Redesigning the Workflow Process to Upload Paper Consents into the Electronic Health Record

Background: Before starting cellular therapy treatment, patients and their physicians must sign consent forms for Standard of Care (SoC) treatment plans as well as ancillary protocols. To avoid delay in patient care, signed SoC consents are scanned into the Electronic Health Record (EHR) in a timely manner, and protocol consents are handed off to the research team to manage as needed. The COVID-19 pandemic forced our large academic center to adapt this consent management workflow to function with fewer onsite staff, which resulted in prolonged turnaround time for consents to be uploaded into the patient's EHR, and operational inefficiencies (e.g. lost consents requiring re-signing, increase workload for staff, etc.). The process involved 4 cross-functional teams, and handoffs spanning multiple physical locations. Combined with the increasing patient volume of our center, the consents process was unsus-tainable and inadequate. Method(s): Our first redesigned process involved physicians dropping off signed consents directly in the clinic workroom.A Research Coordinator would then sort out the protocol consents and hand off SoC consents to the Health Information Systems (HIS) team for EHR scanning. This new process reduced the number of stakeholders handling the consents and consolidated the handoff location to one location. While this allowed for marked improvement in turnaround times for SoC consent scanning, there were additional opportunities to integrate the workflow with the HIS team's existing processes to allow for further efficiencies. After 4 months, we implemented our second redesigned process: after drop-off in the clinic workroom by physicians, the HIS team would collect all consents three times per day and scan SoC consents while setting aside protocol consents for the Research team to pick up. This allowed for SoC consents to be scanned without delay and reduced workload for the Research team all while streamlining our workflow into existing HIS processes. See Figure 1 for workflow iteration details. Result(s): The new processes reduced the average turnaround time for SoC consents scanned into the EHR from 8 to 2 busi-ness days. Furthermore, we have increased the number of consents scanned same day into the EHR from 18% under the 1st redesign, to 52% with the 2nd redesign (see Figure 2). We have also diminished the error rate (including lost consents) to 1% of consents processed. (Figure Presented)(Figure Presented) Conclusion(s): The redesigned consents workflow resulted in quicker uploads into the EHR, increased same day uploads and has made lost consents statistically insignificant. Timely uploads of consents into EHRs have also allowed us to flag and resolve any issues earlierCopyright © 2023 American Society for Transplantation and Cellular Therapy

Tropheryma Whipplei Endocarditis: A Diagnosis In Hindsight

Description of case: We report a case of Tropheryma whipplei endocarditis, a rare cause of bloodculture-negative infective endocarditis (BCNIE). Due to its rarity and lack of availability of diagnostic tests in district hospitals, the diagnosis remains challenging. The objective of this case report is to increase physician awareness of this pathogen. A 61-year-old man presented to the Emergency Department with central chest pain at rest. A 12-lead ECG demonstrated ST- segment depression in V4-V6 leads, and his serial troponin levels were raised. He was commenced on treatment for acute coronary syndrome and transferred to the Coronary Care Unit. An echocardiogram showed a 15mm x 15mm vegetation in the aortic valve with mild aortic regurgitation. His initial microbiology workup, which included two sets of blood cultures (pre-antibiotics), MRSA screen & COVID-19 PCR, was negative. He was transferred to a cardiothoracic centre four days later. Pre-operative CT coronary angiogram showed severe three vessel coronary artery disease. He underwent triple coronary artery by-pass grafts and tissue aortic valve replacement. During early post-op recovery, he had fever episodes and an elevated C-reactive protein of 280 mg/L but normal white cell counts. He was treated with intravenous Tazocin for hospital-acquired pneumonia and discharged on doxycycline. Two weeks post-discharge, he had a positive 16S/18S PCR for Tropheryma whipplei on molecular analysis of the aortic valve. He was treated for Whipples endocarditis with a 4-week course of IV Ceftriaxone, followed by a 12-month course of oral Cotrimoxazole. The patient has reported doing well since the surgery. Discussion(s): Molecular assay with PCR of the heart valve is the mainstay of diagnosing Whipple's endocarditis. There have been 5 previously reported cases of Whipple's endocarditis in the United Kingdom in our knowledge. It is likely under-reported because of a reliance on tissue diagnosis. Preceding intestinal manifestations and arthralgia should raise its clinical suspicion for timely workup. Physician awareness of Whipple's Endocarditis is paramount in investigating for this pathogen.

Stressors, manifestations and course of COVID-19 related distress among public sector nurses and midwives during the COVID-19 pandemic first year in Tasmania, Australia.

