Comparison of fit factors among healthcare providers working in the Emergency Department Center before and after training with three types of N95 and higher filter respirators

This quality improvement study focused on developing an understanding of factors influencing the ability of prenatal genetics counsellors (GCs) to efficiently see patients during the COVID-19 pandemic and strategies to improve their workflow using techniques from human factors and design. The demand for Prenatal Genetics Clinics is rising which has increased pressure on GCs to become more efficient. Genetics counsellors can improve access to their services by reducing the time spent on the tasks performed before and after a genetic counselling encounter, thereby increasing the number of patients they see. We were limited to certain methods to understand the differences in workflow before and during the COVID-19 pandemic. This study involved a literature review, archival analysis of workflow studies conducted before the pandemic, stakeholder meetings and mapping, a brainstorming session, as well as documenting time-on-task in a diary and naturalistic observation sessions. A task analysis was developed to identify factors influencing efficiency related to the design of the space, processes and the use of artefacts. Virtual and on-site workflows show that GCs spend at least half of their time on tasks before and/or after the patient’s appointment. Looking at potential inefficiencies or bottlenecks in workflow formed the development of a strategic plan for improving GC workflows at the prenatal Genetics Clinic. Improvements suggested through this analysis were constrained to support the current number of healthcare providers working within the existing space configuration.

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Use of Ophthalmic Sonography to Evaluate for Intraocular Foreign Body in Both Outpatient and Emergency Department/Urgent Care Patients

Journal of Diagnostic Medical Sonography ◽

10.1177/87564793211033232 ◽

2021 ◽

pp. 875647932110332

Author(s):

Patrick J. Fish

Keyword(s):

Emergency Department ◽

Foreign Body ◽

Foreign Bodies ◽

Outpatient Setting ◽

Intraocular Foreign Body ◽

Urgent Care ◽

Posterior Chamber ◽

Emergency Department Setting ◽

Before And After ◽

Glass Metal

Intraocular foreign bodies (IOFB) present differently depending on the type of material (wood, glass, metal) for the IOFB, extent of the injury, and location of the injury. IOFB and the injury can cause a perforation or penetration of the globe which can require more extensive treatment including surgery. Proper evaluation of the IOFB and injury can help to determine extent of the injury, the prognosis of the vision, and health of the eye before and after treatment but may be difficult for the physician depending on the view of the posterior chamber being compromised by media or simply by patient sensitivity. The extent of the injury may also prevent proper evaluation due to swelling, lacerations on the lids, or pain. Proper ophthalmic sonography can provide a quick evaluation of the globe for any IOFB in both the outpatient setting as well as emergency department setting. Evaluation via sonography may allow the physician to accurately diagnose and properly treat the patient to help restore and prevent further loss of vision.

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139. Impact of Pharmacist Driven Outpatient Fluoroquinolone Stewardship Initiative in Community Based Setting

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.184 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S81-S81

Author(s):

Sarah Norman ◽

Sara Jones ◽

Cara Acklin ◽

Christian Cheatham

Keyword(s):

