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Abbasalizadeh M, Farsi Z, Sajadi SA, Atashi A. The effect of mobile health application training based on micro-learning method on the level of resilience and happiness among intensive care nurses: a randomized controlled trial. BMC Psychiatry 2024; 24:954. [PMID: 39731084 DOI: 10.1186/s12888-024-06429-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 12/20/2024] [Indexed: 12/29/2024] Open
Abstract
BACKGROUND Increasing the level of resilience and happiness of intensive care nurses can lead to an improvement in their psychological health. This study aimed to extract the possible effectiveness of mHealth application utilizing the micro-learning method on a mobile phone platform on the intensive care nurses' resilience and happiness. MATERIALS AND METHODS This single-blind randomized controlled trial was conducted in 2022-24. Sixty nurses working in intensive care units at two hospitals in Tehran, Iran were recruited using purposive sampling and randomly assigned to either the intervention or control group. Techniques of resilience and increasing happiness were taught to the intervention group using the mHealth application based on the micro-learning method. No training was provided to the control group. For data collection, questionnaires of individual characteristics, Connor-Davidson Resilience, and Oxford Happiness were used. RESULTS Before the intervention, there was no significant difference between the mean of the subscales and the total score of resilience and happiness of the intervention and control groups (P < 0.05). However, after the intervention, there was a significant difference (P < 0.05). After using the mHealth application, the total resilience score of the intervention group increased from 67.30 ± 10.12 to 79.27 ± 5.87 (P < 0.0001), while the resilience of the control group changed from 68.80 ± 9.09 to 65.93 ± 8.44 (P = 0.548). Similarly, using the mHealth educational application based on micro-learning led to an increase in the happiness score of the intervention group from 38.50 ± 11.10 to 67.83 ± 8.84 (P < 0.0001), whereas the happiness score of the control group nurses after the intervention (38.93 ± 14.33) compared to the baseline (41.40 ± 14.51) did not change significantly (P = 0.388). CONCLUSIONS The use of the mHealth application based on the micro-learning method played an effective role in training resilience and happiness skills in nurses. It is recommended to conduct more studies using this new educational approach. TRIAL REGISTRATION The study has been registered in the Iranian Registry of Clinical Trials (No. IRCT20221225056916N1, Date: 04/29/2023).
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Affiliation(s)
- Maryam Abbasalizadeh
- Critical Care Nursing Department, Nursing School, Aja University of Medical Sciences, Tehran, Iran
| | - Zahra Farsi
- Research and Ph.D. Nursing Departments, Nursing School, Aja University of Medical Sciences, Kaj St., Shariati St, Tehran, Iran.
| | - Seyedeh Azam Sajadi
- Nursing Management Department, Nursing School, Aja University of Medical Sciences, Tehran, Iran
| | - Afsaneh Atashi
- Department of Psychology, Central Branch, Islamic Azad University, Tehran, Iran
- Faculty of Psychology, Bangalore University, Bangalore, India
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Chang CJ, Huang JR, Shen HC, Sun CY, Liao YT, Ko HJ, Chen YM, Chen WC, Feng JY, Yang KY. Characteristics and outcomes of ICU-admitted COVID-19 patients in the Omicron and Alpha-dominated periods. J Formos Med Assoc 2024:S0929-6646(24)00512-6. [PMID: 39488498 DOI: 10.1016/j.jfma.2024.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 10/16/2024] [Accepted: 10/25/2024] [Indexed: 11/04/2024] Open
Abstract
BACKGROUND Comparing the outcomes of intensive care unit (ICU) admitted COVID-19 patients during the Alpha and Omicron-dominated periods. METHODS Patients with critical COVID-19 disease, requiring ICU admission from May to September 2021 and February to August 2022, were enrolled from a single medical center in Northern Taiwan. Clinical demographics, comorbidities, disease severity, and management strategies were recorded. The 28-day mortality from the two periods were compared both in the original and propensity score (PS)-matched cohort. RESULTS Of 231 patients, 72 (31.2%) were from the Alpha period and 159 (68.8%) from the Omicron period. Patients in the Omicron period were older, had a lower body mass index, more comorbidities, higher disease severities, and increased 28-day mortality (26.4% vs. 13.9%, p = 0.035). In multivariable analysis, the Omicron-dominated period was not identified as an independent factor associated with increased 28-day mortality. COVID-19 patients in Alpha- and Omicron-dominated periods had comparable 28-day mortality in PS-matched cohort (12.1% vs. 18.2%, p = 0.733). Independent factors associated with 28-day mortality were a lower PF ratio (PF ratio <100, adjusted odds ratio [aOR] 2.68, 95% confidence interval, CI 1.21-5.94), septic shock ([aOR] 2.39, 95% CI 1.12-5.09) and absence of remdesivir ([aOR] 0.36, 95% CI 0.16-0.83). CONCLUSION While patients in the Omicron period exhibited greater severity, the variant was not independently linked to higher 28-day mortality in ICU-admitted patients.
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Affiliation(s)
- Chih-Jung Chang
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jhong-Ru Huang
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsiao-Chin Shen
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chuan-Yen Sun
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ying-Ting Liao
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hung-Jui Ko
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yuh-Min Chen
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wei-Chih Chen
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jia-Yih Feng
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Kuang-Yao Yang
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Cancer and Immunology Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Shafigh N, Hasheminik M, Shafigh E, Alipour H, Sayyadi S, Kazeminia N, Khoundabi B, Salarian S. Prediction of mortality in ICU patients: A comparison between the SOFA score and other indicators. Nurs Crit Care 2024; 29:1619-1622. [PMID: 37438106 DOI: 10.1111/nicc.12944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 05/31/2023] [Accepted: 06/07/2023] [Indexed: 07/14/2023]
Abstract
The intensive care unit (ICU) is the most important department for critically ill patients. Different scoring systems are used to assess the severity of the disease and evaluate organ failure during the patient's stay in ICU. Our purpose was to evaluate the C-reactive protein/Albumin (CRP/Alb) ratio and SOFA score as indicators of 28-day mortality in ICU patients. A total of 55 patients were enrolled in this study. CRP and CRP/Alb rates, SOFA scores, and demographic data were used to evaluate 28-day mortality in a referral hospital. Survived and dead patients were significantly different in the CRP, CRP/Alb rates, and SOFA scores. However, in the adjusted model, the SOFA score was the predictor of 28-day mortality in ICU patients. SOFA score was also confirmed as a predictor of mortality in ICU patients. Besides, the role of CRP and CRP/Alb in the prediction of disease prognosis or mortality requires further studies.
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Affiliation(s)
- Navid Shafigh
- Department of Anesthesiology and Critical Care Medicine, School of Medicine, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Morteza Hasheminik
- Department of Nursing, Sabzevar Branch, Islamic Azad University, Sabzevar, Iran
| | - Elnaz Shafigh
- Operative Dentistry Department, Faculty of Dentistry, AJA University of Medical Sciences, Tehran, Iran
| | - Haleh Alipour
- Department of Pediatric Pulmonology, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahram Sayyadi
- Department of Anesthesia, Imam Hossein General Hospital, Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Neda Kazeminia
- Clinical Pharmacy Specialist, Clinical Trials and Pharmacovigilance Department, Food and Drug Administration, Tehran, Iran
| | - Batoul Khoundabi
- Iranian Red Crescent Society, Tehran, Iran
- Research Center for Health Management in Mass Gathering, Red Crescent Society of the Islamic Republic of Iran, Tehran, Iran
| | - Sara Salarian
- Anesthesiology and Fellowship Critical Care Department, School of Medicine, Emam Hosein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Maia G, Martins CM, Marques V, Christovam S, Prado I, Moraes B, Rezoagli E, Foti G, Zambelli V, Cereda M, Berra L, Rocco PRM, Cruz MR, Samary CDS, Guimarães FS, Silva PL. Derivation and external validation of predictive models for invasive mechanical ventilation in intensive care unit patients with COVID-19. Ann Intensive Care 2024; 14:129. [PMID: 39167241 PMCID: PMC11339005 DOI: 10.1186/s13613-024-01357-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 07/29/2024] [Indexed: 08/23/2024] Open
Abstract
BACKGROUND This study aimed to develop prognostic models for predicting the need for invasive mechanical ventilation (IMV) in intensive care unit (ICU) patients with COVID-19 and compare their performance with the Respiratory rate-OXygenation (ROX) index. METHODS A retrospective cohort study was conducted using data collected between March 2020 and August 2021 at three hospitals in Rio de Janeiro, Brazil. ICU patients aged 18 years and older with a diagnosis of COVID-19 were screened. The exclusion criteria were patients who received IMV within the first 24 h of ICU admission, pregnancy, clinical decision for minimal end-of-life care and missing primary outcome data. Clinical and laboratory variables were collected. Multiple logistic regression analysis was performed to select predictor variables. Models were based on the lowest Akaike Information Criteria (AIC) and lowest AIC with significant p values. Assessment of predictive performance was done for discrimination and calibration. Areas under the curves (AUC)s were compared using DeLong's algorithm. Models were validated externally using an international database. RESULTS Of 656 patients screened, 346 patients were included; 155 required IMV (44.8%), 191 did not (55.2%), and 207 patients were male (59.8%). According to the lowest AIC, arterial hypertension, diabetes mellitus, obesity, Sequential Organ Failure Assessment (SOFA) score, heart rate, respiratory rate, peripheral oxygen saturation (SpO2), temperature, respiratory effort signals, and leukocytes were identified as predictors of IMV at hospital admission. According to AIC with significant p values, SOFA score, SpO2, and respiratory effort signals were the best predictors of IMV; odds ratios (95% confidence interval): 1.46 (1.07-2.05), 0.81 (0.72-0.90), 9.13 (3.29-28.67), respectively. The ROX index at admission was lower in the IMV group than in the non-IMV group (7.3 [5.2-9.8] versus 9.6 [6.8-12.9], p < 0.001, respectively). In the external validation population, the area under the curve (AUC) of the ROX index was 0.683 (accuracy 63%), the AIC model showed an AUC of 0.703 (accuracy 69%), and the lowest AIC model with significant p values had an AUC of 0.725 (accuracy 79%). CONCLUSIONS In the development population of ICU patients with COVID-19, SOFA score, SpO2, and respiratory effort signals predicted the need for IMV better than the ROX index. In the external validation population, although the AUCs did not differ significantly, the accuracy was higher when using SOFA score, SpO2, and respiratory effort signals compared to the ROX index. This suggests that these variables may be more useful in predicting the need for IMV in ICU patients with COVID-19. CLINICALTRIALS GOV IDENTIFIER NCT05663528.
