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Jacquot G, Lopez Navarro P, Grange C, Boudali L, Harlepp S, Pivot X, Detappe A. Landscape of Subcutaneous Administration Strategies for Monoclonal Antibodies in Oncology. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2024; 36:e2406604. [PMID: 39165046 DOI: 10.1002/adma.202406604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 07/15/2024] [Indexed: 08/22/2024]
Abstract
In recent decades, subcutaneous (SC) administration of monoclonal antibodies (mAbs) has emerged as a promising alternative to intravenous delivery in oncology, offering comparable therapeutic efficacy while addressing patient preferences. This perspective article provides an in-depth analysis of the technological landscape surrounding SC mAb administration in oncology. It outlines various technologies under evaluation across developmental stages, spanning from preclinical investigations to the integration of established methodologies in clinical practice. Additionally, this perspective article explores emerging trends and prospective trajectories, shedding light on the evolving landscape of SC mAb administration. Furthermore, it emphasizes key checkpoints related to quality attributes essential for optimizing mAb delivery via the SC route. This review serves as a valuable resource for researchers, clinicians, and healthcare policymakers, offering insights into the advancement of SC mAb administration in oncology and its implications for patient care.
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Affiliation(s)
- Guillaume Jacquot
- Institut de Cancérologie Strasbourg Europe, Strasbourg, 67000, France
- Equipe labellisée Ligue contre le Cancer, France
- Strasbourg Drug Discovery and Development Institute (IMS), Strasbourg, 67000, France
| | - Pedro Lopez Navarro
- Institut de Cancérologie Strasbourg Europe, Strasbourg, 67000, France
- Equipe labellisée Ligue contre le Cancer, France
- Strasbourg Drug Discovery and Development Institute (IMS), Strasbourg, 67000, France
| | - Coralie Grange
- Institut de Cancérologie Strasbourg Europe, Strasbourg, 67000, France
- Equipe labellisée Ligue contre le Cancer, France
- Strasbourg Drug Discovery and Development Institute (IMS), Strasbourg, 67000, France
| | - Lotfi Boudali
- Institut de Cancérologie Strasbourg Europe, Strasbourg, 67000, France
- Equipe labellisée Ligue contre le Cancer, France
- Strasbourg Drug Discovery and Development Institute (IMS), Strasbourg, 67000, France
| | - Sébastien Harlepp
- Institut de Cancérologie Strasbourg Europe, Strasbourg, 67000, France
- Equipe labellisée Ligue contre le Cancer, France
- Strasbourg Drug Discovery and Development Institute (IMS), Strasbourg, 67000, France
| | - Xavier Pivot
- Institut de Cancérologie Strasbourg Europe, Strasbourg, 67000, France
- Equipe labellisée Ligue contre le Cancer, France
- Strasbourg Drug Discovery and Development Institute (IMS), Strasbourg, 67000, France
| | - Alexandre Detappe
- Institut de Cancérologie Strasbourg Europe, Strasbourg, 67000, France
- Equipe labellisée Ligue contre le Cancer, France
- Strasbourg Drug Discovery and Development Institute (IMS), Strasbourg, 67000, France
- Equipe de Synthèse Pour l'Analyse, Institut Pluridisciplinaire Hubert Curien (IPHC), UMR 7178 CNRS/University of Strasbourg, Strasbourg, Cedex 2, 67087, France
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Pesonen T, Väisänen V, Aaltonen M, Edgren J, Corneliusson L, Ruotsalainen S, Sinervo T. Determinants of received care time among Finnish home care clients and assisted living facility residents: a time-motion study. BMC Geriatr 2024; 24:754. [PMID: 39266978 PMCID: PMC11391809 DOI: 10.1186/s12877-024-05355-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/03/2024] [Indexed: 09/14/2024] Open
Abstract
BACKGROUND Ageing populations and care workforce shortages across Europe are causing challenges for care services for older people. Therefore, it is paramount that limited care resources are allocated optimally, based on the clients' care needs. Multiple functioning-related factors have been identified that determine the amount of care time clients receive, while organizational and other factors remain largely unexplored. The aim was to examine how various individual and organizational factors are associated with clients' received care time in different care settings. METHODS Cross-sectional observational study design with data from time and motion study, registers, and surveys was used. In total, 1477 home care clients and 1538 residents from assisted living facilities with 24/7 service participated, from 61 Finnish care units. Linear mixed-effect modeling was used to examine the association between individual and organizational-level variables and received care time. RESULTS Physical functioning was the strongest predictor of received care time in both care settings. In home care, greater pain, more unstable health, and higher team autonomy were associated with increased care time. In assisted living, depressive mood and higher staffing level of the organization were associated with care time. Clients who received informal care also received significantly more care time from nurses in both care settings. CONCLUSIONS Physical functioning was the main driver of received care time. Interventions that maintain or improve physical functioning can help restrain the growing need of care resources, although it is important to ensure that each client receives care according to their holistic care needs.
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Affiliation(s)
- Tiina Pesonen
- Finnish Institute for Health and Welfare, Helsinki, Finland.
| | - Visa Väisänen
- Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - Mari Aaltonen
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Johanna Edgren
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | | | - Timo Sinervo
- Finnish Institute for Health and Welfare, Helsinki, Finland
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Väisänen V, Ruotsalainen S, Hietapakka L, Sulander J, Sinervo T. The role of workday characteristics on perceived stress and time pressure among nurses in Finnish long-term care - a cross-sectional study. BMC Health Serv Res 2024; 24:878. [PMID: 39095796 PMCID: PMC11295524 DOI: 10.1186/s12913-024-11294-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 07/09/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Aging populations and nursing workforce issues are causing challenges for long-term care globally, and therefore, improving the work-related wellbeing and retention of nurses is crucial. As such, gaining a further understanding of the factors that affect work strain in long-term care is important. Previously, the effect of job demands on the wellbeing of nurses has been researched principally by subjective instruments. In this study, we examined the relationship between indirectly measured workday characteristics and perceived stress and time pressure among nurses working in Finnish long-term care (assisted living facilities with 24-hour assistance). METHODS A total of 503 nurses from 44 assisted living facilities across Finland completed time measurement surveys and wellbeing questionnaires. The data were linked with client characteristics from the Resident Assessment Instrument register. The relationships between the measured number of care events during the workday, clients' care needs, and the amount of breaktime and perceived stress and time pressure were analyzed using multivariate logistic regression. RESULTS Nurses who had more care events and clients with greater care needs were at higher odds of having high stress. More care events and reduced breaktime were associated with high time pressure. Disruptions during the workday were strongly associated with both high stress and time pressure. Last, nurses who were under high stress and time pressure worked more often in teams with lower team autonomy. CONCLUSIONS Our findings on indirectly measured job demands indicate that dividing the workload equally among nurses through better work division can help reduce the stress and time pressure of nurses in long-term care. In addition, ensuring sufficient breaktime and preventing unnecessary disruptions is important. To help recruit and retain the care workforce, fair management of work that accounts for varying client care needs and workload is needed. In addition, legislative and governance tools, such as staffing level regulation, and further consideration of job demands might aid in reducing the job strain of nurses. PATIENT OR PUBLIC CONTRIBUTION Patients or nurses were not involved in the design of the study, analysis, or interpretation of the results, or in the preparation of the manuscript.
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Affiliation(s)
- Visa Väisänen
- Finnish Institute for Health and Welfare, Welfare State Research and Reform unit, Health and Social Service System Research team, Mannerheimintie 166, Helsinki, 00330, Finland.
- Faculty of Social Sciences and Business Studies, Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland.
| | - Salla Ruotsalainen
- Finnish Institute for Health and Welfare, Welfare State Research and Reform unit, Health and Social Service System Research team, Mannerheimintie 166, Helsinki, 00330, Finland
| | - Laura Hietapakka
- Finnish Institute for Health and Welfare, Welfare State Research and Reform unit, Health and Social Service System Research team, Mannerheimintie 166, Helsinki, 00330, Finland
| | - Juhani Sulander
- Finnish Institute for Health and Welfare, Welfare State Research and Reform unit, Health and Social Service System Research team, Mannerheimintie 166, Helsinki, 00330, Finland
| | - Timo Sinervo
- Finnish Institute for Health and Welfare, Welfare State Research and Reform unit, Health and Social Service System Research team, Mannerheimintie 166, Helsinki, 00330, Finland
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Zaghini F, Calzolari M, Di Nitto M, Longobucco Y, Alvaro R, Cicolini G, Lancia L, Manara DF, Rasero L, Rocco G, Zega M, Mazzoleni B, Sasso L, Bagnasco A. Workload of home care nurses: Italian adaptation, validity, and reliability of the National Aeronautics and Space Administration Task Load Index questionnaire. Public Health Nurs 2024. [PMID: 39092927 DOI: 10.1111/phn.13387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 06/14/2024] [Accepted: 07/11/2024] [Indexed: 08/04/2024]
Abstract
The aim of this study was to adapt the National Aeronautics and Space Administration Task Load Index (NASA-TLX) to the home care setting and translate and validate it in Italian. An online questionnaire containing the Italian version of the NASA-TLX adapted to the home care setting was administered to home care nurses to measure workload. Content Validity Index, Exploratory, and Confirmatory Factor Analyses were used to measure the psychometric characteristics of the modified NASA-TLX. The modified Italian version of NASA-TLX_HC-IT showed good psychometric characteristics in measuring the workload of home care nurses, with excellent fit indices. The reliability, calculated with Cronbach's alpha, was 0.73, indicating adequate reliability. A negative correlation between workload and job satisfaction among home care nurses, as well as a positive association between high workload and intention to leave the workplace, was verified. The modified Italian version of the NASA-TLX_HC-IT was confirmed to be a valid and reliable instrument to measure workload in home care nursing. Furthermore, the correlation between workload and the intention to leave the workplace among home care nurses was an important result that community nursing managers should consider preventing the shortage of home care nurses.
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Affiliation(s)
- Francesco Zaghini
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | | | - Marco Di Nitto
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Yari Longobucco
- Department of Health Science, University of Florence, Florence, Italy
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
- Scientific Committee CERSI-FNOPI, Rome, Italy
| | - Giancarlo Cicolini
- Department of Innovative Technologies in Medicine & Dentistry, "G.d'Annunzio" University of Chieti - Pescara, Chieti, Italy
- FNOPI Board Member, Rome, Italy
| | - Loreto Lancia
- Scientific Committee CERSI-FNOPI, Rome, Italy
- Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L'Aquila, Piazzale Salvatore Tommasi, L'Aquila, Italy
| | - Duilio Fiorenzo Manara
- Scientific Committee CERSI-FNOPI, Rome, Italy
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy
| | - Laura Rasero
- Department of Health Science, University of Florence, Florence, Italy
- Scientific Committee CERSI-FNOPI, Rome, Italy
| | - Gennaro Rocco
- Scientific Committee CERSI-FNOPI, Rome, Italy
- Centre of Excellence for Nursing Scholarship, Rome, Italy
| | - Maurizio Zega
- FNOPI Board Member, Rome, Italy
- Isola Tiberina Hospital - Gemelli Isola, A. Gemelli IRCCS University Hospital Foundation, Rome, Italy
| | | | - Loredana Sasso
- Department of Health Sciences, University of Genoa, Genoa, Italy
- Scientific Committee CERSI-FNOPI, Rome, Italy
| | - Annamaria Bagnasco
- Department of Health Sciences, University of Genoa, Genoa, Italy
- Scientific Committee CERSI-FNOPI, Rome, Italy
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Abdelrahman HH, Hamza M, Essam W, Adham M, AbdulKafi A, Baniode M. Electronic oral health surveillance system for Egyptian preschoolers using District Health Information System (DHIS2): design description and time motion study. BMC Oral Health 2024; 24:807. [PMID: 39014374 PMCID: PMC11253332 DOI: 10.1186/s12903-024-04550-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 07/01/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND Early childhood caries (ECC) is a major global health issue affecting millions of children. Mitigating this problem requires up-to-date information from reliable surveillance systems. This enables evidence-based decision-making to devise oral health policies. The World Health Organization (WHO) advocates the adoption of mobile technologies in oral disease surveillance because of their efficiency and ease of application. The study describes developing an electronic, oral health surveillance system (EOHSS) for preschoolers in Egypt, using the District Health Information System (DHIS2) open-source platform along with its Android App, and assesses its feasibility in data acquisition. METHODS The DHIS2 Server was configured for the DHIS2 Tracker Android Capture App to allow individual-level data entry. The EOHSS indicators were selected in line with the WHO Action Plan 2030. Two modalities for the EOHSS were developed based on clinical data capture: face-to-face and tele/asynchronous. Eight dentists in the pilot team collected 214 events using modality-specific electronic devices. The pilot's team's feedback was obtained regarding the EOHSS's feasibility in collecting data, and a time-motion study was conducted to assess workflow over two weeks. Independent t-test and Statistical Process Control techniques were used for data analysis. RESULTS The pilot team reported positive feedback on the structure of the EOHSS. Workflow adaptations were made to prioritize surveillance tasks by collecting data from caregivers before acquiring clinical data from children to improve work efficiency. A shorter data capture time was required during face-to-face modality (4.2 ± 0.7 min) compared to telemodality (5.1 ± 0.9 min), p < 0.001). The acquisition of clinical data accounted for 16.9% and 21.1% of the time needed for both modalities, respectively. The time required by the face-to-face modality showed random variation, and the tele-modality tasks showed a reduced time trend to perform tasks. CONCLUSIONS The DHIS2 provides a feasible solution for developing electronic, oral health surveillance systems. The one-minute difference in data capture time in telemodality compared to face-to-face indicates that despite being slightly more time-consuming, telemodality still shows promise for remote oral health assessments that is particularly valuable in areas with limited access to dental professionals, potentially expanding the reach of oral health screening programs.
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Affiliation(s)
- Hams H Abdelrahman
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Champollion St., Azarita, 21526, Alexandria, Egypt.
| | - Maha Hamza
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Champollion St., Azarita, 21526, Alexandria, Egypt
| | - Wafaa Essam
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Champollion St., Azarita, 21526, Alexandria, Egypt
| | - May Adham
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Champollion St., Azarita, 21526, Alexandria, Egypt
| | - Abdulrahman AbdulKafi
- Health Information Systems Programme (HISP), Middle East and North Africa (MENA), Amman, Jordan
| | - Mohammad Baniode
- Health Information Systems Programme (HISP), Middle East and North Africa (MENA), Amman, Jordan
- Al Quds University, Jerusalem, Palestine
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Broussard A, Venier B, Rafati AS, Beltsos A, Lee J, Bailey J, Sakkas D, Collins MG. Effort in manual operation of reproductive health cryostorage facilities. Reprod Biomed Online 2024; 49:104348. [PMID: 39213986 DOI: 10.1016/j.rbmo.2024.104348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 06/13/2024] [Accepted: 06/21/2024] [Indexed: 09/04/2024]
Abstract
RESEARCH QUESTION What areas of manual IVF cryostorage operations are common to the safe operation of IVF cryostorage facilities and require effort from embryologists? DESIGN Observational time and motion data were collected by two observers equipped with the digital cameras over 2 weeks at four well-characterized US IVF centres (sites α, β, γ and δ) from 12 participants performing cryostorage tasks. To understand the work processes of the different sites and assist in the data analysis, informal interviews were conducted with the study participants and laboratory directors. Data were analysed to identify work processes that might be eliminated or diminished by automation and software improvements. RESULTS On average, it took 3.4 data record queries per retrieval from cryostorage to identify a cane, while the canister was lifted an average of 1.5 times per retrieval, with a mean 11.8 ± 9.2 s per lift. Of the total time spent working with cryostorage equipment, 47.25% was of a fatiguing nature. Sites α, β and γ utilized one person to fill the liquid nitrogen storage Dewars, while site δ had two technicians working in tandem to move and fill the Dewars, with different frequencies and determination factors for refills and efficiencies. CONCLUSIONS This time and motion study demonstrated significant time investment, task redundancy and fatiguing working conditions among embryologists using manual cryostorage processes. There was a disparity of processes and space capacity across different laboratories. Some of these issues may be addressed by the integration of automation and technology solutions.
