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1.
International Journal of Palliative Nursing ; 29(1):43-47, 2023.
Article in English | MEDLINE | ID: covidwho-2217631

ABSTRACT

BACKGROUND: Nurses played a critical role in providing care for patients throughout the COVID-19 pandemic.

2.
British Journal of Oral and Maxillofacial Surgery ; 60(10):e34-e35, 2022.
Article in English | EMBASE | ID: covidwho-2176810

ABSTRACT

Introduction/Aims: During the COVID-19 pandemic, our unit converted to a see and treat model for the treatment of non-melanoma skin cancers (NMSCs), aiming to undertake complete excision at the first review. The intention was to reduce patient contact, to reduce the risk of virus transmission, whilst keeping waiting times to a minimum. This audit aimed to assess whether "See and treat" is an effective strategy and to determine whether it should continue following easing of lockdown restrictions. Material(s) and Method(s): 300 patients were seen in 'See and treat' clinics from February to December 2021. Results/Statistics: Initial analysis showed 81.9% of patients were treated during the first visit, with the main reason for treatment delay being anticoagulation. Average time from referral to treatment was 46.8 days. Of the lesions: 46.9% were BCCs, 21.2% were SCCs, 9.8% actinic keratosis, and 22.1% were a mixture of other types. 74.5% of the resultant defects were closed primarily, 12.3% were closed with local flaps, 7.1% left open to granulate, 2.5% grafted with Integra and 2.8% closed with FTSG. The complete excision rate was 98.8%. Conclusions/Clinical Relevance: This audit shows that the "See and treat" model is an effective and safe method for the management of NMSCs in an oral and maxillofacial surgery unit. Based on these results, we recommend that this strategy remains in place post-pandemic to reduce clinic appointments and waiting times. Pre-appointment screening could help to detect high risk patients (such as those on anticoagulation) and address these issues before the first visit, further increasing the efficiency of the system. Copyright © 2022

3.
Paediatrics and Child Health (Canada) ; 27(Supplement 3):e23-e24, 2022.
Article in English | EMBASE | ID: covidwho-2190144

ABSTRACT

BACKGROUND: Children living with chronic comorbid conditions are at increased risk for severe COVID-19 disease, though there is limited evidence regarding the risks associated with specific conditions and which children may benefit from targeted COVID-19 therapies. Age-specific baseline indicators of COVID-19 severity are also needed to evaluate the effectiveness of SARS-CoV-2 vaccination strategies in the paediatric population. OBJECTIVE(S): In this study, we aimed to 1) identify factors associated with severe COVID-19 in children, and 2) describe rates of hospitalization, intensive care unit (ICU) admission, and severe COVID-19 within specific pediatric age groups. DESIGN/METHODS: We conducted a national prospective study on hospitalized children with microbiologically confirmed SARS-CoV-2 infection via the Canadian Paediatric Surveillance Program from March 2020-May 2021. Cases were reported voluntarily by a network of >2800 paediatricians and paediatric subspecialists. SARS-CoV-2 hospitalizations were classified as COVID-19-related, incidental infection, or infection control/social admissions. Severe disease was defined as intensive care, ventilatory or hemodynamic requirements, select organ system complications, or death. Outcomes were described among children aged <6 months, 6-23 months, 2-4 years, 5-11 years, and 12-17 years. Risk factors for severe disease were identified using multivariable Poisson regression, adjusting for child age and sex, coinfections, and timing of hospitalization. RESULT(S): We identified 541 children hospitalized with SARS-CoV-2 infection, including 329 (60.8%) with COVID-19-related disease. Median age at admission was 2.8 years (IQR 0.3-13.5) and 42.9% (n=232) had at least one comorbidity. Among COVID-19-related hospitalizations, severe disease occurred in 29.5% of children (n=97/329), including a higher proportion of children aged 2-4 years (48.7%) and 12-17 years (41.3%) (Table 1). Comorbidities associated with severe disease are described in Figure 1, and included technology dependence (adjusted risk ratio [aRR] 1.96, 95% confidence interval [CI] 1.31-2.95), neurologic conditions (e.g. epilepsy and chromosomal/genetic conditions) (aRR 1.87, 95% CI 1.34-2.61), and pulmonary conditions (e.g. bronchopulmonary dysplasia and uncontrolled asthma) (aRR 1.66, 95% CI 1.13-2.42). CONCLUSION(S): While severe outcomes were detected at all ages and among patients with and without comorbidities, neurologic and pulmonary conditions as well as technology dependence were associated with increased risk of severe COVID-19. Children aged 2-4 years more commonly experienced severe COVID-19 in this study, which was conducted at a time when no children were eligible for SARS-CoV-2 vaccines. Notably, this high-risk group remains without access to approved vaccines. These findings may help guide vaccination programs and prioritize targeted COVID-19 therapies for children.

