Staff Changes Research Articles

How Did Levels of Psychological Distress and Perceptions of Workplace Support amongst Children’s Social Work Staff Change during the Covid-19 Pandemic?

Abstract Covid-19 brought about drastic changes in day-to-day life and working practices, and had a profound impact on the mental health and well-being of the general population. Certain professional groups have also been particularly affected. This study sought to explore how levels of psychological distress and perceptions of workplace support amongst social work staff changed during the pandemic. We present the results from a series of surveys conducted in four local authorities (LAs) in England, before and during the Covid-19 pandemic. Social workers and other social care staff (n = 62) were asked about their experiences of psychological distress, using the twelve-item General Health Questionnaire. Overall, we found the proportion of staff reporting elevated levels of psychological distress increased and, in line with previous studies involving social workers, was high relative to the general population. Yet, most staff also said they had high levels of support from managers and colleagues, whilst a small proportion reported an increased perception of workplace support during the pandemic, compared to before. We consider these findings in relation to Organisational Support Theory and reflect on the ability of LAs to provide effective support for social care staff.

Emergency Presentation of Abdominal Pain with Unusual Etiology

Abdominal pain has vast differentials and routine etiologies are diagnosed easily. Difficulty arises with uncommon presentation. This is a case of 28 years old lady presenting to emergency department of Holy Family Hospital, Rawalpindi with worsening abdominal pain, vomiting and loose stools over 2 weeks. Routine examination and workup did not help to find any cause. Ultrasound abdomen suspected matted gut loops with enlarged lymph nodes. CECT abdomen confirmed a non-differentiating tissue collection in right iliac fossa. Later diagnosis of complicated gossybioma (retained gauze surrounded by fibrotic tissue with entero-enteric fistula and fecolith in appendix) was confirmed by laparoscopy that was surgically removed. Conclusion: Gossybioma is infrequent but avoidable complication that needs to be considered by surgeon meticulously especially by swab counting, avoiding staff change over during procedure and consideration in follow up visit.

Prepare the psychiatric inpatient unit for COVID-19 pandemic.

Prepare the psychiatric inpatient unit for COVID-19 pandemic.

The positive association between various demographic characteristics and peak expiratory flow in employees of Zanjan university of medical sciences

Introduction: Peak expiratory flow (PEF) is a reliable criterion for assessing respiratory capacity, and has a wide range of clinical application as a marker of asthma control. However, its wide variability undermines its efficacy. Objectives: This study was designed to evaluate PEF changes in staff of Zanjan University of Medical Sciences. Patients and Methods: Four hundred employees of this university participated in this cross-sectional study. Their PEF values were measured using peak flow meter in the morning at 8 AM and in the afternoon at 2 PM by three times for each individual, and then the highest amount of PEF was recorded about for measurement. Results: Obviously, PEF values were higher in the afternoon (43865 L/min) in comparison to the morning measurements (404.60 L/min) by paired t test (P<0.001). In addition, mean of PEF in the males was higher than the females in the morning (469.77 L/min, versus 355.94 L/min; independent t test, P<0.001), and also PEF mean of the morning and afternoon was higher in the males than females (404.6 L/min, versus 338.65 L/min, independent t test, P<0.001). Additionally, the variability level in the males and females was 8.39±6 and 8.47±4 L/min, respectively. There was a high correlation between the level of PEF variability and height (5.1). Meanwhile, a moderate correlation between PEF level and body mass index (BMI) was detected (1.47). There was not any correlation between the level of PEF and age. Conclusion: Based on our findings, PEF inter-individual variability depends on age, gender height, and BMI however, it is worthwhile that this PEF inter-individual variability to be measured just until 4 PM. All these variables were obtained under the range of 20%; however, relying on references, the variability of 20% is considered as normal.

Designing behavioral interventions using the capability-opportunity-motivation-behavior model and the theoretical domains framework to optimize oxygen saturation maintenance by NICU providers.

