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2.
Front Health Serv Manage ; 38(1): 27-31, 2021 Oct 01.
Article in English | MEDLINE | ID: covidwho-1455387

ABSTRACT

SUMMARY: Critical access hospitals (CAHs) serve their rural communities as the main access points and communication centers for healthcare, typically with very limited financial, staffing, and support resources. Local residents rely on their CAHs as the only providers for many miles around. When the COVID-19 pandemic hit in early 2020, CAH leaders had to rethink operations and priorities, both internally with staffs and externally with community leaders and organizations. Few critical care beds were available when the need was greatest. Testing was problematic, and cultural barriers complicated care. Now, as virus variants strike where vaccination numbers are low, CAH leaders remain wary of financial hits to elective procedure income, limited resources, and added stress for their staffs. Working with community service organizations and larger regional healthcare centers is a crucial strategy for CAHs as they address care delivery issues and ensure that their caregivers can do their jobs now and in the future.


Subject(s)
COVID-19/therapy , Critical Care/organization & administration , Delivery of Health Care/organization & administration , Health Personnel/psychology , Health Personnel/statistics & numerical data , Hospital Administrators/psychology , Rural Health Services/organization & administration , Adult , Animals , Attitude of Health Personnel , Female , Hospital Administration , Humans , Illinois , Leadership , Male , Middle Aged , Organizational Objectives , Pandemics , SARS-CoV-2
4.
Dig Dis Sci ; 66(11): 3635-3658, 2021 11.
Article in English | MEDLINE | ID: covidwho-1406167

ABSTRACT

AIM: To report revolutionary reorganization of academic gastroenterology division from COVID-19 pandemic surge at metropolitan Detroit epicenter from 0 infected patients on March 9, 2020, to > 300 infected patients in hospital census in April 2020 and > 200 infected patients in April 2021. SETTING: GI Division, William Beaumont Hospital, Royal Oak, has 36 GI clinical faculty; performs > 23,000 endoscopies annually; fully accredited GI fellowship since 1973; employs > 400 house staff annually since 1995; tertiary academic hospital; predominantly voluntary attendings; and primary teaching hospital, Oakland-University-Medical-School. METHODS: This was a prospective study. Expert opinion. Personal experience includes Hospital GI chief > 14 years until 2020; GI fellowship program director, several hospitals > 20 years; author of > 300 publications in peer-reviewed GI journals; committee-member, Food-and-Drug-Administration-GI-Advisory Committee > 5 years; and key hospital/medical school committee memberships. Computerized PubMed literature review was performed on hospital changes and pandemic. Study was exempted/approved by Hospital IRB, April 14, 2020. RESULTS: Division reorganized patient care to add clinical capacity and minimize risks to staff of contracting COVID-19 infection. Affiliated medical school changes included: changing "live" to virtual lectures; canceling medical student GI electives; exempting medical students from treating COVID-19-infected patients; and graduating medical students on time despite partly missing clinical electives. Division was reorganized by changing "live" GI lectures to virtual lectures; four GI fellows temporarily reassigned as medical attendings supervising COVID-19-infected patients; temporarily mandated intubation of COVID-19-infected patients for esophagogastroduodenoscopy; postponing elective GI endoscopies; and reducing average number of endoscopies from 100 to 4 per weekday during pandemic peak! GI clinic visits reduced by half (postponing non-urgent visits), and physical visits replaced by virtual visits. Economic pandemic impact included temporary, hospital deficit subsequently relieved by federal grants; hospital employee terminations/furloughs; and severe temporary decline in GI practitioner's income during surge. Hospital temporarily enhanced security and gradually ameliorated facemask shortage. GI program director contacted GI fellows twice weekly to ameliorate pandemic-induced stress. Divisional parties held virtually. GI fellowship applicants interviewed virtually. Graduate medical education changes included weekly committee meetings to monitor pandemic-induced changes; program managers working from home; canceling ACGME annual fellowship survey, changing ACGME physical to virtual site visits; and changing national conventions from physical to virtual. CONCLUSION: Reports profound and pervasive GI divisional changes to maximize clinical resources devoted to COVID-19-infected patients and minimize risks of transmitting infection.


