BACKGROUND

Medical records provide a repository of patient information, physical examination, laboratory findings, and the outcomes of interventions. The completeness of data contained in the electronic medical record (EMR) is an important factor leading to health service improvement. Quality assurance (QA) activities have been utilized to improve documentation in electronic medical records.

To determine the effectiveness of QA interventions (feedback, workshop, and random monitoring system) in improving completeness of data entries in the EMR of resident physicians for COVID-19 teleconsultations.

This was a before-and-after study involving EMR entries of physician trainees on health care workers (HCWs) from March to October 2022 of the COVID-19 pandemic. A chart audit was conducted against a checklist of criteria for three months before and after the interventions. QA interventions included the provision of feedback on the results of the initial chart review; conducting a QA workshop on setting of standards, chart audit, data encoding, analysis, and presentation; and random monitoring/feedback of resident charting. The change in the level of completeness from pre- to post-intervention was computed, and the percentage of charts meeting the minimum standard of 90% completeness was likewise determined.

A total of 362 and 591 chart entries were audited before and after the interventions. The average percentage of completeness of medical records during initial consultation improved from 83% to 95% (p>0.05). The documentation of the reason for seeking consultation significantly increased from < 1% to 84%. The reporting of past exposure and level of risk decreased to 89% (p=0.001) in the initial consult and 12% (p=0.001) in the fit-to-work, respectively. Majority of the criteria for work clearance improved after the intervention. However, the average completeness of entries did not reach 90% post-intervention for fit-to-work consultations.

Feedback, quality assurance workshop, and random monitoring of electronic medical records are effective in increasing documentation practices for the chief complaint and dates of illness duration but showed non-significant increasing trend on overall percentage of EMR completeness for COVID-19 teleconsultations.

BACKGROUND

Infection from SARS-CoV-2 have transient and long-term complications. Persistent symptoms postrecovery with perceptions of overall physical and mental health status are crucial information to construe on follow-up care.

To describe the clinical profile, general, and mental health outcomes of hospital staff who recovered from COVID-19 at follow-up 12 weeks or more post-convalescent.

This was a cross-sectional study on follow-up of hospital staff who recovered from COVID-19. Study population included staff or health care workers of a COVID-19 referral tertiary hospital, who had laboratoryconfirmed COVID-19 via RT-PCR. Informed consent was obtained through phone calls and google forms. Data collection was through a self-administered, on-line google form or voice-call interviewer-assisted questionnaire. Analysis was done with Stata 17 using frequencies, proportions, and cross-tabulations.

Persistent symptoms reported several months post-recovery from COVID-19 included fatigue (25%), difficulty of breathing (23%), muscle weakness (16%), nasal congestion (12%), cough (10%), sore throat (5%), anosmia (3%), and ageusia (2%). Symptoms of physical and mental fatigue post-COVID-19 were reported by 25% (N = 93) with extreme fatigue reported by four staff. Fifteen percent (N = 57) reported that they feel that their workload or schedule needed modification after recovery. Feelings of isolation, depression, and anxiety were the most common mental health issues reported. Screening using validated tools showed that depressive symptoms were present in 45% (N = 145) and anxiety in 18% (N = 53).

Healthcare workers who recovered from COVID-19 for at least 12 weeks or more described their health status as comparable to their overall health one year before the infection. Physical and mental health symptoms reported 12 weeks post-recovery include fatigue, breathlessness, anxiety, and depression and were described in various levels of severity.

Case reports remain to be an essential part of knowledge generation in health care. It is a research design that involves writing about a patient’s illness with either an unusual, new, unexpected, or unique characteristic. It can be about new findings, a novel diagnostic test, unfamiliar adverse events or innovative medical and surgical interventions. It is a detailed description of a patient’s course of illness including symptoms, physical examination findings, laboratory results, treatment modalities and outcomes. The essential element of writing a case report or series is to contribute to the generation of new knowledge. Wellwritten manuscripts have a valuable purpose in medicine as they present new illness, unexpected effects of treatment, novel diagnostic exams or unforeseen patients’ outcomes. The sections of a case report include an Abstract, Introduction or Background, Case Presentation [history, physical examinations, investigations or laboratories, differential diagnosis (if relevant), treatment (if relevant), outcome/follow-up, Discussion, Learning points/Take home messages, Patients perspectives and References. Manuscripts written as case reports or case series by nature of their design are not required to get approval from an Ethics Review Board (ERB). However, there should be an institutional process to clear and register papers. Case reports or a case series has its own distinctive writing components and features as not all single or series of clinical cases are reportable. This article aimed to define case reports/series, describe the different parts, how to write and evaluate a case report manuscript using the CARE guidelines.

