Hospital Team Research Articles

Relationship between patient safety culture and patient experience in hospital settings: a scoping review

BackgroundMeasures of patient safety culture and patient experience are both commonly utilised to evaluate the quality of healthcare services, including hospitals, but the relationship between these two domains remains uncertain. In this study, we aimed to explore and synthesise published literature regarding the relationships between these topics in hospital settings.MethodsThis study was performed using the five stages of Arksey and O’Malley’s Framework, refined by the Joanna Briggs Institute. Searches were conducted in the CINAHL, Cochrane Library, ProQuest, MEDLINE, PsycINFO, SciELO and Scopus databases. Further online search on the websites of pertinent organisations in Australia and globally was conducted. Data were extracted against predetermined criteria.Results4512 studies were initially identified; 15 studies met the inclusion criteria. Several positive statistical relationships between patient safety culture and patient experience domains were identified. Communication and teamwork were the most influential factors in the relationship between patient safety culture and patient experience. Managers and clinicians had a positive view of safety and a positive relationship with patient experience, but this was not the case when managers alone held such views. Qualitative methods offered further insights into patient safety culture from patients’ and families’ perspectives.ConclusionThe findings indicate that the patient can recognise safety-related issues that the hospital team may miss. However, studies mostly measured staff perspectives on patient safety culture and did not always include patient experiences of patient safety culture. Further, the relationship between patient safety culture and patient experience is generally identified as a statistical relationship, using quantitative methods. Further research assessing patient safety culture alongside patient experience is essential for providing a more comprehensive picture of safety. This will help to uncover issues and other factors that may have an indirect effect on patient safety culture and patient experience.

Association between internet exclusion and depressive symptoms among older adults: panel data analysis of five longitudinal cohort studies

Internet exclusion and depressive symptoms are prevalent phenomena among older adults; however, the association between internet exclusion and depressive symptoms remains limited. This study aims to investigate the association between internet exclusion and depressive symptoms among older adults from high-income countries (HICs) and low- and middle-income countries (LMICs). We conducted a comprehensive longitudinal, cross-cultural analysis, and the participants were adults aged 60 years and older from 32 countries participating in five nationally representative longitudinal cohort studies: the Health and Retirement Study (HRS), the English Longitudinal Study of Ageing (ELSA), the Survey of Health, Ageing and Retirement in Europe (SHARE), the China Health and Retirement Longitudinal Study (CHARLS), and the Mexican Health and Ageing Study (MHAS). Internet exclusion was defined as the self-reported absence from internet use. Depressive symptoms were evaluated using the Centre for Epidemiologic Studies of Depression scale (CES-D) or the Euro-Depression scale (Euro-D). These five cohorts, being heterogeneous, were respectively conducted with panel data analysis. Logistic regression, implemented within the generalized estimating equations framework, was used to examine the association between internet exclusion and the likelihood of experiencing depressive symptoms, adjusting for the causal-directed-acyclic-graph (DAG) minimal sufficient adjustment set (MSAS), including gender, age, education, labour force status, household wealth level, marital status, co-residence with children, residence status, cognitive impairment, and functional ability. Our study included a total of 129,847 older adults during the period from 2010 to 2020, with a median follow-up of 5 (2, 7) years. The pooled proportion of internet exclusion was 46.0% in HRS, 32.6% in ELSA, 54.8% in SHARE, 92.3% in CHARLS, and 65.3% in MHAS. Internet exclusion was significantly associated with depressive symptoms across all cohort studies: HRS (OR=1.13, 95% CI 1.07-1.20), ELSA (OR=1.22, 95% CI 1.11-1.34), SHARE (OR=1.55, 95% CI 1.47-1.62), CHARLS (OR=1.49, 95% CI 1.26-1.77), and MHAS (OR=1.48, 95% CI 1.39-1.58). Moreover, internet exclusion was found to be associated with all dimensions of depression in the SHARE, MHAS, and ELSA cohorts (except for sleep and felt sad) cohorts. A considerable proportion of older adults experienced internet exclusion, particularly those in LMICs. Internet exclusion among older adults, irrespective of their geographic location in HICs or LMICs, was associated with a higher likelihood of experiencing depressive symptoms, which demonstrated the importance of addressing barriers to internet access and promoting active participation in the internet society among older adults. National Key R&D Program of China (grant number 2022ZD0160704), the Scientific Research and Innovation Team of The First Affiliated Hospital of Zhengzhou University (grant number ZYCXTD2023005), the Collaborative Innovation Major Project of Zhengzhou (grant number 20XTZX08017), the Joint Project of Medical Science and Technology of Henan Province (grant number LHGJ20220428), and National Natural Science Foundation of China (grant number 82373341).

