Pub Date : 2024-09-17DOI: 10.1101/2024.09.16.24313784
innocent SSEMANDA, Patrick E. Odong, Mubaraka Nasur, David Ejalu, Karen Mwengwe, JMO Tukei
Purpose This study explored the effect of implementing monitoring and Evaluation(M&E) systems on the performance of the Neonatal Intensive care Unit at Yumbe regional referral hospital. Methods A pretest-posttest quasi-experimental design was employed involving 236 neonates, with 103 in the pretest group (Before the implementation monitoring and evaluation systems) and 130 in the posttest group (after the implementation of monitoring and evaluation). The intervention lasted 105 days. Key performance indicators (KPIs) such as; neonatal mortality rates, length of stay, neonatal intensive care’s effectiveness, morbidity rate, survival rates, and infection control were measured. Patient satisfaction as a secondary outcome was also explored through questionnaire surveys. Data collected was entered directly in Microsoft Ware, and exported to the STATA version 18 for analysis Results Neonatal mortality rates significantly decreased from 19.4% in the pretest group to 7.7% in the posttest group(P<0.01). The survival rates improved from 80.6% in the pretest group to 92.3% in the posttest group. The average length of stay was reduced from 10 days (SD=4) to 8 days (SD=3) (P<0.05). Neonatal intensive care effectiveness scores improved from a mean of 2.8 to 3.5 (P<0.01). Compliance with Neonatal intensive care unit protocols increased from 70% to 80% (P<0.01). The reliability of monitoring and evaluation components was high, with Cronbach’s alpha values ranging from 0.754 to 0.915 Conclusion Implementation of monitoring and evaluation systems significantly enhanced NICU’s performance, reduced mortality rate, improved survival rates and improved patient satisfaction. These findings underline the importance of M&E frameworks in optimizing neonatal care.
{"title":"Effect of Monitoring and Evaluation Systems on the Performance of Neonatal Intensive Care Unit at Yumbe Regional referral hospital; A Pre-post quasi-experimental study design","authors":"innocent SSEMANDA, Patrick E. Odong, Mubaraka Nasur, David Ejalu, Karen Mwengwe, JMO Tukei","doi":"10.1101/2024.09.16.24313784","DOIUrl":"https://doi.org/10.1101/2024.09.16.24313784","url":null,"abstract":"Purpose This study explored the effect of implementing monitoring and Evaluation(M&E) systems on the performance of the Neonatal Intensive care Unit at Yumbe regional referral hospital. Methods A pretest-posttest quasi-experimental design was employed involving 236 neonates, with 103 in the pretest group (Before the implementation monitoring and evaluation systems) and 130 in the posttest group (after the implementation of monitoring and evaluation). The intervention lasted 105 days. Key performance indicators (KPIs) such as; neonatal mortality rates, length of stay, neonatal intensive care’s effectiveness, morbidity rate, survival rates, and infection control were measured. Patient satisfaction as a secondary outcome was also explored through questionnaire surveys. Data collected was entered directly in Microsoft Ware, and exported to the STATA version 18 for analysis Results Neonatal mortality rates significantly decreased from 19.4% in the pretest group to 7.7% in the posttest group(P<0.01). The survival rates improved from 80.6% in the pretest group to 92.3% in the posttest group. The average length of stay was reduced from 10 days (SD=4) to 8 days (SD=3) (P<0.05). Neonatal intensive care effectiveness scores improved from a mean of 2.8 to 3.5 (P<0.01). Compliance with Neonatal intensive care unit protocols increased from 70% to 80% (P<0.01). The reliability of monitoring and evaluation components was high, with Cronbach’s alpha values ranging from 0.754 to 0.915 Conclusion Implementation of monitoring and evaluation systems significantly enhanced NICU’s performance, reduced mortality rate, improved survival rates and improved patient satisfaction. These findings underline the importance of M&E frameworks in optimizing neonatal care.","PeriodicalId":501556,"journal":{"name":"medRxiv - Health Systems and Quality Improvement","volume":"65 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142253049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-16DOI: 10.1101/2024.09.14.24313685
Shayma Mohammed Selim, Steven M McPhail, Hannah E Carter, Christina Malatzky, Sanjeewa Kularatna, Sundresan Naicker
Background Patient non-attendance remains a major challenge for health services. Few studies have examined how health service providers think about, potentially address, and prioritise non-attendance within the scope of their practice. This study aimed to (1) explore healthcare professionals’ perspectives, beliefs, and opinions about the impact of patient non-attendance within a publicly-funded outpatient physiotherapy clinic context; (2) explore perceived barriers and facilitators associated with the implementation of non-attendance mitigation strategies; and (3) identify health service staff generated solutions to address perceived barriers and enhance facilitators. Methods A focus group discussion and semi-structured interviews were conducted between June 2023 to January 2024 with 27 physiotherapy department clinic outpatient staff involved in operationalising clinic referral processing, appointment scheduling, or providing care to patients. Data was analysed using a hybrid inductive/deductive framework analysis approach. Results Participants indicated that non-attendance had predominantly negative implications for the health service, healthcare provider, and patient. The interconnected issue of non-attendance encompassed multiple areas and were broadly categorised into five inductively identified themes: impact of non-attendance, perceptions of value, material deprivation, service delivery and built environment, and professional role and identity. Non-attendance mitigation strategies generated by participants were deductively mapped to the theoretical domains framework (TDF) to explore behavioural determinants that may influence successful implementation. This included knowledge, reinforcement, goals, optimism, memory, attention and decision-making, environmental resources and context, and emotions. Conclusions Staff identified multiple strategies for reducing non-attendance; implementing many of these strategies would require additional resourcing. Research determining the effectiveness of such strategies both in the short-term and long-term following implementation into practice remains a priority for future investigation.
