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1.
Germs ; 12(1):1-5, 2022.
Article in English | ProQuest Central | ID: covidwho-1801717

ABSTRACT

The only factor statistically significantly associated with anxiety was job dedication, where a higher level of job dedication was associated with decreased likelihood of the worker having high levels of anxiety (odds ratio (OR)=0.545;95% confidence interval (CI): 0.301;0.990) (Table 1). [...]participation in the study was voluntary and 95% of our participants were females, which may indicate a self-selection bias. [...]being a cross-sectional survey, our research is only a snapshot in time. [...]we wish to highlight the need for advanced interventions in times of crisis to address mental-health concerns of employees and to safeguard their emotional and psychological wellbeing.

2.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-308488

ABSTRACT

Background: The Singapore COVID-19 multi-ministry taskforce commissioned community care facilities (CCFs) as a hospital-sparing strategy amidst rising coronavirus disease 2019 (COVID-19) cases. An exhibition centre was repurposed within ten days as an ad-hoc 3200-bed medical facility (CCF@EXPO) to isolate and treat infected patients amidst concerns of potential COVID-19 transmissions to healthcare staff. This paper deconstructs the implementation of the CCF@EXPO infection prevention and control (IPC) innovation and elicits critical factors which enabled zero transmission of COVID-19 to staff during 100 days of operation using an implementation science framework. Methods: This study employed retrospective analysis using the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework. The CCF@EXPO IPC innovation comprised five key elements: (a) physical environment, (b) work practices, (c) tools and technology, (d) staff training, and (e) audits. Contextual assessment was conducted for baseline and 100 th day of CCF@EXPO operations. Actions taken to improve scores between these timepoints were mapped against the Expert Recommendations for Implementing Change (ERIC) tool to surface key implementation strategies. Results: Positive shifts were observed in all constructs of the i-PARIHS framework, between baseline and 100 th day. The largest shifts were in work practices, tools and technology, and staff training. Key implementation strategies used included: rapid Plan-Do-Study-Act (PDSA) cycles, identifying champions, team building, creating a culture of collaborative learning, multi-disciplinary teamwork, transparency in communications and decision-making, and skillful facilitation. Conclusions: Rapid PDSA cycles anchored by principles to ensure staff safety, was the key approach used in implementation of the CCF@EXPO IPC innovation. Retrospective analysis using the i-PARIHS framework is useful to elicit success factors and to inform preparedness planning of future pandemics.

3.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-316647

ABSTRACT

Background: As the COVID-19 pandemic sweeps across the world, healthcare departments must adapt to meet the challenges of service provision and staff/patient protection. Unlike elective surgery, Acute care surgery (ACS) workloads cannot be artificially reduced providing a unique challenge for administrators to balance healthcare resources between the COVID-19 surge and regular patient admissions. Methods: An extended ACS (eACS) model of care is described with the aim of limiting COVID-19 healthcare worker and patient cross-infection as well as providing 24/7 management of emergency general surgical (GS) and trauma patients. The eACS service comprised 5 independent teams covering a rolling 1:5 24-hr call. Attempts to completely separate eACS teams and patients from the elective side were made. The service was compared to the existing ACS service in terms of clinical and efficiency outcomes. Finally, a survey of staff attitudes towards these changes, concerns regarding COVID-19 and psychological well-being was assessed. Results: There were no staff/patient COVID-19 cross-infections. Compared to the ACS service, eACS patients had reduced overall length of stay (2-days), time spent in the Emergency Room (46 minutes) and time from surgery to discharge (2.4-hours). Mortality was decreased during this time. The eACS model of care saved financial resources and bed-days for the organisation. The changes were well received by team-members who also felt that their safety was prioritised. Conclusion: In healthcare systems affected by COVID-19, an eACS model may assist in preserving psychological well-being for healthcare staff whilst providing 24/7 care for emergency GS and trauma patients.

