Staffing Models Research Articles

Association of Primary Versus Rotating Nephrologist Model of Care in Hemodialysis Programs with Patient Outcomes.

Nephrologist staffing models for patients receiving hemodialysis vary widely. Patients may be cared for continuously by a single primary nephrologist or by a group of nephrologists on a rotating basis. It remains unclear whether these differing care models influence clinical outcomes. In this population-based cohort study of more than 14,000 incident patients on maintenance hemodialysis from Ontario, Canada, we found no difference in mortality, kidney transplantation, home dialysis initiation, hospitalizations, or emergency department visits when care was provided by a single primary nephrologist or a rotating group of nephrologists. These results suggest that primary nephrologist models do not necessarily improve objective clinical outcomes, providing reassurance to patients, providers, and administrators that both models are acceptable options.

“Understanding the journey from A to Z”: centering peer support perspectives to unveil the mechanisms and power of peer support

Purpose This study aims to gain insights from peer support workers (PSWs) on the unseen mechanisms of peer support work that may be applied to implementing a child and youth mental health peer support program in a children’s hospital emergency department (ED). Design/methodology/approach This study used a critical realist perspective with a qualitative research design. Eight participants, all PSWs in health, community and social services working with adults, adolescents and children, were recruited from Alberta, Canada. Data were collected through in-person semi-structured interviews and analyzed using Braun and Clarke’s reflexive thematic analysis. Findings The results generated interrelated patterns of meaning among PSWs that were grouped into three main themes: inside out and outside in, no one leaves empty-handed and sculpting health system softness. Research limitations/implications All participants were trained by the same organization and may have similar understandings and approaches to the peer support role. Participants were predominantly of a similar demographic; thus, participants with minoritized identities may have challenges not represented. Practical implications Using nontraditional staffing models in an acute center may facilitate a shift to meet the chronic and complex issues of the 21st century. Social implications Youth peer support roles may reduce stigma by challenging stereotypes and myths, reduce social isolation and improve meaning, connection and belonging for individuals with mental illness who are often dislocated and disconnected from society. Originality/value This study exemplified the positive impacts peer support could make by improving child, youth and family experiences; reducing stigma; providing hope and help; and embedding the recovery model directly into the ED.

Fast thinking: How unconscious bias and binary language contribute to rationing of care to older persons.

Binary or categorical thinking is a way of thinking in which the brain unconsciously sorts the masses of information it receives into categories. This helps us to quickly process information and keeps us safe through pattern recognition of possible threats. However, it can also be influenced by unconscious and conscious biases that inform our judgements of other people and situations. To examine nursing practice with older people through the lens of unconscious bias. In this critical analysis, using Kahneman's fast and slow thinking, we argue that nurses working with hospitalised older people often rely on thinking quickly in hectic work environments, which can contribute to unconscious and conscious bias, use of binary language to describe older persons and nursing tasks, and ultimately rationing of care. Binary language describes older persons and their care simplistically as nursing tasks. A person is either heavy or light, continent or incontinent, confused or orientated. Although these descriptions are informed in part by nurses' experiences, they also reflect conscious and unconscious biases that nurses hold towards older patients or nursing tasks. We draw on explanations of fast (intuitive) and slow (analytical) to explain how nurses gravitate to thinking fast as a survival mechanism in environments where they are not supported or encouraged to think slow. Nurses survival efforts in getting through the shift using fast thinking, which can be influenced by unconscious and conscious biases, can lead to use of shortcuts and the rationing of care. We believe that it is of paramount importance that nurses be encouraged and supported to think slowly and analytically in their clinical practice. Implications Nurses can engage in journaling and reflecting on their practice with older people to examine possible unconscious bias. Managers can support reflective thinking by supporting nurses through staffing models and encouraging conversations about person-centered care in unit practices.

Strategies to Ensure Adequate Staffing and Self-Reliance in Times of Uncertainty

UCLA Health developed a system-wide in-house float team to meet organizational demands and strategic expansion, merging all facility float teams to create the nursing system float team (NSFT). The NSFT is designed as a centralized functional organizational structure that allows for systematic processes. In addition, the structure is designed to enable expansion into other areas with appropriate managerial oversight. As a result, contract labor dependence decreased by 45%, and self-reliance increased by 41%, providing a favorable operating margin. This article serves as a guide for external organizations to collaborate in developing a systematic approach for redeveloping staffing models.

Patient Outcomes and Unit Composition With Transition to a High-Intensity ICU Staffing Model: A Before-and-After Study.

