Patient Contact Time Research Articles

P003 Service Improvement of Collecting axSpA Disease Activity metrics at Mid Yorkshire Hospital Rheumatology Service

Abstract Background and aims ASAS-EULAR guidance on the management of Axial Spondyloarthropathy (AxSpa) recommends regular collection of Disease Activity Metrics like Bath AxSpa Disease Activity Index (BASDAI) (Ramiro et al., 2022). NICE advocates use of BASDAI in disease management. Mid Yorkshire NHS Rheumatology service also collects BASFI and BASMI measures regularly (6-12 months). This has been historically collected by Physiotherapists. Staff time is at a premium and collection of AxSpa measures was recognised as an opportunity for improvement by utilising the team’s skills. This work mirrors other evaluations of collecting disease monitoring data (Labinsky et al., 2024). The aims of the service improvement project are to maintain collection of disease metrics to inform management of AxSpa and improving utilisation of staff skills. Methods Review of services between 2022/23 recommended educational investment in Non-Qualified Therapy staff (TIs) and use of digital patient management platforms (SystmOne) to improve collection of Disease Activity Metrics. A comprehensive training program was developed for non-qualified therapy staff with training materials and a supervision program to undertake metrics. Clinical processes were developed to allow assessments to be completed in 30 min. Developments included set up of clinics and remote collection of self-reported outcomes by email, text or telephone (validated by Ariza-Ariza et al., 2013). Development of use of SystmOne reduced data entry processes and facilitated collection of Disease Metrics remotely. Physiotherapist and non-qualified staff patient contact and contact time metrics were compared between 1/1/2022 to 7/8/2022 with 1/1/2023 to 7/8/2023, extracting data from SystmOne. Results Total time spent with patients completing AxSpa metrics and treatment increased from 149.78 hours in 2022 to 208.75 hours in 2023. There was a reduction in Physiotherapy time completing AxSpa measures from 145.28 hours to 128.75. TI staff have increased their involvement in completing AxSpa metrics; TI expending 80 hours over 97.5 contacts in 2023, compared to only 4.5 hours in 4 contacts in 2022. Conclusions Investment in training of non-qualified therapy staff to collect axSpa Disease Activity Metrics has improved staff utilisation; Upskilling the TIs and freeing Physiotherapists to be more involved in the treatment of patients. Increases in overall contact time requires further exploration of cause. Improvement of core processes of Disease Activity Metrics requires further ongoing auditing to understand how new roles and processes mature. There are further opportunities to link data collection to local tertiary centres to promote research activity and further exploration of self-reporting of metrics.

Assessing Adherence to Acute Stroke Therapy Guidelines: An Audit Study

Abstract Background The 2023 National Clinical Guidelines for stroke for the UK and Ireland recommended that people with motor recovery goals post stroke should receive at least 3 hours (180 minutes) of rehabilitation per day on at least 5 out of 7 days a week. This is a significant change to previous guidelines that recommended that patients receive at least 45 minutes of each therapy for a minimum of 5 days (NICE 2013). In 2022, the UK Sentinel Stroke National Audit Programme found that only 11.9% received more than 45 minutes of physiotherapy. This highlights that many services were not achieving previous recommendations. Methods In an Irish hospital, two new stroke assistant posts were funded with the aim to maximise therapy time. An audit was performed on compliance with the 2023 national guidelines on an acute stroke unit in august 2023 for patients that were identified as having motor goals post stroke. Data was collected in the form of minutes of direct patient contact time by each therapy –physiotherapy, occupational therapy, speech and language therapy and therapy assistants. This data was compared against recommended therapy time and presented as a percentage of this. Results 9 acute stroke patients who were identified as having motor goals were randomly selected. It was found that none of these patients were meeting current therapy guidelines. When compared to the recommendations, the average amount of therapy that patients received per day ranged from 44 minutes – 132 minutes. On average, patients received 49.1% of recommended therapy. It was also found that therapy assistants were providing, on average, 59.3% of the actual therapy received. Conclusion Stroke patients are not receiving the recommended amount of therapy as per the most recent guidelines. Although the addition of stroke assistants significantly increased therapy time, guidelines were still not achieved.