4.
Open Forum Infectious Diseases ; 9(Supplement 2):S272, 2022.
Article in English | EMBASE | ID: covidwho-2189654

ABSTRACT

Background. COVID-19 can cause serious illness requiring multimodal treatment of the viral infection and its associated complications, including the potential for secondary infections. Studies have suggested an increased risk of fungal infections, including candidemia following severe COVID-19 though understanding of risk factors and clinical outcomes remains unclear. Methods. A multi-center, case-control study of patients with severe COVID-19 was conducted to evaluate risk factors and clinical outcomes in patients who developed candidemia between August 2020 to August 2021. Risk factors associated with candidemia and mortality were characterized using multivariate analyses. Results. A total of 275 patients were enrolled in the study, including 91 patients with severe COVID-19 and subsequent candidemia and 184 patients with severe COVID-19 without candidemia. Most patients received antibiotics prior to candidemia episode (93%), while approximately one-quarter of all patients received biologic for COVID-19. In-hospital mortality was significantly higher in the case group compared to the control group (68% vs 40%, P < 0.01). Multivariable logistic regression revealed that the use of central lines, biologic and paralytic therapy were independent risk factors for candidemia. The presence of candidemia, older age, central line use, and intensive care unit admission were significantly associated with mortality. Demographics and Baseline Characteristics of Study Patients with SARS-CoV-2 Positive With or Without Candidemia Hospitalization Details and Outcomes Conclusion. Clinicians should be aware of the possibility of development of candidemia in hospitalized older patients with severe COVID-19 and should closely monitor those patients at risk. Risk factors for developing candidemia in the setting of COVID-19 are largely consistent with classic risk factors previously identified.

5.
Am J Disaster Med ; 17(2):163-169, 2022.
Article in English | PubMed | ID: covidwho-2164058

ABSTRACT

BACKGROUND: Telehealth emerged early as an important tool to provide clinical care during the COVID-19 pandemic, but statewide implementation strategies were lacking. Needs assessment: We performed a needs assessment at 15 pediatrics clinics in Washington regarding their ability to institute telehealth. Fourteen clinics (93 percent response rate) responded;none had ability to perform telehealth visits. Clinics needed the following specific support structures: (1) an easily implementable, low-cost system, and (2) parity billing for telehealth services. Disaster effort: Two weeks after the needs assessment was performed, we facilitated direct telehealth initiation support to 45 Washington clinics and created a coalition of statewide advocacy groups. These groups advocated for (1) a statewide solution for non-network or poorly resourced providers, which was delivered by the WA Health Care Authority, and (2) parity billing, which was delivered by emergency governor action. CONCLUSION: Engagement with our regional pediatric disaster network was essential in providing guidance and expertise in this needs assessment, telehealth initiation process, and subsequent advocacy efforts. The power we have as pediatricians to coordinate with regional experts helped improve access to telehealth across Washington.

6.
Clinical Psychology Forum ; 2022(355):19-26, 2022.
Article in English | Scopus | ID: covidwho-2126039

ABSTRACT

Due to the rapid spread of Covid-19, the non-epileptic attack disorder (NEAD) service at Salford Royal Hospital had to quickly change its way of working. All appointments prior to this were face-to-face, yet from March 2019 all appointments were changed to telephone or video call. To understand how this may have impacted upon treatment experiences, and identify any changes that could maximise therapy effectiveness, a questionnaire was created and administered to NEAD service-users. Results highlighted wide acceptability of remote appointments, with most respondents indicating satisfaction with their treatment and a maintenance of therapeutic rapport. Face-to-face appointments were however, still preferred by over 50 per cent of respondents and limitations of remote working were raised, such as lack of personal connection and confidentiality. Long-term clinical implications for the service are also discussed, including proposed adaptions and future flexible way of working, that attempt to balance service and client needs. © 2022, British Psychological Society. All rights reserved.