To explore the impact of transitioning from a low- to high-intensity intensivist staffing model on patient outcomes and unit composition. This was a prospective observational before-and-after study of adult ICU patients admitted to a single community hospital ICU before (October 2016-May 2017) and after (June 2017-November 2017) the transition to a high-intensity ICU staffing model. The primary outcome was 30-day all-cause mortality. Secondary outcomes included in-hospital mortality, ICU length of stay (LOS), and unit composition characteristics including type (e.g., medical, surgical) and purpose (ICU-specific intervention vs close monitoring only) of admission. For the primary outcome, 1,219 subjects were included (779 low-intensity, 440 high-intensity). In multivariable analysis, the transition to a high-intensity staffing model was not associated with a decrease in 30-day (odds ratio [OR], 0.90; 95% CI, 0.61-1.34; p = 0.62) or in-hospital (OR, 0.89; 95% CI, 0.57-1.38; p = 0.60) mortality, nor ICU LOS. However, the proportion of patients admitted to the ICU without an ICU-specific need did decrease under the high-intensity staffing model (27.2% low-intensity to 17.5% high-intensity; p < 0.001). Multivariable analysis showed no association between transition to a high-intensity ICU staffing model and mortality or LOS outcomes; however, the proportion of patients admitted without an ICU-specific need decreased under the high-intensity model. Further research is needed to determine whether a high-intensity staffing model may lead to more efficient ICU bed usage.

Abstract TMP40: Cost Analysis Of A Pooled Coordinator Model Versus Traditional Staffing For Acute Stroke Trials

Introduction: Enrollment in acute stroke clinical trials (ASCTs) is complex and unpredictable. Traditional staffing models (TSMs) of research coordinator coverage assign a single research coordinator to cover specific clinical trials, whereas pooled staffing models (PSMs) utilize staff research coordinators to cross-cover multiple clinical trials, typically beyond traditional daytime hours. Methods: We calculated actual PSM costs accrued during one year (1/1/21-12/31/21) for two Phase III ASCTs (NCT03735979, NCT03785678). PSM costs were obtained from existing billing records for specific research coordinator tasks billed hourly ($78/hour) and a “retainer fee” ($690/month) for 24-7 on-call research coordinator coverage. Aspects of research coordinator work included: enrollment, data entry, query resolution, monitor visits, regulatory management, meetings, training/retraining, and patient visits. We compared PSM costs to the cost (salary + fringe) of a TSM full-time research nurse (1.0 full-time equivalent [FTE]) in the identical job class and salary as those employed in the PSM. Results: The estimated one-year cost (salary + fringe) of a 1.0 FTE RN research coordinator was $109,755.36. During the study period, there were 19 enrollments in NCT03735979; 9 occurred outside daytime working hours. The PSM cost was $60,813, equivalent to 0.55 FTE of coordinator coverage in a TSM with 90.0% more enrolled subjects. Additionally, there were 6 enrollments for NCT03785678; 4 outside daytime working hours. The PSM cost was $69,857.00, equivalent to the cost of 0.64 FTE of standardized research coordinator in a TSM with 200% more enrolled subjects. Conclusions: We demonstrated that a PSM for ASCT can be cost-effective for individual studies while increasing enrollment opportunities through 24-7 coordinator coverage. PSMs may offer a solution to the staffing and coverage challenges faced by many institutions seeking to participate in emergent clinical trials. Cost increases or savings with the PSM model would be dependent upon staff compensation, rates of enrollment, and reimbursement at individual sites.

Nursing Assistant Staffing Model: Implementation and Outcome Evaluation in Taiwan Hospitals.

A key policy of the Taiwan healthcare system is promoting the hiring of nursing assistants (NAs) to reduce the workload of nurses. However, few studies in the literature have compared the relative effectiveness of different nurse staffing policies, and no studies have addressed the impact of the NA staffing (NAS) model. This study explored the current status of the NAS model as implemented in Taiwan hospitals and to investigate the methods used to evaluate the outcomes of NAS model implementation. A cross-sectional online survey was performed in hospitals nationwide from June 1 to December 31, 2018. There were 153 government-accredited hospitals being invited to participate in the survey. Of the 139 hospitals that completed the online survey, 26% (36 hospitals) had implemented the NAS model. Many of the hospitals had hired full-time, certified NAs. Most of the tasks assigned to NAs were in the nonprofessional/general and technical work categories. In addition, medical wards were the most frequently assigned workplace, especially on day shifts. Few of the surveyed hospitals had evaluated the effectiveness of the NAS model. Improvement after implementation of the NAS model (based on the 35 outcome indicators) was found to vary significantly. The most commonly used outcome indicator was patient satisfaction. All the stakeholders, including patients, family caregivers, nurses, and nurse supervisors, supported implementation of the NAS model. However, some of the participants expressed concerns regarding the difficulties involved with model implementation. Although the NAS model may be beneficial, further empirical research is necessary to confirm the contributions of NAs. Additional evidence regarding the benefits of the NAS model for hospital performance and patient outcomes may be expected to motivate more hospital administrators to adopt this model.

