COVID-19 Contact Tracing in a Pediatric Hospital: Maximizing Effectiveness Through Specialized Team and Automated Tools

Background: In their interim infection prevention and control recommendations for the coronavirus disease 2019 (COVID-19) pandemic, the Centers for Disease Control and Prevention (CDC) recommend that healthcare facilities have a plan to identify, investigate, and trace potential COVID-19 exposures. In an academic hospital, the scale of such tracing is substantial, given that medically complex patients can have dozens of staff contacts across multiple locations during an encounter. Furthermore, the family-centered care model employed by pediatric institutions precludes visitor exclusion, further complicating tracing efforts. Despite this complexity, tracing accuracy and timeliness is of paramount importance for exposure management. To address these challenges, our institution developed a contact-tracing system that balanced expert participation with automated tracing tools. Methods: Our institution’s contact-tracing initiative includes positive patients, parents and/or visitors, and staff for the enterprise’s inpatient, procedural, and ambulatory locations at the main campus and 4 satellites. The team consists of 11 staff and is overseen by an infection preventionist. For positive patients and parents and/or visitors, potentially exposed staff are automatically identified via a report that extracts staff details for all encounters occurring during the patient’s infectious period. For positive staff, trained contact tracers call the staff member to determine whether mask and distancing practices could result in others meeting CDC exposure criteria. Any potentially exposed healthcare workers (HCWs) receive an e-mail that details exposure criteria and provides follow-up instructions. These HCWs are also entered into a secure, centralized tracking database that (1) allows infection prevention and occupational health staff to query and identify all epidemiologic links between traced patients, parents and/or visitors, and staff, and (2) initiates staff enrollment in a twice-daily symptom tracking system administered via REDCap. Potentially exposed patients and parents and/or visitors are contacted directly by a hospital representative. The contact tracing team, infection prevention staff, and occupational health staff meet daily to review positive staff cases in the last 24 hours. Results: To date, the team has traced ~1,300 patients, 15 parents and/or visitors, and 700 staff. Since the start of the pandemic, tracing and contact notification for all positive cases has been conducted within 24 hours. Through these proactive tracing efforts and other institutional infection prevention initiatives, the institution only experienced 1 staff cluster (N < 15) and <5 hospital-onset patient cases. Conclusions: Equipping a trained group of contact tracers with automated tracking tools can afford infection prevention and occupational health departments the ability to achieve and sustain timely and accurate contact tracing initiatives throughout a large-scale pandemic response.Funding: NoDisclosures: None

Overcoming Barriers to Accessing Surgery and Rehabilitation in Low and Middle-Income Countries: An Innovative Model of Patient Navigation in Nepal

Background Injury and disability are prominent public health concerns, globally and in the country of Nepal. Lack of locally available medical infrastructure, socioeconomic barriers, social marginalization, poor health literacy, and cultural barriers prevent patients from accessing surgical and rehabilitative care. Overcoming these barriers is an insurmountable challenge for the most vulnerable and marginalized, resulting in absence of treatment or even death. Methods Sundar Dhoka Saathi Sewa (SDSS), a non-government organization, provides a patient navigation service which facilitates referrals to tertiary centers from Nepal’s most remote areas. Specific criteria ensure that patient referrals are appropriate in regard to clinical and socioeconomic need, while comprehensive counselling helps guide the patient and family. The SDSS staff meet patients upon arrival in Kathmandu and facilitate admission to the appropriate tertiary hospital. They advocate for the patient, provide medicine, supply food and cover all treatment costs. Results This project has enabled access to treatment for more than 1200 children for conditions leading to long-term disability and/or congenital heart disease. Interventions include a wide range of surgical and rehabilitative procedures such as complex orthopedics, cleft lip and palate, congenital talipes equinovarus, burn contractures, neurological cases, and cardiac surgery for valvular disease, septal defects and other congenital malformations. Discussion The SDSS model of patient navigation is effective in overcoming the barriers to access surgical care and rehabilitation in Nepal. The success is owed to committed international donors, capacity building, effective counselling, advocacy, compassion, and community. We believe that this model could be replicated in other LMICs.

Staff Barriers to Fulfilling Assisted Living Resident Daily Care and Activity Preferences

Person-centered care (PCC), or delivery of care consistent with preferences, has been associated with improved care and quality of life for residents in long-term care (LTC). However, research has shown PCC has not been universally adopted. While general implementation barriers have been identified, little research has focused on barriers to meeting specific types of resident daily care and activity preferences. The purpose of this study was to describe LTC staff barriers to fulfilling specific types of resident preferences. A descriptive, qualitative study with 19 assisted living staff from nursing, dietary, and activities was conducted. Semi-structured interviews focused on identifying work system barriers to meeting specific types of resident preferences were analyzed using thematic analysis. Findings suggest shift assignments, staffing challenges, and facility schedules influence staff ability to meet certain types of preferences. The results suggest innovative design of shift schedules and assignments may help staff meet certain types of preferences. Part of a symposium sponsored by the Research in Quality of Care Interest Group.

Impact of internal migration movements on the schooling process in Turkey: Supervisors’ views

This study attempted to examine the impact of interregional and urban–rural population movements on schools located in areas subjected to high in-migration and out-migration flows in Turkey based on data collected from primary school supervisors (N=150). A cross-sectional survey design was utilized to examine the most pressing problems confronted in those schools, and possible actions that could be taken by various stakeholders were sought. Overall data suggest that those schools serve mostly disadvantaged populations with poor households. Among the main challenges revealed are lack of adequate school resources and poor facilities, problems caused due to ineffective and untimely implementation of the program, high personnel turnover and recruitment of largely inexperienced and relatively less qualified educational staff, and lower levels of parental involvement in children’s schooling. Accordingly, proposed recommendations focused on measures to eliminate capacity and resource constraints, improve hiring practices, and secure adequate supervision and support for educational staff, meet academic and socio-emotional needs of students and facilitate parental involvement in the education of children.

Community Solutions finds the answer in the Cloud

Purpose – This paper aims to observe how Community Solutions, a project and property-management company, has become more disciplined about performance appraisals following the introduction of Dinamiks, a Cloud-based employee performance-management system. Design/methodology/approach – The reasons for the new system, the form it takes and the advantages it is bringing have been explored. Findings – It has been explained how the system helps with HR functions such as identifying where training and development are needed, assessing performance against the company’s competency framework and ensuring that financial targets are met. Practical implications – This paper reveals that the system also improves the system of grading staff, helps to ensure that staff meet or exceed their competencies within an industry-standard competency framework and measures how far staff understand and implement the company’s values. Social implications – This paper touches on the advantages to the environment of a paperless system. Originality/value – It has been revealed how Dinamiks is helping Community Solutions staff to achieve various objectives based around how to behave, meet targets, perform well within their competency framework and recognize the competencies required in the job in the next level above theirs and work toward them.