An Evaluation of the Performance of Five Burnout Screening Tools: A Multicentre Study in Anaesthesiology, Intensive Care, and Ancillary Staff

Burnout is an important occupational hazard and early detection is paramount in preventing negative sequelae in physicians, patients, and healthcare systems. Several screening tools have been developed to replace lengthy diagnostic tools for large-scale screening, however, comprehensive head–to–head evaluation for performance and accuracy are lacking. The primary objective of this study was to compare the diagnostic performance of five burnout screening tools, including a novel rapid burnout screening tool (RBST). This was a cross-sectional study involving 493 hospital staff (anaesthesiology and intensive care doctors, nurses, and ancillary staff) at the COVID-19 frontline across four hospitals in Singapore between December 2020 and April 2021. The Maslach Burnout Inventory-Human Services Survey (MBI-HSS) was used as the reference standard. Five burnout screening tools, the single-item MBI measure of burnout (SI-MBI), dual-item MBI (DI-MBI), abbreviated MBI (aMBI), Single Item Burnout Question (SIBOQ), and the RBST, were administered via a 36-item online survey. Tools were administered simultaneously and responses were anonymised. Burnout prevalence was 19.9%. The RBST and the SI-MBI had the two highest accuracies (87.8% and 81.9% respectively) and AUROC scores (0.86, 95% CI: 0.83–0.89 and 0.86, 95% CI: 0.82–0.89 respectively). However, the accuracy of the RBST was significantly higher than the SI-MBI (p < 0.0001), and it had the highest positive likelihood ratio (+LR = 7.59, 95% CI 5.65–10.21). Brief screening tools detect burnout albeit with a wide range of accuracy. This can strain support services and resources. The RBST is a free screening tool that can detect burnout with a high degree of accuracy.

Implementation Process and Evolution of a Laparotomy-Assisted 2-Port Fetoscopic Spina Bifida Closure Program

<b><i>Introduction:</i></b> Prenatal closure of open spina bifida via open fetal surgery improves neurologic outcomes for infants in selected pregnancies. Fetoscopic techniques that are minimally invasive to the uterus aim to provide equivalent fetal benefits while minimizing maternal morbidities, but the optimal technique is undetermined. We describe the development, evolution, and feasibility of the laparotomy-assisted 2-port fetoscopic technique for prenatal closure of fetal spina bifida in a newly established program. <b><i>Methods:</i></b> We conducted a retrospective cohort study of women consented for laparotomy-assisted fetoscopic closure of isolated fetal spina bifida. Inclusion and exclusion criteria followed the Management of Myelomeningocele Study (MOMS). Team preparation involved observation at the originating center, protocol development, ancillary staff training, and surgical rehearsal using patient-matched models through simulation prior to program implementation. The primary outcome was the ability to complete the repair fetoscopically. Secondary maternal and fetal outcomes to assess performance of the technique were collected prospectively. <b><i>Results:</i></b> Of 57 women screened, 19 (33%) consented for laparotomy-assisted 2-port fetoscopy between February 2017 and December 2019. Fetoscopic closure was completed in 84% (16/19) cases. Over time, the technique was modified from a single- to a multilayer closure. In utero hindbrain herniation improved in 86% (12/14) of undelivered patients at 6 weeks postoperatively. Spontaneous rupture of membranes occurred in 31% (5/16) of fetoscopic cases. For completed cases, median gestational age at birth was 37 (range 27–39.6) weeks and 50% (8/16) of women delivered at term. Vaginal birth was achieved in 56% (9/16) of patients. One newborn had a cerebrospinal fluid leak that required postnatal surgical repair. <b><i>Conclusion:</i></b> Implementation of a laparotomy-assisted 2-port fetoscopic spina bifida closure program through rigorous preparation and multispecialty team training may accelerate the learning curve and demonstrates favorable obstetric and perinatal outcomes.

Electronic health record note review in an outpatient specialty clinic: who is looking?

