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1.
Health Crisis Management in Acute Care Hospitals: Lessons Learned from COVID-19 and Beyond ; : 123-135, 2022.
Article in English | Scopus | ID: covidwho-2322475

ABSTRACT

Nurses are advocates for their patients, and nurse directors are advocates for both patients and their nursing staff, as well as the eyes and ears of senior leadership. During the COVID-19 pandemic, the nursing staff at SBH Health System were fearful and anxious;CDC guidelines were changing frequently. Following the frequently changing instructions on the use and conservation of PPE and isolation precautions was not easy. The presence of nurse directors gave the nursing staff support and education. During this crisis, three staggered daily shifts were created in order to cover, 7 days a week. Along with immediately reducing nursing staff anxiety, nursing staff felt greater support and encouragement from management and leaders, especially on the evening and night shifts. The nursing education department was an indispensable resource at the core of retraining nursing staff from different departments and training nursing staff in new procedures and equipment. The nurse director is one of the most important leadership positions in any hospital, but the heroes of this COVID-19 pandemic are all hospital workers. © SBH Health System 2022.

2.
Health Crisis Management in Acute Care Hospitals: Lessons Learned from COVID-19 and Beyond ; : 99-121, 2022.
Article in English | Scopus | ID: covidwho-2325118

ABSTRACT

The coronavirus pandemic stretched healthcare resources and infrastructure worldwide. The Emergency Department (ED) is a crucial component in the frontline response to the pandemic. In this chapter, we discuss the logistical and operational challenges faced, the innovative solutions employed, and the lessons learned in our ED as we strived to overcome this unprecedented challenge. Whilst we will share much of what we learned, what we did, and what we believe was responsible for our many successes, at the same time, we are left with a sadness that our healthcare systems (and ‘our' could be applied locally to our community, nationally to our country, and globally to our planet) were simply not designed nor prepared to properly confront a pandemic. The number of patient deaths we witnessed still feels somewhat incomprehensible and scarring. We do, however, hope that our learnings may help inform decisions at other EDs, help prepare us for future crises, and, if nothing else, confers confidence in the ED's ability to overcome this pandemic. © SBH Health System 2022.

3.
Journal of General Internal Medicine ; 37:S658-S659, 2022.
Article in English | EMBASE | ID: covidwho-1995841

ABSTRACT

SETTING AND PARTICIPANTS: Internal Medicine residents on general medicine inpatient service in a large, urban academic medical center. DESCRIPTION: Oral case presentations focus on reporting relevant data;however, an overly narrow construction of relevance excludes social data - often deemed unrelated to diagnosis or treatment. Such exclusion may hinder patient- centered care, defined as “care that is respectful ofpatient preferences, needs, and values”. Building on this concept, we share a pilot intervention where residents include social history in opening one-liners for new patient presentations. We hypothesize this as a sustainable opportunity for residents to connect with patients and to appreciate social/cultural factors that impact health. During the intervention, residents receive training, followed by daily “best practice” emails the second week on service. Email reminders are discontinued the final two weeks of the rotation, but residents can choose to continue using social one-liners. EVALUATION: Pre/post surveys evaluate resident attitudes and self-reported behaviors. We measured feasibility by residents' adoption of the social oneliners;sustainability by continuation of social one-liners following the email phase;and assessed attitudes regarding patient care relationships. We report interim results after the 2nd of 5 pilot months. In pre-testing, most residents (12/15) did not incorporate social history into the one-liner (62% rarely;19% never). A small number agreed presenting social history would impact the overall care of patients (14%) and only 24% strongly agreed that incorporating social history might enhance patient-care relationships. In post-testing, 8/10 residents reported including social history during the email phase, and 20% continued the social one-liners after emails discontinued. Regarding attitudes, 40% strongly agreed that incorporating social history enhanced patient-care relationships and 30% felt patients were re-centered. In open-ended feedback, residents noted social one-liners “[benefited] the dispo plan” and “[emphasized] patient-centered not problem-centered care”. DISCUSSION / REFLECTION / LESSONS LEARNED: Preliminary data analysis reveals that residents report increased incorporation of and positive attitudes toward social one-liners. Of note, the pilot occurred during a COVID surge, which likely contributed to findings. Nonetheless, the simple nature of the intervention supports ongoing effort and lends itself to implementation elsewhere.

