scholarly journals How a pandemic changed advanced nurse practitioner (ANP) chest pain assessment from face-to-face to virtual: The impact on clinical workload, diagnosis & patient safety

2021 ◽  
Vol 20 (Supplement_1) ◽  
Author(s):  
S Ingram
Keyword(s):  
Patient Safety ◽  
Chest Pain ◽  
Care Pathway ◽  
Physical Contact ◽  
Exercise Stress ◽  
Pain Clinic ◽  
Improvement Project ◽  
Face To Face ◽  
The Impact ◽  
Clinical Workload

Abstract Funding Acknowledgements Type of funding sources: None. Chest pain presentations to the Emergency Dept. (ED) account for 8% of ED cases annually. In response to the pandemic the usual care pathway of nurse-led assessment in ED and discharge to a chest pain clinic (Ingram  2017) ceased, as face-to-face clinics and diagnostics were curtailed, and staff redeployed. A virtual chest pain clinic was created by one ANP. Telehealth is defined as ‘the entire spectrum of activities used to deliver care remotely, without direct physical contact with the patient’ (Wosik  2020) Purpose This analysis aims to compare the outcomes of the Covid-19 virtual chest pain clinic in 2020 to the same face-to- face clinic period in 2019 with a focus on i. Clinic workload, ii. Patient Outcomes iii. Patient Safety, Methods The ANP performed a telephone consultation and referred for limited diagnostic testing or discharged to primary care. The patient management system (iPIMS) was used as a clinical and audit tool. This service evaluation was registered as quality improvement project. Results From 1/4/20 to 21/7/2020, 130 e-referrals were received compared to 154 face-to-face consults in the same period of 2019. The overall number of clinic episodes was 17% greater during the pandemic period (Fig.1), carried out by 1/3 of the 2019 staff quota. Access to exercise stress testing (EST) was reduced by 88%.  CHD was diagnosed in 26%. Virtual assessment in this high risk group in the absence of timely diagnostics is a risk however 30 day mortality was 0%. Discussion   The pandemic of covid-19 required a rapid redesign of the chest pain service in the midst of staff redeployment. Whilst the total number of referrals is less that the same timeframe in 2019 the ‘virtual’ nature of the service created additional episodes of care with the need for the return clinic in person or by telephone. Conclusion In response to the pandemic the change to a virtual clinic was enabled by ANP experience and permitted continued safe discharge of chest pain patients from the ED. The virtual service does add to the ANP clinical workload with potential risk. As it requires more office time, it prevents the ANP presence in the ED.  It is hoped in time to return to the original model of care as this will be more efficient for the service and the patient.

“New Normal”: Analisis Penerimaan Menggunakan Balance Score Card

2020 ◽  
Vol 3 (2) ◽  
pp. 396-402
Author(s):  
Maria Florentina Rumba ◽  
Margaretha P.N Rozady ◽  
Theresia W. Mado
Keyword(s):  
Higher Education ◽  
Higher Education Institutions ◽  
Normal Phase ◽  
Physical Contact ◽  
New Normal ◽  
Face To Face ◽  
Balance Score Card ◽  
Score Card ◽  
Pros And Cons ◽  
The Impact

