Pediatric Chemotherapy Infusions in Outpatient Examination Rooms: A Novel Patient Care Approach.

Background: Many health care organizations offer pediatric infusions in outpatient infusion centers or, as in our organization, in a hospital-based outpatient Pediatric Infusion Therapy Center (PITC). When restrictions related to the COVID-19 pandemic decreased our PITC appointment capacity by 40%, other patient and family satisfaction issues were exacerbated. We implemented a new approach to pediatric infusions with the aim of improving patient and family satisfaction and reducing the amount of time in an appointment itinerary without negatively affecting patient safety. Methods: Our team used a phased approach to pilot the administration of short chemotherapy infusions in the same outpatient clinic examination rooms where consultation and routine office visits were conducted. Patients saw their specialist for an examination and, if clinically indicated, their infusion was administered in the same room. Appointment itineraries were then completed. The team tracked efficiency, satisfaction, and safety metrics related to the new process. Results: All efficiency metrics improved. No harm came to the 49 unique patients who received a total of 184 infusions. Patient appointment itineraries were shortened by an average of 1.03 hr. Satisfaction survey responses indicated a clear preference (93%) for the new process. Discussion: The novel approach of offering short infusions in outpatient clinic examination rooms provides an opportunity to ease capacity constraints and further increase patient and family satisfaction. This method may be especially helpful for health care organizations when external influences (e.g., lack of physical space, challenging patient volumes, and pandemics) necessitate a change.

Duty hours in emergency medicine: balancing patient safety, resident wellness, and the resident training experience: a consensus response to the 2008 Institute of Medicine resident duty hours recommendations.

BACKGROUND: Representatives of emergency medicine (EM) were asked to develop a consensus report that provided a review of the past and potential future effects of duty hour requirements for EM residency training. In addition to the restrictions made in 2003 by the Accreditation Council for Graduate Medical Education, the potential effects of the 2008 Institute of Medicine (IOM) report on resident duty hours were postulated. DISCUSSION: The elements highlighted include patient safety, resident wellness, and the resident training experience. Many of the changes and recommendations did not affect EM as significantly as other specialties. Current training standards in EM have already emphasized patient safety by requiring continuous onsite supervision of residents. Resident fatigue has been addressed with restrictions of shift lengths and limitation of consecutive days worked. CONCLUSION: One recommendation from the IOM was a required 5-h rest period for residents on call. Emergency department (ED) patient safety becomes an important concern with the decrease in the availability and in the patient load of a resident consultant that may result from this recommendation. Of greater concern is the already observed slower throughput time for admitted patients waiting for resident care, which will increase ED crowding and decrease patient safety in academic institutions. A balance between being overly prescriptive with duty hour restrictions and trying to improve resident wellness was recommended. Discussion is included regarding the appropriate length of EM training programs if clinical experiences were limited by new duty hour regulations. Finally, this report presents a review of the financing issues associated with any changes.

Naloxone administration by nonmedical providers- a descriptive study of County sheriff department training.

THE STUDY BACKGROUND: In 2015 a county sheriff department in Michigan began a training program for its deputies on administration of naloxone for non-medical providers. METHODS: A descriptive analysis was used to evaluate the effectiveness of the program. Data collected from the Sheriff's department allowed the study to quantify the incidence of naloxone administration, describe characteristics related to the administration, and report on aggregate outcomes. RESULTS: Of the reported 184 incidents involving naloxone use the sheriff department had an overall successful administration rate of 94.6% in the cases from 2015 to 2017. It was also noted that the overall number of naloxone administrations showed an upward trend with a greater number of trained deputies. CONCLUSION: The outcome of training non-medical first responders in naloxone administration has been shown to be successful with regard to resuscitation of patients with opioid overdose.

Associations between childhood vaccination status and medical practice characteristics among white, black, and Hispanic children.

BACKGROUND: The purpose of the study was to identify and understand associations between characteristics of medical practices where immunization services are delivered and vaccination status among white, black, and Hispanic children aged less than 19 months. METHODS: Eighty pediatric and family physicians participated in a physician-patient encounters survey that included 684 children aged less than 19 months who received at least 1 vaccination during a randomly selected week in 2003. RESULTS: According to physicians' responses to survey questions, white children who used large medical practices, and black and Hispanic children who used practices, all enrolled in the Vaccine for Children (VFC) program, were more likely to receive vaccines at the recommended age, but Hispanic children who used large Medicaid practices were less likely to receive them at the recommended age. White children who used medical practices that had a large minority patient population were more likely to have completely missed whole series of vaccines. CONCLUSION: Medical practice characteristics varied in importance as determinants of childhood vaccination among white, black, and Hispanic children. Understanding how type of medical practice and other medical practice characteristics may impact the receipt of timely preventive health services is vital to improving health care access in underserved populations.

Tactical emergency medical support: physician involvement and injury patterns in tactical teams.

Medical support provided by physicians in police tactical teams has been firmly embraced by the medical community. Our study revisited the 1995 study inquiring into injury patterns in police tactical teams. A national survey was completed by 209 members of tactical teams throughout the country over a 6-week period. An electronic survey was submitted to the National Tactical Officers Association, the International Tactical Emergency Medical Support Association, and state tactical associations. Teams reporting physician utilization were 47% of the whole (69% were present

Influenza vaccination of health care workers: policies and practices of hospitals in a community setting.

