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Introduction: The coronavirus disease 2019 (COVID-19) pandemic has impacted health care organizations throughout the world. The Southwest Minnesota Region of Mayo Clinic Health System, a community-based health care system, was not immune, and in March 2020, our outpatient services were deferred and decreased by 90%. Method: This article is a review of the approach we used to safely reactivate outpatient care, the tools that we developed, and the outcomes of these reactivation efforts. A novel Outpatient Practice Reactivation Framework was established and used that included Outpatient Clinic Appointment Dashboard, Decision Matrix, Access Management, Virtual Care, and Patient Safety. This framework was guided by patient demand for care and by safety principles, as recommended by state and federal agencies and our internal infectious disease department guidelines. Results and Conclusions: Over the course of 9 weeks, ambulatory visit volumes and clinic utilization rates returned to pre-COVID levels (Pre-COVID fill rate range: 87% to 94%, post-COVID fill rate range: 86% to 89%) exceeding target fill rate of 80%, as a result of establishing the initiative as a shared priority, committing to a robust schedule and decisive actions, creating and maintaining a well-defined structure, taking an inclusive approach, overcommunicating and providing sufficient data for transparency, developing guiding principles, and training and educating staff. [ABSTRACT FROM AUTHOR]

Surgical removal of the uterus is one of the most performed procedures in women, with >600,000 hysterectomies performed per year in the United States alone, most for benign indications. Over the past decade, laparoscopy has become the more popular approach for completion of the hysterectomy globally. The increased uptake of minimally invasive approaches played a role in the adoption of outpatient hysterectomy with estimated volume ranging between 200,000 and 300,000 cases per year. And with more surgeries done in a same-day-discharge setting, screening for iatrogenic surgical injuries would be of paramount importance. The risk of iatrogenic injury to the bladder or ureters during the hysterectomy was estimated to be 0.21%. The rate of injury varied significantly between the different routes, with the highest being for total laparoscopic hysterectomy (0.31%), followed by laparoscopic assisted vaginal hysterectomy (0.29%), total vaginal hysterectomy (0.24%), total abdominal hysterectomy (0.2%), and laparoscopic subtotal hysterectomy (0.14%). Even though the risk of urinary tract injury is extremely low, the consequences related to additional repair, prolonged recovery, resulting disability, and loss of employment, especially if not immediately recognized, could be substantial. The most common risk factors for urinary tract injury are pelvic malignancy, history of pelvic radiation, history of cesarean delivery, prior abdominal surgery, endometriosis, adhesions, broad ligament leiomyomas, and low-volume surgeons (<10 per year). Prompt intraoperative recognition and repair of iatrogenic injuries reduce the risk of significant morbidity (e.g., fistulae formation, deep pelvic infections, and possible deterioration of kidney function). Although cystoscopy may be used intraoperatively to detect such an injury, the question of how often it should be used remains controversial. Although the value of routine cystoscopy per case may be low, the value of routine cystoscopy for the patient and the low-volume surgeon could be high. So, although universal cystoscopy is not required, surgeons early in their career might wish to adopt universal cystoscopy until surgical fortitude is established and experience in assessing level of risk is possible. At that stage, selective cystoscopy could be utilized more appropriately in a cost-effective manner. When index of suspicion is high, or when injury is detected, timely consultation with a urologist may help alleviate the long-term complications by prompt diagnosis and repair when needed. Practice environments that foster collegiality and surgical mentorship for young surgeons optimize outcome and expedite their progress to proficiency, similar to what surgical fellowship programs offer their trainees. (J GYNECOL SURG 37:190) [ABSTRACT FROM AUTHOR]

This document is an abstract from the Journal of Clinical & Translational Science. The first section discusses the need for a scale to assess "gender literacy" in clinical trials, in order to ensure that sex and gender are reported accurately. The second section explores the use of the HOUSES index and heatmap analysis to assess the feasibility of a population health management strategy for colorectal cancer screening rates. The third section raises awareness about the limitations of current portable neuroimaging training and recommends standardized training procedures to expand diversity among field-based neuroimaging technicians. [Extracted from the article]