7.
Chest ; 162(4):A720, 2022.
Article in English | EMBASE | ID: covidwho-2060675

ABSTRACT

SESSION TITLE: Acute COVID-19 and Beyond: from Hospital to Homebound SESSION TYPE: Original Investigations PRESENTED ON: 10/18/2022 02:45 pm - 03:45 pm PURPOSE: In-hospital cardiac arrest (IHCA) has been reported to be as high as 75%, with pooled worldwide case fatality rates (CFR) of COVID-19 patients in the ICU estimated as 37%. To our knowledge, there has not been any systematic reviews specifically investigating world-wide survival outcomes of intubated COVID-19 adult patients who undergo IHCA and receive cardiopulmonary resuscitation (CPR). The aim of our study was to evaluate the outcomes of such patients up until hospital discharge. METHODS: A systematic literature search using relevant keywords was performed for original articles published in Embase, Medline and Pubmed Central databases from 2019 to February 6 2022. Patients aged 18 and older who had COVID-19 and were intubated prior to undergoing cardiac arrest were included. Extracted data were summarized in a table showing publication details and country, study designs, total sample size, comorbidities, age, gender, initial cardiac rhythm during cardiac arrest, initial survival after CPR and survival outcomes up until discharge. STATISTICAL ANALYSIS We performed descriptive statistics using Microsoft Excel. Where applicable, measures such as mean, frequency, proportion and range were used. Case fatality rate was also calculated. Methological quality was assessed using Joanna Briggs Institute (JBI) critical appraisal tools. Interrater accuracy and reliability were assessed using Cohen’s kappa. RESULTS: We screened 912 deduplicated articles, of which 38 studies met our criteria for final inclusion. There were 230 total patients, of which 174 patients (75.7%) were intubated. Out of those, 161 patients (70%) underwent CPR and only 4 survived. CFR defined as total number of intubated COVID-19 patients who underwent CPR and died (n= 157) divided by total number of intubated COVID-19 patients who underwent CPR (n=161) was calculated to be 97.5% (95% Cl: 95.1 – 99.92%). Mean age of intubated COVID-19 patients who underwent CPR was 54 years, with 27.5% being females and 72.5% males. The most reported comorbidities of intubated COVID-19 patients who underwent CPR were hypertension (37.5%), diabetes (30%), prior lung pathology (17.5%), obesity(7.5%), hyperlipidemia (5%), stroke (5%), Coronary Artery Disease (CAD) (2.5%). CONCLUSIONS: Our CFR were higher than has been previously recorded for ICU patients with COVID-19. This suggests that COVID-19 patients on mechanical ventilation who deteriorate to the point of going into cardiac arrest are a particularly vulnerable population, and CPR in this subset of COVID-19 patients may be nearly futile. More studies are needed to investigate preventive and management strategies to mitigate such poor outcomes. CLINICAL IMPLICATIONS: Knowledge of survival outcomes in intubated COVID-19 adult patients can help facilitate early plan of care discussions given the limited resources many hospitals experienced during the pandemic. DISCLOSURES: No relevant relationships by Stephen Avera No relevant relationships by Marshaleen Henriques King No relevant relationships by Sorochi Iloanusi No relevant relationships by Chinedu Ivonye No relevant relationships by Ifeoma Ogbuka No relevant relationships by Titilope Olanipekun

8.
J Hosp Infect ; 120: 23-30, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1540764

ABSTRACT

BACKGROUND: Healthcare-acquired COVID-19 has been an additional burden on hospitals managing increasing numbers of patients with SARS-CoV-2. One acute hospital (W) among three in a Scottish healthboard experienced an unexpected surge of COVID-19 clusters. AIM: To investigate possible causes of COVID-19 clusters at Hospital W. METHODS: Daily surveillance provided total numbers of patients and staff involved in clusters in three acute hospitals (H, M and W) and care homes across the healthboard. All clusters were investigated and documented, along with patient boarding, community infection rates and outdoor temperatures from October 2020 to March 2021. Selected SARS-CoV-2 strains were genotyped. FINDINGS: There were 19 COVID-19 clusters on 14 wards at Hospital W during the six-month study period, lasting from two to 42 days (average, five days; median, 14 days) and involving an average of nine patients (range 1-24) and seven staff (range 0-17). COVID-19 clusters in Hospitals H and M reflected community infection rates. An outbreak management team implemented a control package including daily surveillance; ward closures; universal masking; screening; restricting staff and patient movement; enhanced cleaning; and improved ventilation. Forty clusters occurred across all three hospitals before a January window-opening policy, after which there were three during the remainder of the study. CONCLUSION: The winter surge of COVID-19 clusters was multi-factorial, but clearly exacerbated by moving trauma patients around the hospital. An extended infection prevention and control package including enhanced natural ventilation helped reduce COVID-19 clusters in acute hospitals.