4.
Blood ; 138:3040, 2021.
Article in English | EMBASE | ID: covidwho-1736319

ABSTRACT

INTRODUCTION: Patients (pts) with blood disorders are at particular risk for severe infection and death from COVID-19. Factors that contribute to this risk, including cancer treatment, have not been clearly delineated. The ASH RC COVID-19 Registry for Hematology is a public-facing, volunteer registry reporting outcomes of COVID-19 infection in pts with underlying blood disorders. We report a multivariable analysis of the impact of cancer treatment and other key variables on COVID-19 mortality and hospitalization among pts with blood cancer. METHODS: Data were collected between April 1, 2020, and July 2, 2021. All analyses were performed using R version 4.0.2. Multivariable logistic regression explored associations between mortality and seven patient/disease factors previously reported as important to COVID-19 outcome. Independent variables included: age (>60);sex;presence of a major comorbidity (defined as any of heart disease, hypertension, pulmonary disease and/or diabetes);type of hematologic malignancy;estimated prognosis of < 6 months prior to COVID-19;deferral of ICU care;and administration of cancer treatment in the previous year (excluding single agent hydroxyurea). A secondary multivariable logistic regression explored associations between the same variables and hospitalization with COVID-19. RESULTS: We included all pts in the registry with a malignant diagnosis except for 3 patients excluded based on a data sharing agreement (N=1029). Median age category was 50-59y (range <5y to > 90y). The sample was 42% female and 28% had major comorbidities. Types of hematologic malignancies were 354 (34%) acute leukemia/MDS, 255 (25%) lymphoma, 206 (20%) plasma cell dyscrasia (myeloma/amyloid/POEMS), 116 (11%) CLL, 98 (10%) myeloproliferative neoplasm (MPN). Most pts (73%) received cancer treatment during the previous year, 9% had a pre-COVID-19 prognosis of <6months, and 10% deferred ICU care. COVID-19 mortality in the entire cohort was 17%. In multivariable analyses, age > 60 (OR 2.03, 1.31-3.18), male sex (OR 1.69, 1.11 - 2.61), estimated pre-COVID-19 prognosis of less than 6 months (OR 6.16, 3.26 - 11.70) and ICU deferral (OR 10.87, 6.36 - 18.96) were all independently associated with an increased risk of death. Receiving cancer treatment in the year prior to COVID-19 diagnosis and type of hematologic malignancy were not significantly associated with death. In multivariable analyses, age > 60 (OR 2.46, 1.83 - 3.31), male sex (OR 1.34, 1.02 - 1.76), estimated pre-COVID-19 prognosis of < 6 months (OR 4.81, 2.45 - 10.50), presence of a major comorbidity (OR 1.57, 1.15 - 2.16), and cancer treatment in the previous year (OR 1.50, 1.10 - 2.06) were all independently associated with an increased risk of a severe COVID-19 requiring hospitalization. Pts with a MPN or plasma cell dyscrasia and COVID-19 were less likely to require hospitalization for COVID-19 compared to patients with CLL, leukemia/MDS, or lymphoma. CONCLUSIONS: These analyses confirm the negative impact of age > 60, male sex, pre-COVID-19 prognosis of < 6 months, and deferral of ICU care on mortality among patients with hematologic malignancy and COVID-19. We did not observe an increased risk of COVID-19 mortality among pts with COVID-19 who received blood cancer treatment in the previous year, although rate of hospitalization was higher. Pts with some hematologic malignancies (MPN, plasma cell dyscrasias), may experience less severe COVID-19 infections than others. Disclosures: Anderson: Celgene: Membership on an entity's Board of Directors or advisory committees;Millenium-Takeda: Membership on an entity's Board of Directors or advisory committees;Gilead: Membership on an entity's Board