ABSTRACT
The prolonged battle against the COVID-19 pandemic has left many health care workers physically, mentally, and emotionally exhausted, exacerbating burnout that was already endemic in the healthcare sector. Burnout places not only an individual's well-being but patient care at risk. In this study, we examine protective and risk factors contributing to burnout specifically among older health care workers during COVID-19. We address these questions using data collected from an online survey conducted on health care workers employed at hospitals in Pittsburgh, Pennsylvania in February 2022. Health care workers ages 50 and older (n=165) –a subset of surveyed health care workers– were included in the analytic sample. Participants were asked a series of questions about burnout, mental health, workplace stressors, intent to leave the job, and demographics. Participants were predominantly female (88%) and white (91%) with a mean age of 57.2 years. Almost 70% were registered nurses and the remaining were service, clerical, and technical workers;the mean years of work experience was 21.5 years. Most participants (77%) experienced moderate levels of burnout. Preliminary regression analysis suggests that perceived inadequate staffing (β=2.12, p<.001) and workplace discrimination (β=1.23, p=.001) were positively associated with burnout while job autonomy (β=-1.77, p<.05) and schedule flexibility (β=-.2.09, p=.001) were negatively associated with burnout. Burnout was in turn positively associated with depression, anxiety, and intent to leave the job. These findings demonstrate the need for workplace support to address older health care workers' burnout, better accommodate their needs, and keep them safe and healthy in their jobs.
ABSTRACT
Purpose/Objectives: Bronchiolitis is the most common cause of lower respiratory infections in young children. Studies have demonstrated that improved adherence to an evidenced-based clinical pathway is associated with shorter lengths of stay and lower costs. Despite having a bronchiolitis clinical pathway, the average length of stay of bronchiolitis patients at our tertiary care center was higher than published data showing a national average around 2.5 days. The specific aim of this project was to decrease the average length of stay of patients aged 0-24 months who are admitted with bronchiolitis from a baseline of 2.9 days during the 2019-2020 bronchiolitis season to a goal of 2.5 days by the end of the season in March 2021. Design/Methods: A multidisciplinary task group including hospitalists, respiratory therapy, and nursing was organized to revise and update our current bronchiolitis pathway, protocol, and electronic medical record (EMR) order set. Using a data report tool that was built by IT and linked to our EMR, real time institutional data was obtained and reviewed monthly. Staff feedback was solicited leading to the identification and implementation of the following interventions which were implemented in November 2020: • Decreasing the oxygen saturation goal to 88% for initiating oxygen and for admission and discharge criteria • Improving patient education by updating family education handouts and developing standardized discharge instructions • Adding nursing communication and activatable discharge orders that list the discharge criteria Our primary outcome measure was the monthly average length of stay of admitted bronchiolitis patients. Our process measure was the utilization rate of our bronchiolitis order set. Our balancing measures were the number of intensive care unit (ICU) transfers and the 7-day readmission rate to the hospital and emergency department (ED). Results: We observed the average length of stay during the period of November 2019-March 2020 decreased from 2.9 days to 1.7 days during the November 2020- March 2021 time period (Figure 1). The order set utilization rate during these periods remained high, but decreased somewhat from 85% to 70%. Balancing measures during these periods showed a decrease in ICU transfer rate from 4.76% to 0% and a decrease in the ED/Inpatient readmission rate from 2.45% to 0% (Figure 2). Conclusion/Discussion: The revision of the bronchiolitis clinical pathway coupled with caregiver and family education correlated with a significant reduction in the length of stay of admitted bronchiolitis patients at our tertiary care hospital. However, the coronavirus pandemic drastically reduced the volume of bronchiolitis patients in the 2020-2021 season, with our hospital experiencing a 93% decrease in admissions for this diagnosis. While this project's results are highly encouraging, the coronavirus pandemic and low admission numbers make drawing clear conclusions difficult, and ongoing monitoring will be essential to see if this trend is sustainable.
ABSTRACT
In response to the outbreak of the COVID-19 pandemic, many governments instituted "stay-at-home" orders to prevent the spread of the coronavirus. The resulting changes in work and life routines had the potential to substantially perturb typical patterns of urban water use. We present here an analysis of how these pandemic responses affected California's urban water consumption. Using water demand modeling that fuses an integrated water use database, we first simulated the water use in a business-as-usual (non-pandemic) scenario for essentially all urban areas in California. We then subtracted the business-as-usual water use from the actual use to isolate the changes caused solely by the pandemic response. We found that the pandemic response decreased California's urban water use by 7.9%, which can be largely attributed to an 11.2% decrease in the commercial, industrial, and institutional sector that more than offset a 1.4% increase in the residential sector. The influence of the stay-at-home practices on urban water use is slightly stronger than the combined influences of all non-pandemic factors. This study covers both metropolitans and suburbs;therefore, the results could also be useful for analysis of the impacts of COVID-19 on water use in other urban areas.
ABSTRACT
Background: Digital health technologies are poised to revolutionise the healthcare industry by improving accessibility to services and patient outcomes. The novel coronavirus disease-19 (COVID-19) pandemic has presented unprecedented challenges for the delivery of allied healthcare and has catalysed rapid adoption of telehealth. As such, allied healthcare consumers and providers stand to benefit from the capabilities of the digital health movement, ultimately justifying a scoping review of current and emerging technologies. Objective: To provide decision makers with up-to-date information on the allied health applications of new and emerging digital health technologies; their evidence of efficacy, scope of use, and limitations. Methods: A scoping review of the literature was conducted, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. To synthesise original research, MEDLINE, CINAHL, and EMBASE databases were searched from 2010 to June 2020 and reference lists were examined for randomised control trials analysing the efficacy of these technologies in allied health applications. Results: A total of 14 articles were included with a focus on common musculoskeletal conditions managed by allied health service providers. Studies were selected for data extraction after abstract and full-text screening by three independent reviewers. The results of this review indicate that telehealth technology effectively monitors and progresses patient care, while mobile health applications provide remote support and enable data collection. Conclusion: Emerging trends suggest that digital technologies serve as promising adjuncts to allied healthcare. Further research is warranted regarding the safety and efficacy of digital health technologies in this context.