Impacts of the COVID-19 pandemic on the mental health of healthcare workers has been established, linking workplace factors with high levels of stress, anxiety, depression, insomnia and burnout. Less established is how COVID-19 affects both work, home and social life of nurses and midwives concurrently. This study describes the prevalence and severity of anxiety, depression, post-traumatic stress disorder (PTSD) and insomnia and examines their associations with stressors within the work, home and social environment, among nurses and midwives. A longitudinal, mixed-methods, online survey explored the psychological health of public sector nurses and midwives during the COVID-19 pandemic first year. Surveys were conducted in April (initial) and June 2020 (3-month), and April 2021 (12-month) and consisted of psychological tests including the Patient Health Questionnaire, General Anxiety Disorder, Insomnia Severity Index, and the Impact of Events Scale-Revised; workplace and lifestyle questions, together with free-text comments. The relative strengths of the associations between predictor and outcome variables were estimated using repeated measures ordered logistic regression, and free text responses were themed. Data show diagnostic levels of anxiety (23%, 18%, 21%) at surveys one, two and three respectively, depression (26%, 23% and 28%), PTSD (16%, 12% and 10%) and insomnia (19%, 19% and 21%). The strongest predictors of psychological distress were current home and family stress and poor clinical team support. Factors which will help preserve the mental health of nurses and midwives include strong workplace culture, reducing occupational risk, clear communication processes, and supporting stable and functional relationships at home. The COVID-19 pandemic has increased the visibility of mental distress on nurses and midwives and established they are pivotal to healthcare. The health service has a duty-of-care for the welfare of nurses and midwives who have entered this psychologically taxing profession to future proof service delivery and safeguard its service-response capacity.

No Fans, No Problem: An Investigation of Audience Effects on Shooting Performance in Professional Basketball

Sports, along with nearly all facets of life, have been impacted by the COVID-19 pandemic. The National Basketball Association quickly adopted a unique method to finish the 2019-2020 regular season and playoffs. The entire league quarantined for months in what was known as the "NBA bubble" where games were played in spectator-less arenas. During this time, increases in shooting accuracy were reported. suggesting that free throws and field goals were made at record-breaking levels. This study examined differences in free throw shooting accuracy with and without spectators. Archival data were retrieved and analyzed to evaluate the potential differences. Free throw shooting accuracy with and without spectators were examined in multiple analyses. Our examination revealed free throw percentages were significantly greater in spectator-less arenas compared with the 2018 and 2019 seasons with spectators. Changes of the environmental characteristics, due to spectator-less arenas, were likely contributors to the improved free throw phenomenon reported in this study.

Telemedicine access, care, and outcomes for TIA and minor stroke

Introduction: Telemedicine is increasingly used, but its effectiveness for stroke prevention after minor stroke or TIA is not known. We compared the care and outcomes in patients discharged from an emergency department (ED) with TIA or stroke before and after the implementation of telemedicine stroke prevention clinics in Ontario, Canada. We hypothesized that care and outcomes will remain similar. Methods: We used linked administrative data to identify community-dwelling adults discharged from the ED with TIA or ischemic stroke from April 2015 to March 2020 (pre-telemedicine) and April 2020 to March 2021 (post-telemedicine). We compared access to outpatient physician visits within 90 days, neuroimaging or vascular imaging within 14 days, and echocardiogram within 90 days using standardized differences (SD <0.1 indicates negligeable difference). We used Cox proportional hazard models to compare the adjusted Hazard Ratio (aHR) and 95% confidence intervals of death within 90 days pre- and post-telemedicine and cause-specific hazard models for stroke readmission with adjustment for comorbidities. Results: We identified 47,869 patients (n=40,099 pre- and n=7,770 post-telemedicine), median age 73 years [62, 82], 49% female. Baseline characteristics were similar. There was a rapid uptake in telemedicine use (Figure 1). Physician visits (92.9% vs 93.1%, SD 0.01), neuroimaging (81.3% vs 80.5%, SD 0.02), and echocardiogram use (52.5% vs 53.9% SD 0.03) were similar, but use of vascular imaging increased (74.8% vs 84.3% SD 0.24). Readmission for stroke was stable (3.9% vs 4.0%, aHR 1.00 [0.89, 1.13]), but 90-day death was higher post- compared to pre-telemedicine (2.8% vs 3.6%, aHR 1.19 [1.05, 1.36]). Conclusion: Telemedicine is a promising tool to support routine stroke prevention care. The higher mortality must be interpreted in the context of the COVID19 pandemic. Ongoing monitoring of stroke outcomes is needed. (Figure Presented).

