A Quality Improvement Initiative to Decrease Time to Analgesia in Patients With Sickle Cell and Vaso-Occlusive Crisis: A Population With Disparities in Treatment.

INTRODUCTION: Vaso-occlusive crises (VOCs) are the leading cause of emergency department (ED) visits and hospitalizations in patients with sickle cell disease (SCD). Timely administration of analgesia, within 60 minutes of patient registration, is the standard of care for SCD patients with VOCs. Patients with VOCs have longer times to initial analgesia compared to similar painful conditions. The primary aim of the project is to have 75% of patients with VOCs receive initial analgesia within 60 minutes of being registered, the current recommended time frame from the National Heart, Lung, and Blood Institute (NHLBI). METHODS: A multi-disciplinary team used quality improvement (QI) methodology to develop a plan involving multiple Plan-Do-Study-Act (PDSA) cycles. A rapid evaluation process was employed which included notification of a patient with a VOC being placed in a room, rapid evaluation by all team members and use of an electronic order set. RESULTS: The aim was met 72% of the time during our intervention period, compared to 17% pre-intervention. Average time to initial analgesia was decreased from 61 minutes to 42 minutes (p-value < 0.001), while time to disposition was also decreased when time goals were achieved. CONCLUSION: Using a rapid evaluation process we were able to decrease time to initial analgesia in a patient population that has previously experienced delays in care and decrease overall time to disposition.

Improved Perceptions of Education and Wellness Among General Surgery Residents and Faculty After the Implementation of Outpatient Scribes.

BACKGROUND: Recent studies have revealed a high rate of burnout among general surgery (GS) residents. Efforts to design and implement interventions to mitigate fatigue in surgical trainees are critical. Our aim was to assess the educational and wellness impact of outpatient scribe utilization at an academic GS residency program. METHODS: Electronic surveys were sent to 38 GS residents and 15 faculties who used outpatient scribes for at least 12 months. Questions were scored on a 5-point Likert scale with answers of "Strongly agree" or "Agree" representing affirmative responses. RESULTS: Thirty residents and 14 faculty completed the survey, resulting in an 83% overall response rate. Twenty-eight (93%) residents and 12 (86%) faculty believed that scribes decrease the daily workload of trainees. Twenty-seven (90%) residents felt that scribes allow them more time to focus on patient care and improve the quality of their surgical education. Ninety-three percent of residents (n = 28) and faculty (n = 13) believed that scribes enhance resident well-being. Twenty-four (80%) residents reported that scribes help improve adherence to duty hour restrictions. Twenty-five (83%) residents believed that utilizing scribes is an effective fatigue mitigation strategy for surgical training programs. CONCLUSION: Our findings demonstrate that the implementation of an outpatient scribe program at an academic GS residency program may enhance resident education and wellness.

Scientific innovation's two Valleys of Death: how blood and tissue banks can help to bridge the gap.

Most biomedical basic research in the United States takes place at universities and research institutes and is funded by federal grants. Basic research is awarded billions of federal dollars every year, enabling new discoveries and greater understanding of the fundamental science that makes new innovations and therapies possible. However, when basic research yields an invention of practical use and the research evolves from basic to applied, the playing field changes. Pre-technology licensing federal dollars all but disappear, and innovations rely predominantly on private funding to support the full path from bench to bedside. It is along this path that the scientific advance faces two Valleys of Death. These sometimes insurmountable development stages are the product of the innovation's inherent financial, business and investment risks. Well-planned and executed in vivo studies using quality biological materials demonstrating proof-of-concept is often the key to bridging these gaps, and blood and tissue banks offer unique services and resources to enable this process.