Abstrak: Kebiasaan manusia berubah karena adanya wabah COVID-19, hal ini berpengaruh ketika manusia masuk ke dalam fase new normal. New normal diartikan sebagai keadaan yang tidak biasa dilakukan sebelumnya, yang kemudian dijadikan sebagai standar atau kebiasaan baru yang mesti dilakukan manusia untuk dirinya sendiri maupun untuk bersosialisasi dengan orang lain. Kebiasaan baru ini pun menimbulkan pro dan kontra seiring dengan dampak yang timbul. Lembaga pendidikan tinggi merupakan salah satu yang merasakan dampak penerapan new normal. Perkuliahan yang selama ini dilakukan secara online/daring, akan kembali dilakukan secara luring/tatap muka, dengan tetap menerapkan protokol COVID-19 seperti mengenakan masker, menjaga jarak, mengenakan sarung tangan, serta tidak melakukan kontak fisik seperti berjabat tangan. Masalah yang muncul bukan hanya kecemasan orang tua terhadap anak – anaknya, tetapi bagaimana lembaga pendidikan tinggi mengatur segala sumber daya yang dimiliki agar memenuhi standar penerapan new normal. penelitian ini bertujuan untuk mengetahui penerimaan  terhadap kondisi normal yang baru menggunakan Perspektif balance score card. Abstract: Human habits change because of the COVID-19 outbreak, this affects when humans enter the new normal phase. New normal is defined as a condition that is not normally done before, which is then used as a standard or new habits that must be done by humans for themselves or to socialize with others. This new habit also raises the pros and cons along with the impact arising with the new normal. Higher education institutions are the ones who feel the impact of implementing new normal. Lectures that have been conducted online / online will be re-done offline / face to face, while still applying the COVID-19 protocol such as wearing a mask, keeping a distance, wearing gloves, and not making physical contact such as shaking hands. The problem that arises is not only parents' anxiety about their children, but how higher education institutions regulate all available resources to meet new normal implementation standards. This study aims to determine acceptance of new normal conditions using the balance score card Perspective.

scholarly journals The impact of web-based and face-to-face simulation on patient deterioration and patient safety: protocol for a multi-site multi-method design

2016 ◽  
Vol 16 (1) ◽  
Author(s):  
Simon J. Cooper ◽  
Leigh Kinsman ◽  
Catherine Chung ◽  
Robyn Cant ◽  
Jayne Boyle ◽  
...  
Keyword(s):  
Patient Safety ◽  
Web Based ◽  
Face To Face ◽  
Patient Deterioration ◽  
The Impact

scholarly journals The clinical effectiveness and cost-effectiveness of telephone triage for managing same-day consultation requests in general practice: a cluster randomised controlled trial comparing general practitioner-led and nurse-led management systems with usual care (the ESTEEM trial)

2015 ◽  
Vol 19 (13) ◽  
pp. 1-212 ◽  
Author(s):  
John L Campbell ◽  
Emily Fletcher ◽  
Nicky Britten ◽  
Colin Green ◽  
Tim Holt ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Patient Safety ◽  
Health Status ◽  
Primary Outcome ◽  
Controlled Trial ◽  
Cluster Randomised Controlled Trial ◽  
Telephone Triage ◽  
Face To Face ◽  
The Impact

BackgroundTelephone triage is proposed as a method of managing increasing demand for primary care. Previous studies have involved small samples in limited settings, and focused on nurse roles. Evidence is limited regarding the impact on primary care workload, costs, and patient safety and experience when triage is used to manage patients requesting same-day consultations in general practice.ObjectivesIn comparison with usual care (UC), to assess the impact of GP-led telephone triage (GPT) and nurse-led computer-supported telephone triage (NT) on primary care workload and cost, patient experience of care, and patient safety and health status for patients requesting same-day consultations in general practice.DesignPragmatic cluster randomised controlled trial, incorporating economic evaluation and qualitative process evaluation.SettingGeneral practices (n = 42) in four regions of England, UK (Devon, Bristol/Somerset, Warwickshire/Coventry, Norfolk/Suffolk).ParticipantsPatients requesting same-day consultations.InterventionsPractices were randomised to GPT, NT or UC. Data collection was not blinded; however, analysis was conducted by a statistician blinded to practice allocation.Main outcome measuresPrimary – primary care contacts [general practice, out-of-hours primary care, accident and emergency (A&E) and walk-in centre attendances] in the 28 days following the index consultation request. Secondary – resource use and costs, patient safety (deaths and emergency hospital admissions within 7 days of index request, and A&E attendance within 28 days), health status and experience of care.ResultsOf 20,990 eligible randomised patients (UCn = 7283; GPTn = 6695; NTn = 7012), primary outcome data were analysed for 16,211 patients (UCn = 5572; GPTn = 5171; NTn = 5468). Compared with UC, GPT and NT increased primary outcome contacts (over 28-day follow-up) by 33% [rate ratio (RR) 1.33, 95% confidence interval (CI) 1.30 to 1.36] and 48% (RR 1.48, 95% CI 1.44 to 1.52), respectively. Compared with GPT, NT was associated with a marginal increase in primary outcome contacts by 4% (RR 1.04, 95% CI 1.01 to 1.08). Triage was associated with a redistribution of primary care contacts. Although GPT, compared with UC, increased the rate of overall GP contacts (face to face and telephone) over the 28 days by 38% (RR 1.38, 95% CI 1.28 to 1.50), GP face-to-face contacts were reduced by 39% (RR 0.61, 95% CI 0.54 to 0.69). NT reduced the rate of overall GP contacts by 16% (RR 0.84, 95% CI 0.78 to 0.91) and GP face-to-face contacts by 20% (RR 0.80, 95% CI 0.71 to 0.90), whereas nurse contacts increased. The increased rate of primary care contacts in triage arms is largely attributable to increased telephone contacts. Estimated overall patient–clinician contact time on the index day increased in triage (GPT = 10.3 minutes; NT = 14.8 minutes; UC = 9.6 minutes), although patterns of clinician use varied between arms. Taking account of both the pattern and duration of primary outcome contacts, overall costs over the 28-day follow-up were similar in all three arms (approximately £75 per patient). Triage appeared safe, and no differences in patient health status were observed. NT was somewhat less acceptable to patients than GPT or UC. The process evaluation identified the complexity associated with introducing triage but found no consistency across practices about what works and what does not work when implementing it.ConclusionsIntroducing GPT or NT was associated with a redistribution of primary care workload for patients requesting same-day consultations, and at similar cost to UC. Although triage seemed to be safe, investigation of the circumstances of a larger number of deaths or admissions after triage might be warranted, and monitoring of these events is necessary as triage is implemented.Trial registrationCurrent Controlled Trials ISRCTN20687662.FundingThis project was funded by the NIHR Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 19, No. 13. See the NIHR Journals Library website for further project information.