4.
Int J Surg ; 98: 106210, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1611773

ABSTRACT

BACKGROUND: Non-technical skills are critical to surgical safety. We examined the impact of the COVID-19 pandemic on non-technical skills of operating room (OR) teams in Singapore. MATERIALS AND METHODS: Observers rated live operations using the Oxford NOTECHS system. Pre- and post-COVID observations were captured from November 2019 to January 2020 and from January 2021 to February 2021, respectively. Scores were compared using Schuirmann's Two One-Sided Test procedure. Multivariable linear regression was used to adjust for case mix. A 10% margin of equivalence was set a priori. RESULTS: Observers rated 159 cases: 75 pre-COVID and 84 post-COVID. There were significant differences between groups in surgical department and surgeon-reported case complexity (both P < 0.001). Total NOTECHS scores increased post-COVID on raw analysis (36.1 vs 38.0, P < 0.001) but remained within the margin of equivalence (90% CI 1.3 to 2.6, P < 0.001). Multivariable analysis demonstrated a similar increase within the margin of equivalence (2.0, 90% CI 1.3 to 2.7). Teamwork and cooperation scores increased by 1.0 post-COVID (90% CI 0.8 to 1.3); all other subcomponent scores were equivalent. CONCLUSION: Non-technical skills before and after the peak of the COVID-19 pandemic were equivalent but not equal. A small but statistically significant improvement post-COVID was driven by an increase in teamwork and cooperation skills. These findings may reflect an improvement in team cohesion, which has been observed in teams under duress in other settings such as the military. Future work should explore the effect of the pandemic on OR culture, team cohesion, and resilience.


Subject(s)
COVID-19 , Clinical Competence , Humans , Pandemics , Patient Care Team , SARS-CoV-2
5.
Int J Med Inform ; 158: 104665, 2021 Dec 14.
Article in English | MEDLINE | ID: covidwho-1568753

ABSTRACT

OBJECTIVE: To develop a 2-stage discrete events simulation (DES) based framework for the evaluation of elective surgery cancellation strategies and resumption scenarios across multiple operational outcomes. MATERIALS AND METHODS: Study data was derived from the data warehouse and domain knowledge on the operational process of the largest tertiary hospital in Singapore. 34,025 unique cases over 43 operating rooms (ORs) and 18 surgical disciplines performed from 1 January 2019 to 31 May 2020 were extracted for the study. A clustering approach was used in stage 1 of the modelling framework to develop the groups of surgeries that followed distinctive postponement patterns. These clusters were then used as inputs for stage 2 where the DES model was used to evaluate alternative phased resumption strategies considering the outcomes of OR utilization, waiting times to surgeries and the time to clear the backlogs. RESULTS: The tool enabled us to understand the elective postponement patterns during the COVID-19 partial lockdown period, and evaluate the best phased resumption strategy. Differences in the performance measures were evaluated based on 95% confidence intervals. The results indicate that two of the gradual phased resumption strategies provided lower peak OR and bed utilizations but required a longer time to return to BAU levels. Minimum peak bed demands could also be reduced by approximately 14 beds daily with the gradual resumption strategy, whilst the maximum peak bed demands by approximately 8.2 beds. Peak OR utilization could be reduced to 92% for gradual resumption as compared to a minimum peak of 94.2% with the full resumption strategy. CONCLUSIONS: The 2-stage modelling framework coupled with a user-friendly visualization interface were key enablers for understanding the elective surgery postponement patterns during a partial lockdown phase. The DES model enabled the identification and evaluation of optimal phased resumption policies across multiple important operational outcome measures. LAY ABSTRACT: During the height of the COVID-19 pandemic, most healthcare systems suspended their non-urgent elective surgery services. This strategy was undertaken as a means to expand surge capacity, through the preservation of structural resources (such as operating theaters, ICU beds, and ventilators), consumables (such as personal protective equipment and medications), and critical healthcare manpower. As a result, some patients had less-essential surgeries postponed due to the pandemic. As the first wave of the pandemic waned, there was an urgent need to quickly develop optimal strategies for the resumption of these surgeries. We developed a 2-stage discrete events simulation (DES) framework based on 34,025 unique cases over 43 operating rooms (ORs) and 18 surgical disciplines performed from 1 January 2019 to 31 May 2020 captured in the Singapore General Hospital (SGH) enterprise data warehouse. The outcomes evaluated were OR utilization, waiting times to surgeries and time to clear the backlogs. A user-friendly visualization interface was developed to enable decision makers to determine the most promising surgery resumption strategy across these outcomes. Hospitals globally can make use of the modelling framework to adapt to their own surgical systems to evaluate strategies for postponement and resumption of elective surgeries.

