Limited Workforce Research Articles

Fostering links, building trust, and facilitating change: connectivity helps sustain longitudinal integrated clerkships in small rural and remote communities

BackgroundMaldistribution of medical professionals presents a significant challenge globally and leads to inequitable healthcare access, particularly in remote areas. Longitudinal integrated clerkships (LICs) in rural areas can improve workforce distribution and may be an innovative contributor to solving maldistribution issues. However, to align with healthcare needs, LICs must be sustainable in small communities, which often have a limited medical workforce. This study investigates the key elements underpinning LIC sustainability in small communities.MethodsThis study adopted a constructivist research paradigm in which participants’ constructions of their experiences supporting LICs in small rural communities were explored. Participants were conveniently sampled from the LIC community of practice attending the 2021 virtual annual conference of the Consortium of Longitudinal Integrated Clerkships. Data were collected through video recording and thematically analysed to identify barriers and enablers to running sustainable LIC programmes.ResultsEleven participants fulfilling key roles within LICs, including clinical school directors, program coordinators, and clinical educators, were recruited for the study. Thematic analysis indicated that it is Connectivity, expressed through three subthemes, Fostering Links, Building Trust, and Facilitating Change, which underpins sustainable LICs in small communities.ConclusionsConnectivity is a strong mediator for sustainability of LICs and may be the central defining theme of LICs. Increasing connectivity through prioritizing community engagement, trust-building, and strategic investment enhances the sustainability of rural LICs, ensuring their continued positive contribution to medical workforce distribution in underserved areas.

Unlocking wind power potential to improve energy security in Ethiopia

Ethiopia possesses abundant wind resources that have the potential to revolutionize its energy sector by providing reliable and sustainable electricity through wind power. Despite the presence of a few operational wind farms, the country is facing challenges in generating sustainable electricity. The slow progress in wind power development raises concerns, as the impact of declining power generation from existing wind farms on economic development and return on investment remains insufficiently examined. The research paper aims to examine the status, challenges, and opportunities in developing, deploying, and sustaining wind power generation. This was accomplished through qualitative and quantitative analysis using 11 years of power generation data from operational wind farms and field research. Data sources include Ethiopian Electric Power, wind power operation reports, official government reports, field observations and discussions with wind power operators. The study reveals that challenges such as intermittent wind resources, high initial investment costs, inadequate transmission infrastructure, limited skilled workforce, and environmental concerns hinder the realization of wind energy's full potential. The article provides evidence-based recommendations for policymakers and the wider stakeholders to address the challenges and maximize benefits of wind energy in Ethiopia. This contributes to understanding the current situation and necessary actions to harness the country's abundant wind power potential.

Workforce development in private practice dietetics: experiences and perceptions of experienced practitioners.

Changes in Australian health policies and public funding models have increased the demand for private dietetics services over the past two decades. Limited available workforce data indicate that over half of the Australian dietetics workforce works in private practice at some level, with approximately 30%-50% of dietitians now entering private practice as new graduates. These changes in the sector have implications for dietetics workforce development. The present study aimed to explore private practice dietitians' perceptions and experiences about workforce development needed to successfully work as a private practice dietitian. Australian private practice dietitians were purposively sampled for participation in semistructured interviews on their experiences of, and perceptions about, workforce development needs for successful private practice. Data were analysed using qualitative thematic analysis methods. Sixteen dietitians participated. Twenty-seven themes emerged across seven constructs spanning pathways to practice, the work of private practitioners, workforce preparation, competency development, placements, competency requirements and challenges. Experienced private practice dietitians offer critical insights into the workforce development needs and challenges of the sector. Study participants indicated that their preparation for private practice was suboptimal and they have endured many challenges during their careers. This study highlights the need for a strategic approach to workforce development for private practice, including further research into the preparation and needs of this evolving area.

Influence of Blood Sampling Service Process Reengineering on Medical Services Supply: Quasi-Experimental Study.

