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1.
Am J Surg ; 223(1): 176-181, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1568479

ABSTRACT

OBJECTIVES: Perioperative inefficiency can increase cost. We describe a process improvement initiative that addressed preoperative delays on an academic vascular surgery service. METHODS: First case vascular surgeries from July 2019-January 2020 were retrospectively reviewed for delays, defined as late arrival to the operating room (OR). A stakeholder group spearheaded by a surgeon-informaticist analyzed this process and implemented a novel electronic medical records (EMR) preoperative tool with improved preoperative workflow and role delegation; results were reviewed for 3 months after implementation. RESULTS: 57% of cases had first case on-time starts with average delay of 19 min. Inappropriate preoperative orders were identified as a dominant delay source (average delay = 38 min). Three months post-implementation, 53% of first cases had on-time starts with average delay of 11 min (P < 0.05). No delays were due to missing orders. CONCLUSIONS: Inconsistent preoperative workflows led to inappropriate orders and delays, increasing cost and decreasing quality. A novel EMR tool subsequently reduced delays with projected savings of $1,200/case. Workflow standardization utilizing informatics can increase efficiency, raising the value of surgical care.


Subject(s)
Cost Savings/statistics & numerical data , Efficiency, Organizational/economics , Medical Informatics , Operating Rooms/organization & administration , Vascular Surgical Procedures/organization & administration , Academic Medical Centers/economics , Academic Medical Centers/organization & administration , Academic Medical Centers/statistics & numerical data , Efficiency, Organizational/standards , Efficiency, Organizational/statistics & numerical data , Health Plan Implementation/organization & administration , Health Plan Implementation/statistics & numerical data , Humans , Operating Rooms/economics , Operating Rooms/standards , Operating Rooms/statistics & numerical data , Practice Guidelines as Topic , Program Evaluation , Quality Improvement , Retrospective Studies , Root Cause Analysis/statistics & numerical data , Vascular Surgical Procedures/economics , Vascular Surgical Procedures/statistics & numerical data , Workflow
2.
Ann Intern Med ; 174(12): 1727-1732, 2021 12.
Article in English | MEDLINE | ID: covidwho-1497806

ABSTRACT

Biorepositories provide a critical resource for gaining knowledge of emerging infectious diseases and offer a mechanism to rapidly respond to outbreaks; the emergence of the novel coronavirus, SARS-CoV-2, has proved their importance. During the COVID-19 pandemic, the absence of centralized, national biorepository efforts meant that the onus fell on individual institutions to establish sample repositories. As a safety-net hospital, Boston Medical Center (BMC) recognized the importance of creating a COVID-19 biorepository to both support critical science at BMC and ensure representation in research for its urban patient population, most of whom are from underserved communities. This article offers a realistic overview of the authors' experience in establishing this biorepository at the onset of the COVID-19 pandemic during the height of the first surge of cases in Boston, Massachusetts, with the hope that the challenges and solutions described are useful to other institutions. Going forward, funders, policymakers, and infectious disease and public health communities must support biorepository implementation as an essential element of future pandemic preparedness.


Subject(s)
Academic Medical Centers/organization & administration , COVID-19/prevention & control , Infection Control/methods , Pandemics , Specimen Handling , Boston , Humans , SARS-CoV-2 , Safety-net Providers , Urban Population
3.
Acad Med ; 96(11): 1507-1512, 2021 11 01.
Article in English | MEDLINE | ID: covidwho-1493989

ABSTRACT

The harsh realities of racial inequities related to COVID-19 and civil unrest following police killings of unarmed Black men and women in the United States in 2020 heightened awareness of racial injustices around the world. Racism is deeply embedded in academic medicine, yet the nobility of medicine and nursing has helped health care professionals distance themselves from racism. Vanderbilt University Medical Center (VUMC), like many U.S. academic medical centers, affirmed its commitment to racial equity in summer 2020. A Racial Equity Task Force was charged with identifying barriers to achieving racial equity at the medical center and medical school and recommending key actions to rectify long-standing racial inequities. The task force, composed of students, staff, and faculty, produced more than 60 recommendations, and its work brought to light critical areas that need to be addressed in academic medicine broadly. To dismantle structural racism, academic medicine must: (1) confront medicine's racist past, which has embedded racial inequities in the U.S. health care system; (2) develop and require health care professionals to possess core competencies in the health impacts of structural racism; (3) recognize race as a sociocultural and political construct, and commit to debiologizing its use; (4) invest in benefits and resources for health care workers in lower-paid roles, in which racial and ethnic minorities are often overrepresented; and (5) commit to antiracism at all levels, including changing institutional policies, starting at the executive leadership level with a vision, metrics, and accountability.