scholarly journals What's the risk? Assessment of patients with stable chest pain

2015 ◽  
Vol 2 (2) ◽  
pp. 41-48 ◽  
Author(s):  
Arzu Cubukcu ◽  
Ian Murray ◽  
Simon Anderson
Keyword(s):  
Chest Pain ◽  
Stress Echocardiography ◽  
Clinical Excellence ◽  
Pain Clinic ◽  
Recent Onset ◽  
High Negative Predictive Value ◽  
Estimated Risk ◽  
Artery Disease ◽  
Stable Chest Pain ◽  
The Impact

In 2010, the National Institute for Heath and Clinical Excellence published guidelines for the management of stable chest pain of recent onset. Implementation has occurred to various degrees throughout the NHS; however, its effectiveness has yet to be proved. A retrospective study was undertaken to assess the impact and relevance of this guideline, comparing the estimated risk of coronary artery disease (CAD) with angiographic outcomes. Findings were compared with the recently published equivalent European guideline. A total of 457 patients who attended a Rapid Access Chest Pain Clinic were retrospectively reviewed. CAD risk was assessed according to NICE guidelines and patients were separated into typical, atypical and non-anginal chest pain groups. Risk stratification using typicality of symptoms in conjunction with NICE risk scoring and exercise tolerance testing was used to determine the best clinical course for each patient. The results include non-anginal chest pain – 92% discharged without needing further testing; atypical angina – 15% discharged, 40% referred for stress echocardiography, 35% referred for angiogram and significant CAD revealed in 8%; typical angina – 4% discharged, 19% referred for stress echocardiography, 71% referred for angiogram and 40% demonstrated CAD. Both guidelines appear to overestimate the risk of CAD leading to an excessive number of coronary angiograms being undertaken to investigate patients with typical or atypical sounding angina, with a low pick up rate of CAD. Given the high negative predictive value of stress echocardiography and the confidence this brings, there is much scope for expanding its use and potentially reduce the numbers going for invasive angiography.

scholarly journals 2510

2017 ◽  
Vol 1 (S1) ◽  
pp. 20-21
Author(s):  
Amber L. Allen ◽  
Christopher Barnes ◽  
Kevin S. Hanson ◽  
David Nelson ◽  
Randy Harmatz ◽  
...  
Keyword(s):  
Patient Safety ◽  
Quality Improvement ◽  
Open Source ◽  
Web Sites ◽  
Hospital System ◽  
Improvement Project ◽  
Clinical Quality ◽  
Development Framework ◽  
The Creation ◽  
The Impact

