Hospital bed replacement for acute care of children at home during the COVID-19 pandemic through a Hospital-in-the-Home programme.

OBJECTIVES: During the COVID-19 pandemic, we expanded our Hospital-in-the-Home (HITH) programme to increase capacity and manage COVID-19-positive children. We aimed to assess impact on overall HITH activity and COVID-19-positive outcomes. DESIGN: Prospective comparative cohort study. SETTING: The largest paediatric HITH in Australasia, at The Royal Children's Hospital Melbourne. PATIENTS: Children 0-18 years admitted to HITH during the pandemic. INTERVENTION: We developed a COVID-19 responsive service, and a guideline for COVID-19-positive patients. We compared overall activity prior to and during the pandemic, and COVID-19-positive admissions with different variants. MAIN OUTCOMES: We compared outcomes for all HITH patients before and during the pandemic, and for COVID-19-positive patients admitted first to hospital versus directly to HITH. RESULTS: HITH managed 7319 patients from March 2020 to March 2022, a 21% increase to previously, with a 132% telehealth increase. 421 COVID-19-positive patients (3 days-18.9 years) were admitted to HITH, predominantly high risk (63%) or moderately unwell (33%). Rates of childhood infection in Victoria, with proportion admitted to HITH were: original/alpha variant-3/100 000/month, 0.7%; delta-92/100 000/month, 0.8%; omicron-593/100 000/month, 0.3%. Eligible parents of only 29 of 71 (41%) high-risk children were vaccinated. COVID-19-positive children admitted directly to HITH were less likely to receive COVID-19-specific treatment than those admitted to hospital first (14 of 113 (12%) vs 33 of 46 (72%), p<0.001), reflecting more severe respiratory, but not other features in inpatients. 15 of 159 (10%) were readmitted to hospital, but none deteriorated rapidly. CONCLUSIONS: COVID-19-positive children at high risk or with moderate symptoms can be managed safely via HITH at home, the ideal place for children during the pandemic.

Mid Central Region

MidCentral DHB - Emergency Department Amongst the doom and gloom of COVID-19 in the last few months, there were some wins which should be considered - strengthened team work, discussions around improving patient management, teaching, training and some new equipment. Like most of our colleagues around New Zealand, we are still managing large patient volumes and high acuity presentations - challenges with bed block, flow, access to care, and high admission rates, perpetuating a vicious cycle of large numbers of patients presenting and remaining in ED. Recruitment is an ongoing issue, as well as managing skill mix on the floor to ensure patient safety and flow.

Mid Central Region

Like most of our colleagues around New Zealand, we are dealing with large patient volume and high acuity presentations - challenges with bed block, flow, access to care, and high admission rates, perpetuating a vicious cycle of large numbers of patients presenting and remaining in ED. Staff training continues within the dept for both nursing and medical staff, as well as those nurses who have the opportunity to study for Postgraduate qualifications. [...]this is my last year as the MidCentral regional representative - so get your thinking caps on for anyone you think might be keen to work in this role.

Interventions for the well-being of healthcare workers during a pandemic or other crisis: scoping review.

OBJECTIVES: The aim of this scoping review was to identify pre-existing interventions to support the well-being of healthcare workers during a pandemic or other crisis and to assess the quality of these interventions. DESIGN: Arksey and O'Malley's five-stage scoping review framework was used to identify the types of evidence available in the field of well-being interventions for healthcare workers during a pandemic. PubMed, PsycINFO, Embase, Scopus, Web of Science, CINAHL and ERIC databases were searched to find interventions for the well-being of doctors during pandemics. Owing to a lack of results, this search was expanded to all healthcare workers and to include any crisis. Databases were searched in June 2020 and again in October 2020. INCLUSION/EXCLUSION CRITERIA: Articles were included that studied healthcare workers, reported an intervention design and were specifically designed for use during a pandemic or other crisis. Well-being was defined broadly and could include psychological, physical, social or educational interventions. RESULTS: Searching produced 10 529 total academic references of which 2062 were duplicates. This left 8467 references. Of these, 16 met our inclusion criteria and were included in data extraction. During data extraction, three more papers were excluded. This left 13 papers to summarise and report. Of these 13 papers, 6 were prospective studies and 7 were purely descriptive. None of the interventions were theoretically informed in their development and the quality of the evidence was generally deemed poor. CONCLUSIONS: There are no high-quality, theory-based interventions for the well-being of healthcare workers during a pandemic or other crisis. Given that previous pandemics have been shown to have a negative effect on healthcare workers well-being, it is imperative this shortcoming is addressed. This scoping review highlights the need for high-quality, theory-based and evidence-based interventions for the well-being of healthcare workers during a pandemic.

Mid Central Region

With limitations such as one negative pressure room meant some changes to creating a red zone area for respiratory patients, green zone for low risk, and saw our sub-acute area move from within the ED space to our transitory care unit for several weeks. Ongoing challenges with increased hospital capacity, bed block and challenges with flow are not unusual and our staff continue to work incredibly hard as a team to ensure the patients are looked after, and provided exceptional care while in the ED. [...]challenging is our lack of capacity in the ED, more of a challenge when we had a dedicated isolation 6 bed negative pressure area, but we have now opened this up to our regular patients, and using side rooms and our single negative pressure room for patients who need isolation if meet criteria or need isolation for other reasons.