The effect of nurses' perceived stress on their work engagement and perceived professional benefit during the routine management of the COVID-19 pandemic.

In a previous study, more attention has been given to the psychological state of doctors than to that of nurses although the workload, working hours, and patient contact time are generally higher for nurses than doctors. The current status of nurses' perceived stress, work engagement, and perceived professional benefit during the routine management of the Coronavirus disease 2019 (COVID-19) pandemic and how their perceived stress affects the other two variables are topics that merit research attention. In this study, the status of nurses' perceived stress, work engagement, and perceived professional benefit during the routine management of the COVID-19 pandemic was investigated to explore whether their perceived stress level has any effect on the other two variables. The convenience sampling method was adopted, and 669 nurses from the First People's Hospital of Jingzhou were selected to participate in this study. Questionnaires on perceived stress, work engagement, and perceived professional benefit were used in the survey, and the data were processed using the SPSS 20.0 program for the descriptive statistics, independent sample t-test, analysis of variance. The total score of the nurses' perceived stress was 18.58±4.37 points. The total scores of their work engagement (43.32±14.01) and perceived professional benefit (140.23±17.75). The nurses' total perceived stress score was at an upper-middle level, and their total work engagement and perceived professional benefit scores were relatively high. Overall, perceived stress has a negative effect on nurses' work engagement and perceived professional benefit. That is, the higher the pressure perception of nurses, the lower the degree of work engagement and perceived professional benefit.

Under Armour – Use of personal protective equipment for simulated CPR of COVID-19 patients: an observational study

BackgroundPersonal protective equipment (PPE) protects healthcare workers and patients. Data on guideline compliance on how to dress (donning) or remove (doffing) PPE and the assistance among multiple participants (buddying) are limited. This study assesses the quality of donning, doffing, and buddying of PPE in a simulated medical emergency.MethodPhysicians handling a simulated cardiac arrest of a COVID-19 patient. Adjacent to the victim, PPE was available. The appropriateness of PPE choice was assessed by using video recordings, with each individual participant being analyzed from the beginning of the simulation scenario from two perspectives regarding the selection of items during donning and doffing, hygiene aspects, time, and team support (buddying). The primary outcome was the number of participants being appropriately protected, defined as both wearing (a) all PPE items provided, and (b) all PPE items correctly at the time of first patient contact (FPC). Secondary outcomes included the timing of participants being appropriately protected. Statistical analysis was performed using SPSS (version 28). Mann–Whitney test, chi-square test, and linear regression analysis were performed as appropriate.ResultsAt first patient contact 21% (91/437) were correctly protected. One or more incorrect PPE items were found in 4% (19/437), whereas 61% (265/437) wore one or more PPE items incorrectly. In 14% (62/437), one or more PPE items were missing. The time interval between donning start and FPC was 66 (55–78) sec. Time to FPC was longer in correctly than in incorrectly protected participants 77 (66–87) vs. 64 (54–75) sec; p < 0.001) and decreased by 7 ± 2 s per PPE item omitted (P = 0.002). Correct doffing was observed in 192/345 (56%), while buddying occurred in 120 participants (27%), indicating that they either assisted other participants in some manner (verbally or physically) or received assistance themselves.ConclusionsOur findings imply a need for education in correct and timely PPE donning and doffing. Donning PPE as intended delayed FPC. This and the influence of buddying needs further investigation (German study register number DRKS00023184).

Quantifying unmet need in General Practice: a retrospective cohort study of administrative data

ObjectivesTo assess whether patients attending general practices (GPs) in socioeconomically (SE) deprived areas receive the same amount of care, compared with similar patients (based on age, sex and level of...

Healthcare-Associated Infections (HAIs): Challenges and Measures Taken by the Radiology Department to Control Infection Transmission.

