A macro for calculating the Hubert and Arabie (1985) adjusted Rand statistic is presented. The adjusted Rand statistic gives a measure of classification agreement between two partitions of the same set of objects. The macro is written in the SAS macro language and makes extensive use of SAS/IML software (SAS Institute, 1985a, 1985b). The macro uses two different methods of handling missing values. The default method assumes that each object that has a missing value for the classification category is in its own separate category or cluster for that classification. The optional method places all objects with a missing value for the classification category into the same category for that classification.

OBJECTIVES/GOALS: Febrile infants are a model population for exploring communication, implicit bias, and health disparities in the pediatric emergency department. Using mixed methods, we performed an in-depth analysis of disparities and physician-parent communication, a potentially modifiable driver of inequities. METHODS/STUDY POPULATION: We performed a multicenter cross-sectional study of febrile infants with low-risk for invasive bacterial infection evaluated between 2018-19 across 32 institutions. We performed logistic regression to assess the association between 1) race and ethnicity (Non-Hispanic White [NHW], Non-Hispanic Black [NHB], Hispanic [H], Other Race and/or Ethnicity [O]) and 2) limited English proficiency (LEP) with the standard of care, discharge without lumbar puncture and without antibiotics. We concurrently performed in-depth semi-structured interviews with physicians to explore physician–parent communication and implicit bias in the management decisions for febrile infants. RESULTS/ANTICIPATED RESULTS: Of 3629 low-risk febrile infants, 74.2% received standard of care. NHB, compared to NHW, infants were more likely to receive standard of care (aOR 1.3 [95% CI 1.0-1.7]; aOR H: 1.1 [95% CI 0.9-1.4]; aOR O: 1.0 [95%CI 0.8-1.4]). There was no association between LEP and standard of care (aOR 0.8 [0.61–1.1]). When accounting for documented use of professional interpretation, families with LEP without documented professional interpretation were less likely than families without LEP to receive standard of care (aOR 0.6 [95% CI 0.4–0.9]). Thematic analysis of 13 physician interviews is expected to elucidate aspects of the physician-parent interaction that influence management decisions. DISCUSSION/SIGNIFICANCE: Infant race, ethnicity, and use of professional interpretation, are associated with the management of low-risk febrile infants. Physician behaviors that are influenced by the physician-parent interaction may represent modifiable targets for future interventions to promote health equity.

Within growing marketisation of publicly funded services, the internet has provided new opportunities for marketing, delivery, and coordination of those services. Using web scraping and hyperlink network analysis techniques, this paper examines the ways in which organisations operating in Australia’s evolving National Disability Insurance Scheme (NDIS) system inter-connect online. Social media plays the most important role in the online network. Government agencies also play a central role, with many disability service organisations linking their web users to them. Government agency websites do not hyperlink to disability service providers, suggesting that governments do not see their role as assisting access to such services. Advocacy and peak disability organisations are important in online connections between the websites of government and service organisations. Innovative uses of the internet for online brokerage of disability services are evident. The implications of these findings for service delivery are discussed.

In this study, a convergent parallel mixed-methods design was used to explore stress, resilience and coping in psychological wellbeing practitioner (PWP) trainees (n = 90) at the beginning of their training. Psychometric tests were used to measure levels of self-reported stress, resilience and dispositional coping styles. Open-text survey data regarding the perceived sources of stress at the beginning of training were also qualitatively analysed using thematic analysis (TA). Results indicated that in the early weeks of their training, trainees reported lower levels of resilience and higher levels of stress than those found in the general population. Statistically significant negative correlations were found between stress and resilience, and between stress and the coping styles ‘Planning’, and ‘Active Coping’. Statistically significant positive correlations were found between stress and the coping styles of ‘Denial’ and ‘Focus on and Venting of Emotions’. The qualitative findings provided a context within which to understand these quantitative results. The three themes ‘I can find the unknown quite unsettling’, ‘I question my competences’ and ‘Learning, consolidating and putting it all into practice’ were generated through the qualitative analysis. These themes were connected by an over-arching theme which suggests that the perceived responsibility of the role is an important source of stress for PWP trainees. Implications for future research and the training of PWPs are discussed.