Subject(s)
Academic Medical Centers/ethics , COVID-19/ethnology , Minority Groups/statistics & numerical data , Racism/ethnology , Schools, Medical/statistics & numerical data , Academic Medical Centers/organization & administration , African Americans/ethnology , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/virology , Delivery of Health Care/ethics , Female , Health Personnel/ethics , Humans , Male , SARS-CoV-2/genetics , Schools, Medical/ethics , United States/epidemiology
4.
Acad Med ; 96(11): 1546-1552, 2021 11 01.
Article in English | MEDLINE | ID: covidwho-1493981

ABSTRACT

Racially and ethnically diverse and socioeconomically disadvantaged communities have historically been disproportionately affected by disasters and public health emergencies in the United States. The U.S. Department of Health and Human Services' Office of Minority Health established the National Consensus Panel on Emergency Preparedness and Cultural Diversity to provide guidance to agencies and organizations on developing effective strategies to advance emergency preparedness and eliminate disparities among racially and ethnically diverse communities during these crises. Adopting the National Consensus Panel recommendations, the Johns Hopkins Medicine Office of Diversity, Inclusion, and Health Equity; Language Services; and academic-community partnerships used existing health equity resources and expertise to develop an operational framework to support the organization's COVID-19 response and to provide a framework of health equity initiatives for other academic medical centers. This operational framework addressed policies to support health equity patient care and clinical operations, accessible COVID-19 communication, and staff and community support and engagement, which also supported the National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care. Johns Hopkins Medicine identified expanded recommendations for addressing institutional policy making and capacity building, including unconscious bias training for resource allocation teams and staff training in accurate race, ethnicity, and language data collection, that should be considered in future updates to the National Consensus Panel's recommendations.


Subject(s)
Academic Medical Centers/organization & administration , COVID-19/ethnology , Disasters/prevention & control , Health Equity/standards , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/virology , Civil Defense/organization & administration , Consensus , Cultural Diversity , Government Programs/organization & administration , Government Programs/standards , Healthcare Disparities/ethnology , Humans , Minority Groups/statistics & numerical data , Policy Making , Public Health/standards , SARS-CoV-2/genetics , Social Participation , Socioeconomic Factors , United States/epidemiology
5.
Crit Care Med ; 49(10): 1739-1748, 2021 10 01.
Article in English | MEDLINE | ID: covidwho-1475872

ABSTRACT

OBJECTIVES: The coronavirus disease 2019 pandemic has overwhelmed healthcare resources even in wealthy nations, necessitating rationing of limited resources without previously established crisis standards of care protocols. In Massachusetts, triage guidelines were designed based on acute illness and chronic life-limiting conditions. In this study, we sought to retrospectively validate this protocol to cohorts of critically ill patients from our hospital. DESIGN: We applied our hospital-adopted guidelines, which defined severe and major chronic conditions as those associated with a greater than 50% likelihood of 1- and 5-year mortality, respectively, to a critically ill patient population. We investigated mortality for the same intervals. SETTING: An urban safety-net hospital ICU. PATIENTS: All adults hospitalized during April of 2015 and April 2019 identified through a clinical database search. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of 365 admitted patients, 15.89% had one or more defined chronic life-limiting conditions. These patients had higher 1-year (46.55% vs 13.68%; p < 0.01) and 5-year (50.00% vs 17.22%; p < 0.01) mortality rates than those without underlying conditions. Irrespective of classification of disease severity, patients with metastatic cancer, congestive heart failure, end-stage renal disease, and neurodegenerative disease had greater than 50% 1-year mortality, whereas patients with chronic lung disease and cirrhosis had less than 50% 1-year mortality. Observed 1- and 5-year mortality for cirrhosis, heart failure, and metastatic cancer were more variable when subdivided into severe and major categories. CONCLUSIONS: Patients with major and severe chronic medical conditions overall had 46.55% and 50.00% mortality at 1 and 5 years, respectively. However, mortality varied between conditions. Our findings appear to support a crisis standards protocol which focuses on acute illness severity and only considers underlying conditions carrying a greater than 50% predicted likelihood of 1-year mortality. Modifications to the chronic lung disease, congestive heart failure, and cirrhosis criteria should be refined if they are to be included in future models.


