Team Of Nurses Research Articles

Interprofessional Team Staffing in U.S. Intensive Care Units.

There is a paucity of data, and no consensus, about the composition of interdisciplinary teams of healthcare worker (HCW) that provide care in intensive care units (ICU). Delineate the nature and variation of HCW staff composition in US adult ICUs before the COVID-19 pandemic. A national survey of 574 adult ICUs inquired about ICU staffing. Two sets of survey items asked about: (a) "availability to provide care" in ICU for 11 HCW types, collapsed into six groupings, and (b) presence in formal ICU clinical rounds of nine HCW types, collapsed into six groupings; bedside nurses were assumed to be involved in both categories. Analysis was descriptive, seeking to examine the predominant and full range of staffing patterns. Of surveyed ICUs: 94% were in metropolitan areas, 63% in teaching hospitals, 74% had >250 beds, 66% cared for mixed adult patient types (e.g. medical-surgical), median ICU bed count was 20 (interquartile range 12-25), 27% used some form of telemedicine. In addition to bedside nurses, the core staffing group comprised intensivists, respiratory therapists and pharmacists; in 88% of ICUs all were available to provide care. However, there were 28 different combinations of the six groupings (intensivists, respiratory therapists, pharmacists, attending physician support, advanced bedside nurse support, nurse aides), with the most common one, present in 38% of ICUs, including all six. 96% of ICUs had interprofessional rounds at least five days a week; 78% had them on weekends. Among the ICUs with rounds, 61% of weekday rounding teams included all of intensivists, respiratory therapists and pharmacists. Nutrition, rehabilitation and social support practitioners each participated in rounds in 35-80% of ICUs, and altogether in 28% of ICUs. Except for intensivists, all HCW types participated much less commonly in weekend than in weekday rounds. ICU care almost always included a core team of bedside nurses, intensivists, respiratory therapists, and pharmacists. Beyond that core, great variability was seen in the presence of many other HCW types. Almost all ICUs had interprofessional rounds, with three-quarters also having them on weekends.

Creating Perinatal Nursing Care Plans Using ChatGPT: A Pathway to Improve Nursing Care Plans and Reduce Documentation Burden.

Extensive time spent on documentation in electronic health records (EHRs) impedes patient care and contributes to nurse burnout. Artificial intelligence-based clinical decision support tools within the EHR, such as ChatGPT, can provide care plan recommendations to the perinatal nurse. The lack of explicit methodologies for effectively integrating ChatGPT led to our initiative to build and demonstrate our ChatGPT-4 prompt to support nurse care planning. We employed our process model, previously tested with 22 diverse medical-surgical patient scenarios, to generate a tailored prompt for ChatGPT-4 to produce care plan suggestions for an exemplar patient presenting with preterm labor and gestational diabetes. A comparative analysis was conducted by evaluating the output against a "nurse-generated care plan" developed by our team of nurses on content alignment, accuracy of standardized nursing terminology, and prioritization of care. ChatGPT-4 delivered suggestions for nursing diagnoses, interventions, and outcomes comparable to the "nurse-generated care plan." It accurately identified major care areas, avoided irrelevant or unnecessary recommendations, and identified top priority care. Of the 24 labels generated by ChatGPT-4, 16 correctly utilized standardized nursing terminology. This demonstration of the use of our ChatGPT-4 prompt illustrates the potential of leveraging a large language model to assist perinatal nurses in creating care plans. The next steps are improving the accuracy of ChatGPT-4-generated standardized nursing terminology and integrating our prompt into EHRs. This work supports our broader goal of enhancing patient outcomes while mitigating the burden of documentation that contributes to nurse burnout.

Which diversity factors influence the attribution of competences and co-operation in nursing teams?