Background: The National University Hospital (NUH) is a 1,200 bed tertiary-care hospital with no documented nosocomial transmission of COVID-19 among patients for the first year and a half of the pandemic, despite 65% of the patients being housed in 4- to 8-bedded open cubicles with shared bathrooms. However, this arrangement changed in late September 2021 with large community clusters including in healthcare institutions nationally associated with the spread of the δ (delta) variant of SARS-CoV-2. We conducted a retrospective review of hospital epidemiology data to determine risk factors for SARS-COV-2 transmission during this period. Methods: Index patients were defined as the first patient in an open cubicle with a confirmed positive SARS-CoV-2 PCR test. Contacts were defined as being in the same cubicle as a patient before isolation from 2 days before symptom onset, up to 7 days from positive test if asymptomatic. Clinical and patient movement data were obtained manually from routine clinical records. Proximity of the contact from the index was classified as within, or more than, 2 m away, according to the prevailing definition from the Singapore Ministry of Health. A univariate analysis was performed to identify risk factors for nosocomial acquisition of SARS-CoV-2. The analysis was deemed exempt from ethics review (reference no. NHG-DSRB-2021/01026). Results: From October 1 to November 30, 2021, 30 index cases occurred in open cubicles identified (median, 9 days after admission; IQR, 19 days). Contact tracing yielded 211 contacts, of whom 10 (4.7%) were infected. Linear regression analysis found the duration of contact for each hour spent in the same room as the index case was the only statistically significant risk variable for contracting COVID-19, with an odds ratio 1.02 (Table 1). Conclusions: Patients in open cubicles are at risk for nosocomial transmission of COVID-19 and other infections. The duration of contact appeared to be more important than vaccination status of index or ward ventilation status. Larger multicentered studies are needed to validate this finding, which has significant implications for infection prevention strategies and pandemic planning.

Funding: None

Disclosures: None

OBJECTIVES/GOALS: Well-appearing febrile infants are a model for exploring communication, bias, and health disparities in the pediatric emergency department (ED). Using mixed methods, we will perform an in-depth analysis of disparities and shared decision making, a potentially modifiable driver of inequities. METHODS/STUDY POPULATION: We will conduct a multicenter cross-sectional chart review study of well-appearing febrile infants 29-60 days old treated in the ED and apply multivariable logistic regression to assess the association between 1) race/ethnicity and 2) limited English proficiency with the primary outcome, discharge to home without lumbar puncture and without antibiotics (standard of care). We will concurrently perform an interpretive study using purposive sampling to conduct interviews with: 1) minority parents of febrile infants and 2) ED physicians. By capturing dyadic data, we will triangulate perspectives to elucidate disparities and bias that can emerge in the shared decision making process. RESULTS/ANTICIPATED RESULTS: Forty member institutions of the Pediatric Emergency Medicine Collaborative Research Committee are participating, providing a projected cohort of 3000 infants. In the 6 months since site recruitment, 235 eligible infants have been entered into the dataset (43% minority race/ethnicity, 6% language other than English), 61% of whom received the primary outcome. Chart review has the benefits of 1) ensuring exclusion of ill infants, 2) providing data on interpreter use that is unavailable in administrative datasets, and 3) allowing an analysis of shared decision making. These findings will inform an interpretive study of parent and provider experiences of bias in shared decision making. DISCUSSION/SIGNIFICANCE: We demonstrate the feasibility of a large-scale manual chart review to analyze disparities within a shared decision making context. Partnered with qualitative scholarship, this research will support the development of communication interventions to mitigate implicit bias in the clinical encounter.

For more than a decade, Improving Access to Psychological Therapies (IAPT) has been training a new workforce of psychological therapists. Despite evidence of stress and burnout both in trainee mental health professionals, and qualified IAPT clinicians, little is known about these topics in IAPT trainees. Consequently, this systematic review sought to establish the current state of the literature regarding stress and burnout in IAPT trainees. Electronic databases were searched to identify all published and available unpublished work relating to the topic. On the basis of pre-established eligibility criteria, eight studies (including six unpublished doctoral theses) were identified and assessed for quality. This review identifies that research into the experience of IAPT trainees is under-developed. Existing evidence tentatively suggests that IAPT trainees may experience levels of stress and burnout that are higher than their qualified peers and among the higher end of healthcare professionals more generally. The experience of fulfilling dual roles as mental health professionals and university students concurrently appears to be a significant source of stress for IAPT trainees. More research regarding the levels and sources of stress and burnout in IAPT trainees is urgently needed to confirm and extend these findings. Recommendations for future research in the area are given.