OBJECTIVES/SPECIFIC AIMS: To create a searchable public registry of all Quality Improvement (QI) projects. To incentivize the medical professionals at UF Health to initiate quality improvement projects by reducing startup burden and providing a path to publishing results. To reduce the review effort performed by the internal review board on projects that are quality improvement Versus research. To foster publication of completed quality improvement projects. To assist the UF Health Sebastian Ferrero Office of Clinical Quality & Patient Safety in managing quality improvement across the hospital system. METHODS/STUDY POPULATION: This project used a variant of the spiral software development model and principles from the ADDIE instructional design process for the creation of a registry that is web based. To understand the current registration process and management of quality projects in the UF Health system a needs assessment was performed with the UF Health Sebastian Ferrero Office of Clinical Quality & Patient Safety to gather project requirements. Biweekly meetings were held between the Quality Improvement office and the Clinical and Translational Science – Informatics and Technology teams during the entire project. Our primary goal was to collect just enough information to answer the basic questions of who is doing which QI project, what department are they from, what are the most basic details about the type of project and who is involved. We also wanted to create incentive in the user group to try to find an existing project to join or to commit the details of their proposed new project to a data registry for others to find to reduce the amount of duplicate QI projects. We created a series of design templates for further customization and feature discovery. We then proceed with the development of the registry using a Python web development framework called Django, which is a technology that powers Pinterest and the Washington Post Web sites. The application is broken down into 2 main components (i) data input, where information is collected from clinical staff, Nurses, Pharmacists, Residents, and Doctors on what quality improvement projects they intend to complete and (ii) project registry, where completed or “registered” projects can be viewed and searched publicly. The registry consists of a quality investigator profile that lists contact information, expertise, and areas of interest. A dashboard allows for the creation and review of quality improvement projects. A search function enables certain quality project details to be publicly accessible to encourage collaboration. We developed the Registry Matching Algorithm which is based on the Jaccard similarity coefficient that uses quality project features to find similar quality projects. The algorithm allows for quality investigators to find existing or previous quality improvement projects to encourage collaboration and to reduce repeat projects. We also developed the QIPR Approver Algorithm that guides the investigator through a series of questions that allows an appropriate quality project to get approved to start without the need for human intervention. RESULTS/ANTICIPATED RESULTS: A product of this project is an open source software package that is freely available on GitHub for distribution to other health systems under the Apache 2.0 open source license. Adoption of the Quality Improvement Project Registry and promotion of it to the intended audience are important factors for the success of this registry. Thanks goes to the UW-Madison and their QI/Program Evaluation Self-Certification Tool (https://uwmadison.co1.qualtrics.com/SE/?SID=SV_3lVeNuKe8FhKc73) used as example and inspiration for this project. DISCUSSION/SIGNIFICANCE OF IMPACT: This registry was created to help understand the impact of improved management of quality projects in a hospital system. The ultimate result will be to reduce time to approve quality improvement projects, increase collaboration across the UF Health Hospital system, reduce redundancy of quality improvement projects and translate more projects into publications.

scholarly journals Post-discharge care following acute kidney injury: quality improvement in primary care

2020 ◽  
Vol 9 (4) ◽  
pp. e000891
Author(s):  
Susan J Howard ◽  
Rebecca Elvey ◽  
Julius Ohrnberger ◽  
Alex J Turner ◽  
Laura Anselmi ◽  
...  
Keyword(s):  
Primary Care ◽  
Acute Kidney Injury ◽  
Patient Safety ◽  
Quality Improvement ◽  
Health Outcomes ◽  
Kidney Injury ◽  
Audit And Feedback ◽  
Improvement Project ◽  
General Practices ◽  
The Impact