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Affiliation(s)
- Gabriel Maia
- Laboratory of Pulmonary Investigation, Institute of Biophysics Carlos Chagas Filho, Centro de Ciências da Saúde, Federal University of Rio de Janeiro, Avenida Carlos Chagas Filho, 273, Bloco G-014, Ilha do Fundão, Rio de Janeiro, 21941-902, RJ, Brazil
- Pedro Ernesto University Hospital, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Victoria Marques
- Laboratory of Pulmonary Investigation, Institute of Biophysics Carlos Chagas Filho, Centro de Ciências da Saúde, Federal University of Rio de Janeiro, Avenida Carlos Chagas Filho, 273, Bloco G-014, Ilha do Fundão, Rio de Janeiro, 21941-902, RJ, Brazil
- Department of Cardiorespiratory and Musculoskeletal Physiotherapy, Faculty of Physiotherapy, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Samantha Christovam
- Laboratory of Pulmonary Investigation, Institute of Biophysics Carlos Chagas Filho, Centro de Ciências da Saúde, Federal University of Rio de Janeiro, Avenida Carlos Chagas Filho, 273, Bloco G-014, Ilha do Fundão, Rio de Janeiro, 21941-902, RJ, Brazil
- Department of Cardiorespiratory and Musculoskeletal Physiotherapy, Faculty of Physiotherapy, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Isabela Prado
- Laboratory of Pulmonary Investigation, Institute of Biophysics Carlos Chagas Filho, Centro de Ciências da Saúde, Federal University of Rio de Janeiro, Avenida Carlos Chagas Filho, 273, Bloco G-014, Ilha do Fundão, Rio de Janeiro, 21941-902, RJ, Brazil
- Department of Cardiorespiratory and Musculoskeletal Physiotherapy, Faculty of Physiotherapy, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Bruno Moraes
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA, USA
| | - Emanuele Rezoagli
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Department of Emergency and Intensive Care, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Giuseppe Foti
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Department of Emergency and Intensive Care, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Vanessa Zambelli
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Department of Emergency and Intensive Care, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Maurizio Cereda
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA, USA
| | - Lorenzo Berra
- Respiratory Care Department, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Patricia Rieken Macedo Rocco
- Laboratory of Pulmonary Investigation, Institute of Biophysics Carlos Chagas Filho, Centro de Ciências da Saúde, Federal University of Rio de Janeiro, Avenida Carlos Chagas Filho, 273, Bloco G-014, Ilha do Fundão, Rio de Janeiro, 21941-902, RJ, Brazil
| | - Mônica Rodrigues Cruz
- Pedro Ernesto University Hospital, State University of Rio de Janeiro, Rio de Janeiro, Brazil
- Evandro Chagas National Institute of Infectious diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Cynthia Dos Santos Samary
- Laboratory of Pulmonary Investigation, Institute of Biophysics Carlos Chagas Filho, Centro de Ciências da Saúde, Federal University of Rio de Janeiro, Avenida Carlos Chagas Filho, 273, Bloco G-014, Ilha do Fundão, Rio de Janeiro, 21941-902, RJ, Brazil
- Department of Cardiorespiratory and Musculoskeletal Physiotherapy, Faculty of Physiotherapy, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Fernando Silva Guimarães
- Department of Cardiorespiratory and Musculoskeletal Physiotherapy, Faculty of Physiotherapy, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Pedro Leme Silva
- Laboratory of Pulmonary Investigation, Institute of Biophysics Carlos Chagas Filho, Centro de Ciências da Saúde, Federal University of Rio de Janeiro, Avenida Carlos Chagas Filho, 273, Bloco G-014, Ilha do Fundão, Rio de Janeiro, 21941-902, RJ, Brazil.
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Tarnate PSO, Ong-Lim ALT. Strategic Optimization of Patient Flow and Staffing Schemes during the COVID-19 Pandemic through Operations Management in a Neonatal Intensive Care Unit. ACTA MEDICA PHILIPPINA 2024; 58:90-102. [PMID: 38882916 PMCID: PMC11168953 DOI: 10.47895/amp.v58i7.6334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Background The COVID-19 pandemic posed challenges in making time-bound hospital management decisions. The University of the Philippines -Philippine General Hospital (UP-PGH) is a tertiary COVID-19 referral center located in Manila, Philippines. The mismatch of increasing suspected or confirmed COVID-19 infected mothers with few documented cases of infected infants has caused significant patient overflow and manpower shortage in its NICU. Objective We present an evaluated scheme for NICU bed reallocation to maximize capacity performance, staff rostering, and resource conservation, while preserving COVID-19 infection prevention and control measures. Methods Existing process workflows translated into operational models helped create a solution that modified cohorting and testing schemes. Staffing models were transitioned to meet patient flow. Outcome measurements were obtained, and feedback was monitored during the implementation phase. Results The scheme evaluation demonstrated benefits in (a) achieving shorter COVID-19 subunit length of stay; (b) better occupancy rates with minimal overflows; (c) workforce shortage mitigation with increased non-COVID workforce pool; (d) reduced personal protective equipment requirements; and (e) zero true SARS-CoV-2 infections. Conclusion Designed for hospital operations leaders and stakeholders, this operations process can aid in hospital policy formulation in modifying cohorting schemes to maintain quality NICU care and service during the COVID-19 pandemic.
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Affiliation(s)
- Paul Sherwin O Tarnate
- Division of Infectious and Tropical Diseases in Pediatrics, Department of Pediatrics, Philippine General Hospital, University of the Philippines Manila
| | - Anna Lisa T Ong-Lim
- Division of Infectious and Tropical Diseases in Pediatrics, Department of Pediatrics, Philippine General Hospital, University of the Philippines Manila
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Stroth LC, Jahns F, Bode B, Stender M, Schmidt M, Baschnegger H, Epstein N, Sandmeyer B, Nau C. Workforce strategies during the first wave of the COVID-19 pandemic: a retrospective online survey at intensive care units in Germany. BMC Health Serv Res 2024; 24:407. [PMID: 38561774 PMCID: PMC10985885 DOI: 10.1186/s12913-024-10848-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 03/11/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND As the COVID-19 pandemic swept across the globe at the beginning of 2020, healthcare systems were forced to rapidly adapt and expand to meet the sudden surge in demand for intensive care services. This study is the first systematic analysis of the strategies employed by German hospitals to recruit personnel and expand bed capacities during the first wave of the pandemic, and to evaluate the effectiveness of those recruitment measures. METHODS 152 German hospitals with intensive care capacities were selected and invited to participate in an online-based retrospective survey. Factors like the geographic distribution, individual COVID burden and level of care were considered for inclusion in the sample. The data were analyzed descriptively. RESULTS A total of 41 hospitals participated in the survey. The additional demand for intensive care beds was met primarily by activating intensive care beds that were previously considered as non-operational in existing intensive care units (81% of respondents) and by upgrading recovery rooms (73%). The physician staffing requirements were met at approximately 75%, while the nursing staffing requirements were only met by about 45%. Staffing needs were met through reallocations/transfers (85%), staff recruitment from parental leave or retirement (49%), increased hours worked by internal staff (49%), new staff hiring (44%) and increased use of temporary staff (32%). Staff reallocations/transfers to critical care within a hospital were rated as the most effective measure. In this context, specialized personnel mostly from anesthesiology departments were appointed to intensive care medicine. CONCLUSIONS Despite multiple recruitment efforts, the pandemic has exacerbated the nursing staff shortage. The reallocation of existing staff within hospitals was a key element in covering the staffing needs. However, additional measures and efforts are required in order to ensure that critically ill patients can be cared for without compromise. The results of this study may have important implications for healthcare providers and policymakers, offering an evidence-based foundation for responding to future public health emergencies with agility, efficiency, and success.
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Affiliation(s)
- Lara C Stroth
- Department of Anaesthesiology and Intensive Care, University Medical Centre Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Franziska Jahns
- Department of Anaesthesiology and Intensive Care, University Medical Centre Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Berit Bode
- Department of Anaesthesiology and Intensive Care, University Medical Centre Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Maike Stender
- Department of Anaesthesiology and Intensive Care, University Medical Centre Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Michelle Schmidt
- Department of Anaesthesiology, Medical Faculty, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
- AIXTRA-Competence Center for Training and Patient Safety, Medical Faculty, RWTH Aachen, Forckenbeckstraße 71, 52074, Aachen, Germany
| | - Heiko Baschnegger
- Institut für Notfallmedizin und Medizinmanagement (INM), Klinikum der Universität München, LMU München, Schillerstr. 53, 80336, Munich, Germany
| | - Nurith Epstein
- Institute for Medical Education, University Hospital, LMU Munich, Ziemssenstraße 5, 80336, Munich, Germany
| | - Benedikt Sandmeyer
- Institut für Notfallmedizin und Medizinmanagement (INM), Klinikum der Universität München, LMU München, Schillerstr. 53, 80336, Munich, Germany
| | - Carla Nau
- Department of Anaesthesiology and Intensive Care, University Medical Centre Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
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Murshad SW, Khan AA, Rani S, Kamran M. A Serendipitous Outcome of COVID-19: Modifications to ICU Management. Malays J Med Sci 2023; 30:22-28. [PMID: 38239244 PMCID: PMC10793126 DOI: 10.21315/mjms2023.30.6.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/30/2022] [Indexed: 01/22/2024] Open
Abstract
Nosocomial infections are common in intensive care units (ICUs) and often cause increased morbidity and mortality rates in ICU patients. With the emergence of the highly infectious COVID-19, the high prevalence of hospital-acquired infections (HAIs) in ICU has caused much more concern because patients admitted to the ICU have a more severe and prolonged form of the disease. These patients are more likely to develop HAIs than non-ICU patients. Medical communities adopted several measures to make ICU management safer during the pandemic all over the world. In this study, we re-examined the challenges faced and the changes made in ICU management during the pandemic to speculate how these changes will be relevant post-pandemic and can be permanently incorporated into the ICU to improve safety, management, and critical care and make critical care better equipped for future disease breakouts.
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Affiliation(s)
| | | | - Suraksha Rani
- Jinnah Medical and Dental College, Karachi, Pakistan
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Hill K, McCabe C, Brenner M. Impact of adapting paediatric intensive care units for adult care during the COVID-19 pandemic: a scoping review. BMJ Open 2023; 13:e068174. [PMID: 37640456 PMCID: PMC10462976 DOI: 10.1136/bmjopen-2022-068174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 08/14/2023] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVES The objectives were to categorise the evidence, map out the existing studies and explore what was known about the organisation of paediatric intensive care units (PICUs) during the first 18 months of the COVID-19 pandemic. Additionally, this review set out to identify any knowledge gaps in the literature and recommend areas for future research. DESIGN Scoping review. METHODS This study used Arksey and O'Malley's six-stage scoping review framework. A comprehensive search was conducted using the following databases, CINAHL Complete; MEDLINE; PsycINFO; PsycARTICLES and EMBASE and grey literature search engines. A search strategy with predefined inclusion criteria was used to uncover relevant research in this area. Screening and data collection were done in duplicate. RESULTS 47 631 articles were obtained through searching. However, only 25 articles met the inclusion criteria and were included in the analysis. Three dominant themes emerged from the literature: (1) the reorganisation of space for managing increased capacity; (2) increased staffing and support; and (3) the resulting challenges. CONCLUSION COVID-19 has strained institutional resources across the globe. To relieve the burden on intensive care units (ICUs), some PICUs adjusted their units to care for critically ill adults, with other PICUs making significant changes, including the redeployment of staff to adult ICUs to provide extra care for adults. Overall, PICUs were collectively well equipped to care for adult patients, with care enhanced by implementing elements of holistic, family-centred PICU practices. The pandemic fostered a collaborative approach among PICU teams and wider hospital communities. However, specific healthcare guidelines had to be created to safely care for adult patients.
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Affiliation(s)
- Katie Hill
- School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - Catherine McCabe
- School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Maria Brenner
- School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
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Lee S, Park HJ, Hwang J, Lee SW, Han KS, Kim WY, Jeong J, Kang H, Kim A, Lee C, Kim SJ. Machine Learning-Based Models for Prediction of Critical Illness at Community, Paramedic, and Hospital Stages. Emerg Med Int 2023; 2023:1221704. [PMID: 37404873 PMCID: PMC10317605 DOI: 10.1155/2023/1221704] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 05/08/2023] [Accepted: 06/02/2023] [Indexed: 07/06/2023] Open
Abstract
Overcrowding of emergency department (ED) has put a strain on national healthcare systems and adversely affected the clinical outcomes of critically ill patients. Early identification of critically ill patients prior to ED visits can help induce optimal patient flow and allocate medical resources effectively. This study aims to develop ML-based models for predicting critical illness in the community, paramedic, and hospital stages using Korean National Emergency Department Information System (NEDIS) data. Random forest and light gradient boosting machine (LightGBM) were applied to develop predictive models. The predictive model performance based on AUROC in community stage, paramedic stage, and hospital stage was estimated to be 0.870 (95% CI: 0.869-0.871), 0.897 (95% CI: 0.896-0.898), and 0.950 (95% CI: 0.949-0.950) in random forest and 0.877 (95% CI: 0.876-0.878), 0.899 (95% CI: 0.898-0.900), and 0.950 (95% CI: 0.950-0.951) in LightGBM, respectively. The ML models showed high performance in predicting critical illness using variables available at each stage, which can be helpful in guiding patients to appropriate hospitals according to their severity of illness. Furthermore, a simulation model can be developed for proper allocation of limited medical resources.
