Professionals' Views and Experiences of Using Rehabilitation Robotics With Stroke Survivors: A Mixed Methods Survey

Objective: To understand the reason for low implementation of clinical and home-based rehabilitation robots and their potential.Design: Online questionnaire (November 2020 and February 2021).Subjects: A total of 100 professionals in stroke rehabilitation area were involved (Physiotherapists n = 62, Occupation therapists n = 35).Interventions: Not applicable.Main Measures: Descriptive statistics and thematic content analysis were used to analyze the responses: 1. Participants' details, 2. Professionals' views and experience of using clinical rehabilitation robots, 3. Professionals' expectation and concerns of using home-based rehabilitation robots.Results: Of 100 responses, 37 had experience of rehabilitation robots. Professionals reported that patients enjoyed using them and they increased accessibility, autonomy, and convenience especially when used at home. The main emergent themes were: “aims and objectives for rehabilitation robotics,” “requirements” (functional, software, and safety), “cost,” “patient factors” (contraindications, cautions, and concerns), and “staff issues” (concerns and benefits). The main benefits of rehabilitation robots were that they provided greater choice for therapy, increased the amount/intensity of treatment, and greater motivation to practice. Professionals perceived logistical issues (ease of use, transport, and storage), cost and limited adaptability to patients' needs to be significant barriers to tier use, whilst acknowledging they can reduce staff workload to a certain extent.Conclusion: The main reported benefit of rehabilitation robots were they increased the amount of therapy and practice after stroke. Ease of use and adaptability are the key requirements. High cost and staffing resources were the main barriers.

Use of Continuous Glucose Monitor in Critically Ill COVID-19 Patients Requiring Insulin Infusion: An Observational Study

Context The coronavirus disease 2019 (COVID-19) pandemic has created a need for remote blood glucose (BG) monitoring in the intensive care unit (ICU). Objective To evaluate feasibility and patient safety of a hybrid monitoring strategy of point of care (POC) BG plus continuous glucose monitor (CGM) in the ICU. Design Retrospective analysis. Setting ICU of an academic medical center. Patients Patients with COVID-19 on intravenous (IV) insulin. Intervention After meeting initial validation criteria, CGM was used for IV insulin titration and POC BG was performed every 6 hours or as needed. Main Outcome Measures Outcomes included frequency of POC BG, workflow, safety, and accuracy measures. Results The study included 19 patients, 18 with CGM data, mean age 58 years, 89% on mechanical ventilation, 37% on vasopressors, and 42% on dialysis. The median time to CGM validation was 137 minutes (interquartile range [IQR] 114-206). During IV insulin, the median number of POC values was 7 (IQR 6-16) on day 1, and declined slightly thereafter ( 71% reduction compared to standard of 24 /day). The median number of CGM values used nonadjunctively to titrate IV insulin was 11.5 (IQR 0, 15) on day 1 and increased thereafter. Time in range 70-180mg/dl was 64+/-23% on day 1 and 72+/-16% on day 2-7 while time <70 mg/dl was 1.5 +/-4.1% on day 1 and <1% on days 2-7. Conclusions This study provides data to support that CGM using a hybrid protocol is feasible, accurate, safe, and has potential to reduce nursing and staff workload.

Improving access to primary care: a mixed-methods approach studying a new review appointment system in a Scottish GP practice

A Scottish general practitioner (GP) practice proposed an improvement intervention, shorter pre-bookable ‘review’ appointments, to increase appointment capacity and meet their patients’ demand for appointments. Staff are now able to pre-book these review appointments for patients, guaranteeing that the patient will see the same GP or advanced nurse practitioner (ANP) for both initial and review appointments. By shortening the review appointments, more patients were seen each day, hence the appointment capacity increased. The aim of this project was to examine the impact of the improvement intervention, pre-bookable review appointments, using a mixed-methods approach. Ethnographic methods (non-participant observation, participant observation and eight semistructured interviews with administrative staff) provided qualitative data, to understand the appointment system and to identify areas for further improvement. Quantitative data were then collected to assess: the number of patients receiving ‘on the day’ appointments, with the aim for this to be 95% (outcome measure); by how much the number of appointments available had increased (process measure) and the administrative staff workload (balancing measure). During a 7-week period, 3 months post-intervention, a median of 93% of patients received an ‘on the day’ appointment when they phoned for one between 08:00 and 09:00. The number of appointments available increased by 43%. Administrative staff workload (number of calls received per day) remained the same. Patients prefer being able to book in to see the same GP (continuity of care) and the ability to book in advance. Administrative staff workload decreased in terms of dealing with less frustrated patients. Main suggestions for improvement include introducing later appointments for workers and text reminders for pre-booked (review and online) appointments. The introduction of pre-bookable review appointments improved patient accessibility in the practice. Next steps for improving the appointment system include gaining clinician (GP/ANP) opinions on review appointments and trialling later appointments.

