Impact of a digital care logistics system on care duration, consumer satisfaction and shift leaders' workload in emergency departments

The primary goal of introducing digital information systems in healthcare organisations is to improve care processes and outcomes, however, studies that investigate the impact of digital information systems on the day-to-day operations management from the perspective of workflow and consumer satisfaction in emergency departments are scarce. Therefore, this study aimed to explore the impact of a digital clinical logistics system on the duration of patient care, consumer satisfaction and shift leaders' experience of workload in emergency departments. A longitudinal prospective design was used. Three units participated in the study; an intervention unit, a control unit A (no implemented system) and a control unit B (system already in use). We collected data on care duration, consumer satisfaction and shift leaders' experience of workload for four weeks at five time points both before system implementation (summer 2015, spring 2016) and after system implementation (summer 2016, autumn 2016, winter 2016). The average care duration time increased in the postimplementation period in the intervention and control B units (p < 0.001). Duration of care was higher in the intervention unit than control unit B in summer 2016 (p < 0.001) and winter 2016 (p = 0.009). Similarly, duration of care in control unit A was higher than control unit B in spring 2016 (p < 0.001). Consumer satisfaction decreased in the intervention unit, in winter 2016 (p < 0.001) and the experience of workload increased in the intervention unit, in summer 2016 and autumn 2016 (p < 0.05). However, the patients-to-nurses ratio was doubled in the intervention unit in the last time point postimplementation when compared to the first timepoint, while it remained similar in the control units throughout the study period. This work demonstrated that a digital care logistics system may support in increasing the number of patients treated with the same nursing resources. However, this seems to connect to other outcome variables such as increased care duration, increased experience of workload and decreased consumer satisfaction in some postimplementation time points.

Implementation of Daily Pharmacy Student New Medication Education During Hospitalization to Improve Patient Satisfaction

Introduction: Studies have shown that patients would like to receive more medication education while hospitalized. Higher patient satisfaction has been correlated with lower mortality and fewer hospital readmissions. Methods: This was a quasi-experimental study. Four Doctor of Pharmacy students were assigned 1 medicine inpatient unit to provide education on new medications during the study period, June to September. The primary endpoint was the change in HCAHPS scores for the medication communication domain composite for the intervention unit and a similar control unit that was not receiving the intervention from the pre-intervention to the intervention periods. Results: A total of 124 patients were educated during the intervention period, with an average age of 65 and 2.2 new medications. Average HCAHPS scores for the medication communication domain for the intervention unit increased from 68% pre-intervention to 91% during the intervention ( P = .389) while the control unit remained unchanged at 78% both pre- and during the intervention ( P = .13). Conclusion: An increase in the medication communication HCAHPS score for the intervention unit was observed, while the control unit remained stable. This study has the potential to drive change by implementing pharmacy students throughout inpatient units to educate patients on new medications thereby improving patient satisfaction.

Rigless Remote Intervention: A Case Study of Combo Unit Utilization in Mahakam Offshore East Kalimantan

Mahakam block has been producing for over 40 years and now is in declining phase. Daily drilling and well intervention operations are still actively carried out to sustain and prolong the natural decline curve. Efficiency measures are taken out in each and every aspect of operations to support the diminishing values. One of them is the reduction of offshore platform sizing. Future minimalist platforms have limited top deck space which will further be reduced by the prevalence of: 1. Fixed platform equipment (generators, crane, etc.), and 2. Hazardous area requirement for Zone 0, Zone 1, and Zone 2. The future minimalist platform has a deck space area of approximately 221 m2, not yet taken into account said the reduction factors. The presence of the hazardous area and fixed equipment can reduce the free deck space availability down to 20% from the total deck space. These platforms are not originally designed with well intervention work in mind. However, the past 40 years proves that well intervention should never be left out when extending well’s lifetime is the objective. Well intervention unit, depending on the intervention type, requires top deck space from 26 m2 up to 92 m2 of free space, and an additional 3-4 m2 for lifting, means such as mast unit if the platform does not have a crane. Moreover, in a remote intervention mode, where no supporting barge is present, space requirement above the top deck became crucial as there is no alternative to back load unit to the barge incase the top deck beingover crowded. To support the continuity of remote intervention being more efficient alternative to barge-supported operation, the well intervention team initiates the feasibility study using combo unit as a replacement for conventional slickline and electric line unit. There are three types of combo unit presented in this paper, 1. Split Combo Unit, 2. Combined Drum Combo Unit, and 3. Digital Slickline Combo Unit. These types of unit can reduce the deck space requirement by 30%, reducing number of personnel needed from eight (8) to five (5) personnel in a single shift, improving operation timing efficiency, and improves the contract administration aspect. Despite the seemingly positive results, there are still issues to be resolved, both technical and non-technical, for combo unit to be an all-rounder solution for wireline work. This paper shall provide an early level observation and analysis for the feasibility of combo unit as remote well intervention unit, starting from the methodology to the corresponding results and lesson learnt.