{"title":"“We’re here to help them if they want to come”: A qualitative exploration of hospital staff perceptions and experiences with outpatient non-attendance","authors":"Shayma Mohammed Selim, Steven M McPhail, Hannah E Carter, Christina Malatzky, Sanjeewa Kularatna, Sundresan Naicker","doi":"10.1101/2024.09.14.24313685","DOIUrl":"https://doi.org/10.1101/2024.09.14.24313685","url":null,"abstract":"Background\u0000Patient non-attendance remains a major challenge for health services. Few studies have examined how health service providers think about, potentially address, and prioritise non-attendance within the scope of their practice. This study aimed to (1) explore healthcare professionals’ perspectives, beliefs, and opinions about the impact of patient non-attendance within a publicly-funded outpatient physiotherapy clinic context; (2) explore perceived barriers and facilitators associated with the implementation of non-attendance mitigation strategies; and (3) identify health service staff generated solutions to address perceived barriers and enhance facilitators.\u0000Methods\u0000A focus group discussion and semi-structured interviews were conducted between June 2023 to January 2024 with 27 physiotherapy department clinic outpatient staff involved in operationalising clinic referral processing, appointment scheduling, or providing care to patients. Data was analysed using a hybrid inductive/deductive framework analysis approach.\u0000Results\u0000Participants indicated that non-attendance had predominantly negative implications for the health service, healthcare provider, and patient. The interconnected issue of non-attendance encompassed multiple areas and were broadly categorised into five inductively identified themes: impact of non-attendance, perceptions of value, material deprivation, service delivery and built environment, and professional role and identity. Non-attendance mitigation strategies generated by participants were deductively mapped to the theoretical domains framework (TDF) to explore behavioural determinants that may influence successful implementation. This included knowledge, reinforcement, goals, optimism, memory, attention and decision-making, environmental resources and context, and emotions.\u0000Conclusions\u0000Staff identified multiple strategies for reducing non-attendance; implementing many of these strategies would require additional resourcing. Research determining the effectiveness of such strategies both in the short-term and long-term following implementation into practice remains a priority for future investigation.","PeriodicalId":501556,"journal":{"name":"medRxiv - Health Systems and Quality Improvement","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142253077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-16DOI: 10.1101/2024.09.16.24310069
Suzanne McCarthy, Mary Donnolly, Aislinn Joy, Elaine Lehane, Peter O'Sullivan, Eimear Spain
Introduction The recent surge in clinical claims in Ireland has sparked concerns about the unsustainable trajectory of medical negligence litigation. Current evaluations have primarily focused on the financial and temporal aspects of litigation, leaving a gap in understanding the experiences of plaintiffs within the adversarial system. This study aims to fill this gap by critically exploring the experiences of those affected by medical negligence and the ensuing legal process. Methods A qualitative descriptive approach was employed to explore the experiences of plaintiffs following patient safety incidents and their interactions with the legal process. Semi-structured, open-ended interviews were conducted with participants who had been involved in medical negligence litigation in Ireland. Participants were eligible for inclusion if they were aged 18 years or over and were involved in medical negligence litigation in Ireland (as a plaintiff), whether the case was resolved by negotiated settlement, a form of alternative dispute resolution (e.g. mediation), or trial hearing. Maximum variation sampling was used to capture a diverse range of experiences, with sample size determined by the concept of information power. Recruitment was facilitated by the Health Service Executive (HSE) through invitations sent by The National Open Disclosure Office. Interviews were conducted in-person or online, recorded, transcribed, and analysed thematically. Ethical approval was obtained from the Social Research Ethics Committee of University College Cork. Findings This research presents the views and experiences of fifteen participants; eleven participants shared their experiences relating to an adverse event which impacted a family member (one participant spoke about two family members), nine of whom were children (including both minors and adult children), and three were a spouse. Of the twelve individuals discussed, eight were deceased. Five main themes were identified from the analysis: i) Navigating the aftermath of a patient safety event: Communication, Support and Abandonment; ii) The pathway from adverse event to litigation; iii) Experiences of the Legal System; iv) Emotional and Mental Health Impact of Litigation on Plaintiffs; v) Advocating for Change: Participant Recommendations. Discussion This research highlights the profound impact of actions taken after a patient safety event on patients, families, healthcare professionals, and organisations, and the importance of Open Disclosure in meeting ethical obligations and ensuring healthcare accountability. It explores the complex relationships between financial compensation, justice-seeking, and the healthcare and legal systems. The findings contribute significant insights to the discourse on medical negligence in Ireland.