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Affiliation(s)
- Sijin Lee
- Department of Emergency Medicine, Korea University, College of Medicine, Seoul, Republic of Korea
| | - Hyun Ji Park
- Department of Industrial and Management Engineering, Korea University, Seoul, Republic of Korea
| | - Jumi Hwang
- Department of Industrial and Management Engineering, Korea University, Seoul, Republic of Korea
| | - Sung Woo Lee
- Department of Emergency Medicine, Korea University, College of Medicine, Seoul, Republic of Korea
| | - Kap Su Han
- Department of Emergency Medicine, Korea University, College of Medicine, Seoul, Republic of Korea
| | - Won Young Kim
- Department of Emergency Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jinwoo Jeong
- Department of Emergency Medicine, Dong-A University, College of Medicine, Busan, Republic of Korea
| | - Hyunggoo Kang
- Department of Emergency Medicine, Hanyang University, College of Medicine, Seoul, Republic of Korea
| | - Armi Kim
- Department of Industrial and Management Engineering, Korea University, Seoul, Republic of Korea
| | - Chulung Lee
- School of Industrial and Management Engineering, Korea University, Seoul, Republic of Korea
| | - Su Jin Kim
- Department of Emergency Medicine, Korea University, College of Medicine, Seoul, Republic of Korea
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10
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Dolinaj V, Grujić J, Križanović D, Potkonjak A, Pape T, Banović P. The Price of Hospital Reshaping: Nasal Myiasis Caused by Flesh Fly (Diptera: Sarcophagidae) in Reallocated COVID-19 Intensive Care Unit. Healthcare (Basel) 2023; 11:healthcare11111533. [PMID: 37297672 DOI: 10.3390/healthcare11111533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/22/2023] [Accepted: 05/22/2023] [Indexed: 06/12/2023] Open
Abstract
Myiasis is a condition characterized by fly larvae infestation, most common in tropical regions, but with a risk of occurring anywhere in the world. Here, we report a case of nasal myiasis caused by a sarcophagid fly in a critically ill COVID-19 patient hospitalized in a reallocated ICU department in Serbia and discuss procedures that could prevent the occurrence of similar incidents in reallocated ICU departments worldwide.
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Affiliation(s)
- Vladimir Dolinaj
- Department of Anesthesia and Intensive Care, Clinical Centre of Vojvodina, 21000 Novi Sad, Serbia
- Faculty of Medicine in Novi Sad, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Jasmina Grujić
- Faculty of Medicine in Novi Sad, University of Novi Sad, 21000 Novi Sad, Serbia
- Blood Transfusion Institute Vojvodina, 21000 Novi Sad, Serbia
| | - Davor Križanović
- Department of Anesthesia and Intensive Care, Clinical Centre of Vojvodina, 21000 Novi Sad, Serbia
| | - Aleksandar Potkonjak
- Department of Veterinary Medicine, Faculty of Agriculture, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Thomas Pape
- Natural History Museum of Denmark, Science Faculty, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Pavle Banović
- Department of Microbiology with Parasitology and Immunology, Faculty of Medicine in Novi Sad, University of Novi Sad, 21000 Novi Sad, Serbia
- Department of Prevention of Rabies and Other Infectious Diseases, Pasteur Institute Novi Sad, 21000 Novi Sad, Serbia
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11
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Weblin J, Harriman A, Butler K, Snelson C, McWilliams D. Comparing rehabilitation outcomes for patients admitted to the intensive care unit with COVID-19 requiring mechanical ventilation during the first two waves of the pandemic: A service evaluation. Intensive Crit Care Nurs 2023; 75:103370. [PMID: 36528463 PMCID: PMC9729646 DOI: 10.1016/j.iccn.2022.103370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 11/18/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To compare rehabilitation outcomes of patients admitted to the intensive care unit with COVID-19 and mechanically ventilated during wave 1 and 2, receiving two different models of physiotherapy delivery. METHODS Adults admitted to the intensive care unit between October-March 2021 (wave 2) with a confirmed diagnosis of COVID-19 and mechanically ventilated for >24 hours were included. During wave 2, rehabilitation was provided by physiotherapists over five days, with only emergency respiratory physiotherapy delivered at weekends. Rehabilitation status was measured daily using the Manchester Mobility Score to identify time taken to first mobilise and highest level of mobility achieved at ICU discharge. Outcomes were compared to data previously published from the same ICU during 'wave 1' (March-April 2020) when a seven-day rehabilitation physiotherapy service was provided. RESULTS A total of n = 291 patients were included in analysis; 110 from wave 1, and 181 from wave 2. Patient characteristics and medical management were similar between waves. Mean ± SD time to first mobilise was slower in wave 2 (15 ± 11 days vs 14 ± 7 days), with overall mobility scores lower at both ICU (MMS 5 (Step transferring) vs MMS 4 (standing practice) (4), p < 0.05) and hospital (MMS 7 (Mobile > 30 m MMS) vs MMS 6 (Mobile < 30 m MMS), p < 0.0001) discharge. Significantly more patients in wave 2 required ongoing rehabilitation either at home or as an inpatient compared to wave 1 (81 % vs 49 %, p = 0.003). CONCLUSION The change in physiotherapy staff provision from a seven-day rehabilitation service during wave 1 to a five day rehabilitation service with emergency respiratory physio only at weekends in wave 2 was associated with delayed time to first mobilise, lower levels of mobility at both intensive care unit and hospital discharge and higher requirement for ongoing rehabilitation at the point of hospital discharge.
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Affiliation(s)
- Jonathan Weblin
- Therapy Services, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Adam Harriman
- Therapy Services, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Katrina Butler
- Therapy Services, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Catherine Snelson
- Department of Critical Care, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - David McWilliams
- Centre for Care Excellence, Coventry University & University Hospitals Coventry & Warwickshire NHS Trust, Coventry, United Kingdom.
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12
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Doleman G, Coventry L, Towell-Barnard A, Ghosh M, Gent L, Saunders R, O'Connell B. Staff perceptions of the effectiveness of managerial communication during the COVID-19 pandemic: A cross-sectional study. Int J Nurs Pract 2023:e13149. [PMID: 36942620 DOI: 10.1111/ijn.13149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/23/2023] [Accepted: 03/04/2023] [Indexed: 03/23/2023]
Abstract
AIMS This work aims to explore staff perceptions of (1) the effectiveness of organizational communication during the COVID-19 pandemic and (2) the impact of organizational communication on staff well-being and ability to progress their work and patient care. BACKGROUND Effective coordination and communication are essential in a pandemic management response. However, the effectiveness of communication strategies used during the COVID-19 pandemic is not well understood. DESIGN An exploratory cross-sectional research design was used. A 33-item survey tool was created for the study. METHODS The study was conducted at a tertiary teaching hospital in Western Australia. Convenience sampling was used to recruit participants from nursing, medical, allied health services, administrative and clerical, and personal support services (N = 325). Data were collected between December 2020 and May 2021. RESULTS Overall, all occupational groups found working during the COVID-19 pandemic stressful, and all groups wanted accessible and accurate communication from management and new policies, procedures, and protocols for future outbreaks. CONCLUSIONS The use of occupational group-relevant strategies and COVID-19 protocols, as well as the on-going use of email, face-to-face meetings with debrief sessions, are needed to improve communication and support staff to fulfil their roles.
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Affiliation(s)
- Gemma Doleman
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
- Centre for Nursing Research, Sir Charles Gardiner Hospital, Nedlands, Western Australia, Australia
| | - Linda Coventry
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
- Centre for Nursing Research, Sir Charles Gardiner Hospital, Nedlands, Western Australia, Australia
- Centre for Research in Aged Care, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Amanda Towell-Barnard
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
- Centre for Nursing Research, Sir Charles Gardiner Hospital, Nedlands, Western Australia, Australia
- Centre for Research in Aged Care, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Manonita Ghosh
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
- Centre for Nursing Research, Sir Charles Gardiner Hospital, Nedlands, Western Australia, Australia
| | - Lucy Gent
- Centre for Nursing Research, Sir Charles Gardiner Hospital, Nedlands, Western Australia, Australia
| | - Rosemary Saunders
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
- Centre for Research in Aged Care, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Beverly O'Connell
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
- Centre for Nursing Research, Sir Charles Gardiner Hospital, Nedlands, Western Australia, Australia
- Centre for Research in Aged Care, Edith Cowan University, Joondalup, Western Australia, Australia
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13
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Cinaroglu S. Does increasing the number of beds or health workers contribute to the rational use of scarce public health resources? Glob Health Med 2023; 5:23-32. [PMID: 36865894 PMCID: PMC9974230 DOI: 10.35772/ghm.2023.01006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/07/2023] [Accepted: 02/21/2023] [Indexed: 02/27/2023]
Abstract
Turkey makes substantial investments to increase the number of qualified beds in hospitals, the shortage in health professionals remains one of the main obstacles of the health system in the country. To address this research gap, the study aims to formulate a rational solution for the dilemma on whether to invest in beds or health professionals contribute to the rational use of scarce public health resources. Data for testing the model were derived from the Turkish Statistical Institute across 81 provinces in Turkey. The path analytic approach was used to determine the associations among hospital size, utilization/facility, health workforce, and indicators of health outcomes. The results point to a strong link between quantity of qualified beds, utilization of health services, and facility indicators, and health workforce. Rational use of scarce resources, optimal capacity planning, and increased quantity of health professionals will be beneficial for the sustainability of health care services.
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Affiliation(s)
- Songul Cinaroglu
- Address correspondence to:Songul Cinaroglu, Department of Health Care Management, Hacettepe University Faculty of Economics & Administrative Sciences, 06800, Ankara, Turkey. E-mail:
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14
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Tu WJ, Liu Y, Zeng X. Critical care capacity during the omicron wave of the COVID-19 pandemic in China: far from enough. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 31:100689. [PMID: 36684381 PMCID: PMC9846919 DOI: 10.1016/j.lanwpc.2023.100689] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 12/21/2022] [Accepted: 12/29/2022] [Indexed: 06/17/2023]
Affiliation(s)
- Wen-Jun Tu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Institute of Radiation Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300192, China
| | - Yakun Liu
- Department of General Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Xianwei Zeng
- Department of Neurosurgery, Rehabilitation Hospital of the National Research Center for Rehabilitation Technical Aids, Beijing, China
- Geriatrics Innovation Center, Weifang Renmin Hospital, Weifang, China
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15
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Parotto E, Lamberti-Castronuovo A, Censi V, Valente M, Atzori A, Ragazzoni L. Exploring Italian healthcare facilities response to COVID-19 pandemic: Lessons learned from the Italian Response to COVID-19 initiative. Front Public Health 2023; 10:1016649. [PMID: 36699915 PMCID: PMC9870543 DOI: 10.3389/fpubh.2022.1016649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 12/20/2022] [Indexed: 01/11/2023] Open
Abstract
The COVID-19 pandemic exerted an extraordinary pressure on the Italian healthcare system (Sistema Sanitario Nazionale, SSN), determining an unprecedented health crisis. In this context, a multidisciplinary non-governmental initiative called Italian Response to COVID-19 (IRC-19) was implemented from June 2020 to August 2021 to support the Italian health system through multiple activities aimed to mitigate the effects of the pandemic. The objective of this study was to shed light on the role of NGOs in supporting the SSN during the first pandemic wave by specifically exploring: (1) the main challenges experienced by Italian hospitals and out-of-hospital care facilities and (2) the nature and extent of the IRC-19 interventions specifically implemented to support healthcare facilities, to find out if and how such interventions met healthcare facilities' perceived needs at the beginning of the pandemic. We conducted a cross-sectional study using an interviewer administered 32-item questionnaire among 14 Italian healthcare facilities involved in the IRC-19 initiative. Health facilities' main challenges concerned three main areas: healthcare workers, patients, and facilities' structural changes. The IRC-19 initiative contributed to support both hospital and out-of-hospital healthcare facilities by implementing interventions for staff and patients' safety and flow management and interventions focused on the humanization of care. The support from the third sector emerged as an added value that strengthened the Italian response to the COVID-19 pandemic. This is in line with the Health-Emergency and Disaster Risk Management (H-EDRM) precepts, that call for a multisectoral and multidisciplinary collaboration for an effective disaster management.