Abstract Background Diversity within nursing teams increases due to staff shortages in Germany, nurse migration and the current academization of the profession. Quality of patient care is associated with intraprofessional teamwork. Little is known about how nurse’s own diversity factors and those of team members impact nurse’s perception and behavior in team situations. Methods A quasi-experimental, cross-sectional study with a factorial online survey with fictional case studies (vignettes) was conducted in two German hospital operators in 2023. Nurses of legal age working in hospitals or nursing homes were eligible to participate. Associations of diversity factors, i.e., gender, age, migration background, and qualification, on the participant and vignette level on perceived competences and willingness to cooperate were preliminary analyzed via multi-level fixed effects models in SPSS. Results N = 684 nurses participated (76% female; mean age: 44.2 years; 88% born in Germany; 75% completed vocational training). Competency of team members in patient’s personal hygiene was rated higher by respondents born in Germany (.36), when fictional colleagues were of middle age (.06) compared to higher age and were from Germany (.22) or France (.08) compared to China. Competency in inserting infusions was rated higher by respondents born in Germany (.56), when fictional colleagues were from Germany (.29) or France (.20) compared to China and when one worked together for months compared to days (-.39). Willingness to swap shifts was affected by the fictional length of collaboration (-.08). All significance levels were p<.02. Conclusions How nurses perceive their colleagues’ competences is mainly influenced by their own and the other’s migration background, while willingness to cooperate is only affected by length of collaboration. Improving the onboarding process of new nurses in teams, and providing the time and space for professional exchange might improve mutual trust and teamwork. Key messages • Diversity in German nursing teams increases due to nurse migration and plurality of qualifications. • Facilitating professional exchange about individual competences might improve team work in nurses.

The impact of nurse managers’ boundary spacing leadership on the relationship between nurses’ work embeddedness and innovative work behaviors

AimThis study was designed to examine the nurse managers’ boundary-spacing leadership’s impact on the relationship between nurses’ work embeddedness and innovative work behaviors.BackgroundIn today's evolving healthcare environment, innovation is essential for enhancing patient care, optimizing resources, and supporting healthcare professionals. Nurses are pivotal in driving bedside innovation, but cultivating a culture of innovation within nursing teams involves more than just promoting creative ideas.MethodsThis is a descriptive correlational study that was conducted at one governmental hospital in Tanta, Egypt. Using Nurse Managers Boundary-Spacing Scale for assessing boundary-spacing leadership, The Global Job Embeddedness Scale for measuring work embeddedness, and Innovative Work Behavior Scale for assessing innovative work behavior, 250 nurses were surveyed. Data analysis was run using descriptive and inferential analysis. Correlation and regression analysis were used to examine the study hypotheses.ResultsThere is a statistically significant positive relationship between boundary-spacing leadership and work embeddedness (r = 0.615, p < 0.001). Boundary-spacing leadership accounted for 56% of the variance in work embeddedness and 36% of the variance in nurses' innovative work performance. These results highlight the pivotal role of boundary-spacing leadership in both enhancing nurses' work embeddedness and boosting their innovative behaviors. The substantial variance explained by boundary-spacing leadership underscores its critical influence on fostering a supportive and innovative work environment within the nursing field.ConclusionBoundary spacing leadership style involves connecting internal and external resources, fostering information exchange, and advocating for the nursing team. While work embeddedness positively correlated with innovative work performance, its impact was less significant than boundary-spacing leadership. This suggests that feeling attached to the organization fosters innovation, but leadership style has a stronger influence. Furthermore, the study found a positive and significant correlation between innovative work performance and both work embeddedness and nurse managers' boundary spacing leadership.Practical ImplicationsThe findings emphasize that boundary-spacing leadership is crucial for enhancing both nurses' work embeddedness and innovative behaviors. Healthcare organizations should focus on developing these leadership skills to create a supportive work environment, foster innovation, and improve staff retention

The compassionate care framework plus quality control group improves the quality of postoperative nursing management for patients in anorectal surgery: An observational study.

