scholarly journals Impact of a digital care logistics system on care duration, consumer satisfaction and shift leaders' workload in emergency departments

2021 ◽  
Vol 13 (4) ◽  
Author(s):  
Desale Tewelde Kahsay ◽  
Sanna Salanterä ◽  
Janne Engblom ◽  
Mikko Häikiö ◽  
Laura-Maria Peltonen
Keyword(s):  
Information Systems ◽  
Emergency Departments ◽  
Consumer Satisfaction ◽  
Control Unit ◽  
Digital Information ◽  
System Implementation ◽  
Logistics System ◽  
Time Points ◽  
The Impact ◽  
Intervention Unit

The primary goal of introducing digital information systems in healthcare organisations is to improve care processes and outcomes, however, studies that investigate the impact of digital information systems on the day-to-day operations management from the perspective of workflow and consumer satisfaction in emergency departments are scarce. Therefore, this study aimed to explore the impact of a digital clinical logistics system on the duration of patient care, consumer satisfaction and shift leaders' experience of workload in emergency departments. A longitudinal prospective design was used. Three units participated in the study; an intervention unit, a control unit A (no implemented system) and a control unit B (system already in use). We collected data on care duration, consumer satisfaction and shift leaders' experience of workload for four weeks at five time points both before system implementation (summer 2015, spring 2016) and after system implementation (summer 2016, autumn 2016, winter 2016). The average care duration time increased in the postimplementation period in the intervention and control B units (p < 0.001). Duration of care was higher in the intervention unit than control unit B in summer 2016 (p < 0.001) and winter 2016 (p = 0.009). Similarly, duration of care in control unit A was higher than control unit B in spring 2016 (p < 0.001). Consumer satisfaction decreased in the intervention unit, in winter 2016 (p < 0.001) and the experience of workload increased in the intervention unit, in summer 2016 and autumn 2016 (p < 0.05). However, the patients-to-nurses ratio was doubled in the intervention unit in the last time point postimplementation when compared to the first timepoint, while it remained similar in the control units throughout the study period. This work demonstrated that a digital care logistics system may support in increasing the number of patients treated with the same nursing resources. However, this seems to connect to other outcome variables such as increased care duration, increased experience of workload and decreased consumer satisfaction in some postimplementation time points.

scholarly journals 2084. Implementation of a Diagnostic Stewardship Algorithm by Bedside Nurses to Reduce Unnecessary Urinary Cultures in Hospitalized Adult Patients

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S703-S704
Author(s):  
Valeria Fabre ◽  
Ashley Pleiss ◽  
Zoe Demko ◽  
Anna Sick-Samuels ◽  
Lauri Hicks ◽  
...  
Keyword(s):  
Asymptomatic Bacteriuria ◽  
Control Unit ◽  
Johns Hopkins Hospital ◽  
Post Intervention ◽  
Statistical Process ◽  
Team Members ◽  
Before And After ◽  
Algorithm Implementation ◽  
The Impact ◽  
Intervention Unit

Abstract Background Urine cultures (UCx) are often ordered in patients without symptoms of urinary tract infection. A pilot study was conducted to assess the impact of a nurse-driven UCx diagnostic stewardship intervention for adult inpatients. Methods We interviewed eight nurses to determine the feasibility of a nurse-driven UCx stewardship intervention. Based on their feedback, an algorithm with appropriate indications for UCx was developed (Figure 1) and approved by physicians and nurses for piloting on a 24-bed medicine unit at The Johns Hopkins Hospital. UCx orders/100 patient-days (PD) were trended with statistical process charts in the intervention and a control unit. Nurses used the algorithm to guide discussions with ordering providers and to suggest instances where UCx may be unnecessary (“intervention”). Nurses were educated on an antibiotic (abx) use safety and appropriate testing during live sessions prior to algorithm implementation. Two study team members reviewed all UCx ordered in the intervention unit 12 months before and 6 months after the intervention for appropriateness based on algorithm criteria. Feedback on UCx order appropriateness and case-based discussion were provided to nurses via in-person meetings post intervention. Data were compared using the χ 2 or the Mann–Whitney test as appropriate. The rate of UCx orders before and after the intervention were compared using a standard incident ratio (IRR). Results With algorithm implementation, the mean rate of UCx orders/100 PD decreased from 2.7 to 1.8 (39% decrease) in the intervention unit (IRR 0.61, 95% confidence intervals (CI) 0.45–0.82, P = .16). Mean UCx order rates in the control unit were 2.49 and 2.99, respectively (Figure 2). Characteristics of patients reviewed for appropriateness were similar between the two study periods: median age 63 (IQR 39, 74) vs. 56 (IQR 45, 76), female sex 65% vs. 61%, on hemodialysis 7% vs. 11%, urinary catheter present 20% vs. 29%. The proportion of inappropriate UCx decreased from 59% (98/165) to 50% (32/64) (P = 0.16). There were 8 and 1 cases of asymptomatic bacteriuria inappropriately treated in the pre- and post-intervention periods, respectively (42 and 7 abx days). Conclusion With the appropriate training and tools, nurses can steward UCx and reduce unnecessary testing and abx use Disclosures Sara E. Cosgrove, MD, MS, Basilea: Consultant; Theravance: Consultant.