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Affiliation(s)
- Alicia Broussard
- TMRW Life Sciences, Inc., New York, NY, USA; Generation Next Fertility, New York, NY, USA
| | - Bill Venier
- San Diego Fertility Center, San Diego, CA, USA
| | | | | | - Joseph Lee
- Reproductive Medicine Associates of New York, New York, NY, USA
| | - Jessica Bailey
- Boston IVF-IVIRMA Global Research Alliance, Waltham, MA, USA
| | - Denny Sakkas
- Boston IVF-IVIRMA Global Research Alliance, Waltham, MA, USA
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Tumukunde V, Medvedev MM, Tann CJ, Mambule I, Pitt C, Opondo C, Kakande A, Canter R, Haroon Y, Kirabo-Nagemi C, Abaasa A, Okot W, Katongole F, Ssenyonga R, Niombi N, Nanyunja C, Elbourne D, Greco G, Ekirapa-Kiracho E, Nyirenda M, Allen E, Waiswa P, Lawn JE. Effectiveness of kangaroo mother care before clinical stabilisation versus standard care among neonates at five hospitals in Uganda (OMWaNA): a parallel-group, individually randomised controlled trial and economic evaluation. Lancet 2024; 403:2520-2532. [PMID: 38754454 PMCID: PMC11436264 DOI: 10.1016/s0140-6736(24)00064-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/05/2023] [Accepted: 01/11/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND Preterm birth is the leading cause of death in children younger than 5 years worldwide. WHO recommends kangaroo mother care (KMC); however, its effects on mortality in sub-Saharan Africa and its relative costs remain unclear. We aimed to compare the effectiveness, safety, costs, and cost-effectiveness of KMC initiated before clinical stabilisation versus standard care in neonates weighing up to 2000 g. METHODS We conducted a parallel-group, individually randomised controlled trial in five hospitals across Uganda. Singleton or twin neonates aged younger than 48 h weighing 700-2000 g without life-threatening clinical instability were eligible for inclusion. We randomly assigned (1:1) neonates to either KMC initiated before stabilisation (intervention group) or standard care (control group) via a computer-generated random allocation sequence with permuted blocks of varying sizes, stratified by birthweight and recruitment site. Parents, caregivers, and health-care workers were unmasked to treatment allocation; however, the independent statistician who conducted the analyses was masked. After randomisation, neonates in the intervention group were placed prone and skin-to-skin on the caregiver's chest, secured with a KMC wrap. Neonates in the control group were cared for in an incubator or radiant heater, as per hospital practice; KMC was not initiated until stability criteria were met. The primary outcome was all-cause neonatal mortality at 7 days, analysed by intention to treat. The economic evaluation assessed incremental costs and cost-effectiveness from a disaggregated societal perspective. This trial is registered with ClinicalTrials.gov, NCT02811432. FINDINGS Between Oct 9, 2019, and July 31, 2022, 2221 neonates were randomly assigned: 1110 (50·0%) neonates to the intervention group and 1111 (50·0%) neonates to the control group. From randomisation to age 7 days, 81 (7·5%) of 1083 neonates in the intervention group and 83 (7·5%) of 1102 neonates in the control group died (adjusted relative risk [RR] 0·97 [95% CI 0·74-1·28]; p=0·85). From randomisation to 28 days, 119 (11·3%) of 1051 neonates in the intervention group and 134 (12·8%) of 1049 neonates in the control group died (RR 0·88 [0·71-1·09]; p=0·23). Even if policy makers place no value on averting neonatal deaths, the intervention would have 97% probability from the provider perspective and 84% probability from the societal perspective of being more cost-effective than standard care. INTERPRETATION KMC initiated before stabilisation did not reduce early neonatal mortality; however, it was cost-effective from the societal and provider perspectives compared with standard care. Additional investment in neonatal care is needed for increased impact, particularly in sub-Saharan Africa. FUNDING Joint Global Health Trials scheme of the Department of Health and Social Care, Foreign, Commonwealth and Development Office, UKRI Medical Research Council, and Wellcome Trust; Eunice Kennedy Shriver National Institute of Child Health and Human Development.
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Affiliation(s)
- Victor Tumukunde
- Department of Infectious Disease Epidemiology and International Health, London School of Hygiene & Tropical Medicine, London, UK; Non-Communicable Disease Programme, Medical Research Council-Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Melissa M Medvedev
- Department of Infectious Disease Epidemiology and International Health, London School of Hygiene & Tropical Medicine, London, UK; Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Cally J Tann
- Department of Infectious Disease Epidemiology and International Health, London School of Hygiene & Tropical Medicine, London, UK; Non-Communicable Disease Programme, Medical Research Council-Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda; Department of Neonatal Medicine, University College London Hospitals NHS Trust, London, UK
| | - Ivan Mambule
- Non-Communicable Disease Programme, Medical Research Council-Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Catherine Pitt
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Charles Opondo
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Ayoub Kakande
- Non-Communicable Disease Programme, Medical Research Council-Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Ruth Canter
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Yiga Haroon
- Non-Communicable Disease Programme, Medical Research Council-Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Charity Kirabo-Nagemi
- Non-Communicable Disease Programme, Medical Research Council-Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Andrew Abaasa
- Non-Communicable Disease Programme, Medical Research Council-Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Wilson Okot
- Non-Communicable Disease Programme, Medical Research Council-Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Fredrick Katongole
- Non-Communicable Disease Programme, Medical Research Council-Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Raymond Ssenyonga
- Non-Communicable Disease Programme, Medical Research Council-Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Natalia Niombi
- Non-Communicable Disease Programme, Medical Research Council-Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Carol Nanyunja
- Non-Communicable Disease Programme, Medical Research Council-Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Diana Elbourne
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Giulia Greco
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK; Non-Communicable Disease Programme, Medical Research Council-Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | | | - Moffat Nyirenda
- Non-Communicable Disease Programme, Medical Research Council-Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Elizabeth Allen
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Peter Waiswa
- Department of Health Policy, Planning, and Management, Makerere University, Kampala, Uganda; Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Joy E Lawn
- Department of Infectious Disease Epidemiology and International Health, London School of Hygiene & Tropical Medicine, London, UK.
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Bradley C, Sumethasorn M, Kim JS, Wang S, Martinez L, Chang M, Lemus L, Katebian B, Bruce D, Lee A, Baden R, Yee H, Buxbaum J. Plan-do-study-act (PDSA) interventions to improve real-world endoscopy unit productivity. Endosc Int Open 2024; 12:E642-E648. [PMID: 38707596 PMCID: PMC11068437 DOI: 10.1055/a-2290-0263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 03/06/2024] [Indexed: 05/07/2024] Open
Abstract
Background and study aims The Plan-Do-Study Act (PDSA) ramp is a framework that uses initial small changes to build consensus and momentum for subsequent, iterative process improvement. Our aim was to study its impact on endoscopy unit efficiency and throughput. Methods Following a granular time-and-motion analysis to evaluate baseline performance (phase 1) we instituted successive interventions and measured their impact on core efficiency metrics including procedure volume and turnover time (phases 2-3). Results We identified that inefficiency in turnover of anesthesia-supported endoscopy was the most crucial issue. Implementation of a pre-procedure anesthesia visit in phase 2 reduced turnover time by 15.5 minutes (95% confidence interval 3.9-27.1 minutes). Subsequent changes (phase 3) including front-loaded procedure scheduling and parallel in-room preparation resulted in an 18% increase in procedure volume. Conclusions The PDSA ramp model is an effective means of assessing operational processes, developing novel interventions, and building consensus to improve the real-world productivity in a resource-conscious manner.
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Affiliation(s)
- Christopher Bradley
- Department of Internal Medicine, Division of Gastroenterology, University of Southern California Keck School of Medicine, Los Angeles, United States
| | - Matt Sumethasorn
- Department of Internal Medicine, Division of Gastroenterology, University of Southern California Keck School of Medicine, Los Angeles, United States
| | - Jin Sun Kim
- Division of Gastrointestinal Liver Disease, University of Southern California, Los Angeles, United States
| | - Sarah Wang
- Department of Internal Medicine, Division of Gastroenterology, University of Southern California Keck School of Medicine, Los Angeles, United States
| | - Leslie Martinez
- Los Angeles County Department of Health Services, Los Angeles, United States
| | - Megan Chang
- Los Angeles County Department of Health Services, Los Angeles, United States
| | - Lillian Lemus
- Los Angeles County Department of Health Services, Los Angeles, United States
| | - Behrod Katebian
- Los Angeles County Department of Health Services, Los Angeles, United States
| | - Dara Bruce
- Department of Internal Medicine, Division of Gastroenterology, University of Southern California Keck School of Medicine, Los Angeles, United States
| | - Andy Lee
- Los Angeles County Department of Health Services, Los Angeles, United States
| | - Rachel Baden
- Los Angeles County Department of Health Services, Los Angeles, United States
| | - Hal Yee
- Los Angeles County Department of Health Services, Los Angeles, United States
| | - James Buxbaum
- Department of Internal Medicine, Division of Gastroenterology, University of Southern California Keck School of Medicine, Los Angeles, United States
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Painter JT, Raciborski RA, Matthieu MM, Oliver CM, Adkins DA, Garner KK. Engaging stakeholders to retrospectively discern implementation strategies to support program evaluation: Proposed method and case study. EVALUATION AND PROGRAM PLANNING 2024; 103:102398. [PMID: 38183893 DOI: 10.1016/j.evalprogplan.2023.102398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/12/2023] [Accepted: 12/11/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Availability of evidence-based practices (EBPs) is critical for improving health care outcomes, but diffusion can be challenging. Implementation activities increase the adoption of EBPs and support sustainability. However, when implementation activities are a part of quality improvement processes, evaluation of the time and cost associated with these activities is challenged by the need for a correct classification of these activities to a known taxonomy of implementation strategies by implementation actors. DESIGN Observational study of a four-stage, stakeholder-engaged process for identifying implementation activities and estimating the associated costs. RESULTS A national initiative in the Veterans Health Administration (VHA) to improve Advance Care Planning (ACP) via Group Visits (ACP-GV) for rural veterans identified 49 potential implementation activities. Evaluators translated and reduced these to 14 strategies used across three groups with the aid of implementation actors. Data were collected to determine the total implementation effort and applied cost estimates to estimate the budget impact of implementation for VHA. LIMITATIONS Recall bias may influence the identification of potential implementation activities. CONCLUSIONS This process improved understanding of the implementation effort and allowed estimation of ACP-GV 's budget impact. IMPLICATIONS A four-stage, stakeholder-engaged methodology can be applied to other initiatives when a pragmatic evaluation of implementation efforts is needed.
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Affiliation(s)
- Jacob T Painter
- US Department of Veterans Affairs Medical Center, Central Arkansas Veterans Healthcare System, HSR&D Center of Innovation: Center for Mental Healthcare & Outcomes Research, 2200 Fort Roots Drive, North Little Rock, AR 72114, USA; University of Arkansas for Medical Sciences, College of Pharmacy, Division of Pharmaceutical Evaluation & Policy, 4301 W Markham St., Little Rock, AR 72205, USA.
| | - Rebecca A Raciborski
- US Department of Veterans Affairs Medical Center, Central Arkansas Veterans Healthcare System, HSR&D Center of Innovation: Center for Mental Healthcare & Outcomes Research, 2200 Fort Roots Drive, North Little Rock, AR 72114, USA.
| | - Monica M Matthieu
- US Department of Veterans Affairs Medical Center, Central Arkansas Veterans Healthcare System, HSR&D Center of Innovation: Center for Mental Healthcare & Outcomes Research, 2200 Fort Roots Drive, North Little Rock, AR 72114, USA; Saint Louis University, School of Social Work, 3500 Lindell Blvd., Saint Louis, MO 63103, USA.
| | - Ciara M Oliver
- US Department of Veterans Affairs Medical Center, Central Arkansas Veterans Healthcare System, HSR&D Center of Innovation: Center for Mental Healthcare & Outcomes Research, 2200 Fort Roots Drive, North Little Rock, AR 72114, USA.
| | - David A Adkins
- US Department of Veterans Affairs Medical Center, Central Arkansas Veterans Healthcare System, HSR&D Center of Innovation: Center for Mental Healthcare & Outcomes Research, 2200 Fort Roots Drive, North Little Rock, AR 72114, USA.
| | - Kimberly K Garner
- US Department of Veterans Affairs Medical Center, Central Arkansas Veterans Healthcare System, Geriatric Research, Education and Clinical Center, 2200 Fort Roots Drive, North Little Rock, AR 72114, USA; University of Arkansas for Medical Sciences, College of Medicine, Department of Psychiatry, 4301 W Markham St., Little Rock, AR 72205, USA.
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Pesonen T, Corneliusson L, Väisänen V, Siira H, Edgren J, Elo S, Sinervo T. The relationship between sensory impairment and home care client's received care time-A cross-sectional study. J Adv Nurs 2024; 80:1166-1176. [PMID: 37710399 DOI: 10.1111/jan.15863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/16/2023] [Accepted: 08/30/2023] [Indexed: 09/16/2023]
Abstract
AIM The aim of this study was to explore the relationship between sensory impairment and home care client's received care time. DESIGN A cross-sectional multi-source study. METHODS Data from a self-reported staff survey on care time allocation were merged with registry data from the Resident Assessment Instrument registry (n = 1477). The data were collected during 1 week from 17 home care units in Finland in October 2021. The relationship between sensory impairment and clients received care time was examined using linear regression analyses. RESULTS The linear regression analyses showed that having vision impairment alone increased care time, while dual sensory impairment resulted in decreased received care time. Hearing impairment alone was not statistically significantly associated with care time. CONCLUSION The holistic care need of home care clients with dual sensory impairment may not be adequate. To ensure equality and the individually tailored care of clients, further attention must be paid to clients with sensory impairments, especially those with dual sensory impairment. Furthermore, the competence of home care workers to encounter and communicate with clients with sensory impairment must be developed to support the holistic care. IMPLICATIONS FOR THE PATIENT CARE The sensory impairments of home care clients must be identified in time and considered in care planning and encountering clients. IMPACT As there is a risk that clients with dual sensory impairment are not able to fully express themselves, it is imperative that further attention is paid to clients with sensory impairments, to better understand and support this vulnerable group. Increased awareness and continuous education are needed to better identify and support home care clients with sensory impairment. REPORTING METHOD The study adheres to the STROBE reporting guidelines. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Tiina Pesonen
- Finnish Institute for Health and Welfare, Helsinki, Finland
- Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
| | - Laura Corneliusson
- Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Nursing, Umeå University, Umeå, Sweden
| | - Visa Väisänen
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Heidi Siira
- Research Unit of Health Sciences and Technology/GeroNursing Centre, University of Oulu, Oulu, Finland
| | - Johanna Edgren
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Satu Elo
- Oulu University of Applied Sciences, Oulu, Finland
| | - Timo Sinervo
- Finnish Institute for Health and Welfare, Helsinki, Finland
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Bradley SH, Harper AM, Smith L, Taylor N, Delap H, Pyke H, Girkin J, Sinnott C, Watson J. Great expectations? GPs' estimations of time required to deliver BMJ's '10 minute consultations'. BMJ Open 2024; 14:e079578. [PMID: 38413154 PMCID: PMC10900324 DOI: 10.1136/bmjopen-2023-079578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024] Open
Abstract
OBJECTIVES To estimate the time required to undertake consultations according to BMJ's 10-minute consultation articles.To quantify the tasks recommended in 10-minute consultation articles.To determine if, and to what extent, the time required and the number of tasks recommended have increased over the past 22 years. DESIGN Analysis of estimations made by four general practitioners (GPs) of the time required to undertake tasks recommended in BMJ's 10-minute consultation articles. SETTING Primary care in the UK. PARTICIPANTS Four doctors with a combined total of 79 years of experience in the UK National Health Service following qualification as GPs. MAIN OUTCOME MEASURES Median minimum estimated consultation length (the estimated time required to complete tasks recommended for all patients) and median maximum estimated consultation length (the estimated time required to complete tasks recommended for all patients and the additional tasks recommended in specific circumstances). Minimum, maximum and median consultation lengths reported for each year and for each 5-year period. RESULTS Data were extracted for 44 articles. The median minimum and median maximum estimated consultation durations were 15.7 minutes (IQR 12.6-20.9) and 28.4 minutes (IQR 22.4-33.8), respectively. A median of 17 tasks were included in each article. There was no change in durations required over the 22 years examined. CONCLUSIONS The approximate times estimated by GPs to deliver care according to 10-minute consultations exceed the time available in routine appointments. '10 minute consultations' is a misleading title that sets inappropriate expectations for what GPs can realistically deliver in their routine consultations. While maintaining aspirations for high-quality care is appropriate, practice recommendations need to take greater account of the limited time doctors have to deliver routine care.