6.
PLoS One ; 16(10): e0258866, 2021.
Article in English | MEDLINE | ID: covidwho-1480457

ABSTRACT

AIM: The long-term stress, anxiety and job burnout experienced by healthcare workers (HCWs) are important to consider as the novel coronavirus disease (COVID-19) pandemic stresses healthcare systems globally. The primary objective was to examine the changes in the proportion of HCWs reporting stress, anxiety, and job burnout over six months during the peak of the pandemic in Singapore. The secondary objective was to examine the extent that objective job characteristics, HCW-perceived job factors, and HCW personal resources were associated with stress, anxiety, and job burnout. METHOD: A sample of HCWs (doctors, nurses, allied health professionals, administrative and operations staff; N = 2744) was recruited via invitation to participate in an online survey from four tertiary hospitals. Data were gathered between March-August 2020, which included a 2-month lockdown period. HCWs completed monthly web-based self-reported assessments of stress (Perceived Stress Scale-4), anxiety (Generalized Anxiety Disorder-7), and job burnout (Physician Work Life Scale). RESULTS: The majority of the sample consisted of female HCWs (81%) and nurses (60%). Using random-intercept logistic regression models, elevated perceived stress, anxiety and job burnout were reported by 33%, 13%, and 24% of the overall sample at baseline respectively. The proportion of HCWs reporting stress and job burnout increased by approximately 1·0% and 1·2% respectively per month. Anxiety did not significantly increase. Working long hours was associated with higher odds, while teamwork and feeling appreciated at work were associated with lower odds, of stress, anxiety, and job burnout. CONCLUSIONS: Perceived stress and job burnout showed a mild increase over six months, even after exiting the lockdown. Teamwork and feeling appreciated at work were protective and are targets for developing organizational interventions to mitigate expected poor outcomes among frontline HCWs.


Subject(s)
Anxiety , Burnout, Professional , COVID-19 , Health Personnel/psychology , Pandemics , SARS-CoV-2 , Adult , Aged , Anxiety/epidemiology , Anxiety/psychology , Burnout, Professional/epidemiology , Burnout, Professional/etiology , COVID-19/epidemiology , COVID-19/psychology , Female , Humans , Male , Middle Aged , Prospective Studies , Singapore/epidemiology
7.
Singapore Med J ; 2021 Oct 11.
Article in English | MEDLINE | ID: covidwho-1464031

