Subject(s)
Betacoronavirus/isolation & purification , Coronavirus Infections , Dementia , Hospitalization/statistics & numerical data , Pandemics , Patient Care Management , Pneumonia, Viral , Advance Directives/ethics , Advance Directives/statistics & numerical data , Aged, 80 and over , COVID-19 , Clinical Decision-Making/ethics , Comorbidity , Coronavirus Infections/epidemiology , Coronavirus Infections/psychology , Coronavirus Infections/therapy , Dementia/diagnosis , Dementia/epidemiology , Dementia/physiopathology , Dementia/therapy , Female , Hospital Mortality , Humans , Male , Mental Status and Dementia Tests , Nursing Homes/statistics & numerical data , Patient Care Management/ethics , Patient Care Management/methods , Pneumonia, Viral/epidemiology , Pneumonia, Viral/psychology , Pneumonia, Viral/therapy , SARS-CoV-2 , Severity of Illness Index , United States/epidemiologySubject(s)
COVID-19 , Emotional Intelligence , Neonatal Nursing , Patient Care Management , Physical Distancing , Adaptation, Psychological , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/psychology , Humans , Neonatal Nursing/ethics , Neonatal Nursing/methods , Neonatal Nursing/organization & administration , Organizational Innovation , Patient Care Management/ethics , Patient Care Management/trends , Resilience, Psychological , SARS-CoV-2Subject(s)
Coronavirus Infections , Dementia , Pandemics , Patient Care Management , Pneumonia, Viral , Problem Behavior , Aged , Betacoronavirus , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Coronavirus Infections/psychology , Dementia/epidemiology , Dementia/psychology , France/epidemiology , Humans , Infection Control/organization & administration , Needs Assessment , Organizational Innovation , Pandemics/ethics , Pandemics/prevention & control , Patient Care Management/ethics , Patient Care Management/organization & administration , Patient Care Management/trends , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Pneumonia, Viral/psychology , Public Health , SARS-CoV-2ABSTRACT
The COVID-19 pandemic has raised ethical questions for the cardiovascular leader and practitioner. Attention has been redirected from a system that focuses on individual patient benefit toward one that focuses on protecting society as a whole. Challenging resource allocation questions highlight the need for a clearly articulated ethics framework that integrates principled decision making into how different cardiovascular care services are prioritized. A practical application of the principles of harm minimisation, fairness, proportionality, respect, reciprocity, flexibility, and procedural justice is provided, and a model for prioritisation of the restoration of cardiovascular services is outlined. The prioritisation model may be used to determine how and when cardiovascular services should be continued or restored. There should be a focus on an iterative and responsive approach to broader health care system needs, such as other disease groups and local outbreaks.
Subject(s)
Cardiology Service, Hospital , Cardiovascular Diseases , Coronavirus Infections , Ethics, Institutional , Infection Control/methods , Pandemics , Patient Care Management , Pneumonia, Viral , Betacoronavirus/isolation & purification , COVID-19 , Canada/epidemiology , Cardiology Service, Hospital/organization & administration , Cardiology Service, Hospital/trends , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/therapy , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Humans , Models, Organizational , Organizational Innovation , Pandemics/prevention & control , Patient Care Management/ethics , Patient Care Management/methods , Patient Care Management/standards , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , SARS-CoV-2Subject(s)
Coronavirus Infections , General Practitioners , Pandemics , Patient Care Management , Patient Safety , Pneumonia, Viral , Betacoronavirus , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Coronavirus Infections/psychology , General Practitioners/ethics , General Practitioners/psychology , Humans , Pandemics/prevention & control , Patient Care Management/ethics , Patient Care Management/trends , Physician's Role , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Pneumonia, Viral/psychology , SARS-CoV-2Subject(s)
Clinical Trials as Topic , Coronavirus Infections , Data Accuracy , Pandemics , Patient Care Management , Pneumonia, Viral , Standard of Care , Betacoronavirus , COVID-19 , Clinical Decision-Making/ethics , Clinical Decision-Making/methods , Clinical Trials as Topic/methods , Clinical Trials as Topic/standards , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Humans , Needs Assessment , Outcome Assessment, Health Care , Patient Care Management/ethics , Patient Care Management/methods , Patient Care Management/organization & administration , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , SARS-CoV-2Subject(s)
Coronavirus Infections , Critical Care , Disabled Persons , Pandemics , Patient Care Management/ethics , Patient Selection/ethics , Pneumonia, Viral , Value of Life , Betacoronavirus/isolation & purification , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/psychology , Coronavirus Infections/therapy , Critical Care/ethics , Critical Care/methods , Critical Care/psychology , Helping Behavior , Humans , Pneumonia, Viral/epidemiology , Pneumonia, Viral/psychology , Pneumonia, Viral/therapy , Professionalism/ethics , Prognosis , SARS-CoV-2ABSTRACT
Older people are particularly affected by the COVID-19 outbreak because of their vulnerability as well as the complexity of health organisations, particularly in the often-compartmentalised interactions between community, hospital and nursing home actors. In this endemic situation, with massive flows of patients requiring holistic management including specific and intensive care, the appropriate assessment of each patient's level of care and the organisation of specific networks is essential. To that end, we propose here a territorial organisation of health care, favouring communication between all actors. This organisation of care is based on three key points: To use the basis of territorial organisation of health by facilitating the link between hospital settings and geriatric sectors at the regional level.To connect private, medico-social and hospital actors through a dedicated centralised unit for evaluation, geriatric coordination of care and decision support. A geriatrician coordinates this multidisciplinary unit. It includes an emergency room doctor, a supervisor from the medical regulation centre (Centre 15), an infectious disease physician, a medical hygienist and a palliative care specialist.To organise an ad hoc follow-up channel, including the necessary resources for the different levels of care required, according to the resources of the territorial network, and the creation of a specific COVID geriatric palliative care service. This organisation meets the urgent health needs of all stakeholders, facilitating its deployment and allows the sustainable implementation of a coordinated geriatric management dynamic between the stakeholders on the territory.