This study aimed to investigate the effectiveness of the joint application of the compassionate care framework (CCF) and a quality control (QC) team in improving the quality of postoperative nursing management for patients in anorectal surgery. Patients who underwent anorectal surgery at the China-Japan Friendship Hospital between May 2022 and December 2022 were selected by convenience sampling. A digital random generator was used for random grouping. The odd numbers entered the control group (n = 53) and the even numbers entered the study group (n = 53). The control group received postoperative traditional nursing, and the study group received postoperative nursing and QC team management. A questionnaire survey was used to analyse patients' satisfaction with nursing. The two groups were compared for nursing quality scores, patient satisfaction with nursing care and incidence of complications. After management, compared with the control group, the study group scored significantly higher for the nursing process, environmental management, emergency response and safety protection (p < 0.05 for all). The study group also exhibited higher satisfaction scores with the nursing process, nurse-patient relationship and service attitude compared with the control group (p < 0.05 for all). The complication incidence rate in the study group was significantly lower than in the control group (p < 0.05). The combined use of the CCF and a QC team can effectively improve the quality of postoperative nursing management for patients in anorectal surgery, reduce the incidence of complications and enhance patient satisfaction with nursing care, thus holding significant potential for wider application.

The Impact of Job Crafting Dimensions on Work Engagement Among Nurses: The mediating role of psychological capital

Work significantly influences individual well-being and human growth. Jobs are not solely formulated by companies based on their needs but are also actively modified by the individuals who hold those positions. High-stress professions, such as nursing, highlight how stress levels are influenced by factors like resource availability, patient demands, colleague interactions, and workplace cultural dynamics. Hence, this study investigates the effect of job crafting dimensions on work engagement, and examines psychological capital's mediating role in this relationship. It aims to reveal how job crafting can improve both personal and organizational well-being. This study is a descriptive cross-sectional study. The study was conducted with 348 nurses at Al Dhafra Hospitals in Abu Dhabi, UAE. The analysis utilized in this study was conducted using Structural Equation Modeling (SEM) through SmartPLS 4 and SPSS version 27 for descriptive and correlation analysis. The findings demonstrate that the impacts of job crafting dimensions—task crafting, cognitive crafting, and relational crafting—on work engagement and psychological capital are statistically significant. Additionally, the influence of psychological capital on work engagement is statistically significant. Path analysis revealed that psychological capital mediates the interaction between job crafting dimensions and work engagement. These relationships were shown to be statistically significant. This study reinforces the significance of psychological capital and job crafting dimensions as crucial attributes in the workplace. Hence, it advocates for the healthcare industry to consider the implementation of targeted programs aimed at fostering these attributes within nursing teams. Such strategic initiatives are poised to improve individual well-being among nurses, which is expected to result in enhanced organizational efficiency and a notable decrease in turnover rates over time.

What is known about near miss events in the operating room? A systematic review of studies of mixed methods design.

A near miss event (NME) in healthcare is an event that did not happen but would have caused serious harm if it did. The operating room (OR) is prone to risk and incidents, with estimates that 50% of all hospital adverse events occur in the OR, yet reporting of NME is uncommon in the OR. To carry out a systematic review of studies with mixed methods to establish what is known about NME reporting in the OR. Inclusion criteria will be those studies of mixed methods design, which have been conducted in the OR, with teams of surgeons, anaesthetists or nurses alone or in any combination. Using a publication timeframe of 2001-2023, the following databases were searched: Medline (OVID), CINAHL, Pubmed and Google Scholar. Selected papers for the review were assessed using the Quality Assessment Tool for Studies of Diverse Designs. Fourteen papers were included in the review. NMEs are common occurrences that are underreported in the OR. When NMEs occur in multiples for the same patient, the risk of serious harm increases. Feedback and education about NME helps to improve reporting; ORs with high rates of NME reporting have less serious patient harm events. The implications of the findings for improving healthcare safety are discussed and in particular the adoption of the science of Human Factors Ergonomics into healthcare.