Challenges related to the organizational climate of the nursing team in a public hospital - nurses' perception.

The organizational climate is related to the degree of motivation of its employees. This perception is essentially felt, it is neither seen nor touched, but it is real. This study aims to identify difficulties and potentialities related to the organizational climate of the nursing staff at a public hospital in the Federal District. Methodologically, a descriptive and exploratory study was carried out characterized by a qualitative approach. The thematic content analysis led to three interpretative dimensions: environment and working conditions; communication, interpersonal relationship and work flows; motivation to improve the work environment. The results indicate a deficit of human resources, scarcity of material resources, supplies, precarious physical structure, in addition to interpersonal relationship problems, such as the (de)valuation of professional nurses and nursing. The challenges posed to managers go beyond the technical and structural dimension, the technological complexity of equipment without maintenance, as it unfolds through the human dimension, feelings and unmet needs (of appreciation) of nursing, which needs to be cared for, valued, heard and seen in their care process.

Proactive Psychiatry: Innovating the Delivery of Consultation-Liaison Services in a Pediatric Hospital

BackgroundThe benefits of a proactive consultation-liaison (C-L) psychiatry service have been well-documented in the adult population, including decreased length of stay, increased satisfaction among physicians, and enhanced collaborative care. However, there is no available research on the effectiveness of this model in pediatric hospitals. ObjectiveThis study compared patients ages 5-18 years on a general medical floor receiving a proactive psychiatry consult to concurrent controls receiving no consult and to historical controls receiving traditional reactive consults. MethodNew admissions to two pediatric general medical hospital teams were reviewed on weekday mornings to identify those with active psychiatric concerns. Adjusted negative binomial regression was used to compare the primary outcome of hospital length of stay between the proactive (n=65), concurrent control (n=63), and reactive historical control (n=45) groups. Patient satisfaction, hospitalist satisfaction, and recommendation concordance (degree to which psychiatry recommendations were implemented by the primary team) were also compared between groups as secondary outcome measures. ResultsAfter adjusting for age, sex, race, insurance type, reason for consult, and medical diagnosis, concurrent control patients had 14% (p = 0.295) longer mean length of stay than proactive consults and historical controls had twice (p < 0.001) the mean length of stay of those with proactive consults. Response rate for patient satisfaction scores was low, but responses were modestly more favorable among patients who received proactive C-L services. Based on nine paired pediatric hospitalist pre- and post- surveys, follow-up surveys were statistically significantly more favorable after a proactive psychiatry consult service was introduced. Concordance of recommendations was observed to be higher for proactive consults than concurrent controls for diagnoses and non-medication (other) recommendations. ConclusionThe positive impact of a proactive C-L psychiatry consultation model was observed in a pediatric hospital and was associated with a lower length of stay than concurrent controls and historical reactive consults, higher hospitalist satisfaction among paired responses, and greater concordance of diagnosis and other non-medication recommendations.

Spatial distribution of patients with pressure injuries treated at a teaching hospital