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Affiliation(s)
- Emanuela Parotto
- Dipartimento di Chirurgia DIDAS, Unità Operativa Complessa (UOC) Istituto Anestesia e Rianimazione, Azienda Ospedale Università, Padova, Italy,*Correspondence: Emanuela Parotto ✉
| | - Alessandro Lamberti-Castronuovo
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Novara, Italy,Department for Sustainable Development and Ecological Transition, Università del Piemonte Orientale, Vercelli, Italy
| | - Veronica Censi
- Collegio Universitario Aspiranti Medici Missionari (CUAMM)-Doctors With Africa, Padova, Italy
| | - Martina Valente
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Novara, Italy,Department for Sustainable Development and Ecological Transition, Università del Piemonte Orientale, Vercelli, Italy
| | - Andrea Atzori
- Collegio Universitario Aspiranti Medici Missionari (CUAMM)-Doctors With Africa, Padova, Italy
| | - Luca Ragazzoni
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Novara, Italy,Department for Sustainable Development and Ecological Transition, Università del Piemonte Orientale, Vercelli, Italy
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16
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Topple M, Jaspers R, Watterson J, McClure J, Rosenow M, Pollock W, Pilcher D. Nursing workforce deployment and intensive care unit strain during the COVID-19 pandemic in Victoria, Australia. Aust Crit Care 2023; 36:84-91. [PMID: 36572575 PMCID: PMC9742212 DOI: 10.1016/j.aucc.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 11/29/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic demanded intensive care units (ICUs) globally to expand to meet increasing patient numbers requiring critical care. Critical care nurses were a finite resource in this challenge to meet growing patient numbers, necessitating redeployment of nursing staff to work in ICUs. OBJECTIVE Our aim was to describe the extent and manner by which the increased demand for ICU care during the COVID-19 pandemic was met by ICU nursing workforce expansion in the late 2021 and early 2022 in Victoria, Australia. METHODS This is a retrospective cohort study of Victorian ICUs who contributed nursing data to the Critical Health Information System from 1 December 2021 to 11 April 2022. Bedside nursing workforce data, in categories as defined by Safer Care Victoria's pandemic response guidelines, were analysed. The primary outcome was 'insufficient ICU skill mix'-whenever a site had more patients needing 1:1 critical care nursing care than the mean daily number of experienced critical care nursing staff. RESULTS Overall, data from 24 of the 47 Victorian ICUs were eligible for analysis. Insufficient ICU skill mix occurred on 10.3% (280/2725) days at 66.7% (16/24) of ICUs, most commonly during the peak phase from December to mid-February. The insufficient ICU skill mix was more likely to occur when there were more additional ICU beds open over the 'business-as-usual' number. Counterfactual analysis suggested that had there been no redeployment of staff to the ICU, reduced nursing ratios, with inability to provide 1:1 care, would have occurred on 15.2% (415/2725) days at 91.7% (22/24) ICUs. CONCLUSION The redeployment of nurses into the ICU was necessary. However, despite this, at times, some ICUs had insufficient staff to cope with the number and acuity of patients. Further research is needed to examine the impact of ICU nursing models of care on patient outcomes and on nurse outcomes.
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Affiliation(s)
- Michelle Topple
- Department of Intensive Care, Austin Health, 145 Studley Rd, Heidelberg, Melbourne, Victoria, Australia,Corresponding author
| | - Rose Jaspers
- School of Nursing and Midwifery, Monash University, Wellington Rd, Clayton, Melbourne, Victoria, Australia
| | - Jason Watterson
- Department of Intensive Care, Peninsula Health, 2 Hastings Rd, Frankston, Victoria, Australia,School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, Victoria, Australia
| | - Jason McClure
- Adult Retrieval Victoria, 61-75 Brady St, South Melbourne, Victoria, Australia,Department of Intensive Care, Alfred Hospital, 55 Commercial Rd, Melbourne, Victoria, Australia,School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, Victoria, Australia
| | - Melissa Rosenow
- Adult Retrieval Victoria, 61-75 Brady St, South Melbourne, Victoria, Australia
| | - Wendy Pollock
- School of Nursing and Midwifery, Monash University, Wellington Rd, Clayton, Melbourne, Victoria, Australia
| | - David Pilcher
- Department of Intensive Care, Alfred Hospital, 55 Commercial Rd, Melbourne, Victoria, Australia,School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, Victoria, Australia,Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation, 1/277 Camberwell Rd, Camberwell, Melbourne, Victoria, Australia
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17
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Campbell S, Carnevale FA. Children as an afterthought during COVID-19: defining a child-inclusive ethical framework for pandemic policymaking. BMC Med Ethics 2022; 23:126. [PMID: 36471326 PMCID: PMC9720957 DOI: 10.1186/s12910-022-00866-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 11/23/2022] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND Following the SARS pandemic, jurisdictions around the world began developing ethical resource allocation frameworks for future pandemics-one such framework was developed by Thompson and colleagues. While this framework offers a solid backbone upon which decision-makers can rest assured that their work is driven by rigorous ethical processes and principles, it fails to take into account the nuanced experiences and interests of children and youth (i.e., young people) in a pandemic context. The current COVID-19 pandemic offers an opportunity to re-examine this framework from young people's perspectives, informed by advances in childhood ethics and children's rights. MAIN BODY In this paper, we revisit the Thompson et al. framework and propose adaptations to the ethical processes and values outlined therein. This work is informed by expertise in clinical ethics and literature related to impacts of COVID-19 and other pandemics on the health and well-being of children around the world, though with particular attention to Canada. During the processes of drafting this work, stakeholders were consulted-aligned with the approach used by Thompson and colleagues-to validate the interpretations provided. We also propose a new principle, namely practicability, to indicate the complex balance between what is possible and what is convenient that is required in ethically sound decisions in the context of services affecting young people. We outline and discuss the strengths and limitations of our work and indicate next steps for scholars in the areas of childhood studies and child health. CONCLUSION Efforts to ensure frameworks are truly child-inclusive should be the status-quo, so pandemic impacts and policy implications can be considered in advance of emergency preparedness contexts.
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Affiliation(s)
- Sydney Campbell
- grid.14709.3b0000 0004 1936 8649VOICE Childhood Ethics Research Team, McGill University, Montreal, QC Canada ,grid.17063.330000 0001 2157 2938Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, ON M573M6 Canada ,grid.17063.330000 0001 2157 2938Joint Centre for Bioethics, University of Toronto, Toronto, Canada
| | - Franco A. Carnevale
- grid.14709.3b0000 0004 1936 8649VOICE Childhood Ethics Research Team, McGill University, Montreal, QC Canada ,grid.14709.3b0000 0004 1936 8649Ingram School of Nursing, McGill University, Montreal, QC Canada
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18
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Mackay MC, Gilbert MH, Fournier PS, Dextras-Gauthier J, Boucher F. Management behaviors during the COVID-19 pandemic: The case of healthcare middle managers. Front Psychol 2022; 13:986980. [DOI: 10.3389/fpsyg.2022.986980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 09/21/2022] [Indexed: 11/06/2022] Open
Abstract
BackgroundThe spread of COVID-19 has disrupted the lifestyles of the world’s population. In the workplace, the pandemic has affected all sectors and has changed the way work is organized and carried out. The health sector has been severely impacted by the pandemic and has faced enormous challenges in maintaining healthcare services while providing care to those infected by the virus. At the heart of this battle, healthcare managers were key players in ensuring the orchestration of operations and the physical and mental availability of employees during the crisis. Although few studies have been conducted to identify organizational practices or leadership skills to be adopted in a crisis context, the concrete behaviors of managers have not been documented yet. Therefore, this study aims at filling this gap by studying middle managers’ behaviors facing COVID-19 crisis in the healthcare sector.MethodsUsing a qualitative approach, eight focus groups were conducted online during the pandemic with 37 middle managers from the healthcare community of a Quebec health establishment (Canada) from April to June 2020. Thematic analyses were conducted, and a mixed-methods approach was used to analyse the data based on Viitala’s hierarchical model of management skills.ResultsBased on the six managerial skills proposed in the model of Viitala, 21 specific management behaviors were identified as having been deployed by middle managers at the beginning of the pandemic. Considering that the health sector has been profoundly shaken by this health crisis, in addition to being an environment likely to experience other crises, managers need to develop practical skills in various crisis management situations. Thus, the results guide practitioners by highlighting the importance of team-oriented management behaviors (leadership, supervisory competencies), especially in a crisis context.
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19
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Lamberti-Castronuovo A, Parotto E, Della Corte F, Hubloue I, Ragazzoni L, Valente M. The COVID-19 pandemic response and its impact on post-corona health emergency and disaster risk management in Italy. Front Public Health 2022; 10:1034196. [PMID: 36388364 PMCID: PMC9659979 DOI: 10.3389/fpubh.2022.1034196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 10/14/2022] [Indexed: 01/29/2023] Open
Abstract
Background The COVID-19 pandemic has profoundly impacted societies, influencing countries' Health Emergency and Disaster Risk Management (H-EDRM) systems. By taking Italy as a case study, this research aimed to investigate the response to the COVID-19 pandemic, focusing on the changes made to the existing H-EDRM system, with an emphasis on human resources, health service delivery, and logistics and the forward-looking strategies for the next health emergencies and disasters. Methods We performed a retrospective observational case study using qualitative methodology. Data was collected via semi-structured interviews and analyzed considering the World Health Organization (WHO) H-EDRM framework. Multiple interviewees were selected to obtain a holistic perspective on the Italian response to COVID-19. Stakeholders from five different sectors (policy-making, hospital, primary care, third sector, lay community) from three of the most impacted Italian regions (Piemonte, Lombardia, and Veneto) were interviewed, for a total of 15 respondents. Results Results on human resources revolved around the following main themes: personnel, training, occupational health, and multidisciplinary work; results on health service delivery encompassed the following main themes: public health, hospital, and primary care systems; results on logistics dealt with the following themes: infrastructures, supplies, transports, and communication channels. Lessons learned stressed on the importance of considering pragmatic disaster preparedness strategies and the need for cultural and structural reforms. Stakeholders mentioned several implications for the post-pandemic H-EDRM system in Italy. Conclusions Findings highlight that the interconnection of sectors is key in overcoming pandemic-related challenges and for future disaster preparedness. The implications for the Italian H-EDRM system can inform advancements in disaster management in Italy and beyond.