Antimicrobial Stewardship ◽

Healthcare Providers ◽

Hospital Setting ◽

Secondary Outcome ◽

Quality Improvement Initiative ◽

Oral Antibiotic ◽

Ambulatory Care Setting ◽

Community Based ◽

Before And After ◽

Physician Network

Abstract Background Antimicrobial stewardship initiatives and efforts have historically had a greater emphasis in the inpatient hospital setting. There is a need for outpatient stewardship, and additionally, accreditation standards are starting to require antimicrobial stewardship efforts in the ambulatory care setting. Fluoroquinolones are a target for antimicrobial stewardship based on their broad-spectrum activity, pharmacokinetics/pharmacodynamics, safety profile, downstream resistance, and risk of super infections. The objective of this study was to compare outpatient fluoroquinolone prescribing rates before and after pharmacist led initiative. Methods This was a prospective, quality improvement initiative between October 1, 2019 to June 1, 2020 at a community-based physician network across Indiana. The pharmacist initiative incorporated a live, educational presentation with intervention 1 and an informational letter to healthcare providers across the outpatient physician network with intervention 2. Data was collected from a computer-generated, prescription report. The primary outcome was fluoroquinolone prescribing rates at Central Indiana (CI) sites before and after pharmacist led interventions. Rate of fluoroquinolone prescribing was defined as total number of fluoroquinolone prescriptions per month. The secondary outcome included percentage of fluoroquinolone use at CI sites. Percentage of fluoroquinolone use was defined as monthly number of fluoroquinolones prescriptions compared to monthly number of all oral antibiotic prescriptions. Results There was a 29.8% decrease (382 vs 268 prescriptions) in outpatient fluoroquinolone prescriptions at CI sites after intervention 1 compared to same month of previous year. There was a 43.7% decrease (428 vs 241 prescriptions) in outpatient fluoroquinolone prescriptions at CI sites after intervention 2. There was an overall 2.4% decrease (4.9% vs 2.5%) in percentage of fluoroquinolone use compared to all oral antibiotics at CI sites after intervention 2 compared to same month of previous year. Conclusion These findings suggest the pharmacist led outpatient antimicrobial stewardship initiative successfully decreased fluoroquinolone prescribing rates across the network. Disclosures Christian Cheatham, PharmD, BCIDP, Antimicrobial Resistance Solutions (Shareholder)

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Developing a Dementia Care Training Curriculum for Registered Dietitians

Innovation in Aging ◽

10.1093/geroni/igaa057.1434 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 443-444

Author(s):

Joy Douglas ◽

Christine Ferguson ◽

Beth Nolan

Keyword(s):

Experiential Learning ◽

Healthcare Providers ◽

Dementia Care ◽

Learning Needs ◽

Training Curriculum ◽

Registered Dietitians ◽

Development Team ◽

Average Percentage ◽

Before And After ◽

Care Training

Abstract Research supports the need for healthcare providers who are trained in providing care to older adults with dementia. However, few training options exist for Registered Dietitians (RDs) seeking dementia care training that is specific to nutrition. The purpose of this project was to adapt an existing dementia care training curriculum to meet the learning needs of RDs. The development team included two experts in dementia training and two RDs with expertise in gerontological nutrition. The new training module was based on the existing Positive Approach to Care™ (PAC) curriculum, which incorporates Kolb’s Experiential Learning Theory and the Adult Experiential Learning Cycle. The development team first identified learning objectives for content that would be relevant to RDs who work with persons living with dementia, and modified components of the existing PAC curriculum to meet these objectives. After a preliminary pilot, the 2-hour program was presented to 20 RDs using a combination of lecture presentation, experiential learning, and skill-building techniques. Participants were provided written materials to reinforce the concepts presented. Participants answered five dementia-specific questions before and after the training, and overall, the average percentage of correct answers improved following the training. Two weeks following the training, participants completed an open-ended survey to provide feedback on the training. Participants responded favorably to the mixed learning formats in the training. When asked to rank their preferred learning methods, participants indicated lecture-based learning and experiential learning as their top preferred methods. These findings indicate that the adapted curriculum may improve dementia knowledge among RDs.

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Paediatric attendances of the emergency department in a major Irish tertiary referral centre before and after expansion of free GP care to children under 6: a retrospective observational study

BMJ Paediatrics Open ◽

10.1136/bmjpo-2020-000862 ◽

2021 ◽

Vol 5 (1) ◽

pp. e000862

Author(s):

Irina Korotchikova ◽

Sukainah Al Khalaf ◽

Ewa Sheridan ◽

Rory O'Brien ◽

Colin P Bradley ◽

...