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Affiliation(s)
- Stephen Henry Bradley
- Academic Unit of Primary Care, University of Leeds, Leeds, UK
- York Street Practice, Leeds, UK
| | - Alice M Harper
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - Lesley Smith
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | | | | | | | - Carol Sinnott
- The Healthcare Improvement Studies (THIS) Institute, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Court St Medical Practice, Enniscorthy, Ireland
| | - Jessica Watson
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
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Ayan G, Türkmen E, Uğur E, Akbal E, Sarıtaş B, Erbay Ç, Hayta Ö. Determination of Nursing Care Times Based on the Perroca Patient Classification Instrument in the Inpatient Oncology Unit: A Mixed Method Study. Semin Oncol Nurs 2024:151608. [PMID: 38402019 DOI: 10.1016/j.soncn.2024.151608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 02/26/2024]
Abstract
OBJECTIVES The aim of this study was to determine the daily nursing care times of hospitalized inpatient oncology unit patients according to degree of acuity using the Perroca Patient Classification tool. DATA SOURCES This study used a mixed method sequential explanatory design. The "Nursing Activity Record Form" and "Perroca Patient Classification Instrument" were used for quantitative data collection, and direct observation was performed for 175 hours via time-motion study. Descriptive statistics, between-group comparison, and correlation analysis were used for data analysis. Using a semistructured questionnaire, qualitative data were collected from individual in-depth interviews with seven nurses who participated in the quantitative part of the study. Qualitative data were analyzed by thematic analysis. The reporting of this study followed GRAMMS checklist. CONCLUSIONS As a result of the integration of quantitative and qualitative data, daily nursing care duration was determined as 2 to 2.5 hours for Type 1 patients, 2.6 to 3.5 hours for Type 2 patients, 3.6 to 4.75 hours for Type 3 patients, and 4.76 to 5.5 hours for Type 4 patients. The findings showed that in an inpatient oncology unit, nursing care hours increased as patients' Perroca Patient Classification Instrument acuity grade increased; thus, the instrument was discriminative in determining patients' degree of acuity. IMPLICATIONS FOR NURSING PRACTICE Nurse managers can utilize this study's results to plan daily assignments that are sensitive to patient care needs. The results can also help nurse managers to identify relationships between nurse staffing and patient outcomes at the unit level, as well as to develop ways to analyze such relationships.
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Affiliation(s)
- Güzin Ayan
- Department of Medical Services and Techniques, Kutahya University of Health Sciences, Gediz Vocational of Health Services, Kutahya, Turkey.
| | - Emine Türkmen
- Department of Nursing, Istinye University, Faculty of Health Sciences, Istanbul, Turkey
| | - Esra Uğur
- Department of Nursing, Acibadem Mehmet Ali Aydinlar University Faculty of Health Sciences, Istanbul, Turkey
| | - Elif Akbal
- Anadolu Medical Center Hospital, Gebze, Izmit, Turkey
| | - Banu Sarıtaş
- Anadolu Medical Center Hospital, Gebze, Izmit, Turkey
| | - Çiğdem Erbay
- Anadolu Medical Center Hospital, Gebze, Izmit, Turkey
| | - Özge Hayta
- Anadolu Medical Center Hospital, Gebze, Izmit, Turkey
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13
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Rog D, Brownlee W, Carod-Artal FJ, Kalra S, Barker N, Lowndes C, Pendlebury J, Leclerc S, Amin A, Ashton L, Evans H, De Cock E. Quantifying the administration and monitoring time burden of several disease-modifying therapies for relapsing multiple sclerosis in the United Kingdom: A time and motion study. Mult Scler Relat Disord 2024; 82:105380. [PMID: 38183696 DOI: 10.1016/j.msard.2023.105380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/09/2023] [Accepted: 12/11/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND The treatment landscape for relapsing multiple sclerosis (MS) has changed dramatically in recent decades, including an increasing number of high-efficacy disease-modifying therapies (DMTs) with varied administration and monitoring requirements. Coupled with greater focus on earlier treatment, these factors have resulted in stretching of the capacity of MS specialist services and allied healthcare professionals (HCPs). To assist with the effective planning of MS services in the UK NHS, this study quantified the administration and monitoring time burden associated with high-efficacy DMTs (alemtuzumab, cladribine tablets, fingolimod, natalizumab, and ocrelizumab) for relapsing MS. METHODS A Time and Motion (T&M) study was conducted across four MS centres in the UK, over 3-4 months per centre (Aug 2019-Feb 2021). Time dedicated by HCPs (including but not limited to neurologists, MS specialist nurses, infusion nurses, and healthcare assistants) to pre-specified drug administration and monitoring activities, elicited during pre-study interviews at each centre, was assessed for each of the selected DMTs. Administration activities included: installing peripheral access; pre-medication administration (if needed); preparing drug for infusion; infusion initiation, monitoring, and disconnection; and patient monitoring post-infusion. Monitoring activities included: booking appointments for blood draws; blood draw; retrieval and review of blood results; maintaining blood records and follow-up with the patient; checking availability of MRI results and follow-up with the patient; booking appointments for neurologist or nurse consultations; and checking patient files prior to clinic visits. A T&M model was built using observational T&M study results, data obtained through pre-study interviews, as well as stipulated monitoring intervals from relevant Summaries of Product Characteristics for the selected DMTs, to estimate active HCP time with each DMT, extrapolated over a period of 4 years per-patient. RESULTS For oral DMTs, projected total active HCP time (monitoring only) per-patient over 4 years was 14.7 h for cladribine tablets and 19.2 h for fingolimod. For infused DMTs, total time (administration and monitoring) for alemtuzumab was 37.7 h (6.0 and 31.6 h, respectively), 48.1 h for natalizumab (17.4 and 30.8 h, respectively), and 23.5 h for ocrelizumab (6.1 and 17.4 h, respectively). CONCLUSIONS While active HCP time varied across centres, infused DMTs were projected to require the greatest amount of HCP time associated with administration and monitoring over 4 years versus oral DMTs. These findings may assist MS-specific HCPs in planning and delivering the equitable provision of DMT services for patients with relapsing MS.
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Affiliation(s)
- David Rog
- Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester, UK; Salford Care Organisation, Northern Care Alliance NHS Foundation Trust, Manchester, UK
| | - Wallace Brownlee
- Queen Square MS Centre, UCL Institute of Neurology and NIHR UCL Hospitals Biomedical Research Centre, London, UK
| | | | - Seema Kalra
- Royal Stoke MS Centre of Excellence, Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, Staffordshire, UK
| | - Noreen Barker
- Queen Square MS Centre, UCL Institute of Neurology and NIHR UCL Hospitals Biomedical Research Centre, London, UK
| | - Claire Lowndes
- Royal Stoke MS Centre of Excellence, Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, Staffordshire, UK
| | - Jessica Pendlebury
- Salford Care Organisation, Northern Care Alliance NHS Foundation Trust, Manchester, UK
| | | | - Amerah Amin
- Merck Serono Ltd, Feltham, UK, an affiliate of Merck KGaA
| | - Luke Ashton
- Merck Serono Ltd, Feltham, UK, an affiliate of Merck KGaA
| | - Hannah Evans
- Merck Serono Ltd, Feltham, UK, an affiliate of Merck KGaA
| | - Erwin De Cock
- Syneos Health, Avinguda Diagonal, 571, 3rd floor, Barcelona 08029, Spain.
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Sommer D, Kasbauer J, Jakob D, Schmidt S, Wahl F. Potential of Assistive Robots in Clinical Nursing: An Observational Study of Nurses' Transportation Tasks in Rural Clinics of Bavaria, Germany. NURSING REPORTS 2024; 14:267-286. [PMID: 38391066 PMCID: PMC10885045 DOI: 10.3390/nursrep14010021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/11/2024] [Accepted: 01/21/2024] [Indexed: 02/24/2024] Open
Abstract
Transportation tasks in nursing are common, often overlooked, and directly impact patient care time in the context of staff shortages and an aging society. Current studies lack a specific focus on transportation tasks, a gap our research aims to fill. By providing detailed data on transportation needs in nursing, our study establishes a crucial foundation for the development and integration of assistive robots in clinical settings. In July and September 2023, we conducted weekly observations of nurses to assess clinical transportation needs. We aim to understand the economic impact and the methods nurses use for transportation tasks. We conducted a participant observation using a standardized app-based form over a seven-day observation period in two rural clinics. N = 1830 transports were made by nurses and examined by descriptive analysis. Non-medical supplies account for 27.05% (n = 495) of all transports, followed by medical supplies at 17.32% (n = 317), pharmacotherapy at 14.10% (n = 258) and other other categories like meals or drinks contributing 12.68% (n = 232). Most transports had a factual transport time of under a minute, with patient transport and lab samples displaying more variability. In total, 77.15% of all transports were made by hand. Requirements to collect items or connect transports with patient care were included in 5% of all transports. Our economic evaluation highlighted meals as the most costly transport, with 9596.16 € per year in the observed clinics. Budget-friendly robots would amortize these costs over one year by transporting meals. We support understanding nurses' transportation needs via further research on assistive robots to validate our findings and determine the feasibility of transport robots.
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Affiliation(s)
- Domenic Sommer
- Technology Campus Grafenau, Deggendorf Institute of Technology, 94481 Grafenau, Germany
| | - Jakob Kasbauer
- Technology Campus Grafenau, Deggendorf Institute of Technology, 94481 Grafenau, Germany
| | - Dietmar Jakob
- Technology Campus Grafenau, Deggendorf Institute of Technology, 94481 Grafenau, Germany
| | - Sebastian Schmidt
- Technology Campus Grafenau, Deggendorf Institute of Technology, 94481 Grafenau, Germany
| | - Florian Wahl
- Technology Campus Grafenau, Deggendorf Institute of Technology, 94481 Grafenau, Germany
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Tembo TA, Mollan K, Simon K, Rutstein S, Chitani MJ, Saha PT, Mbeya-Munkhondya T, Jean-Baptiste M, Meek C, Mwapasa V, Go V, Bekker LG, Kim MH, Rosenberg NE. Does a blended learning implementation package enhance HIV index case testing in Malawi? A protocol for a cluster randomised controlled trial. BMJ Open 2024; 14:e077706. [PMID: 38253452 PMCID: PMC10806658 DOI: 10.1136/bmjopen-2023-077706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 01/07/2024] [Indexed: 01/24/2024] Open
Abstract
INTRODUCTION Index case testing (ICT) is an evidence-based approach that efficiently identifies persons in need of HIV treatment and prevention services. In Malawi, delivery of ICT has faced challenges due to limited technical capacity of healthcare workers (HCWs) and clinical coordination. Digitisation of training and quality improvement processes presents an opportunity to address these challenges. We developed an implementation package that combines digital and face-to-face modalities (blended learning) to strengthen HCWs ICT skills and enhance quality improvement mechanisms. This cluster randomised controlled trial will assess the impact of the blended learning implementation package compared with the standard of care (SOC) on implementation, effectiveness and cost-effectiveness outcomes. METHODS AND ANALYSIS The study was conducted in 33 clusters in Machinga and Balaka districts, in Southern Malawi from November 2021 to November 2023. Clusters are randomised in a 2:1 ratio to the SOC versus blended learning implementation package. The SOC is composed of: brief face-to-face HCW ICT training and routine face-to-face facility mentorship for HCWs. The blended learning implementation package consists of blended teaching, role-modelling, practising, and providing feedback, and blended quality improvement processes. The primary implementation outcome is HCW fidelity to ICT over 1 year of follow-up. Primary service uptake outcomes include (a) index clients who participate in ICT, (b) contacts elicited, (c) HIV self-test kits provided for secondary distribution, (d) contacts tested and (e) contacts identified as HIV-positive. Service uptake analyses will use a negative binomial mixed-effects model to account for repeated measures within each cluster. Cost-effectiveness will be assessed through incremental cost-effectiveness ratios examining the incremental cost of each person tested. ETHICS AND DISSEMINATION The Malawi National Health Science Research Committee, the University of North Carolina and the Baylor College of Medicine Institutional Review Boards approved the trial. Study findings will be disseminated through peer-reviewed journals and conference presentations. TRIAL REGISTRATION NUMBER NCT05343390.
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Affiliation(s)
- Tapiwa A Tembo
- Research, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Katie Mollan
- The University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Katherine Simon
- Research, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Sarah Rutstein
- The University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Mike Jones Chitani
- Research, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Pooja T Saha
- Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | | | - Milenka Jean-Baptiste
- The University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Caroline Meek
- The University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | | | - Vivian Go
- Department of Health Behavior, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Linda Gail Bekker
- Department of Medicine, University of Cape Town, Observatory, South Africa
| | - Maria H Kim
- Research, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Nora E Rosenberg
- Department of Health Behavior, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
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Lanoue D, Mir A, van Walraven C, Olynych T, Nott C, MacFadden DR. Resource utilization and cost assessment of a proactive penicillin allergy de-labeling program for low-risk inpatients. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2024; 20:7. [PMID: 38254221 PMCID: PMC10804656 DOI: 10.1186/s13223-023-00864-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 12/05/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND Resource utilization and costs can impede proactive assessment and de-labeling of penicillin allergy among inpatients. METHODS Our pilot intervention was a proactive penicillin allergy de-labeling program for new inpatients with penicillin allergy. Patients deemed appropriate for a challenge with a low-risk penicillin allergy history were administered 250 mg amoxicillin and monitored for 1 h. We performed an explorative economic evaluation using various healthcare professional wages. RESULTS Over two separate 2-week periods between April 2021 and March 2022, we screened 126 new inpatients with a penicillin allergy. After exclusions, 55 were appropriate for formal assessment. 19 completed the oral challenge, and 12 were directly de-labeled, resulting in a number needed to screen of 4 and a number needed to assess of 1.8 to effectively de-label one patient. The assessor's median time in the hospital per day de-labeling was 4h08 with a range of (0h05, 6h45). A single-site annual implementation would result in 715 penicillin allergy assessments with 403 patients de-labeled assuming 20,234 annual weekday admissions and an 8.9% penicillin allergy rate. Depending on the assessor used, the annual cost of administration would be between $21,476 ($53.29 per effectively de-labeled patient) for a pharmacy technician and $61,121 ($151.67 per effectively de-labeled patient) for a Nurse Practitioner or Physician Assistant. CONCLUSION A proactive approach, including a direct oral challenge for low-risk in-patients with penicillin allergy, appears safe and feasible. Similar programs could be implemented at other institutions across Canada to increase access to allergy assessment.
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Affiliation(s)
- Derek Lanoue
- Division of Clinical Immunology and Allergy, McGill University, 1650 Cedar Ave., H3G1A4, Montreal, QC, Canada
| | | | - Carl van Walraven
- The Ottawa Hospital, Ottawa, ON, Canada
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | - Caroline Nott
- The Ottawa Hospital, Ottawa, ON, Canada
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Derek R MacFadden
- The Ottawa Hospital, Ottawa, ON, Canada.
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada.
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Mamballikalam G, Davis D, Sabrish KG. Process reengineering using DMAIC framework for reduction of waiting time in daycare infusion therapy for better patient experience. Int J Qual Health Care 2024; 36:mzad111. [PMID: 38156362 DOI: 10.1093/intqhc/mzad111] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/29/2023] [Accepted: 12/25/2023] [Indexed: 12/30/2023] Open
Abstract
Daycare infusion therapy is an integral aspect of oncology, but increased waiting time raises concerns for patients. Patient-reported experience measures prompted the need to evaluate reasons for prolonged appointment delays. This study seeks to analyze and address patients' concerns, to streamline the process flow and reduce waiting time for daycare infusion therapy thereby enhancing patient experience. The define, measure, analyze, improve, and control methodology was implemented, and its impact on reducing waiting times was evaluated. The objective is to ensure that >85% of patients enter the daycare infusion unit within an hour of their appointment time in 6 months. The baseline data for patient waiting times was measured for a period of 2 months, and the average waiting time was determined. Potential causes contributing to prolonged waiting times were identified through time-motion analysis, with a fishbone diagram categorizing potential causes and a Pareto chart prioritizing them. Plan, do, study, and act cycles were conducted for implementing the changes, and a new process flow mapped. Baseline data showed 32% average adherence to the defined turnaround time of 1 hour, with an average waiting time of 108 minutes. Forty causes were identified for increased waiting time, of which eight were key. Adherence to waiting time turnaround time improved from 32% to 89% and the average waiting time decreased by 59 minutes from 108 minutes, increasing patient satisfaction index by 7.5%. The balancing measures include an increase in operational efficiency and throughput of the unit and the inventory levels of oncology medicine were decreased, leading to a 50% reduction in inventory value, while medication error declined by 0.62%, improving patient safety. The project gained tangible and intangible benefits impacting staff, patients, and relatives while improving operational efficiency. This study, with its scientific and systematic approach, enhanced patient satisfaction, patient safety, and better utilization of resources.