Conceptual framework for the health and well-being of caregivers of HIV/AIDS orphans in North West Province, South Africa

BackgroundThe human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) is an epidemic that continues to increase the burden of care among caregivers of HIV/AIDS orphans. Research has confirmed that HIV/AIDS orphans’ caregivers perform their duties in an unconducive environment. Consequently, this negatively impacts their health leading to inability to discharge caregiving duties effectively. After carefully considering the caregivers’ predicament, the researchers found it imperative to develop a conceptual framework for the North West Province as this province lacks a conceptual framework that addresses the health and well-being of caregivers for orphaned children.MethodsAn exploratory, descriptive and contextual design was used in the study. The population for this study were HIV/AIDS orphans’ caregivers and ward-based professional nurses who also served as outreach team leaders. Non-probability purposive sampling technique was used to select participants for this study. Data was collected using individual semi-structured interviews, focus groups, and field notes. Six steps of thematic analysis were adopted to analyze collected data. The practice-orientated theory by Dickoff, James, and Wiedenbach guided the development of the conceptual framework. These six steps include the agent, recipient, context, procedure, dynamics, and terminus.ResultsThe study findings include home visits, health education, support during disclosure, routine monitoring of blood and growth, mobilization of support systems and resources, and utilization of government services.ConclusionThe conceptual framework seeks to improve the health and well-being of HIV/AIDS orphans caregivers so that they may provide high-quality care to the orphans. The framework guides outreach team leaders and nurses registered in primary health care institutions on the procedure to follow to improve and preserve the health of caregivers of children orphaned by HIV/AIDS.

The impact of negative affects on the high prevalence of anxiety, depression and stress in healthcare professionals.

Psychiatric disorders are the conditions that most contribute to incapacity worldwide. While many healthcare professionals adapt in dealing with various demands, others do not. How much of these conditions is associated with affective experience needs to be studied. Assess the prevalence of anxiety, depression, and stress while investigating the relationship between the presence of positive and negative affect in healthcare professionals. This study's convenience sample consisted of 975 providers (including nursing, physicians, and multidisciplinary team) and administrative professionals (service and supervision teams) working at a general private hospital in Brazil. Data were collected in 2019 through a socio-demographic questionnaire, the Depression Anxiety and Stress Scale (DASS-21), and the Positive and Negative Affect Schedule (PANAS-X). The results are shown through multinomial regression with odds ratio, 95% confidence interval, and P-value. The prevalence of depression, anxiety, and stress was 49.4%, 46.1%, and 49.8%, respectively, showing high prevalence. It was observed that a high presence of negative affect is associated with a greater likelihood of developing anxiety, depression, and stress, while a high presence of positive affect is associated with a lower likelihood of depression and stress prevalence. The high prevalence of anxiety, depression and stress in healthcare professionals is associated with the presence of negative affects. Mental disorders should be measured, and practices adopted to ensure well-being and job performance.

Use of the Electronic Health Record to Improve Nursing Chart Preparation.

In a medical specialty clinic located in a rural community, a nursing team identified an opportunity to decrease the time nursing staff spent preparing charts for patients' upcoming clinical appointments. In collaboration with an informaticist, the nursing project team implemented a quality improvement project with a target goal of decreasing the average time spent preparing charts per patient by 20%, without increasing the number of discrepancies in the chart preparation process. The team used the define, measure, analyze, improve, and control framework to identify two interventions that could decrease time for chart preparation. A standardized chart preparation process was developed, and a condensed nursing view was created within the electronic health record. After the quality improvement project, the average time nurses spent on chart preparation per patient decreased by 18% after the standardized process and 16% after the condensed view was implemented.

Key steps and barriers in the journey of patients with epilepsy through the National Healthcare System in Spain: The EPIPASS qualitative study.