Note entry and review in electronic health records (EHRs) are time-consuming. While some clinics have adopted team-based models of note entry, how these models have impacted note review is unknown in outpatient specialty clinics such as ophthalmology. We hypothesized that ophthalmologists and ancillary staff review very few notes. Using audit log data from 9775 follow-up office visits in an academic ophthalmology clinic, we found ophthalmologists reviewed a median of 1 note per visit (2.6 ± 5.3% of available notes), while ancillary staff reviewed a median of 2 notes per visit (4.1 ± 6.2% of available notes). While prior ophthalmic office visit notes were the most frequently reviewed note type, ophthalmologists and staff reviewed no such notes in 51% and 31% of visits, respectively. These results highlight the collaborative nature of note review and raise concerns about how cumbersome EHR designs affect efficient note review and the utility of prior notes in ophthalmic clinical care.

Impact of a short-term training in emergency and trauma in a tertiary teaching institute

Background: The health-workers working in emergency area need better training to handle emergency patients with sincerity and accurate clinical skills. So, it is imperative to train them on simulation models and prepare them to perform their duties with better skills and higher confidence.Methods: A structured course named as Dr. RMLIMS Emergency and Trauma-Basic Course (DrRMLIMS ET-BC), was designed to effectively train the resident doctors from different departments, nursing staff (pool A) and other health-workers, ancillary staff and security persons (pool B) posted in the casualty and emergency wards. Pool A underwent pretest to ascertain basic knowledge. Post-test questionnaire was taken after training. Predesigned google forms were used for feedback. Pool B underwent counselling and motivating sessions about the sense of team, role of leader and effective communication. Direct observation, officer in-charge’s feedback, buddy feedbacks, patient’s attendants’ feedbacks and self-appraisal were done for evaluation. Paired t test was applied on pool A pretest and post-test scores to evaluate the change in the knowledge.Results: Pool A shows a pre-test mean of 37.83±0.92 (approximately 39%) which improved significantly to 72.16±0.90 post training (p value=0.0000). Pool B revealed significant positive change in the attitude, behavior and sense of team and responsibility.Conclusions: This study shows that this training is an adequate training programme to teach the basics emergency and trauma skills and been successful in increasing knowledge, despite the variations in the vision of different subject specialities.

Questionnaire based assessment of awareness about infection control practices regarding COVID-19 among health care workers

Background: Healthcare workers (HCWs) are at frontline of response of the current pandemic of the COVID-19. This exposes them to risk of infection due to insufficient knowledge and unhealthy practices. The aim of the study was to assess the knowledge of infection control practices among HCWs regarding COVID-19.Methods: A web-based cross-sectional survey was conducted between April 2020 and June 2020. A 21-questions survey was developed and distributed among study population. A total of 622 HCWs working in a dedicated COVID-19 hospital participated in this study. Descriptive statistics was applied to represent participant characteristics and Chi-square test was used to evaluate the level of association among variables with a significance level of <0.05.Results: Out of 622 participants, 443 (71.22%) were females and 179 (28.78%) were males. Majority of the participants were nurses 308 (49.5%) followed by resident doctors 152 (24.4%), faculty doctors 108 (17.3%) and ancillary staff 54 (8.6%). Most participants 424 (68.1%) were less than 30 years of age. The overall response to survey was satisfactory with average correct responses recorded at 70.9%. Faculty doctors and resident doctors scored maximum average of 73% marks.Conclusions: The study participants showed sufficient basic knowledge about infection control practices regarding COVID-19. It also highlights the importance of continued training and educational interventions which are required to battle the present pandemic situation.

Digital Archaeological Archiving in Baden-Württemberg, Germany: an evolving system