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Affiliation(s)
- Gopinath Mamballikalam
- Oncology Centre of Excellence, Aster Medcity, Kochi, Kerala 682027, India
- National Centre for Cancer Care and Research, Hamad Medical Corporation, Doha, PO 3050, Qatar
| | - Deena Davis
- Oncology Centre of Excellence, Aster Medcity, Kochi, Kerala 682027, India
- CIBC, Canada
| | - K G Sabrish
- Oncology Centre of Excellence, Aster Medcity, Kochi, Kerala 682027, India
- Bluedot Medical Assistance, India
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Qureshi SM, Greig MA, Bookey-Bassett S, Purdy N, Kelly H, vanDeursen A, Neumann WP. Computer simulation as a macroergonomic approach to assessing nurse workload and biomechanics related to COVID-19 patient care. APPLIED ERGONOMICS 2024; 114:104124. [PMID: 37657241 DOI: 10.1016/j.apergo.2023.104124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 08/19/2023] [Accepted: 08/22/2023] [Indexed: 09/03/2023]
Abstract
This study uses Digital Human Modelling (DHM) and Discrete Event Simulation (DES) to examine how caring for COVID-19-positive (C+) patients affects nurses' workload and care-quality. DHM inputs include: nurse anthropometrics, task postures, and hand forces. DES inputs include: unit-layout, patient care data, COVID-19 status & impact on tasks, and task execution-logic. The study shows that reducing nurses' biomechanical workload increases mental workload and decreases direct patient care, potentially leading to stress, burnout, and errors. Compared to pre-pandemic conditions, when nurses were assigned five C+ patients, cumulative bilateral shoulder moments and lumbar load decreased by 38%, 36%, and 46%, respectively. However, this was accompanied by increases in mental workload (242%), task waiting-time (70%), and missed-care (353%). These effects were driven by the large increase in required infection control routines. Combining DHM and DES can help evaluate workplace/task designs and provide valuable insights for healthcare system design-policy setting and operational management decision-making.
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Affiliation(s)
- Sadeem Munawar Qureshi
- Human Factors Engineering Lab, Department of Mechanical and Industrial Engineering, Toronto Metropolitan University (formerly Ryerson University), Toronto, Ontario, Canada.
| | - Michael A Greig
- Human Factors Engineering Lab, Department of Mechanical and Industrial Engineering, Toronto Metropolitan University (formerly Ryerson University), Toronto, Ontario, Canada
| | - Sue Bookey-Bassett
- Daphne Cockwell School of Nursing, Toronto Metropolitan University (formerly Ryerson University), Toronto, Canada
| | - Nancy Purdy
- Daphne Cockwell School of Nursing, Toronto Metropolitan University (formerly Ryerson University), Toronto, Canada
| | - Helen Kelly
- University Health Network, Toronto, Ontario, Canada
| | | | - W Patrick Neumann
- Human Factors Engineering Lab, Department of Mechanical and Industrial Engineering, Toronto Metropolitan University (formerly Ryerson University), Toronto, Ontario, Canada
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Cınar C, Esatoglu AE. Productivity Improvement in Pathology Laboratories Using Motion and Time Study Techniques. Turk Patoloji Derg 2024; 40:27-36. [PMID: 37747084 PMCID: PMC10823786 DOI: 10.5146/tjpath.2023.01610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 07/11/2023] [Indexed: 09/26/2023] Open
Abstract
OBJECTIVE This study aimed to determine the standard time required for the performed job and to examine the standard job critically for productivity improvement in the pathology laboratory. MATERIAL AND METHODS In this study that was conducted at a tertiary teaching hospital, observation, fishbone diagram, and flow charts were used to collect the information about the job process. All employees were observed from September 2017 to June 2018. The observations were recorded by video camera in order to overcome the Hawthorne effect. Nine basic procedure steps were followed for productivity improvement. RESULTS Within the scope of the study, the jobs of `trimming tissue blocks` and `sectioning of tissue blocks` was selected. The standard time required was 0.19 minutes for `trimming tissue blocks` and 0.34 minutes for `sectioning of tissue blocks`. The procedure steps, named `Removal of tissue block` and `Fixing the block to the device`, were removed from the flow chart to define the improved method. The implementation of the improved method brought in a gain of 11.28 work days per year. CONCLUSION It is obvious that the pathology laboratory needs to take certain measures to improve working conditions and increase efficiency. Our results demonstrate applying the study techniques could reduce the workload and processing time. This study also shows that the study techniques can be applied in the hospital laboratory. Incorporation of all pathology technicians in the change or innovation process will be important in maintaining the achievements.
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Affiliation(s)
- Canan Cınar
- Department of Healthcare Management, Ankara University, Faculty of Health Sciences, Ankara, Turkiye
| | - Afsun Ezel Esatoglu
- Department of Healthcare Management, Ankara University, Faculty of Health Sciences, Ankara, Turkiye
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20
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Väisänen V, Ruotsalainen S, Säynäjäkangas P, Mänttäri S, Laitinen J, Sinervo T. Effects of workday characteristics and job demands on recovery from work among Finnish home care nurses: a multi-source cross-sectional study. Int Arch Occup Environ Health 2024; 97:65-74. [PMID: 38032508 DOI: 10.1007/s00420-023-02026-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 11/07/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVE Ageing populations and poor care workforce availability are causing increasing job demands for home care nurses across Europe. While recovery from work helps sustain work ability and wellbeing, past research has relied mainly on self-reported measures of health, stressors, and recovery. This study aims to examine how objective and subjective job demands are associated with measured day-time recovery among home care nurses. METHODS Heart rate variability recording was conducted for 95 Finnish home care nurses. The study participants documented their work tasks throughout the workday and filled a wellbeing questionnaire. The amount of care time, breaktime, number of different weekly clients, and their care needs were obtained from the survey. The associations between job demands and measured day-time recovery were analysed using multivariate linear regression. RESULTS The amount of day-time recovery was on average 75 min. The number of different clients during the workday (e.g., care continuity) and higher care needs of the clients were associated with lower day-time recovery. Additionally, something slightly disrupting the course of the workday was associated with increased recovery. CONCLUSIONS Our findings indicate that reducing especially the objective job demands (workday characteristics) can contribute to better day-time recovery among home care nurses. To help sustain work ability and improve wellbeing, day-time recovery can be promoted with better work scheduling that supports care continuity and ensures sufficient care resources and support for nurses with many clients or clients with high care needs.
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Affiliation(s)
- Visa Väisänen
- Finnish Institute for Health and Welfare, Helsinki, Finland.
| | | | | | - Satu Mänttäri
- Finnish Institute of Occupational Health, Oulu, Finland
| | | | - Timo Sinervo
- Finnish Institute for Health and Welfare, Helsinki, Finland
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21
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Kang YJ, Mueller CA, Gaugler JE, Mathiason Moore MA, Monsen KA. Toward ensuring care quality and safety across settings: examining time pressure in a nursing home with observational time motion study metrics based on the Omaha system. J Am Med Inform Assoc 2023; 30:1837-1845. [PMID: 37352394 PMCID: PMC10586029 DOI: 10.1093/jamia/ocad113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/10/2023] [Accepted: 06/14/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND Meaningful data to determine safe and efficient nursing workload are needed. Reasoning a nurse can accomplish a finite number of interventions and location changes per hour, examination of time pressure using time motion study (TMS) methods will provide a comparable indication of safe and efficient workload for an individual nurse. METHODS An observer shadowed 11 nurses at a 250-bed nursing home in the Southeastern United States and recorded 160 h of observations using TimeCaT, web-based TMS data recording software. Predefined Omaha System nursing interventions (N = 57) and locations (N = 8) were embedded within TimeCaT. The time-stamped data were downloaded from TimeCaT and analyzed using descriptive and inferential statistics. Five time pressure metrics were derived from previous TMS findings in acute care settings. RESULTS Overall, nurses spent 66 s for each intervention, performed 65 interventions per hour, stayed 130 s at each location, changed locations 28 times per hour, and multitasked for 29% of working time. Computed hourly time pressure metrics enabled visualization of variability in time pressure metrics over time, with differences in multitasking by licensure, unit/role, and observation session time. CONCLUSIONS Nursing home nurses consistently experienced a high degree of time pressure, especially multitasking for one-third of their working time. To inform staffing decision making and improve the quality of care, resident outcomes, and nurse satisfaction, it is critical to identify ways to mitigate time pressure. Additional research is needed to refine and extend the use of the time pressure metrics.
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Affiliation(s)
- Yu Jin Kang
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | | | - Joseph E Gaugler
- School of Public Health, University of Minnesota, Twin Cities, Minnesota, USA
| | | | - Karen A Monsen
- School of Nursing, University of Minnesota, Twin Cities, Minnesota, USA
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22
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Rao KN, Arora RD, Singh A, Dange P, Nagarkar NM. Observational Learning in Surgical Skill Development. Indian J Surg Oncol 2023; 14:540-544. [PMID: 37900636 PMCID: PMC10611665 DOI: 10.1007/s13193-023-01798-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 07/04/2023] [Indexed: 10/31/2023] Open
Abstract
Observation plays a key role in the development of surgical skills, as it allows trainees to learn from experts and improve their performance through trial-and-error practice. This process, known as motor learning, involves the creation of new neural pathways that enable precise control of surgical instruments through hand movements. In recent years, there has been a shift towards minimally invasive surgery, which requires surgeons to continually learn new motor skills to control specialized instrumentation. Motor learning can be enhanced through repetition and the observation of expert performances. Observational learning is particularly useful when it is used in combination with physical practice, as it can provide hints and clues about important aspects of the task that may not be immediately apparent through verbal instruction alone. The role of mirror neurons, which are activated both when an action is performed and when it is observed, is also important in the process of observational learning. By understanding the mechanisms behind observational learning and the factors that influence its effectiveness, trainers can optimize the use of this method in surgical training.
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Affiliation(s)
- Karthik Nagaraja Rao
- Head Neck Surgery and Oncology, Department of Head and Neck Oncology, All India Institute of Medical Sciences, Raipur, India
| | - Ripu Daman Arora
- Department of Otolaryngology and Head Neck Surgery, All India Institute of Medical Sciences, Raipur, India
| | - Ambesh Singh
- Head Neck Surgery and Oncology, Department of Head and Neck Oncology, All India Institute of Medical Sciences, Raipur, India
| | - Prajwal Dange
- Head Neck Surgery and Oncology, Department of Head and Neck Oncology, All India Institute of Medical Sciences, Raipur, India
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Aron MB, Ndambo MK, Munyaneza F, Mulwafu M, Makungwa H, Nhlema B, Connolly E. A time-motion study of community health workers delivering community-based primary health care in Neno District, Malawi. HUMAN RESOURCES FOR HEALTH 2023; 21:51. [PMID: 37365561 DOI: 10.1186/s12960-023-00839-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/22/2023] [Indexed: 06/28/2023]
Abstract
INTRODUCTION Community health workers (CHWs) are vital resources in delivering community-based primary health care, especially in low-and-middle-income countries (LMIC). However, few studies have investigated detailed time and task assessments of CHW's work. We conducted a time-motion study to evaluate CHWs' time on health conditions and specific tasks in Neno District, Malawi. METHODS We conducted a descriptive quantitative study utilizing a time observation tracker to capture time spent by CHWs on focused health conditions and tasks performed during household visits. We observed 64 CHWs between 29 June and 20 August 2020. We computed counts and median to describe CHW distribution, visit type, and time spent per health condition and task. We utilized Mood's median test to compare the median time spent at a household during monthly visits with the program design standard time. We used pairwise median test to test differences in median time duration for health conditions and assigned tasks. RESULTS We observed 660 CHW visits from 64 CHWs, with 95.2% (n = 628) of the visits as monthly household visits. The median time for a monthly household visit was 34 min, statistically less than the program design time of 60 min (p < 0.001). While the CHW program focused on eight disease areas, pretesting with the observation tool showed that CHWs were engaged in additional health areas like COVID-19. Of the 3043 health area touches by CHWs observed, COVID-19, tuberculosis, and non-communicable diseases (NCDs) had the highest touches (19.3%, 17.6%, and 16.6%, respectively). The median time spent on sexually transmitted infections (STIs) and NCDs was statistically higher than in other health areas (p < 0.05). Of 3813 tasks completed by CHWs, 1640 (43%) were on health education and promotion. A significant difference was observed in the median time spent on health education, promotion, and screening compared to other tasks (p < 0.05). CONCLUSION This study demonstrates that CHWs spend the most time on health education, promotion, and screening per programmatic objectives but, overall, less time than program design. CHWs deliver care for a broader range of health conditions than the programmatic design indicates. Future studies should examine associations between time spent and quality of care delivery.
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Affiliation(s)
- Moses Banda Aron
- Partners In Health/Abwenzi Pa Za Umoyo, PO Box 56, Neno, Malawi.
| | | | | | - Manuel Mulwafu
- Partners In Health/Abwenzi Pa Za Umoyo, PO Box 56, Neno, Malawi
| | - Henry Makungwa
- Partners In Health/Abwenzi Pa Za Umoyo, PO Box 56, Neno, Malawi
| | | | - Emilia Connolly
- Partners In Health/Abwenzi Pa Za Umoyo, PO Box 56, Neno, Malawi
- Division of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Ave, Cincinnati, OH, 45267, United States of America
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45529, United States of America
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24
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Krishna A, Murali S, Moran AE, Saxena A, Gill SS, Hering D, Kaur P. Understanding the Role of Staff Nurses in Hypertension Management in Primary Care Facilities in India: A Time-Motion Study. Prev Chronic Dis 2023; 20:E39. [PMID: 37200503 DOI: 10.5888/pcd20.220232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
INTRODUCTION India is facing a shortage of staff nurses; thus, a better understanding of nurses' workloads is essential for improving and implementing noncommunicable disease (NCD) control strategies. We estimated the proportion of time spent by staff nurses on hypertension and other NCD activities in primary care facilities in 2 states in India. METHODS We conducted a cross-sectional study in 6 purposively selected primary care facilities in Punjab and Madhya Pradesh during July through September 2021. We used a standardized stopwatch to collect data for time spent on direct hypertension activities (measuring blood pressure, counseling, recording blood pressure measurement, and other NCD-related activities), indirect hypertension activities (data management, patient follow-up calls), and non-NCD activities. We used the Mann-Whitney U test to compare the median time spent on activities between facilities using paper-based records and the Simple mobile device-based app (open-source software). RESULTS Six staff nurses were observed for 213 person-hours. Nurses spent 111 person-hours (52%; 95% CI, 45%-59%) on direct hypertension activities and 30 person-hours (14%; 95% CI, 10%-19%) on indirect hypertension activities. The time spent on blood pressure measurement (34 minutes) and documentation (35 minutes) was the maximum time on any given day. Facilities that used paper records spent more median time (39 [IQR, 26-62] minutes) for indirect hypertension activities than those using the Simple app (15 [IQR, 11-19] minutes; P < .001). CONCLUSION Our study found that hypertension activities required more than half of nurses' time in India's primary care facilities. Digital systems can help to reduce the time spent on indirect hypertension activities.