Epilepsy requires continuous medical attention from multiple healthcare specialists, specialized facilities, and community-based care. In Spain, there is no standardized approach to epilepsy care. The aim of this study was to identify the factors impacting on the delivery of high-quality care by exploring key steps and barriers along the patient journey through the Spanish National Healthcare System (NHS). A qualitative study was conducted using opinions and experiences of neurologists, nurses, patients, and caregivers shared in discussion meetings. Using thematic content analyses, relevant aim-focused statements were coded according to prespecified issues in a discussion map (i.e., key steps and barriers), and sub-coded according to emerging issues. Thematic saturation and co-occurrence of key steps/barriers were evaluated to identify the most relevant factors impacting on the delivery of high-quality care. Sixty-five stakeholders took part in discussion meetings (36 neurologists, 10 nurses, 10 patients, and nine caregivers). Six key steps on the patient journey were identified: emergency care, diagnosis, drug therapy, follow-up, referral, and interventional treatment. Of these, follow-up was the most relevant step impacting on the delivery of high-quality patient care, followed by drug therapy and diagnosis. Emergency care was considered a hot-spot step with impact throughout the patient journey. Communication (among HCPs and between HCPs and patients) was a barrier to the delivery of high-quality care at several stages of the patient journey, including drug therapy, follow-up, referral, and interventional treatment. Resource availability was a barrier for diagnosis (especially for confirmation), drug therapy (drug availability), and referral (lack of professionals and specialized centers, and long waiting lists). This is the first study capturing perspectives of four key stakeholders involved in epilepsy care in Spain. We provide an overview of the patient journey through the Spanish NHS and highlight opportunities to improve the delivery of patient-centered care with a chronicity perspective. Patients with epilepsy may require prolonged medical care. In Spain, care is provided by a range of specialist and non-specialist centers. In this study, a team of Spanish neurologists, nurses, patients and caregivers identified barriers that affect the delivery of high-quality care for patients with epilepsy at each stage of their journey through the Spanish NHS. Specific epilepsy training for healthcare providers, appropriate resources for diagnosing and treating patients, and good communication between healthcare workers and patients were identified as important factors in providing high-quality care for patients with epilepsy.

Improving influenza vaccination assessment and uptake, one step at a time in a cancer center.

280 Background: Influenza immunization has shown to decrease morbidity and mortality of influenza infections. From September to December 2022, at the infectious diseases (ID) clinic at our institution, 73% of the patients did not undergo influenza immunization assessment during their clinical encounters and only 3% of the patients had the influenza vaccine administered. Furthermore, documentation of vaccine discussion was done in 73% of cases. Our aim was to improve vaccination assessment from 73% noncompliant to 50%. Methods: A multidisciplinary team of nurses, nurse leaders, pharmacists, and quality specialists was assembled to analyze baseline data on influenza vaccination assessment, administration, and documentation at the ID clinic from Sept to Dec 2022 using The Model for Improvement. Quality tools were utilized including Cause and Effect Diagram, Current State Process Flow Chart and Prioritization Matrix, to identify and prioritize opportunities for improvement creating a worklist for improvement focus. Vaccine assessment measured via EPIC immunization tab marked as reviewed, discrete areas to document vaccination and their administration were not a part of nursing or provider’s workflow. Using the Plan, Do, Study, Act (PDSA) method, the following changes were tested: PDSA Cycle 1; A green sticker highlighted those patients needing vaccine assessment. PDSA Cycle 2; A smart phrase was created for documentation in nurses’ notes and PDSA Cycle 3; provider’s notes regarding vaccine recommendations. Results: Interventions were associated with an improvement of influenza assessment via the immunization tab marked as reviewed in the ID outpatient clinic from 73% noncompliance to 3% noncompliance from September 2023 to March 2024. Concurrent with improvement of our assessment process, our on-site vaccination rate increased from 97% error to 89% error (Table) and there was 50% improvement in provider’s documentation. Conclusions: The formation of a multidisciplinary working group and implementation of quality tools interventions resulted in timely significant improvement in vaccination assessment, documentation, and administration. Subsequently, we were granted institutional approval to add an EPIC clinical decision support tool to standardize influenza vaccination documentation. Future strategies include implementation and evaluation of the utilization of Health Maintenance tool in the ID clinic before expansion to other clinics in our institution. Influenza vaccine administration vs outpatient visits in the ID clinic. Month/Year # Outpatient visits # Vaccines administered in clinic % of vaccines administered Influenza Sep-Dec 2022 1827* 54 2.95% Influenza Sept 2023-March 2024 2682 251 9.36% *Includes video and telephone visits.

Effect of remote surveillance system on management of diagnostic imaging significant actionable findings.