Since 2005, the Landesamt für Denkmalpflege Baden-Württemberg has been collecting semi-structured archaeological digital project data with the aim of one day turning that data into a real long-term digital archive. This process is still ongoing. In the last 15 years appropriate data formats have been defined, and the transition from CAD to GIS as the mainstay of project recording in Baden-Württemberg has been made. The research-driven development of the Software Survey2GIS (GNU GPL), initiated by the Landesamt für Denkmalpflege Baden-Württemberg, facilitates on the one hand an easy-to-use transition of field data into GIS and on the other better control of data formats. We are learning to cope with increasingly more complex data - laser scan, LIDAR and sfm data. The recent advent of commercial archaeology in the state of Baden Württemberg is another factor with which we are confronted. We have experimented with the best methods of convincing archaeologists, technicians and ancillary staff of the necessity of saving their data in a central repository - for example friendliness, even occasional coercion, as well as the guarantee of recoverable data if the deposition rules are followed. The boundary of each saved excavation or survey project is uploaded to the State's own cultural heritage GIS-Application - ADAB - where it can be accessed by researchers. A simple click within the polygon will invoke metadata about the project as well as a selection of quintessential photos. The excavation archive in Baden-Württemberg is, as yet, by no means a fully accessible, usable 'real' digital archive. But we are succeeding in saving the data in a structured manner for future transition into that 'real' archive - hopefully as a pilot project within the framework of the federally financed NFDI infrastructure.

Psychosocial impacts of COVID-19 upon a diverse Australian oncology workforce: From doctors to ancillary staff.

e23016 Background: Potential moral hazards from COVID-19 for patient-facing oncology staff include rationalizing treatment, but prior research into staff distress has not included ancillary/administrative staff or compared geographic settings. We sought to document measures of distress and perceived preparedness from diverse oncology staff during the COVID-19 pandemic response, and correlate these with unfolding events. Methods: We utilised a mixed-methods approach comprising weekly diarising of executive communications and events-by investigators, and prospective self-administered online surveys-by staff. Survey domains included perceived institutional preparedness, personal wellbeing, and perceived stress using a distress thermometer (0-10, no-extreme distress). Responses were Likert-scaled or free-text. Quantitative responses were aggregated by role/site and analysed using R. These were correlated with emergent qualitative themes using the Framework Method. The study was conducted at a metropolitan and a regional hospital in Queensland, Australia. Results: 12 surveys across 18 weeks commencing April 3, 2020 (encompassing 1st lockdown, lockdown easing, and 2nd lockdown) had 993 individual responses. 40% respondents were located regionally. Role categories included: nursing (50%), allied health (18%), medical (16%), administrative (15%), ancillary (e.g. cleaner, food service) (1%). Emergent themes were: S trategies for protection- at work and home. Up to 27% respondents reported being able to attend to critical personal needs only sometimes or less, although patients were perceived to be well supported most/all of the time (>90% responses). Navigating rules and keeping up-high levels of perceived institutional preparedness in >75% responders coexisted alongside fluctuating levels of self-reported distress, from median 5 (IQR 3-7) at 1st lockdown outset to 1 (IQR 1-4) after lockdown restriction easing. Tempered optimism-pride in one’s place was reported both as reflecting healthcare worker identity and as Australians in the context of low local infection rates. No significant differences in distress or preparedness perceptions were evident comparing geographic sites. Framing the new normal-although respondents longitudinally reported increasing familiarity with pandemic directives, distress levels increased concurrently with the announcement of 2nd lockdown. Conclusions: In the context of low local COVID-19 infection rates, oncology staff regardless of role and geographic setting reported high perceptions of institutional preparedness. Distress levels increased concurrently with lockdown phases and reports of distress and psychosocial workload fatigue were made by various workers including administrative and ancillary. These should be considered frontline staff for the purpose of workplace psychosocial support in pandemic responses.

Increasing Facemask Compliance among Healthcare Personnel during the COVID-19 Pandemic

