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Background : In situ simulation has emerged as a powerful quality improvement (QI) tool in the identification of latent safety threats (LSTs). Following the first wave of SARS-CoV-2 at an urban epicenter of the disease, a multi-institutional collaborative was formed to integrate an in-situ simulation protocol across five emergency departments (EDs) for systems improvement of acute airway management. Methods : A prospective, multi-institutional QI initiative using two Plan-Do-Study-Act (PDSA) cycles was implemented across five EDs. Each institution conducted simulations involving mannequins in acute respiratory failure requiring definitive airways. Simulations and systems-based debriefs were standardized. LSTs were collected in an online database, focused on: (1) equipment availability, (2) infection control, and (3) communication. Results : From June 2020 through May 2021, 58 of 70 (82.9%) planned simulations were completed across five sites with 328 unique individual participants. Overall LSTs per simulation (7.00–4.69, p < 0.001) and equipment LSTs (3.00–1.46, p < 0.001) decreased from cycle 1 to cycle 2. Changes in mean LSTs for infection control and communication categories varied among sites. There was no correlation between total LSTs or any of the subcategories and team size. Number of beds occupied was significantly negatively correlated with total and infection control LSTs. Conclusion : This study was unique in simultaneously running a structured in situ protocol across numerous diverse institutions during a global pandemic. This initiative found similar categories of threats across sites, and the protocol developed empowered participants to implement changes to mitigate identified threats.
ABSTRACT
BACKGROUND: In situ simulation has emerged as a powerful quality improvement (QI) tool in the identification of latent safety threats (LSTs). Following the first wave of SARS-CoV-2 at an urban epicenter of the disease, a multi-institutional collaborative was formed to integrate an in situ simulation protocol across five emergency departments (EDs) for systems improvement of acute airway management. METHODS: A prospective, multi-institutional QI initiative using two Plan-Do-Study-Act (PDSA) cycles was implemented across five EDs. Each institution conducted simulations involving mannequins in acute respiratory failure requiring definitive airways. Simulations and systems-based debriefs were standardized. LSTs were collected in an online database, focused on (1) equipment availability, (2) infection control, and (3) communication. RESULTS: From June 2020 through May 2021, 58 of 70 (82.9%) planned simulations were completed across five sites with 328 unique individual participants. Overall LSTs per simulation (7.00-4.69, p < 0.001) and equipment LSTs (3.00-1.46, p < 0.001) decreased from cycle 1 to cycle 2. Changes in mean LSTs for infection control and communication categories varied among sites. There was no correlation between total LSTs or any of the categories and team size. Number of beds occupied was significantly negatively correlated with total and infection control LSTs. CONCLUSION: This study was unique in simultaneously running a structured in situ protocol across numerous diverse institutions during a global pandemic. This initiative found similar categories of threats across sites, and the protocol developed empowered participants to implement changes to mitigate identified threats.
Subject(s)
COVID-19 , SARS-CoV-2 , Humans , Quality Improvement , Prospective Studies , Emergency Service, HospitalABSTRACT
Background: With the second wave of coronavirus disease (COVID-19) Rhino Orbito Cerebral Mucormycosis (ROCM) has emerged as an epidemic in India. Early suspicion and management can reduce disfigurement and mortality. Objectives: To identify the demographic and clinical profile of ROCM, its association with COVID-19 and other predisposing factors. Methods: Hospital Based Cross Sectional Observational study on first hundred consecutive patients with signs and symptoms and radiological findings suggestive of ROCM. Data collected from patient records and analyzed. Results: Out of hundred, 72 patients were Males, 74 from rural areas, all were above eighteen years age, 35 presented with orbital and 27 with facial manifestations of ROCM. Main predisposing factors were history of COVID-19 (71%), previous hospitalization (48%), in Intensive Care Unit (5%) systemic corticosteroid therapy (48%), Diabetes, uncontrolled (45%) and new (21%). Conclusions: ROCM presented with orbital and facial manifestations. Main predisposing factors were Diabetes, COVID-19 and systemic steroids.
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The world, at present, is witnessing grave challenges to its established institutions and shared beliefs due to the outbreak of novel Coronavirus. Almost all of our establishments are under threat and unprecedented disruptions are being witnessed across all spheres of life. Besides medical hunt for discovering the cure, there exists an equally significant need to invent technological solutions for restoring numerous services while considering the restrictions imposed by the pandemic. Therefore, in this research work, we have investigated and analysed the possibilities, opportunities, and applications of IoT technology in the field of food safety and quality control, automatic disinfectant, healthcare systems, wearable health devices, and personal hygiene. We have assessed various features of currently available IoT design platforms and standard protocols and proposed feasible and dynamic strategies for their implementations. The efficacy of the system demonstrates an immense possibility for the continuation of IoT-based technology, even after the Coronavirus scare is over.
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INTRODUCTION: Acute pulmonary embolism (PE) remains an important cause of cardiovascular mortality and morbidity in the USA and worldwide. Catheter-based therapies are emerging as a new armamentarium for improving outcomes in these patients. PURPOSE OF REVIEW: The purpose of this review is to familiarize the clinicians with (1) various types of catheter-based modalities available for patients with acute PE, (2) advantages, disadvantages, and appropriate patient selection for the use of these devices, and (3) evidence base and the relevance of such therapies in the COVID-19 pandemic. RECENT FINDINGS: There are four main types of catheter-based therapies in acute PE: (1) standard catheter-directed thrombolysis (CDT), (2) ultrasound-assisted CDT, (3) pharmacomechanical CDT, and (4) mechanical thrombectomy without thrombolysis. Ultrasound-assisted thrombolysis is the most widely studied modality in this group; however, evidence base for other catheter-based technologies is rapidly emerging. SUMMARY: Current use of catheter-based therapies is most suitable for patients with intermediate and high-risk acute PE. The adoption of a multidisciplinary approach like the pulmonary embolism response team (PERT) is desirable for appropriate patient selection and possibly/potentially improving patient outcomes. We discuss the current status of these therapies.
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SUMMARY STATEMENT: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic placed a tremendous strain on the healthcare system, which led to the deployment of new personnel into acute care settings, early graduation of medical students, and development of new treatment spaces. Education teams at the Montefiore Health System and New York Health and Hospitals/Jacobi Medical Center found simulation, both laboratory-based and in situ, critical to the training of medical staff and investigation of latent safety threats. Through our experience, we encountered unique infection control concerns based on in situ sessions, which prompted us to redesign our programs for the treatment of SARS-CoV-2. Using this experience, we outline our rationale for the use of in situ simulation for newly developed SARS-CoV-2 spaces along with recommendations on safety checks to consider before starting.