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Over the past two decades, the demands placed on modern paramedic systems has changed. Paramedic services can no longer continue to operate on a traditional response model where more ambulances are deployed to meet the rising demand of patients calling for their health needs. Recent research has explored system design in paramedicine and its relationship with organizational performance. Two subsequent paramedic systems have been identified with one, the Professionally Autonomous paramedic system, being linked to higher performance. Yet, how to operationalize this model for system modernization continues to be a gap in practice. To provide health leaders and policy makers with a framework from which to drive paramedic system modernization. This study uses the Knowledge to Action framework to develop an implementation plan for systems that seek to modernize their service delivery model toward that of a Professionally Autonomous paramedic system. A detailed plan of the steps required to undertake system transformation are outlined. Whilst this framework outlines the components required for system modernization, it does not propose an in-depth outline of each of the steps required to achieve each component. Rather, end users are encouraged to develop individual implementation plans tailored to the local context using the comprehensive tools outlined within. This knowledge to action framework provides health leaders and policy makers with a uniform roadmap for paramedic system modernization intended to improve health (clinical) outcomes as well as health system outcomes through the Professional Autonomous paramedicine model. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Medical Imaging & Radiation Sciences is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Medical Imaging & Radiation Sciences is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective The objective of this qualitative, retrospective case study was to explain how and why the Chaguo Letu project was able to successfully make informed strategic decisions on how to implement a Cervical Self Sampling Program (CSSP) in Kenya. Methods This qualitative, inductive, study applied the case study method; a retrospective, explanatory, single bounded case study involving critical reflection on four embedded units of analysis: 1) Participatory Action Research (PAR) methodology, 2) Scenario Based Planning (SBP) method, 3) Existential Phenomenology (EP) method, and 4) Convergent Analytics (CA) model. Theory-related analytic generalization provided the foundation for the data analysis approach. Results The PAR methodology was critical to grounding this complex study and provided a new way of interacting and learning. The SBP data collection and analysis tools performed well in conducting perception analysis and trend/uncertainty analysis exercises. Incorporating EP enabled a deeper investigation of the phenomenon of cervical self-sampling and determined which units of significance (i.e., situational or emotional) had a greater influence on CSSP social acceptability. The CA model provided an approach to make sense of data, turn it into meaningful information and facilitate the convergence of tacit, explicit and cultural knowledge, which ultimately enabled informed decision-making for an uncertain future. Conclusions Applying an integrated approach encompassing the PAR methodology, SBP method, EP method and CA model enabled the Chaguo Letu project to make informed strategic choices on how to implement a CSSP in Kenya. Each element of the study design, by itself, could not have achieved this outcome. [ABSTRACT FROM AUTHOR]

The objective of this study was to determine the factors that increase the odds of long-stay delayed discharge in alternate level of care (ALC) patients using data collected from the Ontario Wait Time Information System (WTIS) database. Retrospective cohort study utilizing data from Niagara Health's WTIS database. WTIS includes individuals admitted to any of the Niagara Health sites that have been designated as ALC. Sample consisted of 16,429 ALC patients who received care in Niagara Health hospitals from September 2014 to September 2019 and were recorded in the WTIS database. ALC designation of 30 or more days was used as the threshold for a long-stay delayed discharge. This study used binary logistic regression modeling to analyze sex, age, admission source, and discharge destination as well needs/barriers requirements to assess the likelihood of a long-stay delayed discharge among acute care (AC) and post-acute care (PAC) patients given the presence of each variable. Sample sizes calculations and receiver operating characteristic curves were used to verify the validity of the regression model. Overall, 10.2% of the sample were considered long-stay ALC patients. Both AC and PAC long-stay ALC patients were more likely to be male [OR = 1.23, (1.06–1.43); OR = 1.28, (1.03–1.60)] and have a discharge destination of a long-term care bed [OR = 28.68, (22.83–36.04); OR = 6.22, (4.75–8.15)]. AC patients had bariatric [OR = 7.16, (3.45–14.83)], behavioral [OR = 1.89, (1.22–2.91)], infection (isolation) [OR = 2.31, (1.63–3.28)], and feeding [OR = 6.38, (1.82–22.30)] barriers hindering discharge. PAC patients had no significant barriers hindering patient discharge. Shifting the focus from ALC patient designation to short- vs long-stay ALC patients allowed this study to focus on the subset of patients that are disproportionately affecting delayed discharges. Understanding the importance of specialized patient requirements in addition to clinical factors can help hospitals become more prepared in preventing delayed discharges. [ABSTRACT FROM AUTHOR]

Fever during chemotherapy is a common and potentially severe complication being increasingly evaluated in emergency departments to minimize morbidity and mortality. Streamlining triage of these patients may improve health outcomes and wait times in the health care system. A retrospective chart review of febrile patients undergoing chemotherapy was conducted at a local emergency department to assess the impact of nurse-initiated protocols on wait times. We identified 315 patients undergoing current chemotherapy presenting with fever. Of these, 140 (44%) and 87 (28%) were initiated on the sepsis and febrile neutropenia nurse-initiated protocols, respectively. In total, 197 (63%) were admitted. The febrile neutropenia protocol had a shorter wait time from triage to disposition than the sepsis protocol (403 minutes [SD = 23] vs 329 minutes [SD = 19], t = 1.71, P = 0.01). Furthermore, the febrile neutropenia protocol demonstrated shorter times from both triage to lab results reported, in addition to the physician initial assessment in the admitted patient subgroup. Decreased wait times from triage associated with the use of a febrile neutropenia protocol could be accounted for by a lower number of lab results required through this protocol in addition to shorter physician assessment times in the admitted population. This study shows that nurse-initiated protocols may influence door-to-antibiotic time for patients undergoing chemotherapy. By having a targeted protocol for the cancer population, health care centers may be able to demonstrate decreased health care expenditure and increased resource availability. Furthermore, as the current population of patients undergoing chemotherapy is at a high risk for neutropenia, prompt management is crucial to minimize mortality. [ABSTRACT FROM AUTHOR]