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Affiliation(s)
- Ashish Krishna
- Indian Council of Medical Research - National Institute of Epidemiology, Chennai, Tamil Nadu Housing Board, Ayapakkam, Chennai - 600077
- Resolve to Save Lives, New Delhi, India
| | - Sharan Murali
- Indian Council of Medical Research - National Institute of Epidemiology, Chennai, India
| | - Andrew E Moran
- Resolve to Save Lives, New York, New York
- Columbia University Irving Medical Center, New York, New York
| | - Ashish Saxena
- Directorate of Health Services, Government of Madhya Pradesh, Bhopal, India
| | - Sandeep Singh Gill
- Department of Health and Family Welfare Punjab, Chandigarh, Punjab, India
| | - Dagmara Hering
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
| | - Prabhdeep Kaur
- Indian Council of Medical Research - National Institute of Epidemiology, Chennai, India
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25
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Feely K, Edbrooke L, Bower W, Mazzone S, Merolli M, Staples J, Martin A. Allied health professionals' experiences and lessons learned in response to a big bang electronic medical record implementation: A prospective observational study. Int J Med Inform 2023; 176:105094. [PMID: 37220703 DOI: 10.1016/j.ijmedinf.2023.105094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 05/02/2023] [Accepted: 05/09/2023] [Indexed: 05/25/2023]
Abstract
INTRODUCTION There is limited evidence describing the impact of electronic medical record (EMR) implementation on allied health professionals' acceptance, expectations, and work efficiencies. This study aims to: A) identify clinician expectations and factors that influence EMR acceptance; B) evaluate perceived usability, technology proficiency and satisfaction; and C) assess the impact of EMR big bang implementation on allied health workflows at three Australian tertiary hospitals. METHODS Repeated measures study pre and six-months post EMR implementation. User acceptance was evaluated with online surveys: Unified Theory of Acceptance and Use of Technology (pre), System Usability Scale and open-ended questions (post). A four-hour time-motion study evaluated changes in allied health inpatient workflows. RESULTS Surveys were completed by 224 allied health clinicians (47% response rate) pre, and 196 (41%) post-implementation. Pre-implementation, 96% of respondents felt using the EMR was a good idea and they would find it useful. Six-months post-implementation 88% liked interacting with the EMR. 64% found it easy to use and most didn't require technical support (78%). While 68% of participants felt very confident, 51% believed they were not using the EMR's full potential. Post-implementation half of participants agreed significant upskilling was required and that EMR workflows were not quick to learn. Live demonstrations were considered the most helpful activity prior to training; hands-on practice in the training environment and superuser support were invaluable preparing for and during go-live. Time-motion data (mean difference (MD) (95% CI)) indicated that following implementation participants spent 2.27% (-3.53, 8.09, p = 0.731) more time in clinical tasks. More time was spent performing clinical documentation (5.39% (1.98, 8.8), p = 0.002). CONCLUSIONS Many factors can impact allied health professional's adoption of a new EMR. Institution-wide, simultaneous big bang EMR implementation, with strong allied health leadership, can lead to positive benefits, particularly in user experience. Ongoing evaluation will drive future improvements.
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Affiliation(s)
- Kath Feely
- EMR Team, The Royal Melbourne Hospital, Level 2, 10 Wreckyn St, Parkville, Victoria 3050, Australia; Allied Health Department, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, Victoria 3000, Australia; Department of Allied Health, The Royal Melbourne Hospital, 300 Grattan Street, Parkville, Victoria 3050, Australia; Allied Health Department, The Royal Women's Hospital 20 Flemington Rd, Parkville, Victoria 3052, Australia.
| | - Lara Edbrooke
- Department of Health Services Research, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, Victoria 3000, Australia; Physiotherapy Department, The University of Melbourne, 161 Barry St, Carlton, Victoria 3053, Australia
| | - Wendy Bower
- Department of Allied Health, The Royal Melbourne Hospital, 300 Grattan Street, Parkville, Victoria 3050, Australia
| | - Sandra Mazzone
- Allied Health Department, The Royal Women's Hospital 20 Flemington Rd, Parkville, Victoria 3052, Australia
| | - Mark Merolli
- Centre for Health, Exercise, and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, L7/161 Barry St, Carlton, Victoria 3010, Australia; Centre for Digital Transformation of Health, The University of Melbourne, 700 Swanston St, Carlton, Victoria 3053, Australia
| | - Julia Staples
- Parkville EMR, Royal Children's Hospital 50 Flemington Rd, Parkville, Victoria 3052, Australia
| | - Alicia Martin
- Allied Health Department, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, Victoria 3000, Australia; Physiotherapy Department, The University of Melbourne, 161 Barry St, Carlton, Victoria 3053, Australia
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Glantz A, Sunnqvist C, Örmon K. The time, places, and activities of nurses in a psychiatric inpatient context - A time and motion study with a time-geographic perspective. Issues Ment Health Nurs 2023; 44:387-395. [PMID: 37126738 DOI: 10.1080/01612840.2023.2194990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Nurses in psychiatric inpatient care spend less time than desired with patients and investigation of the nature of nursing in this setting is needed. This study explores how nursing activities in psychiatric inpatient wards is distributed over time, and with a time-geographic perspective show how this relates to places. Observations were used to register place, activity, and time. A constructed time-geographic chart mapped the nurses' path which showed that nurses spent little time in places where patients are. There might be constraints that affect nursing. Nurses need to evaluate where time is spent and interventions that facilitate relationships are needed.
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Affiliation(s)
- Andreas Glantz
- Department of Nursing, Faculty of Medicine, Umeå University, Umeå, Sweden
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Charlotta Sunnqvist
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
- Committee on Psychiatry, Habilitation and Technical Aids, Lund, Sweden
| | - Karin Örmon
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
- Västra Götaland Region Competence Centre on Intimate Partner Violence, Gothenburg, Sweden
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Acero MX, Minvielle E, Waelli M. Are Nurse Coordinators Really Performing Coordination Pathway Activities? A Comparative Analysis of Case Studies in Oncology. Healthcare (Basel) 2023; 11:healthcare11081090. [PMID: 37107925 PMCID: PMC10137695 DOI: 10.3390/healthcare11081090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/29/2023] [Accepted: 04/07/2023] [Indexed: 04/29/2023] Open
Abstract
Patient Pathway Coordination (PPC) improves patient care quality and safety, particularly in oncology. PPC roles, such as nurse coordinators (NCs), have positively impacted the quality of patient care and reduced financial costs. However, NCs and their real activities in Health Care Organizations (HCOs) are unclear. Our aim was to identify, quantify, and compare all activities performed by NCs in oncology care settings from an organizational approach. Methods: We used qualitative and quantitative approaches based on case study principles. We accumulated 325 observation hours by shadowing and timing the activities of 14 NCs in four French HCO in oncology. Data analysis was conducted using an analytical framework to investigate the Activity of PAtient PAthway Nurse Coordinators in Oncology (APANCO). Results: Our research generated important findings: (1) NC roles and job titles are not standardized. (2) Non-coordination related activities are important in NC work content. Non-coordination times were consistent with distribution times between ward NCs and NCs in centralized structures. Ward NCs had higher non-coordination activities when compared with NCs in centralized structures. (3) PPC times varied for both ward NCs and NCs in centralized structures. Ward NCs performed less design coordination when compared with NCs in centralized structures, and this latter group also performed more external coordination than ward NCs. Conclusions: NCs do not just perform PPC activities. Their position in HCO structures, wards, or centralized structures, influence their work content. Centralized structures allow NCs to focus on their PPC roles. We also highlight different dimensions of NC work and training requirements. Our study could help managers and decision-makers develop PPC roles in oncology.
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Affiliation(s)
- Maria-Ximena Acero
- ARENES-UMR 6051, EHESP, French School of Public Health, University of Rennes, 15 Avenue du Professeur Léon Bernard, 35043 Rennes, France
| | - Etienne Minvielle
- i3-CRG Ecole Polytechnique, CNRS, Institut Polytechnique de Paris, Route de Saclay, 91120 Palaiseau, France
- Gustave Roussy, 114 Rue Edouard Vaillant, 94800 Villejuif, France
| | - Mathias Waelli
- ARENES-UMR 6051, EHESP, French School of Public Health, University of Rennes, 15 Avenue du Professeur Léon Bernard, 35043 Rennes, France
- Global Health Institute, University of Geneva, 24 rue du Général-Dufour, 1211 Geneva, Switzerland
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Acero MX, Minvielle E, Waelli M. Understanding the activity of oncology nurse coordinators: An elaboration of a framework based on an abductive approach. Health Policy 2023; 130:104737. [PMID: 36791597 DOI: 10.1016/j.healthpol.2023.104737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023]
Abstract
Care coordination is a major health system issue, in particular for cancer patients where a lack of coordination may impact quality of care, lived experiences, and care costs. Consequently, new roles facilitating Patient Pathway Coordination (PPC) have been created (nurse coordinators, NC). However, despite their importance, core PPC activities remain unclear. Practices are often heterogeneous and may be far removed from coordination roles, thus posing issues for implementation of PPC policies. To address this, we generated an analytical framework to investigate the Activity of PAtient PAthway Nurse Coordinators in Oncology (APANCO) from an organizational perspective. We adopted an abductive approach, characterized by two phases: the first involved a preliminary theoretical framework confronted with empirical data from two ethnographic fieldwork scenarios. In the second, we confronted the updated framework with data from a care coordination literature review. The final APANCO framework comprised three main categories at micro-level and three at meso-level. The first categories were used to analyze real NC activity at the micro-level and accounted for activities related (or not) to PPC. Meso-level categories considered organizational contexts that might have influenced NC work content. APANCO provided invaluable information on NCs activities. The framework may be used for clinical and managerial skills training and for standardizing job descriptions. These elements are key for decision-makers and managers who implement PPC programs.
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Affiliation(s)
- Maria-Ximena Acero
- ARENES - UMR 6051, CNRS, EHESP (French School of Public Health), Univ Rennes, 15 Avenue du Professeur Lé on Bernard, Rennes 35043, France.
| | - Etienne Minvielle
- i3-CRG Ecole Polytechnique, Route de Saclay, Palaiseau 91120, France; Gustave Roussy, 114 Rue Edouard Vaillant, Villejuif 94800, France
| | - Mathias Waelli
- ARENES - UMR 6051, CNRS, EHESP (French School of Public Health), Univ Rennes, 15 Avenue du Professeur Lé on Bernard, Rennes 35043, France; Global Health Institute, University of Geneva, 24 rue du Général-Dufour 1211 Genève 4, Switzerland
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Coe M, Kawakyu N, Gimbel S, Nyakuya B, Gabriel N, Leonard D, Chale S, Masiye F, Banda CM, Manangwa S, Moyo G, Boyle G, Freistadt F, Kohler P. Nursing Workforce Optimization Study: A Multi-method Evaluation and Process Improvement Intervention for HIV Service Delivery in Tanzania and Zambia. J Assoc Nurses AIDS Care 2023; 34:146-157. [PMID: 36752744 PMCID: PMC10237310 DOI: 10.1097/jnc.0000000000000388] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
ABSTRACT Nurses are often suboptimally used in HIV care, due to misalignment of training and practice, workflow inefficiencies, and management challenges. We sought to understand nursing workforce capacity and support implementation of process improvement strategies to improve efficiency of HIV service delivery in Tanzania and Zambia. We conducted time and motion observations and task analyses at 16 facilities followed by process improvement workshops. On average, each nurse cared for 45 clients per day in Tanzania and 29 in Zambia. Administrative tasks and documentation occupied large proportions of nurse time. Self-reported competency was low at baseline and higher at follow-up for identifying and managing treatment failure and prescribing antiretroviral therapy. After workshops, facilities changed care processes, provided additional training and mentorship, and changed staffing and supervision. Efficiency outcomes were stable despite staffing increases. Collaborative approaches to use workforce data to engage providers in improvement strategies can support roll-out of nurse-managed HIV treatment.
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Affiliation(s)
- Megan Coe
- Department of Child, Family, and Population Health, School of Nursing, University of Washington, Seattle, Washington, USA
| | - Nami Kawakyu
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Sarah Gimbel
- Department of Global Health, and the Department of Child, Family, and Population Health, School of Nursing, University of Washington, Seattle, Washington, USA
| | - Baraka Nyakuya
- International Training and Education Center for Health (I-TECH), Dar es Salaam, Tanzania
| | - Neema Gabriel
- International Training and Education Center for Health (I-TECH), Dar es Salaam, Tanzania
| | - Devotha Leonard
- Training Program Training Coordinator, International Training and Education Center for Health (I-TECH), Dar es Salaam, Tanzania
| | - Stella Chale
- International Training and Education Center for Health (I-TECH), Dar es Salaam, Tanzania
| | - Felix Masiye
- Dean of the School of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia and an Affiliate Assistant Professor at the Institute for Health Metrics and Evaluation (IHME), University of Washington, Seattle, Washington, USA
| | - Charles Masili Banda
- Department of Economics, School of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia
| | - Saturini Manangwa
- Nursing and Midwifery Quality Improvement, Ministry of Health Community Development, Gender, Elderly and Children (MOHCDGEC) Dodoma, Tanzania
| | - Gustav Moyo
- Ministry of Health, Community Development, Gender, Elderly and Children (MOHCDGEC) Dodoma, Tanzania
| | - Gabriela Boyle
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Fernanda Freistadt
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Pamela Kohler
- Department of Global Health, and the Department of Child, Family, and Population Health, School of Nursing, University of Washington, Seattle, Washington, USA
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Pinson J, King OA, Dennett AM, Davis A, Williams CM, Snowdon DA. Exploring the role of medical imaging assistants in Australian medical imaging departments: A mixed-methods study. J Med Radiat Sci 2023; 70:46-55. [PMID: 36261173 PMCID: PMC9977652 DOI: 10.1002/jmrs.623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 09/09/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Allied health assistants are support staff who assist medical imaging professionals in their clinical and non-clinical role. Assistants can improve efficiency of medical imaging services; however, little is known about the specific tasks they perform. METHOD A two-phase explanatory, sequential mixed-methods study design comprising a time motion survey and qualitative interviews was conducted across three health services in Victoria, Australia. Participants were medical imaging assistants supporting medical imaging professionals. Participants recorded tasks completed on a time motion proforma across two working days. Time spent on tasks was categorised into patient related and non-patient related tasks. Semi-structured interviews were conducted to explore assistants' perspectives about tasks, their roles and any responsibilities. Time motion data was descriptively analysed. Qualitative data were audiotaped, transcribed verbatim and analysed using the framework analysis method. Quantitative and qualitative findings were integrated using data triangulation. RESULTS Four medical imaging assistants participated, providing 4170 min of time motion data and 138 min of interview data. Integration of time motion and interview data revealed the medical imaging assistant role is predominantly non-patient facing; autonomous and critical to workflow; diverse and requires flexibility; has the potential to expand into a more patient-facing role. CONCLUSIONS Medical imaging assistants make significant contributions to workflow management. Their role is predominantly non-patient facing but there appear opportunities for the clinical role to expand. Realizing these opportunities will require careful consideration of the challenges and benefits of extending their scope of practice.
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Affiliation(s)
- Jo‐Anne Pinson
- Department of Medical ImagingPeninsula HealthFrankstonVictoriaAustralia,Department of Medical ImagingMonash HealthClaytonVictoriaAustralia,Department of Medical Imaging and Radiation SciencesMonash UniversityClaytonVictoriaAustralia
| | - Olivia A. King
- Allied HealthBarwon HealthGeelongVictoriaAustralia,Allied HealthSouthwest HealthcareWarrnamboolVictoriaAustralia,Monash Centre for Scholarship in Health EducationFaculty of Nursing and Health SciencesClaytonVictoriaAustralia
| | - Amy M. Dennett
- Allied Health Clinical Research OfficeEastern HealthBox HillVictoriaAustralia,School of Allied HealthHuman Services and SportLa Trobe UniversityBundooraVictoriaAustralia
| | - Annette Davis
- Allied Health Workforce Innovation Strategy Education and Research unit (WISER)Monash HealthClaytonVictoriaAustralia
| | - Cylie M. Williams
- School of Primary and Allied Health CareMonash UniversityFrankstonVictoriaAustralia,Academic UnitPeninsula HealthFrankstonVictoriaAustralia
| | - David A. Snowdon
- Academic UnitPeninsula HealthFrankstonVictoriaAustralia,Peninsula Clinical SchoolCentral Clinical SchoolMonash UniversityFrankstonVictoriaAustralia,National Centre for Healthy AgeingFrankstonVictoriaAustralia
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Wong JZW, Park PSW, Frost T, Stephens K, Newk-Fon Hey Tow FK, Garcia PG, Senanayake C, Choi PMC. Using body cameras to quantify the duration of a Code Stroke and identify workflow issues: a continuous observation workflow time study. BMJ Open 2023; 13:e067816. [PMID: 36697041 PMCID: PMC9884893 DOI: 10.1136/bmjopen-2022-067816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE 'Code Stroke' (Code) is used in health services to streamline hyperacute assessment and treatment delivery for patients with ischaemic stroke. However, there are few studies that detail the time spent on individual components performed during a Code. We sought to quantify the time taken for each process during a Code and investigate associations with modifiable and non-modifiable factors. DESIGN Continuous observation workflow time study. SETTING AND PARTICIPANTS Recordings of 100 Codes were performed at a high-volume primary stroke centre in Melbourne, Australia, between January and June 2020 using a body camera worn by a member of the stroke team. MAIN OUTCOME MEASURES The main measures included the overall duration of Codes and the individual processes within the Code workflow. Associations between variables of interest and process times were explored using linear regression models. RESULTS 100 Codes were captured, representing 19.2% of all Codes over the 6 months. The median duration of a complete Code was 54.2 min (IQR 39.1-74.7). Administrative work performed after treatment is completed (median 21.0 min (IQR 9.8-31.4)); multimodal CT imaging (median 13.0 min (IQR 11.5-15.7)), and time between decision and thrombolysis administration (median 8.1 min (IQR 6.1-10.8)) were the longest components of a Code. Tenecteplase was able to be prepared faster than alteplase (median 1.8 vs 4.9 min, p=0.02). The presence of a second junior doctor was associated with shorter administrative work time (median 10.3 vs 25.1 min, p<0.01). No specific modifiable factors were found to be associated with shorter overall Code duration. CONCLUSIONS Codes are time intensive. Time spent on decision-making was a relatively small component of the overall Code duration. Data from body cameras can provide granular data on all aspects of Code workflow to inform potential areas for improvement at individual centres.