{"title":"Plaintiff experiences of the medico-legal environment in Ireland","authors":"Suzanne McCarthy, Mary Donnolly, Aislinn Joy, Elaine Lehane, Peter O'Sullivan, Eimear Spain","doi":"10.1101/2024.09.16.24310069","DOIUrl":"https://doi.org/10.1101/2024.09.16.24310069","url":null,"abstract":"Introduction\u0000The recent surge in clinical claims in Ireland has sparked concerns about the unsustainable trajectory of medical negligence litigation. Current evaluations have primarily focused on the financial and temporal aspects of litigation, leaving a gap in understanding the experiences of plaintiffs within the adversarial system. This study aims to fill this gap by critically exploring the experiences of those affected by medical negligence and the ensuing legal process. Methods\u0000A qualitative descriptive approach was employed to explore the experiences of plaintiffs following patient safety incidents and their interactions with the legal process. Semi-structured, open-ended interviews were conducted with participants who had been involved in medical negligence litigation in Ireland. Participants were eligible for inclusion if they were aged 18 years or over and were involved in medical negligence litigation in Ireland (as a plaintiff), whether the case was resolved by negotiated settlement, a form of alternative dispute resolution (e.g. mediation), or trial hearing. Maximum variation sampling was used to capture a diverse range of experiences, with sample size determined by the concept of information power. Recruitment was facilitated by the Health Service Executive (HSE) through invitations sent by The National Open Disclosure Office. Interviews were conducted in-person or online, recorded, transcribed, and analysed thematically. Ethical approval was obtained from the Social Research Ethics Committee of University College Cork. Findings\u0000This research presents the views and experiences of fifteen participants; eleven participants shared their experiences relating to an adverse event which impacted a family member (one participant spoke about two family members), nine of whom were children (including both minors and adult children), and three were a spouse. Of the twelve individuals discussed, eight were deceased. Five main themes were identified from the analysis: i) Navigating the aftermath of a patient safety event: Communication, Support and Abandonment; ii) The pathway from adverse event to litigation; iii) Experiences of the Legal System; iv) Emotional and Mental Health Impact of Litigation on Plaintiffs; v) Advocating for Change: Participant Recommendations. Discussion This research highlights the profound impact of actions taken after a patient safety event on patients, families, healthcare professionals, and organisations, and the importance of Open Disclosure in meeting ethical obligations and ensuring healthcare accountability. It explores the complex relationships between financial compensation, justice-seeking, and the healthcare and legal systems. The findings contribute significant insights to the discourse on medical negligence in Ireland.","PeriodicalId":501556,"journal":{"name":"medRxiv - Health Systems and Quality Improvement","volume":"47 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142253055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-15DOI: 10.1101/2024.09.13.24313666
Noreen Kamal, ACTEAST Collaborators, Elena A Cora, Simone Alim, Judah Goldstein, David Volders, Shadi Aljendi, Heather Williams, Patrick Fok, Etienne Van Der Linde, Trish Helm-Neima, Tania Chandler, Alix Carter, Renee Cashin, Brian Metcalfe, Julie Savoie, Wendy Simpkin, Fraser Clift, Cassie Chisholm, Michael D. Hill, Bijoy K Menon, Stephen J. Phillips
Background: An evidence-to-practice gap exists in acute ischemic stroke treatment, and improvements in access and efficiency of treatment with iv thrombolysis and endovascular thrombectomy (EVT) is needed. The objective of this study was to improve access and efficiency of ischemic stroke treatment across four Atlantic Canadian Provinces. Methods: A stepped-wedge cluster trial was conducted over 30 months with 3 clusters covering 34 sites. The trial was conducted across all 4 Atlantic Canadian provinces: Nova Scotia (NS), New Brunswick (NB), Prince Edward Island (PE), and Newfoundland and Labrador (NL). The design was quasi-randomized, with each cluster associated with one or more provinces: cluster 1 — NS; cluster 2 — NB and PE; and cluster 3 — NL. The patient population was all ischemic stroke patients across all 4 provinces. The intervention was a 6-month modified Quality Improvement Collaborative (mQIC), which was modified from the Breakthrough Series Collaborative to be half of the 1-year period and conducted virtually. The intervention consisted of assembling an interdisciplinary improvement team, 2 full-day workshops, webinars, and virtual site visits. Suggested changes included 6 process improvement strategies. Results: The proportion of patients that received treatment did not increase significantly with the intervention [0.4% increase for patients that received thrombolysis and/or EVT (p=0.68)]. Median door-to-needle time was reduced by 9.2 minutes with the intervention (p=0.01). Cluster 3 saw the greatest improvements in both access and efficiency. Conclusions: A mQIC intervention resulted in improvement of process measures like door-to-needle time. Quality improvement initiatives may need to be longer to see improvements in proportion of patients treated. Tailored interventions for each health system can ensure that each system sees improvement. In-person activities might be critical to ensure fidelity of the intervention.