327 Background: Delayed assessment of diagnostic imaging (DI) significant actionable findings (AFs) at an oncological center prompted the creation of a safety net system which used technological advancements to improve communication amongst radiologists and patient-facing providers. Significant AFs is an unexpected radiology finding that is not considered imminently life-threatening but for which follow-up action is recommended within a determined timeframe. Due to the robust nature of DI reports significant AFs can be overlooked. The Actionable Finding Vigilance Unit (AFVU) was created to provide a safety net system for the flow of information. Methods: Operationalizing the AFVU required a multidisciplinary approach consisting of executive stakeholders in Patient Safety, Quality, Radiology, and Information Technology amongst others. A list of 24 AFs was created. Stakeholders met weekly to formalize a strategy and execute the planned intervention. Essential elements included: identifying significant AFs for monitoring, obtaining provider buy-in, creating a digital dashboard within the electronic health record, developing a structured DI report for enhanced communication of findings, and implementing registered nurses team for monitoring. The plan – do- study- act methodology was applied. Results: Over a ten-month period, there were a total of 819 findings. 353 significant AFs associated with the pre-determined list for monitoring. Approximately 29% (102/352) required escalation from the AFVU. Patients without a primary physician in the cancer center were considered a vulnerable population. These patients often sought care via the emergency department and were under the oversight of the AFVU. Total volume of significant AFs for this population consisted of 466 findings, 8 % (36/466) required escalation by the AFVU. Conclusions: Utilization of an electronic health record with the capacity to issue immediate electronic notifications to providers, coupled with a digital dashboard for the monitoring all significant AF reported, does create a safety net for providers and patients. The electronic communication of significant AFs is further enhanced using human interaction for case review and follow up. Data highlights the benefit of harmonizing technology with clinician knowledge and workflow as instrumental in promoting safety and reducing risk in healthcare.

“What Matters To Me?” Responses from Older People in the Acute Setting

Abstract Background The ‘What Matters to Me’ question has been used in many areas of the healthcare. In the context of older persons, the focus is typically on improving patient-centred care in long stay settings or in people living with dementia. It is also synonymous with end-of-life decisions. The question is contextual in itself and can elicit a wide range of responses. In this abstract, it was included in the Comprehensive Geriatric Assessment (CGA) in a section about future care and responses were anticipated to be relevant to that subject. Methods The Older Person Specialist Nursing Team developed a CGA document for use in acute care. The “What Matters To Me?” question was included with the intention of discovering and recording older persons’ end of life plans and wishes. The responses to this question were extracted from a random 30 completed CGAs. Results A total of 24 responses were gathered, some participants provided multiple answers. Not documented n=6, 3 themes were identified from the responses; Home; Free time and Worries/Concerns. Return home was the most frequently expressed response; n=13. Other responses identified were enjoyment, pass times and pets; n=9. Worries/Concerns were identified in broad terms; “I’m worried out the future” n=7. Conclusion “What matters” in this context was a broad query and responses may have been influenced by participants current health status, location and fear of the future and the subjectivity of the question and the practitioner. Participants did not mention dying a concern but did allude to the future in a broad context. The “What Matters To Me” question will now be in the social information section and the Older Person Specialist Nursing Team are considering a targeted question related to end-of-life plans and wishes.

Impact of in situ simulation training on quality of postnatal stabilization and resuscitation—a before-and-after, non-controlled quality improvement study

