#69: Improving Communication About the Care and Prevention of Infections in a Pediatric Oncology Unit by Using Patient Daily Goals in Multidisciplinary Rounds

2021 ◽  
Vol 10 (Supplement_1) ◽  
pp. S22-S22
Author(s):  
Escobedo-Melendez Griselda ◽  
Martinez-Albarran Manuel ◽  
Magaña-Saldivar Isadora ◽  
Jimenez Norma ◽  
Gomez-Huerta Elizabeth ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Pediatric Oncology ◽  
Multidisciplinary Team ◽  
Statistical Significance ◽  
Healthcare Providers ◽  
Multidisciplinary Teams ◽  
Use Of Resources ◽  
Multidisciplinary Rounds ◽  
Prevention Of Infections ◽  
Oncology Unit

Abstract Background In children with cancer infections are the most frequent complication, with fatal outcomes if not addressed promptly. Therefore, care and prevention of infections in these patients require multidisciplinary interventions, with effective communication among healthcare providers to reduce the morbidity, length of stay, and the inappropriate use of resources. We used the Institute of Healthcare Improvement (IHI) model for improving the communication among healthcare providers by using patient daily goals after the oncology pediatric unit multidisciplinary rounds. Methods A multidisciplinary team was identified in the pediatric oncology unit. The team received weekly coaching on the IHI methodology. The methodology used included the creation of a block diagram to understand the baseline processes and a key driver diagram. Then, after a literature review, a data collection plan and measures were identified. The team identified different ideas for changes and prioritized them using an impact-effort matrix. Finally, several rounds of Plan-Do-Study-Act (PDSA) cycles reached the desired changes that organized the patient daily goals for sharing in the form of a worksheet. This worksheet was shared with nurses and pharmacist staff, a chat group was created, and the routine use of the daily goals for patient management was taught and incorporated into the rest of the care team staff. The percentage of excellent communication among all multidisciplinary teams and outcomes (length of stay, intensive care unit admission, and mortality) were recorded at baseline and endline. We determined the statistical significance of the baseline vs. endline difference by using χ 2 and t-tests. Results A total of 105 patients with suspected infections were included over a 6-month period (June through November 2019). We found a significant increase per month in the percent of agreement in excellent communication in the patient daily goals between infectious diseases specialist faculty and fellows, nurses, pharmacist, and pediatric oncology faculty and fellows (33.3% vs. 91.3%) (P = 0.004). Length of stay decreased monthly after our interventions (baseline: mean 14.7 days [SD 12.4] vs. after intervention: mean 6.7 days [SD 2.7]) (P = 0.014). There were only one ICU admission and no deaths during the implementation period. Conclusions Our approach using patient daily goals improved communication among a multidisciplinary team, leading to decreased length of stay and supporting adequate outcomes.

scholarly journals Demands and Rewards of Working Within Multidisciplinary Teams in Pediatric Oncology: The Experiences of Canadian Health Care Providers

2014 ◽  
Author(s):  
Sonia Gulati ◽  
David Dix ◽  
Anne Klassen
Keyword(s):  
Health Care Providers ◽  
Pediatric Oncology ◽  
Multidisciplinary Team ◽  
Qualitative Interviews ◽  
Healthcare Providers ◽  
Child Life ◽  
Hospital Environment ◽  
Multidisciplinary Teams ◽  
Limited Information ◽  
Care Providers

