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This document is the final report of T6.6 Legacy systems. D6.9 contains the final updates on the collected information, properties and characteristics, as well as taxonomy approaches of the chosen legacy systems. EU legacy systems, such as PAGER, have been used in the project and more specifically in the use cases where the emergency was an earthquake. In addition, valuable knowledge coming from another legacy system (e.g SUMMA’s medical service) were extracted, in order to design and implement COncORDE’s patient management system & triage. D6.9 lists the final legacy systems and analyze their usage during SnR Operations (Use Cases - Pilot Scenarios).

This document is the final report of T6.6 Legacy systems. D6.9 contains the final updates on the collected information, properties and characteristics, as well as taxonomy approaches of the chosen legacy systems. EU legacy systems, such as PAGER, have been used in the project and more specifically in the use cases where the emergency was an earthquake. In addition, valuable knowledge coming from another legacy system (e.g SUMMA’s medical service) were extracted, in order to design and implement COncORDE’s patient management system & triage. D6.9 lists the final legacy systems and analyze their usage during SnR Operations (Use Cases - Pilot Scenarios).

Objective To develop and implement a multidisciplinary early activation mechanism and bundle of care (eHIP) to improve adherence to ACSQHC standards in a regional trauma centre. Methods Barriers to implementation were categorised using the Theoretical Domains Framework, then linked to specific strategies guided by the Behaviour Change Wheel and Behaviour Change Technique Taxonomy (BCTT). The resulting implementation strategies were assessed using Affordable, Practical, Effective, Acceptable, had Side-effects (APEASE) criteria. Results Eighty-three barriers to implementation of the hip fracture care bundle were identified. The behaviour change wheel process resulted in the identification of 41 techniques to address these barriers. The predominant mechanisms to achieve this were development and implementation of 1) formal policy that outlines eHIP roles; 2) video promotion; 3) pager group; 4) fascia iliaca block enabling; 5) eMR modifications; 6) face-to-face reinforcement and modelling; 7) communication and prompts; 8) environmental restructuring. Conclusion We applied behaviour change theory through a pragmatic evidence-based process. This resulted in a codesigned strategy to overcome staff and organisational barriers to the implementation of a multidisciplinary early activation mechanism and bundle of care (eHIP). Future work will include evaluation of the uptake and clinical impact of the care bundle.

Objective We examine how physicians and nurses use available communication technologies and identify the implications for communication and patient care based on the theory of workarounds. Materials and Methods We conducted a qualitative study at 4 U.S. hospitals during 2017. Researchers spent 2 weeks at each hospital conducting unit-based observation, shadowing, interviews, and focus groups with nurses and physicians. Using an iterative process, we inductively coded and thematically analyzed data to derive preliminary themes. The theory of workarounds provides an organizational lens on workarounds, consisting of 5 components: antecedents, types, effects, managerial stance, and organizational challenges of workarounds. The first 3 components of the theory helped us to organize and explain our findings. Results Communication technologies consisted of pagers and telephones. Antecedents to workarounds included one-way information flow, differential access related to differences in technology types, and technology mismatch. Types of workarounds included bypassing a variety of obstacles and substituting for unavailable resources. Direct effects of workarounds included pager fatigue, interruptions in patient care, and potential errors. Discussion One-way communication technologies created an environment where workarounds could flourish. By placing results within the context of the theory of workarounds, we extend what we know about why and how workarounds develop, and offer strategies to minimize workarounds’ adverse effects. Conclusions Through the theory of workarounds, we see that there is a trajectory to workarounds with potential consequences for clinicians and patients. Two-way communication technologies could minimize workarounds and gaps in information exchange, and reduce unnecessary interruptions and the potential for adverse events.

Hospital medicine groups vary staffing models to match available workforce with expected patient volumes and acuity. Larger groups often assign a single hospitalist to triage pager duty which can be burdensome due to frequent interruptions and multitasking. We introduced a new role, the Triage nurse, to hold the triage pager and distribute patients. We sought to determine the effect of this Triage Nurse on the perceived workload of hospitalists and frequency of pages.We partnered with our patient throughput department to implement the Triage Nurse role who took the responsibility of tracking and distributing admissions among three admitting physicians along with coordinating report. We used the National Aeronautics and Space Administration-Task Load Index (NASA-TLX) to measure perceived workload and accessed pager logs of admitters for 3 months before and after implementation.Overall, 50 of an expected 67 NASA-TLX surveys (74.6%) were returned in the pre-intervention period and 64 of 92 (69.6%) were returned in the post-intervention period. We found a statistically significant reduction in the domains of physical demand, temporal demand, effort and frustration from pre- to post-intervention periods (p 0.01). There was also a significant decrease in the performance domain (p = 0.01) with a lower number indicative of better perceived performance. There was a significant reduction in the mean number of pages received by admitting hospitalists over their 9-h shifts (81.3 + 17.3 vs 52.4 + 7.3; p 0.01).The implementation of the Triage Nurse role was associated with a significant decrease in the perceived workload of admitting hospitalists. Our findings are important because workload and interruptions can contribute to errors and burnout. Future studies should test interventions to improve hospitalist workload and evaluate their effect on patient outcomes and physician wellness.