This study aimed to evaluate the impact of in situ simulation-based training on quality indicators of patient care at a level IV neonatal intensive care unit. A before-and-after, non-controlled quality improvement study was performed at the Division of Neonatology, Medical University of Graz. The educational intervention comprised a period of 4 months, with structured in situ simulation training delivered regularly for neonatal providers and nurses in interprofessional teams. The primary study outcome was the quality of non-technical skills and team interaction during actual postnatal stabilization and resuscitation. This was assessed using video recording during two 2-month observational phases before (pre-training) and after the educational intervention (post-training). Delivery room video recordings were assessed by two external, blinded neonatologists using the Anaesthetists’ Non-Technical Skills (ANTS) score. Furthermore, we collected clinical patient data from video-recorded neonates during the pre- and post-training periods, and training participants’ individual knowledge of neonatal resuscitation guidelines was assessed using a before- and after-questionnaire. A total of 48 healthcare professionals participated in 41 in situ simulation trainings. The level of non-technical skills and team interaction was already high in the pre-training period, and it did not further improve afterwards. Nonetheless, we observed a significant increase in the teamwork event “evaluation of plans” (0.5 [IQR 0.0–1.0] versus 1.0 [1.0–2.0], p = 0.049). Following the educational intervention, training participants’ knowledge of neonatal resuscitation guidelines significantly improved, although there were no differences in secondary clinical outcome parameters.Conclusion: We have successfully implemented a neonatal in situ simulation training programme. The observed improvement in one teamwork event category in the post-training period demonstrates the effectiveness of the training curriculum, while also showing the potential of in situ simulation training for improving postnatal care and, ultimately, patient outcome. What is Known:• In situ simulation-based training is conducted in the real healthcare environment, thus promoting experiential learning which is closely aligned with providers’ actual work.• In situ simulation-based training may offer an additional benefit for patient outcomes in comparison to other instructional methodologies.What is New:• This observational study investigated translational patient outcomes in preterm neonates before and after delivery of high-frequency in situ simulation-based training at a level IV neonatal intensive care unit.• There was a significant increase in the frequency of one major teamwork event following the delivery of in situ simulation-based training, indicating a notable improvement in the non-technical skills domain, which is closely linked to actual team performance.

LEAN Methodology to Improve Endoscopy Unit Efficiency in a Multi-subspecialty Ambulatory Surgery Center: A Pilot Study.

Background and objective Efforts to improve gastrointestinal (GI) endoscopy unit efficiency may lead to increases in colon cancer screening volumes. LEAN management principles applied to GI endoscopy unit practices may serve as a novel foundation for efficiency improvements.We conducted apilot study in an outpatient, hospital-based GI endoscopy unit with the goal of improving endoscopy efficiency by using LEAN principles Methodology A single endoscopist and anesthesiologist along with the nursing care team implemented changes to their practice based on LEAN principles. Efficiency metrics were tracked before these changes and after to assess for improvements. Results We observed statistically significant improvements in waiting room time (13.1 minutes vs. 25.6 minutes, p<0.001), recovery room duration (55.5 minutes vs. 61.8 minutes, p=0.01), total facility time (172.5 minutes vs. 196.1 minutes, p<0.001), and true completion time (19.7 minutes vs. 32.3 minutes, p=0.002) after the implementation of LEAN interventions. Conclusions A systematic and standardized approach using LEAN methodology canimprove GI endoscopy unit operational efficiency. Larger studies are needed to validate our findings and generalize the results to the field broadly.

The Impact of Assessment of Nurses' Experiences in Thoracic Surgery in Onco-Hematological Patients.

Background: Nowadays, Thoracic Surgery is technologically advanced; therefore, it also focuses its attention on nursing care. The aim of the study is to evaluate the effect of the assessment of a dedicated team of nurses (DTN) in all onco-hematological patients undergoing VATS lobectomy for lung cancer on the outcome of the patient, preventing pressure injuries, reducing perioperative stress, duration of operations, complications, and hospital stay times. Methods: We performed a single-center observational retrospective study, including 31 DTN and 760 onco-hematological patients who underwent thoracic surgery between 30 October 2018 and 30 June 2023 at "Vanvitelli" University of Naples. Results: DTN ensures good nursing care before, during, and after surgery. Operative time was reduced by approximately 20 min, decreasing hospital infections in the DNT period and reducing intraoperative complications such as bleeding and hospital costs (p < 0.05). Conclusions: Thoracic surgery nurses require more specialized training to adapt to the development of sophisticated.