The Motivation of Eighth Grade Students When They Learn the Parallelogram Subject in a Computerized Environment

The goal of the current study is to examine the impact of the computerized technological environment on the motivation of eighth graders while learning the subject of parallelogram, and whether there are differences in the level of motivation of students who studied parallelogram in a computerized environment and those who studied the same subject in a traditional school environment. The use of the semi-experimental descriptive analytical curriculum, which consisted of a sample of (30) eighth grade students who were selected in a deliberate manner was implemented. The main study tool is a set of pretests and posttests, along with a computerized intervention unit that is meant to enhance students’ motivation. The results of the study clearly indicate that the involvement of the computerized environment contributed to raising the students’ level of mastery of parallelogram as a subject in eighth graders by raising internal motivation. In light of the findings of the study, the researcher recommends adopting the results of the research, handling the computerized environment as an integral part of the educational system, and qualifying the teacher to be able to actively work within a computerized environment.

Complexities in Defining the Unit of Intervention for Reactive Community-Based Malaria Treatment in the Gambia

With significant declines in malaria, infections are increasingly clustered in households, or groups of households where malaria transmission is higher than in surrounding household/villages. To decrease transmission in such cases, reactive interventions target household members of clinical malaria cases, with the intervention unit (e.g., the “household/s”) derived from an epidemiological and operational perspective. A lack of unanimity regarding the spatial range of the intervention unit calls for greater importance to be placed on social context in conceptualizing the appropriate unit. A novel malaria elimination strategy based on reactive treatment was recently evaluated by a cluster randomized trial in a low transmission setting in The Gambia. Transdisciplinary research was used to assess and improve the effectiveness of the intervention which consisted, among others, of reflecting on whether the household was the most adequate unit of analysis. The intervention was piloted on the smallest treatment unit possible and was further adapted following a better understanding of the social and epidemiological context. Intervention units defined according to (i) shared sleeping spaces and (ii) household membership, showed substantial limitations as it was not possible to define them clearly and they were extremely variable within the study setting. Incorporating local definitions and community preference in the trial design led to the appropriate intervention unit—the compound—defined as an enclosed space containing one or several households belonging to the same extended patrilineal family. Our study demonstrates the appropriateness of using transdisciplinary research for investigating alternative intervention units that are better tailored to reactive treatment approaches.

Systems Addressing Frail Elder Care: An Implementation Study

SAFE CareTM was developed at one hospital and found to be an effective care model for frail older adults. SAFE CareTM includes nurse screening for frailty risks, multidisciplinary assessments, team huddles and care recommendations. Underlying implementation is an organizational change process. Study aim was to evaluate the implementation and outcomes of SAFE CareTM in three additional hospitals. Two units from each hospital were randomized to SAFE CareTM or usual care. Process evaluation employed semi-structured interviews. Inpatients were aged 65+ years with positive frailty risks (N = 1,151). Outcomes evaluated ICU admission, length of stay (LOS), and discharge destination. All outcome analyses were conducted with intention to treat models. Patients were on average 80 years old, 54% female, 58% Caucasian, 83% English speaking, with 3.4 positive frailty risks. Median LOS was 4.2 days, 6.5% ICU admissions, 32% discharge institutional care. Hospitals differed in patient demographics and outcomes. While no differences between treatment groups in patient demographics, intervention patients had more frailty risks and longer expected LOS. 62% of intervention unit patients received intervention. There were no univariate treatment effects on outcomes. In multivariate analysis, intervention unit patients had shorter LOS. While hospitals reported different experiences, all reported challenges in preparing the electronic health record to support SAFE CareTM. Staff reported increased interprofessional team communications. Differences among the hospitals in patients and organizational attributes argue strongly that implementation should be tailored to meet varying institutional needs while common measures and processes underlying implementation should be followed closely.

