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1.
Bone Joint J ; 102-B(6): 671-676, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-1724736

ABSTRACT

AIMS: The current pandemic caused by COVID-19 is the biggest challenge for national health systems for a century. While most medical resources are allocated to treat COVID-19 patients, several non-COVID-19 medical emergencies still need to be treated, including vertebral fractures and spinal cord compression. The aim of this paper is to report the early experience and an organizational protocol for emergency spinal surgery currently being used in a large metropolitan area by an integrated team of orthopaedic surgeons and neurosurgeons. METHODS: An organizational model is presented based on case centralization in hub hospitals and early management of surgical cases to reduce hospital stay. Data from all the patients admitted for emergency spinal surgery from the beginning of the outbreak were prospectively collected and compared to data from patients admitted for the same reason in the same time span in the previous year, and treated by the same integrated team. RESULTS: A total of 19 patients (11 males and eight females, with a mean age of 49.9 years (14 to 83)) were admitted either for vertebral fracture or spinal cord compression in a 19-day period, compared to the ten admitted in the previous year. No COVID-19 patients were treated. The mean time between admission and surgery was 1.7 days, significantly lower than 6.8 days the previous year (p < 0.001). CONCLUSION: The structural organization and the management protocol we describe allowed us to reduce the time to surgery and ultimately hospital stay, thereby maximizing the already stretched medical resources available. We hope that our early experience can be of value to the medical communities that will soon be in the same emergency situation. Cite this article: Bone Joint J 2020;102-B(6):671-676.


Subject(s)
Coronavirus Infections , Models, Organizational , Neurosurgical Procedures , Orthopedic Procedures , Pandemics , Patient Care Team/organization & administration , Pneumonia, Viral , Spinal Cord Compression/surgery , Spinal Fractures/surgery , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19 , Critical Pathways/organization & administration , Efficiency, Organizational , Emergencies , Female , Health Care Rationing/organization & administration , Hospitals, Urban , Humans , Italy , Length of Stay/statistics & numerical data , Male , Middle Aged , Outcome and Process Assessment, Health Care , Prospective Studies , Time-to-Treatment/statistics & numerical data , Young Adult
3.
Int J Environ Res Public Health ; 19(3)2022 01 30.
Article in English | MEDLINE | ID: covidwho-1686746

ABSTRACT

In this paper, the overall efficiency of health centers in Greece is measured by applying the input-oriented model of Data Envelopment Analysis. In addition, four different models were subjected to the input-oriented Data Envelopment Analysis to investigate the contribution of each category of human resources to the efficiency results of the health centers. The bootstrap technique was performed to generate confidence intervals for the models. Data for 155 health centers in Greece were provided by the Ministry of Health. The health centers submitted in the analysis obtained an average efficiency value of 0.932. The average results of the partial models in terms of each input show that the efficiency values achieved by the health centers are mostly influenced by the number of physicians and the number of managers employed. The second factor influencing the efficiency values of the health centers are the number of nursing staff occupied in the health centers. Non-medical staff employed in the health centers had the least contribution to the efficiencies measured. This paper provides important information for the stakeholders and the Government of Greece so as to better allocate the personnel employed in primary health care according to the efficiencies attained by the health centers.


Subject(s)
Efficiency, Organizational , Public Health , Greece , Humans , Workforce
4.
Am J Trop Med Hyg ; 106(2): 389-393, 2022 01 07.
Article in English | MEDLINE | ID: covidwho-1614120

ABSTRACT

In response to the COVID-19 pandemic, clinical research groups across the world developed trial protocols to evaluate the safety and efficacy of treatments for COVID-19. Despite this initial enthusiasm, only a small portion of these protocols were implemented. Of those implemented, a fraction successfully recruited their target sample size to analyze and disseminate findings. More than a year and a half into the COVID-19 pandemic, only a few clinical trials evaluating treatments for COVID-19 have generated new evidence. Productive randomized platform clinical trials evaluating COVID-19 treatments may attribute their success to intentional investments in developing resilient clinical trial infrastructures. Health system resiliency discourse provides a conceptual framework for characterizing attributes for withstanding shocks. This framework may also be useful for contextualizing the attributes of productive clinical trials evaluating COVID-19 therapies. We characterize the successful attributes and lessons learned in developing the TOGETHER Trial infrastructure using a health system resiliency framework. This framework may be considered by clinical trialists aiming to build resilient trial infrastructures capable of responding rapidly and efficiently to global health threats.