Pediatric oncology care in Canada is delivered by multidisciplinary teams consisting of healthcare providers with different areas of expertise. Limited information is available on how the multidisciplinary team influences jobrelated rewards, demands, and stress in pediatric oncology. A qualitative approach was adopted to learn about healthcare providers’ experiences of working within a multidisciplinary team in pediatric oncology. Qualitative interviews were conducted with 33 healthcare providers (13 oncologists, 9 nurses, 5 social workers, and 6 child-life specialists) from four pediatric oncology centres. Topics explored included: demands and rewards associated with how the multidisciplinary team worked; description of one’s area of expertise; and healthcare provider’s responsibilities. Thematic analysis was used to identify sources of demands and rewards of working in a multidisciplinary team. Healthcare providers described rewards of working within a multidisciplinary team in three areas: sharing expertise and collaboration; giving and receiving social and emotional support; and being valued by and valuing team members. Healthcare providers discussed demands of working within a multidisciplinary team in four areas: interpersonal and communication tensions; conflicting views about providing care; role confusion, overlap and being undervalued; and hospital environment. These findings may inform interventions that alleviate healthcare provider stress and promote strategies that lead to greater job satisfaction.

Abstract WP351: Using Standard Work to Improve the Discharge Process on a Neurology Division

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Rose M Donnelly ◽  
Tim Tranor ◽  
Julie Griffin ◽  
Kalcee Foreman ◽  
Adrienne Ford ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Multidisciplinary Team ◽  
Skilled Nursing Facilities ◽  
Multidisciplinary Teams ◽  
Discharge Process ◽  
Nursing Facilities ◽  
Mobile Computer ◽  
Skilled Nursing ◽  
Standard Work ◽  
Inadequate Information

Background and Issues: Patient volume increased significantly over first half of 2011 on the Neurology Service. Bed occupancy increased by 14% over previous year and bed availability became a major constraint. Data showed, patients were discharged late in the day or sometimes stayed an extra night because discharge orders were released too late to place patients in rehab or skilled nursing facilities. Only 16% of patients were discharged by 2:00 pm due to communication barriers and inadequate information exchanged between multidisciplinary teams. There was also an issue with inconsistent acceptance criteria from primary placement facilities which resulted in a longer length of stay. Purpose: Primary goal of project was to free up capacity on the Nursing Division to accommodate the increase in patient volumes without increasing staffing or the number of available beds. Methods: In September 2011, a multidisciplinary team was assembled to understand causes of the problems and develop solutions to resolve. Solutions implemented include working with partner Rehab and Skilled Nursing Facilities to define standardized Acceptance Guidelines to ensure issues could be addressed before day of discharge. Also, processes for releasing discharge orders were redesigned so orders were more frequently written and placed “on hold” the day before expected discharge. A mobile computer was issued to physician rounding teams so orders could be released during rounds instead of batch-released in the afternoon. Additionally, team communication was significantly improved by standardizing a daily multidisciplinary team huddle and implementing a visual communication board to track key information about patients to proactively plan for discharge. Results: The overall length of stay of patients on the Neurology Service decreased from 4.26 days in 2011 to 3.69 days in 2012. Conclusions: Many variables contributed to the decrease in length of stay for patients in this study. No decisive conclusions can be made about the effectiveness of any particular variable. Other variables during this timeframe likely contributed, however the authors of this study presented the most likely factors. Although the findings are exciting, further analysis is needed to isolate the main drivers.

scholarly journals Evaluation of the Implementation of a Multidisciplinary Fast Track Program for Geriatric Acute Hip Fracture Patients at a University Hospital in Resource-Limited Settings

2021 ◽  
Author(s):  
Unchana Sura-amonrattana ◽  
Theerawoot Tharmviboonsri ◽  
Aasis Unnanuntana ◽  
Direk Tantigate ◽  
Varalak Srinonpras
Keyword(s):  
Hip Fracture ◽  
Length Of Stay ◽  
Multidisciplinary Team ◽  
Fast Track ◽  
Statistical Significance ◽  
Medical Complications ◽  
Resource Limited Settings ◽  
Time To Surgery ◽  
Resource Limited ◽  
Significant Difference