ObjectiveDespite evidence-based guidelines, SpO2 maintenance-related practices of care providers remain inconsistent. Our aim was to evaluate the impact of interprofessional learning workshops, bedside coaching, and neonatal intensive care unit (NICU) level enablers on targeted behavioral change of NICU staff, focusing on SpO2 maintenance.MethodsNICU is a specialized area of the hospital with sophisticated monitors where multidisciplinary staff provide round-the-clock care for sick and preterm infants. As a subset of a quality improvement project to improve SpO2 maintenance and reduce desaturation events, three targeted evidence-based staff behaviors were deemed as important based on established capability-opportunity-motivation-behavior and theoretical domains framework models: setting SpO2 alarm limits, using SpO2 alarm management algorithms, and reporting daily summaries of SpO2 during rounds. We conducted interprofessional workshops, provided bedside coaching, and altered unit NICU processes (guidelines, automated SpO2 histogram printouts, defined staff standard work) and measured demonstrable changes in staff reaction, learning, and behaviors by direct observation of behaviors and survey questionnaires.ResultsTwo hundred and seventy-five (87%) and 210 (80%) of NICU staff attended workshops and received bedside coaching, respectively. The proportion of staff expressing satisfaction with workshop and bedside coaching was 85% and 82%, respectively. The proportion of staff reporting improvement in their knowledge and confidence related to SpO2 maintenance increased significantly following the workshop. Targeted behaviors related to SpO2 maintenance like setting appropriate alarm limits, adhering to SpO2 management algorithm, and reporting daily SpO2 summaries during rounds increased from 80% to 96%, 0% to 64%, and 20% to 70%, respectively.ConclusionFocused behavioral change interventions aimed at improving staff capability, opportunity, and motivation resulted in a demonstrable change in targeted staff behaviors related to SpO2 maintenance. Further research is needed to establish ways of optimizing intended staff behaviors while implementing care bundles in a given setting.

Specialized medical care for chronic kidney disease patients during the war in Ukraine

Russian invasion is an unprecedented test for the Ukrainian state, Ukrainian society, and the health care system.
 According to the Ministry of Health of Ukraine, more than 600 healthcare facilities suffered serious damage (more than 100 hospitals and 450 pharmacies were ruined, and more than 200 emergency medical vehicles were destroyed).
 Patients with chronic diseases in the occupied territories and war zones are deprived of medical care and support, which is a direct threat to their lives.
 Chronic kidney disease (CKD) patients are one of the most vulnerable groups. Before the war, almost 10,000 patients were treated with dialysis kidney replacement therapy (KRT) and more than 1,500 had a functioning renal graft in Ukraine. The vast majority of patients with end-stage kidney disease receiving dialysis treatment were evacuated to safer regions, and some of them continued the treatment abroad. However, the war will significantly increase the number of patients in need of kidney care. In addition to the existing number of CKD patients, there will be a large group of patients with acute kidney injury (AKI) as a result of polytrauma, bleeding, injuries, or long-term compression syndrome. Currently, we cannot predict the incidence of AKI. However, according to the previously published data (18% - 34.6% of war victims), we should expect a significant increase in the population of CKD patients shortly which will require immediate changes in both organization and staffing of nephrology care.
 The medical community recognizes the insurmountable difficulties in providing medical support to Ukrainian citizens during the war, in particular patients receiving KRT or kidney recipients. In our opinion, special programs should be created by relevant professional associations together with the institutes of the Ministry of Health of Ukraine and the National Academy of Medical Sciences of Ukraine at both the state and regional levels in all areas.
 Therefore, we consider it extremely important to establish a committee for the organization of the healthcare system for CKD patients during wartime. The committee could be created within the Ukrainian Association of Nephrologists and Kidney Transplantation Specialists, for example, as the Renal Disaster Relief Task Force established by the International Association of Nephrologists. The main tasks of the committee are to create a consensus of the Ukrainian Association of Nephrologists and Kidney Transplantation Specialists on the management of CKD patients and patients with AKI during the war and the post-war period.
 On behalf of the Editorial Board of the Ukrainian Journal of Nephrology and Dialysis, we would like to express our sincere gratitude to all health professionals who, at the risk of their own lives, continue to save patients. All members of the Ukrainian nephrological community are doing everything possible and impossible to ensure the most adequate treatment of kidney patients in wartime. Thank you again.
 We pray for our heroic warriors who fearlessly defend us and defend Ukraine's independence!
 