Keyword(s):

Emergency Department ◽

Health Service ◽

Observational Study ◽

Referral Centre ◽

Tertiary Referral ◽

Tertiary Referral Centre ◽

Period 2 ◽

Time Period ◽

Before And After ◽

Gp Care

ObjectivesTo examine the characteristics of paediatric attendances to the emergency department (ED) in Cork University Hospital (CUH) before and after the expansion of free general practitioner (GP) care to children under the age of 6 years.DesignThis is a retrospective observational study that used a large administrative dataset.SettingThe study was conducted in major Irish tertiary referral centre that serves a total population of over 1.1 million. It is a public hospital, owned and managed by the health service executive.ParticipantsChildren aged 0–15 years who attended CUH ED during the study period of 6 years (2012–2018) were included in this study (n=76 831).InterventionsFree GP care was expanded to all children aged 0–5 years in July 2015.Main outcome measuresPaediatric attendances to CUH ED were examined before (Time Period 1: July 2012–June 2015) and after (Time Period 2: July 2015–June 2018) the expansion of free GP care to children under 6. Changes in GP referral rates and inpatient hospital admissions were investigated.ResultsPaediatric presentations to CUH ED increased from 35 819 during the Time Period 1 to 41 012 during the Time Period 2 (14.5%). The proportion of the CUH ED attendances through GP referrals by children under 6 increased by over 8% in the Time Period 2 (from 10 148 to 14 028). Although the number of all children who attended CUH ED and were admitted to hospital increased in Time Period 2 (from 8704 to 9320); the proportion of children in the 0–5 years group who attended the CUH ED through GP referral and were subsequently admitted to hospital, decreased by over 3%.ConclusionThe expansion of free GP care has upstream health service utilisation implications, such as increased attendances at ED, and should be considered and costed by policy-makers.

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Healthcare pathways and resource use: mapping consequences of ambulance assessment for direct care with alternative healthcare providers

BMC Emergency Medicine ◽

10.1186/s12873-020-00380-5 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Sofi Varg ◽

Veronica Vicente ◽

Maaret Castren ◽

Peter Lindgren ◽

Clas Rehnberg

Keyword(s):

Emergency Department ◽

Acute Care ◽

Resource Use ◽

Healthcare Providers ◽

Healthcare Utilisation ◽

Direct Care ◽

Care Centre ◽

Decision System ◽

Geriatric Ward ◽

Patient Pathways

Abstract Background A decision system in the ambulance allowing alternative pathways to alternate healthcare providers has been developed for older patients in Stockholm, Sweden. However, subsequent healthcare resource use resulting from these pathways has not yet been addressed. The aim of this study was therefore to describe patient pathways, healthcare utilisation and costs following ambulance transportation to alternative healthcare providers. Methods The design of this study was descriptive and observational. Data from a previous RCT, where a decision system in the ambulance enabled alternative healthcare pathways to alternate healthcare providers were linked to register data. The receiving providers were: primary acute care centre or secondary geriatric ward, both located at the same community hospital, or the conventional pathway to the emergency department at an acute hospital. Resource use over 10 days, subsequent to assessment with the decision system, was mapped in terms of healthcare pathways, utilisation and costs for the 98 included cases. Results Almost 90% were transported to the acute care centre or geriatric ward. The vast majority arriving to the geriatric ward stayed there until the end of follow-up or until discharged, whereas patients conveyed to the acute care centre to a large extent were admitted to hospital. The median patient had 6 hospital days, 2 outpatient visits and costed roughly 4000 euros over the 10-day period. Arrival destination geriatric ward indicated the longest hospital stay and the emergency department the shortest. However, the cost for the 10-day period was lower for cases arriving to the geriatric ward than for those arriving to the emergency department. Conclusions The findings support the appropriateness of admittance directly to secondary geriatric care for older adults. However, patients conveyed to the acute care centre ought to be studied in more detail with regards to appropriate level of care.

