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Partner management, partner relationship management examines have a significant spot in writing. We looked for their effect on organization performance through the Employee and Social parts of Company Evaluation interceding factors in Covid-19. Laborers were chosen to accomplish the objectives of the examination. Employees hold and as they are the internal stakeholders. Thus, it becomes necessary to explore their effect in stakeholder relationship management on organizational efficiency, which is highly competitive. The staff was essential to cover the organization's accomplishments. If they functioned as a gathering, the impact might be exceptional. The organization's management would comprehend the workers' prerequisites and aspirations, and a management style of advanced organization systems was resolved. It was found from the investigation that inside partner relationship management framework is organizational performance. Via the eyes of European multinational organizations, the thesis examines the relationship between corporate social responsibility (CSR) and organizational success. Furthermore, the study investigates the role of corporate reputation as a moderator in the CSR-organizational performance linkages. The final data set included 340 responses from senior executives/managers at European multinational corporations.
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SESSION TITLE: Actionable Improvements in Safety and Quality SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/17/2022 12:15 pm - 1:15 pm PURPOSE: Ventilator alarms are an audible and visual safeguard within a system which alerts clinicians to potentially critical changes within the patient or ventilator unit. They are a crucial aspect of patient care;however, not every alarm that is generated by the ventilator will provide actionable information. Unfortunately, this can contribute significantly to the overall alarm burden in the intensive care unit. This has been especially true with the marked increase in ventilator use during the COVID-19 pandemic. The individual impact of each alarm can easily become dampened due to the sheer quantity of alarms, ventilator-related and others. Excessive alarming may lead to cognitive overload and alarm fatigue for providers, and eventually, adversely impact patient outcomes. This potentially can lead to missed life-sustaining interventions and medical errors. METHODS: As part of a quality improvement initiative, we evaluated ventilator alarms through the month of October 2021 in the medical intensive care unit within Bellevue Hospital Center in New York City. Respiratory therapists recorded ventilator parameters and extracted alarm data daily from every ventilator within the medical intensive care unit. Ventilator logs were exported from each individual Servo-U ventilator unit in use onto a USB flash drive and the captured data was uploaded to a secure network for review. For each ventilator, data regarding specific alarm type and priority as defined by the manufacturer, as well as time, frequency, and duration was obtained for review. RESULTS: From October 4, 2021, to October 31, 2021, a total of 30,230 ventilator alarms were initiated over 672 hours in the MICU. This provided an approximate mean of 45 alarms per ventilator hour. Data was collected daily from all MICU ventilators in use which averaged about 12 ventilators per day (between 6-16). The top four alarms as defined by the ventilator were “airway pressure high,” “respiratory rate high,” “PEEP [positive end expiratory pressure] low,” and “expiratory minute volume low.” 18,451 alarms over the month were “airway pressure high.” 3,982 alarms were defined as “respiratory rate high.” 2,220 alarms were “PEEP low” and 2,041 alarms were “expiratory minute volume low.” CONCLUSIONS: Ventilator alarms, both nuisance and actionable alarms, contribute significantly to the alarm burden in the medical intensive care unit. Dedicated research is necessary to ensure safer alarm practices. CLINICAL IMPLICATIONS: Evaluating baseline alarm data allows for assessments as well as analyses of trends and patterns that are contributing to the excessive noise within the intensive care units. This gives hospitals an opportunity to provide targeted multidisciplinary educational initiatives and create standardized protocols to enhance the quality and safety surrounding ventilator alarms within intensive care units. DISCLOSURES: No relevant relationships by Kerry Hena No relevant relationships by Charmel Rogers no disclosure on file for Amit Uppal;No relevant relationships by Tatiana Weinstein
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SESSION TITLE: Impact of Health Disparities and Differences SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Vulnerable patients, including minorities and underserved populations whose care relies on public hospitals, have limited access to advanced cardiac or respiratory care in shock centers or extracorporeal membrane oxygenation (ECMO)-capable hospitals, especially when socioeconomic or insurance barriers play a role in patient selection. Our aim is to describe the implementation of an ECMO program for cardiac and respiratory failure during the COVID-19 pandemic in the largest public health system in the country, as a strategy to mitigate healthcare disparities and improve access to care for minorities. METHODS: We collected clinical, demographic and socioeconomic data of all patients undergoing