scholarly journals P050: The Northern Amazing and Awesome Model: Using positive deviance to impact patient care

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S82-S82
Author(s):  
R. Ohle ◽  
S. McIsaac
Keyword(s):  
Professional Training ◽  
Allied Health ◽  
Case Reports ◽  
Tertiary Care ◽  
Lessons Learned ◽  
Positive Deviance ◽  
Trauma Patients ◽  
Administrative Staff ◽  
Post Intervention ◽  
Allied Health Professionals

Introduction: Positive deviance recognizes that there are individuals and teams within our community of practice that succeed in spite of system constraints. Amazing and awesome rounds has been proposed as a forum to identify behaviours and processes that lead to exceptional results. The objective of this study was to determine the feasibility and acceptability of a structured amazing and awesome rounds model through an innovative educational intervention. Methods: The authors engaged a broad range of professional designations(physicians, surgeons, nurses, respiratory therapists, administrative staff) at a tertiary care institution. A&A rounds were open to all allied health professionals and administrative staff. The Northern A&A rounds model was developed, implemented, and then evaluated as a four-part intervention. This consisted of: 1) Allied health professional training on case selection and analysis, 2) Engaging inter professional members, 3) disseminating lessons learned, and 4) creating an administrative pathway for acting on issues identified through the A&A rounds. The measures of intervention feasibility included the proportion of sessions adherent to the new model and A&A rounds attendance. Post intervention surveys of presenters and attendees were used to determine intervention acceptability. A&A presentation content was reviewed to determine the most frequently adopted components of the model. Results: Nine out of 9(100%) of presented cases were adherent to the three components of the Northern A&A Model. A&A rounds were highest attended of all hospital wide grand rounds(N = 75 SD 2.4 P < 0.001). Nine case presentations were analyzed and 7 action items were identified for amplification across the hospital. Including 3 case reports published of a novel approach to a patient case,a rapid referral for trauma patients at risk for PTSD, AED placement in all community clinics and routine debrief after resuscitations. Presenters included a broad representation of hospital staff including surgeons, emergency physicians, radiologists, nurses, and administrators. Conclusion: The Northern A&A Model was a feasible intervention that was perceived to be effective by both presenters and attendees. The authors believe that this could be readily applied to any hospital seeking to enhance quality of care and patient safety.

scholarly journals P070: Improving handovers in the emergency department: implementation of a standardized team approach

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S101-S102 ◽  
Author(s):  
E.S. Kwok ◽  
S. White
Keyword(s):  
Health Professionals ◽  
Allied Health ◽  
Tertiary Care ◽  
Team Approach ◽  
Tertiary Care Centre ◽  
Risk Area ◽  
Post Intervention ◽  
Allied Health Professionals ◽  
Specific Content ◽  
Care Plans

Introduction: Handovers in the ED are a high risk area for breakdown in team communication, discontinuity of patients’ clinical course, and potential medical errors. This is especially true for morning handovers at our center, when one single overnight MD working with limited resources hands over the entire ED to an oncoming day team of MDs and allied health professionals. We describe a quality improvement (QI) project to implement an inter-professional team approach during handovers. Methods: This prospective QI project took place at an academic tertiary care centre with >160,000 ED visits/yr. An expert working group identified key components of the ideal morning handover, and developed an intervention consisting of standardizing the “location”, “participants”, and “time” components of our handover processes. A research assistant directly observed all 8am handovers for 2 weeks pre- and 2 weeks post-intervention. Outcomes include participant attendance; # of beside RN issues proactively brought forward; frequency of new allied health consults and/or involvement triggered; # of physician interruptions; and time metrics. We report descriptive statistics. Results: During the study period a total of 308 individual patient handovers were observed [Pre:162, Post:146]. Average duration of total handover each morning decreased from 24.9min to 16.3min (p=0.051). Frequency of attendance at handovers increased for various allied health professionals, including care facilitators [Pre:35.7%; Post:91.7%, p=0.005], social workers [Pre:7.1%; Post:66.7%, p=0.003], geriatrics EM (GEM) RNs [Pre:64.3%; Post:83.3%, p=0.391], pharmacists [Pre:0.0%; Post:58.3%, p=0.001], and physiotherapists [Pre:0.0%; Post:58.3%, p=0.001]. Number of specific beside RN issues proactively brought forward increased [Pre:0; Post:4, p=0.049], while the number of physician interruptions during handover decreased [Pre:20; Post:0, p<0.0001]. Frequency of new allied health consults and/or involvement triggered as a result of handover participation increased from 6.8% to 13.7% (p=0.057). Conclusion: Implementation of a standardized team approach to morning handovers in the ED led to significant improvements in inter-professional contributions to patient care plans and overall efficiency. Future planned phases will build on this QI initiative by standardizing specific content of ED handovers.

scholarly journals Trichosporon species isolated from scald burn wound in an immunocompetent adult: a case report from Southern Assam