Subject(s)
COVID-19/therapy , Crisis Intervention/standards , Resource Allocation/methods , Academic Medical Centers/organization & administration , Academic Medical Centers/statistics & numerical data , Adult , COVID-19/epidemiology , Crisis Intervention/methods , Crisis Intervention/statistics & numerical data , Female , Hospitalization/statistics & numerical data , Humans , Male , Massachusetts , Middle Aged , Resource Allocation/statistics & numerical data , Retrospective Studies , Safety-net Providers/organization & administration , Safety-net Providers/statistics & numerical data , Standard of Care/standards , Standard of Care/statistics & numerical data , Urban Population/statistics & numerical data
6.
Am J Emerg Med ; 53: 285.e1-285.e5, 2022 03.
Article in English | MEDLINE | ID: covidwho-1432719

ABSTRACT

STUDY OBJECTIVES: COVID-19 brought unique challenges; however, it remains unclear what effect the pandemic had on violence in healthcare. The objective of this study was to identify the impact of the pandemic on workplace violence at an academic emergency department (ED). METHODS: This mixed-methods study involved a prospective descriptive survey study and electronic medical record review. Within our hospital referral region (HRR), the first COVID-19 case was documented on 3/11/2020 and cases peaked in mid-November 2020. We compared the monthly HRR COVID-19 case rate per 100,000 people to the rate of violent incidents per 1000 ED visits. Multidisciplinary ED staff were surveyed both pre/early-pandemic (April 2020) and mid/late-pandemic (December 2020) regarding workplace violence experienced over the prior 6-months. The study was deemed exempt by the Mayo Clinic Institutional Review Board. RESULTS: There was a positive association between the monthly HRR COVID-19 case rate and rate of violent ED incidents (r = 0.24). Violent incidents increased overall during the pandemic (2.53 incidents per 1000 visits) compared to the 3 months prior (1.13 incidents per 1000 visits, p < .001), as well as compared to the previous year (1.24 incidents per 1000 patient visits, p < .001). Survey respondents indicated a higher incidence of assault during the pandemic, compared to before (p = .019). DISCUSSION: Incidents of workplace violence at our ED increased during the pandemic and there was a positive association of these incidents with the COVID-19 case rate. Our findings indicate health systems should prioritize employee safety during future pandemics.


Subject(s)
COVID-19/psychology , Emergency Service, Hospital/statistics & numerical data , Workplace Violence/statistics & numerical data , Academic Medical Centers/organization & administration , Academic Medical Centers/statistics & numerical data , Adult , COVID-19/prevention & control , COVID-19/transmission , Chi-Square Distribution , Crime Victims/rehabilitation , Data Mining/statistics & numerical data , Emergency Service, Hospital/organization & administration , Female , Health Personnel/psychology , Health Personnel/statistics & numerical data , Humans , Male , Middle Aged , Prospective Studies , Surveys and Questionnaires , Workplace Violence/trends
9.
Am J Health Syst Pharm ; 77(19): 1598-1605, 2020 09 18.
Article in English | MEDLINE | ID: covidwho-1317904