Introduction: Pressure injury (PI) is characterized by pressure exerted mainly on bony prominences, or even related to the use of medical devices. As epidemiological aspects are still scarce in the country, it is appropriate to produce studies that delimit the information for a better characterization of this public health problem, with extraterritorial dimensions. Geoprocessing is a revolutionary technology that encompasses the most diverse disciplines, data, equipment, analysis and interpretations from certain locations and geographic data, thus obtaining maps and/or spreadsheets with information relevant to that particular region that, when used in the health area, allows the identification and mapping of risks and injuries that affect the population. Objective: To demonstrate the technical experience of spatial demarcation and geoprocessing of patients with pressure injuries treated at a teaching hospital in the state of Sergipe. Method: A descriptive epidemiological study was carried out from a data sheet of patients with pressure injuries treated by the Skin Care Service team of a teaching hospital in Sergipe, between 2018 and 2022. Georeferencing and geoprocessing were developed in conjunction with Google Maps and Google Earth software. Results: The study sample consisted of 215 patients with pressure injuries (PI) in which the age group that stood out was the elderly (54.8%), followed by adults (40.0%). It is noted, in the spatial representation, that most of the patients with PL were residents of Greater Aracaju (n=130), followed by the East of Sergipe (n=23) and Central Agreste (n=18). Most of the LPs were acquired prior to admission to the institution studied (55.8%), while the others (44.2%) appeared during the hospital stay. Conclusion: In view of the analysis presented, it was possible to verify that most patients affected by PLs are men and elderly, and that the Greater Aracaju regional was the one that stood out the most because it concentrated most of the patients with PL, whether pre-existing or acquired at hospitalization.

Collaboration cognizance: Development of a self-assessment tool to measure intra-professional collaborative practices (IPCP) in postgraduate medical residents at tertiary care hospitals

BackgroundThe ever-evolving healthcare system of today demands physicians who steer their roles as treatment providers, managers and collaborators. Professionals are highly interdependent due to increased complexity of health problems and risk of errors increases with transitions in care. In hospitals, the main workforce is postgraduate residents; therefore, intraprofessional collaboration amongst residents is essential. Several instruments are available to evaluate interprofessional collaboration amongst physicians, nurses and hospital teams but none specifically assessed intra-professional collaborative practices amongst residents working in tertiary care hospitals in multi-disciplinary teams. This study intends to develop and validate an instrument to self-assess intraprofessional collaborative practices in postgraduate residents undergoing residency in multiple specialties at tertiary care hospitals.ApproachThis study on Instrument Development employed mixed method study design executed in two phases. In phase 1, six domains of intraprofessional collaborative practices were identified from literature and 35 items were developed. Fifteen experts participated in qualitative content validation and provided comments. To establish content validity in phase 2, content validity index (CVI) and content clarity average (CCA) were assessed by seventeen experts. Response process validity was established by cognitive interviewing of 5 postgraduate residents. Pilot testing was done on a sample of 407 residents. Cronbach’s alpha was determined, and confirmatory factor analysis established construct validity.ResultsDuring phase 1, items were modified based on qualitative feedback from 15 experts. In round 2, CVI and CCA were determined based on responses of 17 experts. The items having an I-CVI greater than 0.90 were accepted and six items underwent modifications as their I-CVI fell between 0.78 and 0.90. Similarly, four items with a CCA of less than 2.4 were modified to increase clarity. Cognitive interviews of participants on 30 items resulted in the deletion of 1 item and changes in 5 items. The final instrument had 29 items categorized under six constructs. All items had good factor loadings during CFA, so none was deleted. Cronbach’s Alpha α was 0.937.ConclusionIntraprofessional collaborative practices in residents is a valid and reliable self-assessment tool comprising 29 items measuring six constructs. It may be used by residents to assess their collaborative practices and incorporated in curricula to help develop collaborative practices and their assessment during training of postgraduate residents.

ORAL HEALTH CARE IN PATIENTS OF THE INTENSIVE CARE UNITS.

Introduction: oral hygiene is considered a basic need to protect the health and well-being of the population, with more emphasis for patients under intensive care support. Objective: shortly review the literature about effective role of well-trained professional teams while performing oral care in patients managed in the Intensive Care Unity. Methods: scientific review article, taking as a source of information the current literature published in the PubMed database between 2004 and 2024 including, systematic reviews, meta-analysis, and review studies related with the buccal care procedures, and their relationships with the outcomes of critical ill patients under the infection risks. Results: 28 articles were analyzed, with data of children or adult patients of diverse continents who needed mechanical ventilation, enteral or parenteral feeding, or some invasive procedure favoring the hospital acquired infections, mainly the pneumonias. The reviewed literature most frequently described the lack or insufficient specialized care for the oral cavity of patient with very limited autonomy during hospitalizations. Conclusion: as a whole, there is a need for the dental specialists in the hospital team to personally perform, besides to train in service the nurse staffs and their assistants to carry on the correct methods for the patient daily buccal hygiene, with improvement of general health care and avoiding the worsening during the hospitalization period.

