Planning for post-pandemic cancer care delivery: Recovery or opportunity for redesign?

The delivery of cancer care has never changed as rapidly and dramatically as we have seen with the coronavirus disease 2019 (COVID-19) pandemic. During the early phase of the pandemic, recommendations for the management of oncology patients issued by various professional societies and government agencies did not recognize the significant regional differences in the impact of the pandemic. California initially experienced lower than expected numbers of cases, and the health care system did not experience the same degree of the burden that had been the case in other parts of the country. In light of promising trends in COVID-19 infections and mortality in California, by late April 2020, discussions were initiated for a phased recovery of full-scale cancer services. However, by July 2020, a surge of cases was reported across the nation, including in California. In this review, the authors share the response and recovery planning experience of the University of California (UC) Cancer Consortium in an effort to provide guidance to oncology practices. The UC Cancer Consortium was established in 2017 to bring together 5 UC Comprehensive Cancer Centers: UC Davis Comprehensive Cancer Center, UC Los Angeles Jonsson Comprehensive Cancer Center, UC Irvine Chao Family Comprehensive Cancer Center, UC San Diego Moores Cancer Center, and the UC San Francisco Helen Diller Family Comprehensive Cancer Center. The interventions implemented in each of these cancer centers are highlighted, with a focus on opportunities for a redesign in care delivery models. The authors propose that their experiences gained during this pandemic will enhance pre-pandemic cancer care delivery.     

Defining Staff Injury Due to Client Behavior in the Behavioral Health Care Setting

Continuous Quality Improvement programs require organizations to assess staff related injuries as they correspond to client restrictive procedures. This study compares a three level staff injury system (Mild, Moderate, Severe) against the type of situation in which the injury occurred defined as unintentional, weapon or device used, and during the process of a restrictive procedure. There were 5,685 injuries over a 6-year period: 8.4% of injuries were unintentional, 10.0% involved the use of a device, and 30.7% of injuries occurred as the result of a restrictive procedure. Staff injury at moderate level was associated with restrictive procedures (p < .001).     

Innovative Peer Review Model for Rural Physicians: System Design and Implementation

ABSTRACT:  Context: The peer review process in small rural hospitals is complicated by limited numbers of physicians, conflict of interest, issues related to appropriate utilization of new technology, possibility for conflicting recommendations, and need for external expertise. Purpose: The purpose of this project was to design, test, and implement a virtual peer review system for small rural hospitals in Texas. We sought to define the characteristics of a virtual peer review system in the context of rural health care, and to explore the benefits from peer review administration within a rural network supported by a university. Methods: Physicians from small rural hospitals participated in pilot testing of the system. Policies and procedures reflecting the innovative character of the new peer review process were developed based on legal/regulatory requirements and desired educational focus of the process. An information technology system to support the virtual peer review was selected, tested, and deployed. Findings: The system tests suggested feasibility of the procedures, reliability of the communication lines, and functional anonymity of the hospitals and physicians participating in the virtual peer review. Participating institutions and individual physicians expressed satisfaction with the reliability and user friendliness of the system as demonstrated during the pilot tests. Conclusions: Hospital licensing and accreditation require a process to monitor and evaluate the care of patients. Utilizing means of virtual communication is a viable option for small rural hospitals. This process is dependable, user-friendly and provides functional anonymity to participating hospitals and physicians. The peer review system has successfully functioned since 2004.     

A nurse‐driven process for timely removal of urinary catheters

Catheter‐associated urinary tract infection (CAUTI) comprises 30–40% of all health care‐acquired infections, and 70–80% of these infections are related with use of indwelling urinary catheters. This quality improvement (QI) project was initiated to evaluate the effectiveness of a nurse‐driven urinary catheter removal process in reducing the duration of urinary catheter usage in a general medical ward in Singapore. A pre‐ and post‐study design was adopted. The pre‐implementation data included urinary catheter utilization ratio and CAUTI rates. Over a 6‐months period, nurses used a nurse‐driven urinary catheter removal process to improve rates of timely removal of catheter. Data collected included nurses' compliance with the process and clinical outcomes, such as urinary catheter utilization ratio and CAUTI rates before and after implementation. Compliance with the use of the nurse‐driven process by staff was 89%. The urinary catheter utilization ratio revealed a raise from 0·12 before implementation to 0·18 after implementation. However, CAUTI rates decreased from 4 to 0 per 1000 catheter‐days, indicating a marginally significant difference between the pre and post‐implementation rates (p = 0.06), using Fisher's exact test. The nurse‐driven process decision support tool for optimizing appropriate catheter usage had the potential of reducing a patient's risk of acquiring CAUTI.