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1.
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
2.
J Med Microbiol ; 70(12)2021 Dec.
Article in English | MEDLINE | ID: covidwho-1570171

ABSTRACT

Introduction. During the early days of coronavirus disease 2019 (COVID-19) in Singapore, Tan Tock Seng Hospital implemented an enhanced pneumonia surveillance (EPS) programme enrolling all patients who were admitted from the Emergency Department (ED) with a diagnosis of pneumonia but not meeting the prevalent COVID-19 suspect case definition.Hypothesis/Gap Statement. There is a paucity of data supporting the implementation of such a programme.Aims. To compare and contrast our hospital-resource utilization of an EPS programme for COVID-19 infection detection with a suitable comparison group.Methodology. We enrolled all patients admitted under the EPS programme from TTSH's ED from 7 February 2020 (date of EPS implementation) to 20 March 2020 (date of study ethics application) inclusive. We designated a comparison cohort over a similar duration the preceding year. Relevant demographic and clinical data were extracted from the electronic medical records.Results. There was a 3.2 times higher incidence of patients with an admitting diagnosis of pneumonia from the ED in the EPS cohort compared to the comparison cohort (P<0.001). However, there was no significant difference in the median length of stay of 7 days (P=0.160). Within the EPS cohort, stroke and fluid overload occur more frequently as alternative primary diagnoses.Conclusions. Our study successfully evaluated our hospital-resource utilization demanded by our EPS programme in relation to an appropriate comparison group. This helps to inform strategic use of hospital resources to meet the needs of both COVID-19 related services and essential 'peace-time' healthcare services concurrently.


Subject(s)
COVID-19 , Epidemiological Monitoring , Health Resources/organization & administration , Pneumonia , Emergency Service, Hospital , Hospitalization , Hospitals , Humans , Pandemics , Pneumonia/diagnosis , Pneumonia/epidemiology , Retrospective Studies , Singapore
6.
Int J Health Plann Manage ; 36(S1): 182-189, 2021 May.
Article in English | MEDLINE | ID: covidwho-1318705

ABSTRACT

Being a small island and low-middle income country (LMIC) heavily dependent on global markets for sustaining its basic needs and health system, Maldives faced specific challenges during the COVID-19 pandemic. This was reinforced through tensions between the heavily centralized healthcare delivery and a partially decentralized public health system. Using the pillars of pandemic response proposed by the World Health Organisation, this article explores the planning assumptions, resource estimations and strategies adopted to equip the health system with resources for the pandemic response. The resource need estimates based on projections for COVID-19 identified a shortfall of medical professionals to care for patients while maintaining 55% of the workforce for regular healthcare across the atolls. The findings show that while the policy of lockdown bought time to increase hospital beds and devices, the country was unable to increase the healthcare workforce. Furthermore, as the lockdown eased, the exponential increase of cases took Maldives to the global one per capita incidence. Despite this, with cautious planning and use of resources, the country has so far managed to maintain low mortality from COVID-19. The lessons from this experience are paramount in future pandemic response planning, not only for Maldives, but other small island LMICs.


Subject(s)
COVID-19 , Delivery of Health Care/organization & administration , Health Resources/organization & administration , Health Resources/supply & distribution , Humans , Indian Ocean Islands , Pandemics , SARS-CoV-2
8.
Anesthesiol Clin ; 39(2): 363-377, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1240167

ABSTRACT

In March 2020, the COVID-19 pandemic reached New York City, resulting in thousands of deaths over the following months. Because of the exponential spread of disease, the New York City hospital systems became rapidly overwhelmed. The Department of Anesthesiology at New York Presbyterian (NYP)-Columbia continued to offer anesthesia services for obstetrics and emergency surgery, while redirecting the rest of its staff to the expanded airway management role and the creation of the largest novel intensive care unit in the NYP system. Tremendous innovation and optimization were necessary in the face of material, physical, and staffing constraints.