ABSTRACT

INTRODUCTION: We investigated knowledge, attitudes, and practice (KAP) about COVID-19 and related preventive measures in Singaporeans aged ≥ 60 years. METHODS: This was a population-based, cross-sectional, mixed-methods study (13 May 2020-9 June 2020) of participants aged ≥60 years. Self-reported KAP about ten COVID-19 symptoms and six government-endorsed preventive measures were evaluated. Multivariable regression models identified sociodemographic and health-related factors associated with knowledge, attitudes and practices in our sample. Associations between knowledge/attitude scores, and practice categories were determined using logistic regression. 78 participants were interviewed qualitatively about practice of additional preventive measures and data were analysed thematically. RESULTS: Mean awareness score of the symptoms was 7.2/10. Fever (93.0%) and diarrhoea (33.5%) were the most- and least-known symptoms, respectively. Most knew all six preventive measures (90.4%), perceived them as effective (78.7%), and practiced 'wear a mask' (97.2%). Indians, Malays, and those in smaller housing had poorer mean knowledge of COVID-19 symptoms scores. Older participants had poorer attitudes towards preventive measures. Compared to Chinese, Indians had lower odds of practicing 3/6 recommendations. A one-point increase in knowledge of and attitudes towards preventive measures score had higher odds of always practicing 3/6 and 2/6 measures, respectively. Qualitative interviews revealed use of other preventive measures, e.g. maintaining a healthy lifestyle. CONCLUSION: Elderly Singaporeans displayed high levels of KAP about COVID-19 and related preventive measures, with a positive association between levels of knowledge/attitude, and practice. However, important ethnic and socioeconomic disparities were evident, suggesting key vulnerabilities remain, requiring immediate attention.

8.
Journal of the American College of Surgeons ; 233(5):e102-e103, 2021.
Article in English | Academic Search Complete | ID: covidwho-1461288
9.
Infect Dis Health ; 27(1): 38-48, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1458691

ABSTRACT

BACKGROUND: Large-scale quarantine facilities staffed with non-healthcare workers (NHCW) were instrumental in preventing community spread of COVID-19 (coronavirus disease of 2019). The objective of this study was to determine the effectiveness of a newly developed procedural skills training framework in ensuring personal protective equipment (PPE) compliance of PPE-naïve NHCWs. METHODS: We developed a PPE procedural skills training framework for NHCWs using the Learn, See, Practice, Prove, Do, and Maintain (LSPPDM) framework and international guidelines on PPE for healthcare workers. The NHCWs underwent PPE training using this framework, conducted by a team of Infection Prevention nurses, prior to being stationed within the CCF. Effectiveness of the LSPPDM PPE training framework was assessed using: 1) competency assessment scores for NHCWs, 2) PPE compliance rates from daily audit findings, and, 3) healthcare-associated COVID-19 infection rates of NHCWs. RESULTS: A total of 883 NHCWs had completed the PPE training and demonstrated competency in PPE compliance, fulfilling 100% of the checklist requirements. Mean PPE compliance of all NHCWs during the 11-week study period was noted to be >96%. The post-implementation improvement was statistically significant when the compliance was expressed in 3-days blocks) and in bed management staff (P = < 0.05). None of the 883 NHCWs who underwent PPE training via the LSPPDM framework were diagnosed with healthcare-associated COVID-19 infection. CONCLUSION: An evidence-based skills training framework is effective in PPE training of large numbers of NHCWs, resulting in high compliance of appropriate PPE use and prevention of healthcare-associated COVID-19 infection.


Subject(s)
COVID-19 , Personal Protective Equipment , Health Personnel , Humans , Pandemics , SARS-CoV-2
11.
J Surg Educ ; 79(1): 51-55, 2022.
Article in English | MEDLINE | ID: covidwho-1373173

ABSTRACT

OBJECTIVES: The COVID-19 pandemic has forced a creative transition to virtual platforms due to physical distancing and travel restrictions. We designed and tested a highly scalable virtual training curriculum for novice raters using the Oxford NOTECHS non-technical skills rating system. DESIGN: A three-day training course comprising virtual didactics, virtually facilitated simulations, and independent live observations was implemented. NOTECHS scores were submitted for eleven standardized video simulations and four live operations. Intraclass correlation coefficients (ICCs) were calculated for total NOTECHS scores and subcomponent scores. Raters previously trained in-person with the same standardized videos served as a comparator group for equivalence testing. SETTING: All study activities were conducted in a large academic tertiary referral center in Singapore as part of an ongoing surgical safety initiative. PARTICIPANTS: Seven staff members underwent training (three virtually and four in-person).  None had prior surgical experience or non-technical skills assessment training. RESULTS: ICCs for total NOTECHS scores were 0.85 (95% CI, 0.73-0.98) for virtually trained raters and 0.83 for those trained in-person (95% CI, 0.68-0.99).  Scores were equivalent between groups within a 10% margin. CONCLUSIONS: Non-technical skills assessment can be reliably taught in a highly scalable virtual format. Virtual NOTECHS training is a valuable tool for educational and quality improvement initiatives during the COVID-19 pandemic and for centers that lack ready access to onsite non-technical skills training expertise.