Tertiary hospitals in China are confronted with significant challenges due to limited spatial capacity and workforce constraints, leading to saturated allocation of medical resources and restricted growth in medical service provision. The incorporation of digital health into medical service process reengineering (MSPR) marks a pivotal transformation and restructuring of conventional health service delivery models. Specifically, the application of MSPR to blood sampling services processes reengineering (BSSPR) holds promise for substantially enhancing the efficiency and quality of medical services through streamlining and optimizing these procedures. However, the comprehensive impact of BSSPR has been infrequently quantified in existing research. This study aims to investigate the influence of BSSPR on the efficiency and quality of medical services and to elucidate the key informative technological support points underpinning BSSPR. Data were collected from both the new and old laboratory information systems from August 1, 2019, to December 31, 2021. A combination of statistical description, chi-square test, and t test was used to compare check-in time and waiting time of outpatients before and after the implementation of BSSPR. An interrupted time-series design was used to analyze the impact of BSSPR on medical service efficiency and quality, enabling the control of confounding variables, including changes in medical human resources and both long- and short-term temporal trends. BSSPR had an impact on the efficiency and quality of medical services. Notably, there was a significant increase in the number of patients receiving blood sampling services, with a daily service volume increase of ~150 individuals (P=.04). The average waiting time for patients decreased substantially from 29 (SD 36) to 11 (SD 11) minutes, indicating a marked improvement in patient experience. During the peak period, the number of patients receiving blood sampling services per working hour statistically increased from 9.56 to 16.77 (P<.001). The interrupted time-series model results demonstrated a reduction in patients' waiting time by an average of 26.1 (SD 3.8; 95% CI -33.64 to -18.57) minutes. Although there was an initial decline in the number of outpatients admitted following BSSPR implementation, an upward trend was observed over time (β=1.13, 95% CI 0.91-1.36). BSSPR implementation for outpatients not only reduced waiting time and improved patients' experience but also augmented the hospital's capacity to provide medical services. This study's findings offer valuable insights into the potential advantages of BSSPR and underscore the significance of harnessing digital technologies to optimize medical service processes. This research serves as a foundational basis and provides scientific support for the promotion and application of BSSPR in other health care contexts. By continuing to explore and refine the integration of digital technologies in health care, we can further enhance patient outcomes and elevate the overall quality of medical services.

Understanding occupational therapy perinatal mental health practice in mothers from ethnic minorities: A qualitative study of practitioner perceived barriers and enablers

Introduction: In the United Kingdom, ethnic minority mothers experience increased risk of mental illness compared to white women of British heritage. However, there is insufficient research to guide perinatal mental health occupational therapists to develop services that are accessible and meet the diverse needs of service users. This study explored perinatal mental health occupational therapists’ perceptions of the barriers and enablers to an inclusive service provision for ethnic minority mothers. Methods: A qualitative study was undertaken. Recruitment via social media used non-probability sampling. Semi-structured interviews collected data which were then analysed thematically. Results: Eight occupational therapist participated in the study. Three main themes were identified: observation of caseloads; experience of providing occupational therapy; influence of the therapist’s culture. Participants perceived stigma, fear, language and cultural perceptions created barriers for ethnic minority mothers. Discussion: Limited workforce diversity, ineffective mandatory training and insufficient referral to occupational therapy by other healthcare professionals were believed to negatively impact service delivery. Cultural experience and reflective practice were felt to enable inclusive practice. Recommendations to inform perinatal mental health occupational therapy practice in the United Kingdom and internationally include collaborations to gain a more diverse workforce, improved mandatory training and strategies to increase cultural sensitivity and competence.

Strategic Workforce Management in Malaysia's Food and Beverage Industry: Overcoming Challenges and Cultivating Sustainable Innovation

The food and beverage (F&amp;B) industry is a critical driver of Malaysia’s economic and social development. While contributing significantly to GDP and employment, the sector faces persistent challenges, including high employee turnover, resource constraints, and limited workforce retention strategies. This paper explores the dynamics of perceived organizational support (POS), workforce sustainability, and predevelopment practices within Malaysian small and medium enterprises (SMEs). Drawing on robust theoretical frameworks and empirical data, the findings illuminate the roles of organizational justice, supervisor support, and employee engagement policies. The study offers practical recommendations to foster workforce stability, innovation, and sustainable growth, positioning this research as a strategic blueprint for advancing human resource practices in the F&amp;B industry.