Subject(s)
Anesthesia/statistics & numerical data , Anesthesiology/organization & administration , COVID-19 , Health Resources/organization & administration , Hospitals , Pandemics , Hospital Departments/organization & administration , Humans , New York City , Operating Rooms/organization & administration
9.
BMJ Health Care Inform ; 28(1)2021 May.
Article in English | MEDLINE | ID: covidwho-1223601

ABSTRACT

OBJECTIVES: We describe a hospital's implementation of predictive models to optimise emergency response to the COVID-19 pandemic. METHODS: We were tasked to construct and evaluate COVID-19 driven predictive models to identify possible planning and resource utilisation scenarios. We used system dynamics to derive a series of chain susceptible, infected and recovered (SIR) models. We then built a discrete event simulation using the system dynamics output and bootstrapped electronic medical record data to approximate the weekly effect of tuning surgical volume on hospital census. We evaluated performance via a model fit assessment and cross-model comparison. RESULTS: We outlined the design and implementation of predictive models to support management decision making around areas impacted by COVID-19. The fit assessments indicated the models were most useful after 30 days from onset of local cases. We found our subreports were most accurate up to 7 days after model run.DiscusssionOur model allowed us to shape our health system's executive policy response to implement a 'hospital within a hospital'-one for patients with COVID-19 within a hospital able to care for the regular non-COVID-19 population. The surgical scheduleis modified according to models that predict the number of new patients withCovid-19 who require admission. This enabled our hospital to coordinateresources to continue to support the community at large. Challenges includedthe need to frequently adjust or create new models to meet rapidly evolvingrequirements, communication, and adoption, and to coordinate the needs ofmultiple stakeholders. The model we created can be adapted to other health systems,provide a mechanism to predict local peaks in cases and inform hospitalleadership regarding bed allocation, surgical volumes, staffing, and suppliesone for COVID-19 patients within a hospital able to care for the regularnon-COVID-19 population. CONCLUSION: Predictive models are essential tools in supporting decision making when coordinating clinical operations during a pandemic.


Subject(s)
COVID-19 , Efficiency, Organizational , Emergency Service, Hospital/organization & administration , Models, Organizational , Pandemics , Forecasting , Health Resources/organization & administration , Humans , SARS-CoV-2
11.
Int J Health Plann Manage ; 36(S1): 182-189, 2021 May.
Article in English | MEDLINE | ID: covidwho-1126374

ABSTRACT

Being a small island and low-middle income country (LMIC) heavily dependent on global markets for sustaining its basic needs and health system, Maldives faced specific challenges during the COVID-19 pandemic. This was reinforced through tensions between the heavily centralized healthcare delivery and a partially decentralized public health system. Using the pillars of pandemic response proposed by the World Health Organisation, this article explores the planning assumptions, resource estimations and strategies adopted to equip the health system with resources for the pandemic response. The resource need estimates based on projections for COVID-19 identified a shortfall of medical professionals to care for patients while maintaining 55% of the workforce for regular healthcare across the atolls. The findings show that while the policy of lockdown bought time to increase hospital beds and devices, the country was unable to increase the healthcare workforce. Furthermore, as the lockdown eased, the exponential increase of cases took Maldives to the global one per capita incidence. Despite this, with cautious planning and use of resources, the country has so far managed to maintain low mortality from COVID-19. The lessons from this experience are paramount in future pandemic response planning, not only for Maldives, but other small island LMICs.


Subject(s)
COVID-19 , Delivery of Health Care/organization & administration , Health Resources/organization & administration , Health Resources/supply & distribution , Humans , Indian Ocean Islands , Pandemics , SARS-CoV-2
12.
Int J Gynaecol Obstet ; 152(2): 155-164, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-1125963

ABSTRACT

Worldwide, health systems and care approaches vary widely due to local reality, distance to facilities, cultural norms, resources, staff availability, geography, and politics. Consequently, globally maternal-newborn dyad care and outcomes are highly variable, leading to approximately 800 maternal deaths daily with a 100-fold difference among high- and low-resource countries. Irrespective of where care is received, maternal safety and wellbeing should be preserved. Despite ongoing efforts, however, this is not the case. Large gaps exist between spending and clinical outcomes. Segmented health care, coupled with poor planning and inadequate resource distribution, results in failure to provide essential life-saving treatment. The proposed solution is a regional integrated care model from midwife to advanced level III/IV care and the newborn unit, achieved through effective coordination by site, staff, and clinicians. This model has been successfully implemented in high- to low-resource countries in the past 20 years. In the large diverse population of the United States, constructive steps have been implemented to reduce high maternal mortality in black and rural communities. The COVID-19 pandemic demonstrates the feasibility of rapid resources coordination to provide effective advanced care. The proposed integration of resources will have a major positive impact on the maternal-newborn dyad.