Subject(s)
COVID-19/economics , COVID-19/epidemiology , Economics, Hospital/organization & administration , Gastroenterology/education , Hospital Administration/methods , SARS-CoV-2 , Cities/economics , Cities/epidemiology , Education, Medical, Graduate/organization & administration , Gastroenterology/economics , Hospital Administration/economics , Humans , Internship and Residency , Michigan/epidemiology , Organizational Affiliation/economics , Organizational Affiliation/organization & administration , Prospective Studies , Schools, Medical/organization & administration
9.
J Health Organ Manag ; ahead-of-print(ahead-of-print)2021 Aug 23.
Article in English | MEDLINE | ID: covidwho-1367129

ABSTRACT

PURPOSE: The COVID-19 pandemic has changed the way hospitals work. Strategies that were detached from the boundaries of departments and responsibilities in the COVID-19 pandemic have proven themselves under extreme conditions and show a beneficial influence on patient flow and resource management as well as on the communication culture. The continuation of closer interdisciplinary and cross-sectoral co-operation in a "new clinical routine" could have a positive impact on personnel concepts, communication strategies, and the management of acute care capacities and patient pathways. DESIGN/METHODOLOGY/APPROACH: The aim of the paper is to critically discuss the knowledge gained in the context of the COVID-19 pandemic from the various approaches in patient flow and capacity management as well as interdisciplinary co-operation. More recent research has evaluated patient pathway management, personnel planning and communication measures with regard to their effect and practicability for continuation in everyday clinical practice. FINDINGS: Patient flows and acute care capacities can be more efficiently managed by continuing a culture change towards closer interdisciplinary and intersectoral co-operation and technologies that support this with telemedicine functionalities and regional healthcare data interoperability. Together with a bi-directional, more frequent and open communication and feedback culture, it could form a "new clinical routine". ORIGINALITY/VALUE: This paper discusses a holistic approach on the way away from silo thinking towards cross-departmental collaboration.


Subject(s)
COVID-19/epidemiology , Cooperative Behavior , Hospital Administration , Pneumonia, Viral/epidemiology , Workflow , Female , Humans , Male , Pandemics , Pneumonia, Viral/virology , SARS-CoV-2
10.
Int J Environ Res Public Health ; 18(15)2021 07 21.
Article in English | MEDLINE | ID: covidwho-1346472

ABSTRACT

Studies have demonstrated associations between safety culture and patient safety based on the perceptions of healthcare professionals, but limited attention has been given to the perceptions of nurses. Moreover, most studies have used regression modeling, an approach that limits researchers' ability to identify the most important predictors of patient safety due to intercorrelations among predictors in the model. Therefore, the purpose of this study was to examine the effects of seven dimensions of safety culture on nurse-rated patient safety and identify the relative importance of these dimensions for predicting patient safety. This correlational study used data from the Agency for Healthcare Research and Quality's 2018 Hospital Survey on Patient Safety Culture. Data from 13,031 nurses working in surgical areas of 443 hospitals in the United States were examined using logistic regression and dominance analysis. Staffing adequacy was the strongest predictor of patient safety, followed by hospital management support for patient safety and organizational learning/continuous improvement. However, dominance analysis showed that hospital management support for patient safety was the most important predictor rather than staffing adequacy. Nurse managers and hospital administrators should role model a culture of safety and demonstrate their valuing of patient safety by providing sufficient resources, listening to and valuing staff suggestions regarding patient safety, and providing feedback about organizational changes to improve patient safety.


