Improving Genetics Clinic Efficiency and Capacity Using Design and Human Factors Methods

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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Prognostic factors influencing anatomical and functional outcome of Myringoplasty

Bangladesh Journal of Otorhinolaryngology ◽

10.3329/bjo.v19i1.14858 ◽

2013 ◽

Vol 19 (1) ◽

pp. 18-23

Author(s):

KM Nurul Alam ◽

Mohammad Idrish Ali ◽

Md Mahmudul Huq ◽

Md Abu Hanif

Keyword(s):

Neck Surgery ◽

Cross Sectional Study ◽

Clinical Findings ◽

Cross Sectional ◽

Factors Influencing ◽

Number Of Patients ◽

Before And After ◽

Operative Assessment ◽

Head Neck Surgery

Objective: To assess the rate of healing of tympanic membrane, hearing status before and after operation and determine the factors influencing surgical outcome. Methods: This cross-sectional study was done in the department of Otolaryngology & Head- Neck Surgery of SSMC & Mitford Hospital, Dhaka, during the period of January, 2008 to December, 2009. A total of 60 patients was underwent myringoplasty operation and taken detailed history, clinical findings and post operative assessment. Analyzed data presented by various tables, graphs and figures. Results: The study included 60 patients of myringoplasty operation. Age of the patient was between 15-45 years. Out of 60 patients male was 60% and female was 40%. Highest number of patients was in the age group of 15-25 years. Conclusion: Hearing improvement after myringoplasty in anatomically successful cases improve quality of life of the patient. DOI: http://dx.doi.org/10.3329/bjo.v19i1.14858 Bangladesh J Otorhinolaryngol 2013; 19(1): 18-23

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A Well-Structured Follow-Up Program is Required after Recovery from Coronavirus Disease 2019 (COVID-19); Release from Quarantine is Not the End of Treatment

Journal of Clinical Medicine ◽

10.3390/jcm10112329 ◽

2021 ◽

Vol 10 (11) ◽

pp. 2329

Author(s):

Keun-Mi Lee ◽

Hae-Jin Ko ◽

Geon Ho Lee ◽

A-Sol Kim ◽

Dong-Wook Lee

Keyword(s):

Psychological Stress ◽

Psychological Symptoms ◽

Healthcare Providers ◽

Final Analysis ◽

Physical Symptoms ◽

Forward Selection ◽

Phone Calls ◽

Number Of Patients ◽

Before And After

During the Coronavirus Infection Disease-19 (COVID-19) pandemic, the number of patients released from quarantine is exceeding the number of newly diagnosed cases. This study is a retrospective cohort study in which consultation data were collected from a COVID-19 follow-up health consultation program. The studied population was selected from patients who recovered after quarantine and treatment for COVID-19 in Daegu City and in Gyeongsangbukdo province, Korea, from March to June 2020. The healthcare providers comprised 20 family-medicine specialists who consulted and educated the patients through phone calls in accordance with structured guidelines. Physical and mental status before and after recovery were compared among patients who received a single consultation and those who received two or more consultations. A total of 1604 subjects were selected for the final analysis. Of these, 1145 (71.4%) had one consultation and 459 (28.6%) had two or more. The group that had two or more consultations reported significantly more physical symptoms, more psychological symptoms (including depression), and more psychological stress. Multivariate forward selection logistic regression analysis showed that re-confirmed cases of COVID-19, physical symptoms after quarantine, feelings of depression, and psychological stress had a significant effect on the number of consultations received. In conclusion, COVID-19 has various physical and mental sequelae after discharge from quarantine. Therefore, a well-structured follow-up program is needed after recovery.

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Collected papers prepared under work unit SPANCON: Human factors influencing span of control within military organizations.