Subject(s)
Delivery of Health Care, Integrated/organization & administration , Delivery of Health Care/organization & administration , Health Resources/organization & administration , Infant Health , Maternal Health Services , African Americans , COVID-19 , Female , Humans , Infant, Newborn , Maternal Mortality , Midwifery , Pregnancy , Rural Population , United States
13.
BMC Pregnancy Childbirth ; 21(1): 171, 2021 Mar 01.
Article in English | MEDLINE | ID: covidwho-1112430

ABSTRACT

BACKGROUND: Psychological stress and coping experienced during pregnancy can have important effects on maternal and infant health, which can also vary by race, ethnicity, and socioeconomic status. Therefore, we assessed stressors, coping behaviors, and resources needed in relation to the COVID-19 pandemic in a sample of 162 perinatal (125 pregnant and 37 postpartum) women in the United States. METHODS: A mixed-methods study captured quantitative responses regarding stressors and coping, along with qualitative responses to open-ended questions regarding stress and resources needed during the COVID-19 pandemic. Logistic and linear regression models were used to analyze differences between pregnant and postpartum participants, as well as differences across key demographic variables. Qualitative content analysis was used to analyze open-ended questions. RESULTS: During the COVID-pandemic, food scarcity and shelter-in-place restrictions made it difficult for pregnant women to find healthy foods. Participants also reported missing prenatal appointments, though many reported using telemedicine to obtain these services. Financial issues were prevalent in our sample and participants had difficulty obtaining childcare. After controlling for demographic variables, pregnant women were less likely to engage in healthy stress-coping behaviors than postpartum women. Lastly, we were able to detect signals of increased stressors induced by the COVID-19 pandemic, and less social support, in perinatal women of racial and ethnic minority, and lower-income status. Qualitative results support our survey findings as participants expressed concerns about their baby contracting COVID-19 while in the hospital, significant others missing the delivery or key obstetric appointments, and wanting support from friends, family, and birthing classes. Financial resources, COVID-19 information and research as it relates to maternal-infant health outcomes, access to safe healthcare, and access to baby supplies (formula, diapers, etc.) emerged as the primary resources needed by participants. CONCLUSIONS: To better support perinatal women's mental health during the COVID-19 pandemic, healthcare providers should engage in conversations regarding access to resources needed to care for newborns, refer patients to counseling services (which can be delivered online/via telephone) and virtual support groups, and consistently screen pregnant women for stressors.


Subject(s)
Adaptation, Psychological , COVID-19 , Health Resources/organization & administration , Health Services Accessibility , Parenting/psychology , Perinatal Care , Prenatal Education/methods , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/psychology , Female , Health Care Rationing/statistics & numerical data , Health Services Accessibility/standards , Health Services Accessibility/trends , Humans , Infant, Newborn , Mental Health/standards , Needs Assessment , Perinatal Care/methods , Perinatal Care/organization & administration , Perinatal Care/trends , Pregnancy , SARS-CoV-2 , Stress, Psychological/etiology , Stress, Psychological/prevention & control , Telemedicine/methods , Telemedicine/organization & administration , United States
14.
Anesthesiol Clin ; 39(2): 285-292, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1083950

ABSTRACT

It is difficult to predict the future course and length of the ongoing COVID-19 pandemic, which has devastated health care systems in low- and middle-income countries. Anesthesiology and critical care services are hard hit because many hospitals have stopped performing elective surgeries, staff and scarce hospital resources have been diverted to manage COVID-19 patients, and several makeshift COVID-19 units had to be set up. Intensive care units are overwhelmed with critically ill patients. In these difficult times, low- and middle-income countries need to improvise, perform indigenous research, adapt international guidelines to suit local needs, and target attainable clinical goals.


Subject(s)
Anesthesiology/organization & administration , COVID-19 , Critical Care/organization & administration , Health Resources/organization & administration , Pandemics , Anesthesiology/economics , Critical Care/economics , Developing Countries , Humans , Intensive Care Units , Nepal
16.
Ann Acad Med Singap ; 49(12): 1009-1012, 2020 12.
Article in English | MEDLINE | ID: covidwho-1037619

ABSTRACT

COVID-19 has spread globally, infecting and killing millions of people worldwide. The use of operating rooms (ORs) and the post-anaesthesia care unit (PACU) for intensive care is part of surge response planning. We aim to describe and discuss some of the practical considerations involved in a large tertiary hospital in Singapore. Firstly, considerations for setting up a level III intensive care unit (ICU) include that of space, staff, supplies and standards. Secondly, oxygen supply of the entire hospital is a major determinant of the number of ventilators it can support, including those on non-invasive forms of oxygen therapy. Thirdly, air flows due to positive pressure systems within the OR complex need to be addressed. In addition, due to the worldwide shortage of ICU ventilators, the US Food and Drug Administration has granted temporary approval for the use of anaesthesia gas machines for patients requiring mechanical ventilation. Lastly, planning of logistics and staff deployment needs to be carefully considered during a crisis. Although OR and PACU are not designed for long-term care of critically ill patients, they may be adapted for ICU use with careful planning in the current pandemic.