ECMO at Bellevue Hospital Center, the shock and ECMO center for New York City’s Health and Hospitals’ network. This public health system includes 11 Hospitals and provides care to 1 million New Yorkers. The decision to proceed with ECMO took place with a multidisciplinary team discussion, which was also in charge of providing longitudinal care during their hospitalization. RESULTS: A total of 49 patients were included [30 veno-venous (VV) ECMO, 19 venoarterial (VA) ECMO, including 9 extracorporeal cardiopulmonary resuscitation (ECPR)] from April 1st, 2020 to March 30th, 2022. The median age was 42.6 years, 57% were male, 38% were Hispanic, 35% African American, 14% white, 6% Asian and 8.2% had other ethnicities;33% were uninsured, 49% lived below the poverty level reported for New York City and 20% were undocumented. Level of education was 8th grade or less in 2.1%, high school in 24.5%, ≤ 2 years of college in 10.2%, >4 years of college in 12.2% and unknown in 51%. ECMO survival was 56% for VV ECMO, 44% for VA ECMO and 33% for ECPR. Survival to discharge was 56% for VV, 33% for VA and 33% for ECPR. One VV ECMO patient was bridged to lung transplant, there were no patients bridged to LVAD or heart transplant. Bleeding complications occurred in 3 patients (6%) and there were no procedural related complications. CONCLUSIONS: Our multidisciplinary ECMO program demonstrates feasibility to provide care to underserved and vulnerable populations with outcomes comparable to the national average, despite the challenges related to the potential limitations in bridging strategies for such patients. While socioeconomic and insurance status have a key role in bridging options for ECMO, they should not be a major determinant in denying patients advanced cardiopulmonary support if clinically indicated. CLINICAL IMPLICATIONS: Access to advance cardiorespiratory therapies including ECMO for vulnerable populations is a present need and is feasible with a multidisciplinary team DISCLOSURES: Speaker/Speaker's Bureau relationship with Zoll Please note: 3 years Added 04/04/2022 by Carlos Alviar, value=Honoraria No relevant relationships by Fariha Asef No relevant relationships by Sripal Bangalore No relevant relationships by Samuel Bernard No relevant relationships by Lauren Bianco No relevant relationships by Nishay Chitkara No relevant relationships by Jennifer Cruz No relevant relationships by Michael DiVita Research support relationship with Eurofins Viracor Please note: 12/1/2021 ongoing Added 12/23/2021 by Randal Goldberg, value=Grant/Research Support No relevant relationships by Kerry Hena No relevant relationships by William Howe No relevant relationships by Norma Keller no disclosure on file for Ma-Rosario Mertola;no disclosure on file for Thor Milland;No relevant relationships by vikramjit mukherjee No relevant relationships by Kayla Nunemacher No relevant relationships by Mansi Patel No relevant relationships by Radu Postelnicu No relevant relationships by Deepak Pradhan No relevant relationships by Vito Stasolla no disclosure on file for Amit Uppal;No relevant relationships by Susan Vlahakis No relevant relationships by Kah Loon Wan no disclosure on file for Victoria Yunaev;
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INTRODUCTION: The COVID-19 pandemic overwhelmed New York City hospitals. Shortages of ventilators and sedatives prompted tracheostomy earlier than recommended by professional societies. The objective of this study was to determine the impact of percutaneous dilational tracheostomy (PDT) in COVID-19 patients on critical care capacity. METHODS: This is a single-institution prospective case series of SARS-CoV-2 infected patients undergoing PDT from April 1-June 4, 2020 with follow-up through June 25, 2020 at a public tertiary care center. Clinical data were obtained through medical record review. Mechanically ventilated COVID-19 patients were screened for intervention based on the following criteria: ≥ 6 days of intubation with further need for mechanical ventilation, a fractional inspired oxygen concentration of ≤ 60%, positive end expiratory pressure ≤12, no significant organ dysfunction except acute kidney injury, and minimal pressor requirements. The main outcomes measured were change in 48-hour periprocedural sedative/analgesia requirements, liberation from the ventilator, rate of transfer from the ICU, decannulation, PDT-related complications, and in-hospital survival. RESULTS: Fifty-five patients met PDT criteria and underwent PDT a median of 13 days from intubation. Patient characteristics are found in Table 1. Intravenous midazolam equivalents, fentanyl equivalents and cisatracurium equivalents were significantly reduced post- PDT (Table 2). Thirty-five patients were transferred from the ICU and liberated from the ventilator. Median time from PDT to ventilator liberation and ICU discharge was 10 and 12 days respectively. Decannulation occurred in 45.5% and 52.7% were discharged from acute inpatient care. Median follow-up for the study was 62 days. Four patients had bleeding complications postoperatively and 11 died during the study period. Older age was associated with increased odds of complication (OR 1.12, 95% CI 1.04, 1.23) and death (OR=1.15, 95% CI 1.05, 1.30). CONCLUSIONS: Mechanically ventilated COVID-19 patients undergoing PDT using standard criteria improves ventilator and medication utilization in areas strained by the SARS-CoV-2 pandemic. Long term outcomes after PDT in this population deserve further study.