BackgroundOver the past decade, targeting acute kidney injury (AKI) has become a priority to improve patient safety and health outcomes. Illness complicated by AKI is common and is associated with adverse outcomes including high rates of unplanned hospital readmission. Through national patient safety directives, NHS England has mandated the implementation of an AKI clinical decision support system in hospitals. In order to improve care following AKI, hospitals have also been incentivised to improve discharge summaries and general practices are recommended to establish registers of people who have had an episode of illness complicated by AKI. However, to date, there is limited evidence surrounding the development and impact of interventions following AKI.DesignWe conducted a quality improvement project in primary care aiming to improve the management of patients following an episode of hospital care complicated by AKI. All 31 general practices within a single NHS Clinical Commissioning Group were incentivised by a locally commissioned service to engage in audit and feedback, education training and to develop an action plan at each practice to improve management of AKI.ResultsAKI coding in general practice increased from 28% of cases in 2015/2016 to 50% in 2017/2018. Coding of AKI was associated with significant improvements in downstream patient management in terms of conducting a medication review within 1 month of hospital discharge, monitoring kidney function within 3 months and providing written information about AKI to patients. However, there was no effect on unplanned hospitalisation and mortality.ConclusionThe findings suggest that the quality improvement intervention successfully engaged a primary care workforce in AKI-related care, but that a higher intensity intervention is likely to be required to improve health outcomes. Development of a real-time audit tool is necessary to better understand and minimise the impact of the high mortality rate following AKI.

Transitioning to Blended Learning: Understanding Student and Faculty Perceptions

2011 ◽  
Vol 15 (1) ◽  
Author(s):  
Nanette P. Napier ◽  
Sonal Dekhane ◽  
Stella Smith
Keyword(s):  
Blended Learning ◽  
Student Performance ◽  
Liberal Arts ◽  
Faculty Perceptions ◽  
Liberal Arts College ◽  
Final Exam ◽  
Face To Face ◽  
Faculty Teaching ◽  
Face To Face Instruction ◽  
The Impact

This paper describes the conversion of an introductory computing course to the blended learning model at a small, public liberal arts college. Blended learning significantly reduces face-to-face instruction by incorporating rich, online learning experiences. To assess the impact of blended learning on students, survey data was collected at the midpoint and end of semester, and student performance on the final exam was compared in traditional and blended learning sections. To capture faculty perspectives on teaching blended learning courses, written reflections and discussions from faculty teaching blended learning sections were analyzed. Results indicate that student performance in the traditional and blended learning sections of the course were comparable and that students reported high levels of interaction with their instructor. Faculty teaching the course share insights on transitioning to the blended learning format.

MAGNETIC FIELD IMPACT UPON TRIBOTECHNICAL CHARACTERISTICS OF PERMANENT CONNECTIONS IN RELATION TO FRICTION SHOCK ABSORBERS

2020 ◽  
Vol 2020 (10) ◽  
pp. 4-11
Author(s):  
Victor Tikhomirov ◽  
Aleksandr Gorlenko ◽  
Stanislav Volohov ◽  
Mikhail Izmerov
Keyword(s):  
Magnetic Field ◽  
Friction Factor ◽  
Physical Contact ◽  
Active Centers ◽  
Press Fit ◽  
Electro Magnetic Field ◽  
Investigation Methods ◽  
Electro Magnetic ◽  
The Impact ◽  
The Magnetic Field

The work purpose is the investigation of magnetic field impact upon properties of friction steel surfaces at fit stripping with tightness through manifested effects and their wear visually observed. On the spots of a real contact the magnetic field increases active centers, their amount and saturation with the time of dislocation outlet, and has an influence upon tribo-mating. The external electro-magnetic field promotes the increase of the number of active centers at the expense of dislocations outlet on the contact surface, and the increase of a physical contact area results in friction tie strengthening and growth of a friction factor. By the example of friction pairs of a spentonly unit in the suspension of coach cars there is given a substantiation of actuality and possibility for the creation of technical devices with the controlled factor of friction and the stability of effects achieved is also confirmed experimentally. Investigation methods: the fulfillment of laboratory physical experiments on the laboratory plant developed and patented on bush-rod samples inserted with the fit and tightness. The results of investigations and novelty: the impact of the magnetic field upon the value of a stripping force of a press fit with the guaranteed tightness is defined. Conclusion: there is a possibility to control a friction factor through the magnetic field impact upon a friction contact.

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