Environmental damage due to natural resource extraction, especially in watershed areas, seems to be of increasing concern and so far, from the aspect of aquatic and water resources, plankton is commonly used as an indicator of environmental damage. This study explores the distribution of microphyta as a parameter of environmental damage. The research was conducted in Pager watershed, Central Kalimantan and sampled at 2 (two) stations, namely station A (for the right side of the river) and station B (for the left side of the river). The study was conducted 13 sampling times, which began in the period 25 May 2019 ending until 9 November 2019. Laboratory analysis to identify the type and number of microphyta was carried out at the Palangka Raya University Laboratory. The results showed that the number of microphyta taxa at station A (right side of the river) was 12-13 species, more than station B (left side of the river). The number of microphyta taxa at Station B is 8 - 9 species, it is suspected that there is an influence from the gray water settlements around the left side, especially when the water level drops. The distribution characteristics of microphyta in the Pager river are as follows: large number of taxa/species, low abundance and low diversity index. River/peat water environments are vulnerable to change, especially human interference. This research shows the potential use of microphyta as an indicator of environmental damage.

Background/Aims A timely and effective communication system between hospital staff is vital for teamwork, patient safety and optimal clinical outcomes. This study compared staff perceptions of WhatsApp compared to traditional pagers for clinical communication in one of the largest tertiary care hospitals in Pakistan. Methods A questionnaire regarding factors such as the ease of use and reliability of each communication modality was distributed to interns and residents at the Aga Khan University Hospital in Karachi, Pakistan. Descriptive statistics were computed for percentages, frequencies and statistical significance of categorical variables. Results A total of 163 participants completed the survey. Of these, 95.1% preferred WhatsApp for storing information for later reference, 58.6% considered WhatsApp to be faster in terms of response, and 52.1% found WhatsApp easier to use than pagers. However, 60.7% chose pagers as better suited for emergency situations and 92.6% were concerned that WhatsApp could potentially compromise patient data security. Overall, participants preferred the development of a bespoke app for hospital communications instead. Conclusions WhatsApp was regarded as easier to use and more accessible than pagers, but it was not deemed to be compliant with hospital policies. Productive communication could be optimised with the use of a tailor-made app dedicated solely to clinical communication.

Underground working in different horizons with intricate haulage and traveling roadways is very complex in nature. Wired communication is presently the most adopted technology in Indian underground mines. Also, the cellular network cannot be used for communication due to the non-availability of the coverage link. So, addressing of key-personnel to pass on the information and assign task becomes a challenge for mine management. Implementation of wireless paging systems with routers and/or repeaters at strategic locations can instruct manpower for the jobs as well as obviate the impending mishap, if any, at remote locations of the mine. This paper presents a design of a wireless paging system for underground mines which consists of a two-way alphanumeric paging system operating on a ZigBee based wireless network and a paging terminal software. This paging system can be used to unicast or broadcast messages to all the pagers working in the RF network. A successful field trial of the same is also conducted to devise a node placement strategy for the routing units with prototype pagers in the shaft and traveling roadways at 400 and 500 m horizon of a deep underground coal mine.

The empirical approach is a potential candidate along with other engineering-based loss models within the Prompt Assessment of Global Earthquakes for Response (PAGER) system for rapid social and economic loss estimation. In this study, we focused to evaluate the Sinabang earthquake on 7 January 2020 with Magnitude 6.3. The result of this study shown the green alert for shaking related fatalities and economic losses in 65 % from the estimated fatalities and losses in Sinabang.

BackgroundHealthcare systems revolve around intricate relations between humans and technology. System efficiency depends on information exchange that occur on synchronous and asynchronous platforms. Traditional synchronous methods of communication may pose risks to workflow integrity and contribute to inefficient service delivery and medical care.AimTo compare synchronous methods of communication to Medic Bleep, an instant messaging asynchronous platform, and observe its impact on clinical workflow, quality of work life and associations with patient safety outcomes and hospital core operations.MethodsCohorts of healthcare professionals were followed using the Time Motion Study methodology over a 2-week period, using both the asynchronous platform and the synchronous methods like the non-cardiac pager. Questionnaires and interviews were conducted to identify staff attitudes towards both platforms.ResultsA statistically significant figure (pConclusionThe asynchronous platform improved clinical communication compared with synchronous methods, contributing to efficiencies in workflow and may positively affect patient care.