{"title":"Improving Access and Efficiency of Acute Ischemic Stroke Treatment Across Four Canadian Provinces: A Stepped-Wedge Trial","authors":"Noreen Kamal, ACTEAST Collaborators, Elena A Cora, Simone Alim, Judah Goldstein, David Volders, Shadi Aljendi, Heather Williams, Patrick Fok, Etienne Van Der Linde, Trish Helm-Neima, Tania Chandler, Alix Carter, Renee Cashin, Brian Metcalfe, Julie Savoie, Wendy Simpkin, Fraser Clift, Cassie Chisholm, Michael D. Hill, Bijoy K Menon, Stephen J. Phillips","doi":"10.1101/2024.09.13.24313666","DOIUrl":"https://doi.org/10.1101/2024.09.13.24313666","url":null,"abstract":"Background: An evidence-to-practice gap exists in acute ischemic stroke treatment, and improvements in access and efficiency of treatment with iv thrombolysis and endovascular thrombectomy (EVT) is needed. The objective of this study was to improve access and efficiency of ischemic stroke treatment across four Atlantic Canadian Provinces. Methods: A stepped-wedge cluster trial was conducted over 30 months with 3 clusters covering 34 sites. The trial was conducted across all 4 Atlantic Canadian provinces: Nova Scotia (NS), New Brunswick (NB), Prince Edward Island (PE), and Newfoundland and Labrador (NL). The design was quasi-randomized, with each cluster associated with one or more provinces: cluster 1 — NS; cluster 2 — NB and PE; and cluster 3 — NL. The patient population was all ischemic stroke patients across all 4 provinces. The intervention was a 6-month modified Quality Improvement Collaborative (mQIC), which was modified from the Breakthrough Series Collaborative to be half of the 1-year period and conducted virtually. The intervention consisted of assembling an interdisciplinary improvement team, 2 full-day workshops, webinars, and virtual site visits. Suggested changes included 6 process improvement strategies. Results: The proportion of patients that received treatment did not increase significantly with the intervention [0.4% increase for patients that received thrombolysis and/or EVT (p=0.68)]. Median door-to-needle time was reduced by 9.2 minutes with the intervention (p=0.01). Cluster 3 saw the greatest improvements in both access and efficiency. Conclusions: A mQIC intervention resulted in improvement of process measures like door-to-needle time. Quality improvement initiatives may need to be longer to see improvements in proportion of patients treated. Tailored interventions for each health system can ensure that each system sees improvement. In-person activities might be critical to ensure fidelity of the intervention.","PeriodicalId":501556,"journal":{"name":"medRxiv - Health Systems and Quality Improvement","volume":"75 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142253051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-15DOI: 10.1101/2024.09.13.24313665
Katherine L Mason, Katherine S Allan, Dirk Huyer, June Carroll, Arnon Shmuel Adler, Julie Rutberg, Sheldon Cheskes, Steve Lin, Erik K. Mont, Lindsay Denis, Joel A Kirsh, Kristopher S. Cunningham, Jodi Garner, Liz Siydock, Katie N. Dainty, Matthew Bowes, Karolyn Yee, Paul Dorian, Krystina B. Lewis
Background: Sudden cardiac death (SCD) is a devastating event and a leading cause of mortality, globally. In the young (2-45 years), SCD is often attributable to a heritable cardiac condition. Death investigators are often responsible for investigating the cause of death and communicating their results and risk of heritable cardiac conditions with family members of SCD victims. Family often struggles to comprehend the information that is communicated to them. Purpose: To understand the delivery, reach and impact of communication strategies informing family members of SCD victims about their relative?s cause of death and their own risk for heritable cardiac conditions. Methods: We conducted an explanatory sequential mixed methods study. We collected quantitative data via a web-based survey and qualitative data via telephone interviews to investigate how death investigators in Ontario and Nova Scotia, Canada, communicate with family members of SCD victims. We used descriptive statistics to analyze the survey data and thematic analysis to analyze the qualitative data. We triangulated data at multiple levels. Results: Between October 2022 and July 2023, we surveyed 78 death investigators and interviewed a subset (n=20). Death investigators reported that SCDs due to suspected heritable cardiac conditions were more difficult (40%, n=31) or slightly more difficult (35%, n = 27) to investigate, often requiring a higher frequency of communication with families. Death investigators reported contacting family members via phone (n=75, 96.1%) and used various strategies to achieve their communication goals. Strategies were influenced by family characteristics; involvement of other professionals; characteristics of the investigation, access to resources, and system-level barriers. Conclusion: SCD investigations in the young due to suspected heritable cardiac conditions were more challenging and required a higher frequency of communication. Death investigators used various strategies to achieve their communication goals. Further research should examine how systematic changes can improve communication with family members.