Data-driven innovation at the Grupo Pellas SER company

2016 ◽  
Vol 6 (2) ◽  
pp. 1-16
Author(s):  
David Zamora ◽  
Juan Carlos Barahona
Keyword(s):  
Information Systems ◽  
Business Model ◽  
Business Intelligence ◽  
Data Systems ◽  
System Implementation ◽  
Content Type ◽  
Traceability System ◽  
Increase Productivity ◽  
The Impact ◽  
A Company

Subject area Management of Innovation and Technology/Management Information Systems. Study level/applicability Information Systems. Case overview SER (Sugar, Energy & Rum) was a company belonging to the Grupo Pellas Corporation. The company operated in four countries, had six subsidiaries, employed more than 25,000 people, had more than 43,500 manzanas of sugarcane crops in Nicaragua alone and had global annual sales of more than US$400m. In 2008, due to the negative effects of the crisis on the company’s business model (increasing costs due to higher prices for fuel and decreasing income because of low international sugar prices), the company decided to implement a business intelligence (BI) system to optimize its processes to reduce costs and increase productivity. At that time, the company had more than 100 years of data, information systems that fed into their main business processes and a culture that appreciated data as the basis for decision-making. However, there were inconsistencies among data systems, users received highly complex reports in Excel or green screens and process monitoring happened long after the tasks had been completed. As a response, SER used extract–transform–load to collect and clean data that would be used in the BI system (the case leaves the questions regarding the systems selection unsolved for discussion). Based on their business model, they selected the most critical processes and defined key performance indicators to measure the impact of changes in those processes. They considered graphic design as a tool to make the system more accepted by users and worked together with users so that reports only offered the most important information. The result was improved costs and productivity. They decreased manual time spent by 14 per cent, automated time spent by 10 per cent, and eliminated 1,556 hours of dead time for equipment in the field, which allowed them to increase productivity by US$1m just in sugar. They saved 20,000 trips from the fields to the factories, which represented more than US$1m in savings by monitoring the weight of wagons loaded with sugarcane in real time. They improved client perceptions about the company both locally and internationally by implementing a sugar traceability system. Expected learning outcomes The case “Business Intelligence at the Grupo Pellas SER Company” has as its objective to respond to the question: How does a company make its BI system implementation successful? As such, the case: Discusses what a BI system is and what it provides to a business analyses challenges, benefits and context when implementing a BI system; analyses success factors and recommendations in the BI system implementation process; analyses the process of implementing a BI and highlights the importance of the system priority questions and technological alternatives. Supplementary materials Teaching notes are available for educators only. Please contact your library to gain login details or email [email protected] to request teaching notes. Subject code CSS 11: Strategy

scholarly journals Model-based evaluation of school- and non-school-related measures to control the COVID-19 pandemic

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Ganna Rozhnova ◽  
Christiaan H. van Dorp ◽  
Patricia Bruijning-Verhagen ◽  
Martin C. J. Bootsma ◽  
Janneke H. H. M. van de Wijgert ◽  
...  
Keyword(s):  
Reproduction Number ◽  
Additional Benefit ◽  
Transmission Model ◽  
Time Points ◽  
School Based ◽  
Admission Data ◽  
Age Structured ◽  
The Impact ◽  
Pandemic Wave