Simulation of the Impact on the Workload of the Enlargement of the Clinical Staff of a Specialistic Reference Center

Quality of care and patient satisfaction are important aspects of high standard care. If clinical staff is subject to an elevated workload there is a possible decrease of both. This justifies the development of tools to quantify the workload and to find organizational changes that will normalize it. We have previously developed a simulation system to quantify the workload of the staff working in a regional reference center for the treatment of bleeding and hemorrhagic disorders. The goal of this new work is to simulate, through an agent-based model, the impact of adding a physician to the staff. Ten sets of initial parameters were defined to simulate ten typical weeks. Results show that the introduction of the new physician together with a second ambulatory room can reduce the workload of all the staff to the expected 8-hour. In this situation, in which the staff workload does not exceed the daily capacity, we may suppose that an increase in the quality of care and patient satisfaction will be possible.

Intermittent epidural boluses vs continuous epidural infusion for labour analgesia: which is superior?

Epidurals are considered the gold standard for labour analgesia. The possibility of newer pumps reducing staff workload has reignited interest in the advantages of the intermittent bolus technique, but is this superior to a continuous epidural infusion?

P007 Service evaluation of the nurse-led telephone advice line in the wake of COVID-19: a report of audit and staff satisfaction

Background/Aims The Rheumatology nurse advice line (NAL) at the Royal National Hospital for Rheumatic Diseases (RNHRD, Bath) provides a vital service for direct patient access to specialist advice via a designated voicemail system. Increasing numbers and difficulty connecting call returns have increased staff workload, reduced efficiency and impacted on staff satisfaction. An audit was therefore undertaken to evaluate service use and efficiency, paired with formal assessment of staff satisfaction in order to identify areas for improvement. Methods The total number of monthly calls through the NAL during 2020 were counted. A subset of consecutive calls were audited in detail, documenting temporal parameters in relation to the call being logged, returned and concluded. The number of clinicians and attempts required to contact the patient was noted. An anonymised staff satisfaction questionnaire was completed by NAL nurses and administrators. Data was analysed using Excel. Results An average 653 calls per month (range 340-894) came through the NAL between January and September 2020. 97 consecutive patient contacts were audited from August 2020. Multiple attempts were required to successfully return the call in 19.6% of cases (n = 19/97). Of those, 68.4% (n = 13/19) of calls needed ≥ 2 nurses to contact the patient. In general, the first attempt to return the call was prompt (average 7.6 hours, range 0.1-27.7). However, the time to conclude the call from the patient’s first call log ranged from 0.1 - 142.6 hours (average 12.7 hours) with increased time associated with difficulties contacting the patient or when further advice was required from a Rheumatology doctor (18.5%, n = 18/97). Staff surveys revealed 67% of staff felt that the NAL is a good service to offer patients. However, 67% of staff did not feel the NAL in its current format was easy to manage. Specific comments included that the lack of rota'd responsibility, unpredictable workload and time inefficiencies were barriers to managing the service. Conclusion From this data, we conclude that patient calls are returned promptly, but utilising a system of voicemail and unscheduled call returns is inefficient and contributes to staff dissatisfaction. This data has driven change for service improvement. To improve efficiency, calls will be answered live by an administrator during working hours and patients given a call-back time. A doctor will be named as a single point of contact for the nurses to seek additional advice and a nurse rota will designate responsibility for NAL calls to reduce work-load uncertainty. Follow up service evaluation will include staff and patient satisfaction questionnaires, and repeat audit, with consideration of ways to support frequent service users. Disclosure J. Day: None. J. Ball: None. J. Down: None. R. Sengupta: None. V. Flower: None.