ABSTRACT

PURPOSE: To describe our medical center's pharmacy services preparedness process and offer guidance to assist other institutions in preparing for surges of critically ill patients such as those experienced during the coronavirus disease 2019 (COVID-19) pandemic. SUMMARY: The leadership of a department of pharmacy at an urban medical center in the US epicenter of the COVID-19 pandemic proactively created a pharmacy action plan in anticipation of a surge in admissions of critically ill patients with COVID-19. It was essential to create guidance documents outlining workflow, provide comprehensive staff education, and repurpose non-intensive care unit (ICU)-trained clinical pharmacotherapy specialists to work in ICUs. Teamwork was crucial to ensure staff safety, develop complete scheduling, maintain adequate drug inventory and sterile compounding, optimize the electronic health record and automated dispensing cabinets to help ensure appropriate prescribing and effective management of medication supplies, and streamline the pharmacy workflow to ensure that all patients received pharmacotherapeutic regimens in a timely fashion. CONCLUSION: Each hospital should view the COVID-19 crisis as an opportunity to internally review and enhance workflow processes, initiatives that can continue even after the resolution of the COVID-19 pandemic.


Subject(s)
COVID-19/drug therapy , Medication Therapy Management/organization & administration , Pharmacy Service, Hospital/organization & administration , Practice Guidelines as Topic , Academic Medical Centers/organization & administration , Academic Medical Centers/standards , COVID-19/epidemiology , Hospitals, Urban/organization & administration , Hospitals, Urban/standards , Humans , Leadership , New York/epidemiology , Pandemics/prevention & control , Personnel Staffing and Scheduling/organization & administration , Personnel Staffing and Scheduling/standards , Pharmacists/organization & administration , Pharmacy Service, Hospital/standards , Tertiary Care Centers/organization & administration , Tertiary Care Centers/standards , Workflow , Workforce/organization & administration , Workforce/standards
10.
Acad Med ; 96(11): 1560-1563, 2021 11 01.
Article in English | MEDLINE | ID: covidwho-1310946

ABSTRACT

PROBLEM: American Indians and Alaska Natives hold a state-conferred right to health, yet significant health and health care disparities persist. Academic medical centers are resource-rich institutions committed to public service, yet few are engaged in responsive, equitable, and lasting tribal health partnerships to address these challenges. APPROACH: Maniilaq Association, a rural and remote tribal health organization in Northwest Alaska, partnered with Massachusetts General Hospital and Harvard Medical School to address health care needs through physician staffing, training, and quality improvement initiatives. This partnership, called Siamit, falls under tribal governance, focuses on supporting community health leaders, addresses challenges shaped by extreme geographic remoteness, and advances the mission of academic medicine in the context of tribal health priorities. OUTCOMES: Throughout the 2019-2020 academic year, Siamit augmented local physician staffing, mentored health professions trainees, provided continuing medical education courses, implemented quality improvement initiatives, and provided clinical care and operational support during the COVID-19 pandemic. Siamit began with a small budget and limited human resources, demonstrating that relatively small investments in academic-tribal health partnerships can support meaningful and positive outcomes. NEXT STEPS: During the 2020-2021 academic year, the authors plan to expand Siamit's efforts with a broader social medicine curriculum, additional attending staff, more frequent trainee rotations, an increasingly robust mentorship network for Indigenous health professions trainees, and further study of the impact of these efforts. Such partnerships may be replicable in other settings and represent a significant opportunity to advance community health priorities, strengthen tribal health systems, support the next generation of Indigenous health leaders, and carry out the academic medicine mission of teaching, research, and service.


Subject(s)
Academic Medical Centers/organization & administration , COVID-19/prevention & control , Education, Medical, Continuing/organization & administration , Healthcare Disparities/ethnology , Intersectoral Collaboration , Alaska/epidemiology , Alaskan Natives/ethnology , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/virology , Curriculum , Health Services Needs and Demand , Humans , Indians, North American/ethnology , Public Health/trends , Quality Improvement/standards , Rural Population , SARS-CoV-2/growth & development , Workforce
11.
Nurs Leadersh (Tor Ont) ; 34(2): 39-44, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1290742

ABSTRACT

The rapid cadence of change and the fear of acquiring and spreading COVID-19 - coupled with moral distress exacerbated by fulfilling one's duty to care under extremely challenging conditions - continue to impact nurses' coping ability, resilience and psychological safety globally (McDougall et al. 2020). This paper provides an overview of how an academic health sciences centre (AHSC) has responded to the evolving waves of the COVID-19 pandemic. Specifically, we share our context and the strategies we used to build and enhance nurse resilience and psychological safety at the organizational, clinical team and individual levels. This is followed by a description of our nurses' achievements amid the pandemic.