Care of the Hospitalized Patients with Kidney Failure during COVID-19 Pandemic: Lessons Learned.

Care of the Hospitalized Patients with Kidney Failure during COVID-19 Pandemic: Lessons Learned.

Characteristics of self-harm presentations to the emergency department of the Royal Melbourne Hospital, 2012–2019: Data from the Self-Harm Monitoring System for Victoria

BackgroundRates of self-harm and suicide are increasing world-wide, particularly in young females. Emergency departments (EDs) are a common first point-of-contact for young people who self-harm. We examined age- and sex-related differences in: (1) rates of self-harm over an eight-year period; (2) changes in demographic, presentation, and treatment characteristics over this period, and; (3) rates of, and time to, self-harm re-presentation. MethodsThis was a retrospective observational study of all self-harm presentations in persons aged nine years and older to the Royal Melbourne Hospital ED over an eight-year period, 1 January 2012–31 December 2019. The Royal Melbourne Hospital is one of the largest and busiest public EDs in Melbourne, Australia and serves a primary catchment area of approximately 1.5 million people. ResultsThere were 551,692 presentations to the Royal Melbourne Hospital ED over this period (57.6 % by females). Of these, 7736 (1.4 %) were self-harm related. These self-harm presentations involved 5428 individuals (54.8 % female), giving an overall repetition event-rate of 11.2 %. Self-harm related presentations increased by 5 % per year (Incidence Rate Ratio [IRR 1.05, 95 % CI 1.02–1.08); a 44 % increase over the eight-year period (IRR 1.44, 95 % CI 1.15–1.80). This increase was more pronounced for young people aged< 25 years. The most common method was self-poisoning, primarily by anxiolytics or analgesics. The proportion of presentations involving self-poisoning alone declined modestly over time, whilst the proportion involving self-injury alone increased. For just over half of all presentations the person was seen by ED mental health staff. The median time to first re-presentation was 4.5 months (Inter-Quartile Range [IQR] 0.7–13.2 months). ConclusionsRates of hospital presenting self-harm may be increasing, particularly amongst young people, whilst most self-harm presentations occurred outside office hours; so appropriate ED staffing, training and clinical care models are needed. Around half of those with a repeat episode of self-harm repeated within three months of their index (i.e., first recorded) presentation. Efforts to establish appropriate aftercare services, including alternatives to ED services with service availability 24 h a day 7 days a week, aimed at reducing repetition rates, should be prioritised.

Insights into British Columbian Hospital Pharmacists Perspectives on the Discharge Process.

Background: Transitions of care represent a vulnerable time for patients where unintended therapeutic changes are common and inadequate communication of information frequently results in medication errors. Pharmacists have a large impact on the success of patients during these care transitions; however, their role and experiences are largely absent from the literature. Objectives: The purpose of this study was to gain a greater understanding of British Columbian hospital pharmacists' perceptions of the hospital discharge process and their role in it. Methods: A qualitative study utilizing focus groups and key informant interviews of British Columbian hospital pharmacists was conducted from April to May 2021. Questions asked during interviews were developed following a detailed literature search and included questions regarding the use of frequently studied interventions. Interview sessions were transcribed and then thematically analyzed using both NVivo software and manual coding. Results: Three focus groups with a total of 20 participants and one key informant interview were conducted. Six themes were identified through data analysis: (1) overall perspectives; (2) important roles of pharmacists in discharges; (3) patient education; (4) barriers to optimal discharges; (5) solutions to current barriers; and (6) prioritization. Conclusions and Relevance: Pharmacists play a vital role in patient discharges but due to limited resources and inadequate staffing models, they are often unable to be optimally involved. Understanding the thoughts and perceptions of pharmacists on the discharge process can help us better allocate limited resources to ensure patients receive optimal care.