EP588 - Review of the need for Immediate Nasogastric Tube Insertion in patients with Small Bowel Obstruction: Single Centre Quality Improvement Project

Abstract Aim This QIP was conducted in a busy UK hospital. It aims to review, improve, and stress the importance of early insertion of an NG tube in patients who have clinically suspected or radiologically confirmed small bowel obstruction. Method Retrospective data collection involving 72 patients, in a period from Jan to April 2023 (50 patients) and from May to July 2023 (22 patients)Inclusion criteria: adult patients with SBO (clinically suspected or radiologically confirmed) and NGT insertion advised by the surgical teamExclusion criteria: paediatric patients, LBO, and patients not advised NGT in ED Results In the first cycle, we found that NG insertion is delayed 84% &amp;gt; 7 hrs. With associated morbidity of pneumonia, including aspiration in 20% of patients, ileus and sepsis in 8%, and re-admission and mortality in 6%, respectively. The following interventions were carried out. Broad communication with the ED team to highlight the importance of NG insertion for suspected patients. Provide NGT training for ED nursing staff The surgical team and admission nurses should inquire about NGT insertion before accepting patients' admission to surgical emergency wards. Circulating the QIPS recommendation Trust-wide as sharing learning point Post-intervention, we noticed a 50% delay in NGT insertion, which is a huge improvement compared to the 84% delay Conclusion Early insertion of NG for decompression in both pre and post-op periods is known to decrease associated complications, including bowel oedema, perforation, aspiration pneumonia, and post-ileus, leading to better outcomes and a significant decrease in hospital stay length.

Medical occurrence and safety of SARS-CoV-2 vaccination outside of the hospital setting.

During COVID-19 pandemic, vaccination has been strongly recommended and advocated to prevent COVID-19 infection and adverse outcomes, particularly among at-risk populations. The vaccination against SARS-CoV-2 (COVAC) occurred at off-site locations capable of accommodating large crowds, distinct from the hospital setting, where a team of intensivists, emergency physicians, and nurses, ensuring prompt medical attention (medical occurrences, MO) in cases of adverse event following immunization. Our aims were to estimate the incidence of MO, and to assess its association with demographics, and vaccine characteristics. Our retrospective cohort study included all subject aged 12years and older who received vaccinations at two large out-of-hospital vaccination hubs (Fiera Milano City, Palazzo delle Scintille), between April 12th and August 31st, 2021. Nine hundred and ninety-five thousand and twenty-eight vaccinations were administrated. MOs incidence rate was 278/100,000 doses (95% confidence interval (CI) 268-289). Most MOs were mild (86.27%) and mainly observed in subjects who received the Comirnaty vaccine; 92 MOs (3.32%) were severe and mostly occurred in recipients of the Vaxzeria vaccine. The incidence rate for hospital transfers following vaccination was 4.7/100,000 doses (95% CI 3.5-6.2) and any level of anaphylaxis occurred in 0.4 cases per 100,000 administrated doses (95% CI 0.3.-0.7). Sex, age, type of vaccine and first dose were associated with incidence of MO. Our results showed a low incidence rate in MOs after COVAC, mainly mild and support the feasibility, effectiveness and safety of vaccinations administered in hubs with a dedicated SEU located outside of the hospital setting.

Towards a Region-Wide Glycaemic Management System: Strategies and Applications for Glycaemic Management of Patients with Diabetes During Hospitalisation.

This study proposes a region-wide blood glucose management system to solve the problem of blood glucose management in patients with diabetes. A professional team of doctors, nurses and dietitians jointly developed a region-wide blood glucose management system. The system operates through a collaborative approach where each team member utilises their specialised role, such as data monitoring, algorithm development or patient support, to contribute to a comprehensive blood glucose management network. This integration ensures accurate glucose tracking, personalised feedback and timely adjustments to treatment plans. The system allows the patient to have a good treatment plan, giving comprehensive medical guidance, and the physician team is responsible for the patient's health status. The region-wide blood glucose management system increased the overall blood glucose monitoring rate of patients and reduced the hospitalisation time (from 11.27 days to 9.52 days) and hospitalisation costs (from 12,173.8 yuan to 9502.4 yuan). At the same time, the system effectively counted the incidence and occurrence time of hyperglycaemia and hypoglycaemia adverse events, which can provide a reference for clinical prevention of adverse events. A region-wide blood glucose management system can improve medical efficiency, save medical resources and provide a strong guarantee for the health of patients with diabetes. Compared with the traditional diabetes management mode, the region-wide blood glucose management system is more systematic and standardised, meaning it can better meet the needs of patients with diabetes.