Real-World evaluation of an AI triaging system for chest X-rays: A prospective clinical study

Chest X-rays (CXRs) are crucial for diagnosing and managing lung conditions. While CXR is a common and cost-effective diagnostic tool, interpreting the high volume of CXRs is challenging due to workforce limitations. Artificial intelligence (AI) offers promise in enhancing efficiency and accuracy. However, real-world applicability and generalizability across diverse patient cohorts remain areas of concerns. In our study, the LUNIT INSIGHT CXR Triage software was evaluated in a diverse patient cohort. Forty-three radiologists, blinded to AI results, assessed CXRs categorized into normal, non-urgent, and urgent using a 3-tier classification system. Performance metrics and turnaround times were analyzed.The AI system demonstrated sensitivity of 89% for normal CXRs, specificity of 93%, PPV of 83%, and NPV of 95%, with an F1 score of 0.86 and an AUC of 0.91. For non-urgent CXRs, sensitivity and specificity were 93% and 91%, with PPV and NPV at 94% and 89%, respectively, and an F1 score of 0.94 and an AUC of 0.92. In the urgent category, sensitivity was 82%, specificity 99%, PPV 90%, and NPV 98%. Subgroup analysis revealed consistently high accuracy across various age groups (Young, Adult, Senior), genders, and ethnicities (Chinese, Malay, Indian, Others), with sensitivity, specificity, and AUC consistently above 84%. The AI system also significantly reduced turnaround times across all subgroups, indicating its robust performance and generalizability in diverse healthcare settings.

Protected areas and disparate data: understanding geospatial data synthesis in poaching mitigation

Wildlife poaching remains a global threat to endangered species and human health, yet knowledge gaps remain. As new geospatial technologies are developed, evaluated, and put into practice in protected areas we need to know how protected areas synthesize geospatial data derived from these technologies. In this article, we evaluate results from a survey of protected area personnel and from in-depth interviews with personnel from two protected areas. Our structured survey focused on identifying workflows, characterizing the use of geospatial technologies, understanding how geospatial information is synthesized, and learning about the geospatial tools used by practitioners to make sense of protected area data. In addition, we conducted semi-structured interviews with protected area practitioners to provide added context to complement online survey results. We investigate how geospatial data from protected areas is synthesized by practitioners through the collection, organization, analysis, and fusion of geospatial datasets to support the protection of endangered species from poaching activities. Our results show how protected areas currently utilize two key types of geospatial data: device-based and human-generated. We highlight five themes which emerge via analysis of survey, interview, and observational data. These themes include organizational bureaucracy, trust in data collection and sharing, technical limitations, workforce limitations, and financial stressors. We conclude by outlining a series of challenges and opportunities in geographic information science to guide further research to understand geospatial synthesis in the context of protected area management.

Gender Differences in Perception of Neurosurgery as a Career Choice in Pakistan: A Nationwide Cross-Sectional Survey