Palliative Care Interdisciplinary Teams in Acute Care Hospitals and Cancer Centers: A Job for Sisyphus.

Palliative Care Interdisciplinary Teams in Acute Care Hospitals and Cancer Centers: A Job for Sisyphus.

Professionals' Perceptions of the Colorectal Cancer Pathway: Results of a Co-Constructed Qualitative Study.

Qualitative research on the perceptions of healthcare professionals involved in cancer care about their respective roles in the patient care pathway is limited. Therefore, the aim of this qualitative study was to document these perceptions. A multidisciplinary team that included patient researchers constructed a semi-structured interview guide on the perceptions of the colorectal cancer care pathway by professionals. Interviews were conducted with healthcare professionals from two French hospitals that manage patients with colorectal cancer. Then, the interviews were fully transcribed and analysed by the whole multidisciplinary team. Thirteen healthcare professionals were interviewed (six nurses, four physicians, one psychologist, one social worker and one secretary). They described the colorectal care pathway using a great lexical diversity and listed a significant number of professionals as taking part in this pathway. Among the people mentioned were healthcare professionals working inside and outside the hospital, family members and non-conventional medicine practitioners. However, they did not spontaneously mention the patient. Their views on the role of the referring physician, the general practitioner and the patient were further explored. The interviews highlighted the coordination difficulties among the various professionals, particularly between general practitioners and hospital teams. These data provided interesting elements for developing a tool to help coordination among professionals. This preliminary study, with its participatory design, brings interesting elements of reflection on the care pathway for patients with colorectal cancer. It will continue through the creation of a larger participatory project. Patient partners were included in all steps of this study. This transdisciplinary project was coordinated by a group composed of three patient partners, two healthcare professionals and two humanities and social sciences researchers. Their knowledge of the patient's perspective on the care pathway enriched discussions from the study design to results analysis.

Informing knowledge translation for selective dorsal rhizotomy: A survey of Australian clinicians and people with lived experience of cerebral palsy.

Selective dorsal rhizotomy (SDR) is a neurosurgical intervention used to reduce spasticity in children with cerebral palsy (CP). There is minimal relevant, evidence-based information available for Australian families and clinicians. This study aims to investigate the knowledge of people with lived experience and clinicians regarding SDR, including how they currently access information and what information they seek. Adults with CP, carers of children with CP and clinicians treating children with CP were invited to complete an online survey. Data regarding participant demographics, current knowledge and confidence in knowledge about CP and SDR, information source/s used and participants level of trust in these sources are presented as counts and percentages. Comparisons in knowledge between groups were analysed. A total of 114 surveys were completed: 63 clinicians, 48 carers, and 3 adults with CP. Eighty percent of clinicians were allied health professionals. People with lived experience were less confident in their knowledge about SDR compared to knowledge of CP (P < 0.001). Clinicians rated scientific research literature and the hospital team as the most useful and trustworthy information source. People with lived experience used a wider range of information sources including the internet, rating their community therapy team and other people with lived experience as the most useful. This study identified a lack of confidence in knowledge of SDR for people with lived experience, likely due to a gap in accessible and readable evidence-based information. While both groups differed in how they access information, there was agreement that greater information about SDR is needed.

Rationalizing irrational prescribing-infection-related attitudes and practices across paediatric surgery specialties in a hospital in South India.