{"title":"I am a quarterback: A mixed methods study of death investigators' communication with family members of young sudden cardiac death victims from suspected heritable causes","authors":"Katherine L Mason, Katherine S Allan, Dirk Huyer, June Carroll, Arnon Shmuel Adler, Julie Rutberg, Sheldon Cheskes, Steve Lin, Erik K. Mont, Lindsay Denis, Joel A Kirsh, Kristopher S. Cunningham, Jodi Garner, Liz Siydock, Katie N. Dainty, Matthew Bowes, Karolyn Yee, Paul Dorian, Krystina B. Lewis","doi":"10.1101/2024.09.13.24313665","DOIUrl":"https://doi.org/10.1101/2024.09.13.24313665","url":null,"abstract":"Background: Sudden cardiac death (SCD) is a devastating event and a leading cause of mortality, globally. In the young (2-45 years), SCD is often attributable to a heritable cardiac condition. Death investigators are often responsible for investigating the cause of death and communicating their results and risk of heritable cardiac conditions with family members of SCD victims. Family often struggles to comprehend the information that is communicated to them. Purpose: To understand the delivery, reach and impact of communication strategies informing family members of SCD victims about their relative?s cause of death and their own risk for heritable cardiac conditions. Methods: We conducted an explanatory sequential mixed methods study. We collected quantitative data via a web-based survey and qualitative data via telephone interviews to investigate how death investigators in Ontario and Nova Scotia, Canada, communicate with family members of SCD victims. We used descriptive statistics to analyze the survey data and thematic analysis to analyze the qualitative data. We triangulated data at multiple levels.\u0000Results: Between October 2022 and July 2023, we surveyed 78 death investigators and interviewed a subset (n=20). Death investigators reported that SCDs due to suspected heritable cardiac conditions were more difficult (40%, n=31) or slightly more difficult (35%, n = 27) to investigate, often requiring a higher frequency of communication with families. Death investigators reported contacting family members via phone (n=75, 96.1%) and used various strategies to achieve their communication goals. Strategies were influenced by family characteristics; involvement of other professionals; characteristics of the investigation, access to resources, and system-level barriers. Conclusion: SCD investigations in the young due to suspected heritable cardiac conditions were more challenging and required a higher frequency of communication. Death investigators used various strategies to achieve their communication goals. Further research should examine how systematic changes can improve communication with family members.","PeriodicalId":501556,"journal":{"name":"medRxiv - Health Systems and Quality Improvement","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142268895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-13DOI: 10.1101/2024.09.11.24313499
Honghuan Song, Guoli Li, Zhuping Xu, Feixian Wang, Xiaoping Wang, Bing Dai, Xing Zhang, Jincheng Li, Limei Zhu, Li Yan
Background Hospital-acquired TB (Tuberculosis) infection among healthcare workers (HCWs) and patients is a severe problem due to the increased attributable risk of TB infection among these groups. Methods A standardized tool was applied. The assessment was conducted by direct observation, document review, and interviews with the facility heads. Baseline evaluation of TBIC (Tuberculosis infection control) in TB outpatient , inpatient departments, and laboratories was completed by January 2019. Based on the results, we implemented a comprehensive package of interventions, including administrative, environmental engineering, and respiratory protection (PPE) three-level hierarchy of controls. Subsequent monitoring was finalized quarterly and improvement measures should be formulated accordingly. More than two years of follow-up data was collected until August 31, 2021, by hospitals, municipality CDCs, and Jiangsu provincial CDC. Results At baseline, the implementation rate of administrative, environmental engineering and PPE IC was 57.29%, 59.21%, and 66.63%, respectively. After evaluation and implementation, priority way for cough patients was established, mechanical ventilation and the use of masks were improved, UV and UVGI lights were settled in need. The implementation rate of administrative, environmental and PPE IC were significantly increased to 86.27%, 87.41%, and 98.42% P<0.05 , respectively. Conclusions After more than one and a half years of intervention, TBIC in the designated hospitals has significantly improved. However, the availability of separate TB wards remains suboptimal. TB IC measures must be strengthened to reduce TB transmission among HCWs and non-TB patients. This method was practical and suitable to be popularized in countries with high TB burden
{"title":"Tuberculosis Infection Control in MDR-TB designated hospitals, Jiangsu Province of China","authors":"Honghuan Song, Guoli Li, Zhuping Xu, Feixian Wang, Xiaoping Wang, Bing Dai, Xing Zhang, Jincheng Li, Limei Zhu, Li Yan","doi":"10.1101/2024.09.11.24313499","DOIUrl":"https://doi.org/10.1101/2024.09.11.24313499","url":null,"abstract":"Background Hospital-acquired TB (Tuberculosis) infection among healthcare workers (HCWs) and patients is a severe problem due to the increased attributable risk of TB infection among these groups. Methods A standardized tool was applied. The assessment was conducted by direct observation, document review, and interviews with the facility heads. Baseline evaluation of TBIC (Tuberculosis infection control) in TB outpatient , inpatient departments, and laboratories was completed by January 2019. Based on the results, we implemented a comprehensive package of interventions, including administrative, environmental engineering, and respiratory protection (PPE) three-level hierarchy of controls. Subsequent monitoring was finalized quarterly and improvement measures should be formulated accordingly. More than two years of follow-up data was collected until August 31, 2021, by hospitals, municipality CDCs, and Jiangsu provincial CDC. Results At baseline, the implementation rate of administrative, environmental engineering and PPE IC was 57.29%, 59.21%, and 66.63%, respectively. After evaluation and implementation, priority way for cough patients was established, mechanical ventilation and the use of masks were improved, UV and UVGI lights were settled in need. The implementation rate of administrative, environmental and PPE IC were significantly increased to 86.27%, 87.41%, and 98.42% P<0.05 , respectively. Conclusions After more than one and a half years of intervention, TBIC in the designated hospitals has significantly improved. However, the availability of separate TB wards remains suboptimal. TB IC measures must be strengthened to reduce TB transmission among HCWs and non-TB patients. This method was practical and suitable to be popularized in countries with high TB burden","PeriodicalId":501556,"journal":{"name":"medRxiv - Health Systems and Quality Improvement","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142253053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-12DOI: 10.1101/2024.09.11.24313512
Loretta Gasparini, Nitya Phillipson, Daniel Capurro, Revital Rosenberg, Jim Buttery, Jayne Howley, Sarath Ranganathan, Catherine Quinlan, Niloufer Selvadurai, Michael Wildenauer, Michael South, Gerardo Luis Dimaguila
Background: The use of Large Language Models (LLMs) has exploded since November 2022 but there is sparse evidence regarding LLM use in health, medical and research contexts. Objective: To summarise the current uses of and attitudes towards LLMs across the clinical, research and teaching contexts in our campus. Design: We administered a survey about LLM uses and attitudes. We conducted summary quantitative analysis and inductive qualitative analysis of free text responses. Setting: In August-September 2023, we circulated the survey amongst all staff and students across our campus (approximately n=7500), a fully integrated paediatric academic hospital and research institute. Participants: We received 281 anonymous survey responses. Main outcome measures: We asked about participants' knowledge of LLMs, their current use of LLMs in professional or learning contexts, and perspectives on possible future uses, opportunities, and risks of LLM use. Results: Over 90% of respondents have heard of LLM tools and about two-thirds have used them in their work on our campus. Respondents reported using LLMs for a range of uses, including for generating or editing text and exploring ideas. Many, but not necessarily all, respondents seem aware of the limitations and potential risks of LLMs, including privacy and security risks. Various respondents expressed enthusiasm about opportunities of LLM use, including increased efficiency. Conclusions: Our findings show LLM tools are already widely used on our campus. Guidelines and governance are needed to keep up with practice. We have developed recommendations for the use of LLMs on our campus using insights from this survey.