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Affiliation(s)
- Joseph Zhi Wen Wong
- Department of Neurosciences, Eastern Health, Box Hill Hospital, Box Hill, Victoria, Australia
- Departments of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Peter Si Woo Park
- Department of Neurosciences, Eastern Health, Box Hill Hospital, Box Hill, Victoria, Australia
| | - Tanya Frost
- Department of Neurosciences, Eastern Health, Box Hill Hospital, Box Hill, Victoria, Australia
| | - Karen Stephens
- Department of Neurosciences, Eastern Health, Box Hill Hospital, Box Hill, Victoria, Australia
| | | | - Pamela Gayle Garcia
- Department of Neurosciences, Eastern Health, Box Hill Hospital, Box Hill, Victoria, Australia
| | - Channa Senanayake
- Department of Neurosciences, Eastern Health, Box Hill Hospital, Box Hill, Victoria, Australia
| | - Philip M C Choi
- Department of Neurosciences, Eastern Health, Box Hill Hospital, Box Hill, Victoria, Australia
- Eastern Health Clinical School, Monash University Faculty of Medicine, Nursing and Health Sciences, Clayton, Victoria, Australia
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Kaur N, Lewis C, Staffieri S, Ruddle J, Goranitis I, Stiles J, Dabscheck G. Cost Analysis of Orthoptist-Led Neurofibromatosis Type 1 Screening Clinics. Br Ir Orthopt J 2023; 19:26-34. [PMID: 37063611 PMCID: PMC10103737 DOI: 10.22599/bioj.288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 01/24/2023] [Indexed: 04/18/2023] Open
Abstract
Purpose To conduct a costing study comparing orthoptist-led with consultant-led clinics screening for optic pathway gliomas (OPGs) in children with neurofibromatosis Type 1 (NF1) attending the Royal Children's Hospital (RCH), Melbourne. Methods Patients with NF1 examined in the orthoptist-led NF1 screening clinic and/or consultant-led clinics during the study period were identified. The workflow management software Q-Flow 6® provided data documenting patient's time spent with the orthoptist, nurse, and ophthalmologist. Time points were converted into minutes and multiplied by the cost-per-minute for each profession. A bottom-up micro-costing approach was used to estimate appointment level costs. Bootstrap simulations with 1000 replications were used to estimate 95% confidence intervals (CIs) for the difference in mean appointment time and cost between clinics. Results Data for 130 consultant-led clinic appointments and 234 orthoptist-led clinic appointments were extracted for analysis. The mean time per appointment for the consultant-led clinic was 45.11 minutes, and the mean time per appointment for the orthoptist-led clinic was 25.85 minutes. The mean cost per appointment for the consultant-led clinic was A $84.15 (GBP £39.60) compared to the orthoptist-led clinic at A $20.40 (GBP £9.60). This represents a mean reduction of 19.25 minutes per appointment (95% CI, -24.85 to -13.66) and a mean reduction of A $63.75 (GBP £30.00) per appointment (95% CI, (A $-75.40 to $-52.10 [GBP £ -35.48 to £ -24.52]). Conclusion An orthoptist-led clinic screening for OPGs in patients with NF1 can be a more cost-efficient model of care for ophthalmic screening in this patient group.
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Affiliation(s)
- Navdeep Kaur
- Department of Ophthalmology, The Royal Children’s Hospital, Victoria, AU
| | - Catherine Lewis
- Department of Ophthalmology, The Royal Children’s Hospital, Victoria, AU
| | - Sandra Staffieri
- Department of Ophthalmology, The Royal Children’s Hospital, Victoria, AU
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, AU
- Murdoch Children’s Research Institute, Melbourne, AU
| | - Jonathan Ruddle
- Department of Ophthalmology, The Royal Children’s Hospital, Victoria, AU
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, AU
| | - Ilias Goranitis
- Murdoch Children’s Research Institute, Melbourne, AU
- Health Economics Unit, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, AU
| | - Jay Stiles
- Murdoch Children’s Research Institute, Melbourne, AU
- Health Economics Unit, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, AU
| | - Gabriel Dabscheck
- Department of Ophthalmology, The Royal Children’s Hospital, Victoria, AU
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Fix GM, Kim B, Ruben M, McCullough MB. Direct Observation Methods: a Practical Guide for Health Researchers. PEC INNOVATION 2022; 1:10.1016/j.pecinn.2022.100036. [PMID: 36406296 PMCID: PMC9670254 DOI: 10.1016/j.pecinn.2022.100036] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
OBJECTIVE To provide health research teams with a practical, methodologically rigorous guide on how to conduct direct observation. METHODS Synthesis of authors' observation-based teaching and research experiences in social sciences and health services research. RESULTS This article serves as a guide for making key decisions in studies involving direct observation. Study development begins with determining if observation methods are warranted or feasible. Deciding what and how to observe entails reviewing literature and defining what abstract, theoretically informed concepts look like in practice. Data collection tools help systematically record phenomena of interest. Interdisciplinary teams--that include relevant community members-- increase relevance, rigor and reliability, distribute work, and facilitate scheduling. Piloting systematizes data collection across the team and proactively addresses issues. CONCLUSION Observation can elucidate phenomena germane to healthcare research questions by adding unique insights. Careful selection and sampling are critical to rigor. Phenomena like taboo behaviors or rare events are difficult to capture. A thoughtful protocol can preempt Institutional Review Board concerns. INNOVATION This novel guide provides a practical adaptation of traditional approaches to observation to meet contemporary healthcare research teams' needs.
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Affiliation(s)
- Gemmae M. Fix
- VA Center for Healthcare Organization and Implementation Research, Boston and Bedford, MA, USA
- Boston University School of Medicine, Boston, MA, USA
| | - Bo Kim
- VA Center for Healthcare Organization and Implementation Research, Boston and Bedford, MA, USA
- Department of Psychiatry, Harvard Medical School, Cambridge, MA, USA
| | - Mollie Ruben
- Department of Psychology, University of Maine, Orono, ME, USA
| | - Megan B. McCullough
- VA Center for Healthcare Organization and Implementation Research, Boston and Bedford, MA, USA
- Department of Public Health, University of Massachusetts Lowell, Lowell, MA, USA
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Muho A, Peshkatari A, Wyss K. Work time allocation at primary health care level in two regions of Albania. PLoS One 2022; 17:e0276184. [PMID: 36288384 PMCID: PMC9605026 DOI: 10.1371/journal.pone.0276184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 10/01/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction Although well-performing workforce is essential to equitable and efficient health service delivery, few countries have systematically addressed performance improvements. How health workers use their work time and what tasks they accomplish is here an important starting point. Therefore, a time motion study was conducted to assess the work time allocation patterns of primary health care doctors and nurses in two regions of Albania. Methods We used observation tool to record the time allocation along eight predefined main categories of activities. Conditional to presence at work, 48 health workers were continuously observed in early 2020 before start of the Covid-19 pandemic over five consecutive working days. Results The observed health workers spent 40.7% of their overall working time unproductively (36.8% on waiting for patients and 3.9% on breaks), 25.3% on service provision to users, 18.7% on administrative activities, 12.7% on outreach activities, 1.6% on continuous medical education and 1% on meetings. The study found variations in work time allocation patterns across cadres, with nurses spending more time unproductively, on administrative activities and on outreach and less on all other activities than doctors. Further, the work time allocation patterns were similar between urban and rural settings, except for nurses in rural settings spending less time than those in urban settings on administrative work. Conclusion This study found that primary health care workers in Albania devote a substantial amount of work time to unproductive, service provision to users and administrative activities. Consequently, there is possibility for productivity, respectively efficiency gains in how health workers use their time.
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Affiliation(s)
- Altiona Muho
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
- * E-mail:
| | | | - Kaspar Wyss
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
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Snowdon DA, King OA, Dennett A, Pinson JA, Shannon MM, Collyer TA, Davis A, Williams CM. Delegation of patient related tasks to allied health assistants: a time motion study. BMC Health Serv Res 2022; 22:1280. [PMID: 36280846 PMCID: PMC9590386 DOI: 10.1186/s12913-022-08642-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 10/06/2022] [Indexed: 12/04/2022] Open
Abstract
Background Allied health assistants (AHAs) are support staff who complete patient and non-patient related tasks under the delegation of an allied health professional. Delegating patient related tasks to AHAs can benefit patients and allied health professionals. However, it is unclear whether the AHA workforce is utilised optimally in the provision of patient care. The purpose of this study was to determine the proportion of time AHAs spend on patient related tasks during their working day and any differences across level of AHA experience, clinical setting, and profession delegating the task. Methods A time motion study was conducted using a self-report, task predominance work sampling method. AHAs were recruited from four publicly-funded health organisations in Victoria, Australia. AHAs worked with dietitians, occupational therapists, physiotherapists, podiatrists, social workers, speech pathologists, psychologists, and exercise physiologists. The primary outcome was quantity of time spent by AHAs on individual task-categories. Tasks were grouped into two main categories: patient or non-patient related activities. Data were collected from July 2020 to May 2021 using an activity capture proforma specifically designed for this study. Logistic mixed-models were used to investigate the extent to which level of experience, setting, and delegating profession were associated with time spent on patient related tasks. Results Data from 51 AHAs showed that AHAs spent more time on patient related tasks (293 min/day, 64%) than non-patient related tasks (167 min/day, 36%). Time spent in community settings had lower odds of being delegated to patient related tasks than time in the acute hospital setting (OR 0.44, 95%CI 0.28 to 0.69, P < 0.001). Time delegated by exercise physiologists and dietitians was more likely to involve patient related tasks than time delegated by physiotherapists (exercise physiology: OR 3.77, 95% 1.90 to 7.70, P < 0.001; dietetics: OR 2.60, 95%CI 1.40 to 1.90, P = 0.003). Time delegated by other professions (e.g. podiatry, psychology) had lower odds of involving patient related tasks than physiotherapy (OR 0.37, 95%CI 0.16 to 0.85, P = 0.02). Conclusion AHAs may be underutilised in community settings, and by podiatrists and psychologists. These areas may be targeted to understand appropriateness of task delegation to optimise AHAs’ role in providing patient care. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08642-7.
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Affiliation(s)
- David A Snowdon
- grid.1002.30000 0004 1936 7857Peninsula Clinical School, Central Clinical School, Monash University, Frankston, VIC Australia ,grid.466993.70000 0004 0436 2893Academic Unit, Peninsula Health, Frankston, VIC Australia ,National Centre for Healthy Ageing, Melbourne, VIC Australia
| | - Olivia A King
- grid.1002.30000 0004 1936 7857Monash Centre for Scholarship in Health Education, Monash University, Clayton, VIC Australia ,grid.414257.10000 0004 0540 0062Allied Health Department, Barwon Health, Geelong, VIC Australia
| | - Amy Dennett
- grid.414366.20000 0004 0379 3501Allied Health Clinical Research Office, Eastern Health, Box Hill, VIC Australia ,grid.1018.80000 0001 2342 0938School of Allied Health Human Services and Sport, La Trobe University, Bundoora, VIC Australia
| | - Jo-Anne Pinson
- grid.419789.a0000 0000 9295 3933Medical Imaging Department, Monash Health, Clayton, VIC Australia ,grid.1002.30000 0004 1936 7857Department of Medical Imaging and Radiation Sciences, Monash University, Clayton, VIC Australia ,grid.466993.70000 0004 0436 2893Medical Imaging Department, Peninsula Health, Frankston, VIC Australia
| | - Michelle M Shannon
- grid.1002.30000 0004 1936 7857Peninsula Clinical School, Central Clinical School, Monash University, Frankston, VIC Australia ,grid.466993.70000 0004 0436 2893Academic Unit, Peninsula Health, Frankston, VIC Australia
| | - Taya A Collyer
- grid.1002.30000 0004 1936 7857Peninsula Clinical School, Central Clinical School, Monash University, Frankston, VIC Australia ,grid.466993.70000 0004 0436 2893Academic Unit, Peninsula Health, Frankston, VIC Australia ,National Centre for Healthy Ageing, Melbourne, VIC Australia
| | - Annette Davis
- grid.419789.a0000 0000 9295 3933Allied Health Workforce Innovation Strategy Education Research (WISER) unit, Monash Health, Clayton, VIC Australia
| | - Cylie M Williams
- grid.466993.70000 0004 0436 2893Academic Unit, Peninsula Health, Frankston, VIC Australia ,grid.1002.30000 0004 1936 7857School of Primary and Allied Health Care, Monash University, Frankston, VIC Australia
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Dutia I, Curran D, Donohoe A, Beckman E, Tweedy SM. Time cost associated with sports participation for athletes with high support needs: a time-motion analysis of tasks required for para swimming. BMJ Open Sport Exerc Med 2022; 8:e001418. [PMID: 36213760 PMCID: PMC9535149 DOI: 10.1136/bmjsem-2022-001418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives People with cerebral palsy and high support needs (CP&HSN) are profoundly inactive but also under-represented in studies evaluating physical activity interventions. Reasons for their exclusion have not been evaluated. We hypothesised that CP&HSN would be associated with high time costs of preparatory activities (eg, getting dressed/undressed), possibly contributing to low participation and under-representation. Accordingly, this pilot study aimed to: (1) evaluate whether the time required for preparatory activities was extremely different (≥3 SD) between swimmers with and without CP&HSN; and (2) provide a qualitative indication of the preparatory tasks undertaken by swimmers with CP&HSN. Methods Each of three experienced (5 years) para swimmers with CP&HSN and 20 non-disabled swimmers were timed entering and then exiting the pool on three occasions. Mean entry and exit time for each para swimmer was compared with the group mean for non-disabled swimmers, and differences of greater than 3.0 SD were considered extreme. A qualitative description of the tasks completed by the para swimmers was recorded. Results The differences in time costs between para and non-disabled swimmers met the criterion of extreme. Pool entry times for para swimmers were 8-13 times greater (Effect size = 4.1-8.7). Pool exit times were 6-10 times greater (ES=7.0-9.5). 90% of tasks completed by para swimmers required personal assistance or wheeled mobility. Conclusions This pilot study suggests that, compared with non-disabled swimmers, time costs for preparation to commence or depart training are extremely high for swimmers with CP&HSN. Further research is required to evaluate the veracity of these findings.
