ABSTRACT
Bayhealth Medical Center in Delaware employs more than 4,400 staff. As the Covid-19 pandemic approached, the task was to successfully shift staff to care for the upcoming critically ill Covid-19 patients. Our small community hospitals had to respond with a plan that provided safe care of patients and a redeployment plan for staff that ensured safety and protection. The leadership team evaluated our resources and devised a plan for appropriately educating and placing staff in the areas best suited to their background and skills. • Assess staffing resources available • Educate staff for caring for Covid-19 patients • Devise a redeployment plan for physicians, nurses, and nursing assistants • Prepare surgical areas for Covid-19 care units • Optimize care for Covid-19 patients by providing more front line staff Our leadership team determined that elective surgeries would likely be put on hold for an indefinite period of time. The perioperative department became a resource pool to assist and support the critical care areas as well as shift to an overflow area of care for Covid-19 patients. The staff were personally evaluated for their work history, knowledge and skills. Many Periop nurses and APRNs had recent critical care experience. They were placed in the critical care units and emergency departments. Some nurses were best suited for acuity adaptable care. Others became part of the Covid-19 management team that provided direction for staff exposures and quarantine protocols. Anesthesiologists were redeployed as ICU Intensivist. Educators were posted off site to test community members for Covid-19. Non Covid-19 patients had to be cared for in a protected environment as well. The whole work environment had to be repurposed. Redeployment occurred from April to June of 2020. Redeployment of the majority of perioperative staff during the Covid-19 pandemic provided ten to thirty percent additional staff for the frontline care of Covid-19 patients. This support minimized nursing stress and allowed for optimized care. Keeping staff informed and involving staff with planning were essential for success. Redeployed staff currently reflect back with pride while answering this unprecedented call of duty. As health care facilities adapt to face future challenges associated with redeployment of staff many lessons can be learned. Front line staff must be supported during an overwhelming number of critical patients. Appropriately planning, preparation and appropriate reeducation of staff are crucial.
ABSTRACT
PURPOSE: Temporary COVID-19 guideline recommendations have recently been issued to expand the use of colony-stimulating factors in patients with cancer with intermediate to high risk for febrile neutropenia (FN). We evaluated the cost-effectiveness of primary prophylaxis (PP) with biosimilar filgrastim-sndz in patients with intermediate risk of FN compared with secondary prophylaxis (SP) over three different cancer types. METHODS: A Markov decision analytic model was constructed from the US payer perspective over a lifetime horizon to evaluate PP versus SP in patients with breast cancer, non-small-cell lung cancer (NSCLC), and non-Hodgkin lymphoma (NHL). Cost-effectiveness was evaluated over a range of willingness-to-pay thresholds for incremental cost per FN avoided, life year gained, and quality-adjusted life year (QALY) gained. Sensitivity analyses evaluated uncertainty. RESULTS: Compared with SP, PP provided an additional 0.102-0.144 LYs and 0.065-0.130 QALYs. The incremental cost-effectiveness ranged from $5,660 in US dollars (USD) to $20,806 USD per FN event avoided, $5,123 to $31,077 USD per life year gained, and $7,213 to $35,563 USD per QALY gained. Over 1,000 iterations, there were 73.6%, 99.4%, and 91.8% probabilities that PP was cost-effective at a willingness to pay of $50,000 USD per QALY gained for breast cancer, NSCLC, and NHL, respectively. CONCLUSION: PP with a biosimilar filgrastim (specifically filgrastim-sndz) is cost-effective in patients with intermediate risk for FN receiving curative chemotherapy regimens for breast cancer, NSCLC, and NHL. Expanding the use of colony-stimulating factors for patients may be valuable in reducing unnecessary health care visits for patients with cancer at risk of complications because of COVID-19 and should be considered for the indefinite future.