Subject(s)
Adaptation, Psychological , COVID-19/nursing , Nursing Staff, Hospital/organization & administration , Resilience, Psychological , Academic Medical Centers/organization & administration , COVID-19/epidemiology , Humans , Leadership , Nursing Staff, Hospital/psychology , Pandemics , Patient Care Team/organization & administration , SARS-CoV-2
12.
J Wound Ostomy Continence Nurs ; 47(5): 459-469, 2020.
Article in English | MEDLINE | ID: covidwho-1270772

ABSTRACT

PURPOSE: The purpose of this study was to describe medical device-related pressure injuries (MDRPIs) in hospitalized pediatric patients. DESIGN: A prospective, descriptive study. SAMPLE/SUBJECTS AND SETTING: The sample comprised 625 patients cared for in 8 US pediatric hospitals. Participants were aged preterm to 21 years, on bed rest for at least 24 hours, and had a medical device in place. METHODS: Two nursing teams, blinded to the other's assessments, worked in tandem to assess pressure injury risk, type of medical devices in use, and preventive interventions for each medical device. They also identified the presence, location, and stage of MDRPI. Subjects were observed up to 8 times over 4 weeks, or until discharge, whichever occurred first. RESULTS: Of 625 enrolled patients, 42 (7%) developed 1 or more MDRPIs. Two-thirds of patients with MDRPIs were younger than 8 years. Patients experiencing MDRPIs had higher acuity scores on hospital admission, were more frequently cognitively and/or functionally impaired, or were extreme in body mass index. Respiratory devices caused the most injuries (6.19/1000 device-days), followed by immobilizers (2.40/1000 device-days), gastric tubes (2.24/1000 device-days), and external monitoring devices (1.77/1000 device-days). Of the 6336 devices in place, 36% did not have an MDRPI preventive intervention in place. Clinical variables contributing to MDRPI development included intensive care unit care (odds ratio [OR] 8.9, 95% confidence interval [CI] 1.9-43.6), use of neuromuscular blockade (OR 3.7, 95% CI 1.7-7.8), and inotropic/vasopressor medications (OR 2.7, 95% CI 1.7-4.3). Multivariable analysis indicated that Braden QD scores alone predicted MDRPI development. CONCLUSION: Medical devices are common in hospitalized infants and children and these medical devices place patients at risk for MDRPI.


Subject(s)
Equipment and Supplies/standards , Pressure Ulcer/therapy , Academic Medical Centers/organization & administration , Academic Medical Centers/statistics & numerical data , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/complications , COVID-19/prevention & control , Equipment and Supplies/statistics & numerical data , Female , Humans , Male , Middle Aged , Pediatrics/instrumentation , Pediatrics/statistics & numerical data , Pressure Ulcer/prevention & control , Prospective Studies , Risk Assessment/methods , Risk Factors
13.
JAMA Netw Open ; 4(6): e2113539, 2021 06 01.
Article in English | MEDLINE | ID: covidwho-1269080