Infections contracted during healthcare delivery in a hospital or ambulatory setting are collectively referred to as healthcare-associated infections (HAIs). Healthcare workers and patients alike are vulnerable to serious problems as a result of the risk of HAIs. In the healthcare system, HAIs are considered among the most common and serious health problems. However, the occurrence of HAIs differs between different types of clinical departments within the hospital. Recently, the risk of HAIs has been increasing in radiology departments globally due to the central role of radiology in guiding clinical decisions for the diagnosis, treatment, and monitoring of different diseases from almost all medical specialties. The radiology department is particularly vulnerable to HAIs because it serves as a transit hub for infected patients, non-infected patients, and healthcare workers. Furthermore, as the number of patients referred to radiology and the length of patient contact time has increased, thanks to modern imaging techniques such as computed tomography and magnetic resonance imaging, the risk of HAIs has also increased significantly. With the increasing use of interventional radiological procedures, patients and healthcare workers face a potentially greater risk of contracting HAIs due to the invasive nature of such procedures. Although not exhaustive, we attempted through a literature search to provide a general overview of infection prevention and control practices, address HAIs in the radiology departments, and highlight the challenges and measures taken to control infection transmission in the radiology departments.

93 Patients With Sickle Cell Disease Pain Crises Are Often Undertreated in the Out-of-Hospital Setting: A Multi-Agency Cohort Study

93 Patients With Sickle Cell Disease Pain Crises Are Often Undertreated in the Out-of-Hospital Setting: A Multi-Agency Cohort Study

Effectiveness of Student-Led Interventions on Improving Diabetes Outcomes: A Systematic Review

ABSTRACT Background Diabetes education and treatment is a public health priority. Student-delivered strategies have the potential to offer low-cost, high-quality healthcare services to underserved patients while giving students practice experience. However, the effectiveness of these interventions is unknown. Purpose To document study characteristics and the effectiveness of student-delivered interventions on diabetes health outcomes. Methods Databases searched included Medline, CINAHL Plus, and others. Appropriate keywords/subject headings were used to identify studies meeting inclusion criteria. Two reviewers independently extracted data which were compared, and conflicts resolved by discussion. Results Seven studies met inclusion criteria. Six had statistically significant improvement in outcomes including HbA1c, a long-term glycemic control indicator (n = 4), blood pressure (n = 3), physical activity (n = 1), and exercise stage of change (n = 1). Studies involved medical (n = 3), pharmacy (n = 2), nursing (n = 1), and exercise science (n = 1) students. Studies with improved outcomes tended to have more patient contact. Discussion This review provides evidence that student-led diabetes interventions may be effective at improving outcomes, although studies reviewed are limited by lack of comparison groups and representative samples. Translation to Health Education Practice: Student-delivered diabetes interventions may improve outcomes, especially with adequate patient contact time. Studies of theory- and evidence-based student-led diabetes interventions involving health education/promotion students are warranted.

Public Perceptions About Home Delivery of Medication Service and Factors Associated with the Utilization of This Service

IntroductionHome medication delivery service is a major service for the public. It reduces overcrowding and unnecessary visits to health centers. This study aims to investigate the public perception of home delivery of medication service in Jordan and evaluate factors affecting the use of this service.MethodsThe study was conducted in March 2022 using an online survey. Participants were asked to fill out a validated questionnaire to evaluate their perception of home delivery of medication service.ResultsAmong the 1032 adult participated in this study, the majority reported that they had heard of home delivery of medication service (n = 832, 80.6%). However, only 30.9% of them have used this service before. Results showed that 71.4% of the participants (n = 737) believe that home delivery of medication service is more convenient and accessible than in-store drug refill. In addition, 65.6% of the participants (n = 677) believed that home delivery of medication service is suitable only for refill-prescription drugs (65.0%). The main pros of the service as perceived by the study participants were to serve sick patients, elderly, and disabled people (n = 822, 79.7%). In contrast, the inability of patients to build a professional relationship with pharmacists using home delivery of medications service was the most perceived con of this service (n = 627, 60.8%). Finally, regression analysis revealed that older participants, those with chronic diseases, and those who visit community pharmacies two times or more per month revealed higher use of the service (P = <0.05).ConclusionThis study has shown that most participants showed positive perceptions toward the home delivery of medication services. However, participants believed that this service may decrease pharmacist’s patient contact time, thus affecting the quality of medication counseling. More comprehensive future studies are necessary to examine the financial aspects of such a service and its associated drawbacks.