{"title":"A survey of Large Language Model use in a hospital, research, and teaching campus","authors":"Loretta Gasparini, Nitya Phillipson, Daniel Capurro, Revital Rosenberg, Jim Buttery, Jayne Howley, Sarath Ranganathan, Catherine Quinlan, Niloufer Selvadurai, Michael Wildenauer, Michael South, Gerardo Luis Dimaguila","doi":"10.1101/2024.09.11.24313512","DOIUrl":"https://doi.org/10.1101/2024.09.11.24313512","url":null,"abstract":"Background: The use of Large Language Models (LLMs) has exploded since November 2022 but there is sparse evidence regarding LLM use in health, medical and research contexts.\u0000Objective: To summarise the current uses of and attitudes towards LLMs across the clinical, research and teaching contexts in our campus.\u0000Design: We administered a survey about LLM uses and attitudes. We conducted summary quantitative analysis and inductive qualitative analysis of free text responses.\u0000Setting: In August-September 2023, we circulated the survey amongst all staff and students across our campus (approximately n=7500), a fully integrated paediatric academic hospital and research institute.\u0000Participants: We received 281 anonymous survey responses.\u0000Main outcome measures: We asked about participants' knowledge of LLMs, their current use of LLMs in professional or learning contexts, and perspectives on possible future uses, opportunities, and risks of LLM use.\u0000Results: Over 90% of respondents have heard of LLM tools and about two-thirds have used them in their work on our campus. Respondents reported using LLMs for a range of uses, including for generating or editing text and exploring ideas. Many, but not necessarily all, respondents seem aware of the limitations and potential risks of LLMs, including privacy and security risks. Various respondents expressed enthusiasm about opportunities of LLM use, including increased efficiency. Conclusions: Our findings show LLM tools are already widely used on our campus. Guidelines and governance are needed to keep up with practice. We have developed recommendations for the use of LLMs on our campus using insights from this survey.","PeriodicalId":501556,"journal":{"name":"medRxiv - Health Systems and Quality Improvement","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142185047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-11DOI: 10.1101/2024.09.06.24313083
Amanda Marr Chung, Joseph Murungu, Precious Chitapi, Rudo Chikodzore, Peter Case, Jonathan Gosling, Roly Gosling, Sinokuthemba Xaba, Getrude Ncube, Owen Mugurungi, Patience Kunaka, Stefano M. Bertozzi, Caryl Feldacker
The global health community has recognized the importance of integrating and sustaining health programs and forming equitable partnerships. Corresponding with these objectives, international aid donors are embracing the principle of localization. The Voluntary Medical Male Circumcision (VMMC) in Zimbabwe is a large vertical HIV prevention program primarily funded through development assistance for health. Program stakeholders want to sustainably integrate VMMC into routine health services so that the program will continue to be a cost-effective HIV prevention strategy through 2030. The purpose of this paper is to describe a bottom-up process of sustainably integrating the program into routine health services through an approach that empowers local stakeholders. At the district level, we facilitated changes to accelerate integration and sustainability. To evaluate our intervention, we used a mixed methods design comprising analysis of district-level work plans with qualitative and quantitative indicators, combined with a survey assessing sustainability capacity of the program, administered at midline and endline to district teams. In all five pilot districts we facilitated the transition of VMMC into the government’s district administration, resulting in a locally owned and managed program, while also strengthening individual and team capacity. We observed improvements across all World Health Organization health system building blocks, suggesting that the intervention strengthened the overall health system. The sustainability survey showed a reduction in funding stability but a significant increase in communications, program adaptation, and organizational capacity. Compared to traditional top-down change initiatives, the participatory approach to integration was an effective way of addressing specific VMMC challenges at the district level whilst maintaining management and oversight at provincial and national levels. Other health programs in low- and middle-income countries seeking to integrate and sustain health services at subnational levels should consider this diagonal, bottom-up model to promote local leadership development and health system strengthening.