AbstractThe role of school-based contacts in the epidemiology of SARS-CoV-2 is incompletely understood. We use an age-structured transmission model fitted to age-specific seroprevalence and hospital admission data to assess the effects of school-based measures at different time points during the COVID-19 pandemic in the Netherlands. Our analyses suggest that the impact of measures reducing school-based contacts depends on the remaining opportunities to reduce non-school-based contacts. If opportunities to reduce the effective reproduction number (Re) with non-school-based measures are exhausted or undesired and Re is still close to 1, the additional benefit of school-based measures may be considerable, particularly among older school children. As two examples, we demonstrate that keeping schools closed after the summer holidays in 2020, in the absence of other measures, would not have prevented the second pandemic wave in autumn 2020 but closing schools in November 2020 could have reduced Re below 1, with unchanged non-school-based contacts.

Authors’ response to AAEM on the impact of advanced practice provider staffing in emergency departments

2021 ◽  
Author(s):  
Jesse M. Pines ◽  
Amer Z. Aldeen ◽  
John Bedolla ◽  
Maura Polansky ◽  
Tamara S. Ritsema ◽  
...  
Keyword(s):  
Emergency Departments ◽  
Advanced Practice ◽  
The Impact

scholarly journals 152. Applying A Difference-in-Difference Analysis to Assess Effect of Antimicrobial Stewardship Strategies on Changes in Antimicrobial Use

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S86-S86
Author(s):  
Ann F Chou ◽  
Yue Zhang ◽  
Makoto M Jones ◽  
Christopher J Graber ◽  
Matthew B Goetz ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Clinical Pharmacist ◽  
Antibiotic Use ◽  
Feedback Mechanism ◽  
Health Care Facilities ◽  
Antimicrobial Use ◽  
Time Points ◽  
The Difference ◽  
The Impact ◽  
Over Time

Abstract Background About 30–50% of inpatient antimicrobial therapy is sub-optimal. Health care facilities have utilized various antimicrobial stewardship (AS) strategies to optimize appropriate antimicrobial use, improve health outcomes, and promote patient safety. However, little evidence exists to assess relationships between AS strategies and antimicrobial use. This study examined the impact of changes in AS strategies on antimicrobial use over time. Methods This study used data from the Veterans Affairs (VA) Healthcare Analysis & Informatics Group (HAIG) AS survey, administered at 130 VA facilities in 2012 and 2015, and antimicrobial utilization from VA Corporate Data Warehouse. Four AS strategies were examined: having an AS team, feedback mechanism on antimicrobial use, infectious diseases (ID) attending physicians, and clinical pharmacist on wards. Change in AS strategies were computed by taking the difference in the presence of a given strategy in a facility between 2012–2015. The outcome was the difference between antimicrobial use per 1000 patient days in 2012–2013 and 2015–2016. Employing multiple regression analysis, changes in antimicrobial use was estimated as a function of changes in AS strategies, controlling for ID human resources in and organizational complexity. Results Of the 4 strategies, only change in availability of AS teams had an impact on antimicrobial use. Compared to facilities with no AS teams at both time points, antibiotic use decreased by 63.9 uses per 1000 patient days in facilities that did not have a AS team in 2012 but implemented one in 2015 (p=0.0183). Facilities that had an AS team at both time points decreased use by 62.2 per 1000 patient days (p=0.0324). Conclusion The findings showed that AS teams reduced inpatient antibiotic use over time. While changes in having feedback on antimicrobial use and clinical pharmacist on wards showed reduced antimicrobial use between 2012–2015, the differences were not statistically significant. These strategies may already be a part of a comprehensive AS program and employed by AS teams. In further development of stewardship programs within healthcare organizations, the association between AS teams and antibiotic use should inform program design and implementation. Disclosures All Authors: No reported disclosures

scholarly journals Exploring the impact of a complex intervention for women with depression in contexts of adversity: A pilot feasibility study of COURRAGE-plus in South Africa

