Tracking aspects of healthcare activity during the first nine months of COVID-19 in Ireland: a secondary analysis of publicly available data

Background: Sláintecare aims to introduce universal healthcare in Ireland. The COVID-19 pandemic poses both challenges and opportunities to this process. This study explored the impact of COVID-19 on aspects of Irish healthcare during the first nine months of the pandemic and considers the implications for Sláintecare implementation. Methods: Secondary analysis was undertaken on publicly available data on three key domains of the Irish healthcare system: primary care, community-based allied healthcare, and hospitals. Descriptive statistics were computed using Microsoft Excel 2016. Results: Up to March 2021, 3.76 million COVID-19 tests were performed by Ireland’s public healthcare system, 2.48 million (66.0%) of which were referred from the community. General practitioners delivered 2.31 million telephone triages of COVID-19 symptoms, peaking in December 2020 when 416,607 consultations occurred. Patient numbers across eight allied healthcare specialties fell by 35.1% versus previous years, with the greatest reductions seen in speech and language therapy (49.0%) and audiology (46.1%). Hospital waiting lists increased from 729,937 to 869,676 (or by 19.1%) from January 2019 to January 2021. In January 2021, 629,919 patients awaited a first outpatient clinic appointment, with 170,983 (27.1%) waiting longer than 18 months. The largest outpatient lists were observed in orthopaedic surgery (n=77,257); ear, nose and throat surgery (n=68,073); and ophthalmology (n=47,075). The proportion of patients waiting more than 12 months for a day-case gastrointestinal endoscopy rose from 6.0% in January 2020 to 19.0% in January 2021. Conclusions: Healthcare activity has been significantly disrupted by COVID-19, leading to increased wait times and greater barriers to healthcare access during the pandemic. Yet, Ireland’s health system responses also revealed strong willingness and ability to adapt and to implement novel solutions for healthcare delivery, rapidly and at scale. This has demonstrated what is achievable under Sláintecare and provides a unique opportunity to ‘build back better’ towards sustainable recovery.

Oxford Guidelines for adult day-case tonsillectomy

Oxford guidelines were developed after critically reviewing the existing literature and aim to assist anaesthetists, surgeons and allied healthcare staff in providing optimal care for patients undergoing tonsillectomy as a day-case procedure. Appropriate patient selection, provision of robust analgesia, antiemesis, perioperative warming and hydration are key factors to ensure patient comfort and allow same-day discharge. Patients can be discharged home after a minimum observation of 6h as this is the period with the greatest risk of primary haemorrhage. All patients must have a clear and safe understanding of which complications may occur and know how to seek help. A team effort and close collaboration between the anaesthetic, surgical, theatre and ward teams are essential to achieve optimum outcomes and reduce the rate of failed discharges.

The Knowledge, Attitude and Practices of Allied Healthcare Professionals and Nurses towards Blood Sugar Level Measurement (BSL) for Non-Diabetic Patients in Pre- and Post-Surgery

Hypoglycemia complications in pre-and post-surgery are common among hospitalized patients with or without diabetes mellitus (DM) and associated with undesired treatment outcomes (1,2,3). That derived our incentive to conduct this “cross-sectional study of total 102 randomly selected respondents” aims to assess the knowledge, attitude, and practices among allied healthcare professionals and nurses towards BSL measurement for hospitalized nondiabetic patients in pre-and post-surgery. Data for this study was obtained in a questionnaire-based format from respondents. The questionnaire includes questions on demographical data, participant’s knowledge, attitude (reaction towards some hypoglycemic signs and symptoms), and evaluation of participant’s practices. Analysis shows that 74.5% of participants were aware of hypoglycemia complications, and 20.5% had some knowledge, while the rest (4.9%) were not aware. 72.5% of the participants showed the right attitude towards the signs and symptoms of hypoglycemia. The rest of the participants (27.5%) were not able to distinguish between the signs and symptoms of cardiac complications and hypoglycemic complications. We found that 68.6% of the participants followed the guidelines of BSL measurement at their workplace (hospital) while 31.4% of participants don’t. We found an association between the occupation and knowledge of the participants (P = 0.046). A significant association between occupation and practices of the participants was also found (P = 0.003). This study shows that nurses are more aware of hypoglycemia complications in pre-or post-surgery than AHPs. These results hint that AHPs need to expand their knowledge and awareness of hypoglycemia complications in pre-and post-surgery in order to avoid undesired treatment outcomes. Key words: Blood sugar level (BSL), Hypoglycemia, Non-diabetic, pre-and post-surgery, Nil-By-Mouth (NBM), Allied Healthcare Professionals (AHPs).