Subject(s)
COVID-19 , Pandemics , Clinical Competence , Curriculum , Humans , SARS-CoV-2
12.
JCO Oncol Pract ; 17(3): e343-e354, 2021 03.
Article in English | MEDLINE | ID: covidwho-1154056

ABSTRACT

PURPOSE: We present the strategy of a comprehensive cancer center organized to make operations pandemic proof and achieve continuity of cancer care during the COVID-19 pandemic. METHODS: Disease Outbreak Response (DORS) measures implemented at our center and its satellite clinics included strict infection prevention, manpower preservation, prudent resource allocation, and adaptation of standard-of-care treatments. Critical day-to-day clinical operations, number of persons screened before entry, staff temperature monitoring, and personal protection equipment stockpile were reviewed as a dashboard at daily DORS taskforce huddles. Polymerase chain reaction swab tests performed for patients and staff who met defined criteria for testing of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection were tracked. Descriptive statistics of outpatient attendances and treatment caseloads from February 3 to May 23, 2020, were compared with the corresponding period in 2019. RESULTS: We performed COVID-19 swabs for 80 patients and 93 staff, detecting three cancer patients with community-acquired COVID-19 infections with no nosocomial transmission. Patients who required chemotherapy, radiotherapy, or surgery and patients who are on maintenance treatment continued to receive timely treatment without disruption. The number of intravenous chemotherapy treatments was maintained at 97.8% compared with 2019, whereas that of weekly radiotherapy treatments remained stable since December 2019. All cancer-related surgeries proceeded without delay, with a 0.3% increase in workload. Surveillance follow-ups were conducted via teleconsultation, accounting for a 30.7% decrease in total face-to-face clinic consultations. CONCLUSION: Through the coordinated efforts of a DORS taskforce, it is possible to avoid nosocomial SARS-CoV-2 transmissions among patients and staff without compromising on care delivery at a national cancer center.


Subject(s)
Advisory Committees , COVID-19/prevention & control , Cancer Care Facilities/organization & administration , Continuity of Patient Care/organization & administration , Infection Control/organization & administration , Ambulatory Care/organization & administration , COVID-19/epidemiology , COVID-19/transmission , COVID-19 Nucleic Acid Testing , Community-Acquired Infections/epidemiology , Cross Infection/epidemiology , Health Care Rationing , Health Personnel , Hospitalization , Humans , Mass Screening , Personal Protective Equipment/supply & distribution , SARS-CoV-2 , Singapore/epidemiology
13.
BMJ Open ; 11(3): e045949, 2021 03 19.
Article in English | MEDLINE | ID: covidwho-1143049