Subject(s)
COVID-19/drug therapy , COVID-19/therapy , Randomized Controlled Trials as Topic , Research Design , Delivery of Health Care/organization & administration , Efficiency, Organizational , Humans , SARS-CoV-2
5.
PLoS One ; 16(12): e0260798, 2021.
Article in English | MEDLINE | ID: covidwho-1599553

ABSTRACT

Despite remarkable academic efforts, why Enterprise Resource Planning (ERP) post-implementation success occurs still remains elusive. A reason for this shortage may be the insufficient addressing of an ERP-specific interior boundary condition, i.e., the multi-stakeholder perspective, in explaining this phenomenon. This issue may entail a gap between how ERP success is supposed to occur and how ERP success may actually occur, leading to theoretical inconsistency when investigating its causal roots. Through a case-based, inductive approach, this manuscript presents an ERP success causal network that embeds the overlooked boundary condition and offers a theoretical explanation of why the most relevant observed causal relationships may occur. The results provide a deeper understanding of the ERP success causal mechanisms and informative managerial suggestions to steer ERP initiatives towards long-haul success.


Subject(s)
Delivery of Health Care, Integrated/organization & administration , Efficiency, Organizational/standards , Financial Management, Hospital/methods , Health Care Rationing/standards , Health Resources/organization & administration , Hospital Information Systems/standards , Resource Allocation/methods , Humans , Planning Techniques , Software
7.
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
8.
Int J Environ Res Public Health ; 18(22)2021 11 18.
Article in English | MEDLINE | ID: covidwho-1534054

ABSTRACT

Healthcare systems internationally are working under increasing demand to use finite resources with greater efficiency. The drive for efficiency utilises process improvement methodologies such as Lean Six Sigma. This study outlines a pilot Lean Six Sigma intervention designed to release nursing time to care within a peri-operative environment; this was achieved by collaborating with stakeholders to redesign the process for laparoscopic hernia surgical case preparation (set up) material. Across 128 laparoscopic hernia surgical cases, the pilot resulted in a 55% decrease in overall nursing time spent in gathering and preparing materials for laparoscopic hernia surgical cases, with a corresponding reduction in packaging waste. The major impact of releasing nursing time to care within busy Operating Room environments enabled nurses to focus on continuing to deliver high-quality care to their patients and reduce pressure expressed by the Operating Room nurses. The results have led to an ongoing review of other surgical procedures preparation to further release nursing time and will be of interest to perioperative teams internationally.


Subject(s)
Operating Room Nursing , Total Quality Management , Efficiency, Organizational , Humans , Operating Rooms , Pilot Projects , Quality Improvement
12.
J Appl Psychol ; 106(8): 1118-1136, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1368909

ABSTRACT

While some organizations are thriving during the COVID-19 pandemic, many are experiencing a crisis-a threat to organizational longevity, time pressure, and inadequate resources. Building on prior work examining emotions during times of crisis and changes that people undergo during major life transitions, as well as media accounts suggesting that employees have had positive and negative emotions tied to aspects of working during COVID-19, we adopt a person-centric view to examine profiles of monthly emotions regarding organizational reopening. Additionally, we consider how employees transition from one profile of emotions to another across months. In so doing, we consider whether feelings of hope, gratitude, fear, and resentment co-occur for employees; how employees transition across profiles from one month to the next as a function of perceptions of organizational leaders' trustworthiness and their handling of the COVID-19 crisis; and how changes in profile membership relate to employee well-being, work outcomes, and prevention behaviors to avoid contracting COVID-19. Using 1,422 total measurements from August 2020 to November 2020 from employees at a single university during two monthly transitions with significant crisis-related events (i.e., return to in-person teaching, students living on campus, announcement of pay cuts and furloughs, and the subsequent announcement that some of those conditions would change), we identified four profiles of monthly emotions, with perceived leader trustworthiness and handling of the pandemic being critical features of why employees belonged to different profiles between August-September and October-November. Further, we found implications of monthly transitions for work and COVID-related outcomes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Subject(s)
COVID-19 , Efficiency, Organizational , Emotions , Pandemics , Adult , COVID-19/epidemiology , Female , Humans , Male
13.
Br J Hosp Med (Lond) ; 82(7): 1-4, 2021 Jul 02.
Article in English | MEDLINE | ID: covidwho-1337826