A low neurosurgeon-to-patient ratio persists to be a problem in many developing nations including Pakistan. Concurrent gender disparities further exacerbate the challenges posed by the already limited workforce. An understanding of the perceptions of neurosurgery among female early career doctors is crucial in the evolution of the field in terms of both, workforce strength and inclusivity. A cross-sectional study was conducted across public and private medical schools of Pakistan. A close-ended self-administered questionnaire was employed to assess subject-reported challenges and perceptions regarding neurosurgery. Statistical analysis was performed using SPSS version 28, and p< 0.05 was considered significant. The influence of these perceptions on the choice of neurosurgery as a career was determined by binary logistic regression analysis. Of the 387 responses received from over 45 institutions across the country, 55.6% were females and 44.4% were male respondents. Compared to men, women were more likely to opt out of neurosurgery due to fear of problems with parenting (p<0.001), absence of daycare facilities (p<0.001), lack of female role models (p=0.001), fear of gender discrimination (p<0.001), and the mental (p=0.04) and physical distress (p=0.008) associated with neurosurgery. Binary logistic regression revealed that these concerns were responsible for an increased likelihood of opting out of neurosurgery among female medical students and intern doctors. Significant differences exist in how male and female medical students perceive neurosurgery as a career choice. Interventions including availability of day care facilities for children, creation of inclusive workplace environment, and promotion of mentorship programs catering to women can help bridge this gap and contribute to evolution of the field of neurosurgery in the developing world.

Potential promises and perils of artificial intelligence in psychotherapy -The AI Psychotherapist (APT).

Since the release of ChatGPT, popular demand has driven the use of social chatbots as pseudo-AI psychotherapists. With time, it is inevitable that these technologies will be deployed in some form as dedicated psychotherapy interventions. Here, we attempt to forecast the implications for psychotherapy including the unique benefits to distributive justice as well as concerns for the quality of the therapy and its societal impact. An AI psychotherapist (APT) has the potential to provide engaging clinical interactions given its capacity for highly realistic interaction as well as its high level cognitive and emotional capabilities. Moreover, it can potentially address financial and workforce limitations on access to therapy. However, an APT may cause significant iatrogenic harm if released without adequate quality control and oversight by trained psychotherapists. If not appropriately designed and regulated, APTs have potential to mislead and reinforce maladaptive coping behaviours. Given societal drivers and possible benefits, these technologies will inevitably be deployed; thus, it is incumbent upon us as a professional body to consider their regulation.

Challenges in Managing Diabetes in Ghana: Healthcare Infrastructure, Access, and Education

This review discussed the multifaceted challenges of managing diabetes in Ghana, focusing on healthcare infrastructure, access to care, and public education. The article highlighted the uneven distribution of healthcare facilities, resource shortages, and workforce limitations as significant barriers to effective diabetes care. It also examined the geographic and economic disparities that hinder access to medical services, particularly in rural areas. Furthermore, the review delved into the critical role of public education, emphasizing the impact of low awareness, cultural misconceptions, and inadequate health campaigns on diabetes management. The methodology used involved analyzing existing literature and reports on healthcare challenges in Ghana to provide a comprehensive overview of the current situation. The article was concluded by identifying opportunities for improvement, including expanding outreach programs, leveraging technology, strengthening healthcare infrastructure, and fostering community involvement and government-NGO collaboration to enhance diabetes management in Ghana. Keywords: Diabetes Management, Healthcare Infrastructure, Access to Care, Public Education, Ghana.

Educating for success: ambulatory anesthesia training.

This article explores the unique intersection of the challenges confronting ambulatory anesthesiology education and charts a trajectory forward. The proportion of ambulatory, nonoperating room (NORA), and office-based surgical cases continues to rise; however, the requirements for trainees in these settings have remained static. The rapid evolution of the field combined with a limited workforce also makes continuing education essential, and we discuss the current and future states of ambulatory anesthesia education. Although numerous resources are available across an array of platforms to foster both trainee education and continuing education for practicing anesthesiologists, there is a paucity of current literature evaluating the impact of new curricula developed specifically for ambulatory, NORA, or office-based anesthesiology (OBA). We begin with an appraisal of the current state of ambulatory anesthesiology training and evaluate the gap between current graduate medical education and trends in ambulatory surgery. We then develop a vision for an ideal state of future ambulatory education for residents as well as anesthesiologists in practice and highlight the priorities necessary to reach this vision.