 Slava Ukraini! Heroiam slava!

Assessing the effect of proactive maintenance scheduling on maintenance costs and airline profitability

This study mainly aims to examine the perception of Turkish Airlines Technic staff about the effect of proactive maintenance scheduling (PMS) on maintenance costs (MCs) and airline profitability (AP). Another purpose of the study is to reveal if the perception of the staff changes according to the demographic features and experience of the staff. As far as it is known, there is no direct study addressing the effects of PMS on MCs and airline profitability. The study is considered to be a first in this context. In the study, Turkish Airlines-THY was chosen as the company that was handled. The fact that the company has a separate special maintenance & repair group (Turkish Airlines Technic-THYT) was effective in the selection of this company. Some additional qualifications (very rooted, with corporate governance, Turkey's top largest & full-service carrier, member of IATA and Star Alliance, and a listed company (in BIST) were also among other factors affecting the selection. Methodologically, it was used a quantitative survey with a sample of 133 THYT staff. The staff has been chosen among departments that take place actively/directly in maintenance. Besides questions that aim to measure the perception of THYT staff on the effects of PMS on MCs and AP, some demographic and experience-related questions were asked in order to find out if the perception of the staff changes according to their qualifications. The data were collected by online survey method and analyzed with SPSS version 22. Necessary tests together with Chi-square and Fisher’s tests were carried out to analyze the results. It was concluded that there is a strong correlation between PMS and the MCs. The study proved that PMS has a great decreasing effect on MCs and a great increasing effect on AP. The study also revealed that THYT personnel is like-minded and that PMS reduces MCs and increases AP as well.

The Relationship between Nursing Staff's Change Fatigue, Psychological Resilience, and Job Satisfaction at Mansoura University Hospital

The Relationship between Nursing Staff's Change Fatigue, Psychological Resilience, and Job Satisfaction at Mansoura University Hospital

Physical Health Screening in a Mental Health Setting

AimsResearch demonstrates greater mortality and physical health morbidity in those with mental illness, as compared to the general population. National Health Service (NHS) England has introduced policies to reflect this and promote improvements in physical healthcare for mental health patients. Inpatient admission provides a valuable opportunity to action such recommendations and offer a detailed health review, guided by local frameworks. A new annual audit commenced in Cheshire and Wirral Partnership NHS Foundation Trust (CWP) assesses admission physical health screening on its adult acute inpatient wards.MethodsAudit standard was 100% compliance to CWP's admission pathway (Policy CP35). Parameters included doctor's review, medical history, physical examination, drug history, medication chart, allergy status, venous thromboembolic risk, blood tests, electrocardiogram (ECG), physiological observations, smoking history, body mass index (BMI) and falls risk. Data were collected retrospectively for all patients admitted or transferred to Juniper Ward, an acute adult inpatient unit in Bowmere Hospital in Chester, during October 2020 (cycle 1) and September 2021 (cycle 2). Different months were assessed due to senior staff changes in October 2021.Results30 patients were identified in 2020 and 37 in 2021. In 2020 the most consistently achieved parameters were, in order, medication chart/drug history, doctor's review and past medical history. In 2021 the most consistently achieved parameters were medication chart/drug history, smoking status and past medical history. Across both years completion of the cardiometabolic tool was lowest, although this improved from 6.7% to 16.2%. In 2020 there were 5 parameters achieving <50% compliance (cardiometabolic, physiological observations, smoking status, BMI and falls risk). In 2021 this reduced to 3 parameters (doctor's review, cardiometabolic tool, falls risk). Local policy was updated following the 2020 results, amending the criteria for doctor's review from commenced within 6 hours, to completed within 12 hours. Improvement was seen in all other areas in 2021, with medication chart/drug history documentation achieved in 100% of admissions.ConclusionGeneralised improvement was seen following the 2020 audit, although only one parameter reached 100% compliance and most remained under 75%. The first cycle led to a policy change with respect to the doctor's review timeframe, although this limited direct comparison between years. A flow chart will be trialled on Juniper Ward, highlighting required tasks and assigning ownership to specific team members. The local Medical Education team were also made aware of the results to inform junior doctor induction. The audit will be repeated in Autumn 2022.