Subject(s)
COVID-19/therapy , Critical Care/organization & administration , Health Resources/organization & administration , Intensive Care Units/organization & administration , Operating Rooms/organization & administration , Tertiary Care Centers/organization & administration , COVID-19/epidemiology , Critical Care/methods , Critical Illness , Health Care Rationing/organization & administration , Health Services Accessibility/organization & administration , Humans , Pandemics , Respiration, Artificial , Singapore/epidemiology
17.
Int J Gynaecol Obstet ; 152(2): 155-164, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-986187

ABSTRACT

Worldwide, health systems and care approaches vary widely due to local reality, distance to facilities, cultural norms, resources, staff availability, geography, and politics. Consequently, globally maternal-newborn dyad care and outcomes are highly variable, leading to approximately 800 maternal deaths daily with a 100-fold difference among high- and low-resource countries. Irrespective of where care is received, maternal safety and wellbeing should be preserved. Despite ongoing efforts, however, this is not the case. Large gaps exist between spending and clinical outcomes. Segmented health care, coupled with poor planning and inadequate resource distribution, results in failure to provide essential life-saving treatment. The proposed solution is a regional integrated care model from midwife to advanced level III/IV care and the newborn unit, achieved through effective coordination by site, staff, and clinicians. This model has been successfully implemented in high- to low-resource countries in the past 20 years. In the large diverse population of the United States, constructive steps have been implemented to reduce high maternal mortality in black and rural communities. The COVID-19 pandemic demonstrates the feasibility of rapid resources coordination to provide effective advanced care. The proposed integration of resources will have a major positive impact on the maternal-newborn dyad.


Subject(s)
Delivery of Health Care, Integrated/organization & administration , Delivery of Health Care/organization & administration , Health Resources/organization & administration , Infant Health , Maternal Health Services , African Americans , COVID-19 , Female , Humans , Infant, Newborn , Maternal Mortality , Midwifery , Pregnancy , Rural Population , United States
18.
Anesth Analg ; 131(2): 351-364, 2020 08.
Article in English | MEDLINE | ID: covidwho-980720

ABSTRACT

Health care systems are belligerently responding to the new coronavirus disease 2019 (COVID-19). The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a specific condition, whose distinctive features are severe hypoxemia associated with (>50% of cases) normal respiratory system compliance. When a patient requires intubation and invasive ventilation, the outcome is poor, and the length of stay in the intensive care unit (ICU) is usually 2 or 3 weeks. In this article, the authors review several technological devices, which could support health care providers at the bedside to optimize the care for COVID-19 patients who are sedated, paralyzed, and ventilated. Particular attention is provided to the use of videolaryngoscopes (VL) because these can assist anesthetists to perform a successful intubation outside the ICU while protecting health care providers from this viral infection. Authors will also review processed electroencephalographic (EEG) monitors which are used to better titrate sedation and the train-of-four monitors which are utilized to better administer neuromuscular blocking agents in the view of sparing limited pharmacological resources. COVID-19 can rapidly exhaust human and technological resources too within the ICU. This review features a series of technological advancements that can significantly improve the care of patients requiring isolation. The working conditions in isolation could cause gaps or barriers in communication, fatigue, and poor documentation of provided care. The available technology has several advantages including (a) facilitating appropriate paperless documentation and communication between all health care givers working in isolation rooms or large isolation areas; (b) testing patients and staff at the bedside using smart point-of-care diagnostics (SPOCD) to confirm COVID-19 infection; (c) allowing diagnostics and treatment at the bedside through point-of-care ultrasound (POCUS) and thromboelastography (TEG); (d) adapting the use of anesthetic machines and the use of volatile anesthetics. Implementing technologies for safeguarding health care providers as well as monitoring the limited pharmacological resources are paramount. Only by leveraging new technologies, it will be possible to sustain and support health care systems during the expected long course of this pandemic.


Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections/therapy , Critical Care/organization & administration , Delivery of Health Care, Integrated/organization & administration , Health Resources/organization & administration , Health Services Accessibility/organization & administration , Infection Control/organization & administration , Pneumonia, Viral/therapy , COVID-19 , COVID-19 Testing , Clinical Laboratory Techniques , Coronavirus Infections/diagnosis , Coronavirus Infections/transmission , Coronavirus Infections/virology , Health Services Needs and Demand/organization & administration , Humans , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Needs Assessment/organization & administration , Occupational Exposure/adverse effects , Occupational Exposure/prevention & control , Occupational Health , Pandemics , Patient Care Team/organization & administration , Pneumonia, Viral/diagnosis , Pneumonia, Viral/transmission , Pneumonia, Viral/virology , Point-of-Care Systems/organization & administration , Point-of-Care Testing/organization & administration , Risk Factors , SARS-CoV-2 , Severity of Illness Index
19.
Stroke Vasc Neurol ; 6(2): 267-273, 2021 06.
Article in English | MEDLINE | ID: covidwho-961137

ABSTRACT

BACKGROUND AND PURPOSE: Spain has been heavily affected by COVID-19. Reallocation of resources for managing the outbreak might have caused a disruption in stroke care. This study analyses the impact on stroke care of reorganising the healthcare system in response to the first COVID-19 outbreak peak in Spain and the strategies adopted by Spanish stroke units to deal with this impact. MATERIALS AND METHODS: We obtained data from a structured survey sent to the responsible of stroke units across the country. We recorded the number of strokes, stroke code activations, intravenous thrombolysis treatments and mechanical thrombectomies during February and March 2019 and 2020. We also collected information on the impact on workflow metrics and on the availability of specialised neurological care and rehabilitation treatments, the characteristics of stroke care for patients with SARS-CoV-2 infection and the impact on human resources. We compared the activity data between 2019 and 2020 and the information on activity and impact on stroke care between regions classified according to the disease incidence rate. RESULTS: Fifty-seven (75%) of all stroke units in Spain responded to the survey. There was an overall reduction in admissions for all stroke types during the outbreak's peak and in the number of stroke code activations and intravenous thrombolysis treatments, results that were independent of the COVID-19 incidence rate. Participants reported a delay in workflow metrics and a reduction of admissions to stroke units, outpatient clinics and rehabilitation therapies. Specific pathways and protocols for managing stroke patients with SARS-CoV-2 infection have been established. CONCLUSION: The COVID-19 outbreak has jeopardised all phases of stroke care. As a consequence, some patients with stroke did not receive adequate treatment.


Subject(s)
COVID-19/therapy , Delivery of Health Care, Integrated/organization & administration , Health Resources/organization & administration , Health Services Accessibility/organization & administration , Stroke Rehabilitation , Stroke/therapy , Thrombectomy , Thrombolytic Therapy , COVID-19/diagnosis , COVID-19/epidemiology , Health Care Surveys , Healthcare Disparities , Humans , Incidence , Spain/epidemiology , Stroke/diagnosis , Stroke/physiopathology , Time Factors , Workflow
20.
Rev Epidemiol Sante Publique ; 68(5): 302-305, 2020 Sep.
Article in French | MEDLINE | ID: covidwho-888892

ABSTRACT

Following the onset of the global COVID-19 pandemic and the alerts issued by the World Health Organization, for several months attention has been focused on Africa as a potentially severely endangered continent. A sizable number of African countries, mainly low and middle income, suffer from limited available resources, especially in critical care, and COVID-19 is liable to overwhelm their already fragile health systems. To effectively manage what is shaping up as a multidimensional crisis, the challenge unquestionably goes beyond the necessary upgrading of public health infrastructures. It is also a matter of anticipating and taking timely action with regard to factors that may mitigate the propagation of SARS-CoV2 and thereby cushion the shock of the pandemic on the African continent. While some of these factors are largely unmanageable (climate, geography…), several others (socio-cultural, religious, audio-visual, and potentially political…) could be more or less effectively dealt with by African governments and populations.


Subject(s)
Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Africa/epidemiology , BCG Vaccine/therapeutic use , Betacoronavirus/physiology , COVID-19 , Climate , Coronavirus Infections/economics , Coronavirus Infections/therapy , Health Resources/organization & administration , Health Resources/statistics & numerical data , Health Resources/supply & distribution , History, 20th Century , History, 21st Century , Humans , Infection Control/economics , Infection Control/history , Infection Control/organization & administration , Infection Control/standards , Pandemics/economics , Pandemics/statistics & numerical data , Pneumonia, Viral/economics , Pneumonia, Viral/therapy , Poverty Areas , Professional Role , Public Health/economics , Public Health/history , Public Health/statistics & numerical data , SARS-CoV-2 , Social Media , Social Responsibility , Socioeconomic Factors , World Health Organization
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