Scheduling Internal Medicine Healthcare Providers Using Mathematical Programming

2017 ◽  
Author(s):  
Sunil Vekaria
Keyword(s):  
Internal Medicine ◽  
Mathematical Programming ◽  
Healthcare Providers

scholarly journals Qualitative investigation of trace-based communication: how are traces conceptualised in healthcare teamwork?

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e038406
Author(s):  
Sayra Cristancho ◽  
Emily Field
Keyword(s):  
Internal Medicine ◽  
Healthcare Providers ◽  
Constructivist Grounded Theory ◽  
Teaching Hospitals ◽  
Secondary Outcome ◽  
Qualitative Investigation ◽  
Qualitative Nature ◽  
Saving Face ◽  
Critical Process ◽  
Biological Literature

ObjectivesThis interview-based qualitative study aims to explore how healthcare providers conceptualise trace-based communication and considers its implications for how teams work. In the biological literature, trace-based communication refers to the non-verbal communication that is achieved by leaving ‘traces’ in the environment and other members sensing them and using them to drive their own behaviour. Trace-based communication is a key component of swam intelligence and has been described as a critical process that enables superorganisms to coordinate work and collectively adapt. This paper brings awareness to its existence in the context of healthcare teamwork.DesignInterview-based study using Constructivist Grounded Theory methodology.SettingThis study was conducted in multiple team contexts at one of Canada’s largest acute-care teaching hospitals.Participants25 clinicians from across professions and disciplines. Specialties included surgery, anesthesiology, psychiatry, internal medicine, geriatrics, neonatology, paramedics, nursing, intensive care, neurology and emergency medicine.InterventionNot relevant due to the qualitative nature of the study.Primary and secondary outcomeNot relevant due to the qualitative nature of the study.ResultsThe dataset was analysed using the sensitising concept of ‘traces’ from Swarm Intelligence. This study brought to light novel and unique elements of trace-based communication in the context of healthcare teamwork including focused intentionality, successful versus failed traces and the contextually bounded nature of the responses to traces. While participants initially felt ambivalent about the idea of using traces in their daily teamwork, they provided a variety of examples. Through these examples, participants revealed the multifaceted nature of the purposes of trace-based communication, including promoting efficiency, preventing mistakes and saving face.ConclusionsThis study demonstrated that clinicians pervasively use trace-based communication despite differences in opinion as to its implications for teamwork and safety. Other disciplines have taken up traces to promote collective adaptation. This should serve as inspiration to at least start exploring this phenomenon in healthcare.

scholarly journals 980. Drexel Medicine Resident Knowledge, Practices and Attitudes Regarding Pre-exposure prophylaxis (PrEP)

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S518-S518
Author(s):  
Jen E Mainville ◽  
Ed Gracely ◽  
Zsofia Szep
Keyword(s):  
Internal Medicine ◽  
Male Partner ◽  
Healthcare Providers ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Major Barrier ◽  
Medicine Resident ◽  
Highly Effective ◽  
Prevention Method ◽  
Exposure Prophylaxis

Abstract Background Pre-exposure prophylaxis (PrEP) is a highly effective daily oral antiretroviral medication that was approved by the FDA in 2012 and has been shown to reduce the risk of HIV by 95% in real-world studies. Despite this, many healthcare providers are not offering PrEP to their patients who are at risk for HIV. Methods We performed a cross-sectional study among Drexel Internal Medicine, Family Medicine, and Obstetrics and Gynecology residents. The survey included questions about experience, knowledge, attitudes toward and barriers to using PrEP. The survey was adapted from previous studies regarding medical providers’ attitudes and knowledge about PrEP (Petroll, 2016; Seifman, 2016; Blumenthal, 2105). A Likert 5-point scale was used for attitude and barriers questions. Results Among 143 participants, 80% specialized in Internal Medicine. 43% of participants were in their first year of training and the mean age (+ SD) was 28.8 + 2. 76% reported never initiating a conversation about PrEP with a patient and only 18% reported ever prescribing PrEP to their patients. 92% reported being very or extremely willing to prescribe PrEP to a male with a current male partner known to be HIV positive. Only 43% of residents reported being moderately likely to prescribe PrEP to a patient coming in for a STI exposure. 68% of residents reported their knowledge about PrEP was a major barrier to prescribing PrEP. Conclusion We found that most residents have minimal experience with prescribing PrEP, and knowledge was identified as the largest barrier. Additional education and a better understanding of PrEP indications is necessary to ensure eligible PrEP patients have access to this highly effective HIV prevention method. Disclosures All Authors: No reported disclosures