Psychiatric-psychotherapeutic and psychosocial care for refugees: effects and future prospects of the refuKey project - perspective of experts

Introduction Refugees have been shown to be a vulnerable population with increased psychiatric morbidity and lack of access to adequate mental health care. By establishing cooperations between psychosocial centers and psychiatric clinics the state funded project refuKey by NTFN e.V. and DGPPN aims to improve access to and quality of mental health care for traumatized refugees pursuing a stepped-care model.ObjectivesAs part of a larger project evaluation study four focus-groups among experts were conducted to explore the impact of refuKey on refugees’ mental health care.MethodsData analysis was conducted using Mayring qualitative content analysis as well as an additional quantitative survey with state refugee reception centers’ employees.ResultsThe results indicate that refuKey faciliated the access to mental health care for refugees in terms of systematic identification of mental disorders, eased transitions and increased networking between the mental health care institutions and sectors. Planning and implementation of treatment is described as being more coordinated, solution oriented and sustainable due to multiprofessional collaboration and regular use of qualified interpreters. Reduced distress as well as increased transcultural expertise was found for professionals.Conclusions The persisting barriers for refugees in access to mental health care, especially to psychotherapeutic treatment and the emotional burden for professionals underlines the need for further support and research. The experts highly endorse the continuance of refuKey. Furthermore, they call for expansion of the project in terms of staff and new sites and changes of health policies to guarantee the access to adequate health care for traumatized refugees.DisclosureNo significant relationships.

P05 The impact of COVID-19 on antifungal stewardship in a UK tertiary teaching hospital: a review of prescribing practices and therapeutic drug monitoring of posaconazole

BackgroundPosaconazole is a triazole antifungal licensed for the prevention of invasive fungal infections (IFI) in haemato-oncology patients and treatment of IFI where first-line therapy has failed. In January 2020 COVID-19 hit the UK, with many NHS services reduced to meet the unprecedented challenges of the pandemic. We audited prescriptions and therapeutic drug monitoring (TDM) of posaconazole and compared the results with an audit conducted pre-COVID-19 to assess the impact of the pandemic on antifungal stewardship (AFS).MethodsInpatients prescribed posaconazole over two 3 month periods (1 October to 31 December 2019 and 2020) at Addenbrooke's Hospital, Cambridge, were identified using an electronic computer system and their records reviewed for demographic, diagnostic and therapeutic data. Posaconazole levels were performed at the national Mycology Reference Laboratory, Bristol, using guide levels of 0.7–3.75 mg/L (prophylaxis) and 1–3.75 mg/L (treatment). The first pre-dose level for each patient was used in analyses. Audit standards included (i) all inpatients on posaconazole to have an indication in local guidelines; (ii) to have the correct loading dose prescribed; (iii) to have a pre-dose level taken (iv) at the correct time (i.e. between Day 3–8) after commencing therapy or a dose change; (v) to have a turnaround time of ≤5 days; and (vi) to stop posaconazole appropriately.ResultsForty-two 42 inpatients received posaconazole in 2020 (49, 2019). In total, 39/42 (93%) patients had an appropriate indication [46/49, (94%), 2019]: 38/40 (95%) for prophylaxis [45/45, (100%) 2019]; 1/2 (50%) for treatment [1/1, (100%) 2019]. In 2020, 34/42 (81%) of patients received the correct loading dose [41/46 (89%), 2019). TDM was performed on 33/42 (79%) patients [46/46 (100%), 2019], 18/42 (43%) 3–8 days after starting [25/46 (54%), 2019] and 3/13 (23%) after a dose change [9/10 (90%), 2019]; 32/33 (97%) of TDM results were reported in ≤5 days [32/46 (70%), 2019]. Posaconazole was stopped in 24/26 (92%) patients who were no longer receiving immunosuppression and/or neutropenia had resolved [23/23 (100%), 2019].ConclusionsDespite the pressures of COVID-19, there were good standards of care with only slight reductions in compliance, with the exception of TDM. This may have reflected the change from face-to-face to virtual meetings with haemato-oncology, as well as representing issues of staff shortages and changes in hospital priorities. Such data have highlighted the usefulness of technology to facilitate AFS, e.g. electronic prescribing order sets, which would provide us with quality assurance in a system that will be facing ongoing pressures from the pandemic for years to come.

