Mitigating primary care provider burnout with interdisciplinary dyads and shared care delivery

Rationale, aims and objectives: Increased incidence of chronic illnesses coupled with physician shortages have yielded strain on primary care providers (PCP) to meet care demands. Interdisciplinary providers such as nurse practitioners and physician assistants have increasingly been embedded into primary care teams to alleviate some workload demand. Little evidence exists about the impact of interdisciplinary PCP care delivery models on provider outcomes. The objective of this study was to investigate the impact of interdisciplinary PCP care delivery on provider burnout, job satisfaction and intention to leave current position. Methods: We conducted a cross sectional mail survey using Dillman methodology of primary care practices (e.g., internal medicine) across New York State. A random sample of interdisciplinary PCPs (physicians, nurse practitioners, and physician assistants) (n=333) responded. The Provider Co-management Index (α = .85) was used to measure how well interdisciplinary dyads co-management care delivery attributes (effective communication; mutual respect and trust; shared philosophy of care). Provider outcomes were measured with validated AHRQ and HRSA items for burnout, job satisfaction and intention to leave position. Descriptive statistics, logistic regression models, crude and adjusted odds ratios were calculated, controlling for participant and practice characteristics. Results: Almost 30% of participants reported burnout with three times the odds of intending to leave their current position within one year. With each unit increase in effective co-management between interdisciplinary dyads there was 15% less burnout and 10% less odds of intention to leave position. Conclusion: Incorporating interdisciplinary specialties in primary care appears promising to alleviate some adverse provider outcomes. Organizations contemplating delivery models to promote well-being and retention may consider co-management. Cost effectiveness research is needed to determine financial sustainability of interdisciplinary care delivery.

Multitasking behaviors and provider outcomes in emergency department physicians: two consecutive, observational and multi-source studies

Background Multitasking is a key skill for emergency department (ED) providers. Yet, potentially beneficial or debilitating effects for provider functioning and cognition are underexplored. We therefore aimed to investigate the role of multitasking for ED physicians’ work stress and situation awareness (SA). Methods Two consecutive, multi-source studies utilizing standardized expert observations in combination with physicians’ self-reports on stress and SA were set out in an academic ED. To control for ED workload, measures of patient acuity, patient counts, and ED staff on duty were included. Regression analyses estimated associations between observed proportion of time spent in multitasking with matched ED physicians’ reports on stress (study 1) and SA (study 2). Results ED physicians engaged between 18.7% (study 1) and 13.0% (study 2) of their worktime in multitasking. Self-reported as well as expert-observed multitasking were significantly associated. This confirms the internal validity of our observational approach. After controlling for ED workload, we found that physicians who engaged more frequently in multitasking perceived higher work stress (Beta = .02, 95%CI .001–.03; p = .01). In study 2, ED physicians with more frequent multitasking behaviors reported higher SA (B = .08, 95%CI .02–.14; p = .009). Conclusions Multitasking is often unavoidable in ED care. Our findings suggest that ED physicians’ multitasking increases stress experiences, yet, may facilitate professional’s experiences of situation awareness. Our results warrant further investigation into potentially ambivalent effects of ED providers’ multitasking in effectively sharing time between competing demands while maintaining performance and safety.

Association between person-centred care and healthcare providers’ job satisfaction and work-related health: a scoping review

ObjectiveThis scoping review aimed to explore and describe the research on associations between person-centred care (PCC) and healthcare provider outcomes, for example, job satisfaction and work-related health.DesignScoping review.Eligibility criteriaStudies were included if they were empirical studies that analysed associations between PCC measurement tools and healthcare providers outcomes.Search strategySearches in PubMed, CINAHL, Psychinfo and SCOPUS databases were conducted to identify relevant studies published between 2001 and 2019. Two authors independently screened studies for inclusion.ResultsEighteen studies fulfilled the inclusion criteria. Twelve studies were cross-sectional, four quasi-experimental, one longitudinal and one randomised controlled trial. The studies were carried out in Sweden, The Netherlands, the USA, Australia, Norway and Germany in residential care, nursing homes, safety net clinics, a hospital and community care. The healthcare provider outcomes consisted of job satisfaction, burnout, stress of conscience, psychosocial work environment, job strain and intent to leave. The cross-sectional studies found significant associations, whereas the longitudinal studies revealed no significant effects of PCC on healthcare provider outcomes over time.ConclusionMost studies established a positive association between PCC and healthcare provider outcomes. However, due to the methodological variation, a robust conclusion could not be generated. Further research is required to establish the viability of implementing PCC for the improvement of job satisfaction and work-related health outcomes through rigorous and consistent research.

Comparative Study of Oncology Information Systems for Better Patient and Provider Outcomes

Cancer is among the top three chronic diseases both in developed countries as well as underdeveloped countries. The diagnosis, medication, and treatment for cancer is extremely costly. Typically, cancer treatment involves surgery, radiotherapy, and chemotherapy. Owing to the extremely high price of medicine and treatment along with cytotoxicity of medication, cancer treatment warrants extraordinary care in treating cancer patients. Oncology information systems (OIS) provide an all-in-one solution for such problems. The OIS can integrate different treatment protocols and update change in dose and treatment in real time.