Experimental Staffing Models in Inpatient Acute Mental Health Services : A Longitudinal Comparative Study of Occupational Therapy Services

Introduction: An NHS Mental Health Trust in England recently used an experimental staffing model by including Occupational Therapists (OT) in the staff numbers on ten working age adult acute inpatient wards. Aims: This study aims to compare different staffing models involving occupational therapists and make recommendations for preferred staffing models. Methods: This is a longitudinal comparative study of archived patient and multi-disciplinary electronic records and data collected from Kent and Medway NHS and Social Care Partnership Trust. Areas of analysis included quantitative data and qualitative coding and theming, covering the period February 2016-June 2019 during the experimental staffing model, and July 2019-March 2021, when the model ended and teams were Occupational Therapy-led. Full ethical approval and consent was gained in 2020 from the Trust and University to request and access data to complete this research. Results: This experimental staffing model resulted in less delivery of Occupational Therapy specific interventions, resulting in poorer retention rates and impacting on patient and student experiences. Since working in Occupational Therapy led teams, the quality of Occupational Therapy interventions, job retention, student experiences, patient care and safety have improved. Conclusions: The recommended staffing model for working age acute mental health wards has Occupational Therapists embedded in OT-led teams. Staffing tools need to be developed that involve Allied Health Professional leaders and this field needs more research.

Organizational Culture and Staffing Models at the Centers for Disease Control and Prevention

Organizational Culture and Staffing Models at the Centers for Disease Control and Prevention

Abstract A055: Enhancing mammography quality in Wisconsin: Barriers and facilitators in developing a shared measurement system

Abstract Breast cancer mortality rates have decreased over several decades although these declines have been unequal. In Wisconsin, some parts of the state experience higher mortality than others, and Black women have the highest breast cancer mortality rate compared to women of other races/ethnicities although mammography screening rates are similar across populations. The Mammographic Quality Initiative (MQI) seeks to examine the role of mammography quality and develop a sustainable statewide model of monitoring and enhancing mammography quality, towards improving equity of early-stage breast cancer diagnoses and survival. Building on a collaborative statewide initiative in Illinois which showed reductions in disparities after documenting and addressing variability in mammographic technical quality and follow-up time, MQI will adapt the Illinois tools for Wisconsin using a transdisciplinary collaborative approach. MQI is a project of the Community and Cancer Science Network (CCSN), a statewide initiative to address cancer disparities. CCSN uses a transdisciplinary model that emphasizes learning and innovation, and full, equitable engagement of non-academic partners. Within MQI, this involves engaging research, community-based organizations, and radiology as initiative leadership and creating learning collaboratives in multiple Wisconsin regions. Learning collaboratives are employed in healthcare to improve patient outcomes through shared learning and practice improvement[CT1] . The learning collaboratives will contribute to the development of a common set of measures to monitor mammography quality and the development of a shared measurement system to monitor and improve outcomes. In its first year, MQI engaged large health systems, and high and low-resourced clinics and stand-alone mammography centers in Southeastern Wisconsin to involve them in the early stages of a learning collaborative. MQI’s leadership documents these engagements as part of the evaluation. Analysis of qualitative data collected identified barriers and facilitators to the development of a shared measurement system. Barriers included: 1) significant variation in how mammogram data reporting occurs that impedes participation, 2) difficulty in tracking follow-up data when a patient is referred for diagnostic services, and 3) multiple strains on system resources including staffing, capacity or payor models. However, a significant facilitator of engagement is a dedicated “champion” who is respected and trusted within the healthcare system. Champions included radiologists, technologists, or other key leaders. The initial analysis supports a front-loaded focus on development of partnerships and collaborative infrastructure. These findings give context and insight into a transdisciplinary approach that has the potential to be adapted and applied to other research programs and collaboratives working to impact population level disparity outcomes. Citation Format: Kelly Hackett, Laura Pinsoneault, Tobi Cawthra, Beth Brunner, Tommi Thompson, Melinda Stolley, Joan Neuner. Enhancing mammography quality in Wisconsin: Barriers and facilitators in developing a shared measurement system [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A055.