After an increase of central line–associated bloodstream infections (CLABSIs) at our community hospital in 2021, a case-control study suggested that patients with CLABSIs were 3.0 times more likely to have missed daily chlorhexidine gluconate (CHG) bathing than patients without CLABSIs.To increase the rate of daily CHG bathing in hospitalized patients with central lines and subsequently reduce the number of CLABSIs.Our pre-post intervention was launched on September 2022 and consisted of enhancements to the electronic health record (EHR) to simplify the identification of overdue CHG bathing instances to increase compliance, and therefore decrease the CLABSI rate at our hospital. A workflow was implemented Monday–Friday utilizing these EHR enhancements for active surveillance to engage frontline nursing staff and address gaps in care in real time.After the initiative was implemented, adherence to daily CHG bathing increased from 94.9% to 95.3%, with a considerable disparity between weekdays (97.6%) and weekends (89.3%). After weekend data were excluded, the post-intervention increase in the adherence rate was statistically significant (p = .003).This initiative underscored the importance of involving health care informatics partners and showed how technology can bridge gaps in health care quality. Outreach and reminders effectively improved CHG bathing adherence by emphasizing the importance of consistent communication and follow-up. [ABSTRACT FROM AUTHOR]

Background: Communication gaps, whether incomplete or fragmented communication, have been the cause of many disasters in human civilisation. Coordination of healthcare is directly related to proper communication and handoffs among multidisciplinary teams throughout multiple shifts during a patient's hospitalisation., Local Problem: Patient surveys and direct patient feedback at Mayo Clinic Health System in Mankato, Minnesota, indicated that patient communication with physicians and nurses had declined in 2017 and 2018. Viewing this as an opportunity for improvement, our leadership initiated several changes to increase physician and nurse communication with patients, which resulted in no notable improvements., Methods: A systematic quality improvement approach was implemented by using Six Sigma methodology. Stakeholders from multidisciplinary teams were assembled as the project team. The five steps of Six Sigma methodology (Define, Measure, Analyse, Improve and Control) were followed to create a quality improvement intervention., Intervention: We developed a standardised and easy-to-use bedside team rounding tool to improve patient communication with physicians and nurses., Results: Postintervention patient satisfaction top-box scores exceeded target improvements for both physician (from 78.5% to 82.0%, p<0.01) and nurse (from 80.5% to 83.1%, p=0.04) communication domains. Physicians had a 33-point increase in percentile rank (from 41st to 74th percentile rank), and nurses had a 25-point increase in percentile rank (from 59th to 84th percentile rank). This increase in communication ranked our institution at the top of national benchmark organisations., Conclusions: Overwhelmingly positive patient feedback was achieved, and postintervention employee satisfaction was primarily positive when compared with preintervention satisfaction., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Since the introduction of a hospitalist physician model of care by Wachter and Goldman in 1996, important changes have occurred to address the care of hospitalized patients. This model was followed by the introduction of laborist physicians by Louis Weinstein in 2003, although large health maintenance organization practices have used this model since the 1990s. The American Congress of Obstetricians and Gynecologists supported the laborist model in a 2016 statement that was reaffirmed in 2017, recommending "the continued development and study of the obstetric and gynecologic hospitalist model as one potential approach to improve patient safety and professional satisfaction across delivery settings." Based on a recent American College of Obstetricians and Gynecologists publication, the problem is an anticipated staffing shortage of 6000 to 8800 obstetricians and gynecologists by 2020 and nearly 22,000 by 2050. The current workforce in obstetrics is aging, retiring early, and converting to part-time employment at an increasing rate. At the same time, the number of patients seeking obstetric and gynecologic care is dramatically increasing because of health care reform and population statistics. The solution is the use of alternative labor and delivery staffing models that include all obstetric providers (health care professionals). We present an alternative to the physician laborist model-a midwife laborist model in a collaborative practice with obstetricians practicing in a high-risk community setting., (© 2019 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc.)