2056. Retrospective Analysis of Intravenous Vancomycin Outcomes in Patients Discharged to Skilled Nursing Facilities

Background Patients treated with intravenous (IV) vancomycin at skilled nursing facilities (SNFs) are at increased risk for adverse events. Methods Single-center, retrospective chart review to assess specific outcomes of patients receiving IV vancomycin discharged to an SNF from a single institution under the care of infectious diseases (ID) physicians. Population included all patients under the care of an ID provider between November 1, 2017 and October 31, 2018 with GFR > 30 who were discharged to an SNF on IV vancomycin for a minimum of 2 weeks. Patients with chronic kidney disease and patients younger than 18 years old were excluded. It was intended that all patients have weekly labs, including vancomycin troughs, communicated to the ID provider. Outcomes evaluated included complications related to vancomycin therapy, assessment of appropriate trough timing and sub-therapeutic troughs (defined as a trough less than 10), and assessment of communication to the prescribing physician. Complications were defined as vancomycin trough greater than 30, increase in serum creatinine greater than 0.5 above baseline, documented adverse events related to vancomycin, or hospital readmission during antibiotic therapy. Results 25 patients who met inclusion criteria were admitted to 14 different SNFs. Osteomyelitis was the most common indication and MRSA was the most commonly isolated organism. 13 of 25 patients experienced the predefined complications; 5 of 25 patients had at least one trough value greater than 30. 13 of 25 patients had troughs drawn at inappropriate times in relation to doses and 15 of 25 patients had either absent or incomplete labs communicated to the prescriber. 4 of 25 patients had at least one trough value less than 10. Only 2 of 25 patients assessed had no complications, troughs appropriately drawn, and lab values communicated to the prescriber. Conclusion Patients discharged to SNFs on vancomycin had high rates of complications, low rates of appropriate laboratory monitoring, and poor communication between SNFs and the prescribing ID physician. Vancomycin administration at an SNF warrants careful monitoring for patient safety and demonstrates an area with significant opportunity for improvement. Disclosures All authors: No reported disclosures.

Does more sense make sense? An empirical test of high and low interactive retail technology

Purpose The purpose of this paper is to provide insight into whether “more sense makes sense” when attempting to encourage consumers to purchase retail products using technology; that is, does engaging senses in addition to visual and aural senses, such as haptic touch, through interactive retail technology lead to an easier and more enjoyable consumption experience of retail products for consumers, while also enhancing service provider outcomes? To test this assumption (“more sense makes sense”), this study empirically examines whether differences are present in the consumer experience (usefulness, ease of use and customer-perceived value) and service provider outcomes (satisfaction and purchase intentions) across retail technologies with and without haptic touch enabled. Design/methodology/approach The study randomly allocated participants to either the haptic touch (haptic touch, visual and aural senses, n = 135) or no haptic touch (visual and aural senses only, n = 182) interactive retail technology condition. The data were analyzed using multivariate analysis of covariance. Findings The data provide support for the use of high-interactive technology achieved through the inclusion of haptic touch by showing it to provide a more visually appealing, easy to use, enjoyable and entertaining experience. However, the results also provide insight into boundaries of where the use of haptic touch does not significantly increase outcomes. Overall, the results suggest high-interactive retail technology using haptic touch provides a more entertaining experience for consumers, which leads to increased satisfaction with service providers, but this does not translate into a significant increase in purchase intentions. Originality/value This study examines the consumer and service provider benefits and limitations of using haptic touch in interactive retail technology. The effects of haptic touch for both the consumer and service provider have not previously been empirically examined thoroughly in a technological setting.

The Mobile Surgical Outreach Model for women with genital fistula in the Democratic Republic of Congo

Aims: To describe the PH Mobile Surgical Outreach (MSO) model of care delivery for women with GF and to present data highlighting the program’s scope and clinical impact in 2011-2017. Methods: PH created the MSO program to deliver health services to women with genital fistula (GF) living in remote areas in DRC. The MSO model facilitates reintegration through community education about GF, leveraging local staff in all aspects of care. Outreach trips are organized annually/bi-annually per site, depending on case volume and funding. Site selection is a two-step process: (1) identification of accessible, strategically located hospitals; (2) initial site visit and readiness assessment. This paper presents 2011-2017 MSO activities, including geographic scope, patient and provider outcomes. Results: The MSO team has worked with 43 clinic sites across 12 provinces. Since 2011, they have conducted 77 site visits and provided surgical care for 2,017 women. Table1 summarizes surgeries conducted annually by province, 2011-2017.Table 2 provides a clinical snapshot of 2017 case mix. Conclusions: The MSO model demonstrates feasibility and indicates program successes for capacity-building in skilled medico-surgical care and enhancing community awareness of GF. Training serves to improve local provider skills, strengthens health workforce and offers scalable, sustainable solutions to prevention and treatment.

Continuous Quality Improvement

For the anesthesia provider early in his or her career, the concept of continuous quality improvement (CQI) seems far-reaching in daily practice. CQI is a concept that crosses multiple disciplines focusing on improving the provision of care from one episode to the next. Unlike traditional performance improvement or quality improvement initiatives that initiate change for a specific issue, CQI challenges system thinking with cyclic re-evaluation of processes for both improvement and sustainability. Data driven, CQI concepts are approached using a systematic methodology that supports inquiry, change management, and process development. The American Society of Anesthesiologists, American Medical Association, Centers for Medicare and Medicaid Services, and multiple regulatory agencies support CQI. This approach engages evidence-based medicine and promotes improved patient and provider outcomes.