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Affiliation(s)
- Alessandro Lamberti-Castronuovo
- CRIMEDIM-Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Novara, Italy,Department for Sustainable Development and Ecological Transition, Università del Piemonte Orientale, Vercelli, Italy,*Correspondence: Alessandro Lamberti-Castronuovo
| | - Emanuela Parotto
- Department of Surgery DIDAS, Azienda Ospedale Università, Padova, Italy
| | - Francesco Della Corte
- CRIMEDIM-Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Novara, Italy,Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Ives Hubloue
- Research Group on Emergency and Disaster Medicine, Vrije Universiteit Brussel, Brussels, Belgium
| | - Luca Ragazzoni
- CRIMEDIM-Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Novara, Italy,Department for Sustainable Development and Ecological Transition, Università del Piemonte Orientale, Vercelli, Italy
| | - Martina Valente
- CRIMEDIM-Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Novara, Italy,Department for Sustainable Development and Ecological Transition, Università del Piemonte Orientale, Vercelli, Italy
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20
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Marmo R, Pascale F, Diana L, Sicignano E, Polverino F. Lessons learnt for enhancing hospital resilience to pandemics: A qualitative analysis from Italy. INTERNATIONAL JOURNAL OF DISASTER RISK REDUCTION : IJDRR 2022; 81:103265. [PMID: 36061241 PMCID: PMC9419438 DOI: 10.1016/j.ijdrr.2022.103265] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 08/18/2022] [Accepted: 08/19/2022] [Indexed: 06/15/2023]
Abstract
The COVID-19 pandemic has outlined the need to strengthen the resilience of healthcare systems. It has cost millions of human lives and has had indirect health impacts too. Hospital buildings have undergone extensive modifications and adaptations to ensure infection control and prevention measures, and, as it is happened following past epidemics, the COVID-19 experience might change the design of hospital buildings in the future. This paper aims to capitalise on the knowledge developed by the stakeholders directly involved with the hospital response during the pandemic to generate new evidence that will enhance resilience of hospital buildings to pandemics. The research adopted qualitative research methods, namely literature review and interviews with Italian experts including doctors and facility managers to collect data which were analysed through a thematic analysis. The findings include the identification of new needs for hospital buildings and the related actions to be taken or already performed at hospital building and service level which are viable for long term implementation and are aimed at improving hospital resilience to pandemics. The results specify how to improve resilience by means of structural modifications (e.g. placing filter zones among different wards, ensuring the presence of airborne infection isolation rooms at least in the emergency departments), technological changes (e.g. oversizing capacity such as medical gases, information technology improvement for delivering healthcare services remotely), and operational measures (e.g. assessing the risk of infection before admission, dividing acute-care from low-care assets). The needs discussed in this paper substantiate the urge to renovate the Italian healthcare infrastructures and they can be considered useful elements of knowledge for enhancing hospital resilience to pandemics in the extended and in the post-COVID-19 era.
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Affiliation(s)
- Rossella Marmo
- Department of Civil Engineering, University of Salerno, 84084, Fisciano, Italy
| | - Federica Pascale
- Faculty of Science and Engineering, Anglia Ruskin University, CM1 1SQ, Chelmsford, UK
| | - Lorenzo Diana
- Department of Civil, Building and Environmental Engineering, University of Naples "Federico II", 80138, Naples, Italy
| | - Enrico Sicignano
- Department of Civil Engineering, University of Salerno, 84084, Fisciano, Italy
| | - Francesco Polverino
- Department of Civil, Building and Environmental Engineering, University of Naples "Federico II", 80138, Naples, Italy
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Abstract
Pandemics, increases in disease incidence that affect multiple regions of the world, present huge challenges to health care systems and in particular to policymakers, public health authorities, clinicians, and all health care workers (HCWs). The recent COVID-19 pandemic has resulted in millions of severely ill patients, many of whom who have required hospital and intensive care unit (ICU) admission. The discipline of critical care is a vital and integral component of pandemic preparedness. Safe and effective critical care has the potential to improve outcomes, motivate individuals to seek timely medical attention, and attenuate the devastating sequelae of a severe pandemic. To achieve this, suitable critical care planning and preparation are essential.
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Efendi F, Aurizki GE, Auwalin I, McKenna L. The Need for Speed: A Qualitative Study on Nurse Recruitment and Management Amidst the COVID-19 Pandemic in Indonesia. J Multidiscip Healthc 2022; 15:1809-1817. [PMID: 36060420 PMCID: PMC9431772 DOI: 10.2147/jmdh.s370758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/15/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Ferry Efendi
- Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia
- Community, Family and Gerontological Nursing Research Group, Universitas Airlangga, Surabaya, Indonesia
- Correspondence: Ferry Efendi, Faculty of Nursing, Universitas Airlangga, Campus C Mulyorejo, Surabaya, East Java, 60115, Indonesia, Tel +62 31 591 3754, Email
| | - Gading Ekapuja Aurizki
- Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia
- Community, Family and Gerontological Nursing Research Group, Universitas Airlangga, Surabaya, Indonesia
| | - Ilmiawan Auwalin
- Faculty of Economics and Business, Universitas Airlangga, Surabaya, Indonesia
| | - Lisa McKenna
- School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
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23
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Stone E, Irving LB, Tonga KO, Thompson B. Sustaining the Australian respiratory workforce through the COVID-19 pandemic: a scoping literature review. Intern Med J 2022; 52:1115-1122. [PMID: 35195945 PMCID: PMC9111702 DOI: 10.1111/imj.15718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 02/10/2022] [Indexed: 11/29/2022]
Abstract
The outbreak of the COVID-19 pandemic in late 2019 and in 2020 presented challenges to healthcare workers (HCW) around the world that were unexpected and dramatic. The relentless progress of infection, starting in China and rapidly spreading to Europe, North America and elsewhere gave more remote countries, like Australia, time to prepare but also time for unease. HCW everywhere had to readjust and change their work practices to cope. Further waves of infection and transmission with newer variants pose challenges to HCW and health systems, even after mass vaccination. Respiratory medicine HCW found themselves at the frontline, developing critical care services to support intensive care units and grappling with unanticipated concerns about safety, risk and the need to retrain. Several studies have addressed the need for rapid changes in the healthcare workforce for COVID-19 and the impact of this preparation on HCW themselves. In this paper, we present a scoping review of the literature on preparing HCW for the pandemic, explore the Australian experience of building the respiratory workforce and propose evidence-based recommendations to sustain this workforce in an unprecedented high-risk environment.
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Affiliation(s)
- Emily Stone
- Department of Thoracic Medicine and Lung TransplantationSt Vincent's Hospital SydneySydneyNew South WalesAustralia
- School of Clinical MedicineUNSW Medicine and Health, St Vincent's Clinical CampusSydneyNew South WalesAustralia
| | - Louis B. Irving
- Department of Respiratory and Sleep MedicineRoyal Melbourne HospitalMelbourneVictoriaAustralia
| | - Katrina O. Tonga
- Department of Thoracic Medicine and Lung TransplantationSt Vincent's Hospital SydneySydneyNew South WalesAustralia
- School of Clinical MedicineUNSW Medicine and Health, St Vincent's Clinical CampusSydneyNew South WalesAustralia
- Northern Clinical SchoolUniversity of SydneySydneyNew South WalesAustralia
| | - Bruce Thompson
- School of Health SciencesSwinburne University of TechnologyMelbourneVictoriaAustralia
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24
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Moosavi J, Fathollahi-Fard AM, Dulebenets MA. Supply chain disruption during the COVID-19 pandemic: Recognizing potential disruption management strategies. INTERNATIONAL JOURNAL OF DISASTER RISK REDUCTION : IJDRR 2022; 75:102983. [PMID: 35475018 PMCID: PMC9027543 DOI: 10.1016/j.ijdrr.2022.102983] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 02/20/2022] [Accepted: 04/19/2022] [Indexed: 05/25/2023]
Abstract
The COVID-19 pandemic has made a significant impact on various supply chains (SCs). All around the world, the COVID-19 pandemic affects different dimensions of SCs, including but not limited to finance, lead time, demand changes, and production performance. There is an urgent need to respond to this grand challenge. The catastrophic impact of the COVID-19 pandemic prompted scholars to develop innovative SC disruption management strategies and disseminate them via numerous scientific articles. However, there is still a lack of systematic literature survey studies that aim to identify promising SC disruption management strategies through the bibliometric, network, and thematic analyses. In order to address this drawback, this study presents a set of up-to-date bibliometric, network, and thematic analyses to identify the influential contributors, main research streams, and disruption management strategies related to the SC performance under the COVID-19 settings. The conducted analyses reveal that resilience and sustainability are the primary SC topics. Furthermore, the major research themes are found to be food, health-related SCs, and technology-aided tools (e.g., artificial intelligence (AI), internet of things (IoT), and blockchains). Various disruption management strategies focusing on resilience and sustainability themes are extracted from the most influential studies that were identified as a part of this work. In addition, we draw some managerial insights to ensure a resilient and sustainable supply of critical products in the event of a pandemic, such as personal protective equipment (PPE) and vaccines.
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Affiliation(s)
- Javid Moosavi
- School of the Built Environment, University of Technology Sydney, Sydney, Australia
| | - Amir M Fathollahi-Fard
- Department of Electrical Engineering, École de Technologie Supérieure, University of Quebec, 1100 Notre-Dame St. W., Montreal, Quebec, Canada
| | - Maxim A Dulebenets
- Department of Civil & Environmental Engineering, Florida A&M University-Florida State University (FAMU-FSU) College of Engineering, 2035 E Paul Dirac Dr., Sliger Building, Suite 275, Tallahassee, FL, 32310, USA
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25
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Moon RC, Brown H, Rosenthal N. Healthcare Resource Utilization of Patients With COVID-19 Visiting US Hospitals. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:751-760. [PMID: 35183449 PMCID: PMC8849836 DOI: 10.1016/j.jval.2021.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 10/19/2021] [Accepted: 12/01/2021] [Indexed: 05/03/2023]
Abstract
OBJECTIVES Severe cases of COVID-19 have overwhelmed hospital systems across the nation. This study aimed to describe the healthcare resource utilization of patients with COVID-19 from hospital visit to 30 days after discharge for inpatients and hospital-based outpatients in the United States. METHODS A retrospective cohort study was conducted using Premier Healthcare Database COVID-19 Special Release, a large geographically diverse all-payer hospital administrative database. Adult patients (age ≥ 18 years) were identified by their first, or "index," visit between April 1, 2020, and February 28, 2021, with a principal or secondary discharge diagnosis of COVID-19. RESULTS Of 1 454 780 adult patients with COVID-19, 33% (n = 481 216) were inpatients and 67% (n = 973 564) were outpatients. Among inpatients, mean age was 64.4 years and comorbidities were common. Most patients (80%) originated from home, 10% from another acute care facility, and 95% were admitted through the emergency department. Of these patients, 23% (n = 108 120) were admitted to intensive care unit and 14% (n = 66 706) died during index hospitalization; 44% were discharged home, 15% to nursing or rehabilitation facility, and 12% to home health. Among outpatients, mean age was 48.8 years, 44% were male, and 60% were emergency department outpatients (n = 586 537). During index outpatient visit, 79% were sent home but 10% had another outpatient visit and 4% were hospitalized within 30 days. CONCLUSIONS COVID-19 is associated with high level of healthcare resource utilization and in-hospital mortality. More than one-third of inpatients required post hospital healthcare services. Such information may help healthcare providers better allocate resources for patients with COVID-19 during the pandemic.
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Affiliation(s)
- Rena C Moon
- PINC AI Applied Sciences, Premier Inc, Charlotte, NC, USA
| | - Harold Brown
- PINC AI Applied Sciences, Premier Inc, Charlotte, NC, USA
| | - Ning Rosenthal
- PINC AI Applied Sciences, Premier Inc, Charlotte, NC, USA.
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26
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Carter C, Aedy H, Osborn M, Rooney M, Notter J. Service evaluation of a COVID-19 critical care orientation programme. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:452-458. [PMID: 35439073 DOI: 10.12968/bjon.2022.31.8.452] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND During the first wave of the COVID-19 pandemic in the UK, south London had the highest number of COVID-19 patients admitted to critical care. At one hospital, staff being redeployed to critical care were invited to attend an orientation to critical care workshop. AIM To carry out a service evaluation of the training outcomes from rapidly redeployed staff who completed the workshop during the first wave of the COVID-19 pandemic (March-July 2020). METHODS Two stages were used, the first was a post-workshop evaluation questionnaire completed immediately after the training, with the second involving a single centre e-survey questionnaire two months later. FINDINGS In total 131 health professionals attended the workshop, and 124 (95%) post-course evaluations were completed. Some 116 staff were contacted for the e-survey, with a response rate of 34% (n=40). Overall, the training was well evaluated. Of the 40 respondents, 70% (n=28) had volunteered, but only just over half (n=21, 52%) went on to work in critical care. CONCLUSION This article describes the organisational response of one NHS acute hospital to the unprecedented challenges that arose from the COVID-19 pandemic. The service evaluation identified the importance of a pedagogical approach, which not only delivered clinical content, but also allayed anxiety for health professionals preparing to work in a new environment.