ABSTRACT

Importance: How the COVID-19 pandemic has affected academic medicine faculty's work-life balance is unknown. Objective: To assess the association of perceived work-life conflict with academic medicine faculty intention to leave, reducing employment to part time, or declining leadership opportunities before and since the COVID-19 pandemic. Design, Settings, and Participants: An anonymous online survey of medical, graduate, and health professions school faculty was conducted at a single large, urban academic medical center between September 1 and September 25, 2020. Main Outcomes and Measures: Self-assessed intention to leave, reducing employment to part time, or turning down leadership opportunities because of work-life conflict before and since the COVID-19 pandemic. Results: Of the 1186 of 3088 (38%) of faculty members who answered the survey, 649 (55%) were women and 682 (58%) were White individuals. Respondents were representative of the overall faculty demographic characteristics except for an overrepresentation of female faculty respondents and underrepresentation of Asian faculty respondents compared with all faculty (female faculty: 649 [55%] vs 1368 [44%]; Asian faculty: 259 [22%] vs 963 [31%]). After the start of the COVID-19 pandemic, faculty were more likely to consider leaving or reducing employment to part time compared with before the pandemic (leaving: 225 [23%] vs 133 [14%]; P < .001; reduce hours: 281 [29%] vs 206 [22%]; P < .001). Women were more likely than men to reduce employment to part time before the COVID-19 pandemic (153 [28%] vs 44 [12%]; P < .001) and to consider both leaving or reducing employment to part time since the COVID-19 pandemic (leaving: 154 [28%] vs 56 [15%]; P < .001; reduce employment: 215 [40%] vs 49 [13%]; P < .001). Faculty with children were more likely to consider leaving and reducing employment since the COVID-19 pandemic compared with before the pandemic (leaving: 159 [29%] vs 93 [17%]; P < .001; reduce employment: 213 [40%] vs 130 [24%]; P < .001). Women with children compared with women without children were also more likely to consider leaving since the COVID-19 pandemic than before (113 [35%] vs 39 [17%]; P < .001). Working parent faculty and women were more likely to decline leadership opportunities both before (faculty with children vs without children: 297 [32%] vs 84 [9%]; P < .001; women vs men: 206 [29%] vs 47 [13%]; P < .001) and since the COVID-19 pandemic (faculty with children vs faculty without children: 316 [34%] vs 93 [10 %]; P < .001; women vs men: 148 [28%] vs 51 [14%]; P < .001). Conclusions and Relevance: In this survey study, the perceived stressors associated with work-life integration were higher in women than men, were highest in women with children, and have been exacerbated by the COVID-19 pandemic. The association of both gender and parenting with increased perceived work-life stress may disproportionately decrease the long-term retention and promotion of junior and midcareer women faculty.


Subject(s)
COVID-19/psychology , Faculty, Medical/psychology , Perception , Work-Life Balance/standards , Academic Medical Centers/organization & administration , Academic Medical Centers/statistics & numerical data , Adult , COVID-19/prevention & control , Faculty, Medical/statistics & numerical data , Female , Humans , Job Satisfaction , Male , Middle Aged , Schools, Medical/organization & administration , Schools, Medical/standards , Schools, Medical/statistics & numerical data , Surveys and Questionnaires , Texas , Work-Life Balance/statistics & numerical data
14.
Acad Med ; 96(11): 1529-1533, 2021 11 01.
Article in English | MEDLINE | ID: covidwho-1226568

ABSTRACT

The COVID-19 crisis has seriously affected academic medical centers (AMCs) on multiple levels. Combined with many trends that were already under way pre pandemic, the current situation has generated significant disruption and underscored the need for change within and across AMCs. In this article, the authors explore some of the major issues and propose actionable solutions in 3 areas of concentration. First, the impact on medical students is considered, particularly the trade-offs associated with online learning and the need to place greater pedagogical emphasis on virtual care delivery and other skills that will be increasingly in demand. Solutions described include greater utilization of technology, building more public health knowledge into the curriculum, and partnering with a wide range of academic disciplines. Second, leadership recruiting, vital to long-term success for AMCs, has been complicated by the crisis. Pressures discussed include adapting to the dynamics of competitive physician labor markets as well as attracting candidates with the skill sets to meet the requirements of a shifting AMC leadership landscape. Solutions proposed in this domain include making search processes more focused and streamlined, prioritizing creativity and flexibility as core management capabilities to be sought, and enhancing efforts with assistance from outside advisors. Finally, attention is devoted to the severe financial impact wrought by the pandemic, creating challenges whose resolution is central to planning future AMC directions. Specific challenges include recovery of lost clinical revenue and cash flow, determining how to deal with research funding, and the precarious economic balancing act engendered by the need to continue distance education. A full embrace of telehealth, collaborative policy-making among the many AMC constituencies, and committing fully to being in the vanguard of the transition to value-based care form the solution set offered.


