Pediatric Interfacility Transfers – Association of Pre-transfer Vital Signs with Length of Stay at a Tertiary Care Center

Objective: Determine which abnormal pre-transfer vital signs predict longer length of stay (LOS) for pediatric patients transferred to a tertiary care center. Patients and Methods: A retrospective study of all patients transferred between Aug 2016 and Jan 2017 to Maine Medical Center’s pediatric inpatient units, PICU, and Emergency Department with pediatric consult. Charts were examined for pre-transfer vital signs and diagnosis. The primary outcome of interest was LOS. Vital signs were determined to be normal or abnormal using the 2015 PALS Guidelines. Results: Two hundred thirty-six pediatric patients were included. Median LOS was 42.5 hours; median age was 68.0 months. Patients with abnormal RRs before transfer have significantly longer LOS than patients with normal RRs (p= 0.017). Abnormal heart rate, temperature, and oxygen saturation did not predict LOS. Blood pressure (BP) was obtained in only 47.9% of patients; abnormal BP predicted a significantly longer LOS (p= 0.035). Conclusions: The predictive value of an abnormal vital sign in pediatric patients at pre-transfer hospitals varied. RR had a significant correlation with LOS in this tertiary care center, whereas heart rate, temperature, and oxygen saturation did not. Abnormality of BP, although only captured in fewer than half of patients, was associated with longer LOS. With more consistent monitoring in children, BP may also be a good predictor of LOS after transfer. These results may help guide both referring and accepting provider decision-making

Improving safety using HFMEA and insitu simulation prior to initiating contrast MRI studies in an ambulatory setting

The objective of this event was to test a new system for emergency response to MRI contrast reactions by ensuring staff familiarity with emergency equipment and a newly drafted emergency response protocols, and to mitigate any LST identified.https://knowledgeconnection.mainehealth.org/lambrew-retreat-2021/1020/thumbnail.jp

Leveraging the intersectionality of healthcare and hospitality to diversify workforce talent and enhance patient experience

As healthcare becomes more of a consumerism-based industry, organizations and leaders are embracing innovative approaches and models to drive patient choice and brand loyalty. Northwell Health, New York State’s largest comprehensive health system, has integrated hospitality as a core pillar within its dynamic patient experience strategy. This informative case report highlights Northwell’s pragmatic approach to designing, implementing, and sustaining an experiential internship program entitled, Hospitality in Healthcare Internship. The program has resulted in action-oriented patient experience performance improvement opportunities as well as create a robust pipeline of hospitality-minded talent into the organization. Experience Framework This article is associated with the Environment & Hospitality lens of The Beryl Institute Experience Framework (https://theberylinstitute.org/experience-framework/). Access other PXJ articles related to this lens. Access other resources related to this lens

Multifocal Bone Pain, Recurrent Fevers and Anemia in a 15-Year-Old

Introduction: Chronic recurrent multifocal osteomyelitis (CRMO) is an autoinflammatory bone disorder that primarily affects children with recurrent episodes of sterile osteomyelitis in one or more bones. Patients usually present with recurrent bone pain, though it is often a diagnosis of exclusion with most patients undergoing extensive work-up to arrive at a diagnosis. Clinical Findings: This 15-year-old female presented with months of progressive multifocal bone pain, 22-pound weight loss and recurrent fevers. Work-up as an outpatient included a positive screening assay and IgM Western blot Panel positive for Lyme disease, treated with a 28-day course doxycycline without resolution of the symptoms, elevated inflammatory markers and normocytic anemia. She was admitted for further workup when pain progression prevented ambulation. Diagnoses, Interventions and Outcomes: The patient was treated with ketorolac with notable improvement in pain. Labs were unrevealing for underlying infection, autoimmune or hematologic etiology. Spinal MRI demonstrated a compression deformity of her 4th cervical vertebra as well as multifocal bone marrow signal abnormalities. Percutaneous CT-guided core needle biopsy of the manubrium was performed and was consistent with CRMO. Bacterial culture from the bone biopsy grew Cutibacterium (formerly Propionibacterium) acnes. She was discharged on naproxen with some improvement in pain and subsequently received antibiotic treatment when bone culture resulted positive. Conclusions: This case illustrates an unusual presentation of CRMO and emphasizes that it should be on the differential for patients with ongoing bone pain, weight loss and anemia. Multi-disciplinary approach is necessary and early suspicion is important in determining appropriate diagnostic evaluation and targeted treatment

Open-Ended Questions in Web Surveys: Can Increasing the Size of Answer Boxes and Providing Extra Verbal Instructions Improve Response Quality?

Previous research has revealed techniques to improve response quality in open-ended questions in both paper and interviewer-administered survey modes. The purpose of this paper is to test the effectiveness of similar techniques in web surveys. Using data from a series of three random sample web surveys of Washington State University undergraduates, we examine the effects of visual and verbal answer-box manipulations (i.e., altering the size of the answer box and including an explanation that answers could exceed the size of the box) and the inclusion of clarifying and motivating introductions in the question stem. We gauge response quality by the amount and type of information contained in responses as well as response time and item nonresponse. The results indicate that increasing the size of the answer box has little effect on early responders to the survey but substantially improved response quality among late responders. Including any sort of explanation or introduction that made response quality and length salient also improved response quality for both early and late responders. In addition to discussing these techniques, we also address the potential of the web survey mode to revitalize the use of open-ended questions in self-administered surveys

Open-Ended Questions in Web Surveys: Can Increasing the Size of Answer Boxes and Providing Extra Verbal Instructions Improve Response Quality?