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Affiliation(s)
- Chris Carter
- Senior Lecturer, Birmingham City University, Birmingham
| | - Helen Aedy
- Critical Care Outreach Sister, University Hospital Lewisham, London
| | | | - Martine Rooney
- Matron Critical Care, University Hospital Lewisham, London
| | - Joy Notter
- Professor of Community Healthcare Studies, Birmingham City University, Birmingham
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27
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Ochiai K, Oka T, Kato N, Kondo Y, Otomo Y, Swienton RE. Differences in the Awareness and Knowledge of Radiological and Nuclear Events Among Medical Workers in Japan. Front Public Health 2022; 10:808148. [PMID: 35433584 PMCID: PMC9006773 DOI: 10.3389/fpubh.2022.808148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 02/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background Previous research revealed a lack of comfort and knowledge regarding nuclear and radiological events among medical staff. We investigated the awareness and knowledge of radiological and nuclear events among the Japanese medical staff by comparing differences by occupation (doctors, nurses, and other medical specialists). Methods We conducted a cross-sectional questionnaire survey among trainees undergoing Japanese disaster medical training courses between July 2014 and February 2016. The differences by occupation were evaluated for all questions on awareness and knowledge concerning disasters or radiological and nuclear events and demographics. Results Among the occupations, there were significant differences in the willingness to work onsite based on the types of disaster, familiarity with the national disaster medical response system, the accuracy rate of some knowledge about medical practice and the risk, and demographic characteristics such as practical experience and educational degree. The accuracy rates of responses to some questions on knowledge were very low in all occupations. Conclusion There were significant differences in awareness and knowledge of radiological and nuclear events by occupation. We believe that the results can be used to develop and modify the content of training courses on radiological and nuclear events to make such courses beneficial for each healthcare worker.
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Affiliation(s)
- Kanae Ochiai
- Trauma and Acute Critical Care Medical Center, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
| | - Tomo Oka
- Emergency Medical Center, Fujisawa City Hospital, Kanagawa, Japan
| | - Nagisa Kato
- Trauma and Acute Critical Care Medical Center, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
| | - Yuji Kondo
- Department of Emergency, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Yasuhiro Otomo
- Trauma and Acute Critical Care Medical Center, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
| | - Raymond E Swienton
- University of Texas Southwestern Medical Center, Dallas, TX, United States
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28
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Hegde K, Sharma H, Killedar M, Betadur D. Establishment of a Rapid Response, 100-Bedded COVID-19 Hospital With General Wards and Intensive Care Unit Within 35 Days in North Karnataka, India: Report From the Field. Disaster Med Public Health Prep 2022; 17:e173. [PMID: 35361301 PMCID: PMC9151629 DOI: 10.1017/dmp.2022.85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 03/09/2022] [Accepted: 03/17/2022] [Indexed: 02/07/2023]
Abstract
In the state of Karnataka, India, the first case of coronavirus disease (COVID-19) was diagnosed on March 9, 2020. As stated by the WHO, around 15% of COVID-19 patients require treatment in the Intensive Care Unit (ICU). Keeping this in mind, along with the increase in COVID-19 patients in Karnataka, it was predicted that the prevailing general wards and ICUs would be overburdened with the added non-COVID-19 diseases and infirmities. Hence, it was decided to set up a separate infrastructure to reduce the chances of transmission among the patients within the hospital. Thus, the board at SDM College of Medical Sciences & Hospital, Dharwad, Karnataka, took the responsibility to establish a fully equipped 100-bedded hospital in its premise as part of the national and state services to combat the outbreak. The aim of the study was to establish an isolated, fully functional hospital, equipped with all necessary diagnostic and critical care facilities to treat patients diagnosed with COVID-19 in North Karnataka, India.
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Affiliation(s)
- Kiran Hegde
- Department of Hospital Administration, SDM College of Medical Sciences & Hospital, Karnataka, India
| | - Himanshu Sharma
- Department of Hospital Administration, SDM College of Medical Sciences & Hospital, Karnataka, India
| | - Makhdoom Killedar
- Department of Hospital Administration, SDM College of Medical Sciences & Hospital, Karnataka, India
| | - Deepak Betadur
- Department of Hospital Administration, SDM College of Medical Sciences & Hospital, Karnataka, India
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Nasa P, Azoulay E, Chakrabarti A, Divatia JV, Jain R, Rodrigues C, Rosenthal VD, Alhazzani W, Arabi YM, Bakker J, Bassetti M, De Waele J, Dimopoulos G, Du B, Einav S, Evans L, Finfer S, Guérin C, Hammond NE, Jaber S, Kleinpell RM, Koh Y, Kollef M, Levy MM, Machado FR, Mancebo J, Martin-Loeches I, Mer M, Niederman MS, Pelosi P, Perner A, Peter JV, Phua J, Piquilloud L, Pletz MW, Rhodes A, Schultz MJ, Singer M, Timsit JF, Venkatesh B, Vincent JL, Welte T, Myatra SN. Infection control in the intensive care unit: expert consensus statements for SARS-CoV-2 using a Delphi method. THE LANCET. INFECTIOUS DISEASES 2022; 22:e74-e87. [PMID: 34774188 PMCID: PMC8580499 DOI: 10.1016/s1473-3099(21)00626-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/16/2021] [Accepted: 09/16/2021] [Indexed: 02/07/2023]
Abstract
During the current COVID-19 pandemic, health-care workers and uninfected patients in intensive care units (ICUs) are at risk of being infected with SARS-CoV-2 as a result of transmission from infected patients and health-care workers. In the absence of high-quality evidence on the transmission of SARS-CoV-2, clinical practice of infection control and prevention in ICUs varies widely. Using a Delphi process, international experts in intensive care, infectious diseases, and infection control developed consensus statements on infection control for SARS-CoV-2 in an ICU. Consensus was achieved for 31 (94%) of 33 statements, from which 25 clinical practice statements were issued. These statements include guidance on ICU design and engineering, health-care worker safety, visiting policy, personal protective equipment, patients and procedures, disinfection, and sterilisation. Consensus was not reached on optimal return to work criteria for health-care workers who were infected with SARS-CoV-2 or the acceptable disinfection strategy for heat-sensitive instruments used for airway management of patients with SARS-CoV-2 infection. Well designed studies are needed to assess the effects of these practice statements and address the remaining uncertainties.
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Affiliation(s)
- Prashant Nasa
- NMC Speciality Hospital, Dubai, United Arab Emirates
| | - Elie Azoulay
- Saint-Louis Teaching Hospital, APHP, University of Paris, Paris, France
| | | | | | - Ravi Jain
- Mahatma Gandhi Medical College and Hospital, Jaipur, India
| | - Camilla Rodrigues
- PD Hinduja National Hospital and Medical Research Centre, Mumbai, India
| | | | | | - Yaseen M Arabi
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Jan Bakker
- New York University Grossman School of Medicine, New York, NY, USA; Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA; Erasmus University Medical Center, Rotterdam, Netherlands; Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Matteo Bassetti
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | | | - George Dimopoulos
- Attikon University Hospital, Athens, Greece; National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Bin Du
- State Key Laboratory of Rare, Complex and Critical Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Sharon Einav
- Shaare Zedek Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | | | - Simon Finfer
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; Imperial College London, London, UK
| | - Claude Guérin
- University de Lyon, Lyon, France; Institut Mondor de Recherches Biomédicales, Créteil, France
| | - Naomi E Hammond
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, Newton, Adelaide, SA, Australia
| | - Samir Jaber
- Hôpital Saint-Éloi, Montpellier University Hospital, Montpellier, France
| | - Ruth M Kleinpell
- Vanderbilt University School of Nursing, Vanderbilt University, Nashville, TN, USA
| | - Younsuck Koh
- College of Medicine, University of Ulsan College of Medicine, University of Ulsan, Seoul, South Korea
| | - Marin Kollef
- Washington University School of Medicine, Washington University, St Louis, MO, USA
| | - Mitchell M Levy
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Flavia R Machado
- Hospital Sao Paulo, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | | | - Mervyn Mer
- Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa; Faculty of Health Sciences University of the Witwatersrand, Johannesburg, South Africa
| | | | - Paolo Pelosi
- IRCCS for Oncology and Neurosciences, San Martino Policlinico Hospital, Genoa, Italy; University of Genoa, Genoa, Italy
| | - Anders Perner
- Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Jason Phua
- Alexandra Hospital, National University Health System, Singapore; National University Hospital, National University Health System, Singapore
| | - Lise Piquilloud
- University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Mathias W Pletz
- Institute of Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
| | - Andrew Rhodes
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Marcus J Schultz
- Amsterdam University Medical Centers, Locatie AMC, Amsterdam, Netherlands; Mahidol Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand; Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | | | | | | | - Tobias Welte
- German Center of Lung Research, Hannover, Germany
| | - Sheila N Myatra
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
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Mortensen CB, Zachodnik J, Caspersen SF, Geisler A. Healthcare professionals' experiences during the initial stage of the COVID-19 pandemic in the intensive care unit: A qualitative study. Intensive Crit Care Nurs 2022; 68:103130. [PMID: 34538544 PMCID: PMC8354791 DOI: 10.1016/j.iccn.2021.103130] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 07/28/2021] [Accepted: 07/31/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND The COVID-19 pandemic called for rapidly considerable changes in the healthcare system. Healthcare professionals from different departments within the hospital settings were enrolled in the emergency preparedness. This study, therefore, aimed to explore the healthcare professionals' experiences attending the ICU-preparedness and caring for patients with COVID-19 during the initial stage of the pandemic. METHODS A descriptive explorative qualitative study was conducted by interviewing healthcare professionals during spring 2020, exploring their experiences as part of the ICU-preparedness team and caring for patients with COVID-19 in the ICU. Healthcare professionals from different departments were recruited by purposive sampling. The interviews were transcribed verbatim and analysed using content analysis. FINDINGS Sixteen nurses and four physicians from a university hospital in Denmark participated. The analysis revealed three main themes and eight sub-themes. The main themes were (1) Professionalism in work-life (adaption, the patient's welfare, insecurity, and security), (2) Community Spirit (responsibility and contribution), and (3) Institutional organisation (the role of management, loss of freedom, and information). INTERPRETATION Despite work specialities and professions, the participants reported a uniformity of similar experiences of uncertainties, but also a sense of community arose during the first phase of COVID-19. RECOMMENDATIONS To ensure resilience and mental health, and well-being for the healthcare professionals, comprehensive support should be provided. Guidelines for interventions and training are necessary to promote preparedness and reduce psychological stress.
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Affiliation(s)
- Camilla Bekker Mortensen
- Department of Anaesthesiology and Intensive Care Medicine, Centre for Anaesthesiological Research, Zealand University Hospital, Koege, Denmark,Department of Health Sciences, Faculty of Medicine, Lund University, Sweden,Corresponding author at: Centre for Anaesthesiological Research, Department of Anaesthesiology, Zealand University Hospital, Lykkebaekvej 1, 4600 Koege, Denmark
| | - Josephine Zachodnik
- Department of Anaesthesiology and Intensive Care Medicine, Centre for Anaesthesiological Research, Zealand University Hospital, Koege, Denmark
| | - Sidsel Fjordbak Caspersen
- Department of Anaesthesiology and Intensive Care Medicine, Centre for Anaesthesiological Research, Zealand University Hospital, Koege, Denmark
| | - Anja Geisler
- Department of Anaesthesiology and Intensive Care Medicine, Centre for Anaesthesiological Research, Zealand University Hospital, Koege, Denmark
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Evaluación de los planes de contingencia en la atención a pacientes en unidades de cuidados intensivos en la pandemia COVID-19. J Healthc Qual Res 2022; 37:291-298. [PMID: 35249860 PMCID: PMC8825313 DOI: 10.1016/j.jhqr.2021.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 11/23/2022]
Abstract
Introducción La expansión de las áreas de cuidados de intensivos ha sido una de las medidas más significativas en esa obligada adaptación a la evolución de las distintas fases de la pandemia por la COVID-19. El objetivo es evaluar el despliegue de los planes de contingencia en la atención a pacientes ingresados en Unidades de Cuidados Intensivos (UCI) durante el periodo del 19 de marzo al 20 de abril de 2020, en un hospital público, referencia para 300.000 habitantes, perteneciente al Servicio Galego de Saúde. Materiales y métodos Investigación cualitativa a partir de grupos focales, con muestreo sistemático. A partir de la adaptación al entorno sanitario de las 10 medidas recomendadas por Deloitte para afrontar una pandemia, se realizó una evaluación por la Unidad de Calidad del Área Sanitaria. Como indicadores de resultados, se evaluaron el número de pacientes con COVID-19, porcentaje de pacientes con ingreso hospitalario, % de pacientes con ingreso en UCI, así como el número de fallecidos por COVID-19, en siete áreas sanitarias en el periodo del 19 marzo al 20 de abril de 2020. Resultados La evaluación cualitativa identificó dos áreas de mejora (comunicación y evaluación de riesgos) de las 10 medidas recomendadas (80%). El área sanitaria presenta la menor tasa relativa (2,6%) y absoluta (16) de pacientes fallecidos, así como la menor tasa relativa (7,9%) y absoluta (24) de pacientes ingresados en servicios de intensivos por COVID-19. La tasa de infección en profesionales ha sido de 4,4%. Conclusiones La simplicidad e identificación de áreas de mejora sumado al escaso consumo de recursos son fortalezas de esta propuesta. Esta autoevaluación puede ser útil para detectar áreas de mejora.