Subject(s)
COVID-19 , Delivery of Health Care , Hospitals , Humans , SARS-CoV-2 , Scotland/epidemiology
10.
16th International System of Systems Engineering Conference (SoSE) ; : 37-42, 2021.
Article in English | Web of Science | ID: covidwho-1501338

ABSTRACT

Systems of Systems (SoS) and the challenges they present are very complex. The National Health Service (NHS) is one such complex system within the UK that is facing a number of challenges. These range from an ageing and growing population with evolving healthcare needs, to increasing costs and reliance on private services. As such, a number of programmes and models have been introduced to transform care. Digital-first Primary Care (DfPC) is one such example. DfPC allows for faster and improved patient access to primary care by providing the choice of telephone and online consultations via the patient's GP practice or digital GP providers. The DfPC model has been at the forefront of primary care during the coronavirus (Covid-19) pandemic, hence the need for current research to evaluate its impact, suitability, and value in a post-pandemic world. Whilst this area is of high interest in the research community, there exists a gap in the method of analysis used. In this paper, the case for a soft systems methodology approach to DfPC is put forward. It aims to highlight the complexity of the NHS, and the benefits and challenges with online consultations, with initial findings by way of pilot interviews with GPs also being put forth.

11.
IEEEE Southeast Conference (SoutheastCon) ; : 622-629, 2021.
Article in English | Web of Science | ID: covidwho-1398290

ABSTRACT

Amid a world of the COVID-19 pandemic, people often have turned to social media as a means of communicating and receiving information. Within existing social networks one can discover a wide range of messages that vary in sentiment, measure of helpfulness, and/or intended harm. In this paper, we measure the utility of Tweets based on their ability to propagate throughout the Twittersphere as well as the salient features that contribute to their successful propagation. In this work, we consider five types of Tweets that can be classified as: (1) Caution & Advice, (2) Doubt & Criticism, (3) Rumor & Counter-Rumors, (4) Generic Harm, and (5) Non-Situational Information. Our results suggest that, on average, Caution & Advice messages propagate fastest while messages classified as Generic Harm have the slowest propagation.

12.
Pharmacy Education ; 21(1):373-381, 2021.
Article in English | Web of Science | ID: covidwho-1395846

ABSTRACT

Background: The COVID-19 pandemic required pharmacy educators to seek creative and innovative ways of delivering learning outcomes in the virtual environment. Objective Structured Clinical Examinations (OSCEs) have been particularly challenging to deliver online. Objective: To explore the use of asynchronous video interview software as a platform for virtual OSCEs in pharmacy education, and for conducting brief structured research interviews. Method: Fourth year Bachelor of Pharmacy students at an Australian university, were interviewed via asynchronous video interview software (Big Interview) about their perceptions of using the platform for virtual OSCEs. Results: 37 students (92.5%) used Big Interview to complete at least one summative OSCE case during a team-based simulation. Seven research interviews were recorded by six students. Positive comments focussed on facilitation of self-reflection and self-correction in patient questioning and counselling. Negative views concerned the lack of authenticity, including the robotic and artificial nature of interactions. Conclusion: Asynchronous video interview software for pharmacy OSCEs may assist formative learning and self-reflection, offering an adjunct to, but not replacement of, in-person communication.

13.
Conf Proc IEEE SOUTHEASTCON ; 2021-March, 2021.
Article in English | Scopus | ID: covidwho-1219676

ABSTRACT

Amid a world of the COVID-19 pandemic, people often have turned to social media as a means of communicating and receiving information. Within existing social networks one can discover a wide range of messages that vary in sentiment, measure of helpfulness, and/or intended harm. In this paper, we measure the utility of Tweets based on their ability to propagate throughout the Twittersphere as well as the salient features that contribute to their successful propagation. In this work, we consider five types of Tweets that can be classified as: (1) Caution Advice, (2) Doubt Criticism, (3) Rumor Counter-Rumors, (4) Generic Harm, and (5) Non-Situational Information. Our results suggest that, on average, Caution Advice messages propagate fastest while messages classified as Generic Harm have the slowest propagation. © 2021 IEEE.