Previous research has revealed techniques to improve response quality in open-ended questions in both paper and interviewer-administered survey modes. The purpose of this paper is to test the effectiveness of similar techniques in web surveys. Using data from a series of three random sample web surveys of Washington State University undergraduates, we examine the effects of visual and verbal answer-box manipulations (i.e., altering the size of the answer box and including an explanation that answers could exceed the size of the box) and the inclusion of clarifying and motivating introductions in the question stem. We gauge response quality by the amount and type of information contained in responses as well as response time and item nonresponse. The results indicate that increasing the size of the answer box has little effect on early responders to the survey but substantially improved response quality among late responders. Including any sort of explanation or introduction that made response quality and length salient also improved response quality for both early and late responders. In addition to discussing these techniques, we also address the potential of the web survey mode to revitalize the use of open-ended questions in self-administered surveys

Improving Inclusive Communication: Pilot Results from a Simulation-Based Learning Opportunity to Practice Taking a Sexual Health History

Introduction: Sexual and gender minority (lesbian, gay, bisexual, transgender, questioning; LGBTQ+) patients experience health care inequities. Simulation using standardized patients (SPs) is an effective tool for communication-based training. To promote equitable practice, we created an experiential learning opportunity for residents to practice inclusive communication and improve their comfort in caring for LGBTQ+ patients while maintaining the psychological safety of SPs. Methods: Our interdisciplinary team explored relevant simulation curricula, conducted a focus group with LGBTQ+ SPs, created a didactic presentation, and designed and implemented a simulated case. Family medicine residents participated in the training and completed pre- and post-training surveys rating their confidence in sexual health communication and working with sexual and gender minority patients. We compared Likert scale ratings in pre- and post-training surveys using a Wilcoxon signed-rank test. SPs completed post-simulation surveys rating their psychological safety. Results: Residents completed pre-training (n = 13) and post-training (n = 12) surveys. Confidence improved in every category, reaching significance for confidence in obtaining a sexual health history from LGBTQ+ patients. Four SPs completed post-simulation surveys. All SPs reported that the event had educational value and was a positive experience. Discussion: This innovative simulation training with an equity focus improved learner confidence and maintained the psychological safety of SPs. We speculate that curricular design elements of interdisciplinary collaboration and co-creation with SPs with lived experience may have contributed to the success. Conclusions: Through interdisciplinary collaboration and experiential learning, we created a valuable learning opportunity that allowed residents to improve their confidence in taking inclusive sexual health histories of LGBTQ+ patients

Optimizing psychological safety- perspectives of Standardized Patients who identify as LGBTQ+

Innovative collaboration with LGBTQ+ Standardized Patients yields remarkable impact in development of inclusive sexual health curriculahttps://knowledgeconnection.mainehealth.org/lambrew-retreat-2023/1021/thumbnail.jp

Simulation to Improve Health Equity- Pilot results from a Standardized Patient-based learning opportunity to practice taking an inclusive sexual health history

Improving Inclusive Communication Pilot results from a Simulation-based learning opportunity to practice taking a sexual health history.https://knowledgeconnection.mainehealth.org/lambrew-retreat-2023/1019/thumbnail.jp

Patient Transport in the Time of COVID-19: Using Health Care Failure Mode and Effect Analysis with Simulation to Test and Modify a Protocol

Introduction: In March 2020, in response to the COVID-19 pandemic, an interprofessional, interdisciplinary team at Maine Medical Center used Healthcare Failure Mode and Effect Analysis (HFMEA) and in situ simulation to rapidly identify and mitigate latent safety threats (LST) in patient transport protocols. Methods: Following HFMEA steps, stakeholders representing a variety of disciplines assembled to address transport of patients with COVID-19. A process map was created to describe the process. With hazard analysis using table-top simulation followed by in situ simulation, we identified, categorized, and scored LSTs. Mitigation strategies were identified during structured debriefing. Results: Fourteen LSTs were identified in the categories of infection prevention (4), care coordination (2), equipment (2), facilities (2), teams (2), clinical skills (1), and diagnosis and treatment (1). Of these, 10 had “critical” hazard scores. Mitigation solutions were tested with in situ simulation. Results were shared with leadership and led to changes in hospital-wide protocols. Discussion: The COVID-19 pandemic presented an urgent need to create or adapt protocols to keep patients and staff safe. Our team combined simulation with HFMEA methodology to improve the safety of protocols for transporting patients with COVID-19. Simulation enabled recreation of real-world experience that exposed LSTs more thoroughly than mental walkthroughs alone. Use of HFMEA methodology supported quantifying identified LSTs and proposing mitigation strategies, while in situ simulation facilitated testing many proposed strategies. Conclusions: HFMEA used with in situ simulation provides an effective method to efficiently and thoroughly probe a process for failure modes, providing practical mitigation strategies