Hand Hygiene Behaviors Monitored by an Electronic System in the Intensive Care Unit

Background Hand hygiene (HH) compliance is hard to improve, and underlying behaviors are not clearly understood among healthcare workers. We aim to use an electronic HH system installed in an intensive care unit (ICU) to study healthcare workers’ HH behaviors and underlying reasons. Methods An electronic hand hygiene system was installed in a 10-bed surgical intensive care unit that automatically detected HH opportunities when healthcare workers entered or exited a patient room and tracked the healthcare worker's HH compliance. HH compliance rate and patient contact time were calculated and analyzed at both the ICU and individual levels over time. Results A total of 27,692 HH opportunities were recorded during this 6-month trial period. The HH compliance rate was significantly higher when healthcare workers exited patient rooms than when they entered rooms (37.3% vs. 26.1%, P < 0.001). The full, partial, and total HH compliance rates of quick in-out of room (in room less than 3 seconds) events were significantly lower than those of long in-out room (in room more than 30 seconds) events (23.45% vs 32.77%, 21.44% vs 35.03%, and 44.88% vs 67.81% respectively) (P-value < 0.001). There were also significantly differences in HH compliance among individual healthcare workers (P < 0.001). No statistically significant difference was found in overall HH compliance rate and patient contact time over hours of the day or days of the week except partial HH compliance rates. Conclusions Hand hygiene behaviors are complex and healthcare worker dependent. This study showed patterns in healthcare workers’ HH behaviors at both the ICU and individual level, which could facilitate targeted and personalized interventions to improve healthcare workers’ HH compliance. Hand hygiene (HH) compliance is hard to improve, and underlying behaviors are not clearly understood among healthcare workers. We aim to use an electronic HH system installed in an intensive care unit (ICU) to study healthcare workers’ HH behaviors and underlying reasons. An electronic hand hygiene system was installed in a 10-bed surgical intensive care unit that automatically detected HH opportunities when healthcare workers entered or exited a patient room and tracked the healthcare worker's HH compliance. HH compliance rate and patient contact time were calculated and analyzed at both the ICU and individual levels over time. A total of 27,692 HH opportunities were recorded during this 6-month trial period. The HH compliance rate was significantly higher when healthcare workers exited patient rooms than when they entered rooms (37.3% vs. 26.1%, P < 0.001). The full, partial, and total HH compliance rates of quick in-out of room (in room less than 3 seconds) events were significantly lower than those of long in-out room (in room more than 30 seconds) events (23.45% vs 32.77%, 21.44% vs 35.03%, and 44.88% vs 67.81% respectively) (P-value < 0.001). There were also significantly differences in HH compliance among individual healthcare workers (P < 0.001). No statistically significant difference was found in overall HH compliance rate and patient contact time over hours of the day or days of the week except partial HH compliance rates. Hand hygiene behaviors are complex and healthcare worker dependent. This study showed patterns in healthcare workers’ HH behaviors at both the ICU and individual level, which could facilitate targeted and personalized interventions to improve healthcare workers’ HH compliance.

A Comparison of Self-evaluated Survey and Work Sampling Approach for Estimating Patient-care Unit Cost Multiplier in Genetic Nursing Activities