Evaluating the Impact of COVID19 on Nutrition Jobs in the New York Metropolitan Area: A Comparison of Position Listings and Reported Needs from Before and During the Pandemic

The Covid19 pandemic has caused significant changes in staffing and training needs in the healthcare workforce. Among the practitioners impacted are dietitians and nutritionists. This study compared samples of position announcements in nutrition and dietetics from 2017 and 2021. Differences by both total number of position and position categories were found to be significantly different (p<.05) between the two time periods studied. There was a decrease of about 50% in the total number of positions posted in the first three months of 2021 as compared to the same months in 2017. Changes across position location were also significant. As a % of the total positions, specialty programs were the only category to show growth over the time period studied. These included overall increases in outpatient clinical programs focusing on HIV/AIDs, cancer, and hemodialysis, and more notably in 2021, eating disorders, obesity, and mental health programs. Differences in specific skills and credentials desired were consistent with needs in these practice areas. Awareness of changes in the employment landscape can help to better prepare students and interns to meet emerging patient care needs and workforce demands.

Hand Hygiene Auditing: Is It a Roadway to Improve Adherence to Hand Hygiene Among Hospital Personnel?

BackgroundOver the years, there has been an increase in hospital-acquired infections (HAIs) among patients in India. One of the main reasons is a lack of compliance with infection control guidelines, such as hand hygiene. So the present study was conducted to determine the compliance of hand hygiene among healthcare workers in a private tertiary care teaching hospital in South India.Materials and methodsThe prospective observational study was carried out between April 2017 and March 2020. Nineteen areas were directly observed for hand hygiene (HH) compliance. At each location, HH audit was conducted for one hour per day for five days per month. HH complete adherence rate (HHCAR) and HH partial adherence rate (HHPAR) were analyzed.ResultsNine hundred and twenty observation periods were completed during the entire study period. Overall, hand hygiene complete adherence rate was 29.9% (11,981/39,998); partial adherence rate was 45.3% (18,131/39,998) and the non-adherence rate was 24.7% (9886/39,998). A better adherence rate was seen among nurses (44.7%), followed by other staff (33.7%) and doctors (33.04%). Moment-specific adherence rates show almost equal adherence rates of 50.7%, 50.75%, and 50.1%, respectively, for moments 2, 3, and 4, and comparatively low for moments 1 and 5 (48.4% and 47.6%, respectively).ConclusionDespite adequate hand hygiene facilities, compliance remains low. Hand hygiene is a bundle care approach that needs to consider factors including healthcare staff, clinical, institutional, environmental, and behavioral changes. Multimodal interventions and multidisciplinary commitment are mandatory for sustained compliance.