Subject(s)
Hospital Administration , Nurse Administrators , Attitude of Health Personnel , Cross-Sectional Studies , Humans , Organizational Culture , Patient Safety , Safety Management , Surveys and Questionnaires , United States
12.
Int J Health Plann Manage ; 36(6): 2062-2078, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1300396

ABSTRACT

Lean Management method has been applied in several fields before its implementation in healthcare area. Among the different techniques associated with Lean, in this paper, we are focused on Kanban system, which is a method that presents several benefits such as inventory holding reduction or improvement of the employees' satisfaction. Our main objective is to carry out a literature review focused on Kanban methodology applied to health care. In this sense, this study can serve as a script to improve hospital management in pandemic periods, such as the one currently lived on COVID-19. We carry out a literature review searching in four different databases. We combine several terms to achieve our objective. We identify several articles which describe Kanban methodology applied to health field. More specifically, we present in what areas (nursing or pharmacy, among others) this method has been applied. In addition, we show all the barriers as well as benefits caused by the implementation of this system. There are a few studies focused on analysing how Kanban is applied to health care. Therefore, we can affirm that this topic is still recent.


Subject(s)
COVID-19 , Hospital Administration , Delivery of Health Care , Health Services , Humans , SARS-CoV-2
13.
Crit Care ; 25(1): 226, 2021 06 30.
Article in English | MEDLINE | ID: covidwho-1286048

ABSTRACT

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


Subject(s)
Clinical Deterioration , Hospital Administration/statistics & numerical data , Mortality/trends , Time-to-Treatment/standards , Aged , Cross-Sectional Studies , Female , Hospital Administration/standards , Humans , Intensive Care Units/organization & administration , Intensive Care Units/statistics & numerical data , Length of Stay/statistics & numerical data , Male , Middle Aged , Organ Dysfunction Scores , Regression Analysis , Retrospective Studies , Risk Assessment/methods , Risk Assessment/standards , Risk Assessment/statistics & numerical data , Time-to-Treatment/statistics & numerical data
14.
Eur J Cancer ; 153: 123-132, 2021 08.
Article in English | MEDLINE | ID: covidwho-1275290

ABSTRACT

BACKGROUND: Changes in the management of patients with cancer and delays in treatment delivery during the COVID-19 pandemic may impact the use of hospital resources and cancer mortality. PATIENTS AND METHODS: Patient flows, patient pathways and use of hospital resources during the pandemic were simulated using a discrete event simulation model and patient-level data from a large French comprehensive cancer centre's discharge database, considering two scenarios of delays: massive return of patients from November 2020 (early-return) or March 2021 (late-return). Expected additional cancer deaths at 5 years and mortality rate were estimated using individual hazard ratios based on literature. RESULTS: The number of patients requiring hospital care during the simulation period was 13,000. In both scenarios, 6-8% of patients were estimated to present a delay of >2 months. The overall additional cancer deaths at 5 years were estimated at 88 in early-return and 145 in late-return scenario, with increased additional deaths estimated for sarcomas, gynaecological, liver, head and neck, breast cancer and acute leukaemia. This represents a relative additional cancer mortality rate at 5 years of 4.4 and 6.8% for patients expected in year 2020, 0.5 and 1.3% in 2021 and 0.5 and 0.5% in 2022 for each scenario, respectively. CONCLUSIONS: Pandemic-related diagnostic and treatment delays in patients with cancer are expected to impact patient survival. In the perspective of recurrent pandemics or alternative events requiring an intensive use of limited hospital resources, patients should be informed not to postpone care, and medical resources for patients with cancer should be sanctuarised.


Subject(s)
COVID-19/epidemiology , Neoplasms/mortality , Neoplasms/therapy , COVID-19/mortality , COVID-19/virology , Computer Simulation , Delivery of Health Care/organization & administration , Hospital Administration , Hospitals , Humans , Neoplasms/pathology , Pandemics , Proportional Hazards Models , SARS-CoV-2/isolation & purification
15.
JAMA ; 325(16): 1631-1639, 2021 04 27.
Article in English | MEDLINE | ID: covidwho-1237389