To compare patient care multipliers estimated from subjective evaluation against work sampling (WS) techniques in genetic nursing activities. An observational WS technique was conducted from November to December 2019 with nine genetic nurses in a tertiary referral center in Malaysia. The WS activity instrument was devised, validated, and pilot tested. All care- and non-care-related activities were sampled at 10-minute intervals within 8hours of working over 14days, followed by a subjective evaluation of activities survey over the same period. Bonferroni correction was undertaken for multiple testing with a p value of 0.0025. The two techniques produced significant differences in genetic nurses' activities categorization. The WS showed that compared with subjective evaluation, direct care (19.3% vs. 45.0%; p<.001) was estimated to be significantly lower, and indirect care (40.4% vs. 25.6%; p<.001) and unit-related activity (28.5% vs. 16.9%; p<.001) were higher. Both techniques produced a similar proportion of time spent in other non-care activities (12.0%) but differed in genetic meetings and information-gathering activities. While the multipliers for patient face-to-face contact were significantly larger between WS (4.57) and the survey (1.94), the multipliers for patient care time were smaller between WS (1.47) and the survey (1.24), indicating that caution should be taken when multiplying for patient contact time compared to patient care activity to determine the cost of care provision. A considerable proportion of time spent away from the patient needs to be allocated to patient-related care time. Thus, estimating the paid cost solely based on direct time with patients considerably underestimates the cost per hour of nurses' care. It is recommended to employ 'patient-related activity' instead of the 'face-to-face contact' multiplier because the former did not significantly differ from the one estimated using WS.

P083 Undergraduate rheumatology teaching in the UK: a survey of teachers

Background/AimsSince the last UK wide survey of undergraduate (UG) education in rheumatology in 2000 (1), the landscape of both university teaching and clinical services has altered significantly. There has been an increase in the number of medical schools (26 to 37), rise in student numbers, curricula expansions, plus the impact of Covid-19. This survey evaluates the current status of rheumatology teaching in the UK and highlights areas for the Rheumatology community to consider when planning future training.MethodsIn early 2021, a ‘Survey Monkey’ was emailed to named MSK leads representing all 37 UK schools. This included open and closed questions and explored themes from previous published surveys. Reminders were sent after 2 and 4 weeks.ResultsResponses were received from 34/37 (92%) schools. There is wide variation in what, when and how teaching is delivered, but the vast majority deliver rheumatology specific teaching spread across years 1-5. Overall length of clinical rheumatology exposure varied from 3 days to 7 weeks, delivered either as separate days (e.g. in integrated placements or PBL), as formal blocks (often with orthopaedics) or within a student selected component. Approximately 25% of teaching is delivered in primary care. Most is delivered in Year 4. Most schools have a designated rheumatology lead: a clinical academic or clinician. Teaching is acknowledged in most job plans with educational roles discussed at appraisals. Small group teaching remains the most common method of delivering formal teaching, followed by on-line learning and lectures. The majority of teaching is delivered by consultants, trainees and research fellows.A wide range of barriers were noted including competing pressures from clinical work, lack of physical space for teaching and the volume of medical students. Due to COVID-19, 50% of medical schools suspended placements at some point during the pandemic. 70% of schools reported a 50-75% reduction in patient contact time for students reflecting the national data re: 20% of rheumatology departments functioning at less than 50% during the pandemic (2). Many schools reported designing new innovative (often online) resources to support learning during the pandemic. Available resources such as the Versus Arthritis patient examination videos (available on YouTube) and flipbook were noted to be particularly useful learning resources.ConclusionOver the past 20 years, rheumatology UG teaching has remained strong but time for dedicated rheumatology training has reduced in some centres. Remote learning has become more common, which coupled with Covid, has raised concerns amongst teachers that students are not getting sufficient clinical exposure. There is interest for a rheumatology UG community to create and share online resources and act as a source of support.Disclosure P. Watson: Other; Pip is employed by the BSR as eLearning editor. D. Coady: None. D. Southam: Other; Daisy is employed by the BSR as head of Education. D. Andrew: None. V. Logan: Other; Victoria is employed by the BSR as Director of Marketing and Education. R. Wakefield: None.