14.
Socius ; 7, 2021.
Article in English | Scopus | ID: covidwho-1199891

ABSTRACT

Academia serves as a valuable case for studying the effects of social forces on workplace productivity, using a concrete measure of output: scholarly papers. Many academics, especially women, have experienced unprecedented challenges to scholarly productivity during the coronavirus disease 2019 (COVID-19) pandemic. The authors analyze the gender composition of more than 450,000 authorships in the arXiv and bioRxiv scholarly preprint repositories from before and during the COVID-19 pandemic. This analysis reveals that the underrepresentation of women scientists in the last authorship position necessary for retention and promotion in the sciences is growing more inequitable. The authors find differences between the arXiv and bioRxiv repositories in how gender affects first, middle, and sole authorship submission rates before and during the pandemic. A review of existing research and theory outlines potential mechanisms underlying this widening gender gap in productivity during COVID-19. The authors aggregate recommendations for institutional change that could ameliorate challenges to women’s productivity during the pandemic and beyond. © The Author(s) 2021.

15.
Statistical Journal of the IAOS ; 37(1):19-24, 2021.
Article in English | Scopus | ID: covidwho-1175529
16.
International Journal of STD and AIDS ; 31(SUPPL 12):45, 2020.
Article in English | EMBASE | ID: covidwho-1067091

ABSTRACT

Introduction: We present our contingency plan for the management of patients presenting to our Emergency Department (ED) requiring HIV (Human Immunodeficiency Virus) Post-Exposure Prophylaxis (PEP) during the COVID-19 pandemic. Method: The pre-COVID pathway relied on patients who needed PEP being dispensed a 5 day supply of PEP. A generic leaflet was included in each PEP pack. This contained a large amount of medical jargon and no contact details for local services. A handwritten fax referral was sent to Genitourinary Medicine (GUM) who would recall the patient for face to face (F2F) review in order to obtain baseline screening and supply an additional 23 days of medication. F2F follow up testing was arranged at 2 weeks and 8-12 weeks post-PEP. Results: An electronic PEP referral was introduced and the ED Clinical Decision Support Guideline (CDGS) was redesigned. Pharmacy was able to supply 28 days of PEP meaning that if a patient was required to self-isolate, they would have an adequate supply of treatment at home. The patient information leaflet was rewritten using simple terminology and details of local GUM services were included. Baseline bloods were taken within ED removing the need for F2F appointments. Upon receipt of the PEP referral, a Health Advisor would call the patient and arrange for confirmatory home testing kits to be sent at the required window period. Patients attending ED who were non-Manchester residents were eligible for the same service thus reducing unnecessary F2F contact at other clinics. 16 patients were successfully referred from ED to GUM between May/June 2020. Discussion: Our new pathway has helped us to substantially mitigate risk for patients requiring PEP via the ED. Following the success of this collaborative project, we have decided to adopt this pathway permanently as we predict demand for PEP will increase as the UK begins to ease lockdown restrictions.

17.
Socius ; 7, 2021.
Article in English | Scopus | ID: covidwho-1054790

ABSTRACT

We utilize longitudinal social network data collected pre–COVID-19 in June 2019 and compare them with data collected in the midst of COVID in June 2020. We find significant decreases in network density and global network size following a period of profound social isolation. While there is an overall increase in loneliness during this era, certain social network characteristics of individuals are associated with smaller increases in loneliness. Specifically, we find that people with fewer than five “very close” relationships report increases in loneliness. We further find that face-to-face interactions, as well as the duration and frequency of interactions with very close ties, are associated with smaller increases in loneliness during the pandemic. We also report on factors that do not moderate the effect of social isolation on perceived loneliness, such as gender, age, or overall social network size. © The Author(s) 2021.