{"title":"Sustainable integration of a vertical voluntary medical male circumcision program into routine health services in Zimbabwe: A mixed methods evaluation of a participatory change intervention","authors":"Amanda Marr Chung, Joseph Murungu, Precious Chitapi, Rudo Chikodzore, Peter Case, Jonathan Gosling, Roly Gosling, Sinokuthemba Xaba, Getrude Ncube, Owen Mugurungi, Patience Kunaka, Stefano M. Bertozzi, Caryl Feldacker","doi":"10.1101/2024.09.06.24313083","DOIUrl":"https://doi.org/10.1101/2024.09.06.24313083","url":null,"abstract":"The global health community has recognized the importance of integrating and sustaining health programs and forming equitable partnerships. Corresponding with these objectives, international aid donors are embracing the principle of localization. The Voluntary Medical Male Circumcision (VMMC) in Zimbabwe is a large vertical HIV prevention program primarily funded through development assistance for health. Program stakeholders want to sustainably integrate VMMC into routine health services so that the program will continue to be a cost-effective HIV prevention strategy through 2030. The purpose of this paper is to describe a bottom-up process of sustainably integrating the program into routine health services through an approach that empowers local stakeholders. At the district level, we facilitated changes to accelerate integration and sustainability. To evaluate our intervention, we used a mixed methods design comprising analysis of district-level work plans with qualitative and quantitative indicators, combined with a survey assessing sustainability capacity of the program, administered at midline and endline to district teams. In all five pilot districts we facilitated the transition of VMMC into the government’s district administration, resulting in a locally owned and managed program, while also strengthening individual and team capacity. We observed improvements across all World Health Organization health system building blocks, suggesting that the intervention strengthened the overall health system. The sustainability survey showed a reduction in funding stability but a significant increase in communications, program adaptation, and organizational capacity. Compared to traditional top-down change initiatives, the participatory approach to integration was an effective way of addressing specific VMMC challenges at the district level whilst maintaining management and oversight at provincial and national levels. Other health programs in low- and middle-income countries seeking to integrate and sustain health services at subnational levels should consider this diagonal, bottom-up model to promote local leadership development and health system strengthening.","PeriodicalId":501556,"journal":{"name":"medRxiv - Health Systems and Quality Improvement","volume":"35 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142185077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-11DOI: 10.1101/2024.09.10.24312854
Ziying Zhang, Habib Chaudhury
Introduction Recreational activity is a rising topic in long-term care settings as it contributes to residents' physical and emotional wellbeing. As residents' abilities of sustaining and initiating activities decline, the care environment becomes vital in supporting residents maintain meaningful engagement in activities and life. Understanding how various aspects of the care environment influence residents' opportunities and quality of recreational activity engagement is a timely and relevant topic in the context of improving quality of life for residents with dementia. The research questions guiding this scoping review are: (1) How do staff characteristics and organisational policies influence residents' levels of participation in planned and self-directed activities? (2) What is the role of the physical environmental features in common spaces of the care setting in supporting residents' activity participation? Methods and analysis This review will follow the Arksey and O'Malley scoping review methodology. The search strategy will be applied to five bibliographic and citation databases. Study selection will occur in two steps: first, two reviewers will screen the titles and abstracts of all search results, and second, the first author will independently conduct a full-text review. Data will be extracted from the included studies and analyzed using Braun and Clarke's thematic analysis. The extracted data will be presented in a narrative format, accompanied by tables that reflect the review's objectives. Ethics and dissemination Since the methodology of the study involves collecting data from publicly available publications, it does not require ethics approval. The findings will offer valuable insights to inform the design, practice and research of long-term care and recreational activities. The scoping review results will be disseminated through an open- access publication in a peer-reviewed journal.
{"title":"Social, Physical Environmental and Organizational Factors related to Recreational Activity of Residents with Dementia in Long-Term Care Homes: A Scoping Review Protocol","authors":"Ziying Zhang, Habib Chaudhury","doi":"10.1101/2024.09.10.24312854","DOIUrl":"https://doi.org/10.1101/2024.09.10.24312854","url":null,"abstract":"Introduction\u0000Recreational activity is a rising topic in long-term care settings as it contributes to residents' physical and emotional wellbeing. As residents' abilities of sustaining and initiating activities decline, the care environment becomes vital in supporting residents maintain meaningful engagement in activities and life. Understanding how various aspects of the care environment influence residents' opportunities and quality of recreational activity engagement is a timely and relevant topic in the context of improving quality of life for residents with dementia. The research questions guiding this scoping review are: (1) How do staff characteristics and organisational policies influence residents' levels of participation in planned and self-directed activities? (2) What is the role of the physical environmental features in common spaces of the care setting in supporting residents' activity participation?\u0000Methods and analysis\u0000This review will follow the Arksey and O'Malley scoping review methodology. The search strategy will be applied to five bibliographic and citation databases. Study selection will occur in two steps: first, two reviewers will screen the titles and abstracts of all search results, and second, the first author will independently conduct a full-text review. Data will be extracted from the included studies and analyzed using Braun and Clarke's thematic analysis. The extracted data will be presented in a narrative format, accompanied by tables that reflect the review's objectives.\u0000Ethics and dissemination\u0000Since the methodology of the study involves collecting data from publicly available publications, it does not require ethics approval. The findings will offer valuable insights to inform the design, practice and research of long-term care and recreational activities. The scoping review results will be disseminated through an open- access publication in a peer-reviewed journal.","PeriodicalId":501556,"journal":{"name":"medRxiv - Health Systems and Quality Improvement","volume":"56 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142185048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-11DOI: 10.1101/2024.09.10.24313267