Equitable Nurse Assignments Within the Context of Census-Driven Staffing Models

Equitable Nurse Assignments Within the Context of Census-Driven Staffing Models

International Survey of Perfusion Practice for Pediatric and Congenital Heart Surgery: 2021 Results

The conduct of cardiopulmonary bypass in neonatal, infant, and pediatric patients continuously evolves as new devices and innovative techniques are introduced. Since 1989, periodic pediatric perfusion surveys have been conducted to ascertain practice patterns involving demographics, equipment, and perfusion techniques. The goal of this current project is to provide an updated perspective on international pediatric and congenital perfusion practice since the last survey conducted in 2016. In July 2021, a 100-question perfusion survey was distributed to 284 pediatric cardiac surgery centers using a secure web browser-based data application. Each center was given a unique survey hyperlink to ensure one response per institution and to monitor the response rate. Centers were given 1 month to complete the survey and electronic reminders were sent weekly to nonrespondents. After the survey was closed, information from completed surveys was exported to a software program for analysis. Responses were received from 153 of 284 pediatric centers for a response rate of 54%. Sixty respondents (39%) were from North American (NA) centers while 93 respondents (61%) were from non-North American (NNA) centers. The vast majority of centers use a roller head arterial pump (93%), hollow fiber oxygenators with open reservoirs (86%), and integrated arterial line filters (73%). The use of modified ultrafiltration was reported by 76% of centers. Ninety-two percent of centers reported the use of selective antegrade cerebral perfusion for aortic arch repairs. The N + 1 staffing model was most prevalent (52%), followed by two perfusionists per case (33%). Periodic surveys continue to be a useful modality in assessing regional variation in pediatric perfusion practice. This survey marked the first time the majority of responses came from non-North American institutions. Identifying these practice patterns may aid in the development of, and adherence to, regional standards and guidelines. This would foster the reduction of variation in practice and potentially improve patient safety.

International Survey of Perfusion Practice for Pediatric and Congenital Heart Surgery: 2021 Results.

The conduct of cardiopulmonary bypass in neonatal, infant, and pediatric patients continuously evolves as new devices and innovative techniques are introduced. Since 1989, periodic pediatric perfusion surveys have been conducted to ascertain practice patterns involving demographics, equipment, and perfusion techniques. The goal of this current project is to provide an updated perspective on international pediatric and congenital perfusion practice since the last survey conducted in 2016. In July 2021, a 100-question perfusion survey was distributed to 284 pediatric cardiac surgery centers using a secure web browser-based data application. Each center was given a unique survey hyperlink to ensure one response per institution and to monitor the response rate. Centers were given 1 month to complete the survey and electronic reminders were sent weekly to nonrespondents. After the survey was closed, information from completed surveys was exported to a software program for analysis. Responses were received from 153 of 284 pediatric centers for a response rate of 54%. Sixty respondents (39%) were from North American (NA) centers while 93 respondents (61%) were from non-North American (NNA) centers. The vast majority of centers use a roller head arterial pump (93%), hollow fiber oxygenators with open reservoirs (86%), and integrated arterial line filters (73%). The use of modified ultrafiltration was reported by 76% of centers. Ninety-two percent of centers reported the use of selective antegrade cerebral perfusion for aortic arch repairs. The N + 1 staffing model was most prevalent (52%), followed by two perfusionists per case (33%). Periodic surveys continue to be a useful modality in assessing regional variation in pediatric perfusion practice. This survey marked the first time the majority of responses came from non-North American institutions. Identifying these practice patterns may aid in the development of, and adherence to, regional standards and guidelines. This would foster the reduction of variation in practice and potentially improve patient safety.

Implementing and sustaining a breast cancer prospective surveillance rehabilitation program: an institutional perspective.

The prospective surveillance model (PSM) is an evidence-based rehabilitation care delivery model that facilitates functional screening and intervention for individuals undergoing cancer treatment. While PSM is empirically validated and feasible in practice, implementation into cancer care delivery has languished. The purpose of this manuscript is to characterize the barriers and facilitators to implementing PSM in a breast cancer center and to share policy and process outcomes that have sustained the model in practice. The PSM implementation was undertaken as a quality improvement initiative of our cancer center. We retrospectively assessed barriers to implementation and define those according to the Consolidated Framework for Implementation Research (CFIR). Implementation strategies are defined based on the Expert Recommendations for Implementation Change (ERIC) taxonomy. Breast center policy changes and stakeholder-reported process improvement outcomes at the clinic and system level are described. PSM implementation facilitation was driven primarily by adapting the model to align with the cancer center workflow, engaging interdisciplinary stakeholders as program champions, enhancing knowledge and awareness among cancer care providers, and changing infrastructure to support the model. System and clinic-level policy and process changes included the development of clinical pathways, EHR order sets and automated referrals, new staffing models, and adapted clinical workflows. Our report provides insight on implementing the PSM at a single institution in a cancer care delivery setting. Successful implementation strategies addressed individual, clinic, and system-level barriers and facilitated process and policy changes that have enabled PSM sustainment. Improving integration of rehabilitation services into oncology care has significant implications for survivorship care by enhancing proactive management of functional morbidity. Improving integration of rehabilitation services into oncology care has significant implications for survivorship careby enhancing proactive management of functional morbidity.