The Use of Light Sensors in Alcohol Gel Dispensers to Improve Hand Hygiene Compliance of Health Care Workers

Background: Improving adherence to hand hygiene (HH) of healthcare workers (HCWs) is a challenge for health institutions, and the use of technologies has been considered an important strategy within this process. Methods: To evaluate the impact of the use of alcohol-based hand rub gel (ABHR) dispensers with light sensors on the adherence to HH by HCWs. This is a prospective quasi-experimental study with comparative analysis between two 4-bed adult intensive care units at a private, tertiary-care hospital conducted over 22 weeks. An approach detection module with an LED lamp was attached to the ABHR dispenser. As a healthcare personnel approached it, the sensor was activated, and a red light turned on as a visual stimulus for HH. The color of the light changed to blue when HH was performed. All ABHR dispensers had electronic counters, but light sensors were installed only in the 4-bed dispensers of the intervention unit. Throughout the period, direct observation of adherence to HH was performed by 4 nurses who had previously been rated with an excellent coefficient of agreement (κ test = 0.951 and 0.902). At the end of the study, a perception survey was performed with the HCWs. Results: The median activation of ABHR dispensers per week was higher in the intervention unit with 1,004 (IQR, 706–1,455) versus 432 (IQR, 350–587) in the control group (P < .001). The same occurred when compared to the median activation per 1,000 patient days, with 53,069 (IQR, 47,575–67,275) versus 19,602 (IQR, 15,909–24,500) in the control group (P < .001). However, there was no evidence of difference in adherence to HH during direct observation between the 2 groups: 51.0% HH compliance (359 of 704) in the control group and 53.8% HH compliance (292 of 543) in the intervention group (P = .330). The same result emerged when we evaluated the “My Five Moments for HH” and by professional category. HCWs (N=66) answered the perception survey: 66.6% stated that lighting devices caught their attention regularly or most of the time and 59% agreed that the devices motivated HH. Conclusions: Using light sensors in ABHR dispensers can be an effective technology for improving HH. This finding was evident in the evaluation of the number of uses of the ABHR dispensers and in the HCW perceptions. Although direct observation did not show statistical evidence of difference between the groups, adherence was higher in the intervention group.Funding: NoneDisclosures: None

Effectiveness of a simple intervention for prevention of catheter-associated urinary tract infections on a medical hospital unit

Background: Urinary tract infections (UTI) are one of the most common hospital-acquired infections with 80% as a result of urinary catheterisation. Aim/Objective: This study examined the impact of a simple intervention consisting of a daily chart reminder in patients with indwelling urinary catheters (IUC) on the duration of catheter use and the incidence of catheter-associated UTIs (CAUTIs). Methods: The trial used a prospective pretest–post-test design with a control group over a six-month period conducted on two medical units of a community teaching hospital. We included all patients admitted to two medical units between 1 June and 30 November 2016 who had an IUC inserted at the study site. During the intervention phase, a sticker was placed in the charts of patients with urinary catheters reminding physicians to assess for catheter removal if not clinically necessary. Results: A total of 195 patients participated in this study (112 control unit, 83 intervention unit). There was a decrease in the duration of IUC use on the intervention unit from 11.7 days to 7.5 days ( P = 0.0028). There was a decrease in repeated catheterisation from 11.1% to 2.1% ( P = 0.0882), and CAUTIs from 17.5% to 4.6% ( P = 0.0552) but this did not reach statistical significance. Discussion: The implementation of a daily IUC reminder sticker in patient charts was associated with a significant reduction in the mean duration of indwelling catheter use with a trend towards a reduction in the frequency of repeated urinary catheterisation and rate of CAUTIs.