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Farmer D, Pascual J, Kaplan LJ. COVID-19 and the role of medical professional societies. COVID-19 PANDEMIC 2022. [PMCID: PMC8175767 DOI: 10.1016/b978-0-323-82860-4.00010-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Responding to the coronavirus disease 2019 pandemic has helped craft a global medical community of medical professional society members and nonmembers alike in ways previously unanticipated. The public-facing elements of medical professional societies include their websites, official organs, and educational elements that have been liberated using a Free Open-Access Medical education approach. Work products including guidelines, blogs, and social media offerings have helped clinicians to prepare for pandemic care or refine existing practices to support outcome excellence. Often, that guidance has flowed from collaborations between medical professional organizations, some of which are novel and might not have occurred outside of a dire global need. Leaders of such organizations have been catapulted into the spotlight by the universal need for information and guidance—including that of one’s home government—and appeared quite regularly in print and digital media as well as live radio broadcasts. Finally, the need to pursue remote medical professional organization work as well as education has developed member and nonmember facilities with a host of digital platforms. Such skill sets have also helped to maintain communication between clinicians and patient's remote family members to support patient- and family-centered care while maintaining shared decision making. The flexibility and innovation that characterize medical professional organizations have been highlighted by the realities of providing pandemic care.
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Hörold M, Drewitz KP, Piel J, Hrudey I, Rohr M, Brunnthaler V, Hasenpusch C, Ulrich A, Otto N, Brandstetter S, Apfelbacher C. Intensive Care Units Healthcare Professionals’ Experiences and Negotiations at the Beginning of the COVID-19 Pandemic in Germany: A Grounded Theory Study. INQUIRY: THE JOURNAL OF HEALTH CARE ORGANIZATION, PROVISION, AND FINANCING 2022; 59:469580221081059. [PMID: 35522185 PMCID: PMC9082755 DOI: 10.1177/00469580221081059] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Faced with the pandemic of the novel coronavirus (SARS-CoV-2), healthcare professionals (HCPs) in intensive care units (ICU) adjusted their organizational, operational, and personal procedures to ensure care for COVID-19 patients. We used grounded theory approach to explore ICU HCPs' perspectives on professional action at the beginning of the COVID-19 pandemic in Germany from March to July 2020. The study aimed to examine implicit principles on negotiating social practice and interaction of ICU HCPs in an exceptional situation, which was characterized by a high level of changes. We conducted theme-guided qualitative telephone/virtual interviews with 39 ICU HCPs from ten German federal states. The data collection followed the principles of theoretical sampling. We adpoted grounded theory approach proposed by Charmaz and discussed using Lüscher’s theoretical concept of ambivalence. The analysis revealed five interconnected categories about the ICU HCPs’ negotiation of social practice and interaction at the beginning of the COVID-19 pandemic in Germany. In this context, a complex field of ambivalence (key category) emerged between habits and routines of a pre-pandemic normality. Pragmatic restructuring processes were initiated, which quickly resulted in a new normality of a “daily routine of preparation”. Dealing with ambivalence offers the potential for change.
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Affiliation(s)
- Madlen Hörold
- Otto von Guericke University Magdeburg, Faculty of Medicine, Institute of Social Medicine and Health Systems Research, Magdeburg, Saxony-Anhalt, Germany
| | - Karl Philipp Drewitz
- Otto von Guericke University Magdeburg, Faculty of Medicine, Institute of Social Medicine and Health Systems Research, Magdeburg, Saxony-Anhalt, Germany
| | - Julia Piel
- Otto von Guericke University Magdeburg, Faculty of Medicine, Institute of Social Medicine and Health Systems Research, Magdeburg, Saxony-Anhalt, Germany
| | - Ilona Hrudey
- Otto von Guericke University Magdeburg, Faculty of Medicine, Institute of Social Medicine and Health Systems Research, Magdeburg, Saxony-Anhalt, Germany
| | - Magdalena Rohr
- University of Regensburg, Faculty of Medicine, Medical Sociology, Regensburg, Bavaria, Germany
- University of Regensburg, University Children’s Hospital Regensburg (KUNO-Clinics), Regensburg, Bavaria, Germany
| | - Vreni Brunnthaler
- University of Regensburg, Faculty of Medicine, Medical Sociology, Regensburg, Bavaria, Germany
| | - Claudia Hasenpusch
- Otto von Guericke University Magdeburg, Faculty of Medicine, Institute of Social Medicine and Health Systems Research, Magdeburg, Saxony-Anhalt, Germany
| | - Angela Ulrich
- Otto von Guericke University Magdeburg, Faculty of Medicine, Institute of Social Medicine and Health Systems Research, Magdeburg, Saxony-Anhalt, Germany
| | - Niklas Otto
- Otto von Guericke University Magdeburg, Faculty of Medicine, Institute of Social Medicine and Health Systems Research, Magdeburg, Saxony-Anhalt, Germany
- University Hospital Magdeburg, Magdeburg, Saxony-Anhalt, Germany
| | - Susanne Brandstetter
- University of Regensburg, University Children’s Hospital Regensburg (KUNO-Clinics), Regensburg, Bavaria, Germany
| | - Christian Apfelbacher
- Otto von Guericke University Magdeburg, Faculty of Medicine, Institute of Social Medicine and Health Systems Research, Magdeburg, Saxony-Anhalt, Germany
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How the Middle East is facing COVID-19. COVID-19 PANDEMIC 2022. [PMCID: PMC8175783 DOI: 10.1016/b978-0-323-82860-4.00008-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The rapid spread of coronavirus disease 2019 (COVID-19) across the Middle East countries dictates different preparedness and response plans implemented locally. We aim to emphasize the unique challenges during fighting this pandemic in the region and take the opportunity to enumerate, evaluate, and illustrate the effort done by various countries in this regard. The Middle East region is geographically, politically, economically, and religiously a susceptible area, with very different health-care infrastructures, which imposes unique challenges for effective control of this pandemic. These challenges include compromised health-care systems, prolonged regional conflicts, wars and humanitarian crises, suboptimal cooperation levels, and frequent religious gatherings. These factors are interrelated and collectively influence the response to the pandemic in this region. Here, we extensively emphasize these challenges and take measures toward mitigating the spread of COVID-19.
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Panchyrz I, Pohl S, Hoffmann J, Gatermann C, Walther F, Harst L, Held HC, Kleber C, Albrecht M, Schmitt J. Die Rolle der Universitätskliniken im regionalen medizinischen Versorgungsmanagement zur Bewältigung der COVID-19 Pandemie. ZEITSCHRIFT FÜR EVIDENZ, FORTBILDUNG UND QUALITÄT IM GESUNDHEITSWESEN 2021; 167:68-77. [PMID: 34774428 PMCID: PMC8580327 DOI: 10.1016/j.zefq.2021.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 08/31/2021] [Accepted: 09/19/2021] [Indexed: 11/11/2022]
Abstract
Hintergrund Die komplexe und dynamische Situation im aktuellen Pandemiegeschehen erfordert eine regional abgestimmte und vernetzte Zusammenarbeit in der Gesundheitsversorgung zwischen den verschiedenen Akteuren des Gesundheitswesens, dem stationären Sektor sowie dem öffentlichen Gesundheitsdienst. Ziel der Untersuchung war, das Versorgungsmanagement hinsichtlich der regionalen Vernetzungs- und Kommunikationsstrukturen während der COVID-19-Pandemie im Jahr 2020 zu beleuchten. Methode Im Rahmen des vom Bundesministerium für Bildung und Forschung (BMBF) geförderten Projekts „egePan Unimed“ wurde im November 2020 allen Vorständen der 35 deutschen Universitätskliniken ein Online-Fragebogen zum Pandemiemanagement zugesandt. Im Zentrum des Fragebogens standen die Kernthemen Regionale Vernetzung, Krisenmanagement, Datenaustausch und Kommunikation mit politischen Akteuren. Der Fragebogen bestand aus 37 geschlossenen und drei offenen Fragen. Nach der Pilotierung erfolgte die Einladung zur Befragung dreimal per E-Mail und einmal telefonisch. Ergebnisse Von den befragten Universitätskliniken (n = 25, Response 71,4%) bestand bei 68% eine abgestimmte Zusammenarbeit mit anderen regionalen Krankenhäusern und bei 86% mit Vertretern des Öffentlichen Gesundheitsdienstes (ÖGD). Eine koordinierte Zusammenarbeit mit dem ambulanten Sektor wurde seltener (26%) angegeben. 84% der Universitätskliniken gaben an, eine Leitungsfunktion im Rahmen eines regionalen COVID-19-Pandemiemanagements innezuhaben. Ein Datenaustausch im Zuge des Pandemiemanagements fand bei 75% mit regionalen Kliniken und bei 67% mit überregionalen Kliniken statt. Schlussfolgerung Zur Bewältigung der regionalen medizinischen Versorgung während der COVID-19-Pandemie im Jahr 2020 nahmen Universitätskliniken sehr häufig eine koordinierende Rolle im komplexen pandemischen Versorgungsgeschehen ein. Es bestanden dabei häufig strukturierte Kooperationen mit regionalen Kliniken und Gesundheitsämtern und vergleichsweise selten mit dem ambulanten Versorgungsbereich. Gerade diese Zusammenarbeit hätte jedoch das Potenzial, Überbelegungen von Kliniken zu verhindern.
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Vranas KC, Golden SE, Mathews KS, Schutz A, Valley TS, Duggal A, Seitz KP, Chang SY, Nugent S, Slatore CG, Sullivan DR, Hough CL. The Influence of the COVID-19 Pandemic on ICU Organization, Care Processes, and Frontline Clinician Experiences: A Qualitative Study. Chest 2021; 160:1714-1728. [PMID: 34062115 PMCID: PMC8164514 DOI: 10.1016/j.chest.2021.05.041] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/20/2021] [Accepted: 05/25/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic resulted in unprecedented adjustments to ICU organization and care processes globally. RESEARCH QUESTIONS Did hospital emergency responses to the COVID-19 pandemic differ depending on hospital setting? Which strategies worked well to mitigate strain as perceived by intensivists? STUDY DESIGN AND METHODS Between August and November 2020, we carried out semistructured interviews of intensivists from tertiary and community hospitals across six regions in the United States that experienced early or large surges of COVID-19 patients, or both. We identified themes of hospital emergency responses using the four S framework of acute surge planning: space, staff, stuff, system. RESULTS Thirty-three intensivists from seven tertiary and six community hospitals participated. Clinicians across both settings believed that canceling elective surgeries was helpful to increase ICU capabilities and that hospitals should establish clearly defined thresholds at which surgeries are limited during future surge events. ICU staff was the most limited resource; staff shortages were improved by the use of tiered staffing models, just-in-time training for non-ICU clinicians, designated treatment teams, and deployment of trainees. Personal protective equipment (PPE) shortages and reuse were widespread, causing substantial distress among clinicians; hands-on PPE training was helpful to reduce clinicians' anxiety. Transparency and involvement of frontline clinicians as stakeholders were important components of effective emergency responses and helped to maintain trust among staff. INTERPRETATION We identified several strategies potentially to mitigate strain as perceived by intensivists working in both tertiary and community hospital settings. Our study also demonstrated the importance of trust and transparency between frontline staff and hospital leadership as key components of effective emergency responses during public health crises.
