S183 S290
Objective:
Residents use pocket references to track everything from
management guidelines and site-specific protocols to contact infor-
mation for consultants. Though much content has evolved into digital
formats, quickly extracting information from documents during a
clinical shift can be challenging. While publicly available reference
apps are useful, they generally lack customization. We present an
open-source approach to create a rehabilitation reference mobile web
application (app) that provides content customized to a training
program
e
in this case, a spinal cord injury rotation. Topics include:
American Spinal Injury Association (ASIA) exam scoring, functional
expectations based on neurological level of impairment, neurogenic
bowel and bladder, pressure injuries, deep vein thrombosis, auto-
nomic dysreflexia, orthostatic hypotension, and site-specific admission
orders. The app files are stored in an online software repository and
use hypertext markup language (HTML) and Javascript to emulate an
iOS or Android app. With some basic HTML skill, anyone can extend
functionality with new content and freely share these app variations.
Because the app runs on any web server, revisions to the custom app
are seen instantly, avoiding complicated code deployment through app
stores. Our objective was to assess the feasibility of implementation
by novices using a tutorial.
Design:
Observational study.
Setting:
Academic hospital.
Participants:
6 staff members with no web programming experience.
Interventions:
Participants followed a tutorial to start a web server,
edit the app and create a new feature, simulating the process of
implementation at another residency program and contribution back
to the project.
Main Outcome Measures:
Self-reported duration to complete tuto-
rial; ratings of difficulty and usefulness of app on 7-point scales
Results:
Mean duration was 26 minutes. Mean rating of difficulty was
3.5 (7 being ‘extremely difficult’); mean usefulness was 6.0 (7 being
’extremely useful’).
Conclusions:
Our simple approach to app creation offers a custom-
ized, collaborative, and useful reference for trainees and facilitates
the democratization of technology among the healthcare workforce.
Level of Evidence:
Level IV
Poster 159:
Trends of Admission and Discharge Times to an
Inpatient Rehabilitation Facility and Implications for
Safety and Quality: A Single-Center Retrospective
Review
Emily Gray, MD (Northwell Health System), Adrian Cristian, MD MHCM
Disclosures:
Emily Gray: I Have No Relevant Financial Relationships To
Disclose
Objective:
Admissions to Inpatient Rehabilitation Facilities (IRFs) are
trending toward patients with multiple comorbidities, complex pri-
mary and secondary diagnoses with resultant higher Case Mix Index. On
a daily basis, multiple admissions and discharges are scheduled which
can be chaotic for patients and staff. This creates potential medical
errors at transition points in care, and errors for inpatients as staff is
more focused on processing admissions/discharges. This can lead to
poor patient satisfaction for both patients on the unit and those being
admitted or discharged which may impact satisfaction scores.
Design:
Retrospective chart review.
Setting:
Single-Center Acute Inpatient Rehabilitation Facility.
Participants:
200 admissions over a 3-month period.
Interventions:
Not applicable.
Main Outcome Measures:
Day of week and times of day of admis-
sions/discharges. Patient diagnoses, transfers to acute floor and
discharge condition were collected for further review.
Results:
Most transitions of care are concentrated during weekdays
with only 9.5% of admissions and 17% of discharges on weekends. A
significant overlap of the time of admission and discharge exists,
mostly between 12-5PM. Only 26% of discharges occur before the goal
of Noon, 10% of which after 5PM. 48.5% of admissions arrive after 5PM,
7.5% after 8PM.
Conclusions:
Almost half of admissions to this IRF occur during a
staffing mismatch, as physicians and nurses are more limited
at night, thus creating opportunities for medical errors. A
culture change is required to spread out discharges, and
therefore admissions, across 7-days and increase the number of
discharges before noon to allow for dedicated time for the care of
inpatients and admissions. With information gleaned from this
study, and in order to address safety and quality concerns, a pilot
intervention has been implemented during which extra staff
are present on high volume admission evenings. This facilitates
safe and appropriate care for patients arriving in the evening
and limits errors which may accompany the increased work
burden.
Level of Evidence:
Level V
Poster 160:
Evaluation of Resident Research, Program Support,
and Barriers
Jeremy L. Stanek, MD (Univ of MO-Columbia, Columbia, Missouri,
United States), Jane A. Emerson, MD
Disclosures::
Jeremy Stanek: I Have No Relevant Financial Relation-
ships To Disclose
Objective:
To evaluate trends and limitations in PM&R resident
research and to develop and improve our policies thereby enhancing
resident research participation.
Design:
Online survey.
Setting:
PM&R residency programs.
Participants:
Chief residents at ACGME accredited PM&R programs.
Interventions:
Not applicable.
Main Outcome Measures:
A survey allowed statistical information to
be gathered regarding the average number of resident posters/podium
presentations accepted to major national yearly meetings. We also
determined whether departments utilize research committees or a
mandatory review process or have funding limitations and what those
limitations include.
Results:
Forty-six of 80 programs responded. Sixteen percent of
programs have 4 resident presentations accepted yearly to AAPM&R
and one program more than 20. Twenty-five percent have 2 pre-
sentations accepted to AAP each year. Twenty-one percent have an
average of 5 presentations accepted to other conferences. Sixty
percent require resident research undergo review prior to confer-
ence submission, and 37% have a committee that reviews resident
research. The responsibility of 94% of the committees is only to
give productive feedback/helpful recommendations. Six programs
allow denial of resident research submission by someone not
working with the resident. Seven programs have limitations on
conference attendance. However, 78% allow residents to attend all
conferences when research is accepted for presentation. Most
residents use educational days from a fixed number allowed each
year for conference attendance. Almost 100% of programs provide
funding for attendance, most without limitation on what confer-
ence is attended. Nearly all departments cover travel, lodging,
meals, and registration fees. Over half provide allotments of con-
ference funds to residents annually, and 37% without a financial
limit. Thirty-three percent receive funding outside of their
department.
Conclusions:
Most PM&R programs provide a great deal of resources
for resident research and allow for conference attendance with few
limitations.
Level of Evidence:
Level II
S183
Abstracts / PM R 9 (2017) S131-S290