Front-line nurses' responses to organisational changes during the COVID-19 in Spain: A qualitative rapid appraisal.

AIMS: To identify the organisational changes faced by front-line nurses working with COVID-19 patients during the first wave and describe how they responded to these changes. BACKGROUND: The COVID-19 pandemic has altered the provision of care and the management of health care around the world. Evolving information about SARS-CoV-2 meant that health care facilities had to be reorganised continually, causing stress and anxiety for nurses. METHODS: Qualitative study based on Rapid Research Evaluation and Appraisal (RREAL). The research took place in hospital and community health settings of the Spanish national health system with a purposive sampling of 23 front-line nurses. Semi-structured interviews were conducted between May and June 2020. The duration was 30-45 min per interview. We used the Dedoose® data analysis software to perform a thematic analysis. RESULTS: Nurses responded to organisational changes using the following strategies: improvisation, adaptation and learning. CONCLUSION: Our rapid approach allowed us to record how nurses responded to changing organisation, information that is easily lost in a disaster such as the COVID-19. IMPLICATIONS FOR NURSING MANAGEMENT: Knowing about their strategies can help planning for future health disasters, including subsequent waves of the COVID-19.

Increased time from physiological derangement to critical care admission associates with mortality.

BACKGROUND: Rapid response systems aim to achieve a timely response to the deteriorating patient; however, the existing literature varies on whether timing of escalation directly affects patient outcomes. Prior studies have been limited to using 'decision to admit' to critical care, or arrival in the emergency department as 'time zero', rather than the onset of physiological deterioration. The aim of this study is to establish if duration of abnormal physiology prior to critical care admission ['Score to Door' (STD) time] impacts on patient outcomes. METHODS: A retrospective cross-sectional analysis of data from pooled electronic medical records from a multi-site academic hospital was performed. All unplanned adult admissions to critical care from the ward with persistent physiological derangement [defined as sustained high National Early Warning Score (NEWS) > / = 7 that did not decrease below 5] were eligible for inclusion. The primary outcome was critical care mortality. Secondary outcomes were length of critical care admission and hospital mortality. The impact of STD time was adjusted for patient factors (demographics, sickness severity, frailty, and co-morbidity) and logistic factors (timing of high NEWS, and out of hours status) utilising logistic and linear regression models. RESULTS: Six hundred and thirty-two patients were included over the 4-year study period, 16.3% died in critical care. STD time demonstrated a small but significant association with critical care mortality [adjusted odds ratio of 1.02 (95% CI 1.0-1.04, p = 0.01)]. It was also associated with hospital mortality (adjusted OR 1.02, 95% CI 1.0-1.04, p = 0.026), and critical care length of stay. Each hour from onset of physiological derangement increased critical care length of stay by 1.2%. STD time was influenced by the initial NEWS, but not by logistic factors such as out-of-hours status, or pre-existing patient factors such as co-morbidity or frailty. CONCLUSION: In a strictly defined population of high NEWS patients, the time from onset of sustained physiological derangement to critical care admission was associated with increased critical care and hospital mortality. If corroborated in further studies, this cohort definition could be utilised alongside the 'Score to Door' concept as a clinical indicator within rapid response systems.

[Strategy for planning and execution of a large-scale SARS-CoV-2 seroprevalence study on teaching hospital workers during a pandemic situation]. / Estrategia de planificación y ejecución de un estudio a gran escala de seroprevalencia de SARS-CoV-2 en trabajadores de un hospital universitario durante una situación de pandemia.

OBJECTIVE: To describe the planning and execution process of a massive seroprevalence study for SARS-CoV-2 in professionals of the Hospital Universitario Fundación Alcorcón (HUFA) (Spain). METHODS: A description is presented of the plan designed and developed at the HUFA for the execution of the extraction of the samples for serology from all the professionals who worked in the hospital between 14 and 29 April 2020. A descriptive analysis of the participation of the professionals in the study is carried out. Extraction areas, health personnel, and execution times were planned. A total of 2326 extractions were assigned to health personnel, the remaining extractions were assigned to workers from external companies. RESULTS: A total of 2641 workers (90.5%) out of 2918 candidates participated in the study. The professional category most analysed was nursing with 28.3% (n = 590). The percentage of compliance with schedule planning was 28.6%. Up to a maximum of 298 daily extractions were planned. The busiest day was the 4th day of the study with 399 extractions. CONCLUSIONS: The organising of such a large study, with a 100% coverage of those who worked in the hospital, and with such a great response from the workers involved, has led to obtaining results of high reliability in the seroprevalence study carried out. Although the percentage of participation was very high, the level of compliance with the planning was low.