We introduce a Bayesian framework for incorporating time-varying noisy reported data on damage and loss information to update near real-time loss estimates/alerts for the U.S. Geological Survey’s Prompt Assessment of Global Earthquakes for Response (PAGER) system. Initial loss estimation by PAGER immediately following an earthquake includes several uncertainties. Historically, the PAGER’s alerting on fatality and economic losses has not incorporated location-specific reported data on physical damage or casualties for a given earthquake. The proposed framework provides the ability to include early reports on fatalities at any given time and improve the overall impact forecast for the earthquake. The reported data on fatalities or damage are generally incomplete and noisy, especially in the early hours of the disaster. To address these challenges, we develop a recursive Bayesian updating framework that takes into account the loss projection model and the measurement and model uncertainties. The framework is applied to loss data for three example earthquakes, and the results show that the proposed updating improves the loss estimates and alert level to the correct level within the first day of the earthquake.

Responsibility for the overnight on-call pager can be nerve-wracking, particularly to CPE students and those who are new to chaplaincy. This reflection attempts to reframe the terror we may associate with night-time and draws on the spirituality of John of the Cross in offering encouragement to those who wish to do this work with greater openness, equanimity, or courage.

Interruptions are germane to inpatient medical practice but carry the consequences of reduced error prevention, psychological stress, and impaired knowledge consolidation among trainees. In this mixed methods study, we captured 172 task changes via time-motion observations of four residents on a general neurology service and completed semi-structured interviews with the same group. Twenty-five percent of task changes were due to interruptions, the majority via pager communications, and only 2% required urgent clinical attention. Residents reported frustration towards inefficient aspects of the pager system. Given the high rates of interruptions identified, we propose mitigating strategies such as triaging communications by urgency.

The United States Geological Survey’s Prompt Assessment of Global Earthquakes for Response (PAGER) alert system provides rapid (10–20 min) but general loss estimates of ranges of fatalities and economic impact for significant global earthquakes. FEMA’s Hazus software, in contrast, provides time-consuming (2–5 h) but more detailed loss information quantified in terms of structural, social, and economic consequences estimated at a much higher spatial resolution for large domestic earthquakes. We developed a rapid hybrid post-earthquake product that takes advantage of the best of both loss models. First, though, we conducted a systematic comparison of loss estimates from PAGER with Hazus for all significant, relatively recent, domestic earthquakes for which adequate loss data exist—augmented by a dozen ShakeMap scenarios. The systematic comparison of Hazus and PAGER losses provided the basis for selecting the specific loss metrics to present from each system. The signature product will serve as a supplement to the widely deployed PAGER alert product for significant domestic earthquakes.

Background Hospitals across the country are investing millions of dollars to adopt new Health Insurance Portability and Accountability Act (HIPAA)-compliant secure text messaging systems. However, in nearly all cases, these implementations are occurring without evaluation of their impact on patient care. Objective To evaluate perceived impact on patient care and workflow of new text messaging system implemented in obstetrics at Yale-New Haven Hospital and to inform guidelines for future implementations in emergent settings. Methods A new HIPAA-compliant texting system was implemented in obstetrics in 2016. Before implementation of the new system, residents and nurses were surveyed on perceived effect of communication system (pagers with text receiving, service mobile phones, personal cell phones) on clinical workflow and patient care using 5-point Likert scale and open-ended questions. Following roll-out (1 and 6 months), both teams were surveyed with same questions. Results were compared using Wilcoxon–Mann–Whitney test (0–1 months and then 0–6 months). Open-ended question results were qualitatively compared for recurrent unifying themes. Results In both nursing and resident domains, 1 month after implementation, the new communication system was perceived to significantly improve efficiency and patient care across all metrics. After 6 months, this effect decayed in nearly all categories (including efficiency, real-time communication, and knowledge of covering provider). The exception was nurse's knowledge of which resident to contact and resident's timely evaluation of patient, for which we observed sustained improvements. System shortcomings identified included interrupted connection (i.e., dropped calls), dysfunctional and inaccurate alert system, and unclear identification of the covering provider. Conclusion A new text-messaging–based communication system may improve efficiency and patient care in emergent settings, but system shortcomings can substantially erode potential benefits over time. We recommend implementers evaluate new systems for a set of specific functional requirements to increase probability of sustained improvement and decrease risk of poor patient outcomes.