Antibiotic use in paediatric surgical specialties is understudied. We investigated the antibiotic prescribing practices of paediatric general and cardiovascular surgical teams in a tertiary hospital in South India. Mixed-methods study including observations from ward rounds, semi-structured interviews, and review of antibiotic prescribing. Field notes from observations and interview transcripts were coded using NVivo and thematically analysed. Data collection and analysis were iterative and continued until thematic saturation. Quantitative data were analysed using descriptive statistics. Data included 62 h of observation, 24 interviews, one case study and 200 patient chart reviews (100/specialty). Senior surgeons make key decisions, referring to their own experience when prescribing antibiotics. Being outcome-driven, the doctors often prescribe antibiotics at the earliest indication of infection with a reluctance to de-escalate, even when an infection is not diagnosed. This practice is more acute among surgeons who consider themselves responsible for their patients' health and attribute the consistently low surgical site infection rates to this practice.In general surgery, 83.3% (80/96; 4 lost to follow-up) of patients were prescribed antibiotics for the duration of their stay with oral antibiotics prescribed at discharge. The surgeons use antibiotics prophylactically for patients who may be vulnerable to infection. The antimicrobial stewardship team was considered to have limited influence in the decision-making process. Outcome-driven decision-making in surgery leads to overprescription of antibiotics and prolonged surgical prophylaxis. The rationale for suboptimal practices is complicated by the surgeons' beliefs about the contextual determinants of health in India.

The Mechanics, Art, and Value of Central Line Stewardship

Background: Central venous catheter (CVC) utilization and central-line associated bloodstream infection (CLABSI) have increased nationwide. Busy providers can easily overlook the recommended practice of daily assessment of the ongoing indication for CVC. Prospective audit and feedback (PAF) is widely used and the gold standard for antibiotic stewardship programs (ASP), but reports involving PAF for device use are scarce. Therefore, we decided to evaluate the usefulness and feasibility of PAF for reducing device utilization and ultimately CLABSI rates at our 528-bed tertiary care hospital. Methods: A PAF-based Central Line Stewardship (CLS) initiative was launched in February 2023, with a team of hospitalists, infectious diseases physicians, health informatics, vascular access nurses, and infection preventionists. On business days, CVC line-lists were exported from the electronic medical record (EMR), into a REDCap (Research Electronic Data Capture) database for team members to evaluate, in real-time, all non-ICU CVCs in place for more &gt;72 hours (Figures 1 and 2). For CVCs eligible for stewardship, CLS members placed Legal-approved note into the patient’s EMR, advising CVC removal or alternative IV access (Figure 3). CVCs continued to be audited until removal or patient discharge. Recommendation outcomes were tracked over the subsequent 72 hours for acceptance. Standardized Utilization Rates (SUR) and Infection Rates (SIR) were calculated and compared using the National Healthcare Safety Network. Results: Between February and August 2023, the CLS team reviewed 861 CVCs, representing 581 unique patient encounters, and made 622 recommendations. Recommendations to remove or replace the CVC represented 23.5% (146) of reviews, and 57% of these CVCs were removed within 3 days. 95% of removed lines had no adverse outcomes and did not require reinsertion. Hospital-wide CVC utilization decreased 18.7% from a SUR of 1.006 in the previous year, to 0.818 during the 7-month pilot period (p &lt; 0 .001). In the 4 months following the pilot period, decreased CVC utilization was sustained with an SUR of 0.797. Non-ICU CLABSI SIR decreased from 1.282 in 2022 to 1.024 in 2023 (p=0.36). Average time physician required for CLS review approximated a 0.4 full-time equivalent a week. The intervention was well received, with requests for expansion to urinary catheters. Conclusion: CLS safely and significantly reduced device-utilization; directly via documentation and recommendation, and indirectly through increased awareness and the Hawthorne Effect. Examples of the “art” of CLS include when to leave a discoverable note and how to determine ongoing need for CVC in a fragile patient.

Exemple d’une équipe territoriale de niveau 3 (« recours ») dans le TDAH : l’Équipe de Coordination Lyonnaise des troubles de l’Attention et de l’Hyperactivité (ECLAH)

