Primary healthcare practitioners were in the front line to deal with COVID-19 and reorganize their practice to avoid inappropriate use of hospital services

Abstract Aims To ascertain the effectiveness of the newly formed surgical ED during Covid-19 outbreak in terms of: Methods/Study design Retrospective cohort of 992 patients were identified and included from the period of the 5th April to 5th May 2020 Inclusion criteria: All patients attended and triaged in the new surgical emergency department. Exclusion criteria: Patients who were not triaged. Results The temporary surgical emergency department was successful in accommodating all surgical patients categorized 2, 3 and 4 with category 4 being the highest number at 45%. Hospital services were successfully accessed in 771(77.72%) during patients stay in ED including Bloods and imaging with X-ray as the most service used at 42.33%. 221(22.27%) patients didn’t require any investigations and were discharged after review by the surgical doctor within the 4-hour window. Conclusion Presence of a dedicated surgical emergency during the covid period was essential to separate medical patients from non-medical patients. Having a decision maker on the front line right after triage has reduced the overall number of admissions, number of emergency breeches and unnecessary investigations. Having a dedicated space with dedicated team could make a huge impact on the service in terms of time, effort and money spent.

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A theory-based exploration of antibiotic use in primary healthcare in Gezira state, Sudan

Implementation Science Communications ◽

10.1186/s43058-021-00229-3 ◽

2021 ◽

Vol 2 (1) ◽

Author(s):

Anna-Leena Lohiniva ◽

Einas Elwali ◽

Duha Abuobaida ◽

Ashwag Abdulrahim ◽

Paul Bukuluki ◽

...

Keyword(s):

Behaviour Change ◽

Primary Healthcare ◽

Theoretical Domains Framework ◽

Antibiotic Use ◽

Local Context ◽

Change Strategy ◽

Qualitative Research Study ◽

Inappropriate Use ◽

Healthcare Settings ◽

Behaviour Change Wheel

Abstract Background Inappropriate use of antibiotics is a major contributing factor to the emergence of antimicrobial resistance globally, including in Sudan. Objectives The project aimed to develop a theory-driven behaviour change strategy addressing both prescribers and patients based on factors that are driving antibiotic use in primary healthcare settings in Gezira state in Sudan. Methods The strategy was designed based on the Theoretical Domains Framework (TDF) to identify behavioural domains and the Behaviour Change Wheel (BCW) to select appropriate intervention functions. The process included (1) a formative qualitative research study and (2) a knowledge co-production workshop that utilized the results of the qualitative study to design a salient, appropriate, and credible behaviour change strategy. Results The TDF domains related to prescribers that emerged from the study included knowledge, skills, and intention. The selected BCW intervention functions included education, training, modelling, and persuasion. The main TDF domains related to patients included social influences and intention. The selected BCW intervention functions included enablement and education. Conclusion Using the TDF and BCW intervention functions, the study identified behavioural domains that influence antibiotic prescription and consumption in rural primary healthcare settings in Gezira state in Sudan and appropriate intervention functions to modify these behaviours. Knowledge co-production ensured that the evidence-based strategy was acceptable and practical in the local context.

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The Organization of Hospital Services for Casualties Due to the Bombing of Cities, Based on Experience Gained in Barcelona—with Special Reference to the Classification of Casualties

Proceedings of the Royal Society of Medicine ◽

10.1177/003591573903300102 ◽

1939 ◽

Vol 33 (1) ◽

pp. 13-23 ◽

Cited By ~ 3

Author(s):

J. Trueta

Keyword(s):

Total Population ◽

First Aid ◽

Hospital Services ◽

Front Line ◽

Priority List ◽

Finger Nail ◽

Surgical Units ◽

Standard Classification ◽

Minor Injuries

(1) Difference between modern “total population” war and old-fashioned war. Difference between bombing of ( a) military objectives and ( b) civilian population. ( a) The heavy bomb, e.g. 750 lb., with large fragments, upward throw, great destruction of buildings. ( b) The light bomb with finger nail fragments, horizontal throw, great velocity. There is in addition the incendiary bomb, little used in Barcelona because the buildings are built of stone and concrete. (2) Aerial bombing of a town produces injuries needing more immediate hospitalization than most front-line wounds. At the same time it is possible in a town to organize rapid collection of patients and their immediate transfer to hospital. (3) Experience shows that it is most desirable to make this transfer of patients to hospital a primary consideration. On arrival they are “ sorted” and minor injuries are given First Aid treatment and sent home, others are fully examined, classified, and dispatched to the theatres on a priority list, to nearby wards for resuscitation, to wards for rest, or sent on to plaster rooms for splintage, or to a neurosurgical centre. (4) First-aid posts in a town should be in hospitals and treat superficial injuries, &c., after primary sorting in the hospital reception room. (5) First-aid posts in outlying areas should carry out the same function for the same type of cases; all the more seriously wounded, including those with tiny penetrating wounds, should be dispatched without first aid treatment direct to hospital. (6) Hospital arrangements, for circulation of ambulances, for sorting, undressing of patients, docketing of valuables, &c. (7) Classification must be carried out by surgeons of experience and judgment. They must regard not only a standard priority list but the particular clinical picture and prognosis in each case. (8) The surgeon will furthermore draft the cases with regard to the special abilities of the surgical units available, e.g. chest, abdomen, or limbs. (9) Review of wounds in limbs, chest, abdomen, and head, caused by fragments from heavy bombs or by splinters from small light bombs. (10) Injuries from falling masonry. (11) Standard classification by urgency of operation. (12) Classification re possible early evacuation.

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Business: Conceptualizations of Organizational Change Viewed Through the Lens of Power: A Tutorial for the Speech-Language Pathologist/Audiologist Administrator

Perspectives on Administration and Supervision ◽

10.1044/aas21.1.9 ◽

2011 ◽

Vol 21 (1) ◽

pp. 9-17

Author(s):

Patrick R. Walden

Keyword(s):

Organizational Change ◽

Health Care Organizations ◽

Social Power ◽

Social Systems ◽

Front Line ◽

Organization Level ◽

Speech Language Pathologist ◽

Constant State ◽

Theories Of Change ◽

Or Organization

Both educational and health care organizations are in a constant state of change, whether triggered by national, regional, local, or organization-level policy. The speech-language pathologist/audiologist-administrator who aids in the planning and implementation of these changes, however, may not be familiar with the expansive literature on change in organizations. Further, how organizational change is planned and implemented is likely affected by leaders' and administrators' personal conceptualizations of social power, which may affect how front line clinicians experience organizational change processes. The purpose of this article, therefore, is to introduce the speech-language pathologist/audiologist-administrator to a research-based classification system for theories of change and to review the concept of power in social systems. Two prominent approaches to change in organizations are reviewed and then discussed as they relate to one another as well as to social conceptualizations of power.

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