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Affiliation(s)
- Kelly C Vranas
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR; Division of Pulmonary and Critical Care, Oregon Health & Science University, Portland, OR; Palliative and Advanced Illness Research (PAIR) Center, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| | - Sara E Golden
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR
| | - Kusum S Mathews
- Division of Pulmonary, Critical Care, & Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Amanda Schutz
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Thomas S Valley
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI
| | - Abhijit Duggal
- Department of Critical Care, Respiratory Institute, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| | - Kevin P Seitz
- Division of Pulmonary, Allergy, and Critical Care Medicine, Vanderbilt University, Nashville, TN
| | - Steven Y Chang
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Ronald Reagan-UCLA Medical Center, Los Angeles, CA
| | - Shannon Nugent
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR; Department of Psychiatry, Oregon Health & Science University, Portland, OR
| | - Christopher G Slatore
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR; Division of Pulmonary and Critical Care, Oregon Health & Science University, Portland, OR
| | - Donald R Sullivan
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR; Division of Pulmonary and Critical Care, Oregon Health & Science University, Portland, OR; Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | - Catherine L Hough
- Division of Pulmonary and Critical Care, Oregon Health & Science University, Portland, OR
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Nursing Interventions for Patient Empowerment during Intensive Care Unit Discharge: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111049. [PMID: 34769569 PMCID: PMC8582948 DOI: 10.3390/ijerph182111049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/16/2021] [Accepted: 10/17/2021] [Indexed: 11/17/2022]
Abstract
Intensive care unit discharge is an important transition that impacts a patient's wellbeing. Nurses can play an essential role in this scenario, potentiating patient empowerment. A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (the PRISMA Statement. Embase), PubMed/MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), CUIDEN Plus, and LILACS databases; these were evaluated in May 2021. Two independent reviewers analyzed the studies, extracted the data, and assessed the quality of evidence. Quality of the studies included was assessed using the Cochrane risk-of-bias tool. Of the 274 articles initially identified, eight randomized controlled trials that reported on nursing interventions had mainly focused on patients' ICU discharge preparation through information and education. The creation of ICU nurse-led teams and nurses' involvement in critical care multidisciplinary teams also aimed to support patients during ICU discharge. This systematic review provides an update on the clinical practice aimed at improving the patient experience during ICU discharge. The main nursing interventions were based on information and education, as well as the development of new nursing roles. Understanding transitional needs and patient empowerment are key to making the transition easier.
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Lie I, Stafseth S, Skogstad L, Hovland IS, Hovde H, Ekeberg Ø, Ræder J. Healthcare professionals in COVID-19-intensive care units in Norway: preparedness and working conditions: a cohort study. BMJ Open 2021; 11:e049135. [PMID: 34635518 PMCID: PMC8506047 DOI: 10.1136/bmjopen-2021-049135] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 09/15/2021] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE To survey the healthcare professionals' background and experiences from work with patients with COVID-19 in intensive care units (ICUs) during the first wave of the COVID-19 pandemic in Norway. DESIGN Observational cohort study. SETTING COVID-ICUs in 27 hospitals across Norway. PARTICIPANTS Healthcare professionals (n=484): nurses (81%), medical doctors (9%) and leaders (10%), who responded to a secured, web-based questionnaire from 6 May 2020 to 15 July 2020. PRIMARY AND SECONDARY MEASURES Healthcare professionals': (1) professional and psychological preparedness to start working in COVID-ICUs, (2) factors associated with high degree of preparedness and (3) experience of working conditions. RESULTS The age of the respondents was 44.8±10 year (mean±SD), 78% were females, 92% had previous ICU working experience. A majority of the respondents reported professional (81%) and psychological (74%) preparedness for working in COVID-ICU. Factors significantly associated with high professional preparedness for working in COVID-19-ICU in a multivariate logistic model were previous ICU work experience (p<0.001) and participation in COVID-ICU simulation team training (p<0.001). High psychological preparedness was associated with higher age (p=0.003), living with spouse or partner (p=0.013), previous ICU work experience (p=0.042) and participation in COVID-ICU simulation team training (p=0.001). Working with new colleagues and new professional challenges were perceived as positive in a majority of the respondents, whereas 84% felt communication with coworkers to be challenging, 46% were afraid of being infected and 82% felt discomfort in denying access for patient relatives to the unit. Symptoms of sweating, tiredness, dehydration, headache, hunger, insecurity, mask irritation and delayed toilet visits were each reported by more than 50%. CONCLUSIONS Healthcare professionals working during the first wave of COVID-ICU patients in Norway were qualified and prepared, but challenges and potential targets for future improvements were present. TRIAL REGISTRATION NUMBER NCT04372056.
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Affiliation(s)
- Irene Lie
- Centre for Patient Centered Heart and Lung Research, Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway
| | - Siv Stafseth
- Department of Postoperative and Intensive Care, Administrative Section, Oslo University Hospital, Oslo, Norway
- Department of MEVU, Lovisenberg Diaconal University College, Oslo, Norway
| | - Laila Skogstad
- Department of Research, Sunnaas Sykehus HF, Nesoddtangen, Norway
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | | | - Haakon Hovde
- Critical Care Nurses, Norwegian Nurses Association, Oslo, Norway
| | - Øivind Ekeberg
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Johan Ræder
- Department of Anaesthesiology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Chhibber A, Kharat A, Kneale D, Welch V, Bangpan M, Chaiyakunapruk N. Assessment of health equity consideration in masking/PPE policies to contain COVID-19 using PROGRESS-plus framework: a systematic review. BMC Public Health 2021; 21:1682. [PMID: 34525995 PMCID: PMC8443429 DOI: 10.1186/s12889-021-11688-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/29/2021] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION There is increasing evidence that COVID-19 has unmasked the true magnitude of health inequity worldwide. Policies and guidance for containing the infection and reducing the COVID-19 related deaths have proven to be effective, however the extent to which health inequity factors were considered in these policies is rather unknown. The aim of this study is to measure the extent to which COVID-19 related policies reflect equity considerations by focusing on the global policy landscape around wearing masks and personal protection equipment (PPE). METHODS A systematic search for published documents on COVID-19 and masks/PPE was conducted across six databases: PubMed, EMBASE, CINAHL, ERIC, ASSIA and Psycinfo. Reviews, policy documents, briefs related to COVID-19 and masks/PPE were included in the review. To assess the extent of incorporation of equity in the policy documents, a guidance framework known as 'PROGRESS-Plus': Place of residence, Race/ethnicity, Occupation, Gender/sex, Religion, Education, Socioeconomic status, Social capital, Plus (age, disability etc.) was utilized. RESULTS This review included 212 policy documents. Out of 212 policy documents, 190 policy documents (89.62%) included at least one PROGRESS-plus component. Most of the policy documents (n = 163, 85.79%) focused on "occupation" component of the PROGRESS-plus followed by personal characteristics associated with discrimination (n = 4;2.11%), place of residence (n = 2;1.05%) and education (n = 1;0.53%). Subgroup analysis revealed that most of the policy documents (n = 176, 83.01%) were focused on "workers" such as healthcare workers, mortuary workers, school workers, transportation workers, essential workers etc. Of the remaining policy documents, most were targeted towards whole population (n = 30; 14.15%). Contrary to "worker focused" policy documents, most of the 'whole population focused' policy documents didn't have a PROGRESS-plus equity component rendering them equity limiting for the society. CONCLUSION Our review highlights even if policies considered health inequity during the design/implementation, this consideration was often one dimensional in nature. In addition, population wide policies should be carefully designed and implemented after identifying relevant equity related barriers in order to produce better outcomes for the whole society.
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Affiliation(s)
| | - Aditi Kharat
- School of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Dylan Kneale
- The Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre), UCL Social Research Institute, University College London, London, UK
| | - Vivian Welch
- Bruyere Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Mukdarut Bangpan
- The Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre), UCL Social Research Institute, University College London, London, UK
| | - Nathorn Chaiyakunapruk
- School of Pharmacy, University of Utah, Salt Lake City, UT, USA.
- School of Pharmacy, Monash University, Subang Jaya, Malaysia.
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Holthof N, Luedi MM. Considerations for acute care staffing during a pandemic. Best Pract Res Clin Anaesthesiol 2021; 35:389-404. [PMID: 34511227 PMCID: PMC7726522 DOI: 10.1016/j.bpa.2020.12.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 12/07/2020] [Indexed: 12/15/2022]
Abstract
The increase in interconnectedness of the global population has enabled a highly transmissible virus to spread rapidly around the globe in 2020. The COVID-19 (Coronavirus Disease 2019) pandemic has led to physical, social, and economic repercussions of previously unseen proportions. Although recommendations for pandemic preparedness have been published in response to previous viral disease outbreaks, these guidelines are primarily based on expert opinion and few of them focus on acute care staffing issues. In this review, we discuss how working in acute care medicine during a pandemic can affect the physical and mental health of medical and nursing staff. We provide ideas for limiting staff shortages and creating surge capacity in acute care settings, and strategies for sustainability that can help hospitals maintain adequate staffing throughout their pandemic response.
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Affiliation(s)
- Niels Holthof
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Markus M Luedi
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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De Pace V, Caligiuri P, Ricucci V, Nigro N, Galano B, Visconti V, Da Rin G, Bruzzone B. Rapid diagnosis of SARS-CoV-2 pneumonia on lower respiratory tract specimens. BMC Infect Dis 2021; 21:926. [PMID: 34493222 PMCID: PMC8423595 DOI: 10.1186/s12879-021-06591-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 08/19/2021] [Indexed: 12/24/2022] Open
Abstract
Background The ongoing SARS-CoV-2 pandemic requires the availability of accurate and rapid diagnostic tests, especially in such clinical settings as emergency and intensive care units. The objective of this study was to evaluate the diagnostic performance of the Vivalytic SARS-CoV-2 rapid PCR kit in lower respiratory tract (LRT) specimens. Methods Consecutive LRT specimens (bronchoalveolar lavage and bronchoaspirates) were collected from Intensive Care Units of San Martino Hospital (Genoa, Italy) between November 2020 and January 2021. All samples underwent RT-PCR testing by means of the Allplex™ SARS-CoV-2 assay (Seegene Inc., South Korea). On the basis of RT-PCR results, specimens were categorized as negative, positive with high viral load [cycle threshold (Ct) ≤ 30] and positive with low viral load (Ct of 31–35). A 1:1:1 ratio was used to achieve a sample size of 75. All specimens were subsequently tested by means of the Vivalytic SARS-CoV-2 rapid PCR assay (Bosch Healthcare Solutions GmbH, Germany). The diagnostic performance of this assay was assessed against RT-PCR through the calculation of accuracy, Cohen’s κ, sensitivity, specificity and expected positive (PPV) and negative (NPV) predictive values. Results The overall diagnostic accuracy of the Vivalytic SARS-CoV-2 was 97.3% (95% CI: 90.9–99.3%), with an excellent Cohen’s κ of 0.94 (95% CI: 0.72–1). Sensitivity and specificity were 96% (95% CI: 86.5–98.9%) and 100% (95% CI: 86.7–100%), respectively. In samples with high viral loads, sensitivity was 100% (Table 1). The distributions of E gene Ct values were similar (Wilcoxon’s test: p = 0.070), with medians of 35 (IQR: 25–36) and 35 (IQR: 25–35) on Vivalytic and RT-PCR, respectively (Fig. 1). NPV and PPV was 92.6% and 100%, respectively. |