Subject(s)
Academic Medical Centers/organization & administration , COVID-19/psychology , Delivery of Health Care/trends , Students, Medical/psychology , Academic Medical Centers/economics , Biomedical Technology/instrumentation , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/virology , Competency-Based Education/methods , Creativity , Education, Distance/methods , Education, Medical, Graduate/economics , Humans , Leadership , Policy Making , SARS-CoV-2/genetics , Telemedicine
16.
Disaster Med Public Health Prep ; 14(6): 792-795, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-1174601

ABSTRACT

In response to the rapid spread of novel coronavirus disease 2019 (COVID-19), health-care systems should establish procedures for early recognition and management of suspected or confirmed cases. We describe the various steps taken for the development, implementation, and dissemination of the interdisciplinary COVID-19 protocol at Jackson Health System (JHS), a complex tertiary academic health system in Miami, Florida. Recognizing the dynamic nature of COVID-19, the protocol addresses the potential investigational treatment options and considerations for special populations. The protocol also includes infection prevention and control measures and routine care for suspected or proven COVID-19 patients.


Subject(s)
Academic Medical Centers/organization & administration , COVID-19/epidemiology , Clinical Protocols , Infection Control/organization & administration , COVID-19/diagnosis , COVID-19/therapy , Humans , Inservice Training , SARS-CoV-2
17.
Nurs Adm Q ; 45(2): 126-134, 2021.
Article in English | MEDLINE | ID: covidwho-1165559

ABSTRACT

This article describes how a national nursing association and a major academic medical center responded to the coronavirus disease-2019 (COVID-19) pandemic during the first wave of the outbreak in the United States (January to August 2020). The organizations share their lived experiences as they quickly found themselves at the forefront of the crisis. The article discusses how early warning signs from a world away sparked collaboration, innovation, and action that grew to a coordinated, organization-wide response. It also explores how leaders in 2 distinct but interrelated environments rose to the challenge to leverage the best their organizations had to offer, relying on the expertise of each to navigate changes that were made to almost every aspect of work. From tentative first steps to rapid implementation of innovative policies and procedures, the organizations share lessons learned and benefits reaped. The article includes practical crisis response strategies for the nursing profession and health care systems moving forward.


Subject(s)
Academic Medical Centers/organization & administration , American Nurses' Association/organization & administration , COVID-19/epidemiology , Delivery of Health Care/organization & administration , Leadership , Capacity Building/organization & administration , Humans , New York City/epidemiology , Pandemics , SARS-CoV-2
18.
Nurs Adm Q ; 45(2): 114-117, 2021.
Article in English | MEDLINE | ID: covidwho-1165553

ABSTRACT

The COVID-19 pandemic has affected millions of Americans, including health care staff. This article traces the experience of 1 nurse leader as she falls ill, only to learn that she has, indeed, been infected with the virus. She describes her 4-week quarantine, including the impact on her family and her attempts to continue to support her staff. As she recovers from the acute onslaught of COVID, the focus shifts back to her nurse leader role. In this role, she and her colleagues manage the logistics of caring for more than 150 COVID-positive patients a day in the 719-bed academic medical center. This included staffing the hospital, given the extreme challenges of staff availability limited by concerns such as school closings and at-risk family members. Now with the hospital's daily volume of COVID-positive patients greatly reduced, there is an opportunity to reflect on lessons learned, including what went well during the peak of the crisis and where there were opportunities. Leadership and staff are experiencing a sense of pride at their exceptional care of this complex population, even while exploring opportunities to be even better prepared should COVID erupt once again.