Development Strategy for Arabic Coffee Processing Business in Kreasi Kopi Medan

Various strategies and innovations are implemented as steps to achieve the desired profits and goals. However, it is also necessary to maintain business continuity for a long time and expand the business so that the wheels of the business continue to run smoothly. This research aims to analyse internal and external company factors that influence the development of Arabica coffee processing businesses in the research area, to analyse development strategies and alternative strategies for developing Arabica coffee processing businesses. The data analysis method was carried out using descriptive qualitative and using a SWOT analysis diagram. The results of this research are internal factors of strength, namely: initial business capital, attractive business name, place design, affordable prices, quality raw materials, varied menu variants, taste of coffee drinks and payment methods. Internal factors of weakness are: less strategic business location, limited workforce, service, product visuals, parking facilities and product variants that are not durable. External factors of opportunity are: consumer image, use of technology, consumers buying consistently, changes in consumer tastes, consumers buying online, adding menu variants and social media as promotion. External threat factors are: similar competitors, similar products, the existence of substitute drinks, fluctuations in raw material prices and declining consumer interest. Based on the SWOT analysis diagram, it is known that the company's position is in quadrant 1, supporting an aggressive strategy.

Barriers to Engagement with Gastrointestinal Health Management

BackgroundAlthough behavioral interventions have been effective in gastrointestinal (GI) conditions, barriers exist in implementing these interventions into clinical practice. The majority of previously published studies have focused on workforce limitations and have not considered individual and social determinants of health (SDoH) factors that can impact engagement in GI behavioral healthcare.AimsTo characterize barriers to engagement in appointment attendance and health management, explore individual and SDoH factors impacting GI behavioral healthcare engagement, and identify barriers that occur more often for patients with SDoH-related vulnerability (low health literacy and/or financial insecurity).MethodsA survey was distributed to adult patients who had been seen in Gastroenterology at the Dartmouth-Hitchcock Medical Center from June 2022 to December 2022.ResultsOne hundred participants [mean age = 58 years, 57.1% women] completed the survey. SDoH vulnerability was present in 32.3% of the population. For the entire sample, 73% reported at least one barrier to accessing care and 75% reported at least one factor which impacted health management. Those with SDoH vulnerability reported significantly more barriers to attending appointments and to managing health. In addition, they were significantly more likely to endorse physical health problems, difficulty affording medical bills, pain, mobility issues, trauma experiences, significant stress, and difficulty with concentration.ConclusionsPatients in a GI clinic reported multiple barriers to accessing care and participating in health management. Innovative, multi-level strategies are needed to address barriers to ensure that all patients are able to obtain quality GI behavioral health services.

Understanding the impact of distance and disadvantage on lung cancer care and outcomes: a study protocol

BackgroundLung cancer is the third most common cancer in the UK and the leading cause of cancer mortality globally. NHS England guidance for optimum lung cancer care recommends management and treatment by a specialist team, with experts concentrated in one place, providing access to specialised diagnostic and treatment facilities. However, the complex and rapidly evolving diagnostic and treatment pathways for lung cancer, together with workforce limitations, make achieving this challenging. This place-based, behavioural science-informed qualitative study aims to explore how person-related characteristics interact with a person’s location relative to specialist services to impact their engagement with the optimal lung pathway, and to compare and contrast experiences in rural, coastal, and urban communities. This study also aims to generate translatable evidence to inform the evidence-based design of a patient engagement intervention to improve lung cancer patients’ and informal carers’ participation in and experience of the lung cancer care pathway.MethodsA qualitative cross-sectional interview study with people diagnosed with lung cancer < 6 months before recruitment (in receipt of surgery, radical radiotherapy, or living with advanced disease) and their informal carers. Participants will be recruited purposively from Barts Health NHS Trust and United Lincolnshire Hospitals NHS Trusts to ensure a diverse sample across urban and rural settings. Semi-structured interviews will explore factors affecting individuals’ capability, opportunity, and motivation to engage with their recommended diagnostic and treatment pathway. A framework approach, informed by the COM-B model, will be used to thematically analyse facilitators and barriers to patient engagement.DiscussionThe study aligns with the current policy priority to ensure that people with cancer, no matter where they live, can access the best quality treatments and care. The evidence generated will be used to ensure that lung cancer services are developed to meet the needs of rural, coastal, and urban communities. The findings will inform the development of an intervention to support patient engagement with their recommended lung cancer pathway.Protocol registrationThe study received NHS Research Ethics Committee (Ref: 23/SC/0255) and NHS Health Research Authority (IRAS ID 328531) approval on 04/08/2023. The study was prospectively registered on Open Science Framework (16/10/2023; https://osf.io/njq48).