Clinical impact of physician staffing transition in intensive care units: a retrospective observational study

BackgroundIntensivists play an essential role in improving the outcomes of critically ill patients in intensive care units (ICUs). The transition of ICU physician staffing from low-intensity ICUs (elective intensivist or no intensivist consultation) to high-intensity ICUs (mandatory intensivist consultation or a closed ICU) improves clinical outcomes. However, whether a transition from high-intensity to low-intensity ICU staffing affects ICU outcomes and quality of care remains unknown.MethodsA retrospective observational study was conducted to examine the impact of high- versus low-intensity staffing models on all-cause mortality in a suburban secondary community hospital with 400 general beds and 8 ICU beds. The ICU was switched from a high-intensity staffing model (high-former period) to low-intensity staffing in July 2019 (low-mid period) and then back to high-intensity staffing in March 2020 (high-latter period). Patients admitted from the emergency department, general ward, or operating room after emergency surgery were enrolled in these three periods and compared, balancing the predicted mortality and covariates of the patients. The primary outcome was all-cause mortality analyzed using hazard ratios (HRs) from Cox proportional hazards regression. An interrupted time-series analysis (ITSA) was also conducted to evaluate the effects of events (level change) and time.ResultsThere were 962 eligible admissions, of which 251, 213, and 498 occurred in the high-former, low-mid, and high-latter periods, respectively. In the matched group (n = 600), the all-cause mortality rate comparing the high-former period with the low-mid period showed an HR of 0.88 [95% confidence interval (CI), 0.56, 1.39; p = 0.58] and that comparing the high-latter period with the low-mid period showed an HR of 0.84 [95% CI, 0.54, 1.30; p = 0.43]. The result for comparison between the three periods was p = 0.80. ITSA showed level changes of 4.05% [95% CI, -13.1, 21.2; p = 0.63] when ICU staffing changed from the high-former to the low-mid period and 1.35% [95% CI, -13.8, 16.5; p = 0.86] when ICU staffing changed from the low-mid to the high-latter period.ConclusionThere was no statistically significant difference in all-cause mortality among the three ICU staffing periods. This study suggests that low-intensity ICU staffing might not worsen clinical outcomes in the ICU in a medium-sized community hospital. Multiple factors, including the presence of an intensivist, other medical staff, and practical guidelines, influence the prognosis of critically ill patients.

Staff Experiences of Integrating Peer Support Workers and Clinical Staff in Community-Based Residential Mental Health Rehabilitation: A Pragmatic Grounded Theory Analysis.

Mental health services are increasingly incorporating the views and expertise of people with a lived experience of mental illness in service delivery. A novel approach to this is the 'integrated staffing model' being trialled at two Australian public residential mental health rehabilitation services (Community Care Units, CCUs) where peer support workers (PSWs) occupy the majority of staff roles and work alongside clinicians. Semi-structured interviews were completed with fifteen staff 12-to-18-months after service commencement. Transcripts were analysed following principles of grounded theory analysis. Key emergent themes were: (1) recovery is a deeply personal and non-linear process; (2) The CCU as a transitional learning environment; (3) the integrated staffing model facilitates an effective rehabilitation team; and (4) coming together under the integrated staffing model required a steep learning curve. The findings suggest that the integrated staffing approach may provide a pathway to facilitate the meaningful inclusion of PSWs in rehabilitation settings.

A Nationwide Survey of Gastroenterology Program Leadership Regarding Implementation of the GI Hospitalist Model.

Academic gastroenterology (GI) hospitalists are increasing, however the impacts on fellowship training and clinical care are unclear. Motivations for implementation of the GI hospitalist model are uninvestigated. We aimed to determine the prevalence of GI hospitalists, explore motivations for and against adoption of a GIH model, and investigate the model's effects on fellowship training. Leadership at current general GI fellowships were surveyed about current staffing models, as well as effects and perceptions of the hospitalist model. There was a total of 52 (26%) respondents and 12 (23%) reported having a GI hospitalist at their institution. A majority of respondents stated burnout and reduced time on service for other faculty was a primary reason for hiring a GI hospitalist. The largest perceived benefit of a hospitalist is reduced burnout and time on service for outpatient GI faculty. Many respondents also believed a GIH would improve fellowship education and quality of inpatient care.