18.
Clinical Cancer Research ; 26(18 SUPPL), 2020.
Article in English | EMBASE | ID: covidwho-992026

ABSTRACT

Objective: To evaluate patterns of patient management in an academic Radiation Oncology department between3/17/20 and 5/8/20 during the COVID-19 pandemic. Background: As a response to the worldwide COVID-19 pandemic, our Radiation Oncology department instituted anumber of measures to limit spread of the disease to our patients and staff. This included prospectively evaluatingall new referrals for radiation treatment and determining an appropriate course of action, which if appropriateincluded delaying the start of radiation, hypofractionation, or using other modalities of treatment prior to start ofradiation. Methods: We analyzed data for 82 patients between 3/17/20-5/8/20 to evaluate patterns of management. The chi-squared test was used to evaluate the descriptive characteristics of the study population, with P values ≤ 0.05considered statistically significant. One sample t-test was used to compare the statistical mean difference betweensample variables. Data were analyzed using SPSS 24.0 software (IBM, Armonk, NY, USA). Results: The data set comprised 38% Caucasians and 59% African Americans. An age breakdown revealed 12.3%below age 30, 42% between ages 30-60, and 45.7% over age of 60. When the data were analyzed by gender, wenoted a significant difference by site of treatment (p=0.005) and whether immediate treatment was required or not(p=0.029). This likely reflects gender-driven differences in cancer site with patients diagnosed with prostate cancergetting LHRH agonist therapy prior to start of radiation. Hypofractionated radiation schedules were used in 2patients with cord compression early during the study period compared to 3 patients who received standardfractionation later, and one person elected to go straight to hospice care (p=0.002). Of patients for heterotopicossification prophylaxis, 3/14 declined radiation and one was over the weight limit of the radiation table (p=0.000).41% of patients were inpatients. No patients developed COVID-19 during our study period. Conclusion: A prospective evaluation of new patient referrals may have helped mitigate the spread of COVID-19 atour Radiation Oncology facility. This is one of several prospective measures that our department took to protectpatients and staff.

19.
J Hosp Infect ; 109: 44-51, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-948697

ABSTRACT

BACKGROUND: Healthcare worker (HCW) behaviours, such as the sequence of their contacts with surfaces and hand hygiene moments, are important for understanding disease transmission. AIM: To propose a method for recording sequences of HCW behaviours during mock vs actual procedures, and to evaluate differences for use in infection risk modelling and staff training. METHODS: Procedures for three types of care were observed under mock and actual settings: intravenous (IV) drip care, observational care and doctors' rounds on a respiratory ward in a university teaching hospital. Contacts and hand hygiene behaviours were recorded in real-time using either a handheld tablet or video cameras. FINDINGS: Actual patient care demonstrated 70% more surface contacts than mock care. It was also 2.4 min longer than mock care, but equal in terms of patient contacts. On average, doctors' rounds took 7.5 min (2.5 min for mock care), whilst auxiliary nurses took 4.9 min for observational care (2.4 min for mock care). Registered nurses took 3.2 min for mock IV care and 3.8 min for actual IV care; this translated into a 44% increase in contacts. In 51% of actual care episodes and 37% of mock care episodes, hand hygiene was performed before patient contact; in comparison, 15% of staff delivering actual care performed hand hygiene after patient contact on leaving the room vs 22% for mock care. The number of overall touches in the patient room was a modest predictor of hand hygiene. Using a model to predict hand contamination from surface contacts for Staphylococcus aureus, Escherichia coli and norovirus, mock care underestimated micro-organisms on hands by approximately 30%.


Subject(s)
Cross Infection , Hand Hygiene , Infection Control , Guideline Adherence , Hand , Hand Disinfection , Health Personnel , Humans , Patient Care , Patient Simulation , Patients' Rooms
20.
BMJ Leader ; 2020.
Article in English | Scopus | ID: covidwho-916306

ABSTRACT

Background: The COVID-19 pandemic has exposed front-line healthcare workers to unprecedented risks and stressors threatening both physical and mental health. Prior work in the military has found that team identification, or the sense that one was a part of a team, can help reduce stress and prevent burnout during prolonged stress. Methods: We conducted repeated cross-sectional surveys embedded within emergency department workflow to understand whether team identification was associated with reduced reports of stress and burnout among front-line workers. Results: During the 10-week study which spanned the first wave of COVID-19, 327 of 431 (76%) front-line healthcare workers responded to at least one round of the survey. Higher team identification was associated with significantly less work stress (B=-0.60, 95% CI -0.84 to to -0.40, p<0.001) and burnout (B=-12.87, 95% CI -17.73 to -8.02, p<0.001) in cross-sectional analyses. Further evidence of the protective effect of team identification for work stress (B=-0.36, 95% CI -0.76 to 0.05, p=0.09) and burnout (B=-13.25, 95% CI -17.77 to -8.73, p<0.001) was also found in prospective longitudinal evidence. Conclusion: This work suggests work team identification is a key buffering factor against feelings of stress and burnout. Efforts to promote team identification may offer a promising way for leaders to support front-line healthcare workers' well-being during the COVID-19 pandemic. These results can inform ongoing COVID-19 operational and quality improvement initiatives. © 2020 Author(s) (or their employer(s)). No commercial re-use. See rights and permissions. Published by BMJ.

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