Improving Quality of Communication in Pediatric Perioperative Outpatient Setting Using AIDET and Commit to Sit

Abstract Problem: Effective and therapeutic communication in the health care setting is multidisciplinary, complex, and has unique challenges for each microsystem. The perioperative setting is an especially challenging environment for healthcare workers to provide therapeutic communication, as uniquely high-risk and time-sensitive information must be disseminated in a language that is understandable for the patient(Osborne-Smith & Kyle Hodgen, 2017). A microsystem assessment of an outpatient pediatric perioperative setting reflected some of the challenges the healthcare workers were facing when communicating with their patients and family members. Upon evaluation of the monthly NRC (National Research Corporation) score prior to implementation of two communication tools AIDET and Commit to Sit as a part of the quality improvement intervention, the perioperative outpatient setting needed improvement in several areas of communication. Patients reported low satisfaction scores regarding: trust providers with care, care providers listened, was told when could leave, got help as soon as wanted, care provider explained things, facility would recommend, and procedure began on time (Appendix J). Context: The pediatric perioperative outpatient setting in which the interventions were carried out services pediatric population ranging from two to eighteen years of age. The racial and ethnic background of both the staff members and patient population were diverse, with Hispanic, Asian American, Caucasian, African American, and American Indians making up a vast majority of the setting. The main population the two communication tools utilized for communication quality improvement targeted was the healthcare staff members who interact with the pediatric population and their family members as a routine part of the work. These healthcare staff 3 members included nurses, anesthesiologists, surgeons, child life specialists, and surgical technicians. Interventions: Two communication tools, AIDET (Acknowledge, Introduce, Duration, Explanation, and Thank you) and Commit to Sit, were taught and encouraged to use for all staff members in the outpatient setting. Culturally competent care, the Acknowledge part of AIDET, was also highlighted and strongly encouraged to take note of and utilize when providing care. Information on how to utilize AIDET and Commit to Sit was disseminated through unit-wide email as well as a presentation on what the two communications are and some examples on how they can be used. Key points on the two communication tool utilization were emphasized through roleplay simulation involving one staff member and two project group members. Three roleplay scenarios, each with a different focus on culturally competent care and the two communication tools in general, helped the staff members understand how AIDET and Commit to Sit can become part of their patient communication going forward. Information on culturally competent care for different patient populations and resources to measures one’s own biases were introduced and encouraged to use as well. Measures: The effectiveness of the communication tools were measured via monthly National Research Corporation (NRC) patient satisfaction scores before and after implementation. These scores are based on unit-specific questions that allow the patient and/or family member to rate if specific parts of their care met their expectations. These survey answers are then collected and analyzed to see if unit goals for the NRC scores are being met every month. Knowledge on AIDET and Commit to Sit concepts were measured through pre and post-implementation survey written by the project group. The pre-implementation survey measured the level of knowledge the staff had on the two concepts, six months after they were introduced to them by the last 4 project group. A post-implementation survey was used to measure whether the roleplay-simulation and sufficient time between the first and second presentation by the current project group allowed increased understanding of AIDET and Commit to Sit. Results: The goal of this project was to improve overall NRC scores in the pediatric perioperative outpatient setting. AIDET with an emphasis on cultural competence and Commit to Sit were two communication tools chosen to help the outpatient clinic staff improve certain areas of their communication. Problems the staff were facing were evaluated and staff input was encouraged throughout the process to better their learning experience. Staff pre vs. post-implementation survey data showed 100% of those who answered believed education and reinforcement on AIDET and Commit to Sit were useful in increasing patient satisfaction. Overall NRC score from before any education on AIDET and Commit to Sit was 80.7. After all education materials were disseminated, the overall NRC score was 83.3, an increase of 2.6 overall NRC score for the outpatient clinic. Conclusion: AIDET, a communication framework, and Commit to Sit, a reminder for healthcare professionals to provide eye-level communication whenever possible, helped increase overall patient satisfaction NRC scores. AIDET allows for providers to remind themselves important pertinent information patients find most important such as duration. Commit to Sit reminders placed throughout the unit in the form of posters helps healthcare staff take a few extra seconds to get to eye-level with the patient and their family members, making them feel more appreciated and help them approach the healthcare professional more easily. These changes in the perception of therapeutic communication with patients for healthcare providers showed to be effective in increasing overall patient satisfaction

Optimal Ventilation Design for Flammable Gas Leaking from Gas Box Used in Semiconductor Manufacturing: Case Study on Korean Semiconductor Industry