Counselling of the Surgical Patient: Opinion of Caregivers

Aim: The aim of this study was to ascertain the opinion of caregivers on counselling of the surgical patient in tertiary healthcare facilities in Port Harcourt in the months of May and June 2020. Background: The care of the surgical patient partly requires that an informed consent be obtained before a therapeutic or diagnostic surgical objective is accomplished. Surgical counselling should therefore alleviate the fears of patients and relatives on intended surgery and anesthesia and prepare patient for possible postsurgical deficits. Materials and Methods: All surgical caregivers available at the point in time who gave their consent were recruited for this cross-sectional descriptive study carried out in the wards and specialist surgical out-patient clinics of Teaching Hospitals in Port Harcourt, Nigeria between the months of May and June 2020 using semi-structured questionnaires. Data obtained was analysed using the Statistical Package for the Social Sciences (SPSS) version 20.0. Results: Although 89.8% of respondents affirmed communicating information on the nature and purpose of the treatment to patients, only 161 (56.7%), 158 (55.6%), 156 (54.9%), and 156 (54.9%) responded in the affirmative to discussing the involved risks, potential benefits, available alternatives and the effects of non-treatment respectively. Lack of adequate time for consultation was considered a hinderance by 230 (81.0%) respondents. Conclusion: The challenge most asserted as a hinderance to surgical patients’ counselling was short patient contact time during counselling sessions. The overstretched tertiary health facilities can be decongested if efforts are made by governments to ensure optimum function of the health centers.

In safe hands: a qualitative study on older adults’ experiences of a tailored primary health care unit

Objective: Today’s health care system faces challenges in meeting the needs of older people with multimorbidity. To better cope with these needs, tailored primary health care with geriatric competence and person-centred care has been suggested. The aim of this study was to explore older patients’ experiences of a tailored primary health care unit. Design: This was a qualitative study using semi-structured individual interviews and qualitative content analysis. Setting and patients: Nineteen patients were recruited from a tailored PHC unit for people aged 75 years or older in a region in central Sweden. Methods: The interview data were analysed using inductive category development. Results: In the analysis, the theme In safe hands when in need of primary health care emerged. The interviewees expressed a desire to participate in their own care. Easy access, enough consultation time and a calm environment, along with the PHC professionals’ welcoming and attentive approach enhanced their feeling of being in safe hands. PHC professionals were perceived as having geriatric knowledge and taking responsibility for the care of older patients. Although the interviewees experienced that they received attention for their health conditions, a need for a more preventive approach to care emerged. Conclusion: Older patients highly appreciated their tailored PHC unit and they emphasised that it was an improvement compared to the ordinary PHC centre. This study provides insights into older patients’ experiences, which may be helpful in the ongoing process of improving care for older patients in PHC. KEY POINTS Older patients attending a tailored Primary health care (PHC) unit felt acknowledged, unlike in the ordinary PHC centre, which facilitated their participation in their care. The calm environment, specialist geriatric competence and ample patient contact time enabled them to feel secure and taken care of. Older patients expressed a need for an incorporation of social services and health promotion visits at the tailored PHC unit.

Hand hygiene behaviours monitored by an electronic system in the intensive care unit – a prospective observational study

It is difficult to improve compliance with hand hygiene (HH), and underlying behaviours are not clearly understood among healthcare workers. To study HH behaviours among healthcare workers. This was a prospective observational study. A Sanibit electronic HH system was installed in a 10-bed surgical intensive care unit (ICU) that detected HH opportunities automatically when healthcare workers entered or exited a patient room, andtracked the HH compliance of healthcare workers. The HH compliance rate and patient contact time were calculated and analysed at both ICU level and individual level over time. In total, 27,692 HH opportunities were recorded over this 6-month trial period. The HH compliance rate was significantly higher when healthcare workers exited patient rooms than when they entered patient rooms (37.3% vs 26.1%; P<0.001). Full, partial and total HH compliance rates of 'quick in and quick out' (in room for <3s) events were significantly lower than those of 'long in and long out' (in room for >30s) events (23.45% vs 32.77%, 21.44% vs 35.03% and 44.88% vs 67.81%, respectively; P<0.001). There were also significant differences in HH compliance between individual healthcare workers (P<0.001). No significant differences in overall HH compliance rate and patient contact time were found between hours of the day or days of the week, except partial HH compliance rates. Patterns of HH behaviours among healthcare workers are complex and variable, which could facilitate targeted and personalized interventions to improve HH compliance. NCT03948672.

