Objective: The COVID-19 pandemic has (and will continue to have) quite a strong impact on patients whose mental conditions worsen due to isolation, disruption of usual routine, activities, and loss of community support, if not the infection itself. Therefore, exploring and evaluating existing ways and proposing new ways to communicate and maintain a strong therapeutic alliance between therapists and patients was important.
Methods: A semi-structured interview based on a homemade grid designed to assess participants’ opinions on access to telehealth services and their efficiency. Period of study: March 2020 to June 2021.
Results: Impact of COVID-19 on daily life: 70% experienced isolation due to the pandemic life-changing, 65% experienced anxiety, 42% depression, and 28% anger. Teleconsultations’ perceptions during the COVID-19 pandemic were perceived as a good solution for a pandemic era and no need for displacement (30%). 38% thought that video consultation is a better option than telephone consultations, with 60% stating a similar level of comfort in video/phone consultation compared to in-person. Recommendations to address Mental Health (MH) care delivery soon after this pandemic were: Patients (60%) are interested in accessing a website (or mobile application) on resources of MH services available in their city/region.
Conclusions: Results show that isolation and anxiety were the factors most affecting the social life and conditions of participants, with some significant levels of depression and anger. Participants largely accepted the transition to virtual care with some improvements.

In our health system with multiple campuses, a universal admissions order (UAO) was introduced to further improve patient flow. We hypothesized that the UAO would more evenly distribute health system capacity, with an increase in admissions to the community affiliate sites. Inpatient and emergency department (ED) metrics were evaluated, and included total admissions, admissions to each clinical site from each ED, the time to the inpatient bed being ready to receive the ED patient, boarding times, and the left without being seen rate. After implementation of the UAO, the average time to inpatient beds being ready to accept ED patients decreased at all three clinical sites by an average of 25 minutes. Admissions were more evenly distributed amongst the three clinical sites, with 3% of all admissions admitted to a new campus. While there were likely other variables at play, there was system-wide reduction in the time to inpatient beds being ready to accept ED patients, and an improvement in boarding at the main clinical site. Our work suggests that a UAO could be a useful adjunct to central capacity management in a health system with multiple clinical campuses.

Objective: To describe perceptions among healthcare payers of the importance of and challenges in ensuring accurate member identity in payer organizational operational performance.
Methods: A survey of 35 US healthcare payer executives evaluated perceptions of the importance of accurate member identity to efficient operations and achieving payer strategic priorities, improved financial performance and member satisfaction, and the associated challenges.
Results: Healthcare payers were highly aware that accuracy of member identity is essential to operational effectiveness and efficiency (90.0%). Leading organizational challenges were managing high risk members (43.3%) and effective member engagement (40.0%), both impacted by member misidentification. A majority (73.3%) indicated that current system capabilities do not enable the capture and sharing of accurate, complete member identity, with 43.0% stating it was extremely/somewhat difficult to add member data sources and remove member record duplicates. Only 10.0% were moderately or highly satisfied with the accuracy of their existing member identity management solutions.
Conclusions: Inability to know “who is who” is perceived by payer organizations as impeding financial performance and growth, operational efficiency, and member engagement/satisfaction. While recognizing that member identity impacts nearly every aspect of payer operations, most payer executives lacked confidence in their organization’s ability and deployed technology to achieve a complete and accurate 360-degree view of members.

Objective: The positive impact of quality improvement (QI) on organizational and system outcomes has the potential to contribute to a high-performing health system. Physician engagement in QI has been linked to the success and sustainability of improvement initiatives. An informed overview of physicians’ interests in QI, opportunities to be involved in QI efforts, and insights into physicians’ experiences of participation, both in hospital and general practice is critical to understanding the challenges and opportunities for physician engagement in QI. The purpose of this study was to gain insight into both the number of physicians currently trained and participating in QI and identify key barriers preventing physicians from being trained and participating in QI.
Methods: A cross-sectional online survey was used to evaluate physician engagement in QI. A total of 231 physicians across Ontario, Canada, participated in the study.
Results: Results indicate that leadership should continue to make Quality Improvement (QI) training opportunities available to physicians.
Conclusions: If more physicians are to be engaged in QI, there is a need to clearly identify and communicate opportunities for QI projects.

Objective: To review “triggers” for deteriorating patients who required intervention by a medical emergency response team (MET). In addition, to assess whether these “triggers” differed by medical or surgical governance of these patients. A secondary objective was to report laboratory investigations performed via the MET, with particular interest in tests duplicating haemoglobin (Hb) values and their degree of concordance within the context of low-cost, high value inpatient care.
Methods: This quality improvement initiative involved a prospective observational cohort of inpatients, who were attended to by the MET at Royal Perth Hospital in Perth, Western Australia over a 2-year period between 2020 and 2022.
Results: The mean number of MET calls for inpatients under surgical governance was slightly higher than for those patients under medical governance (1.34 vs. 1.25 calls respectively p =.03). Hypotension triggered a MET call in 184 (40.9%) surgical patients compared to 154 (28%) under medical governance (p <.001). Comparing haemoglobin values obtained from FBP and VBG, Lin’s concordance correlation coefficient (CCC) was found to be 0.986, 95%CI: 0.983, 0.989. The Bland-Altman limits of agreement suggest that the haemoglobin value on a VBG ranges from 9.55 g/L higher than the FBP to 4.7 g/L lower than the FBP.
Conclusions: Significant differences in the frequency of triggers for patients under medical vs surgical governance highlight the need for proactive planning around hypotension management of patients under surgical governance. In addition, understanding the nuances between haemoglobin values obtained from FBP and VBG can help with value-based health care and efficiencies in patient care, since measuring haemoglobin values is one of the key components in hypotension management.

Objective: Previous studies had found that rest breaks can not only prevent or improve negative reactions to stress in healthcare staff, but also reduce turnover in understaff conditions, improve work performance, and ultimately improve patient outcomes. As a result, many inpatient units had implemented a nursing position called a Break Nurse, whose sole purpose was to provide rest breaks. However, the implementation of a Break Nurse and its effectiveness was not reported in literature. Therefore, this quality improvement QI project proposed to implement Break Nurses on an acute care unit of impatient setting and investigate its effectiveness on nursing staff.
Methods: The selected unit previously utilizing a Break-Buddy model for securing rest breaks was able to start a two 8-hour shift Break Nurse model. The hypothesis is that the Two-Break-Nurse model, when compared with the Break-Buddy model, will better secure rest breaks, reduce burnout symptoms experienced by nursing staff. The validated tool used to measure burnout is the Maslach Burnout Inventory. The study utilized pre- and post-implementation self-report survey statistical analysis to report outcomes.
Results: In the end, 14 individuals had responded to both pre- and post-implementation surveys. The results show that there was statistically significant improvement of Emotional Exhaustion. Due to the small sample size, the measurement of Depersonalization and Personal Accomplishment did not show statistically significant improvement.
Conclusions: The Two-Break-Nurse model is effective at reducing emotional exhaustion for nursing staff. Further studies are needed to measure in a larger scale the effectiveness of break nurse model on other aspects of burnout and the improvement of clinical outcomes.