ABSTRACT

INTRODUCTION: The health, psychological and socioeconomic vulnerabilities of low-wage migrant workers have been magnified in the COVID-19 pandemic, especially in high-income receiving countries such as Singapore. We aimed to understand migrant worker concerns and coping strategies during the COVID-19 pandemic to address these during the crisis and inform on comprehensive support needed after the crisis. METHODS: In-depth semi-structured interviews were carried out with migrant workers diagnosed with COVID-19. The participants were recruited from a COVID-19 mass quarantine facility in Singapore through a purposive sampling approach. Interviews were transcribed verbatim and thematic analysis performed to derive themes in their collective experience during the crisis. RESULTS: Three theme categories were derived from 27 interviews: migrant worker concerns during COVID-19, coping during COVID-19 and priorities after COVID-19. Major stressors in the crisis included the inability to continue providing for their families when work is disrupted, their susceptibility to infection in crowded dormitories, the shock of receiving the COVID-19 diagnosis while asymptomatic, as well as the isolating conditions of the quarantine environment. The workers coped by keeping in contact with their families, accessing healthcare, keeping updated with the news and continuing to practise their faith and religion. They looked forward to a return to normalcy after the crisis with keeping healthy and having access to healthcare as new priorities. CONCLUSION: We identified coping strategies employed by the workers in quarantine, many of which were made possible through the considered design of care and service delivery in mass quarantine facilities in Singapore. These can be adopted in the set-up of other mass quarantine facilities around the world to support the health and mental well-being of those quarantined. Our findings highlight the importance of targeted policy intervention for migrant workers, in areas such as housing and working environments, equitable access to healthcare, and social protection during and after this crisis.


Subject(s)
Adaptation, Psychological , COVID-19/diagnosis , COVID-19/psychology , Transients and Migrants/psychology , Humans , Interviews as Topic , Pandemics , Quarantine/psychology , Singapore
14.
Eur Arch Otorhinolaryngol ; 278(9): 3375-3380, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1086578

ABSTRACT

PURPOSE: We aim to study the prevalence of olfactory and taste dysfunction (OTD) in subjects residing in a Community Care Facility (CCF), a center unique to Singapore that is dedicated to isolate foreign workers with COVID-19 infection who have mild disease with minimal or no symptoms. METHODS: This is a cross-sectional study analyzing data prospectively collected from COVID-19-positive subjects who were admitted into a single-center Singapore EXPO CCF from 1st May 2020 to 1st July 2020. The following variables were collected: age, gender, ethnicity, anosmia, ageusia and acute respiratory infection (ARI) symptoms. Symptoms of anosmia and ageusia were self-declared via a mandatory questionnaire administered on admission. RESULTS: A total of 1983 subjects were included. The overall prevalence of anosmia and ageusia is 3.0% and 2.6%, respectively. 58% of anosmic subjects have co-existent ageusia and 72.6% of anosmic subjects have no concurrent sinonasal symptoms. OTD is less likely to present in subjects who are asymptomatic for ARI, compared to those symptomatic for ARI (anosmia: 2.0% versus 4.4% p = 0.002; ageusia: 1.6% versus 4.2% p < 0.001). There is a difference in the prevalence of OTD between the different ethnic groups (Indian, Chinese, Bangladeshi and Others), with Chinese and Bangladeshi reporting a higher prevalence (p < 0.043) CONCLUSION: The true prevalence of OTD in COVID-19-positive subjects may be low with aggressive screening of all subjects, including those asymptomatic for ARI.


Subject(s)
COVID-19 , Olfaction Disorders , Cross-Sectional Studies , Humans , Olfaction Disorders/epidemiology , Olfaction Disorders/etiology , Prevalence , SARS-CoV-2 , Singapore/epidemiology , Taste Disorders/diagnosis , Taste Disorders/epidemiology , Taste Disorders/etiology
15.
JAMA Otolaryngol Head Neck Surg ; 147(5): 418-425, 2021 05 01.
Article in English | MEDLINE | ID: covidwho-1086243