Genetic testing in early-onset atrial fibrillation.

Atrial fibrillation (AF) is a globally prevalent cardiac arrhythmia with significant genetic underpinnings, as highlighted by recent large-scale genetic studies. A prominent clinical and genetic overlap exists between AF, heritable ventricular cardiomyopathies, and arrhythmia syndromes, underlining the potential of AF as an early indicator of severe ventricular disease in younger individuals. Indeed, several recent studies have demonstrated meaningful yields of rare pathogenic variants among early-onset AF patients (∼4%-11%), most notably for cardiomyopathy genes in which rare variants are considered clinically actionable. Genetic testing thus presents a promising opportunity to identify monogenetic defects linked to AF and inherited cardiac conditions, such as cardiomyopathy, and may contribute to prognosis and management in early-onset AF patients. A first step towards recognizing this monogenic contribution was taken with the Class IIb recommendation for genetic testing in AF patients aged 45 years or younger by the 2023 American College of Cardiology/American Heart Association guidelines for AF. By identifying pathogenic genetic variants known to underlie inherited cardiomyopathies and arrhythmia syndromes, a personalized care pathway can be developed, encompassing more tailored screening, cascade testing, and potentially genotype-informed prognosis and preventive measures. However, this can only be ensured by frameworks that are developed and supported by all stakeholders. Ambiguity in test results such as variants of uncertain significance remain a major challenge and as many as ∼60% of people with early-onset AF might carry such variants. Patient education (including pretest counselling), training of genetic teams, selection of high-confidence genes, and careful reporting are strategies to mitigate this. Further challenges to implementation include financial barriers, insurability issues, workforce limitations, and the need for standardized definitions in a fast-moving field. Moreover, the prevailing genetic evidence largely rests on European descent populations, underscoring the need for diverse research cohorts and international collaboration. Embracing these challenges and the potential of genetic testing may improve AF care. However, further research-mechanistic, translational, and clinical-is urgently needed.

Longitudinal program evaluation of an inter-institutional mentorship network for pediatric rheumatology using a quality improvement framework

BackgroundThe American College of Rheumatology (ACR)/Childhood Arthritis and Rheumatology Research Alliance (CARRA) Mentoring Interest Group (AMIGO) is an inter-institutional mentorship program launched to target mentorship gaps within pediatric rheumatology. Initial program evaluation indicated increased mentorship access. Given the small size of the pediatric rheumatology workforce, maintaining a consistent supply of mentors was a potential threat to the longevity of the network. Our aims were to: (i) describe the sustainability of AMIGO over the period 2011–2018, (ii) highlight ongoing benefits to participants, and (iii) describe challenges in the maintenance of a mentorship network.MethodsA mixed-methods approach centered on a quality improvement framework was used to report on process and outcomes measures associated with AMIGO annual cycles.ResultsUS and Canada Pediatric rheumatology workforce surveys identified 504 possible participants during the time period. As of fall 2018, 331 unique individuals had participated in AMIGO as a mentee, mentor or both for a program response rate of 66% (331/504). Survey of mentees indicated high satisfaction with impact on general career development, research/scholarship and work-life balance. Mentors indicated increased sense of connection to the community and satisfaction with helping mentees despite limited perceived benefit to their academic portfolios. Based on AMIGO’s success, a counterpart program for adult rheumatology, Creating Adult Rheumatology Mentorship in Academia (CARMA), was launched in 2018.ConclusionsDespite the challenges of a limited workforce, AMIGO continues to provide consistent access to mentorship opportunities for the pediatric rheumatology community. This experience can inform approaches to mentorship gaps in other academic subspecialties.