Objective: Prior studies of universal masking have not measured facemask compliance. We performed a quality improvement study to monitor and improve facemask compliance among healthcare personnel (HCP) during the coronavirus disease 2019 (COVID-19) pandemic. Design: Mixed-methods study Setting: Tertiary care center in West Haven, Connecticut Patients: HCP including physicians, nurses, and ancillary staff Methods: Facemask compliance was measured through direct observations during a 4-week baseline period after universal masking was mandated. Frontline and management HCP completed semi-structured interviews from which a multimodal intervention was developed. Direct observations were repeated during a 14-week period following implementation of the multimodal intervention. Differences between units were evaluated with chi-squared testing using the Bonferroni correction. Facemask compliance between baseline and intervention periods was compared using time series regression. Results: Among 1,561 observations during the baseline period, median weekly facemask compliance was 82.2% (range, 80.8%-84.4%). Semi-structured interviews were performed with 16 HCP. Qualitative analysis informed the development of a multimodal intervention consisting of audit and passive feedback, active discussion, and increased communication from leadership. Among 2,651 observations during the intervention period, median weekly facemask compliance was 92.6% (range, 84.6%-97.9%). There was no difference in weekly facemask compliance between COVID-19 and non-COVID-19 units. The multimodal intervention was associated with an increase in facemask compliance (β=0.023, p=0.002) Conclusions: Facemask compliance remained suboptimal among HCP despite a facility-wide mandate for universal masking. A multimodal intervention consisting of audit and passive feedback, active discussion, and increased communication from leadership was effective in increasing facemask compliance among HCP.

Abstract P865: Pediatric Stroke Algorithm Revision: Focus on Education Process

Background: While the incidence of Pediatric stroke is low at 2.3 to 13 per 100,000 children, our institution saw a need for a pediatric stroke algorithm to provide guidance when children present with stroke symptoms. The process began with development and release of a pediatric stroke guideline in 2017. After initiation of the guideline, mock stroke alerts periodically were performed with feedback provided by staff. After several reviews and revisions, the paradigm of a guideline was discarded in favor of an algorithm, a more accurate reflection of the necessity for clinical judgement rather than a series of predetermined steps. In June 2020, the Pediatric Stroke Algorithm was revised to incorporate one algorithm for both Emergency Room (ER) and inpatient areas after a recent mock stroke alert in the Pediatric Intensive Care Unit (PICU) and following feedback. The purpose behind our process improvement project was to provide education regarding the updated Pediatric Stroke Algorithm to all relevant clinical areas. Methods: The first step was to identify the staff in patient care areas that would need education on the updated Pediatric Stroke Algorithm. Next, we identified the methods of communication that would be utilized to ensure all staff received proper education. Results: In 2020, the updated Pediatric Stroke Algorithm document was placed on the UK HealthCare Care Web page (Clinical Web Page). Information on the location of the document was sent to the key stakeholders for nursing, physician, and appropriate ancillary staff in the ER and PICU for further distribution. The algorithm was presented in various stroke committee meetings and sent by email to team members of these committees to share with their staff. The algorithm was further presented at the PICU Collaborative Practice Meeting and posted on the PICU share point site, in the ER, and PICU areas. Conclusions: A comprehensive educational process of the revised Pediatric Stroke Algorithm was successfully completed with all the appropriate staff.

Curtailing Unnecessary Waste Among Operating Room Personnel: Evaluating the Cost Awareness of Commonly Used Surgical Items

Background Operating rooms (ORs) generate 70% of hospital waste, leading to increased costs for the hospital, patient, and the environment. The lack of cost awareness among physicians has been well documented; however, there is little information on anesthesiologists or ancillary OR staff. This study aimed to evaluate the cost awareness of commonly used items at an academic medical center among OR personnel. Methods Anonymous surveys were distributed to OR personnel (nurses, surgical technicians (STs), nurse anesthetists, anesthesiologists, surgeons, and residents), asking for the estimated costs of ten commonly used items. These costs were then compared against actual costs to evaluate the accuracy of participants’ estimates. Responders were clustered by job, highest level of education, and years of experience for comparison. Results 167 surveys were collected, and overall only 16.4% of estimates were accurate within 50% of actual price. No significant differences in accuracy between groups were identified overall ( P = .2), but both surgical and anesthesia attendings had significantly higher rates of correct responses than their respective residents. No difference was seen in accuracy when all attendings (surgeons and anesthesiologists) were compared with either nurses or STs. Linear regression demonstrated no correlation between number of years at current position or years at institution and number of correct responses ( R2 = .0025 and R2 = .005, respectively). Discussion Addressing the knowledge deficit around item costs via global education of all OR personnel (surgeons, anesthesia providers, and ancillary staff) could be a viable pathway to reduce waste, and thus cost, for our healthcare system.