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A Structured Curriculum for Interprofessional Training of Emergency Medicine Interns

Western Journal of Emergency Medicine ◽

10.5811/westjem.2019.11.44139 ◽

2019 ◽

Vol 21 (1) ◽

pp. 149-151 ◽

Cited By ~ 1

Author(s):

Ashley Rider ◽

Tiffany Anaebere ◽

Mariko Nomura ◽

David Duong ◽

Charlotte Wills

Keyword(s):

Emergency Department ◽

Emergency Medicine ◽

Interprofessional Education ◽

Hospital Setting ◽

Scope Of Practice ◽

Registered Nursing ◽

Interprofessional Training ◽

Before And After ◽

Team Based Care ◽

Improve Health

Interprofessional education (IPE) has been shown to improve health outcomes and patient satisfaction. IPE is now represented in the Accreditation Council for Graduate Medical Education’s emergency medicine (EM) milestones given the team-based nature of EM. The Highland Allied Health Rotation Program (H-AHRP) was developed by residents to enhance and standardize IPE for EM residents in a single hospital setting. H-AHRP was incorporated into the orientation month for interns starting in the summer of 2016. EM interns were paired with emergency department preceptors in registered nursing (RN), respiratory therapy (RT), pharmacy (PH), laboratory (LAB), and social work (SW) in either a four-hour shadowing experience (RN, RT, PH) or lecture-based overview (LAB, SW). We conducted a survey before and after the program. Overall, the EM interns reported an improved understanding of the scope of practice and day-to-day logistics after working with the preceptors. They found the program helpful to their future as physicians and would recommend it to other residencies. The H-AHRP program allows for the early incorporation of IPE into EM training, enhances interns’ understanding of both the scope and logistics of their colleagues, and is a well-received effort at improving team-based care.

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Effect of COVID-19 outbreak on emergency department attendances in an Italian academic hospital

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.207 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

M Poletto ◽

G Perri ◽

F Malacarne ◽

B Bianchet ◽

A Doimo ◽

...

Keyword(s):

Emergency Department ◽

Initial Phase ◽

Mainland China ◽

Hospital Setting ◽

Academic Hospital ◽

Significant Difference ◽

Before And After ◽

Life Threatening ◽

The Mean ◽

Critical Patients

Abstract Background Coronavirus disease 2019 (COVID-19) is a viral infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The disease was discovered during the 2019 outbreak in Mainland China and the first cases were reported in Italy on February 21, 2020. This study evaluates the emergency department (ED) attendances of an academic hospital in northern Italy before and after media reported the news of the first infected patients in Italy. Methods Adult attendances in ED in February 2020 were analysed dividing the period into 4 weeks (days 1-7, 8-14, 15-21, 22-28) compared with the same periods in 2019. The visits were analysed separately according to the Italian colour code of triage: white (non-critical), green (low-critical), yellow (medium critical), red (life-threatening). The mean weekly number of attendances was compared with t-test. Results February 2020 total ED attendances compared with February 2019 were 4865 vs 5029 (-3.3%), of which white codes were 834 vs 762 (+9.4%), green 2450 vs 2580 (-5.0%), yellow 1427 vs 1536 (-7.1%), red 154 vs 151 (+2.0%). February 2020 weekly mean ED attendances compared with February 2019 had statistically significant difference only in the fourth week (days 22-28) for green codes (75 vs 92, p = 0.007) and yellow codes (41 vs 52, p = 0.047), not for white (27 vs 26, p = 0.760) and red codes (5 vs 5, p = 0.817). The first three weeks of February 2020 compared with 2019 showed no statistically significant difference in weekly mean ED attendances. Conclusions There was a significant reduction of green and yellow codes attendances at ED in the fourth week of February 2020, corresponding to the initial phase of Italian COVID-19 outbreak. The fear of contracting SARS-CoV-2 by attending the ED probably acted as a significant deterrent in visits, especially for low and medium critical patients. Additional data are required to better understand the phenomenon, including the behaviour of non-critical attendances. Key messages A reduction of green and yellow codes attendances was reported during initial phase of COVID-19 outbreak in an Italian academic hospital. Fear of contracting COVID-19 infection in a hospital setting could impact on emergency department attendances.

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