Coronavirus and Its Impacts on Health Workers Retention: A Systematic Review and Meta-Synthesis

Background: The present study aimed to determine the prerequisites and requirements for retention of human resources during the Covid-19 disaster. It was tried in this study to systematically review the challenges and prerequisites, strategies, and measures related to the retention of health workers during the disaster.Methods: This is a systematic review and meta-synthesis of all the articles related to the factors affecting the retention of human resources during the Covid-19 disaster. The articles were searched using the keywords Retention, Human resource, and COVID-19 in the following databases without a time limit: PubMed, Scopus, and Web of science. To select the studies, the titles, abstracts, and full texts that complied with the inclusion criteria of the present systematic review were examined, and the 226 preliminary results and abstract were screened. Finally, 23 full texts were obtained, and regarding the type and nature of the materials extracted from the studies, a meta-synthesis was used to analyze and aggregate the results of the systematic review.Results: The 23 articles included in the systematic review and meta-synthesis were reviewed, and the effects of the Covid-19 disaster on the healthcare staff and the retention strategies were considered as the main themes of the study. In this regard, stigma and violence against the staff, burnout and stress, increased staff workload, acquisition of communication skills, employees' mental and physical health, employee safety during disaster, staff mobilization to assist the current forces, expansion of cyberspace infrastructures, and motivational-health incentives were selected as codes.Conclusion: Retention or non-retention of the personnel during or after a disaster can be caused by the multifaceted effects of the crisis on people. Thus, a combination of several appropriate strategies should be used to respond to it in order to reduce the adverse effects of the disaster. Also, aligning the personnel can help using their synergistic power to face and respond to the challenges ahead.

Financial strategic impact on clinical laboratory managers - A review

The cost of operating a clinical lab where cost containment remains a major challenge is to be maintained in conjunction with smooth running of laboratory operations. This study aimed to account the results of service cost using workload-based costing in clinical laboratories. The review aimed at establishing cost containment strategies of all lab test services based on workload of the technical team in a clinical lab. Articles were searched in online databases, such as PUBMED, MEDLINE and Google scholar using keywords “financial, strategic, impact, clinical laboratory, managers.” Manual Search of Journals were also done. Articles were reviewed and analysed. The relevant articles were reviewed which showed the value analysis of lab services and its costs along with technical staff workload provides insights on the relationship between variables and the uncertainty of financial strategic effects.

An Improved Decision Tree Algorithm for Electricity Theft Prediction and Analysis

At present, there are many kinds of electricity theft and the corresponding approaches to combat this are insufficient. Manual approaches result in a heavy staff workload and are inefficient. In this paper, the data from an electricity information acquisition system is collected and mined using Python. Based on an understanding of the business and an analysis of the information value (IV) measure, important characteristic indexes are selected and an improved decision tree algorithm is used to construct a model of power theft by users. This method effectively narrows the range of users suspected of power theft, improving the pertinence of audit, and providing strong support for reducing the financial losses of power supply enterprises and ensuring the safety of power grid operation.

Acceptability and Feasibility of Perioperative Music Listening: A Rapid Qualitative Inquiry Approach

Perioperative music decreases pain, anxiety, and analgesia requirements while increasing patient satisfaction. We investigated the acceptability of perioperative music at a women’s and children’s hospital in Singapore, seeking to uncover barriers and facilitators to implementation in routine practice over a 12-week period. We used an undergraduate-led Rapid Qualitative Inquiry approach that includes data collection from multiple sources, iterative analysis, and additional data collection when necessary. Participants consisted of anesthesiologists and nurses working in the preoperative area, operating room, and postoperative recovery areas. In Stage 1, nurses and anesthesiologists answered a survey assessing attitudes and knowledge about perioperative music and attended a presentation introducing the intervention. In Stage 2, the results of the Stage 1 survey were disclosed, and nurses and anesthesiologists completed a second survey (Stage 1 survey questions with an additional query about implementation). Twenty-nine nurses were interviewed with semi-structured questions on barriers and facilitators to implementation. In Stage 3, nurses retook the Stage 2 survey after one month of implementation. The implementation of perioperative music was both acceptable and feasible in Singapore. The nurses’ and anesthesiologists’ acceptability increased over time with mostly positive qualitative feedback. Implementation barriers, including patient interest, timing of patient turnover, and added staff workload, appeared minor and could potentially be overcome by utilizing the intervention in the preoperative instead of postoperative area, deploying music in operating rooms with slower turnover, and evenly distributing staff workload. Local implementation stakeholders may make additional recommendations for scaling-up perioperative music interventions to fit other workflows while improving the patient experience.