and delivery. Although the key foci of academy strength and conditioning programmes generally prioritised injury reduction, performance improvement, and building a physical base for future development, the methods used to achieve these outcomes were varied. Finally, participants reported how relationships between support staff and technical coaching staff had a direct impact on the implementation of FMS and strength programmes. We have provided rich insights into a range of factors that may facilitate or hinder FMS and strength development within youth football players and thus helped to advance understanding of the practical implications of focusing on these key skills within athlete development programmes.

Lean approach to the management of patients undergoing intravitreal injections during COVID-19 pandemic.

Background:To introduce Lean approach principles in the management of patients undergoing intravitreal injections (IVIs) for wet age-related macular degeneration.Methods:Retrospective single-centre cohort study. Services location, IVIs scheduling, utilization of staff, data recording methods, ophthalmic examination and surgical procedures were analysed; a new Intravitreal Injection Centre (IVIC) was developed according to Lean principles. Mean number of daily IVIs performed, mean time between registration and discharge, mean turnover time in between patients, percentages of performed IVIs on the monthly scheduled IVIs and of patients rating their experience ⩾8/10 via standardized feedback questionnaires were retrospectively analysed.Results:The mean IVIs number per day increased from 20 ± 4.08 to 50 ± 7.07, and the mean time between registration and discharge of a patient decreased from 240 ± 14.14 to 60 ± 8.16 min (p = 0.00057 and p < 0.00001, respectively). Mean turnover time in between patients decreased from 10 ± 1.41 to 8 ± 2 min (p = 0.055). The percentage of monthly IVIs performed on the total of scheduled IVIs increased from 60% to 100%, and the percentage of satisfied patients who rated IVIC ⩾8/10 increased from 45% to 95% (p = 0.0177 and p < 0.00105, respectively).Conclusion:The IVIC improved the quality, efficiency, speed of the overall procedures and clinical capacity of the IVI service through a fast one-way route for patients, limiting time wasted and total distance travelled. This model facilitates the creation of a one-stop clinic through the just-in-time management principle and may be relevant to other ophthalmology services.