Evaluation of a New Integrated Discharge Prescription Form

2001 ◽  
Vol 35 (7-8) ◽  
pp. 953-958 ◽  
Author(s):  
Nicolas Paquette-Lamontagne ◽  
William M McLean ◽  
Lysanne Besse ◽  
Jean Cusson
Keyword(s):  
Internal Medicine ◽  
Community Pharmacy ◽  
Healthcare Providers ◽  
Teaching Hospitals ◽  
Control Group ◽  
Patient Profile ◽  
Prescription Form ◽  
Patient Profiles ◽  
Internal Medicine Wards ◽  
Discharge Prescription

OBJECTIVE: To determine whether a new discharge prescription form which integrates admission medications, in-hospital changes, and discharge medications could enhance the accuracy of information in patient profiles in community pharmacies after hospital discharge. DESIGN: Nonrandomized, prospective, multi-site study. SETTINGS: Internal medicine wards of the three teaching hospitals (1200 beds) of the Centre Hospitalier de l'Université de Montréal. SUBJECTS: Patients admitted to the internal medicine wards between January 4 and 31, 1999, at St.-Luc and Notre-Dame Hospitals formed the control group and received a usual discharge form (UD). Those admitted between February 1 and 28, 1999, received the new discharge prescription form (DPF) capturing the list of admission medications and revisions during hospitalization; they served as the experimental group. METHODS: Patient profiles were reviewed to calculate conformity rates of community pharmacy patient profiles after discharge and the rate of overall conformity for each group in the study. Each drug in the patient profile was assessed according to six criteria. Healthcare providers' satisfaction with the DPF was assessed via a written questionnaire. RESULTS: Eighty-nine patients and 669 discharge medications were studied. The patient profiles had a higher conformity rate in the DPF group than in the UD group (82% vs. 40%; p < 0.001); improvement could be attributed to higher conformity rates, particularly for two criteria (medications stopped in hospital and dose changes in hospital). CONCLUSIONS: Integration of admission medications, in-hospital changes, and discharge medications on a single form increases the conformity rates of community pharmacy patient profiles after hospitalization. This tool is well accepted by both pharmacists and physicians and may lead to a major decrease in drug-related problems.

scholarly journals Oncology workload in a tertiary hospital during the COVID-19 pandemic

2021 ◽  
pp. 201010582110511
Author(s):  
Jianbang Chiang ◽  
Valerie Yang ◽  
Shuting Han ◽  
Qingyuan Zhuang ◽  
Siqin Zhou ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Emergency Department ◽  
General Surgery ◽  
Medical Oncology ◽  
Healthcare Providers ◽  
Healthcare Facility ◽  
Tertiary Hospital ◽  
Urgent Care ◽  
H1n1 Pandemic ◽  
Care Needs

Introduction Workload in oncology during a pandemic is expected to increase as manpower is shunted to other areas of need in combating the pandemic. This increased workload, coupled with the high care needs of cancer patients, can have negative effects on both healthcare providers and their patients. Methods This study aims to quantify the workload of medical oncologists compared to internal medicine physicians and general surgeons during the current COVID-19 pandemic, as well as the previous H1N1 pandemic in 2009. Results Our data showed decrease in inpatient and outpatient workload across all three specialties, but the decrease was least in medical oncology (medical oncology −18.5% inpatient and −3.8% outpatient, internal medicine −5.7% inpatient and −24.4% outpatient, general surgery −17.6% inpatient, and −39.1% outpatient). The decrease in general surgery workload was statistically significant. The proportion of emergency department admissions to medical oncology increased during the COVID-19 pandemic. Furthermore, the study compared the workload during COVID-19 with the prior H1N1 pandemic in 2009 and showed a more drastic decrease in patient numbers across all three specialties during COVID-19. Discussion We conclude that inpatient and outpatient workload in medical oncology remains high despite an ongoing COVID-19 pandemic. The inpatient medical oncology workload is largely contributed by the stable number of emergency department admissions, as patients who require urgent care will present to a healthcare facility, pandemic or not. Healthcare systems should maintain manpower in medical oncology to manage this vulnerable group of patients in light of the prolonged COVID-19 pandemic.