BackgroundAttention Deficit Hyperactivity Disorder (ADHD) affects 6% of children and 3% of adults, representing approximately 481,600 youths and 240,800 adults in the Auvergne-Rhône-Alpes region. Despite its prevalence, the French national strategy for neurodevelopmental disorders (2023–2027) highlights the lack of dedicated healthcare pathways for ADHD and the challenges in accessing diagnosis, treatment, and psychosocial rehabilitation. In Auvergne-Rhône-Alpes, the discordance between the significant public health issue posed by ADHD and the local healthcare resources has often led to misdirection and congestion of specialized hospital teams. This situation persists despite the well-documented medical and societal complications of untreated ADHD. At the Vinatier Hospital in Lyon, several specialized teams offer expertise in ADHD for children and adults, but there was no specific team dedicated to ADHD until recently. The Lyon ADHD Coordination Team (ECLAH)Formed in November 2023 at the initiative of professionals from the Vinatier Hospital, ECLAH is a multidisciplinary team comprising psychologists, neuropsychologists, psychiatrists, child psychiatrists, addiction specialists, pharmacists, project managers, and clinical research associates. ECLAH aims to meet the national strategy's requirements for ADHD in the Auvergne-Rhône-Alpes region by coordinating care networks, providing information, training, care, and conducting research in the field of ADHD. ECLAH functions as a resource team, complementing existing structures without replacing them, and focuses on specialization and expertise in ADHD to enhance ongoing efforts. Training MissionThe team contributes to the “Inter-University Diploma in ADHD across all ages” (DIU). The training “ADHD: From Screening to Support” equips healthcare professionals with the knowledge and tools necessary for ADHD diagnosis and treatment. The “DIVA Adult 5.0: Diagnostic Goal!” training focuses on diagnostic reasoning and interviewing techniques for ADHD evaluation. These programs adhere to current scientific data and ADHD guidelines from recognized scientific societies, with a Qualiopi® certification pending for continuous medical education validation. Following training, professionals receive implementation support through multidisciplinary guidance meetings. Coordination and Information MissionECLAH is organizing a care network for ADHD in Auvergne-Rhône-Alpes, collaborating with general practitioners, health and educational institutions, medico-social establishments, penitentiary care, expert centers, and patient associations. The team provides information and guidance to institutions and professionals seeking ADHD-related resources either directly or through its developing website. The team maintains adherence to scientific data and best practice recommendations (RBPP) in the region, fostering expertise through awareness, training, tele-expertise, and multidisciplinary concertation meetings. ECLAH also coordinates with national ADHD organizations, contributing to the harmonization of practices and the development of ADHD guidelines. Care MissionECLAH offers third-line or “recourse” consultations for children and adults with complex cases requiring diagnostic or therapeutic support. These consultations, often involving differential diagnoses and comorbidity assessments, are conducted in partnership with specialized units such as the Center for the Evaluation of Language, Learning, and Attention Disorders (CETESLA) for child psychiatry and the University Addiction Service of Lyon (SUAL) for adults. ECLAH also provides psychoeducation and therapeutic education groups for individuals with complex ADHD or contraindications to medication. A support group for caregivers is planned, leveraging the “BREF” psychoeducation program. Research MissionECLAH engages in medical research, focusing on ADHD characteristics in women by hormonal status, the cessation of methylphenidate treatment in adolescents, links between asthma and ADHD, and screening for ADHD in high-level young athletes. ConclusionECLAH is a third-level territorial team supporting professionals and their ADHD patients in Auvergne-Rhône-Alpes. By coordinating the regional care network, ECLAH enhances the existing care structures, ensuring access to reliable ADHD information and treatment pathways. The team plans to introduce a psychoeducation group for families and prioritize ADHD detection in penitentiary settings for both adults and youths.

Factors associated with work sustainability in patients with bone metastasis.

Working while receiving cancer treatment is challenging for patients, with considerable impact on their quality of life (QOL). However, there have been no reports on the factors that prevent employment in patients with bone metastases. This study aimed to investigate the employment status and factors impacting the continued employment of patients with bone metastases. We analyzed clinical data from new patients consulting The University of Tokyo Hospital team for bone metastasis treatment between June 2015 and September 2017. Patients who were working at the time of cancer diagnosis (n=124) completed four QOL questionnaires. Factors associated with work sustainability were identified via univariate analysis and a chi-squared test. Multivariate logistic regression analysis was used for significant variables. Relationships between employment and QOL scales were investigated using the Wilcoxon rank-sum test, with P<.05 considered as statistically significant. Among the 124 patients, only 45 (36.3%) were still working when the questionnaire was administered. Multivariate analysis revealed temporary employment, lytic or mixed bone metastases, and lower limb or acetabular metastasis, as significant factors hindering work sustainability. The QOL scores were high in the continued employment group. However, the relationship between employment status and pain remains unclear. Lytic or mixed bone metastases and the lower limb and acetabular metastasis were significantly associated with employment resignation. Mobility difficulties may prevent patients with bone metastases from sustaining employment. Collaboration between rehabilitation professionals, oncologists, and workplaces is imperative to address this problem.