BACKGROUND: The Advisory Committee on Immunization Practices has long recommended that health care workers receive annual influenza vaccinations to prevent transmission of disease to vulnerable patients, but HCW vaccination rates remain low, and there is little information about hospital policies promoting employee vaccination. METHODS: Our objective was to collect information about and compare hospital influenza vaccination policies and practices regarding health care workers in the metropolitan Atlanta community and identify relationships between policies and practices and employee coverage rates. Senior staff of infection control and of employee health programs at 12 hospitals in the metropolitan Atlanta community completed an in-person interview using a structured guide. RESULTS: All study hospitals provided vaccine free of charge to employees in on-site clinics. Seven of the 9 hospitals clustered between 34% and 47% of their employees vaccinated, with an average of 41%. The hospitals that included flexibility and better accessibility, such as providing vaccination carts and adding more hours of vaccine availability, had somewhat higher hospital employee vaccination rates. Personal contact in the form of educational presentations appears to have more influence on employee decisions than distributing printed educational materials. CONCLUSION: Hospitals in the Atlanta community had several similar policies and practices to improve immunization coverage of their staff. Human interactions with employees as well as ease of vaccine access may be more successful at increasing coverage rates than mass approaches such as posters or flyers.

A qualitative assessment of factors influencing acceptance of a new rotavirus vaccine among health care providers and consumers.

BACKGROUND: In 2006, a new rotavirus vaccine (RotaTeq) was licensed in the US and recommended for routine immunization of all US infants. Because a previously licensed vaccine (Rotashield) was withdrawn from the US for safety concerns, identifying barriers to uptake of RotaTeq will help develop strategies to broaden vaccine coverage. METHODS: We explored beliefs and attitudes of parents (n = 57) and providers (n = 10) towards rotavirus disease and vaccines through a qualitative assessment using focus groups and in-depth interviews. RESULTS: All physicians were familiar with safety concerns about rotavirus vaccines, but felt reassured by RotaTeq's safety profile. When asked about likelihood of using RotaTeq on a scale of one to seven (1 = "absolutely not;" 7 = "absolutely yes") the mean score was 5 (range = 3-6). Physicians expressed a high likelihood of adopting RotaTeq, particularly if recommended by their professional organizations and expressed specific interest in post-marketing safety data. Similarly, consumers found the RotaTeq safety profile to be favorable and would rely on their physician's recommendation for vaccination. However, when asked to rank likelihood of having their child vaccinated against rotavirus (1 = "definitely not get;" 7 = "definitely get"), 29% ranked 1 or 2, 36% 3 or 4, and 35% 5 to 7. CONCLUSION: Our qualitative assessment provides complementary data to recent quantitative surveys and suggests that physicians and parents are likely to adopt the newly licensed rotavirus vaccine. Increasing parental awareness of the rotavirus disease burden and providing physicians with timely post-marketing surveillance data will be integral to a successful vaccination program.

Behavior and beliefs about influenza vaccine among adults aged 50-64 years.

OBJECTIVE: To examine demographics and beliefs about influenza disease and vaccine that may be associated with influenza vaccination among 50- to 64-year-olds. METHODS: A national sample of adults aged 50-64 years surveyed by telephone. RESULTS: Variables associated with receiving influenza vaccination included age, education level, recent doctor visit, and beliefs about vaccine effectiveness and vaccine safety. Beliefs about influenza vaccination varied by race/ethnicity, age, education, and gender. CONCLUSION: The finding of demographic differences in beliefs suggests that segmented communication messages designed for specific demographic subgroups may help to increase influenza vaccination coverage.

Duty hours in emergency medicine: balancing patient safety, resident wellness, and the resident training experience: a consensus response to the 2008 institute of medicine resident duty hours recommendations.

Representatives of emergency medicine (EM) were asked to develop a consensus report that provided a review of the past and potential future effects of duty hour requirements for EM residency training. In addition to the restrictions made in 2003 by the Accreditation Council for Graduate Medical Education (ACGME), the potential effects of the 2008 Institute of Medicine (IOM) report on resident duty hours were postulated. The elements highlighted include patient safety, resident wellness, and the resident training experience. Many of the changes and recommendations did not affect EM as significantly as other specialties. Current training standards in EM have already emphasized patient safety by requiring continuous on-site supervision of residents. Resident fatigue has been addressed with restrictions of shift lengths and limitation of consecutive days worked. One recommendation from the IOM was a required 5-hour rest period for residents on call. Emergency department (ED) patient safety becomes an important concern with the decrease in the availability and in the patient load of a resident consultant that may result from this recommendation. Of greater concern is the already observed slower throughput time for admitted patients waiting for resident care, which will increase ED crowding and decrease patient safety in academic institutions. A balance between being overly prescriptive with duty hour restrictions and trying to improve resident wellness was recommended. Discussion is included regarding the appropriate length of EM training programs if clinical experiences were limited by new duty hour regulations. Finally, this report presents a review of the financing issues associated with any changes.

"Why tell me now?" the public and healthcare providers weigh in on pandemic influenza messages.

As scientists closely watch avian influenza A (H5N1) or "bird flu" as a potential progenitor of an influenza pandemic, researchers from the Department of Health and Human Services, Centers for Disease Control and Prevention, and Oak Ridge Institute for Science and Education conducted with focus groups with the public and interviews with healthcare providers to test pandemic influenza messages. General public findings include variable awareness of pandemic influenza, subtle changes in terms (eg, flu or influenza), and challenged communication; and "vaccine priority group" opposition to the term priority group because it meant they could be left out. Healthcare providers reported Goggle and local infectious disease specialists as dominant sources of pandemic information. The results of the study provide specific guidance for those who will develop messages about pandemic influenza for the public and healthcare provider audiences.