ABSTRACT

Importance: Three-dimensionally printed nasopharyngeal swabs (3DP swabs) have been used to mitigate swab shortages during the coronavirus disease 2019 (COVID-19) pandemic. Clinical validation for diagnostic accuracy and consistency, as well as patient acceptability, is crucial to evaluate the swab's performance. Objective: To determine the accuracy and acceptability of the 3DP swab for identifying severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Design, Setting, and Participants: A diagnostic study was conducted from May to July 2020 at 2 tertiary care centers in Singapore with different reference swabs (FLOQSwab [COPAN Diagnostics] or Dacron swab [Deltalab]) and swab processing techniques (wet or dry) to evaluate the performance of the 3DP swab compared with traditional, standard-of-care nasopharyngeal swabs used in health care institutions. The participants were patients with COVID-19 in the first 2 weeks of illness and controls with acute respiratory illness with negative test results for SARS-CoV-2. Paired nasopharyngeal swabs were obtained from the same nostril and tested for SARS-CoV-2 by reverse-transcriptase polymerase chain reaction. The sequence of swabs was randomized based on odd and even participant numbers. Main Outcomes and Measures: Primary outcome measures were overall agreement (OA), positive percentage agreement (PPA), and negative percentage agreement of the 3DP swab compared with reference swabs. Secondary outcome measures were the correlation of cycle threshold (Ct) values of both swabs. Results: The mean (SD) age of participants was 45.4 (13.1) years, and most participants were men (87 of 89 [97.8%]), in keeping with the epidemiology of the COVID-19 pandemic in Singapore. A total of 79 patients with COVID-19 and 10 controls were recruited. Among the patients with COVID-19, the overall agreement and PPA of the 3DP swab was 91.1% and 93.5%, respectively, compared with reference swabs. The PPA was 100% for patients with COVID-19 who were tested within the first week of illness. All controls tested negative. The reverse-transcriptase polymerase chain reaction Ct values for the ORF1ab and E-gene targets showed a strong correlation (intraclass correlations coefficient, 0.869-0.920) between the 3DP and reference swab on independent testing at each institution despite differences in sample processing. Discordant results for both gene targets were observed only at high Ct values. Conclusions and Relevance: In this diagnostic study of 79 patients with COVID-19 and 10 controls, the 3DP swab performed accurately and consistently across health care institutions and could help mitigate strained resources in the escalating COVID-19 pandemic.


Subject(s)
COVID-19 Nucleic Acid Testing/instrumentation , COVID-19/diagnosis , Nasopharynx/virology , Printing, Three-Dimensional , Adult , Equipment Design , Humans , Middle Aged , Pandemics , SARS-CoV-2
16.
Ann Intern Med ; 174(2): 247-251, 2021 02.
Article in English | MEDLINE | ID: covidwho-1089165

ABSTRACT

Singapore is one of the most densely populated small island-states in the world. During the coronavirus disease 2019 (COVID-19) pandemic, Singapore implemented large-scale institutional isolation units called Community Care Facilities (CCFs) to combat the outbreak in the community by housing low-risk COVID-19 patients from April to August 2020. The CCFs were created rapidly by converting existing public spaces and used a protocolized system, augmented by telemedicine to enable a low health care worker-patient ratio (98 health care workers for 3200 beds), to operate these unique facilities. In the first month, a total of 3758 patients were admitted to 4 halls, 4929 in-house medical consults occurred, 136 patients were transferred to a hospital, 1 patient died 2 weeks after discharge, and no health care workers became infected. This article shares the authors' experience in operating these massive-scale isolation facilities while prioritizing safety for all and ensuring holistic patient care in the face of a public health crisis and lean health care resources.


Subject(s)
COVID-19/epidemiology , COVID-19/prevention & control , Facility Design and Construction , Quarantine , Humans , Pandemics , SARS-CoV-2 , Singapore/epidemiology , Telemedicine
17.
J Med Imaging Radiat Oncol ; 65(2): 139-145, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1085304