RFID Device Development With MQTT To Prevent Attendance Cheating on Narotama University Student

Presence is one of the important things, both in the school environment and in the work environment. Through the presence of an officer or staff can find out the presence of someone both in the work environment and in the school environment. The application of IoT in the school environment, especially at the university has been widely applied, but there are some problems such as cheating when making attendance to get the value of attendance in the classroom, therefore the application of this technology must be developed to prevent students from cheating when making attendance. The use of the Raspberry, Rdm6300 device and also the use of MQTT broker, the expected results in this study, the device that has been developed can prevent students from cheating while doing attendance and also makes students more disciplined, the use of MQTT broker on this device is so that each device in the Classes will only take attendance pages according to classrooms, and classrooms will change every 10 minutes when staff change courses and class hours
 
 Keywords : MQTT, RFID, Rasberry

Optimal Minimal-Perturbation University Scheduling With Faculty Preferences

In the university scheduling problem, sometimes additions or cancellations of sections of a course occur shortly before the beginning of the academic term, necessitating last-minute teaching staffing changes. We present a decision-making framework that both minimizes the number of course swaps, which are inconvenient for instructors, and maximizes instructors' preferences for section times they wish to teach. The model is formulated as an integer linear program (ILP). Numerical simulations for a hypothetical mid-sized academic department are presented.

How London maxillofacial units faced the demands of COVID lockdown and lessons learnt

IntroductionIn the UK between the March 23, 2020 and May 10, 2020, the government enforced a lockdown. This, combined with COVID, caused OMFS hospitals across London to experience a change in staffing, resources and patient presentations. This study examines these changes, how patient care was adapted during this period and what can be learnt for the future. MethodData was collected from OMFS units attached to all 4 level 1 trauma centers in London. Prospective data was collected from March 23, 2020–May 10, 2020 (1st period). Retrospective data was collected from hospital coding records for 23rd of March - May 10, 2019 (2nd period). Data was collected on all referrals to the OMFS team including diagnosis, patient demographics and treatment received. ResultsThere was an 84% reduction in patients presenting with mandible fracture. 2 units with dental emergency services experienced no change in dental abscess presentations whilst the other 2 units saw a decrease of 70–75%.There was a trend towards reducing admission and general anaesthetic treatments. Most mandible fractures were treated in the outpatient setting with 1 unit discharging 100% of mandible fractures that presented to A&E. Only 13 of 72 paediatric lacerations were treated with general anaesthetic. ConclusionThe COVID lockdown period, like war time, posed great challenges to healthcare provision. This paper presents the changes experienced and how patients were managed. Aiming to allow reflection and learning to guide changes in management to be adopted for the future.

Participatory action research intervention for improving sleep in inpatients with cancer.

To design and implement a plan to improve oncohaematological patients' sleep. The hospital environment can compromise inpatients' sleep, negatively impacting on health outcomes and patient satisfaction. The improvement plan was designed in collaboration with 18 professionals, 3 patients and 3 accompanying relatives. The study designed followed the SQUIRE 2.0guidelines. Outcome variables were self-reported patient satisfaction regarding sleep, measured using a 30-item, ad hoc questionnaire and a 10-point visual analogue scale, completed by 318 oncohaematological inpatients (pre-intervention n=120, post-intervention, n=198) in a comprehensive cancer centre in Spain from 2017 to 2019. Overall, 61.5% (n=190) of the inpatients reported sleep alterations, and 92.6% reported interruptions in their nightly sleep. Half slept less than 6h/night, but 58.0% said they felt rested upon waking, despite the interruptions. These outcomes were similar before and after the intervention. The improvement plan identified four domains for work (professionals, care procedures, instruments/environment and patients/relatives), 10 areas for improvement and 35 actions for implementation. However, overall sleep worsened significantly, from 6.73 to 6.06 on the 10-point scale. The intervention significantly improved variables related to professionals' behaviour, including noise during the shift change, conversations at the control desk and the use of corridor lights. Sleep disturbances were mainly caused by pain/discomfort and infuser alarms, and collectively they decreased significantly after the intervention (p=.008). However, overall sleep worsened significantly, from 6.73 to 6.06 on the 10-point scale. Pain, clinical devices and noise made by professionals are the main causes of sleep disturbances. Involving professionals in decision-making to improve patients' sleep have a positive impact on noise levels. This study proposes new strategies for improving sleep by increasing staff awareness and changing attitudes towards patients' sleep. Nurses should be involved in addressing sleep disturbances during hospitalization.