Safety of Air Medical Transport of Patients With COVID-19 by Personnel Utilizing Routine Personal Protective Equipment

BackgroundAir medical transport of patients with known or suspected COVID-19 likely represents a high-risk exposure to crewmembers as aircraft cabins are quite small resulting in very close personal contact. The actual risk to medical crewmembers is not known.MethodsWe conducted an IRB-exempt, retrospective study of air medical transport of patients with known or suspected COVID-19 by eight programs in the Four Corners Region to determine the number of symptomatic COVID-19 among air medical crew members compared to total exposure time. All programs utilized similar routine PPE including N-95 masks and eye protection. Total exposure time was considered from time of first patient contact until hand-off at a receiving hospital.ResultsThere were 616 air transports: 62% by fixed-wing and 38% by rotor-wing aircraft between March 15th and September 6th 2020. 407 patients (66%) were confirmed COVID+ and 209 (34%) were under investigation. Patient contact time ranged from 38 to 432 minutes with an average of 140 minutes. The total exposure time for medical crew was 2,924 hours; exposure time to confirmed COVID+ patients was 2008 hours. Only 30% of patients were intubated, the remainder had no oxygen (8%), low flow nasal cannula (42%), mask (11%), high-flow nasal cannula (4.5%) and CPAP or BPAP (3.5%). Two flight crew out of 108 developed COVID that was presumed related to work.ConclusionsAir Medical Transport of patients with known or suspected COVID-19 utilizing routine PPE is remarkably safe for medical crew members, even when patients are not intubated. This has implications for healthcare personnel in any setting that involves care of patients with COVID-19 in similarly confined spaces.

Performance and impact of an airway management team launched during the COVID-19 pandemic.

PurposeTo determine the performance and impact of an airway management team (AMT) assembled during the COVID-19 pandemic.MethodsWe conducted a retrospective cohort review of all adult patients who had received airway management services from the AMT (n = 269) and administered a survey questionnaire targeting physicians who had the option to activate the AMT (n = 77). The retrospective review determined the performance of the AMT, and the physicians’ survey evaluated the impact of the AMT. The study was conducted at a large Canadian health centre (1,133 beds) from 28 March to 30 June 2020. We included patients in the cohort review who were ≥18 yr of age, whose chart showed that the AMT was activated, and whose airway was managed outside the operating room. We reviewed both electronic medical records and paper chart documentation. Outcomes included intubation success, number of intubation attempts, intubation time, team response time, patient contact time, intubation complications, and breaches of personal protective equipment (PPE) protocol. The physicians’ survey evaluated the relevance, performance, reasonableness, and clinical utility of the AMT.ResultsThe AMT intubated 231 patients. Charts showed that 91% of intubations were accomplished on first attempt. The mean (standard deviation) intubation time was 2.1 (0.2) min. The complication rate was minimal. The incidence of breaching PPE protocol items was less than 6%. No AMT members reported COVID-19 symptoms. The response rate for the physician’s survey was 36%. The consensus among the participants was that the AMT had considerable clinical utility during the COVID-19 pandemic.ConclusionAn AMT assembled during the COVID-19 pandemic showed high competency and effectiveness, and had favourable impact on the main responsible physicians who activated the team.

Understanding multidisciplinary care for people with rheumatic disease in British Columbia, Canada, through patients, nurses and physicians voices: a qualitative policy evaluation