ABSTRACT

The NHS has always struggled to effectively adopt innovative medical technologies. A report by The Medical Technology Group argues that a new system for the widespread adoption of technology is needed. The report argues that, considering the growing backlog of procedures caused by the COVID-19 pandemic, medical technology can increase efficiency and deliver better outcomes for patients, while helping the NHS to recover.


Subject(s)
Biomedical Technology/organization & administration , COVID-19/epidemiology , Drug Industry/organization & administration , Efficiency, Organizational , Humans , Pandemics , Quality of Health Care , Quality of Life , SARS-CoV-2 , Systems Integration
15.
Ann Ig ; 33(5): 513-517, 2021.
Article in English | MEDLINE | ID: covidwho-1317344

ABSTRACT

Abstract: Starting from the minimum requirements indicated by Lombardy Region, a validation checklist has been developed by experts in design, healthcare layout planning, hygiene and public health, planning and compliance, in order to provide managers of COVID-19 massive vaccination centers with a useful and easy-to-use tool to ensure quality, safety and efficiency of the different activities performed.


Subject(s)
COVID-19 Vaccines , COVID-19/prevention & control , Community Health Centers/organization & administration , Mass Vaccination/organization & administration , SARS-CoV-2 , Validation Studies as Topic , COVID-19 Vaccines/supply & distribution , Checklist , Community Health Centers/standards , Efficiency, Organizational , Facility Design and Construction , Humans , Hygiene , Italy , Patient Safety , Quality Assurance, Health Care , Quality Indicators, Health Care
16.
Ann Ig ; 33(5): 499-512, 2021.
Article in English | MEDLINE | ID: covidwho-1317343

ABSTRACT

Abstract: After SARS-CoV-2 vaccines development came at an unprecedented speed, ensuring safe and efficient mass immunization, vaccine delivery be-came the major public health mandate. Although mass-vaccination sites have been identified as essential to curb COVID-19, their organization and functioning is challenging. In this paper we present the planning, implementation and evalua-tion of a massive vaccination center in Lombardy - the largest Region in Italy and the most heavily hit by the pandemic. The massive hub of Novegro (Milan), managed by the Gruppo Ospedaliero San Donato, opened in April 2021. The Novegro mass-immunization model was developed building a la-yout based on the available scientific evidence, on comparative analysis with other existing models and on the experience of COVID-19 immunization delivery of Gruppo Ospedaliero San Donato. We propose a "vaccine islands" mass-immunization model, where 4 physicians and 2 nurses operate in each island, with up to 10 islands functioning at the same time, with the capacity of providing up to 6,000 vaccinations per day. During the first week of activity a total of 37,900 doses were administered (2,700/day), most of them with Pfizer vaccine (85.8%) and first doses (70.9%). The productivity was 10.5 vaccines/hour/vaccine station. Quality, efficiency and safety were boosted by ad-hoc personnel training, quality technical infrastructure and the presence of a shock room. Constant process monitoring allowed to identify and promptly tackle process pitfalls, including vaccine refusals (0.36%, below expectations) and post-vaccinations adverse reactions (0.4%). Our innovative "vaccine islands" mass-immunization model might be scaled-up or adapted to other settings. The Authors consider that sharing best practices in immunization delivery is fundamen-tal to achieve population health during health emergencies.