2021 ◽  
Vol 9 (12) ◽  
pp. 3700
Author(s):  
Barnamoy Bhattacharjee ◽  
Debadatta D. Chanda ◽  
Atanu Chakravarty
Keyword(s):  
Fungal Infection ◽  
Bacterial Infections ◽  
Case Reports ◽  
Tertiary Care ◽  
Fungal Colonization ◽  
Trauma Patients ◽  
Sensitivity Testing ◽  
Industrial Worker ◽  
Burn Wounds ◽  
Trichosporon Species

There are quite a good number of case reports on fungal infection in burn wounds in addition to the conventionally notorious bacterial infections in immune-compromised burn trauma patients leading to protracted course of morbidity and higher chances of mortality due to delay in diagnosis. The incidence of fungal infection in burn patients has been increasing with paradigm shift of causal fungus over last 2 decades from Candida albicans and molds to non-albicans Candida, Trichosporon species and other yeast like fungus. But there are rarely few cases of invasive Trichosporon infection in scald burn wounds in immunocompetent individuals. We therefore report a case of Trichosporon species isolation from a scald burn ulcer of an immunocompetent young male industrial worker in 2nd week of its clinical course which responded to oral fluconazole followed by skin grafting since this case scenario in itself is an uncommonly presented and reported event coupled with finding of first ever case with such presentation in this tertiary care institute of Southern Assam. This case is also reported with intention of raising awareness in surgeons for keeping vigil on non-healing burn wounds with empirical antibiotics and about the need of timely pus culture and sensitivity testing to rule out fungal colonization and prevent mortality due to disseminated fungal infection.

scholarly journals Case Reports: Multifaceted Experiences Treating Youth with Severe Obesity

2019 ◽  
Vol 16 (6) ◽  
pp. 927 ◽  
Author(s):  
Karen Schaller ◽  
Linda Stephenson-Somers ◽  
Adolfo Ariza ◽  
Maheen Quadri ◽  
Helen Binns
Keyword(s):  
Severe Obesity ◽  
Child Protective Services ◽  
Case Reports ◽  
Tertiary Care ◽  
Lessons Learned ◽  
Medical Team ◽  
Health Providers ◽  
Protective Services ◽  
Integral Role

The management of youth with severe obesity is strongly impacted by social determinants of health and family dynamics. We present case studies of three patients seen in our tertiary care obesity treatment clinic as examples of the challenges faced by these patients and their families, as well as by the medical team. We discuss how these cases illustrate potential barriers to care, the role of child protective services, and we reflect upon lessons learned through the care of these patients. These cases highlight the need for comprehensive care in the management of youth with severe obesity, which can include: visits to multiple medical specialists, and mental and behavioral health providers; school accommodations; linkage to community resources; and, potentially, child protective services involvement. Through the care of these youth, our medical team gained more experience with using anti-obesity medications and meal replacements. The care of these youth also heightened our appreciation for the integral role of mental health services and community-based resources in the management of youth with severe obesity.

Knowledge of COVID-19 among nursing and Allied health care professionals working in tertiary care hospital

2020 ◽  
Vol 11 (SPL1) ◽  
pp. 103-109 ◽  
Author(s):  
Sai Ravi Teja Kamineni ◽  
Pandian Balu ◽  
Poonguzhali Sivagananam ◽  
Poongodi Chellapandian ◽  
Udayakumari Meesala Chelladurai ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Allied Health ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Allied Health Professionals ◽  
Cross Sectional ◽  
Allied Health Care ◽  
Adequate Knowledge

The rapid spread of the COVID-19 pandemic has become a major cause of concern for the healthcare profession. The pandemic is on-going and actively developing and countries around the world are taking drastic measures to reduce the spread of disease by measures like initiating social distancing, closing of schools and nonessential businesses. The present study is being conducted to assess the knowledge of COVID-19 among the nursing and allied health care professionals. A cross sectional study on knowledge of COVID-19 was conducted among nursing and allied health care professionals working in tertiary care hospital. A structured questionnaire comprised of 25 questions developed by investigators was administered to 177 health care professionals that includes nursing and allied health professionals working in a tertiary care hospital. Among the 177 nursing and allied health care professionals, majority 92.1% of them has adequate knowledge regarding the present global pandemic and 7.9% had moderate knowledge. This study concludes that nursing and allied health care services professionals in tertiary centre has adequate knowledge regarding COVID-19 pandemic.

Zone 1, or 3? Approach to zone selection and pitfalls for REBOA placement in trauma.