Objetivo: Analisar a literatura científica a respeito da comunicação por meios eletrônicos entre profissionais de saúde. Método: Revisão integrativa da literatura, realizada nas bases de dados e/ou portais PubMed, Biblioteca Virtual em Saúde e Cochrane, até agosto de 2018, com descritores combinados, que respondem à pergunta norteadora: “Como ocorre a comunicação eletrônica entre os profissionais de saúde na assistência ao paciente?. Resultados: Seis artigos foram incluídos, publicados de 2011 a 2016, no idioma Inglês. Os recursos foram smartphone, pager e tablet. Os aplicativos utilizados foram WhatsApp, Medigram e Serviço de Mensagens Curtas (SMS). Agilidade, facilidade de uso e auxílio na tomada de decisão foram as vantagens encontradas no uso desse recurso na comunicação dos profissionais; dentre as desvantagens estão ausência de privacidade e de confidencialidade das informações, interrupções na assistência e inabilidade no uso do recurso tecnológico. Conclusão: O uso de aplicativos para troca de mensagens e comunicação interdisciplinar de fato proporciona agilidade na comunicação, mas a confidencialidade desses dados ainda é uma questão a ser tratada. Assim, cabe ao enfermeiro conduzir a comunicação com os demais profissionais, preservando a privacidade do paciente.

WhatsApp (Facebook), which is a popular instant messaging “app” that is available on several platforms globally, allows users to share text, images, and video (and much more) over an end-to-end encrypted connection. We have investigated its use among the oral and maxillofacial surgery junior trainees’ WhatsApp group at King’s College Hospital, a level one trauma centre in London, and reviewed existing studies. On five of the seven days analysed, there were 191 communications. Most (n = 127, 67%) were related to administrative issues and patient care (n = 62, 33%). Only two (1%) related to neither and were classified as “other”. No communications were sent to the group over the weekend. WhatsApp is a popular means of communication among junior trainees within our department, and can be used to send concise information to several people at once, often more quickly than by telephone, pager, or email. The technology, however, should be used carefully, and it raises important questions on confidentiality, which have recently been addressed by the medical director of the NHS in the wake of its use as a “cascade mechanism” during major terrorist incidents. We also discuss the potential value of emerging methods of communication that have been specifically designed for use in healthcare.

> Our alarms ring promptly in the early mornings, a synchronous wakeup call for resident physicians. We hurry to get dressed, brew our coffee, and head into the hospital. It is the height of the coronavirus disease 2019 pandemic and we are careful to isolate ourselves during our commutes. It is our civic duty. We used to take for granted the familiar sounds of our daily migrations from home to work; the rhythmic streams of music played a bit too loudly through the headphones of fellow train passengers, the cacophonous honking of horns in backed up traffic, and the quick “hellos” exchanged between passersby in the crosswalk. Now, we hear mostly silence. > This sense of eerie quiet and seclusion also permeates the hospital, and beyond. At sign out, we greet our colleagues with smiles that remain hidden under our surgical masks. We bathe shared pagers and workstations in antiseptic, sterilizing the process of transition from shift to shift. In caring for patients, we struggle to build rapport amid the barriers of personal protective gear and safe social distancing practices. We grapple with laughter and loss through plastic face shields, human touch diminished as a silent enemy invades. After work, we have difficulty effectively processing our experiences and emotions, our friends and loved ones accessible only virtually or from afar. We feel … Address correspondence to Dr Danielle Rabinowitz, Md, MM, Department of Pediatrics, Boston Children’s Hospital, 300 Longwood Ave, Boston MA, 02115. E-mail: danielle.rabinowitz{at}childrens.harvard.edu

In this article, we examine how insulin pens and pumps – two major devices for delivering insulin, the anabolic hormone used to treat Type 1 diabetes – are designed to conceal and fashion insulin delivery around their appearance as key communication technologies. Insulin pens and insulin pumps transform the aesthetics of insulin delivery away from the medicalized appearance of syringes toward that of beautiful technological artifacts. They both hide and draw attention to their status as technological artifacts and their medical use through a set of desirable, though sometimes incongruous, device aesthetics. Deliberately marketed around their resemblance to pens or pagers, insulin delivery devices are examples of skeuomorphs that “materialize the metaphor” of writing instruments and telecommunication tools into their design. We analyze how diabetes education and marketing materials present insulin delivery devices through skeuomorphic performances of use that uphold norms of concealment in diabetes self-management in conditions of social and medical surveillance. Drawing on patents, educational and marketing materials, and our own experiences with these devices, we argue that the skeuomorphic design of these devices morally regulates the embodied performance of diabetes.