Abstract Background: Hip fractures are common among frail, older people and associated with multiple adverse outcomes, including death. Timely and appropriate care by a multidisciplinary team may improve outcomes. Implementing a team to jointly deliver the service in resource-limited settings is challenging, particularly on the effectiveness of patient outcomes. Methods: A retrospective cohort study to compare outcomes of hip fracture patients aged 65 or older admitted at Siriraj hospital pre- and post-implementation of the Fast-track program. The primary outcome was the incidence of medical complications. The secondary outcomes were time to surgery, factors related to the occurrence of various complications, in-hospital mortality, and mortality at month 3, month 6 and month 12 after the operation. Results: 302 patients were enrolled from the Siriraj hospital’s database between October 2016 and October 2018; 151 patients in each group with a mean age of 80 years were analyzed. Clinical parameters were similar between groups except the Fast-track group comprising more patients with dementia (37.1% VS 23.8%, p<0.012). In the Fast-track group, there was a significantly higher proportion of patients underwent surgery within 72-hours (80.3% VS 44.7%, p<0.001) and the length of stay was significantly shorter (11 days (8-17) VS 13 days (9-18), p=0.017). There was no significant difference in medical complications and mortality. Stratified analysis by dementia status showed a trend in delirium reduction in both demented and non-demented groups, and a pressure injury reduction among patients with dementia after the program was implemented but there was no statistical significance.Conclusions: The implementation of a multidisciplinary team for hip fracture patients is feasible in resource-limited settings. In the Fast-track system, time to surgery was reduced and the length of stay was shortened. Other outcome benefits were not shown, which may be due to incomplete uptake of all involved disciplines.

scholarly journals Experiences and impact of international medical volunteering: a multi-country mixed methods study

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e041599 ◽  
Author(s):  
Mary McCauley ◽  
Joanna Raven ◽  
Nynke van den Broek
Keyword(s):  
Low Income ◽  
Online Survey ◽  
Positive Impact ◽  
Healthcare Providers ◽  
International Medical ◽  
Middle Income ◽  
Use Of Resources ◽  
The Uk ◽  
Medical Volunteers ◽  
The Impact

ObjectiveTo assess the experience and impact of medical volunteers who facilitated training workshops for healthcare providers in maternal and newborn emergency care in 13 countries.SettingsBangladesh, Ghana, India, Kenya, Malawi, Namibia, Nigeria, Pakistan, Sierra Leone, South Africa, Tanzania, UK and Zimbabwe.ParticipantsMedical volunteers from the UK (n=162) and from low-income and middle-income countries (LMIC) (n=138).Outcome measuresExpectations, experience, views, personal and professional impact of the experience of volunteering on medical volunteers based in the UK and in LMIC.ResultsUK-based medical volunteers (n=38) were interviewed using focus group discussions (n=12) and key informant interviews (n=26). 262 volunteers (UK-based n=124 (47.3%), and LMIC-based n=138 (52.7%)) responded to the online survey (62% response rate), covering 506 volunteering episodes. UK-based medical volunteers were motivated by altruism, and perceived volunteering as a valuable opportunity to develop their skills in leadership, teaching and communication, skills reported to be transferable to their home workplace. Medical volunteers based in the UK and in LMIC (n=244) reported increased confidence (98%, n=239); improved teamwork (95%, n=232); strengthened leadership skills (90%, n=220); and reported that volunteering had a positive impact for the host country (96%, n=234) and healthcare providers trained (99%, n=241); formed sustainable partnerships (97%, n=237); promoted multidisciplinary team working (98%, n=239); and was a good use of resources (98%, n=239). Medical volunteers based in LMIC reported higher satisfaction scores than those from the UK with regards to impact on personal and professional development.ConclusionHealthcare providers from the UK and LMIC are highly motivated to volunteer to increase local healthcare providers’ knowledge and skills in low-resource settings. Further research is necessary to understand the experiences of local partners and communities regarding how the impact of international medical volunteering can be mutually beneficial and sustainable with measurable outcomes.

scholarly journals Population Characteristics of Cats Adopted from an Urban Cat Shelter and the Influence of Physical Traits and Reason for Surrender on Length of Stay

