Adapting a Picu for Adult Patients during a Pandemic: Impacts and Learning from Interprofessional Care of Critically Ill Adults with Covid-19

BACKGROUND AND AIM: Worldwide health systems have been strained by the COVID-19 pandemic. Surging numbers of critically ill adult patients demanded urgent system-wide responses. Our Paediatric Intensive Care Unit (PICU) underwent a care delivery model redesign and rapid shift in processes and resources to care for critically ill adults at the peak of the pandemic. We describe novel adaptions made to accommodate adult patients for the first time in this paediatric setting. Personal insights of clinical staff, leaders and adult care partners about the experience of caring for critically ill adult patients are shared. METHOD(S): Program components included;preparation, education, collaboration (both interprofessional and interorganizational), continuous process improvement, and staff well-being initiatives. Interprofessional team impacts gathered during the implementation phase of the program and 10 months following were analysed using Havelock's Theory of Change framework1. RESULT(S): The Adult COVID-19 program facilitated rapid team capacity building and supported responsive care for adult patients. Over 12 weeks, 35 adults (426 patient days) received care in the PICU. Staff acknowledged;1] the burden of providing high quality care for adults, 2] the opportunity for individual and team growth and 3] guiding paediatric principals of strength-based, family-centered care enhanced the quality of care provided and provider perceptions of accomplishment. CONCLUSION(S): This program facilitated a rapid transformation and expansion in models of care and processes, successfully enhanced the team's capacity to deliver quality evidence-based service to adults with COVID-19 and was a source of personal growth and meaning for the health care team.

Veterinary-led puppy parties: A cross sectional survey to quantify the methods and approaches undertaken within UK veterinary practices

In the United Kingdom, companion animal veterinary practices offer in-clinic puppy socialization programs, referred to as “Puppy parties”. Studies examining puppy parties are limited, and minimal data is available on the delivery of these programs. This study aimed to describe the methods and approaches used by UK veterinary professionals providing in-clinic puppy parties. A cross-sectional descriptive survey was distributed via social media and by direct email to veterinary practices known to offer puppy parties on their public domains. Respondents were required to have worked in a UK veterinary practice offering parties or equivalent between January 2010 and March 2019. Descriptive data was collected on participant and practice demographics, puppy eligibility, program structure and environment, the inclusion of canine behavior and training, client education and the effect of COVID-19. All (n=81) respondents were included for analysis. Findings described variation in the structure of in-clinic puppy parties, particularly as they relate to puppy age, class size, and program duration. “Habituation to practice” was the most common reason for delivery (60.5%), with “Monetary gain” the least likely reason (50.6%). Puppy parties commonly began at 8-9 weeks of age (53.1%), and most (77.8%) persisted beyond the sensitive period of socialization (>12 weeks). Where some puppy parties did not permit intra-species interactions (6.2%), others provided the opportunity for socialization through controlled play (53.1%). Program duration ranged from a singular session (28.4%) to cumulative sessions of ≥4 weeks (34.6%). The “1st vaccination of the primary course” was the minimum requirement to attend most parties (75.3%) and deworming was rarely required (24.7%). While behavior topics (87.2%) were commonly discussed, staff generally lacked training and behavior qualifications (65.4%). Finally, all parties were discontinued following COVID-19 restrictions. In conclusion, the results of the study provided a descriptive framework of puppy party programs run by UK veterinary practices. Future researchers may seek to examine which methods used in the delivery of puppy programs best promote canine welfare and behavioral wellness.

Feasibility of Virtual Optimization of Guideline Directed Medical Therapy in Hospitalized Patients with HFrEF During the Covid-19 Pandemic: The IMPLEMENT-HF Pilot Study

Introduction: Implementation of GDMT for HFrEF remains low. We assessed the feasibility of a virtual GDMT Team for optimization of GDMT during hospitalization for non-CV conditions. Hypothesis: A GDMT Team will improve GDMT optimization compared with usual care. Methods: Consecutive hospitalized patients with HFrEF≤40% were prospectively identified. Patients with critical illness, cardiology consult, de-novo HF, COVID-19 & SBP ≤90mmHg were excluded. February 3 to March 1, 2020 served as a pre-intervention period during which patients were screened, but did not receive GDMT Team interventions. From March 2 to June 21, 2020, a pharmacist-physician team provided up to 1 suggestion daily for GDMT optimization (evidence-based ß-blockers, ACEi/ARB/ARNI, & MRA) to treating teams based on an evidence-based algorithm. The primary outcome of a composite GDMT optimization score, the net of positive therapeutic changes (+1 for new initiations/uptitrations) & negative therapeutic changes (-1 for discontinuations/downtitrations) during hospitalization, was compared between the pre- vs. post-intervention periods. Multivariable linear regression models were built adjusting associations for clinical factors. Safety outcomes requiring intervention or GDMT downtitration were identified. Results: Of 187 encounters, 84 (45%) met eligibility criteria: 28 pre-intervention, 56 post-intervention. Mean age was 68±11 yrs, 70% men, and 61% White. Of 88 GDMT Team suggestions, 49 (56%) were followed by discharge. During the intervention, cumulative COVID-19 hospitalizations rose from 0 to 11085 in MA. Mean GDMT optimization score was -0.14 (95% CI: -0.58 to +0.30) pre-intervention & +0.64 (95% CI: +0.35 to +0.93) post-intervention (P=0.004). In a model inclusive of demographics, comorbidities, vital signs, potassium levels, eGFR, & LVEF, the intervention was the only factor associated with higher GDMT optimization score (β coeff 0.89;P=0.008). Safety events included 1 instance each of AKI, hyperkalemia, bradycardia, & hypotension. Conclusion: Admission for non-CV conditions is a feasible setting for GDMT optimization. A virtual GDMT Team was associated with improved GDMT;this implementation strategy warrants testing in a prospective RCT.