scholarly journals Coronavirus Disease-2019, Diabetes and Dialysis: An Internal Medicine Conundrum Proposal for a Suitable and Easy-to-Handle Prevention Protocol

2020 ◽  
Vol 6 (2) ◽  
pp. 27-36
Author(s):  
Felice Strollo ◽  
◽  
Ersilia Satta ◽  
Carmine Romano ◽  
Carmelo Alfarone ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Health Personnel ◽  
Medical Equipment ◽  
Healthcare Providers ◽  
Time Lags ◽  
Endstage Renal Disease ◽  
Patient Health ◽  
Prevention Protocol ◽  
Individual Protection ◽  
Protection Devices

Background Frail populations burdened with chronic diseases can get more severe forms of coronavirus disease-2019 (COVID-19) and have a higher mortality rate. Aim To test the efficacy of a severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) containment protocol in patients with endstage renal disease (ESRD) diabetes mellitus (DM) requiring dialysis, who are a typical example of the above category. Methods The protocol included: (i) daily telephone COVID-19 related triage for patients and their general practitioners (GPs); (ii) social distancing; (iii) environment sanitization, including ambulances, transfer vans, medical equipment, patient/health personnel clothing, and individual protection devices; (iv) adoption of quota systems for patients allowed to the dialysis room, and increased time lags among dialysis shifts. Eight hundred twenty-five (825) patients on dialysis (315 with and 510 without DM), and 381 healthcare providers (HCPs) were monitored continuously from the start of the pandemic until the end of the lockdown. Results No HCPs were infected, while only two patients on dialysis were positive for SARS-CoV-2: one with DM, who died in intensive care, and one without DM, who recovered at home. The adopted contagion containment protocol proved to be effective for both HCPs and patients. Conclusion Therefore, we propose it as a useful model for any internal medicine or ESRD specialized units dealing with patients on dialysisoriented with or without DM.

Content and structure of ward rounds focusing interprofessional collaboration on an internal medicine ward: An observational study of interprofessional collaboration

2021 ◽  
pp. 205715852110527
Author(s):  
Ella Källén ◽  
Stephanie Nimström ◽  
Kristina Rosengren
Keyword(s):  
Internal Medicine ◽  
Patient Safety ◽  
Interprofessional Collaboration ◽  
Qualitative Content Analysis ◽  
Healthcare Providers ◽  
University Hospital ◽  
Internal Medicine Ward ◽  
Interprofessional Teamwork ◽  
Ward Rounds ◽  
Hybrid Distance

Ward rounds are crucial for the exchange of information among healthcare professionals to achieve joint planning and shared decision-making in healthcare to enhance patient safety. The aim of this study was to describe the content and structure of ward rounds focusing on interprofessional collaboration on an internal medicine ward at a university hospital in Western Sweden. An inductive qualitative approach was used to explore 13 participatory observations of ward rounds (sitting/team rounds). Qualitative content analysis was used. The analysis revealed one category, titled interprofessional teamwork, that utilises all available resources, which consisted of three subcategories: usefulness of specialist competencies, collaboration for patient safety, and leading healthcare to achieve goal fulfilment. It was also found that the participating specialists’ competencies were not being optimally used before patients were discharged from the hospital. Therefore, communication and leadership skills were revealed as ways to improve interprofessional teamwork to achieve goal fulfilment and patient safety regarding care and treatment issues on the ward. We found that reversing the order of ward rounds to start with the sitting round followed by the team round (i.e. hybrid distance participation methods), with the same ward round leader who has skills in leadership and interprofessional teamwork, could eliminate the need for healthcare providers to repeat questions and tasks (i.e. double work) on their ward rounds. Second, patient involvement is grounded in collaboration, and can be emphasised through person-centred care to facilitate patient safety during hospital stays.