A SYSTEMATIC REVIEW OF STUDIES RELATING TO THE PSYCHOLOGICAL WELL-BEING OF DOCTORS AND ALLIED HEALTHCARE PROFESSIONALS DURING THE COVID-19 PANDEMIC

Doctors and other allied healthcare professionals are constantly exposed to stressful situations that can undoubtedly negatively affect their psychological well-being. This precarious situation has been further exacerbated due to the COVID-19 pandemic. This study aims to explore the mental stress and trauma among doctors, in light of the pandemic. A number of relevant studies (quantitative, qualitative, mixed methods, and case studies) have been gathered to present a global trajectory of the responses of the doctors in the pandemic, and, as a consequence how this has impacted their psychological well-being. Collated findings suggest a need for a more nuanced and global approach, which is necessary towards addressing the immediate and long-lasting effects of the pandemic within the medical community. This study also provides a theoretical framework that can be used to design psychological interventions which can target the healthcare profession. Keywords: community psychology; COVID-19, healthcare professionals, psychological well-being; systematic review

Patient quality criteria for a multidisciplinary integrated care pathway for von Hippel-Lindau syndrome.

e13534 Background: The objective was to establish a comprehensive set of patient-driven recommendations for specialists and allied healthcare professionals for the care of individuals with the multiple neoplasia syndrome von Hippel-Lindau (VHL). VHL patients require multiple surgeries during the course of their lifetimes, due to cysts and tumors in various organs including the kidney, brain, eye, spine, pancreas, adrenal glands, and broad ligament/epididymis. Screening and care from multiple specialists form the backbone of their care, yet this is rarely coordinated in an optimal manner. Methods: The Dutch VHL patient organization (Belangenvereniging VHL) initiated this process, and approached specialists and expert patients for input. Using components of consensus methodology, a 20-member multidisciplinary panel produced an integrated care pathway relating to the provision of care for VHL patients by patients, medical specialists, specialist nurses and allied healthcare professionals. Items were developed by 3 rounds of email correspondence in which the basis was formed for a consensus meeting which constituted the third round of review. The fourth and final round was an email review of the consensus output. Results: The panel agreed on recommendations for the optimal quality of care for VHL patients, in the form of a decision tree, which is supervised by a nurse specialist as a main contact point. These items were grouped under categories of "Diagnosis" and "Patient Pathway" and included recommendations on training, communication, and quality assessment as well as specific items related to VHL diagnosis clinics, non-academic treatment clinics, and follow-up survivor groups. The Netherlands has 3 official Expert Reference Centers for VHL care (Groningen, Utrecht, Nijmegen), and the patient organization and allied specialists are planning to publish this protocol, while implementing its practice in those 3 sites. Conclusions: Medical specialists (internists, endocrinologists, urologists, neurosurgeons, ophthalmologists, geneticists, etc) and specialist nurses play a vital role alongside allied healthcare professionals to provide care to people with VHL and their families. Yet VHL patients and their families are the experts most acquainted with their own unmet needs. We present a set of standards and consensus recommendations from the patient perspective for the roles for these practitioners to provide optimal VHL care. These recommendations could form the basis for facilitated development of comprehensive integrated pathways for any pleiotropic neoplasia syndrome, and represent best-practice collaboration between patient organizations and national expertise centers to provide value-based healthcare.

P65 Improving the experiance of teaching for foundation doctors in a busy general surgery department

Introduction In the national training survey undertaken by the GMC in 2019 the general surgery teaching programme at North Bristol Trust scored 35.24 for local teaching; significantly lower than the national average. We aimed to introduce a teaching programme for foundation doctors on their general surgery rotations to help them meet the objectives set out by The UK Foundation Programme curriculum and gain further insight into general surgery and the roles of allied healthcare professionals. Methods A survey consisting of Likert scale and open ended questions was distributed to foundation doctors at the start and end of their foundation programme placements from August to December 2019. During this period a general surgery teaching programme was introduced consisting of once weekly sessions led by allied healthcare professionals and once weekly consultant led sessions. Results The number of foundation doctors agreeing with the statement ‘I think the General Surgical Unit is a good training and learning environment for foundation doctors rose by 33% (59% to 92%). There was an increase of 59% (24% to 83%) in the number of foundation doctors who felt they had good educational opportunities during their general surgical attachment. Conclusion The implementation of a general surgery teaching programme involving specific consultant-led sessions and sessions led by allied healthcare professionals (bariatric specialists, amputation counsellors, palliative care specialists) is invaluable to foundation doctors. It retains the interest of surgically and non-surgically inclined foundation doctors and is an essential element of a general surgical placement in a teaching hospital.

The effectiveness of implementation strategies for promoting evidence informed interventions in allied healthcare: a systematic review

Background Evidence based practice in health care has become increasingly popular over the last decades. Many guidelines have been developed to improve evidence informed decision making in health care organisations, however it is often overlooked that the actual implementation strategies for these guidelines are as important as the guidelines themselves. The effectiveness of these strategies is rarely ever tested specifically for the allied health therapy group. Methods Cochrane, Medline, Embase and Scopus databases were searched from 2000 to October 2019. Level I and II studies were included if an evidence informed implementation strategy was tested in allied health personnel. The SIGN method was used to evaluate risk of bias. The evidence was synthesised using a narrative synthesis. The National Health and Medical Research Council (NHMRC) model was applied to evaluate the grade for recommendation. Results A total of 490 unique articles were identified, with 6 primary studies meeting the inclusion criteria. Three different implementation strategies and three multi-faceted components strategies were described. We found moderate evidence for educational meetings, local opinion leaders and patient mediated interventions. We found stronger evidence for multi-faceted components strategies. Conclusion Few studies describe the effectiveness of implementation strategies for allied healthcare, but evidence was found for multi-faceted components for implementing research in an allied health therapy group population. When considering implementation of evidence informed interventions in allied health a multi-pronged approach appears to be more successful.