Subject(s)
COVID-19/prevention & control , Community Health Centers/organization & administration , Mass Vaccination/organization & administration , Models, Theoretical , Pandemics , SARS-CoV-2 , COVID-19/epidemiology , COVID-19 Vaccines , Community Health Centers/statistics & numerical data , Efficiency, Organizational , Facilities and Services Utilization , Facility Design and Construction , Humans , Italy/epidemiology , Mass Vaccination/methods , Mass Vaccination/statistics & numerical data , Quality Improvement
17.
Epilepsy Res ; 176: 106689, 2021 10.
Article in English | MEDLINE | ID: covidwho-1303518

ABSTRACT

OBJECTIVE: The objective of this study is to assess the role of prior experience with virtual care (through e-visits) in maintaining continuity in ambulatory epilepsy care during an unprecedented pandemic situation, comparing in person versus e-visit clinic uptake. METHODS: This is an observational study on virtual epilepsy care (through e-visits) over two years, during a pre-COVID period (14 months) continuing into the COVID-19 pandemic period (10 months). For a small initial section of patients seen during the study period a physician survey and a patient satisfaction survey were completed (n = 53). Outcomes of eVisits were analyzed using descriptive statistics. RESULTS: Median numbers of epilepsy clinic visits conducted during the COVID-19 period (27.5 new and 113 follow up) remained similar to the median uptake during the pre-COVID period (28 new and 116 follow up). Prior experience with e-visits for epilepsy yielded smooth transition into the pandemic period, with several other advantages. The majority of eVisits were successful despite technical difficulties and major components of history and management were still easily implemented. Results from patient surveys supported that a significant amount of time and money were saved, which was in keeping with our health-economic analysis. CONCLUSION: Our study is one of the first few reports of fully integrated virtual care in a comprehensive epilepsy clinic starting much before start of the COVID-19 pandemic. The results of our study support the feasibility of using virtual care to deliver specialized outpatient care in a comprehensive epilepsy center.


Subject(s)
COVID-19/epidemiology , Epilepsy/therapy , Telemedicine/methods , User-Computer Interface , Adult , Aged , Efficiency, Organizational , Epilepsy/diagnosis , Epilepsy/economics , Female , Health Care Costs , Health Services Accessibility , Humans , Male , Medical History Taking/methods , Middle Aged , Ontario , Patient Satisfaction , Patient-Centered Care , Telemedicine/economics , Young Adult
18.
Am J Manag Care ; 27(6): 225-226, 2021 06.
Article in English | MEDLINE | ID: covidwho-1281052

ABSTRACT

OBJECTIVES: The COVID-19 pandemic has fundamentally changed the workflow of clinics. We applied Lean Six Sigma processes to optimize clinic workflow to reduce patient wait times and improve the patient experience. STUDY DESIGN: Prospective cohort study. METHODS: We implemented (1) pushing most extended wait times to the end of the workflow by rooming the patient directly and (2) using distractions during the waiting process by using educational videos and a timer for physician arrival in the patient exam room. We compared the patient wait times and subcomponents of Press Ganey scores as a surrogate for changes in patient experience and satisfaction from the preimplementation period (n = 277) to the 3-month (September 1, 2020, to November 30, 2020) postimplementation period (n = 218). RESULTS: There was a significant reduction in overall throughput time (38 vs 35 minutes) and wait before rooming (11 vs 8 minutes), and increased physician time with patients (15 vs 17 minutes) (P < .0001 for all). These results corresponded with a significant improvement in Press Ganey subcomponents of (1) waiting time in the exam room before being seen by the care provider, (2) degree to which you were informed about any delays, (3) wait time at clinic (from arriving to leaving), and (4) length of wait before going to an exam room (P < .001 for all). CONCLUSIONS: Simple, inexpensive measures can improve patient engagement and provide a safe setting for patients for clinic visits in the wake of COVID-19. In the future, clinics' common wait areas could be reappropriated to increase the number of clinic exam rooms.


Subject(s)
Ambulatory Care Facilities/standards , COVID-19/epidemiology , Efficiency, Organizational , Total Quality Management , Workflow , Humans , Pandemics , Patient Satisfaction , Pilot Projects , Pneumonia, Viral/epidemiology , Pneumonia, Viral/virology , Prospective Studies , SARS-CoV-2 , Waiting Lists
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