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Affiliation(s)
- Iain Dutia
- School of Human Movement and Nutrition Sciences, The University of Queensland, Saint Lucia, Queensland, Australia,School of Allied Health, Australian Catholic University–Brisbane Campus, Banyo, Queensland, Australia
| | - Declan Curran
- School of Human Movement and Nutrition Sciences, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Adam Donohoe
- School of Human Movement and Nutrition Sciences, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Emma Beckman
- School of Human Movement and Nutrition Sciences, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Sean Michael Tweedy
- School of Human Movement and Nutrition Sciences, The University of Queensland, Saint Lucia, Queensland, Australia
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Kalne PS, Mehendale AM. The Purpose of Time-Motion Studies (TMSs) in Healthcare: A Literature Review. Cureus 2022; 14:e29869. [DOI: 10.7759/cureus.29869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022] Open
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Nieminen H, Hakulinen T, Puumalainen T, Sirén P, Palmu AA. Time and labour costs of preventive health care, including vaccinations, in Finnish child health clinics. PLoS One 2022; 17:e0270835. [PMID: 36190966 PMCID: PMC9529095 DOI: 10.1371/journal.pone.0270835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 06/17/2022] [Indexed: 11/30/2022] Open
Abstract
In Finland all children are entitled to regular health check-up visits at child health clinics (CHC). During the visits public health nurses and physicians follow-up the growth and development of the child, evaluate the welfare of the family, give health counselling and vaccinate the children. The aim of this study was to measure the time used by the nurses and physicians for different tasks during the visits and evaluate the costs of preventive health care procedures. Special emphasis was on time and costs used for administering vaccinations. The study was conducted in four CHCs. Trained observers measured the time used for predefined tasks with a stopwatch application operating on a tablet computer. Labour costs of visits and vaccinations were evaluated by using the gross average salary costs of health care personnel. Time used for vaccine logistics and other administrative tasks was obtained by interviewing the nurses in charge of the vaccine logistics at each CHC. Altogether 325 CHC visits of children <13 months were followed. Public health nurse used for a visit in average 49 (range 12-101) minutes, and the corresponding labour costs were 17 (4-35) Euros. Vaccines were administered at 183 visits. Children got on average 2.4 (1-4) vaccine doses per visit. The observed time used for vaccinations was 10.2 (1.6-25) minutes and the costs 3.58 (0.57-8.62) Euros per visit. The observed time included guidance, preparation, administration, and documentation of vaccinations. Adding one dose into a visit increased the time spent on vaccination on average 2.8 minutes (0.99 Euros). The mean non-observed time used for vaccine logistics outside the visits was 3.4 minutes and cost 1.19 Euros per dose. Administering of the vaccines of the Finnish vaccination programme is relatively simple and inexpensive because Finnish children have regular scheduled visits to CHCs.
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Affiliation(s)
- Heta Nieminen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Tampere, Finland
- * E-mail:
| | - Tuovi Hakulinen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Taneli Puumalainen
- Department for Safety, Security and Health, Ministry of Social Affairs and Health, Helsinki, Finland
| | - Päivi Sirén
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Tampere, Finland
| | - Arto A. Palmu
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Tampere, Finland
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Yan X, Husby H, Mudiganti S, Gbotoe M, Delatorre-Reimer J, Knobel K, Hudnut A, Jones JB. Evaluating the Impact of a Point-of-Care Cardiometabolic Clinical Decision Support Tool on Clinical Efficiency Using Electronic Health Record Audit Log Data: Algorithm Development and Validation. JMIR Med Inform 2022; 10:e38385. [PMID: 36066940 PMCID: PMC9490545 DOI: 10.2196/38385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/10/2022] [Accepted: 07/26/2022] [Indexed: 11/13/2022] Open
Abstract
Background Electronic health record (EHR) systems are becoming increasingly complicated, leading to concerns about rising physician burnout, particularly for primary care physicians (PCPs). Managing the most common cardiometabolic chronic conditions by PCPs during a limited clinical time with a patient is challenging. Objective This study aimed to evaluate a Cardiometabolic Sutter Health Advanced Reengineered Encounter (CM-SHARE), a web-based application to visualize key EHR data, on the EHR use efficiency. Methods We developed algorithms to identify key clinic workflow measures (eg, total encounter time, total physician time in the examination room, and physician EHR time in the examination room) using audit data, and we validated and calibrated the measures with time-motion data. We used a pre-post parallel design to identify propensity score–matched CM-SHARE users (cases), nonusers (controls), and nested-matched patients. Cardiometabolic encounters from matched case and control patients were used for the workflow evaluation. Outcome measures were compared between the cases and controls. We applied this approach separately to both the CM-SHARE pilot and spread phases. Results Time-motion observation was conducted on 101 primary care encounters for 9 PCPs in 3 clinics. There was little difference (<0.8 minutes) between the audit data–derived workflow measures and the time-motion observation. Two key unobservable times from audit data, physician entry into and exiting the examination room, were imputed based on time-motion studies. CM-SHARE was launched with 6 pilot PCPs in April 2016. During the prestudy period (April 1, 2015, to April 1, 2016), 870 control patients with 2845 encounters were matched with 870 case patients and encounters, and 727 case patients with 852 encounters were matched with 727 control patients and 3754 encounters in the poststudy period (June 1, 2016, to June 30, 2017). Total encounter time was slightly shorter (mean −2.7, SD 1.4 minutes, 95% CI −4.7 to −0.9; mean –1.6, SD 1.1 minutes, 95% CI −3.2 to −0.1) for cases than controls for both periods. CM-SHARE saves physicians approximately 2 minutes EHR time in the examination room (mean −2.0, SD 1.3, 95% CI −3.4 to −0.9) compared with prestudy period and poststudy period controls (mean −1.9, SD 0.9, 95% CI −3.8 to −0.5). In the spread phase, 48 CM-SHARE spread PCPs were matched with 84 control PCPs and 1272 cases with 3412 control patients, having 1119 and 4240 encounters, respectively. A significant reduction in total encounter time for the CM-SHARE group was observed for short appointments (≤20 minutes; 5.3-minute reduction on average) only. Total physician EHR time was significantly reduced for both longer and shorter appointments (17%-33% reductions). Conclusions Combining EHR audit log files and clinical information, our approach offers an innovative and scalable method and new measures that can be used to evaluate clinical EHR efficiency of digital tools used in clinical settings.
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Affiliation(s)
- Xiaowei Yan
- Center for Health Systems Research, Sutter Health, Walnut Creek, CA, United States
| | - Hannah Husby
- Center for Health Systems Research, Sutter Health, Walnut Creek, CA, United States
| | - Satish Mudiganti
- Center for Health Systems Research, Sutter Health, Walnut Creek, CA, United States
| | - Madina Gbotoe
- Center for Health Systems Research, Sutter Health, Walnut Creek, CA, United States
| | - Jake Delatorre-Reimer
- Department of Clinical Informatics, NorthBay Healthcare, Fairfield, CA, United States
| | - Kevin Knobel
- Sutter Gould Medical Foundation, Sutter Health, Modesto, CA, United States
| | - Andrew Hudnut
- Sutter Medical Group, Sutter Health, Sacramento, CA, United States
| | - J B Jones
- Center for Health Systems Research, Sutter Health, Walnut Creek, CA, United States
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Jokiniemi K, Kärkkäinen A, Korhonen K, Pekkarinen T, Pietilä A. Outcomes and challenges of successful clinical nurse specialist role implementation: Participatory action research. Nurs Open 2022; 10:704-713. [PMID: 36065161 PMCID: PMC9834530 DOI: 10.1002/nop2.1336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/01/2022] [Accepted: 08/08/2022] [Indexed: 01/16/2023] Open
Abstract
AIM To describe the clinical nurse specialist role and its outcomes and challenges. DESIGN Participatory Action Research conducted in Finland between the fall of 2017 and the end of 2018. METHODS A core participatory action research team (n = 10) led the design, implementation and evaluation of the research. Multiple data collection methods were used. The study is reported using the Enhancing the QUAlity and Transparency Of health Research (EQUATOR) guidelines for participatory action research. RESULTS The clinical nurse specialist used most of the time in clinical patient care followed by clinical nursing leadership and scholarship activities. Outcomes of successful implementation led to increased visibility of nursing expertise, development, integration and quality assurance of nursing processes and practice, and promotion of knowledge translation and unit and collaborator cooperation. Furthermore, role challenges were also recognized.
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Affiliation(s)
- Krista Jokiniemi
- Department of Nursing Science, Faculty of Health SciencesUniversity of Eastern FinlandKuopioFinland
| | - Anne Kärkkäinen
- Department of PsychiatryUniversity Hospital of KuopioKuopioFinland,Department of Nursing ScienceUniversity of Eastern FinlandKuopioFinland
| | | | | | - Anna‐Maija Pietilä
- Department of Nursing Science, Faculty of Health SciencesUniversity of Eastern FinlandKuopioFinland
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Garg S, Dewangan M, Nanda P, C K, Sahu A, Xalxo L. Assessing the time use and payments of multipurpose community health workers for the various roles they play-a quantitative study of the Mitanin programme in India. BMC Health Serv Res 2022; 22:1018. [PMID: 35948908 PMCID: PMC9364297 DOI: 10.1186/s12913-022-08424-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/05/2022] [Indexed: 11/30/2022] Open
Abstract
Background Community health workers (CHWs) are crucial human resources for health. While specialist CHWs focus on a single disease vertically, the generalist or multipurpose CHWs perform wider functions. The current study was aimed at examining the time multipurpose CHWs spend on performing their different roles. This can help in understanding the importance they attach to each role. Since CHWs in many developing countries are classified as part-time volunteers, this study also aimed to assess the adequacy of CHW payments in relation to their time use. Methods The study covered a well-established CHW programme in India's Chhattisgarh state. It had 71,000 multipurpose part-time CHWs known as Mitanins. Data collection involved interviews with a representative sample of 660 rural and 406 urban Mitanins. A semi-structured tool was designed and field tested. It included 26 pre-coded activities of CHWs placed under their six purposes or roles. Prompting and triangulation were used during interviews to mitigate the possibility of over-reporting of work by CHWs. The recall period was of one week. Descriptive analysis included comparison of key indicators for rural and urban Mitanins. A multi-variate linear model was used to find the determinants of CHW time-use. Results The rural and urban Mitanins respectively spent 25.3 and 34.8 h per week on their CHW work. Apart from location (urban), the total time spent was associated with size of population covered. The time-use was well balanced between roles of service-linkage, providing health education and curative care directly, COVID-19 related work and action on social determinants of health. More than half of their time-use was for unpaid tasks. Most of the cash-incentives were concentrated on service linkage role. The average payment earned by Mitanins was less than 60% of legal minimum wage. Conclusion The time-use pattern of Mitanins was not dictated by cash-incentives and their solidarity with community seemed be a key motivator. To allow wide ranging CHW action like Mitanins, the population per CHW should be decided appropriately. The considerable time multipurpose CHWs spend on their work necessitates that developing countries develop policies to comply with World Health Organisation's recommendation to pay them fairly. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08424-1.
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Affiliation(s)
- Samir Garg
- State Health Resource Centre, Chhattisgarh, Raipur, India.
| | | | - Prabodh Nanda
- State Health Resource Centre, Chhattisgarh, Raipur, India
| | - Krishnendhu C
- State Health Resource Centre, Chhattisgarh, Raipur, India
| | - Ashu Sahu
- State Health Resource Centre, Chhattisgarh, Raipur, India
| | - Lalita Xalxo
- State Health Resource Centre, Chhattisgarh, Raipur, India
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Costs of Next-Generation Sequencing Assays in Non-Small Cell Lung Cancer: A Micro-Costing Study. Curr Oncol 2022; 29:5238-5246. [PMID: 35892985 PMCID: PMC9330154 DOI: 10.3390/curroncol29080416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 07/10/2022] [Accepted: 07/16/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Next-generation sequencing (NGS) of tumor genomes has changed and improved cancer treatment over the past few decades. It can inform clinicians on the optimal therapeutic approach in many of the solid and hematologic cancers, including non-small lung cancer (NSCLC). Our study aimed to determine the costs of NGS assays for NSCLC diagnostics. Methods: We performed a micro-costing study of four NGS assays (Trusight Tumor 170 Kit (Illumina), Oncomine Focus (Thermo Fisher), QIAseq Targeted DNA Custom Panel and QIASeq Targeted RNAscan Custom Panel (Qiagen), and KAPA HyperPlus/SeqCap EZ (Roche)) at the StemCore Laboratories, the Ottawa Hospital, Canada. We used a time-and-motion approach to measure personnel time and a pre-defined questionnaire to collect resource utilization. The unit costs were based on market prices. The cost data were reported in 2019 Canadian dollars. Results: Based on a case throughput of 500 cases per year, the per-sample cost for TruSight Tumor 170 Kit, QIASeq Targeted DNA Custom Panel and QIASeq Targeted RNAscan Custom Panel, Oncomine Focus, and HyperPlus/SeqCap EZ were CAD 1778, CAD 599, CAD 1100 and CAD 1270, respectively. The key cost drivers were library preparation (34–60%) and sequencing (31–51%), followed by data analysis (6–13%) and administrative support (2–7%). Conclusions: Trusight Tumor 170 Kit was the most expensive NGS assay for NSCLC diagnostics; however, an economic evaluation is required to identify the most cost-effective NGS assay. Our study results could help inform decisions to select a robust platform for NSCLC diagnostics from fine needle aspirates, and future economic evaluations of the NGS platforms to guide treatment selections for NSCLC patients.
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Walser E, Zhang CJ, Cristancho S, Lingard L, Ott M. Faculty and resident perceptions of surgical resident workload in comparison to objective data. Surgery 2022; 172:1109-1113. [PMID: 35871851 DOI: 10.1016/j.surg.2022.04.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 02/25/2022] [Accepted: 04/29/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Little is known of the way in which stakeholders in surgical education perceive trainee workload. METHODS A web-based survey examining the perception of current resident workload (as a percentage of daytime activities) was distributed to the faculty and residents in a Canadian general surgery residency program. The analysis compared the trainee and faculty responses against a 660-hour resident workload observation dataset. RESULTS A total of 17 residents and 16 faculty completed the survey (74%, 67% participation). The resident estimations of workload were accurate for task categories (r = 0.91) and individual tasks (r = 0.92). The faculty estimations were accurate for task category (r = 0.90) but less so for individual tasks (r = 0.78). The residents perceived that significantly less time was allocated toward educational activities than faculty. Both of the groups underestimated the amount of time spent on indirect patient care (IPC). CONCLUSION The faculty overestimate educational tasks as a proportion of workload. Both of the groups underestimated IPC tasks. This information can guide resident training program design and be used to bridge gaps between resident and faculty perceptions of resident workload.
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Affiliation(s)
- Eric Walser
- Division of General Surgery, Department of Surgery, Schulich School of Medicine, Western University, London, Ontario, Canada
| | - Chris J Zhang
- Schulich School of Medicine, Western University, London, Ontario, Canada
| | - Sayra Cristancho
- Center for Education Research and Innovation, Schulich School of Medicine, Western University, London, Ontario, Canada
| | - Lorelei Lingard
- Center for Education Research and Innovation, Schulich School of Medicine, Western University, London, Ontario, Canada
| | - Michael Ott
- Division of General Surgery, Department of Surgery, Schulich School of Medicine, Western University, London, Ontario, Canada; Center for Education Research and Innovation, Schulich School of Medicine, Western University, London, Ontario, Canada; Department of Oncology, Faculty of Medicine, Schulich School of Medicine, Western University, London, Ontario, Canada.
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Becker-Haimes EM, Ramesh B, Buck JE, Nuske HJ, Zentgraf KA, Stewart RE, Buttenheim A, Mandell DS. Comparing output from two methods of participatory design for developing implementation strategies: traditional contextual inquiry vs. rapid crowd sourcing. Implement Sci 2022; 17:46. [PMID: 35854367 PMCID: PMC9295107 DOI: 10.1186/s13012-022-01220-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 06/24/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Participatory design methods are a key component of designing tailored implementation strategies. These methods vary in the resources required to execute and analyze their outputs. No work to date has examined the extent to which the output obtained from different approaches to participatory design varies. METHODS We concurrently used two separate participatory design methods: (1) field observations and qualitative interviews (i.e., traditional contextual inquiry) and (2) rapid crowd sourcing (an innovation tournament). Our goal was to generate and compare information to tailor implementation strategies to increase the use of evidence-based data collection practices among one-to-one aides working with children with autism. Each method was executed and analyzed by study team members blinded to the output of the other method. We estimated the personnel time and monetary costs associated with each method to further facilitate comparison. RESULTS Observations and interviews generated nearly double the number of implementation strategies (n = 26) than did the innovation tournament (n = 14). When strategies were classified into implementation strategies from the Expert Recommendations for Implementing Change (ERIC) taxonomy, there was considerable overlap in the content of identified strategies. However, strategies derived from observations and interviews were more specific than those from the innovation tournament. Five strategies (13%) reflected content unique to observations and interviews and 3 (8%) strategies were unique to the innovation tournament. Only observations and interviews identified implementation strategies related to adapting and tailoring to context; only the innovation tournament identified implementation strategies that used incentives. Observations and interviews required more than three times the personnel hours than the innovation tournament, but the innovation tournament was more costly overall due to the technological platform used. CONCLUSIONS There was substantial overlap in content derived from observations and interviews and the innovation tournament, although there was greater specificity in the findings from observations and interviews. However, the innovation tournament yielded unique information. To select the best participatory design approach to inform implementation strategy design for a particular context, researchers should carefully consider unique advantages of each method and weigh the resources available to invest in the process.