Navigating Mental Health Frontiers: A Scoping Review of Accessibility for Rural LGBTIQA+ Communities

ABSTRACT Mental healthcare for LGBTQIA+ populations in rural areas remains unequal, despite societal progress toward inclusivity. This review examines the specific obstacles faced in rural areas, such as limited services, workforce deficiencies, and travel burdens for treatment, which exacerbate existing mental health inequities. By following the Joanna Briggs Institute methodology, an exploration of SCOPUS, EBSCO Host (All), and Ovid databases yielded 2373 articles. After careful screening, 21 articles from five countries were selected, primarily using qualitative interviews and quantitative online surveys. Analysis through the Lévesque framework reveals the complex challenges faced by LGBTQIA+ individuals in rural mental healthcare. Discrepancies in approachability, acceptability, availability, affordability, and appropriateness were identified. Geographical isolation, discrimination, and a lack of LGBTQIA+-attuned professionals further compound these issues. Societal stigma, discrimination, and economic constraints hinder individuals from accessing and engaging in mental health services. This study highlights the need for purposeful interventions to improve rural mental health access for sexual and gender minorities.

Emergency Department Provider Staffing among Critical Access Hospitals in Minnesota

Background: Access to healthcare remains a challenge in many rural regions. Rural critical access hospitals (CAHs) remain essential access points. Providing 24-hour access, CAH emergency departments (EDs) rely on medical staff who can treat a wide range of problems. Family physicians/general practitioners have traditionally staffed rural EDs. However, this staffing model may be changing. This study aims to characterize the current medical staffing profiles of Minnesota’s CAH EDs. Methods: From January to February 2021, the executive leaders of all of Minnesota’s 77 CAHs were invited to complete a voluntary online survey about ED staffing patterns at their facility. Results: 37/77 of MN’s CAHs responded to the survey (48% response rate). Just over half (51.4%) of the respondents reported ED physician staffing practices that included multiple physician specialties (family medicine, internal medicine, emergency medicine) while 32.4% reported staffing exclusively with family medicine physicians. A majority, 27/37 (73%), reported including non-physicians on their ED medical staff, especially at CAHs that were part of a larger healthcare system. Discussion: CAHs often operate with limited workforce and resource options. This study demonstrates that MN’s CAHs exhibit a variety of ED staffing patterns with staffing decisions driven by multiple factors. Family medicine physicians contribute to CAH ED coverage. Future studies may expand our understanding of how ED staffing models impact community health, disease outcomes, and CAH financial viability. Conclusion: ED staffing patterns across Minnesota’s CAHs vary significantly with variable use of physicians and non-physician providers. Family physicians remain an important specialty for CAH ED coverage

Key informant perspectives on implementing genomic newborn screening: a qualitative study guided by the Action, Actor, Context, Target, Time framework

Newborn screening (NBS) programmes are highly successful, trusted, public health interventions. Genomic sequencing offers the opportunity to increase the benefits of NBS by screening infants for a greater number and variety of childhood-onset conditions. This study aimed to describe who needs to do what, when, and for whom to deliver genomic newborn screening (gNBS) and capture perceived implementation barriers and enablers. ‘Key informants’ (individuals involved in the delivery of NBS) were interviewed. The Actor, Action, Context, Time and Target framework guided data collection and analysis. Participants (N = 20) identified new Actions required to deliver gNBS (educating healthcare providers, longitudinal psychosocial support), NBS Actions needing modification (obtaining consent) and NBS Actions that could be adopted for gNBS (prompt referral pathways). Obtaining consent in a prenatal Context was a source of some disagreement. The Time to disclose high chance results was raised as a key consideration in gNBS programme design. Genetic counsellors were identified as key Actors in results management, but workforce limitations may be a barrier. Online decision support tools were an enabler to offering gNBS. The implementation of gNBS will require behaviour changes from HCPs delivering NBS. Findings can inform how to deliver gNBS at population-scale.