Background. Workplace or employees’ clinics play a vital role in disease outbreaks as there could be an influx of sick personnel. Processes and patient flows during pandemics should be documented to identify good practices and sources of operational inefficiencies. Objective. To describe the patient flow, health delivery processes, and areas for improvement at the UPHS during the early phase of the COVID-19 pandemic from May to June 2020. Methods. This was a cross-sectional study involving patient flow analysis of processes at the employees’ clinic of the University of the Philippines-Philippine General Hospital. The study was divided into two major components: clinic process time measurement and process flow mapping. Data collection involved time elements and narrative descriptions of good practices and problems in the process flow. Results. The UPHS staff attended to 1,514 employees’ visits during the 15 working days from May to June 2020. The total UPHS service time from arrival to end of consultation of an employee with a COVID-19-related concern was an average of 1 hour 3 minutes (SD±39 minutes) with a mean total waiting time of 46 minutes (SD±37 minutes). Good practices identified were personnel flexibility in doing other tasks, good communication, and infection control measures. Areas for improvement included symptom screening, implementation of physical distancing, and disinfection practices. Conclusion. The process flows in the UPHS clinic consisted of COVID-19 related consultations, non-COVID-19 related concerns, and swabbing services. Good communication, staff flexibility, infection control measures, and leadership were identified as good practices. Occasional lapses in symptom screening at triage, physical distancing among employees in queuing lines, and inconsistent disinfection practices were the areas for improvement.
Humans ; COVID-19 ; Physical Phenomena ; Delivery of Health Care

Background. Telemedicine provides access to health care services during pandemics. It can be utilized to screen asymptomatic persons, follow up close contacts of confirmed cases, monitor individuals with symptoms, conduct specialty consultations, and offer health services to patients during pandemics. Objective. To describe the telemedicine processes, good practices, and areas for improvement in the University of the Philippines Health Service (UPHS) during the COVID-19 pandemic. Methods. This was a cross-sectional study to document telemedicine processes in UPHS. All teleconsultations of employees and students of Philippine General Hospital (PGH) and UP Manila (UPM) during the two-week study period in October 2020 were included. Quantitative data was collected from different modes of patient entry into the UPHS telemedicine services: email, Online Consultation Request and Appointment (OCRA) System, and phone hotlines. Qualitative information was gathered as narrative descriptions of observations in the clinic’s service delivery areas. A focus group discussion was also conducted to illustrate the different steps of the pathway used for telemedicine. Results. The telemedicine services of UPHS consisted of virtual triage, COVID-19/non-COVID-19 consultation, and telemonitoring. The UPHS virtual triage received patient concerns through OCRA or the hotline numbers. On the other hand, the COVID-19 teleconsultation service provided care to employees and students who contacted the clinic regarding symptoms or exposure via email. The non-COVID-19 service had teleconsultation for patients with other medical concerns. Coordination among staff and presence of a consultant were identified as good practices, while the areas for improvement include the lack of written protocols in issuing fit-to-work clearance for difficult cases and the optional use of OCRA for UPHS consult. Conclusion. Telemedicine services at the UPHS included tele-triaging, teleconsultations, and telemonitoring with use of phone calls, short messaging service (SMS), emails, and OCRA. Timely coordination, on-site duty consultants, and use of technology were identified as good practices. Lack of protocols and inconsistent OCRA use are areas for improvement.
Pandemics ; Telemedicine ; Ambulatory Care Facilities

Background: The Filipino family has always been described to have solid household, innate close family ties and high regard to interpersonal relationships. However, there has been paucity of local studies regarding Filipino families and how specifically do Filipinos see, define and perceive a family unit in general. Objective: To explore Filipino family’s concepts and ideas of what qualities represent and define a well family. Method: The study was qualitative in design with mixed data collection methods: 18 interviews, 10 Focus Group Discussions, and a literature review. Results: Caring parents, unconditional love, able to maintain a good relationship between family members, constant presence for loved ones and capacity to forgive were reflected as important characteristics of a well Filipino family. Love and respect are considered to be the foundations and faith in God as an important component of a family. However, the wellness of the family begins with husband-wife relationship and that a strong and happy marital relationship will provide mutual support, encouragement and understanding. Likewise, financial capability combined with a commitment to provide for the family’s future was a quality believed to bind the family together. Physical well-being and the absence of diseases were also part of family wellness. Conclusion The nine qualities of a well Filipino family include loving, affectionate, responsible family members; spiritually healthy; has the capacity to provide; having strong husband-wife relationship; effective parents; has a system of open communication within the family; united with flexible family structure; spends time together; and physically healthy with good community life.
Family ; Parents ; Marriage ; Love ; Respect ; Family Structure