Pagers or ‘bleeps’ have been used for intra-hospital communication for over 30 years but are time inefficient and antiquated. To investigate how social media has affected the use of pagers we compared pager activity with instant messaging patterns over a 6-month period in a large, UK, teaching hospital. In 2017, it was estimated that 10% of the world’s pagers were used in the UK National Health Service at an estimated cost of £6.6 million/year (a figure which does not include network costs or cost incurred by inefficiency).1 This antiquated technology is associated with a number of issues. Pagers are typically associated with substantial time inefficiency,2 a quarter of pager messages are unnecessary3 and 65% interrupt patient care.4 Understandably, therefore, pagers are not popular with doctors.2 In response to these shortcomings, the UK Health and Social Care Secretary has called for the health service to ‘#purgethepager’.5 Instant messaging on the wards either takes the form of informal, non-condoned usage via social media platforms such as WhatsApp (which are not designed for communication of patient information), or hospital-provided applications that are specifically tailored for clinical use. In 2018, a large university hospital introduced one such application, Medxnote, a mobile encrypted instant messaging application. After initial pilots, Medxnote was made available to all employees of the Trust in 2018. Pagers continue to be in use which provides a unique opportunity to assess the impact of a new technology on traditional patterns of hospital communication. ### Data collection Message logs between 12 November 2018 and 30 April 2019 were provided by Medxnote. Logs included a unique, anonymised identifier for the sender and recipient(s) of each message …

Underground working in different horizons with intricate haulage and traveling roadways is very complex in nature. Wired communication is presently the most adopted technology in Indian underground mines. Also, the cellular network cannot be used for communication due to the non- availability of the coverage link. So, addressing of key-personnel to pass on the information and assign task becomes a challenge for mine management. Implementation of wireless paging systems with routers and/or repeaters at strategic locations can instruct manpower for the jobs as well as obviate the impending mishap, if any, at remote locations of the mine. This paper presents a design of a wireless paging system for underground mines which consists of a two-way alphanumeric paging system operating on a ZigBee based wireless network and a paging terminal software. This paging system can be used to unicast or broadcast messages to all the pagers working in the RF network. A successful field trial of the same is also conducted to devise a node placement strategy for the routing units with prototype pagers in the shaft and traveling roadways at 400 and 500 m horizon of a deep underground coal mine.

Due to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, sufficient distance between people is absolutely necessary, especially in waiting rooms of medical care institutions. This is frequently difficult to realize due to restricted spatial capacities.This study investigated the possibility of enabling patients to spend the waiting period outside of the waiting room of the ENT outpatient department, in order to reduce the number of patients in the waiting rooms and therefore observe distancing rules. This was realized by the use of a pager system.During the timeframe of 12.5 weeks (04.06.2020-31.08.2020), ENT outpatients were issued with pagers. The patients could thus move freely within the hospital and grounds. The pager system was activated 10-15 min before the appointment, to call patients back to the outpatient ENT clinic. questionnaires were used to evaluate the system and examine patients' acceptance and satisfaction.The 137 questionnaires analyzed showed satisfaction with the system, not only regarding distancing rules but also with the more comfortable waiting time.Introduction of a pager system for patients could help to meet hygiene and distance rules, and also increase comfort during (often unavoidable) waiting times for patients in the university hospital ENT outpatient department. The long-term use of such a system seems promising.HINTERGRUND: Aufgrund der Pandemie mit dem neuartigen Coronavirus (SARS-CoV-2) sollte überall auf ausreichend Abstand zwischen Personen geachtet werden, insbesondere auch in Wartebereichen medizinischer Versorgungseinrichtungen. Bei oftmals eingeschränkten räumlichen Kapazitäten ist dies jedoch nicht immer problemlos realisierbar.Wir untersuchten die Möglichkeit, mittels eines Pagersystems den Patienten unserer HNO-Ambulanz eine Wartezeit außerhalb des eigentlichen Wartebereichs zu ermöglichen, um damit die Anzahl der Patienten im Wartebereich zu reduzieren, und die Einhaltung der Abstandsregeln zu gewährleisten.In einer Zeitspanne von 12,5 Wochen (Beginn 04.06.2020, Ende 31.08.2020) erfolgte die Ausgabe von Pagern an die Patienten unserer HNO-Ambulanz. Teilnehmenden Patienten war es damit möglich, sich während der Wartezeit auf dem gesamten Klinikgelände frei zu bewegen. Der Pager wurde 10–15 min vor dem Termin aktiviert, und der Patient damit zurück in die HNO-Ambulanz gerufen. Mittels Fragebögen erfolgte eine Evaluation des Systems, um die Akzeptanz und Zufriedenheit der Patienten zu eruieren.137 Fragebögen wurden analysiert, hierbei zeigte sich eine Zufriedenheit mit dem System – nicht nur, was die Einhaltung der Abstandsregeln betrifft, sondern auch bzgl. eines höheren Komforts während der Wartezeit.Die Einführung eines Pagersystems für Patienten führt neben der Wahrung der Hygiene- und Abstandsregeln auch zu einer Erhöhung des Komforts während der (häufig nicht zu vermeidenden) Wartezeit für die Patienten in der universitären Ambulanz einer HNO-Klinik. Daher erscheint ein langfristiger Einsatz eines solchen Systems vielversprechend.

