Evaluation of a Graduated Exposure Procedure to Teach Extended Mask Wearing in Various Settings to Children With Autism

During the COVID-19 outbreak, the Center for Disease Control (CDC) recommended that everyone 2 years and older wear a face mask while in a community setting. However, children with autism may be reluctant to wear a mask, particularly for extended durations. In the current study, we implemented a graduated exposure procedure to teach mask wearing for a minimum of 1 hour in an early intensive behavioral (EIBI) intervention clinic to three children diagnosed with autism. We subsequently probed mask wearing, and if necessary implemented the graduated exposure procedure, in each participant’s home and in a mock physician’s office. Finally, we collected probe data on mask wearing in another community setting and 1 month post-treatment maintenance data in the EIBI clinic. During baseline, participants wore masks for 0 second to 5 minutes. After treatment, all participants wore the mask for at least 1 hour in each setting, with maintenance probes indicating 4 to 5 hour mask tolerance.

Secondary care interface: optimising communication between teams within secondary care to improve the rehabilitation journey for older people

Effective communication between members of the multidisciplinary team is imperative for patient safety. Within the Medicine for the Elderly wards at Royal Victoria Hospital (RVH) in Dundee, we identified an inefficient process of information-sharing between the orthopaedics outpatient department (OPD) at the main teaching hospital and our hospital’s rehabilitation teams, and sought to improve this by introducing several changes to the work system. Our aim was for all patients who attended the OPD clinic to have a plan communicated to the RVH team within 24 hours.Before our intervention, clinic letters containing important instructions for ongoing rehabilitation were dictated by the OPD team, transcribed and uploaded to an electronic system before the RVH team could access them. We analysed clinic attendances over a 4-week period and found that it took 15 days on average for letters to be shared with the RVH teams. We worked with both teams to develop a clinical communication tool and new processes, aiming to expedite the sharing of key information. Patients attended the OPD with this form, the clinician completed it at the time of their appointment and the form returned with the patient to RVH on the same day.We completed multiple Plan–Do–Study–Act cycles; before our project was curtailed by the COVID-19 pandemic. During our study period, seven patients attended the OPD with a form, with all seven returning to RVH with a completed treatment plan documented by the OPD clinician. This allowed rehabilitation teams to have access to clinic instructions generated by orthopaedic surgeons almost immediately after a patient attended the clinic, essentially eliminating the delay in information-sharing.The introduction of a simple communication tool and processes to ensure reliable transfer of information can expedite information-sharing between secondary care teams and can potentially reduce delays in rehabilitation.

Enhanced Scheduling Support to Improve Continuity of Care in a Resident Training Clinic

ABSTRACT Background Clinical continuity is recognized as a driver of satisfaction for patients and physicians. Greater continuity may positively affect trainee decisions to enter primary care. Maintaining clinical continuity remains a challenge in residency clinics. Objective We determined whether enhanced scheduling support was associated with improvement in internal medicine resident continuity with patients. Methods This study was conducted from June 2017 to December 2018. In the intervention clinic, a single scheduling staff member (ratio of 10 residents to 1 scheduler) was colocated within the clinical space, allowing the scheduler to participate in clinical discussions and direct communication with physicians regarding future appointments. In the comparison clinic, scheduling staff (19:1 ratio) were located at a remote front desk area and relied on patient reports or electronic health record orders to identify appointment needs and arrange follow-up appointments. The main outcome of the intervention was resident continuity, calculated using the continuity for physician formula. Results During the study period, mean resident continuity was 23% (range 13%–37%) in the comparison clinic (57 residents) and 54% (range 38%–66%) in the intervention clinic (10 residents). Resident continuity was significantly higher in the intervention clinic compared with the traditional control clinic for every quarter measured (P < .001 for all comparisons). Conclusions Enhancing scheduling support through colocation and a lower resident to scheduler ratios was associated with significantly higher rates of resident continuity compared with a traditional front desk model, with results sustained over 18 months.

EVALUATING AN INTERVENTION TO PREVENT SELF-NEGLECT IN VULNERABLE ADULT HEALTHCARE PATIENTS

Alleged self-neglect is the most commonly reported type of abuse to Adult Protective Service (APS) agencies nationwide. Researchers, healthcare practitioners and APS staff in Texas collaborated on a project funded by the U.S. Administration for Community Living to develop and evaluate an intervention to prevent self-neglect in older and/or disabled adults. Nineteen primary care clinics in a large healthcare system were randomized to intervention (intensive case management over a four-month period) and control (usual healthcare) groups. Patients with risk factors for self-neglect in these clinics were randomly selected, and 480 patients consented to participate in the study. Baseline EMR data indicated the most common risk factors for self-neglect included depression (54% of these participants), dependence in activities of daily living (28%), and dementia (27%). Social workers conducted a home visit with 287 intervention clinic patients, identified their needs, developed a care plan, and followed up regularly with patients. Based on the Adult Self-Neglect Assessment, 61% were identified as having concerns related to self-neglect. Their most frequently identified areas of need for help were food assistance/nutrition (54%), functional limitations (40%), social isolation (36%), home modifications (34%), and mental health issues (32%). Along with public assistance, and referrals to home- and community-based services, findings are promising for preventing patients from becoming self-neglecting in the future. Only 7 intervention clinic participants were reported by project staff to APS for suspected abuse, neglect or exploitation during the 16-month study. This type of multi-disciplinary collaboration can inform development of evidence-based innovations in practice and policy.