PsycEXTRA Dataset ◽

10.1037/e413322004-001 ◽

1969 ◽

Keyword(s):

Human Factors ◽

Work Unit ◽

Span Of Control ◽

Military Organizations ◽

Factors Influencing

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Survey of Cloud Computing in Healthcare Sector

International Journal of Advanced Research in Computer Science and Software Engineering ◽

10.23956/ijarcsse/v7i7/0222 ◽

2017 ◽

Vol 7 (7) ◽

pp. 337

Author(s):

S. Karthiga Devi ◽

B. Arputhamary

Keyword(s):

Cloud Computing ◽

Healthcare Providers ◽

High Volume ◽

Healthcare Services ◽

Healthcare Sector ◽

Cloud Infrastructure ◽

Healthcare Organizations ◽

Privacy And Security ◽

Healthcare Data ◽

Number Of Patients

Today the volume of healthcare data generated increased rapidly because of the number of patients in each hospital increasing. These data are most important for decision making and delivering the best care for patients. Healthcare providers are now faced with collecting, managing, storing and securing huge amounts of sensitive protected health information. As a result, an increasing number of healthcare organizations are turning to cloud based services. Cloud computing offers a viable, secure alternative to premise based healthcare solutions. The infrastructure of Cloud is characterized by a high volume storage and a high throughput. The privacy and security are the two most important concerns in cloud-based healthcare services. Healthcare organization should have electronic medical records in order to use the cloud infrastructure. This paper surveys the challenges of cloud in healthcare and benefits of cloud techniques in health care industries.

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Impact of Michigan’s new opioid prescribing laws on spine surgery patients: analysis of the Michigan Spine Surgery Improvement Collaborative

Journal of Neurosurgery Spine ◽

10.3171/2020.7.spine20729 ◽

2020 ◽

pp. 1-6

Author(s):

Paul Park ◽

Victor Chang ◽

Hsueh-Han Yeh ◽

Jason M. Schwalb ◽

David R. Nerenz ◽

...

Keyword(s):

Spine Surgery ◽

Spinal Surgery ◽

Readmission Rate ◽

Rating Scale ◽

Short Term ◽

Readmission Rates ◽

Opioid Prescribing ◽

Number Of Patients ◽

Before And After ◽

The Impact

OBJECTIVEIn 2017, Michigan passed new legislation designed to reduce opioid abuse. This study evaluated the impact of these new restrictive laws on preoperative narcotic use, short-term outcomes, and readmission rates after spinal surgery.METHODSPatient data from 1 year before and 1 year after initiation of the new opioid laws (beginning July 1, 2018) were queried from the Michigan Spine Surgery Improvement Collaborative database. Before and after implementation of the major elements of the new laws, 12,325 and 11,988 patients, respectively, were treated.RESULTSPatients before and after passage of the opioid laws had generally similar demographic and surgical characteristics. Notably, after passage of the opioid laws, the number of patients taking daily narcotics preoperatively decreased from 3783 (48.7%) to 2698 (39.7%; p < 0.0001). Three months postoperatively, there were no differences in minimum clinically important difference (56.0% vs 58.0%, p = 0.1068), numeric rating scale (NRS) score of back pain (3.5 vs 3.4, p = 0.1156), NRS score of leg pain (2.7 vs 2.7, p = 0.3595), satisfaction (84.4% vs 84.7%, p = 0.6852), or 90-day readmission rate (5.8% vs 6.2%, p = 0.3202) between groups. Although there was no difference in readmission rates, pain as a reason for readmission was marginally more common (0.86% vs 1.22%, p = 0.0323).CONCLUSIONSThere was a meaningful decrease in preoperative narcotic use, but notably there was no apparent negative impact on postoperative recovery, patient satisfaction, or short-term outcomes after spinal surgery despite more restrictive opioid prescribing. Although the readmission rate did not significantly increase, pain as a reason for readmission was marginally more frequently observed.

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Analysis of work-related accidents and ill-health in Brazil since the introduction of the accident prevention factor

BMC Public Health ◽

10.1186/s12889-021-10706-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Helena Eri Shimizu ◽

Josierton Cruz Bezerra ◽

Luciano José Arantes ◽

Edgar Merchán-Hamann ◽

Walter Ramalho

Keyword(s):