Kshitij Pandit, Luke Wang, Joel Rosenberg, Nicole Goldhaber, Jill C Buckley, Sonia Ramamoorthy, Kristin L Mekeel, Aditya Bagrodia
Introduction Operating room (OR) turnover time (TT), defined as the interval between the completion of one surgery and the start of the next, is a critical measure of OR efficiency impacting healthcare costs, patient outcomes, and surgical staff well-being. Previous research has identified various contributors to TT, such as surgical team dynamics, OR preparation, and interdisciplinary workflows. However, the influence of surgeon-specific factors like gender, administrative roles, and experience on TT remains underexplored. This study aims to address this gap by examining how these individual surgeon characteristics impact OR efficiency. Methods We conducted a retrospective study at the UC San Diego School of Medicine, a tertiary academic medical center. We analysed 12,820 surgical case entries from January 2022 to July 2023, sourced from the electronic health record system. Surgeons were categorized by gender, ethnicity, years of experience, training at UCSD, academic rank, and administrative roles (Table 1). Data on turnover time (TT) were calculated by summing six components: wrap-up time after the first case, wheeling out to clean-up start, clean-up duration, completion of clean-up to the start of second case setup, second case setup, and wheeling in the patient for the second case. Cases exceeding two standard deviations above the mean TT were excluded to remove outliers caused by extraordinary circumstances unrelated to normal surgical workflow. Surgeons with less than 3 recorded case entries were also excluded to ensure a reliable representation. We utilized Mann-Whitney U test for binary variables and Kruskal-Wallis H test for variables with more than two categories. Multivariable linear regression was applied, adjusting for multiple comparisons using Holm correction. A p-value of less than 0.05 was considered statistically significant. All data analysis was performed using IBM SPSS version 29. Results: Our analysis of 12,820 surgical cases revealed that surgeons in administrative roles and those with over ten years of experience demonstrated significantly shorter turnover times (TT). Specifically, administrators demonstrated a TT of 27 minutes, compared to 35 minutes for non-administrators (p<0.001) (Table 2). Surgeons with more than ten years of experience had a TT of 31 minutes, versus 37 minutes for those with less experience (p<0.001). Multivariable linear regression confirmed these associations, with significant reductions in TT linked to administrative roles (beta: -7.2; 95% confidence interval (CI): -8.2 to -6.2, p<0.001) and surgeon experience (beta: -4.7, 95% CI: -5.9 to -3.5, p< 0.001). Conclusion: We recommend efforts focusing on building a standardized environment for surgeons regardless of their background. This could lead to not only an equitable OR culture but also an overall increase in the institution efficiency and patient outcomes.
{"title":"Surgeon Factors and Their Association With Operating Room Turnover Time","authors":"Kshitij Pandit, Luke Wang, Joel Rosenberg, Nicole Goldhaber, Jill C Buckley, Sonia Ramamoorthy, Kristin L Mekeel, Aditya Bagrodia","doi":"10.1101/2024.09.10.24313267","DOIUrl":"https://doi.org/10.1101/2024.09.10.24313267","url":null,"abstract":"Introduction Operating room (OR) turnover time (TT), defined as the interval between the completion of one surgery and the start of the next, is a critical measure of OR efficiency impacting healthcare costs, patient outcomes, and surgical staff well-being. Previous research has identified various contributors to TT, such as surgical team dynamics, OR preparation, and interdisciplinary workflows. However, the influence of surgeon-specific factors like gender, administrative roles, and experience on TT remains underexplored. This study aims to address this gap by examining how these individual surgeon characteristics impact OR efficiency. Methods We conducted a retrospective study at the UC San Diego School of Medicine, a tertiary academic medical center. We analysed 12,820 surgical case entries from January 2022 to July 2023, sourced from the electronic health record system. Surgeons were categorized by gender, ethnicity, years of experience, training at UCSD, academic rank, and administrative roles (Table 1). Data on turnover time (TT) were calculated by summing six components: wrap-up time after the first case, wheeling out to clean-up start, clean-up duration, completion of clean-up to the start of second case setup, second case setup, and wheeling in the patient for the second case. Cases exceeding two standard deviations above the mean TT were excluded to remove outliers caused by extraordinary circumstances unrelated to normal surgical workflow. Surgeons with less than 3 recorded case entries were also excluded to ensure a reliable representation. We utilized Mann-Whitney U test for binary variables and Kruskal-Wallis H test for variables with more than two categories. Multivariable linear regression was applied, adjusting for multiple comparisons using Holm correction. A p-value of less than 0.05 was considered statistically significant. All data analysis was performed using IBM SPSS version 29. Results: Our analysis of 12,820 surgical cases revealed that surgeons in administrative roles and those with over ten years of experience demonstrated significantly shorter turnover times (TT). Specifically, administrators demonstrated a TT of 27 minutes, compared to 35 minutes for non-administrators (p<0.001) (Table 2). Surgeons with more than ten years of experience had a TT of 31 minutes, versus 37 minutes for those with less experience (p<0.001). Multivariable linear regression confirmed these associations, with significant reductions in TT linked to administrative roles (beta: -7.2; 95% confidence interval (CI): -8.2 to -6.2, p<0.001) and surgeon experience (beta: -4.7, 95% CI: -5.9 to -3.5, p< 0.001). Conclusion:\u0000We recommend efforts focusing on building a standardized environment for surgeons regardless of their background. This could lead to not only an equitable OR culture but also an overall increase in the institution efficiency and patient outcomes.","PeriodicalId":501556,"journal":{"name":"medRxiv - Health Systems and Quality Improvement","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142185079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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