Introduction of a bleepless intern on-call era.

BACKGROUND: The current bleep communication system between nurses and interns on-call in most Irish hospitals has been linked with interruption in patient care, disruption to workflow, inefficiency, increased burden and stress to the on-call health staff. A new electronic system was introduced in a University Hospital to replace and eliminate bleep usage during on-call hours. METHODS: An Intern on-call task electronic template was generated using Microsoft Excel Spreadsheet. This electronic system enabled users to review and respond to requests placed by nursing healthcare staff. This project initially underwent a trial process in three wards for a period of two weeks in June 2023. Interns and nurses were asked to fill a survey before and after introduction of the system. The project was implemented across all wards in August 2023 and a secondary survey was obtained. In addition, the spreadsheets were analysed retrospectively. RESULTS: During the trial, twenty-six interns and twenty nurses were surveyed before and after implementation of the electronic system. Interns satisfaction rate was 73% and stress was reported to be reduced by 65%. Notably, 57% of interns reported a reduction in workload and the number of bleeps was reported to be as <10 by 42%. Nurses reported a decrease in the number of bleeps they needed to send overall by 65% and by 55% for repeated jobs. Workload was reported to be increased by 15% by nurses. However, exactly half of the nurses were unhappy with the new system and stress levels were unchanged. CONCLUSION: This project has shown promising results, efficient and clear communication was noted with an overall positive feedback and satisfaction rate by doctors. However, as evident, from a nursing perspective further work is needed to further progress into a system that can benefit both parties involved.

Factors That Influence Non-Motor Impairment Across the ALS-FTD Spectrum: Impact of Phenotype, Sex, Age, Onset and Disease Stage.

Objective: This study aimed to establish (1) the pattern and severity of neuropsychiatric symptoms and other non-motor symptoms of sleep and mood, across ALS phenotypes in comparison to bvFTD and (2) the contribution of non-modifiable factors including age, sex and disease state to the severity of symptoms experienced by ALS patients. Methods: Consecutive participants were recruited to the study and underwent a detailed clinical, cognitive, behavioral and neuroimaging assessment. Neuropsychiatric and other non-motor symptoms were determined using the Cambridge Behavioral Inventory, the CBI-R. The scores were converted to define impairment in terms of mild, moderate and severe symptoms for each subscale. Rate, severity and contribution of King's staging and modifiable factors were also determined and a regression model identified predictors of symptom severity. Results: In total, 250 participants (115 ALS, 98 bvFTD, and 37 ALS-FTD patients) were recruited. A similar pattern of neuropsychiatric symptom severity was identified (apathy, disinhibition and stereotypic behavior) for all behavioral phenotypes of ALS compared to bvFTD (all p > 0.05). Neuropsychiatric symptoms were also present in cases defined as ALSpure and the cognitive phenotype of ALS (ALSci) although they occurred less frequently and were at the milder end of the spectrum. Disordered sleep and disrupted mood were common across all phenotypes (all p < 0.05). The severity of sleep dysfunction was influenced by both sex and age (all p < 0.05). Neuropsychiatric symptoms, sleep and mood disorders were common early in the disease process and deteriorated in line with progression on the Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-R; all p < 0.05). Diagnostic phenotype, disease duration and global cognition scores were the strongest predictors of non-motor and neuropsychiatric impairments. Conclusion: The current findings reveal strikingly similar patterns of changes across the subgroups of ALS and bvFTD, supporting the concept of the ALS-FTD spectrum. The findings further highlight the impact of non-motor and neuropsychiatric symptoms in patients with ALS, that are often as severe as that seen in ALS-FTD and bvFTD. This study advances understanding across the ALS-FTD spectrum that may accelerate the early identification of patient needs, to ensure prompt recognition of symptoms and thereby to improve clinical awareness, patient care and management.