2021 ◽  
pp. 002076402110102
Author(s):  
Rochelle A Burgess ◽  
Niklas Jeske ◽  
Shahana Rasool ◽  
Ayesha Ahmad ◽  
Anna Kydd ◽  
...  
Keyword(s):  
Mental Health ◽  
South Africa ◽  
Narrative Therapy ◽  
Mental Distress ◽  
Social Intervention ◽  
Friedman Test ◽  
Time Points ◽  
Symptoms Of Depression ◽  
The Impact ◽  
Collective Narrative

Background: Depression is a leading cause of disease burden worldwide but is often undertreated in low- and middle-income countries. Reasons behind the treatment gap vary, but many highlight a lack of interventions which speak to the socio-economic and structural realties that are associated to mental health problems in many settings, including South Africa. The COURRAGE-PLUS intervention responds to this gap, by combining a collective narrative therapy (9 weeks) intervention, with a social intervention promoting group-led practical action against structural determinants of poor mental health (4 weeks), for a total of 13 sessions. The overall aim is to promote mental health, while empowering communities to acknowledge, and respond in locally meaningful ways to social adversity linked to development of mental distress. Aim: To pilot and evaluate the effectiveness of a complex intervention – COURRAGE-PLUS on symptoms of depression as assessed by the Patient Health Questionnaire (PHQ-9) among a sample of women facing contexts of adversity in Gauteng, South Africa. Methods: PHQ-9 scores were assessed at baseline, post collective narrative therapy (midline), and post social intervention (endline). Median scores and corresponding interquartile ranges were computed for all time points. Differences in scores between time points were tested with a non-parametric Friedman test. The impact across symptom severities was compared descriptively to identify potential differences in impact across categories of symptom severity within our sample. Results: Participants’ ( n = 47) median depression score at baseline was 11 (IQR = 7) and reduced to 4 at midline (IQR = 7) to 0 at endline (IQR = 2.5). The Friedman test showed a statistically significant difference between depression scores across time points, [Formula: see text](2) = 49.29, p < .001. Median depression scores were reduced to 0 or 1 Post-Intervention across all four severity groups. Conclusions: COURRAGE-PLUS was highly effective at reducing symptoms of depression across the spectrum of severities in this sample of women facing adversity, in Gauteng, South Africa. Findings supports the need for larger trials to investigate collective narrative storytelling and social interventions as community-based interventions for populations experiencing adversity and mental distress.

T3 Are Burns a Chronic Condition: Examining Physical and Mental Functioning up to 20 Years After Injury

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S2-S3
Author(s):  
Callie Abouzeid ◽  
Audrey E Wolfe ◽  
Gretchen J Carrougher ◽  
Nicole S Gibran ◽  
Radha K Holavanahalli ◽  
...  
Keyword(s):  
Mental Health ◽  
Hospital Stay ◽  
National Database ◽  
Time Points ◽  
Patient Reported ◽  
Burn Survivors ◽  
Population Demographic ◽  
The Impact ◽  
Over Time

Abstract Introduction Burn survivors often face many long-term physical and psychological symptoms associated with their injury. To date, however, few studies have examined the impact of burn injuries on quality of life beyond 2 years post-injury. The purpose of this study is to examine the physical and mental well-being of burn survivors up to 20 years after injury. Methods Data from the Burn Model System National Database (1997–2020) were analyzed. Patient-reported outcome measures were collected at discharge with a recall of preinjury status, and then at 5, 10, 15, and 20 years after injury. Outcomes examined were the Physical Component Summary (PCS) and Mental Component Summary (MCS) of the Short Form-12. Trajectories were developed using linear mixed methods model with repeated measures of PCS and MCS scores over time and controlling for demographic and clinical variables. The model fitted score trajectory was generated with 95% confidence intervals to demonstrate score changes over time and associations with covariates. Results The study population included 420 adult burn survivors with a mean age of 42.4 years. The population was mainly male (66%) and white (76.4%) with a mean burn size of 21.5% and length of hospital stay of 31.3 days. Higher PCS scores were associated with follow-up time points closer to injury, shorter hospital stay, and younger age. Similarly, higher MCS scores were associated with earlier follow-up time points, shorter hospital stay, female gender, and non-perineal burns. MCS trajectories are demonstrated in the Figure. Conclusions Burn survivors’ physical and mental health worsened over time. Such a trend is different from previous reported results for mental health in the general population. Demographic and clinical predictors of recovery over time are identified.

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