of Directors or advisory committees;Janssen: Membership on an entity's Board of Directors or advisory committees;Sanofi-Aventis: Membership on an entity's Board of Directors or advisory committees;Bristol Myers Squibb: Membership on an entity's Board of Directors or advisory committees;Pfizer: Membership on an entity's Board of Directors or advisory committees;Scientific Founder of Oncopep and C4 Therapeutics: Current equity holder in publicly-traded company, Current holder of individual stocks in a privately-held company;AstraZeneca: Membership on an entity's Board of Directors or advisory committees;Mana Therapeutics: Membership on an entity's Board of Directors or advisory committees. Desai: Janssen R&D: Research Funding;Astex: Research Funding;Kura Oncology: Consultancy;Agios: Consultancy;Bristol Myers Squibb: Consultancy;Takeda: Consultancy. Goldberg: Celularity: Research Funding;Genentech: Consultancy, Membership on an entity's Board of Directors or advisory committees;Astellas: Consultancy, Membership on an entity's Board of Directors or advisory committees;Aptose: Consultancy, Research Funding;Prelude Therapeutics: Research Funding;DAVA Oncology: Honoraria;Pfizer: Research Funding;Arog: Research Funding;Aprea: Research Funding;AbbVie: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding. Neuberg: Madrigal Pharmaceuticals: Other: Stock ownership;Pharmacyclics: Research Funding. Radhakrishnan: Janssen India: Honoraria;Dr Reddy's Laboratories: Honoraria, Membership on an entity's Board of Directors or advisory committees;Aurigene: Speakers Bureau;Novartis: Honoraria;Johnson and Johnson: Honoraria;Pfizer: Consultancy, Honoraria;Astrazeneca: Consultancy, Honoraria;Emcure Pharmaceuticals: Other: payment to institute;Cipla Pharmaceuticals: Honoraria, Other: payment to institute;Bristol Myers Squibb: Other: payment to institute;Roche: Honoraria, Other: payment to institute;Intas Pharmaceutical: Other: payment to institute;NATCO Pharmaceuticals: Research Funding. Sehn: Genmab: Consultancy;Debiopharm: Consultancy;Novartis: Consultancy. Sekeres: Novartis: Membership on an entity's Board of Directors or advisory committees;Takeda/Millenium: Membership on an entity's Board of Directors or advisory committees;BMS: Membership on an entity's Board of Directors or advisory committees. Tallman: Kura: Membership on an entity's Board of Directors or advisory committees;Syros: Membership on an entity's Board of Directors or advisory committees;Innate Pharma: Membership on an entity's Board of Directors or advisory committees;Novartis: Membership on an entity's Board of Directors or advisory committees;Biosight: Membership on an entity's Board of Directors or advisory committees;Roche: Membership on an entity's Board of Directors or advisory committees;Jazz Pharma: Membership on an entity's Board of Directors or advisory committees;Oncolyze: Membership on an entity's Board of Directors or advisory committees;KAHR: Membership on an entity's Board of Directors or advisory committees;Orsenix: Membership on an entity's Board of Directors or advisory committees;Daiichi-Sankyo: Membership on an entity's Board of Directors or advisory committees;Abbvie: Membership on an entity's Board of Directors or advisory committees;Amgen: Research Funding;Rafael Pharmaceuticals: Research Funding;Glycomimetics: Research Funding;Biosight: Research Funding;Orsenix: Research Funding;Abbvie: Research Funding;NYU Grand Rounds: Honoraria;Mayo Clinic: Honoraria;UC DAVIS: Honoraria;Northwell Grand Rounds: Honoraria;NYU Grand Rounds: Honoraria;Danbury Hospital Tumor Board: Honoraria;Acute Leukemia Forum: Honoraria;Miami Leukemia Symposium: Honoraria;New Orleans Cancer Symposium: Honoraria;ASH: Honoraria;NCCN: Honoraria.

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