Health Status ◽

Occupational Health ◽

Health Services ◽

Economic Activity ◽

Accident Prevention ◽

Multiplication Factor ◽

Work Related ◽

Factors Influencing ◽

Before And After ◽

External Causes

Abstract Background Since 2004, Brazil has had a national policy for occupational health and safety. This policy means companies’ tax burden is altered according to the numbers of work-related accidents and ill-health amongst their workers. In 2010, a multiplication factor was introduced to this policy, called the Accident Prevention Factor. The idea of this new multiplication factor is to encourage individual employers to take initiatives to prevent accidents and ill health in the workplace. This study was designed to investigate the incidence of work-related accidents and ill-health in Brazil according to their causes, their severity, and the economic activity in which they occur, and to compare the data before and after the introduction of the Accident Prevention Factor. Methods An ecological study was conducted by analyzing the time series of work-related accidents/ill-health between 2008 and 2014 from the Brazilian social security system (Previdência Social) statistical yearbooks. Incidences were calculated per cause, economic activity, and severity of the accident/ill-health. Data from before and after the introduction of the Accident Prevention Factor were compared using the Mann-Whitney test per cause and per economic activity. Statistical analyses were made using the SPSS software, with significance set at 5%. Results A reduction in the incidence of work-related accidents/ill-health was found across all the groups of causes analyzed, except for the groups “external causes of morbidity and mortality” and “factors influencing health status and contact with health services.” Greater reductions were found for diseases of the musculoskeletal system and connective tissue and diseases of the nervous system. Reductions in work-related accidents/ill-health were found in the different economic activities and in the different severity groups. The highest reduction after the introduction of the Accident Prevention Factor was in manufacturing and production (p < 0.05). Conclusions Overall, the incidence of accidents/ill-health was found to be on decline, except those with external causes of morbidity and mortality and those involving factors influencing health status and contact with health services. The biggest reduction was found in manufacturing and production. However, generally speaking progress still needs to be made in accident prevention and occupational health across a whole range of work environments.

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Perspectives of Healthcare Professionals Regarding Factors Associated with Antimicrobial Resistance (AMR) and Their Consequences: A Cross Sectional Study in Eastern Province of Saudi Arabia

Antibiotics ◽

10.3390/antibiotics10070878 ◽

2021 ◽

Vol 10 (7) ◽

pp. 878

Author(s):

Mohamed A. Baraka ◽

Amany Alboghdadly ◽

Samar Alshawwa ◽

Asim Ahmed Elnour ◽

Hassan Alsultan ◽

...

Keyword(s):

Antimicrobial Resistance ◽

Inappropriate Prescribing ◽

Healthcare Providers ◽

Cross Sectional Study ◽

Sectional Study ◽

Key Factors ◽

Eastern Province ◽

Cross Sectional ◽

Factors Associated ◽

Factors Influencing

Factors reported in the literature associated with inappropriate prescribing of antimicrobials include physicians with less experience, uncertain diagnosis, and patient caregiver influences on physicians’ decisions. Monitoring antimicrobial resistance is critical for identifying emerging resistance patterns, developing, and assessing the effectiveness of mitigation strategies. Improvement in prescribing antimicrobials would minimize the risk of resistance and, consequently, improve patients’ clinical and health outcomes. The purpose of the study is to delineate factors associated with antimicrobial resistance, describe the factors influencing prescriber’s choice during prescribing of antimicrobial, and examine factors related to consequences of inappropriate prescribing of antimicrobial. A cross-sectional study was conducted among healthcare providers (190) in six tertiary hospitals in the Eastern province of Saudi Arabia. The research panel has developed, validated, and piloted survey specific with closed-ended questions. A value of p < 0.05 was considered to be statistically significant. All data analysis was performed using the Statistical Package for Social Sciences (IBM SPSS version 23.0). 72.7% of the respondents have agreed that poor skills and knowledge are key factors that contribute to the inappropriate prescribing of antimicrobials. All of the respondents acknowledged effectiveness, previous experience with the antimicrobial, and reading scientific materials (such as books, articles, and the internet) as being key factors influencing physicians’ choice during antimicrobial prescribing. The current study has identified comprehensive education and training needs for healthcare providers about antimicrobial resistance. Using antimicrobials unnecessarily, insufficient duration of antimicrobial use, and using broad spectrum antimicrobials were reported to be common practices. Furthermore, poor skills and knowledge were a key factor that contributed to the inappropriate use and overuse of antimicrobials, and the use of antimicrobials without a physician’s prescription (i.e., self-medication) represent key factors which contribute to AMR from participants’ perspectives. Furthermore, internal policy and guidelines are needed to ensure that the antimicrobials are prescribed in accordance with standard protocols and clinical guidelines.

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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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