Improving care safety by characterizing task interruptions during interactions between healthcare professionals: an observational study.

Few studies have investigated interruptions to the work of professionals practicing in inpatient hospitals, and even fewer take account of the functions that make up the system. Safety of care can be improved by considering avoidable interruptions during interactions between managerial and care delivery functions. The present study describes the characteristics of interruptions to the work of professionals working in the inpatient hospital sector, with respect to their typology, frequency, duration, and avoidability in the context of interactions between functions. This direct observational study of interruptions in hospital care was performed in the Pays de la Loire (west coast) area of France. A total of 23 teams (17 institutions) working in medical or surgical specialties (excluding intensive care) were included. Observations were performed between May and September 2019, and lasted seven consecutive hours per team. A pair of observers simultaneously observed the same professional for ∼30 min. Each occupational category was examined. Reported characteristics were: (i) the method and duration of the request, (ii) the location of interrupted and interrupting persons, (iii) the reaction of the interrupted person, (iv) the characteristics of the interrupting person, and (v) the classification of interrupted and interrupting tasks according to their function. An avoidable interruption was defined. Interruptions during interactions between professionals were categorised in terms of their function and avoidability. Descriptive statistical analyses (mean, standard deviation, and distribution) were run. In particular, cross-comparisons were run to highlight avoidability interruptions and interactions between managerial and care delivery functions during the working day, for different professional categories, and for the location of the request. Overall, 286 interrupted professionals were observed and 1929 interruptions were characterised. The majority of interruptions were due to a face-to-face request (58.7%), lasting ≤30 s (72.5%). Professionals engaged in the response in 49.3% of cases. A total of 57.4% of interruptions were avoidable. The average number of interruptions was 10.5 (SD = 3.2) per hour per professional. An analysis of avoidability and interactions between managerial and care delivery functions found that the period between 12:00 and 13:00 was the riskiest in terms of care safety. This study highlighted the characteristics of interruptions to the activity of professionals working in inpatient hospitals. Care teams could focus on making medical and nursing professionals much more aware of the importance of interruptions, and each team could decide how to best-manage interruptions, in the context of their specific working environment.

Dalbavancin in Real Life: Economic Impact of Prescription Timing in French Hospitals.

INTRODUCTION: The extended half-life of dalbavancin justifies a once-a-week dosing schedule and is supposed to favour early discharge. These advantages may therefore compensate for the cost of dalbavancin, but no real-life assessment has been conducted to date. We aimed to assess the real-life budget impact of dalbavancin through its impact on the length of stay in French hospitals. METHODS: A multicentre cohort based on the French registry of dalbavancin use in 2019 was compared to the French national discharge summary database. Lengths of stay and budget impact related to the infection type, the time of introduction of dalbavancin, the type of catheter and patient subgroups were assessed. An early switch was defined when dalbavancin was administered as the first or second treatment and within less than 11 days of hospitalization. RESULTS: A total of 179 patients were identified in the registry, and 154 were included in our study. Dalbavancin was mostly used for bone and joint infections (56.0%), infective endocarditis (19.0%) and acute bacterial skin and skin structure infections (6.0%). When compared to the data for similar patients in the national database, the length of stay was almost always shorter for patients treated with dalbavancin (up to a reduction of 13 days). The budget impact for dalbavancin was heterogeneous but frequently generated savings (up to 2257.0 €). Early switching (within less than 11 days) was associated with savings (or lesser costs), with even greater benefits within 7 days of hospitalization. Patients who required a deep venous catheter as well as the most severe patients benefited the most from dalbavancin. CONCLUSION: Our study confirms that dalbavancin is associated with early discharge, which can offset its cost and generate savings. The greatest benefit is achieved with an early switch.

[Knowledge of geriatric oncology in nursing homes: survey among healthcare professionals working in nursing homes in Pays-de-la-Loire.] / Connaissance de l'onco-gériatrie en Ehpad : enquête réalisée auprès des professionnels de santé dans les Ehpad des Pays-de-la-Loire.

OBJECTIVE: The increased incidence of cancer with age and rise of oral chemotherapy will affect the management of nursing home's residents. The aim of our study was to evaluate knowledge and practices in oncogeratric of nursing home's professionals from Pays-de-la-Loire and to raise awareness. METHODS: In partnership with UCOG-pl, OMEDIT and Observatoire du Cancer, we realised an observational survey from April to September 2017. Three questionnaires were sent to coordonary doctors (CD), nurses and paramedics, along with informative documents. RESULTS: In 589 nursing homes, 82 CD, 147 nurses and 240 paramedics gave an answer. The estimation of cancer's prevalence was 8,75%. Breast and prostate cancers were the most frequent. Nursing homes were an appropriate place to screen cancers by 79% of professionals. Some difficulties were reported by more than 80 % of them (coordination, residents' relationships...). At least, 20% of professionals couldn't define properly oncogeriatric. Only 73% of CD, 16% of nurses and 5% of paramedics knew about ongeriatric evaluations. Only 50% of CD knew about the G8 table, 15% of the oral cancer treatment file, 34% UCOG and 23% of the Observatoire du Cancer. Less than 5% of other professionals knew about this tool and these organisations. After information, most of the professionals think they will use them. Oral chemotherapy was already used by 90% of nurses, but the follow-up was considered inadequate. DISCUSSION: Our survey shows a low awareness about oncogeriatric by the nursing home's professionals. This misreading and under-diagnosis of cancer in nursing homes could partly explain by the lake of training, communication and coordination with oncology professionals and the distinctive characteristics of nursing home's residents. Study suggests that raising awareness of oncogeriatric and its challenges to all professionals would improve the care of the elderly with cancer.