ABSTRACT

INTRODUCTION: We aimed to study anxiety and burnout among Division of Radiological Sciences (RADSC) staff during the COVID-19 pandemic and identify potential risk and protective factors. These outcomes were compared with non-RADSC staff. METHODS: A cross-sectional online study was conducted between 12 March and 20 July 2020 in the largest public tertiary hospital receiving COVID-19 cases. Burnout and anxiety were assessed with the Physician Work-Life Scale and the Generalized Anxiety Disorder-7 Scale, respectively. Workplace factors were examined as potential risk and protective factors using multivariable ordinary least squares regression analyses, adjusting for pertinent demographic characteristics. RESULTS: RADSC staff (n = 180) and non-RADSC staff (n = 1458) demonstrated moderate-to-severe anxiety rates of 6.7 and 13.2 % and burnout rates of 17.8 and 23.9 %, respectively. RADSC staff reported significantly lower anxiety (mean ± SD: 4.0 ± 3.7 vs 4.9 ± 4.5; P-value < 0.05), burnout (mean ± SD: 1.9 ± 0.7 vs 2.1 ± 0.8; P-value < 0.01), increased teamwork (82.2% vs 74.1%; P-value < 0.05) and fewer night shifts (36.7% vs 41.1%; P-value < 0.01). Among RADSC staff, higher job dedication was associated with lower anxiety (b (95% CI) = -0.28 (-0.45, -0.11)) and burnout (b (95% CI) = -0.07 (-0.11,-0.04)), while longer than usual working hours was associated with increased anxiety (b (95% CI) = 1.42 (0.36, 2.45)) and burnout (b (95% CI) = 0.28 (0.09, 0.48)). CONCLUSIONS: A proportion of RADSC staff reported significant burnout and anxiety, although less compared to the larger hospital cohort. Measures to prevent longer than usual work hours and increase feelings of enthusiasm and pride in one's job may further reduce the prevalence of anxiety problems and burnout in radiology departments.


Subject(s)
Anxiety Disorders/epidemiology , Burnout, Professional/epidemiology , COVID-19/psychology , Health Workforce/statistics & numerical data , Pandemics , Radiology Department, Hospital , Adult , Anxiety Disorders/psychology , Burnout, Professional/psychology , Cross-Sectional Studies , Female , Humans , Male , SARS-CoV-2 , Singapore
19.
Injury ; 51(10): 2135-2141, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-623925

ABSTRACT

BACKGROUND: As the COVID-19 pandemic sweeps across the world, healthcare departments must adapt to meet the challenges of service provision and staff/patient protection. Unlike elective surgery, acute care surgery (ACS) workloads cannot be artificially reduced providing a unique challenge for administrators to balance healthcare resources between the COVID-19 surge and regular patient admissions. METHODS: An enhanced ACS (eACS) model of care is described with the aim of limiting COVID-19 healthcare worker and patient cross-infection as well as providing 24/7 management of emergency general surgical (GS) and trauma patients. The eACS service comprised 5 independent teams covering a rolling 1:5 24-hr call. Attempts to completely separate eACS teams and patients from the elective side were made. The service was compared to the existing ACS service in terms of clinical and efficiency outcomes. Finally, a survey of staff attitudes towards these changes, concerns regarding COVID-19 and psychological well-being was assessed. RESULTS: There were no staff/patient COVID-19 cross-infections. Compared to the ACS service, eACS patients had reduced overall length of stay (2-days), time spent in the Emergency Room (46 min) and time from surgery to discharge (2.4-hours). The eACS model of care saved financial resources and bed-days for the organisation. The changes were well received by team-members who also felt that their safety was prioritised. CONCLUSION: In healthcare systems not overwhelmed by COVID-19, an eACS model may assist in preserving psychological well-being for healthcare staff whilst providing 24/7 care for emergency GS and trauma patients.


Subject(s)
Coronavirus Infections/prevention & control , Cross Infection/prevention & control , Delivery of Health Care/methods , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Surgery Department, Hospital/organization & administration , Surgical Procedures, Operative , Adult , Aged , Attitude of Health Personnel , Betacoronavirus , COVID-19 , Emergency Service, Hospital , Female , Health Personnel , Humans , Infection Control , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Length of Stay , Male , Medical Staff, Hospital/organization & administration , Middle Aged , SARS-CoV-2 , Workflow
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