Cognitive changes in professional value and career development amid the COVID-19 pandemic: A qualitative study of nurses' experiences.

To explore cognitions in nurses' professional value and career development amid the COVID-19 pandemic and to analyse influencing factors. A qualitative descriptive study design was employed. Thirty practising nurses from three general hospitals in Chengdu, China, were purposively recruited. Face-to-face semi-structured interviews were conducted. The content analysis was used for data analysis. After the outbreak of the COVID-19 pandemic, there were obvious cognitive changes in nurses' professional value, including improvement in the cognition of professional value, awareness of the broadening of the field of acting professional value, and realization of increasingly high requirements in careers. Approval and gratitude of patients, social recognition and attention, self-awareness of nurses were main influencing factors. For cognitive changes in career development, nurses became more motivated to develop their careers, had a clearer understanding of career development environment, and acquired a clearer understanding of what was needed to advance careers. Hospital support, social respect, family support, and team atmosphere were key influencing factors. The contributions made by nurses in the prevention and control of the COVID-19 pandemic have prompted positive changes in their cognition of professional value and career development. To promote nurses' positive understanding and approach to career development, measures should be taken by hospitals. Further, social respect, family support and team cooperation can enhance nurses' enthusiasm for career development.

Organization of Palliative Care Provision in the Palliative Care Department During War Time

The city of Kyiv is characterized by a high level (258.6 cases per 100,000 population) of cancer incidence and mortality. The objective: to determine the problem and prospects of providing inpatient oncology care based on the experience of the department of the Kyiv City Clinical Oncology Center (KCCOC). Materials and methods. A retrospective analysis of the work of the palliative care department of communal non-commercial enterprise “KCCOC” for 2001–2023 was carried out. The center includes a 25-bed hospital and mobile palliative care teams. A multidisciplinary approach was the basis of providing palliative care to an incurable cancer patient. Results. During this period 9,164 cancer patients in the terminal stage with high mortality rate (81.04%) received inpatient care. The average duration of stay in the hospital was 17.7 bed-days. Approximately 6% of patients readmit to the department, some of them – 3-4 times. Approximately 94% of hospitalized patients had a pain syndrome, 86% of patients received opioid analgesia. During this period, mobile palliative care teams registered and served 3,124 cancer patients, among whom 62% of patients were transferred after inpatient treatment, more than 5,700 primary visits were made. The clinical route of the palliative patient was developed and improved, which made it possible to optimize palliative care for a seriously ill oncological patient. The peculiarities of providing palliative care to incurable oncological patients in the conditions of martial law have been determined. Conclusions. Comprehensive palliative care should be a unified system of mobile and stationary care, which will make possible to control the somatic condition of the palliative patient, correct the symptoms of the disease, provide long-term support to the patient at home, which is economically feasible, allows to provide care to a larger number of patients and hospitalize in time if it is necessary. The creation of an extensive system of mobile palliative care is promising in improvement of palliative care for oncology patients (it will reduce the burden on general somatic hospitals and inpatient palliative departments), as well as qualitatively improve the provision of palliative care to patients in the primary care network.

Care First-Fund Later (CareFFuL): an end-of-life home care quality improvement project

Previous work found referrals for end-of-life care are made late in the dying process and assessment processes for care funding, through continuing healthcare fast-track funding often inhibit people being able...