Subject(s)
COVID-19/nursing , Nursing Staff, Hospital/organization & administration , Academic Medical Centers/organization & administration , COVID-19/epidemiology , COVID-19/physiopathology , Female , Humans , Leadership , Pandemics , Quarantine , SARS-CoV-2
19.
Acad Med ; 96(7): 1005-1009, 2021 07 01.
Article in English | MEDLINE | ID: covidwho-1165513

ABSTRACT

PROBLEM: The COVID-19 pandemic has challenged health care systems in an unprecedented way by imposing new demands on health care resources and scientific knowledge. There has also been an exceedingly fast accumulation of new information on this novel virus. As the traditional peer-review process takes time, there is currently a significant gap between the ability to generate new data and the ability to critically evaluate them. This problem of an excess of mixed-quality data, or infodemic, is echoing throughout the scientific community. APPROACH: The authors aimed to help their colleagues at the Rambam Medical Center, Haifa, Israel, manage the COVID-19 infodemic with a methodologic solution: establishing an in-house mechanism for continuous literature review and knowledge distribution (March-April 2020). Their methodology included the following building blocks: a dedicated literature review team, artificial intelligence-based research algorithms, brief written updates in a graphical format, large-scale webinars and online meetings, and a feedback loop. OUTCOMES: During the first month (April 2020), the project produced 21 graphical updates. After consideration of feedback from colleagues and final editing, 13 graphical updates were uploaded to the center's website; of these, 31% addressed the clinical presentation of the disease and 38% referred to specific treatments. This methodology as well as the graphical updates it generated were adopted by the Israeli Ministry of Health and distributed in a hospital preparation kit. NEXT STEPS: The authors believe they have established a novel methodology that can assist in the battle against COVID-19 by making high-quality scientific data more accessible to clinicians. In the future, they expect this methodology to create a favorable uniform standard for evidence-guided health care during infodemics. Further evolution of the methodology may include evaluation of its long-term sustainability and impact on the day-to-day clinical practice and self-confidence of clinicians who treat COVID-19 patients.


Subject(s)
Academic Medical Centers , Biomedical Research , COVID-19 , Evidence-Based Practice/methods , Information Dissemination/methods , Information Services , Review Literature as Topic , Academic Medical Centers/methods , Academic Medical Centers/organization & administration , Artificial Intelligence , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/therapy , Disease Outbreaks , Evidence-Based Practice/organization & administration , Humans , Information Services/organization & administration , Israel/epidemiology , Peer Review, Research
20.
Acad Med ; 96(7): 974-978, 2021 07 01.
Article in English | MEDLINE | ID: covidwho-1153257

ABSTRACT

The COVID-19 pandemic has disrupted medical research, pushing mentors and mentees to decide if COVID-19 research would be germane to the early career investigator's developing research portfolio. With COVID-19 halting hundreds of federal trials involving non-COVID-19 research, mentors and mentees must also consider the broader moral calling of contributing to COVID-19 research. At the time of writing, the National Institutes of Health had responded to the pandemic with significant funding for COVID-19 research. However, because this pandemic is a new phenomenon, few mentors have expertise in the disease and relevant established resources. As a result, many mentors are unable to provide insight on COVID-19 research to early career investigators considering a pivot toward research related to this disease. The authors suggest 4 ways for mentees and mentors to respond to the changes the pandemic has brought to research funding and opportunities: (1) include COVID-19 research in existing portfolios to diversify intellectual opportunities and reduce funding risks; (2) negotiate the mentor-mentee relationship and roles and expectations early in project discussions-considering, as relevant, the disproportionate burden of home responsibilities often borne by early career faculty members who are women and/or from a minority group; (3) address any mentor limitations in content expertise; and (4) if the decision is to pivot to COVID-19 research, select projects with implications generalizable beyond this pandemic to other infectious outbreaks or to the redesign of health care delivery. Mentors and mentees must weigh the relevance of COVID-19 research projects to the postpandemic world and the amount of available funding against the developing interests of early career investigators. Academic medical centers nationwide must enable seasoned and early career researchers to contribute meaningfully to COVID-19 and non-COVID-19 research.


Subject(s)
Biomedical Research , COVID-19 , Career Choice , Decision Making , Faculty, Medical , Mentoring , Mentors , Academic Medical Centers/organization & administration , Biomedical Research/methods , Biomedical Research/organization & administration , Faculty, Medical/organization & administration , Faculty, Medical/psychology , Humans , Interprofessional Relations , Mentoring/methods , Mentoring/organization & administration , Mentors/psychology , Research Support as Topic , United States
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