A physician reflects on the significance of responding to the pager, particularly during one Sunday Mass when she was summoned for assistance. How do we answer when we are called?

In this book chapter, we introduce a pipeline to mine significant biomedical entities (or bioentities) in biological networks. Our focus is on prioritizing both bioentities themselves and the associations between bioentities in order to reveal their biological functions. We will introduce three tools BEERE, WIPER, and PAGER 2.0 that can be used together for network analysis and function interpretation: (1) BEERE is a network analysis tool for "Biomedical Entity Expansion, Ranking and Explorations," (2) WIPER is an entity-to-entity association ranking tool, and (3) PAGER 2.0 is a service for gene enrichment analysis.

In the past few years, wireless devices, including pocket PCs, pagers, mobile phones, etc, have gained popularity among a variety of users across the world and the use of mobile phones in particular, has increased significantly in many parts of the world, especially in India. Cell phones are now the most popular form of electronic communication and constitute an integral part of adolescents’ daily lives, as is the case for the majority of mobile phone users. In fact, mobile phones have turned from a technological tool to a social tool. Therefore, the influence of cell phones on young people needs to be thoroughly examined. In this paper, we explore the attitude of young adults towards cell phones and identify the hidden classes of respondents according to the patterns of mobile phone use. The Latent Class Analysis (LCA) serves as a tool to detect any peculiarities, including those gender-based. LCA measures the value of an unknown latent variable on the basis of the respondents’ answers to various indicator variables; for this reason, a proper selection of indicators is of great importance here. In this work, we propose a method of selecting the most useful variables for an LCA-based detection of group structures from within the examined data. We apply a greedy search algorithm, where during each phase the models are compared through an approximation to their Bayes factor. The method is applied in the process of selecting variables related to mobile phone usage which are most useful for the clustering of respondents into different classes. The findings demonstrate that young people display various feelings and attitudes toward cell phone usage.

Literature reviews generally analyse and synthesis the evidence (or lack thereof) in a particular topic area and they are an increasingly popular form of scholarly activity. The scoping review is a popular literature review approach that has been adopted across the social and health sciences over the last fifteen years. With this upsurge in use, differences of opinion about how to analyse and report scoping reviews has also grown. Drawing on work carrying out a scoping review on oral health and child maltreatment, we put forward a structured approach to analysis and reporting of such reviews: the PAGER (Patterns, Advances, Gaps, Evidence for practice and Research recommendations) framework. In this article, we reflect on the strengths and limitations of the framework, drawing on examples, laying out the methodological processes, and making suggestions as to how it might improve reporting. The article makes a contribution to efforts that seek to improve the reporting and utility of scoping reviews in health and social research.

Introduction The Covid-19 pandemic period necessitated the early graduation of medical students in the UK to join the healthcare workforce as Foundation Interim Year 1 (FiY1) doctors. The aim of this project was to develop and implement a sequential simulation session to improve and assess FiY1 preparedness towards approaching deteriorating patients. Methods A total of 12 FiY1 doctors participated in the session containing three sequential major stations: complex new admission, ward based management, and acute deterioration. Participants were required to interpret investigations, perform examinations, create management plans, and escalate to senior clinicians using a pager. Preparedness to practice was measured quantitatively on six point Likert-type scales and qualitatively using a semi structured interview. Results Following the session there was a significant improvement in preparedness for giving treatment (median(IQR): pre-simulation 3(3–4) vs. post-simulation 4(4–4.75); p=0.04) and paperwork (2(2–3.75) vs. 4(3.25–4.75); p=0.03). Following the FiY1 period participants demonstrated significant improvement in preparedness for giving treatment (median(IQR): pre-simulation 3(3–4) vs. post-FiY1 4.5(4–5); p=0.01), communication and team-working (4(3.25–4.75) vs. 5(5–5.75); p=0.01), and paperwork (2(2–3.75) vs. 5(5–5); p=0.01). Participants felt that the FiY1 programme improved integration within treatment teams and facilitated training, whilst medical school placements did not place students in the role of a decision maker and left them feeling apprehensive and unprepared to practice. Discussion and Conclusion This session provided an engaging method of increasing preparedness towards common challenges new physicians face. This study suggests future senior medical student apprenticeships should give the same investment, opportunities and responsibilities as that of the FiY1 programme