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Affiliation(s)
- Emily M Becker-Haimes
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3rd floor, Philadelphia, PA, 19104, USA.
- Hall Mercer Community Mental Health, University of Pennsylvania Health System, Philadelphia, USA.
| | - Brinda Ramesh
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3rd floor, Philadelphia, PA, 19104, USA
| | - Jacqueline E Buck
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3rd floor, Philadelphia, PA, 19104, USA
- Sandra Rosenbaum School of Social Work, University of Wisconsin-Madison, Madison, WI, USA
| | - Heather J Nuske
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3rd floor, Philadelphia, PA, 19104, USA
| | - Kelly A Zentgraf
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3rd floor, Philadelphia, PA, 19104, USA
| | - Rebecca E Stewart
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3rd floor, Philadelphia, PA, 19104, USA
| | - Alison Buttenheim
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
- Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - David S Mandell
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3rd floor, Philadelphia, PA, 19104, USA
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Wu DTY, Murdock P, Vennemeyer S, Mynatt JM, Chih MY. Challenges in inpatient care coordinators’ clinical workflow and opportunities in designing a health IT solution: A mixed methods study. INTERNATIONAL JOURNAL OF CARE COORDINATION 2022. [DOI: 10.1177/20534345221111004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Inpatient care coordinators (ICCs) in the United States play a critical role in case management and care transition. ICCs spend a large amount of time in chart review and documentation through electronic health record (EHR) systems. However, significant knowledge gaps exist regarding their workflow barriers and their use of health information technology (Health IT). Using only quantitative or quantitative methods does not provide a comprehensive picture about ICC’s workflow due to its complex and dynamic nature. This work aimed to address this gap by conducting a mixed-methods study to understand the workflow of ICCs and identifying challenges in care deliver and documentation activities. Methods The study adopted a concurrent triangulation design including qualitative interviews with 12 ICC staff members in the United States followed by extraction of their EHR event logs for one month. The qualitative interview data were analyzed thematically, and the log data were analyzed statistically. The results were triangulated and interpreted. Results Three major workflow barriers faced by ICCs were identified: long travel time, heavy documentation load, and suboptimal communication. The event logs provided empirical evidence to support the workflow barriers identified in the interviews, especially in travel time and documentation load. Discussion ICC workflow has several inefficiencies. The study generated four design considerations to develop a Health IT solution: Mobility, EHR integration, Team-based Communication, and User Adoption to improve workflow efficiency and care coordination. Using a mixed-methods approach is effective and efficient in collecting and analyzing clinical workflow.
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Affiliation(s)
- Danny TY Wu
- Department of Biomedical Informatics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Medical Sciences Baccalaureate Program, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Paul Murdock
- Department of Biomedical Informatics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Medical Sciences Baccalaureate Program, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Scott Vennemeyer
- Department of Biomedical Informatics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Medical Sciences Baccalaureate Program, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Janie M Mynatt
- Department of Social Work, Care Management and Spiritual Care, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Ming-Yuan Chih
- Department of Clinical Leadership and Management, University of Kentucky College of Health Sciences, Lexington, KY, USA
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Zhang CJ, Walser E, Mierzwa A, Ott M. Learning Interrupted: Educational Impact of Interruptions on Surgical Residents. JOURNAL OF SURGICAL EDUCATION 2022; 79:875-884. [PMID: 35185000 DOI: 10.1016/j.jsurg.2022.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 01/17/2022] [Accepted: 01/21/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The complex workflow of surgical residents in the workplace-based learning environment makes interruptions an unavoidable aspect of clinical work. Interruptions have been shown to affect cognitive load, surgical performance, and medical error. The purpose of this study was to describe the effects of interruptions on surgical resident education. DESIGN Junior residents were observed by 2 trained observers using time-motion methodology between September 2018-August 2019. Interruptions were identified and coded retroactively based on predefined criteria. We captured key features of interruptions including frequency, duration, task interrupted, outcome, and learner perceived educational value. SETTING This study took place at London Health Sciences Centre in London, Ontario, Canada, a tertiary level academic health care center associated with the Schulich School of Medicine & Dentistry at Western University. PARTICIPANTS Junior residents on a General Surgery service were eligible for participation. Participation was voluntary. 8 residents were observed over 24 clinical periods. RESULTS A total of 278.2 hours of resident workflow were observed, and 229 interruptions were recorded. Interruptions account for 57.9 minutes/day of a surgical resident (SD = 60.7). Interruptions occur at a frequency of 0.82 interruptions/hour. Disruptive interruptions, that interfere with the continuation or completion of the original task, occur at a frequency of 0.11 interruptions/hour. Disruptive interruptions occurred at a higher frequency of 0.34 interruptions/hour during periods of feedback, coaching and informal teaching. DISCUSSION We observed that tasks of higher learner perceived educational value are often interrupted by tasks of lower learner perceived education value. Valuable educational experiences such as feedback, coaching and informal teaching are interrupted at a greater rate and experience disruptions at a disproportionate rate. We identified feedback, coaching and informal teaching as an education task vulnerable to disruptive interruptions that would benefit from interventions targeted toward preventing interruption. Suggested interventions include "formalizing" feedback, coaching and informal teaching.
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Affiliation(s)
- Chris J Zhang
- Schulich School of Medicine, Western University, London, Ontario, Canada
| | - Eric Walser
- Division of General Surgery, Department of Surgery, Schulich School of Medicine, Western University, London, Ontario, Canada
| | - Anna Mierzwa
- Schulich School of Medicine, Western University, London, Ontario, Canada
| | - Michael Ott
- Schulich School of Medicine, Western University, London, Ontario, Canada; Division of General Surgery, Department of Surgery, Schulich School of Medicine, Western University, London, Ontario, Canada; Center for Education Research and Innovation, Schulich School of Medicine, Western University, London, Ontario, Canada; Department of Oncology, Faculty of Medicine, Schulich School of Medicine, Western University, London, Ontario, Canada.
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Ntuku H, Smith-Gueye C, Scott V, Njau J, Whittemore B, Zelman B, Tambo M, Prach LM, Wu L, Schrubbe L, Kang Dufour MS, Mwilima A, Uusiku P, Sturrock H, Bennett A, Smith J, Kleinschmidt I, Mumbengegwi D, Gosling R, Hsiang M. Cost and cost effectiveness of reactive case detection (RACD), reactive focal mass drug administration (rfMDA) and reactive focal vector control (RAVC) to reduce malaria in the low endemic setting of Namibia: an analysis alongside a 2×2 factorial design cluster randomised controlled trial. BMJ Open 2022; 12:e049050. [PMID: 35738650 PMCID: PMC9226870 DOI: 10.1136/bmjopen-2021-049050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES To estimate the cost and cost effectiveness of reactive case detection (RACD), reactive focal mass drug administration (rfMDA) and reactive focal vector control (RAVC) to reduce malaria in a low endemic setting. SETTING The study was part of a 2×2 factorial design cluster randomised controlled trial within the catchment area of 11 primary health facilities in Zambezi, Namibia. PARTICIPANTS Cost and outcome data were collected from the trial, which included 8948 community members that received interventions due to their residence within 500 m of malaria index cases. OUTCOME MEASURES The primary outcome was incremental cost effectiveness ratio (ICER) per in incident case averted. ICER per prevalent case and per disability-adjusted life years (DALY) averted were secondary outcomes, as were per unit interventions costs and personnel time. Outcomes were compared as: (1) rfMDA versus RACD, (2) RAVC versus no RAVC and (3) rfMDA+RAVC versus RACD only. RESULTS rfMDA cost 1.1× more than RACD, and RAVC cost 1.7× more than no RAVC. Relative to RACD only, the cost of rfMDA+RAVC was double ($3082 vs $1553 per event). The ICERs for rfMDA versus RACD, RAVC versus no RAVC and rfMDA+RAVC versus RACD only were $114, $1472 and $842, per incident case averted, respectively. Using prevalent infections and DALYs as outcomes, trends were similar. The median personnel time to implement rfMDA was 20% lower than for RACD (30 vs 38 min per person). The median personnel time for RAVC was 34 min per structure sprayed. CONCLUSION Implemented alone or in combination, rfMDA and RAVC were cost effective in reducing malaria incidence and prevalence despite higher implementation costs in the intervention compared with control arms. Compared with RACD, rfMDA was time saving. Cost and time requirements for the combined intervention could be decreased by implementing rfMDA and RAVC simultaneously by a single team. TRIAL REGISTRATION NUMBER NCT02610400; Post-results.
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Affiliation(s)
- Henry Ntuku
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco, San Francisco, California, USA
| | - Cara Smith-Gueye
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco, San Francisco, California, USA
| | - Valerie Scott
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco, San Francisco, California, USA
| | - Joseph Njau
- JoDon Consulting Group LLC, Atlanta, Georgia, USA
| | - Brooke Whittemore
- Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Brittany Zelman
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco, San Francisco, California, USA
| | - Munyaradzi Tambo
- Multidisciplinary Research Centre, University of Namibia, Windhoek, Namibia
| | - Lisa M Prach
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco, San Francisco, California, USA
| | - Lindsey Wu
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, UK
| | - Leah Schrubbe
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco, San Francisco, California, USA
| | - Mi-Suk Kang Dufour
- Division of Prevention Science, University of California San Francisco, San Francisco, California, USA
| | - Agnes Mwilima
- Ministry of Health and Social Services, Zambezi Region, Katima Mulilo, Namibia
| | - Petrina Uusiku
- Ministry of Health and Social Services, Windhoek, Namibia
| | - Hugh Sturrock
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco, San Francisco, California, USA
| | - Adam Bennett
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco, San Francisco, California, USA
| | - Jennifer Smith
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco, San Francisco, California, USA
| | - Immo Kleinschmidt
- Faculty of Health Sciences, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Davis Mumbengegwi
- Multidisciplinary Research Centre, University of Namibia, Windhoek, Namibia
| | - Roly Gosling
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco, San Francisco, California, USA
| | - Michelle Hsiang
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco, San Francisco, California, USA
- Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Alekhya G, Giri PP, M C A, Behera BK, Subba SH. A time-motion study of the COVID-19 vaccination process in an urban primary health center of Odisha, India. Hum Vaccin Immunother 2022; 18:2073759. [PMID: 35727159 PMCID: PMC9359350 DOI: 10.1080/21645515.2022.2073759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Vaccination is a critical tool in protecting against COVID-19. It is essential to know the time for each activity in a COVID-19 vaccination process for better management, especially during a pandemic. Thus, we conducted a time-motion study to identify activities that led to delayed/increased waiting time in an urban primary health center in Bhubaneswar, India. We observed 196 COVID-19 vaccine beneficiaries over one month (June 2021) from when they arrived at the vaccination center until they left the center. A data collection form and a Stopwatch were used to estimate the time taken for various activities involved in COVID-19 vaccine delivery. The time taken was expressed in mean and median. We also compared the time taken during the first and second doses using the Mann-Whitney U test. The total mean time spent at the vaccination center was 40:56 ± 20:52 minutes. The activity that took the longest was 'waiting time in queue before vaccination', which was 34:22 ± 20:56 min constituting 82% of the total time. The activity that took longer for the second dose than the first was the beneficiary verification in the Co-WIN portal with a median of 27 seconds and 36 seconds, respectively (p < .001). This study will help program managers formulate better strategies to improve the vaccination process making it more efficient.
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Affiliation(s)
- G Alekhya
- Department of Community Medicine and Family Medicine, AIIMS Bhubaneswar, Bhubaneswar, Odisha, India
| | - Prajna Paramita Giri
- Department of Community Medicine and Family Medicine, AIIMS Bhubaneswar, Bhubaneswar, Odisha, India
| | - Arjun M C
- Department of Community Medicine and Family Medicine, AIIMS Bhubaneswar, Bhubaneswar, Odisha, India
| | - Binod Kumar Behera
- Department of Community Medicine and Family Medicine, AIIMS Bhubaneswar, Bhubaneswar, Odisha, India
| | - Sonu Hangma Subba
- Department of Community Medicine and Family Medicine, AIIMS Bhubaneswar, Bhubaneswar, Odisha, India
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Mustaffa KH, Shafie AA, Ngu LH. A comparison of self-evaluated survey and work sampling approach for estimating patient-care unit cost multiplier in genetic nursing activities. Asian Nurs Res (Korean Soc Nurs Sci) 2022; 16:170-179. [PMID: 35714898 DOI: 10.1016/j.anr.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 05/17/2022] [Accepted: 06/06/2022] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To compare patient care multipliers estimated from subjective evaluation against work sampling techniques in genetic nursing activities. METHODS An observational work sampling technique was conducted from November to December 2019 with nine genetic nurses in a tertiary referral centre in Malaysia. The work sampling activity instrument was devised, validated, and pilot tested. All care and noncare-related activities were sampled at 10-minute intervals within 8 hours of working over 14 days, followed by a subjective evaluation of activities survey over the same period. Bonferroni correction was undertaken for multiple testing with a p value of 0.0025. RESULTS The two techniques produced significant differences in genetic nurses' activities categorization. The work sampling showed that compared with subjective evaluation, direct care (19.3% versus 45.0%; p < .001) was estimated to be significantly lower, and indirect care (40.4% versus 25.6%; p < .001) and unit-related care (28.5% versus 16.9%; p < .001) were higher. Both techniques produced a similar proportion of time spent in other noncare activities (12.0%) but differed in genetic meetings and information-gathering activities. While the multipliers for patient face-to-face contact were significantly larger between work sampling (4.57) and the survey (1.94), the multipliers for patient care time were smaller between work sampling (1.47) and the survey (1.24), indicating that caution should be taken when multiplying for patient contact time compared to patient care activity to determine the cost of care provision. CONCLUSION A considerable proportion of time spent away from the patient needs to be allocated to patient-related care time. Thus, estimating the paid cost solely based on direct time with patients considerably underestimates the cost per hour of nurses' care. It is recommended to employ 'patient-related activity' instead of the 'face-to-face contact' multiplier because the former did not significantly differ from the one estimated using work sampling.
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Affiliation(s)
- Khairu Hazwan Mustaffa
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Science, Universiti Sains Malaysia, Minden, Penang, Malaysia; Department of Pharmacy, Hospital Sultanah Nur Zahirah, Kuala Terengganu, Terengganu, Malaysia
| | - Asrul Akmal Shafie
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Science, Universiti Sains Malaysia, Minden, Penang, Malaysia.
| | - Lock-Hock Ngu
- Department of Genetics, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
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Kim SK, Lee J, Lee J, Ahn J, Kim H. Health and economic impact of a smoking cessation program in Korean workplaces. Health Promot Int 2022; 37:6631501. [PMID: 35788310 DOI: 10.1093/heapro/daac063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Smoking is a leading cause of diseases and death, with significant socioeconomic consequences. The purpose of this study was to evaluate the health and economic effectiveness of a workplace smoking cessation program. A total of 89 smokers from seven workplaces in Korea were the participants of the program. For 4 months, individual counseling based on the transtheoretical model (TTM) was conducted and interpersonal and organizational components were applied to encourage entire workplaces to encourage employee smoking cessation. The primary outcome was whether participants quit smoking or not. We also evaluated the changes in attitude and perceptions related to smoking cessation before and after the program and estimated the program's economic effects. Economic effects were defined as reductions in productivity losses and medical expenses. We calculated the return on investment (ROI) values representing the averted cost through the program compared to program cost. At the end of the program, 40.4% of participants quit smoking. Improvements were observed in TTM-based attitudes and perceptions. The mean reduction in productivity losses was estimated to be $187,609.94 for 2 yr and the mean reduction in medical expenses was $3,136.49 at 20 yr among seven workplaces. When accounting for these reductions, the ROI was 15.39 (ranging from -1.00 to 44.53). These effects were robust under various scenarios. The smoking cessation program should be expanded to a wider variety of workplaces. In the future, more sophisticated economic assessment methods should be developed and applied to facilitate workplace recruitment and attract management support.
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Affiliation(s)
- Soo Kyoung Kim
- Department of Health Convergence, Ewha Womans University, Seoul, Korea
| | - Jeongeun Lee
- Health Insurance Review and Assessment Service, Wonju, Korea
| | - Jaeun Lee
- Department of Health Care Policy Research, Korea Institute for Health and Social Affairs, Sejong, Korea
| | - Jeonghoon Ahn
- Department of Health Convergence, Ewha Womans University, Seoul, Korea
| | - Hyekyeong Kim
- Department of Health Convergence, Ewha Womans University, Seoul, Korea
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