BackgroundIn 2011, the province of British Columbia (BC) moved to allow patients with complex rheumatic disease to be seen by nurses along with their rheumatologist by introducing a ‘Multidisciplinary Care Assessments’ (MCA) billing code (G31060).ObjectiveTo describe multidisciplinary care introduced as part of MCAs across BC and investigate the perceived impact of this intervention, the addition of nurses to the care team, on patient care from the perspective of patients, nurses, and rheumatologists.MethodsWe conducted semi-structured interviews, informed by a qualitative evaluation approach with patients, nurses, and rheumatologists from September 2019 – August 2020. Interviews investigated 1) the experiences of all stakeholders with adopting the multidisciplinary care billing code, 2) the perceived role of the nurse in the care team, and 3) the perceived impact of multidisciplinary care on patient experience and outcomes. We purposefully sampled practices for maximum variation of geographical location (rural vs. urban), size of practice (i.e., patient caseload), and number of nurses employed.ResultsWe interviewed 21 patients, 13 nurses, and 12 rheumatologists from across BC. Our analysis identified variation in the way rheumatologists adopted multidisciplinary care across BC. Our analysis showed some heterogeneity in the way the MCA was delivered in rheumatology practices; however, patient education was identified as the core role of nurses across practices. We identified six core themes describing the impact of this model of care, all representing improvements in the way practices functioned, from improved efficiency to access, patient experience, time management, clinician experience, and patient health outcomes. Contextual factors that influenced the presence of these themes were related to the time the nurses spent with patients and the professional roles they performed.ConclusionOur results suggest nurse care can complement physician care by extending contact time for patients and promoting the efficient use of health care professionals’ skills, time, and resources. These data may encourage future uptake of the billing code to help ensure the policy delivers maximum benefits to patients given the wide range of perceived benefits described by clinicians and patients.

An Updated Definition and Severity Classification of Chronic Obstructive Pulmonary Disease Exacerbations: The Rome Proposal.

The current definition of a chronic obstructive pulmonary disease (COPD) exacerbation (ECOPD) is based solely on worsening respiratory symptoms, with severity classified post hoc by the healthcare resource used to treat the event, which may vary among practitioners and healthcare systems. These shortcomings support a need to revise the ECOPD definition and severity classification to one that is useful at time of patient contact. To achieve this, an expert panel used a modified Delphi method of five rounds of questions generated by a thorough review of the literature, supplemented by virtual discussions. For the 80 identified questions, the agreement level was rated using a Likert scale from 0 (strongly disagree) to 9 (strongly agree). Consensus was defined a priori as a median score ≥7 (strong agreement). The proposed definition states: "In a patient with COPD, an exacerbation is an event characterized by dyspnea and/or cough and sputum that worsens over ≤14 days, that may be accompanied by tachypnea and/or tachycardia, often associated with increased local and systemic inflammation caused by airway infection, pollution, or other insult to the airways." Three severity categories (mild, moderate, or severe) were defined using integration of six clinically measurable variables: intensity of dyspnea, oxygen saturation, respiratory rate, heart rate, C-reactive protein, and, if indicated, arterial blood gases. In conclusion, by incorporating measurable clinical and laboratory variables at the time of exacerbation, the Rome proposal for an updated definition of ECOPD could help standardize care and outcomes for clinicians and researchers alike. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Case-control study evaluating risk factors for SARS-CoV-2 outbreak amongst healthcare personnel at a tertiary care center

BackgroundDespite several outbreaks of SARS-CoV-2 amongst healthcare personnel (HCP) exposed to COVID-19 patients globally, risk factors for transmission remain poorly understood. MethodsWe conducted an outbreak investigation and case-control study to evaluate SARS-CoV-2 transmission risk in an outbreak among HCP at an academic medical center in California that was confirmed by whole genome sequencing. ResultsA total of 7/9 cases and 93/182 controls completed a voluntary survey about risk factors. Compared to controls, cases reported significantly more patient contact time. Cases were also significantly more likely to have performed airway procedures on the index patient, particularly placing the patient on high flow nasal cannula, continuous positive airway pressure (CPAP), or bilevel positive airway pressure (BiPAP) (OR = 11.6; 95% CI = 1.7 –132.1). DiscussionThis study highlights the risk of nosocomial infection of SARS-CoV-2 from patients who become infectious midway into their hospitalization. Our findings also reinforce the importance of patient contact time and aerosol-generating procedures as key risk factors for HCP infection with SARS-CoV-2. ConclusionsRe-testing patients for SARS-CoV-2 after admission in suspicious cases and using N95 masks for all aerosol-generating procedures regardless of initial patient SARS-CoV-2 test results can help reduce the risk of SARS-COV-2 transmission to HCP.