BackgroundHealthcare systems revolve around intricate relations between humans and technology. System efficiency depends on information exchange which occur on synchronous and asynchronous platforms. Traditional synchronous methods of communication may pose risks to workflow integrity and contribute to inefficient service delivery and medical care.AimTo compare synchronous methods of communication to an instant messaging (IM) asynchronous platform and observe its impact on clinical workflow, quality of work life and associations with patient safety outcomes and hospital core operations.MethodsCohorts of healthcare professionals were followed using the Time Motion Study methodology over a two-week period, using both the asynchronous platform and synchronous methods like the non-cardiac pager. Questionnaires and interviews were conducted to identify staff attitudes towards both platforms.ResultsA statistically significant figure (P

Gloucestershire Hospitals NHS Foundation trust comprises sites in Cheltenham and Gloucester (GRH). As part of the COVID-19 response, emergency services were temporarily reconfigured to GRH. This was rapidly implemented, to maximise patient safety whilst managing high patient volumes and potentially high levels of staff sickness. In theatres, communication is critical to safe working. Much has been done in our Trust to improve theatre briefings. We aimed to assess how communication in theatres was impacted by changes made to working patterns during COVID-19. A SurveyMonkeyTM collected demographics, and Likert scale responses assessing team working, communication, briefings, and staff well-being. The survey was distributed to all surgical specialties, anaesthetic, and theatre staff. A total of 100 responses were collected over 5 weeks. The survey confirmed that COVID-19 had a significant impact on working structures. 60% of respondents worked in different teams, and 44% felt outside of their comfort zone. 72% found communication more difficult, with 92% attributing this to PPE. The majority (72%) felt briefings covered specific C-19 related issues and they could raise concerns (77%). However, only 26% of respondents felt this was true for emergency briefings. This is the focus of our initial change. We plan to improve briefings whilst re-engaging those stakeholders who were less involved during the early phase of the initial pandemic. Our high volume of emergency work means that we can implement rapid PDSA cycles following focused discussion groups. Some simple changes have already been made, including introduction of a dedicated pager for the operating general surgeon, and allocation of a CEPOD co-ordinator to attend morning handover. We plan to repeat the survey in 6 weeks. We will also conduct interviews with staff which, in addition to evaluating service improvement, will give vital information to guide ongoing refinements.

Introduction ‘Bleep’ systems are a central communication tool between medical and nursing teams in hospital. The majority of bleeps are for non-urgent tasks, this inefficient use of the bleep system leads to routine tasks take longer to complete and disruption of patient care. The Health and Social Care Secretary ordered pagers for non-emergency communications be removed from the NHS by 2021. Objective Reduction in the number of bleeps for non-urgent tasks in a tertiary paediatric hospital. Methods A multi-professional working group was established and developed a standard operating procedure (SOP) for bleeping including a ‘traffic light’ system with non-urgent tasks (completion within 1–4hrs) categorized as green. A job book with designated time slots for medical visits to each ward was introduced. A number of PDSAs (Plan, Do, Study, Act) cycles were completed using the job books but were ultimately unsuccessful. Therefore, a new direction using an electronic solution was explored. The FORWARD app (a secure messaging platform) was chosen to be piloted on two wards. Baton phones pre-installed with FORWARD were given to the medical and nursing teams alongside training. Communication via the platform was limited to non-urgent tasks and urgent tasks remained via the bleep system. Results Telecommunications records from two weeks either side of implementation of FORWARD app demonstrated a significant reduction in the number of bleeps, the median decreasing from 21 to 12 (run chart available). The feedback was positive, and the nurses reported doctors responded more quickly on FORWARD. The main challenge was inconsistent wireless internet connection, affecting acknowledgment of tasks. Conclusion This project has shown that a novel, secure messaging platform can effectively reduce the number of non-urgent bleeps. This requires an appropriate induction to the platform, a SOP on the use of the platform/bleeps and adequate IT infrastructure to ensure reliability and safety. This trial has also highlighted the importance of careful consideration of the governance implications when using patient identifiable data which is a clinical governance requirement for patient safety. Collaboration with the trust digital informatics and information governance team has led to the development of acceptable user policies to guide this.