Highly flammable substances such as hydrogen and silane are used in the semiconductor manufacturing process. When gas leaks, it is mixed with outside air and connected to a treatment facility through the duct inside the gas box. This study investigated optimal exhaust design to prevent fire explosions and health problems by optimizing the exhaust volume when hydrogen leaks from the gas box of semiconductor manufacturing equipment. After selecting the leakage rate amount based on the KS C IEC 60079-10-1, SEMI S6-0707E, and SEMI F-15 standards, a gas box was manufactured. Subsequently, the fan speed required to ventilate the gas box more than five times per minute according to the SEMI standard and the opening area and location that can reduce the lower explosive limit (LEL) to less than 25% in the event of hydrogen leakage were determined. When the air intakes were placed on the left and right, the flow rate was measured at 32 L per minute (LPM), and the maximum concentration was measured at 9111 ppm. This is less than 25% of the LEL of hydrogen and is believed to be capable of preventing fire and explosion, even if a similarly flammable gas leaks inside the gas box

OBSERVATIONS OF STRATOSPHERIC OZONE MIXING RATIO BY GROUND-BASED MILLIMETERWAVE MEASUREMENTS AT SOOKMYUNG WOMEN'S UNIVERSITY

$^{a}$J.J. OH (email address:[email protected]) express sincere thanks to Prof. de Zafra for his help on the data reduction.Author Institution: SookMyung Women's University; Departmentment of Chemistry, SookMyung Women's University; Departmentment of Chemistry, Taeduk Radio Astronomy ObservatoryThe $J = 6_{1,5} - 6_{0,6}$ rotational transition of stratospheric ozone at 110.8359 GHz has been observed using a Schottky diode mixer receiver at Sookmyung Women's University in Seoul during 8-26 March 2000 by the load switching method. The instrument consists of a millimeter wave receiver, a multi-channel spectrometer and a computer. The mixer block is cooled to a temperature of 20 K by a closed cycle refrigerator of liquid He and the system temperature was determined to be about 850 K. The observed spectrum has been analyzed to determine variations in the ozone mixing ratio at various altitudes above Seoul. The retrieval algorithm used to obtain the data will be discussed and the variations of the altitude profiles will be compared

Reliable and robust method for abdominal muscle mass quantification using CT/MRI: An explorative study in healthy subjects.

BackgroundQuantification of abdominal muscle mass by cross-sectional imaging has been increasingly used to diagnose sarcopenia; however, the technical method for quantification has not been standardized yet. We aimed to determine an optimal method to measure the abdominal muscle area.MethodsAmong 50 consecutive subjects who underwent abdominal CT and MRI for possible liver donation, total abdominal muscle area (TAMA) and total psoas muscle area (TPA) at the L3 inferior endplate level were measured by two blinded readers. Inter-scan agreement between CT and MRI and inter-reader agreement between the two readers were evaluated using intraclass correlation coefficient (ICC) and within-subject coefficient of variation (WSCV). To evaluate the effect of measurement level, one reader measured TAMA and TPA at six levels from the L2 to L4 vertebral bodies.ResultsTAMA was a more reliable biomarker than TPA in terms of inter-scan agreement (ICC: 0.928 vs. 0.788 for reader 1 and 0.853 vs. 0.821 for reader 2, respectively; WSCV: 8.3% vs. 23.4% for reader 1 and 10.4% vs. 22.3% for reader 2, respectively) and inter-reader agreement (ICC: 0.986 vs. 0.886 for CT and 0.865 vs. 0.669 for MRI, respectively; WSCV: 8.2% vs. 16.0% for CT and 11.6% vs. 29.7% for MRI, respectively). In terms of the measurement level, TAMA did not differ from the L2inf to L4inf levels, whereas TPA increased with a decrease in measurement level.ConclusionsTAMA is a better biomarker than TPA in terms of inter-scan and inter-reader agreement and robustness to the measurement level. CT was a more reliable imaging modality than MRI. Our results support the use of TAMA measured by CT as a standard biomarker for abdominal muscle area measurement

Singlet Exciton Delocalization in Gold Nanoparticle-Tethered Poly(3-hexylthiophene) Nanofibers with Enhanced Intrachain Ordering

The effects of Al content (0.53 <= Al <= 9.65 wt%) on microstructure, texture, magnetic flux density, permeability, core loss and magnetic domain structure of Fe-Al based electrical steel were measured or observed. Average grain size decreased as Al content increased, but Al contents had no severe effects on texture. Magnetic flux density and permeability tends to decrease as Al content increased. Total core loss P-tot was separated into hysteresis loss P-h, eddy-current loss P-e and anomalous loss P-a. As Al increased, P-h increased, but P-e and P-a decreased, so the optimal grain size increased. To reduce core loss of electrical steel with high resistivity, annealing should be conducted at high temperature and for a long time to increase grain size.111Nsciescopu