Animals ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. 940 ◽  
Author(s):  
Miller ◽  
Ward ◽  
Beatty
Keyword(s):  
Length Of Stay ◽  
Animal Welfare ◽  
Coat Color ◽  
Population Characteristics ◽  
Study Cohort ◽  
Potential Predictor ◽  
Use Of Resources ◽  
Stray Cats ◽  
Hazard Ratios ◽  
Physical Traits

Measures aimed at reducing the length of stay (LOS) of cats in shelters can promote animal welfare and more efficient use of resources. The extent to which variables shown to impact LOS are broadly applicable is unclear. The aim of this study was to describe a population of cats adopted from an urban shelter, and to analyze the association between potential predictor variables and LOS. A study cohort was identified retrospectively from shelter records (n = 2584), 48.8% of which were < 12 weeks old at admission, and 80.7% were stray. Among 445 cats relinquished by owners, reasons for surrender were primarily owner-related (87.2%). Overall, reason for surrender and coat color were significantly associated with LOS. Hazard ratios showed that all reasons for surrender for owner-relinquished cats were associated with a shorter LOS than stray cats and this association was significant (p < 0.05) for all except cat behavioral or medical reasons. In contrast to previous reports, white cats had a significantly (p < 0.05) longer LOS than black cats. This study highlights an important role for shelter-specific baseline data to inform and measure the effect of interventional studies aimed at improving animal welfare by reducing LOS in shelter-housed cats

scholarly journals Developing implementation strategies to adopt Enhanced Recovery After Surgery (ERAS®) guidelines

BJS Open ◽  
2020 ◽  
Vol 5 (2) ◽  
Author(s):  
Jennifer Y Lam ◽  
Alexandra Howlett ◽  
Duncan McLuckie ◽  
Lori M Stephen ◽  
Scott D N Else ◽  
...  
Keyword(s):  
Implementation Strategy ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Healthcare Providers ◽  
Implementation Strategies ◽  
Multidisciplinary Teams ◽  
Successful Implementation ◽  
Care Pathways ◽  
Audit System ◽  
Local Contexts

Abstract Background Strong implementation strategies are critical to the success of Enhanced Recovery after Surgery (ERAS®) guidelines, though little documentation exists on effective strategies, especially in complex clinical situations and unfamiliar contexts. This study outlines the process taken to adopt a novel neonatal ERAS® guideline. Methods The implementation strategy was approached in a multi-pronged, concurrent but asynchronous fashion. Between September 2019 and January 2020, healthcare providers from various disciplines and different specialties as well as parents participated in the strategy. Multidisciplinary teams were created to consider existing literature and local contexts including potential facilitators and/or barriers. Task forces worked collaboratively to develop new care pathways. An audit system was developed to record outcomes and elicit feedback for revision. Results 32 healthcare providers representing 9 disciplines and 5 specialties as well as 8 parents participated. Care pathways and resources were created. Elements recommended for a successful implementation strategy included identification of champions, multidisciplinary stakeholder involvement, consideration of local contexts and insights, patient/family engagement, education, and creation of an audit system. Conclusion A multidisciplinary and structured process following principles of implementation science was used to develop an effective implementation strategy for initiating ERAS® guidelines.

scholarly journals 144 The Use of a Multidisciplinary Team Discharge “Huddle” to Improve Patient Flow and Planning

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii1-iii16
Author(s):  
Mary Randles ◽  
Sylvia Hickey ◽  
Susanne Cotter ◽  
Carmel Walsh ◽  
Kieran O'Connor ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Patient Care ◽  
Multidisciplinary Team ◽  
Older Persons ◽  
Patient Flow ◽  
Geriatric Medicine ◽  
City Centre ◽  
Nurse Specialist ◽  
Complex Care ◽  
Clinical Nurse