Nursing Staff's Change Fatigue, Psychological Resilience, and Job Satisfaction at Mansoura University Hospital

Nursing Staff's Change Fatigue, Psychological Resilience, and Job Satisfaction at Mansoura University Hospital

Working in a care home during the COVID-19 pandemic: How has the pandemic changed working practices? A qualitative study

BackgroundThe pandemic has significantly affected care homes’ residents and families through the national visiting restrictions. However, less is known on the impact these changes have had on the care home workforce. The aim of this research was to explore the impact of COVID-19 on the working practices of care home staff, caring for people living with dementia.MethodsRemote qualitative, semi-structured interviews were conducted with care home staff caring for people living with dementia (PLWD) in the UK.ResultsParticipants were recruited to the larger programme of research via convenience sampling. Interviews were conducted via telephone or online platforms. This research employed inductive thematic analysis. Sixteen care home staff were included in this study. Three overarching themes were developed from the analysis that conveyed changes to the everyday working practices of the care home workforce and the impact such changes posed to staff wellbeing: (1) Practical implications of working in a care home during the COVID-19 pandemic; (2); Staff values and changes to the staff roles (3): Impact to the care home staff and concerns for the care sector.ConclusionsThe COVID-19 pandemic has significantly disrupted the daily working practices of care home staff, with staff forced to adopt additional roles on top of increased workloads to compensate for the loss of external agencies and support. Support and guidance must be offered urgently to inform care home staff on how to best adapt to their new working practices, ensuring that they are adequately trained.

The impact of case order and intraoperative staff changes on spine surgical efficiency

BACKGROUND CONTEXTDespite concerted efforts toward quality improvement in high-volume spine surgery, there remains concern that increases in case load may compromise the efficient and safe delivery of surgical care. There is a paucity of evidence to describe the effects of spine case order and operating room (OR) team structure on measures of intraoperative timing and OR efficiency. PURPOSEThis study aims to determine if intraoperative staff changes and surgical case order independently predict extensions in intraoperative timing after spinal surgery for spondylotic diseases. STUDY DESIGN/ SETTINGRetrospective cohort analysis PATIENT SAMPLEAll patients over age 18 who underwent primary or revision decompression and/or fusion for degenerative spinal diseases between 2017 to 2019 at a single academic institution were retrospectively identified. Exclusion criteria included absence of descriptive data and intraoperative timing parameters as well as surgery for traumatic injury, infection, and malignancy. OUTCOME MEASURESIntraoperative timing metrics including total theater time, wheels in to induction, induction start to cut, cut to close, and close to wheels out. Postoperative outcomes included length of hospital stay and 90-day hospital readmissions. METHODSSurgical case order and intraoperative changes in staff (circulator and surgical scrub nurse or technician) were determined. Patient demographics, surgical factors, intraoperative timing and postoperative outcomes were recorded. Extensions in each operative stage were determined as a ratio of the actual duration of the parameter divided by the predicted duration of the parameter. Univariate and multivariate analyses were performed to compare outcomes within case order and staff change groups. RESULTSA total of 1,108 patients met the inclusion criteria. First, second, and third start cases differed significantly in intraoperative extensions of total theater time, wheels in to induction, induction start to cut, cut to close, and close to wheels out. On regression, decreasing case order predicted extension in wheels in to induction time. Surgeries with intraoperative staff changes were associated with increases in total theater time, induction start to cut time, cut to close time, close to wheels out time, and length of hospital stay. Switch in primary circulator predicted extended theater time and cut to close time. Relief of primary circulator or scrub predicted extended total theater time, induction start to cut time, cut to close time, and close to wheels out time. CONCLUSIONSIntraoperative staff change in spine surgery independently predicted extended operative duration. However, higher case order was not significantly associated with procedural time.