One of the shortcomings of many modern serious games and medical simulations lies in their inability to model even some modicum of unpredictability of real life situations. Interactions with a standardized patient may teach healthcare professional students how to diagnose a clinical condition, better manage a patient, or help them improve their bedside manners, but such simulated interactions will not prepare the learners to deal with unpredictability of clinical situations, interruption, and task switching. Distractions occur from colleagues, clinical decision support alerts, pagers, smartphones, or audible alarms. All these interruptions can potentially alter the course of patient care and the outcome of a patient's treatment. A simulated virtual patient (VP) may teach critical thinking skills, but once a student has successfully diagnosed a VP, the simulation stops providing educational value. In this paper we propose a generalizable method for integrating agent-based models into serious games and simulations. In the proposed paradigm, a human player (learner) takes on the role of a single agent in the model (e.g, a healthcare professional), while the output of the model controls the environment, the rules of agent interactions, and all the other agents that the human player interacts with (non-player characters). Moreover, we will present two use cases demonstrating that the use of agent-based models as behavior controllers for non-player characters introduces a degree of unpredictability in a virtual patient simulation and in a serious game designed to teach middle and high-school students about the spread of infectious diseases.

Streamlining communication between radiology and referring services is vital to ensure appropriate care with minimal delays. Increased subspecialization has led to compartmentalization of the radiology department with many physicians working in disparate areas. At our hospital, we anecdotally noted that a significant portion of incoming phone calls were misdirected to the wrong workstations. This resulted in wasted time, unnecessary interruptions, and delays in care because the referring clinicians could not efficiently navigate the radiology department staffing structure. Our quality improvement project involved developing a web-based tool allowing the emergency department (ED) to more efficiently contact the appropriate radiology desk and reduce misdirected phone calls.Surveys were sent to radiology residents and ED providers (attendings, residents, physician assistants) to assess how often phone calls were misdirected to the wrong radiology station. Radiology residents were asked which stations received the most misdirected phone calls, and what station the caller was often looking for. ED providers were asked which stations they intended when they were told they called the wrong station, and a series of questions in the survey assessed their knowledge of commonly called radiology station (Plain Film, CT Body, Ultrasound, Neuoradiology, Pediatrics, and Overnight Desk). ED and radiology physicians worked together to design a simple, easily accessed web-based tool that allowed the ED clinicians to determine which station should be called during for each hour of the day, which integrated differences in staffing by radiology throughout the day. After the tool had been implemented for 8 months, surveys were again sent to radiology residents and ED clinicians asking the same questions as before to assess for any significant change in response. Additional questions were added to the ED survey to assess awareness of the new tool.An interactive, easily updated schedule with optimal contact numbers was made available through the ED intranet. The design allowed for easy modification of contact numbers over time to accommodate changes in coverage location or staffing models. Prior to implementation contact information was presented on a static screen, which was unable to be changed and included multiple incorrect and defunct numbers. Additionally, contact defaulted to a general radiology pager, which was carried by a resident only responsible for plain films for most of the day. Numbers included in the new intranet tool were all pertinent reading room stations, all scheduling desks, and all technologist workspaces. Different schedules were provided for weekdays and weekends. Initial survey results showed that prior to the intervention, 74% of radiology residents said they received misdirected phone calls at least twice a day, and 57.9% of ED respondents reached the wrong recipient at least once per day. Frequencies of misdirected calls dropped to 58.4% of radiology residents (P = 0.37) and 17.9% of ED respondents (P0.01) on follow-up surveys 8 months after the tool was established. After establishing the new tool, 82.1% of ED respondents were aware of the new intranet contact tool and were using it to contact radiology. On the series of questions assessing ED respondents' knowledge of radiology numbers, over 50% of respondents knew the correct answer or answered using the call sheet after implementation; this resulted in statistically significant increases in accuracy for Body, Neuroradiology, and Pediatric radiology stations. Furthermore, with the exception of ED plain films, there was a statistically significant reduction in number of responses who said the general radiology pager should be called for reads. Fifty percent of radiology residents believed there was a reduction in the number of misdirected phone calls from the ED with this tool.Our tool was successful in accomplishing multiple goals. First, over 80% of ED respondents adopted the new tool. Second, the number of misdirected phone calls based on the subjective perception of ED respondents and radiology residents was reduced. Third, we objectively improved the ED respondents' behavior pattern in contacting the radiology department by either calling the correct number using the call tool, and by reducing the number of respondents who use the pager. Going forward, we hope to be able to expand use of this tool throughout the hospital in order to provide more timely and efficient care with other services by streamlining access between referring services and the appropriate radiology recipients.