#2302 Bleeding risk stratification following kidney biopsy using “MAJOR BLEEDING RISK SCORE”

Abstract Background and Aims Kidney biopsy (KB) is the gold standard in diagnosing the majority of kidney diseases. While generally KB is a safe procedure, a complication rate of 6-8% has been reported, mainly bleeding. Halimi et al. proposed “The Major Bleeding Risk Score” (MBRS) identifying 11 risk factors (out of a maximum of 41 points) associated with the likelihood of major complications (such bleeding requiring transfusion, arteriography, nephrectomy or death). Method In this retrospective study, we analyzed 358 native KB conducted between 2017 and 2022 by the interventional nephrology team in a tertiary hospital. Following the application of the MBRS, 273 KB were finally included to validate the score within our cohort. Results We analyzed 273 KB, 46.5% were male, with a mean age of 53.6 ± 18.5 years. The majority of KB were performed on the left kidney (82.4%), with an average of 2.1 ± 0.7 cylinders and 12.33 ± 6.27 glomeruli. The MBRS stratified patients into three risk groups: G1 for scores from 0 to 9 points (36.6% KB), G2 for scores between 10 to 19 points (38.8% KB) and G3 for scores from 20 to 29 points (24.5% KB). Eleven patients (4%) had major complications (0.3% in G1, 1.5% in G2 and 2.2% in G3). The risk of bleeding increased proportionally with risk stage (G1 1% vs G2 3.8% vs G3 9%, p=0.037). Patients who experienced a complication after KB had a significantly higher MBRS than patients who did not develop complications (19 ± 5.23 points vs 13 ± 7.19 points, p=0,01). Patients who developed complications associated anaemia, thrombopenia and lower BMI more frequently than patients who did not develop complications (23.6 ± 5.9 vs. 27.3 ± 5.4, p=0.03). The pathology with the highest bleeding was thrombotic microangiopathy [OR 10,54 (2,39-46,51)]. Conclusion The MBRS adequately stratifies patients according to bleeding risk and could be a valuable tool in the clinical practice guiding the decision to proceed with the kidney biopsy.

Perioperative Management of Traditional and Direct Oral Anticoagulants in Hip Fracture Patients.

Hip fractures are an increasingly common injury in the senior population and almost always require surgical fixation or prosthetic replacement. These surgeries, according to the American Academy of Orthopaedic Surgeons, are considered high-risk for bleeding, especially in a population fraught with comorbidities and often presenting on anticoagulation medications. Direct oral anticoagulants represent a class of drugs that have been becoming more popular in use in this population, with many benefits over the historically used Warfarin. There are recommendations for preoperative discontinuation and postoperative resumption of these medications, which can be more readily managed for elective surgeries. However, there is a paucity of literature detailing best practice guidelines for the perioperative management of direct oral anticoagulants when a patient presents with a hip fracture. This review article summary of the periprocedural management of DOACs for hip surgery was developed by examining the American College of Chest Physicians evidence-based clinical practice guidelines, Perioperative Guidelines on Antiplatelet and Anticoagulant Agents written by anesthesiologists, various retrospective studies, and drug labels for pharmacokinetic data. These recommendations should be used as a guideline, along with the collaboration of multidisciplinary hospital teams during inpatient admission, to manage these complex patients.

Decoding healthcare teamwork: a typology of hospital teams

ABSTRACT The effectiveness of healthcare depends on successful teamwork. Current understanding of teamwork in healthcare is limited due to the complexity of the context, variety of team structures, and unique demands of healthcare work. This qualitative study aimed to identify different types of healthcare teams based on their structure, membership, and function. The study used an ethnographic approach to observe five teams in an English hospital. Data were analyzed using a combined inductive-deductive approach based on the Temporal Observational Analysis of Teamwork framework. A typology was developed, consisting of five team types: structural, hybrid, satellite, responsive, and coordinating. Teams were challenged to varying degrees with staffing, membership instability, equipment shortages, and other elements of the healthcare environment. Teams varied in their ability to respond to these challenges depending on their characteristics, such as their teamworking style, location, and membership. The typology developed in this study can help healthcare organizations to better understand and design effective teams for different healthcare contexts. It can also guide future research on healthcare teams and provide a framework for comparing teams across settings. To improve teamwork, healthcare organizations should consider the unique needs of different team types and design effective training programs accordingly.