Abstract Background Patient flow, the movement of patients is an integral part of the patient care pathway. With the goal of improving overall patient care and discharge planning, a hospital wide, multidisciplinary team based, patient discharge meeting or ‘HUDDLE’ was devised with the goal of facilitating onward care planning for all inpatients especially those with complex discharge needs in a city centre teaching hospital. Methods The patient flow huddle has evolved to include a Patient Flow Clinical Nurse Manager, Bed Manager, Medicine for Older Persons Clinical Nurse Specialist, Physiotherapist/Occupational Therapist, Consultant Geriatrician and Geriatric Medicine Registrar. Each team in the hospital are requested to attend at least twice a week. Predicted discharge dates are established. Teams discuss patients who have a requirement for rehabilitation, either short-term or complex rehabilitation and patients over 65 years who may need review from Older Persons Services .We sought to optimise issues including housing, home care packages, interim home supports, community intervention team referrals, integrated care and Nursing Home Support Scheme applications. Results There were 3918 Emergency Department presentations by adults over 75 in 2018 and 2113 admissions (3704, 2081 respectively in 2017). Accuracy for discharge within one day of PDD ranged from 52.5% (Jan) to 72.6 % (Nov). The average length of stay was 6.2days (SD 0.47). 172 patients (84 female, 88 male) were admitted for slow stream rehabilitation (median length of stay 30 days). Conclusion Rather than using a negative view of older adults as potential ‘bed blockers’, the discharge huddle allowed a pro-active approach to assist medical and surgical teams in the management and re-enablement of patients with complex care needs. Early identification of such patients with complex care and discharge needs allowed greater focus on appropriate planning earlier in the patient’s hospital journey.

Outbreak of varicella in a pediatric oncology unit

1998 ◽  
Vol 31 (3) ◽  
pp. 166-169 ◽  
Author(s):  
John Kavaliotis ◽  
Ioanna Loukou ◽  
Matia Trachana ◽  
Nick Gombakis ◽  
Hetakeia Tsagaropoulou-Stigga ◽  
...  
Keyword(s):  
Pediatric Oncology ◽  
Oncology Unit

Complementary/alternative medicine use in a pediatric oncology unit in Turkey

2007 ◽  
Vol 48 (5) ◽  
pp. 540-543 ◽  
Author(s):  
Ceyda Karadeniz ◽  
F. Güçlü Pınarlı ◽  
Aynur Oğuz ◽  
Türkiz Gürsel ◽  
Berna Canter
Keyword(s):  
Alternative Medicine ◽  
Pediatric Oncology ◽  
Complementary Alternative Medicine ◽  
Medicine Use ◽  
Oncology Unit

scholarly journals Palliative care in paediatric oncology: perceptions, expertise and practices from the perspective of the multidisciplinary team

2015 ◽  
Vol 36 (2) ◽  
pp. 56-62 ◽  
Author(s):  
Adriana Ferreira da Silva ◽  
Helena Becker Issi ◽  
Maria da Graça Corso da Motta ◽  
Daisy Zanchi de Abreu Botene
Keyword(s):  
Palliative Care ◽  
Multidisciplinary Team ◽  
Structured Interview ◽  
Paediatric Oncology ◽  
Lessons Learned ◽  
Team Members ◽  
Descriptive Research ◽  
The Family ◽  
Research Questions ◽  
Oncology Unit

OBJECTIVE: To reveal the perceptions, expertise and practices of multi-professional teams providing palliative care to children in a paediatric oncology unit. The research questions were based on everyday care, facilitations and difficulties, essential aspects of professional approaches, and the inter-disciplinary focus of care for children in palliative care and their families. METHOD: Qualitative, exploratory and descriptive research. Data were collected from June to October 2013 from nine professional multidisciplinary team members by means of a semi-structured interview submitted to thematic analysis. RESULTS: The following four themes emerged from analysis: palliative care: conceptions of the multi-professional team; the construction of singular care; the facilitations and difficulties experienced by the team and significant lessons learned. CONCLUSIONS: The subjects revealed that the team also suffers with the death of a child and, like the family, moves toward the construction of coping mechanisms for the elaboration of mourning. Paradoxically, the team shares knowledge to determine the foundations of a singular therapeutic project and inserts the family in this process so that it can be the protagonist of the child's care.

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