2018 ◽  
Vol 2 (1) ◽  
Author(s):  
Jacob J Glaser ◽  
Matthew Lamb ◽  
Antonio Pepe
Keyword(s):  
Hemorrhagic Shock ◽  
Critically Ill ◽  
Case Reports ◽  
Balloon Occlusion ◽  
Lessons Learned ◽  
Trauma Patients ◽  
The Ideal

The use of Balloon Occlusion of the aorta (BAO) in cases of non compressible torso hemorrhage has become more common. While prospective multicenter data is being collected, and case reports are many, there is still significant debate on the ideal place for BAO in critically ill trauma patients. With each application of the technique there are opportunities for lessons learned, and opportunities to inform other users while consensus in the trauma community is obtained.We report on the successful use of BAO for the management of hemorrhagic shock, and discuss several such lessons that may improve outcomes in future patients.

scholarly journals Promoting COVID-19 vaccination among healthcare personnel: a multifaceted intervention at a tertiary care center in Japan

2021 ◽  
pp. 1-26
Author(s):  
Akane Takamatsu ◽  
Hitoshi Honda ◽  
Tomoya Kojima ◽  
Kengo Murata ◽  
Hilary Babcock
Keyword(s):  
Medical Center ◽  
Care Center ◽  
Tertiary Care ◽  
Vaccination Rate ◽  
Multifaceted Intervention ◽  
Vaccine Hesitancy ◽  
Healthcare Personnel ◽  
Tertiary Care Center ◽  
Post Intervention ◽  
Post Vaccination

Abstract Objective The COVID-19 vaccine may hold the key to ending the pandemic, but vaccine hesitancy is hindering the vaccination of healthcare personnel (HCP). Design Before-after trial Participants and setting Healthcare personnel at a 790-bed tertiary care center in Tokyo, Japan. Interventions A pre-vaccination questionnaire was administered to HCP to examine their perceptions of the COVID-19 vaccine. Then, a multifaceted intervention involving (1) distribution of informational leaflets to all HCP, (2) hospital-wide announcements encouraging vaccination, (3) a mandatory lecture, (4) an educational session about the vaccine for pregnant or breastfeeding HCP, and (5) allergy testing for HCP at risk of allergic reactions to the vaccine was implemented. A post-vaccination survey was also performed. Results Of 1,575 HCP eligible for enrollment, 1,224 (77.7%) responded to the questionnaire, 43.5% (n =533) expressed willingness to be vaccinated, 48.4% (n = 593) were uncertain, and 8.0% (n=98) expressed unwillingness to be vaccinated. The latter two groups were concerned about the vaccine’s safety rather than its efficacy. Post-intervention, the overall vaccination rate reached 89.7% (1,413/1,575), with 88.9% (614/691) of the pre-vaccination survey respondents who answered “unwilling” or “unsure” eventually receiving a vaccination. In the post-vaccination questionnaire, factors contributing to increased COVID-19 vaccination included information and endorsement of vaccination at the medical center (26.4%; 274/1,037). Conclusions The present, multifaceted intervention increased COVID-19 vaccinations among HCP at a Japanese hospital. Frequent support and provision of information were crucial for increasing the vaccination rate and may be applicable to the general population as well.

scholarly journals 600. Decreased Hospital Readmission After Programmatic Strengthening of an Outpatient Parenteral Antimicrobial Therapy (OPAT) Program

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S362-S363
Author(s):  
Gaurav Agnihotri ◽  
Alan E Gross ◽  
Minji Seok ◽  
Cheng Yu Yen ◽  
Farah Khan ◽  
...  
Keyword(s):  
Hospital Readmission ◽  
Multinomial Logistic Regression ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Intervention Group ◽  
Care Hospital ◽  
Full Time ◽  
Post Intervention ◽  
Before And After ◽  
The Impact

Abstract Background Although it is recommended that an OPAT program should be managed by a formal OPAT team that supports the treating physician, many OPAT programs face challenges in obtaining necessary program staff (i.e nurses or pharmacists) due to limited data examining the impact of a dedicated OPAT team on patient outcomes. Our objective was to compare OPAT-related readmission rates among patients receiving OPAT before and after the implementation of a strengthened OPAT program. Methods This retrospective quasi-experiment compared adult patients discharged on intravenous (IV) antibiotics from the University of Illinois Hospital before and after implementation of programmatic changes to strengthen the OPAT program. Data from our previous study were used as the pre-intervention group (1/1/2012 to 8/1/2013), where only individual infectious disease (ID) physicians coordinated OPAT. Post-intervention (10/1/2017 to 1/1/2019), a dedicated OPAT nurse provided full time support to the treating ID physicians through care coordination, utilization of protocols for lab monitoring and management, and enhanced documentation. Factors associated with readmission for OPAT-related problems at a significance level of p&lt; 0.1 in univariate analysis were eligible for testing in a forward stepwise multinomial logistic regression to identify independent predictors of readmission. Results Demographics, antimicrobial indications, and OPAT administration location of the 428 patients pre- and post-intervention are listed in Table 1. After implementation of the strengthened OPAT program, the readmission rate due to OPAT-related complications decreased from 17.8% (13/73) to 6.5% (23/355) (p=0.001). OPAT-related readmission reasons included: infection recurrence/progression (56%), adverse drug reaction (28%), or line-associated issues (17%). Independent predictors of hospital readmission due to OPAT-related problems are listed in Table 2. Table 1. OPAT Patient Demographics and Factors Pre- and Post-intervention Table 2. Factors independently associated with hospital readmission in OPAT patients Conclusion An OPAT program with dedicated staff at a large academic tertiary care hospital was independently associated with decreased risk for readmission, which provides critical evidence to substantiate additional resources being dedicated to OPAT by health systems in the future. Disclosures All Authors: No reported disclosures

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