Telehealth for patients with interstitial lung diseases (ILD): results of an international survey of clinicians

P6 Figure 1Clinicians’ opinions about methods and practices that are being used to monitor disease progression in patients with ILD using tele-health[Figure omitted. See PDF]ConclusionA minority of ILD clinicians completing this survey used telehealth to monitor patients, but of those who did, there was some support for clinical utility. Our findings emphasise the need for robust research in telehealth as a mode for the delivery of healthcare services for ILD and highlight the need to assess patients’ perspectives to improve telehealth experiences in ILD patients.

NRCS response to 2020 agricultural production limitations as a result covid-19

In the spring and early summer of 2020, many agricultural production facilities were forced to reduce processing rates of agricultural commodities. Milk production plants were unable to quickly change milk packaging from ½ pint milk cartons destined for school lunches to larger containers for grocery stores as the nation's schools switched to virtual learning. Bulk commodities destined for restaurants needed to be repackaged as restaurants were closed due to the pandemic. Meat processing plants had to reduce production rates as COVID-19 outbreaks among their employees slowed production lines and increased the required time for sanitation of facilities to take place. These processing reductions led to commodity stockpiles in excess of what could be processed before spoilage. Milk needed to be land spread as a waste product, swine and poultry needed to be depopulated and disposed of since continued feeding was not feasible, and other specialty crops needed to be disposed of when storage capacity limits were reached. NRCS took steps to provide producers with technical and financial help to address the proper disposal of depopulated animals. This paper will detail the steps taken by NRCS to address this issue to protect natural resources on the farm and the environment. © ASABE 2021 Annual International Meeting

Population-based rates of emergency department visits for stroke in the different phases of COVID19 restriction and reopening

Introduction: Reductions in hospital visits for stroke during the COVID19 pandemic have been reported, but few have studied this question on a population-basis and less is understood about the temporal trends after economic and social reopening. We aimed to describe the rate of emergency department visits for acute stroke before and after the declaration of the pandemic, through the different phases of reopening, in the population of Ontario, Canada (14 million people). Methods: Using administrative data linkage, we will show the age- and sex-standardized rate of weekly emergency department visits for ischemic or hemorrhagic stroke between January 1 to September 30, 2020. Pandemic declaration was on March 11, 2020 (week 11) and phase 1 reopening started on May 19, 2020 (week 20) in Ontario. We will use piecewise regression analysis models to evaluate the changes in rates during the pandemic and after reopening. Results: We identified 5,617 emergency department visits for stroke (53% male, median age 74 IQR [63,83]) between January 1 to May 19, 2020 (week 20). Data beyond May 19, 2020 are not available yet, but these will be presented at the ISC 2021. The proportion of patients treated at a comprehensive stroke center was similar pre- and post-pandemic (41.7% versus 42.7%, standard difference (SD) 0.02), as was the proportion of people admitted to hospital (87.9% versus 86.7%, SD 0.03), treated with intravenous thrombolysis (11.6% versus 11.8%, SD 0.01), or underwent endovascular thrombectomy (5.1% versus 4.8%, SD 0.02). Weekly rates of stroke visits decreased after the pandemic declaration, but they seem to increase after week 16 (Figure 1). We show rates from 2019 for comparison. Conclusions: Population-based rates of emergency department visits for stroke initially decreased after the pandemic compared to pre-pandemic rates. Changes in rates after reopening and the results of the piecewise regression analysis will be presented at the ISC 2021.(Figure Presented).

Strategic Route Planning to Manage Transit’s Susceptibility to Disease Transmission

Transit agencies have experienced dramatic changes in service and ridership because of the COVID-19 pandemic. As communities transition to a new normal, strategic measures are needed to support continuing disease suppression efforts. This research provides actionable results to transit agencies in the form of improved transit routes. A multi-objective heuristic optimization framework employing the non-dominated sorting genetic algorithm II algorithm generates multiple route solutions that allow transit agencies to balance the utility of service to riders against the susceptibility of routes to enabling the spread of disease in a community. This research uses origin?destination data from a sample population to assess the utility of routes to potential riders, allows vehicle capacity constraints to be varied to support social distancing efforts, and evaluates the resulting transit encounter network produced from the simulated use of transit as a proxy for the susceptibility of a transit system to facilitating the transmission of disease among its riders. A case study of transit at Oregon State University is presented with multiple transit network solutions evaluated and the resulting encounter networks investigated. The improved transit network solution with the closest number of riders (1.2% more than baseline) provides a 10.7% reduction of encounter network edges.