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SESSION TITLE: Disaster Medicine Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: COVID-19 created significant strain on the supply of ventilators in New York City and many hospitals prepared resource allocation policies should the demand exceed supply. Available resource allocation guidelines depend on objective variables for allocation and reallocation decisions, however little attention has been focused on reallocation strategies. In such a scenario, resources should remain allocated to patients most likely to survive with the smallest increment in committed resources. Understanding how these guidelines perform in the context of a novel pathogen is an important consideration in disaster planning. Numerous allocation guidelines exist however nearly all utilize a Sequential Organ Failure Assessment (SOFA) score, and many are very similar. We sought to evaluate the performance of ventilator reallocation by applying the New York State Ventilator Allocation Guidelines to a cohort of COVID-19 patients. METHODS: A retrospective cohort study of the first 50 intubated COVID-19 patients admitted to an ICU at a one tertiary referral center and two community hospitals in New York City. SOFA scores were calculated at time of intubation, 48 hours, 120 hours, and 168 hours after intubation. Per the New York Guidelines, patients would have their ventilator reallocated at 48 hours if their interval SOFA score increased, did not change from an initial SOFA of 8-11, or was greater than 11. At 120 hours it would be reallocated if their SOFA score worsened or was greater than 7. At 168 hours it would be reallocated if their SOFA score worsened. Ventilator reallocation was simulated and no reallocation was made for any patient. RESULTS: The average SOFA (n=48) at the time of intubation was 6.1 ± 2.5. At the 48-hour assessment (average SOFA 6.9 ± 3.1, n=48), 26 (54%) patients would have their ventilator reallocated, 3 (12%) of whom would later be extubated. At the 120-hour assessment (average SOFA 7.1 ± 2.9, n=43) 12 (67%) of the remaining simulated ventilated patients would have their ventilators reallocated, 4 (33%) of whom would otherwise later be extubated. At the 168-hour assessment (average SOFA 7.6 ± 3.3, n=41) 4 (80%) of the simulated remaining ventilated patients would have their ventilators reallocated. 42 patients (88%) of the cohort would have had their ventilator reallocated at some time during the 168-hour observation period, 9 (21%) of whom would later be extubated. CONCLUSIONS: Tertiary triage will likely occur if ventilators are rationed according to current guidelines during a COVID-19 pandemic. This may have implications for disaster planning and resource allocation policies in areas impacted by outbreaks of COVID-19. CLINICAL IMPLICATIONS: Challenges persist regarding the appropriate length of a ventilator time trial for a novel disease. Patients should be prioritized for ventilator reallocation that is proportional to their mortality and to the strain on the scarce resource. DISCLOSURES: No relevant relationships by Vikramjit Mukherjee, source=Web Response, value=Consulting fee Removed 04/27/2020 by Vikramjit Mukherjee, source=Web Response No relevant relationships by Amit Uppal, source=Web Response No relevant relationships by Brandon Walsh, source=Web Response