scholarly journals Gender-Based Discrimination and Sexual Harassment Among Academic Internal Medicine Hospitalists

2021 ◽  
Vol 16 (2) ◽  
pp. 84-89
Author(s):  
Sanjay Bhandari ◽  
Pinky Jha ◽  
Cynthia Cooper ◽  
Barbara Slawski
Keyword(s):  
Internal Medicine ◽  
United States ◽  
Sexual Harassment ◽  
Academic Medicine ◽  
Healthcare Providers ◽  
The United States ◽  
Academic Institutions ◽  
Career Opportunities ◽  
Gender Based

BACKGROUND: Gender-based discrimination and sexual harassment, both implicit and overt, have been reported in academic medicine. This study examines experiences of academic hospitalists regarding gender-based discrimination and sexual harassment. METHODS: A survey was distributed to Internal Medicine hospitalists at university-based academic institutions in the United States. Questions assessed experiences regarding gender-based discrimination and sexual harassment in their interactions with patients, as well as with other healthcare providers (HCPs). RESULTS: Eighteen institutions participated in the survey, resulting in 336 individual responses. Female hospitalists more frequently reported inappropriate touch, sexual remarks, gestures, and suggestive looks by patients compared with male peers both over their careers (P < .001) and in the last 30 days (P < .001). Similarly, females more frequently reported being referred to with inappropriate terms of endearment (eg, “dear,” “honey,” “sweetheart”) by patients both over their careers (P < .001) and in the last 30 days (P < .001). Almost 100% of females reported being mistaken by patients for nonphysician HCPs over their careers, compared with 29% of males (P < .001) (76% vs 10%, in the last 30 days; P < .001). Similarly, females more frequently reported sexual harassment over their careers (P < .05) and being mistaken for nonphysician HCPs by colleagues both over their careers (P < .001) and in the last 30 days (P < .001). Females rated their sense of respect both by patients (P < .001) and colleagues (P < .001) lower than males (P < .001). More females than males reported that gender negatively impacted their career opportunities (P < .001). CONCLUSION: This survey demonstrates that gender-based discrimination and sexual harassment are commonly encountered by academic hospitalists, with a significantly higher number of females reporting these experiences.

The Historical Development of Burden of Treatment Compliance

2014 ◽  
Vol 19 (5) ◽  
pp. 13-15
Author(s):  
Stephen L. Demeter
Keyword(s):  
Internal Medicine ◽  
Treatment Compliance ◽  
World Health ◽  
International Classification Of Functioning ◽  
Sixth Edition ◽  
Burden Of Treatment ◽  
Specific Goal ◽  
Surrogate Measure ◽  
Health Organization

Abstract A long-standing criticism of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) has been the inequity between the internal medicine ratings and the orthopedic ratings; in the comparison, internal medicine ratings appear inflated. A specific goal of the AMA Guides, Sixth Edition, was to diminish, where possible, those disparities. This led to the use of the International Classification of Functioning, Disability, and Health from the World Health Organization in the AMA Guides, Sixth Edition, including the addition of the burden of treatment compliance (BOTC). The BOTC originally was intended to allow rating internal medicine conditions using the types and numbers of medications as a surrogate measure of the severity of a condition when other, more traditional methods, did not exist or were insufficient. Internal medicine relies on step-wise escalation of treatment, and BOTC usefully provides an estimate of impairment based on the need to be compliant with treatment. Simplistically, the need to take more medications may indicate a greater impairment burden. BOTC is introduced in the first chapter of the AMA Guides, Sixth Edition, which clarifies that “BOTC refers to the impairment that results from adhering to a complex regimen of medications, testing, and/or procedures to achieve an objective, measurable, clinical improvement that would not occur, or potentially could be reversed, in the absence of compliance.

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