ABSTRACT

Importance: Safe reduction of the cesarean delivery rate is a national priority. Objective: To evaluate the rates of cesarean delivery for nulliparous, term, singleton, vertex (NTSV) births in California in the context of a statewide multifaceted intervention designed to reduce the rates of cesarean delivery. Design, Setting, and Participants: Observational study of cesarean delivery rates from 2014 to 2019 among 7 574 889 NTSV births in the US and at 238 nonmilitary hospitals providing maternity services in California. From 2016 to 2019, California Maternal Quality Care Collaborative partnered with Smart Care California to implement multiple approaches to decrease the rates of cesarean delivery. Hospitals with rates of cesarean delivery greater than 23.9% for NTSV births were invited to join 1 of 3 cohorts for an 18-month quality improvement collaborative between July 2016 and June 2019. Exposures: Within the collaborative, multidisciplinary teams implemented multiple strategies supported by mentorship, shared learning, and rapid-cycle data feedback. Partnerships among nonprofit organizations, state governmental agencies, purchasers, and health plans addressed the external environment through transparency, award programs, and incentives. Main Outcomes and Measures: The primary outcome was the change in cesarean delivery rates for NTSV births in California and a difference-in-differences analysis was performed to compare cesarean delivery rates for NTSV births in California vs the rates in the rest of the US. A mixed multivariable logistic regression model that adjusted for patient-level and hospital-level confounders also was used to assess the collaborative and the external statewide actions. The cesarean delivery rates for NTSV births at hospitals participating in the collaborative were compared with the rates from the nonparticipating hospitals and the rates in the participating hospitals prior to participation in the collaborative. Results: A total of 7 574 889 NTSV births occurred in the US from 2014 to 2019, of which 914 283 were at 238 hospitals in California. All California hospitals were exposed to the statewide actions to reduce the rates of cesarean delivery, including the 149 hospitals that had baseline rates of cesarean delivery greater than 23.9% for NTSV births, of which 91 (61%) participated in the quality improvement collaborative. The rate of cesarean delivery for NTSV births in California decreased from 26.0% (95% CI, 25.8%-26.2%) in 2014 to 22.8% (95% CI, 22.6%-23.1%) in 2019 (relative risk, 0.88; 95% CI, 0.87-0.89). The rate of cesarean delivery for NTSV births in the US (excluding California births) was 26.0% in both 2014 and 2019 (relative risk, 1.00; 95% CI, 0.996-1.005). The difference-in-differences analysis revealed that the reduction in the rate of cesarean delivery for NTSV births in California was 3.2% (95% CI, 1.7%-3.5%) higher than in the US (excluding California). Compared with the hospitals and the periods not exposed to the collaborative activities, and after adjusting for patient characteristics and time using a modified stepped-wedge analysis, exposure to collaborative activities was associated with a lower odds of cesarean delivery for NTSV births (24.4% vs 24.6%; adjusted odds ratio, 0.87 [95% CI, 0.85-0.89]). Conclusions and Relevance: In this observational study of NTSV births in California from 2014 to 2019, the rates of cesarean delivery decreased over time in the setting of the implementation of a coordinated hospital-level collaborative and statewide initiatives designed to support vaginal birth.


Subject(s)
Cesarean Section/statistics & numerical data , Health Policy , Hospitals/statistics & numerical data , Quality Improvement , California , Female , Hospital Administration , Humans , Infant, Newborn , Infant, Newborn, Diseases/epidemiology , Logistic Models , Multivariate Analysis , Parity , Pregnancy , State Government
16.
Emerg Microbes Infect ; 10(1): 998-1001, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1231007

ABSTRACT

The designated hospitals are another health approach besides Fangcang shelter hospitals and newly built temporary hospitals for responding to COVID-19 epidemic in China. Faced with the emergency situation, about 1512 hospitals from 363 cities have been designated in China to tackle the spread of COVID-19. They were local hospitals repurposed by the Chinese government as a regional public health response. Their comprehensive services mainly include: "fever-clinics" to screen patients, COVID-19 department for higher-levels of medical care, and makeshift wards for emergencies. As the only COVID-19 designated hospital in Shanghai, we documented three characters (Centralized response and action system, Comprehensive functions, Closed-Loop Management System) and three strategies (Resource allocation, Prevention of nosocomial infection, Management during the post-COVID-19 pandemic stage) from the experience in responding to COVID-19 pandemic. Lastly, learning the lessons from COVID-19 pandemic, a more efficacy and rapid national response to public health emergencies is required. Serving as an essential component of public health system, the COVID-19-designated hospitals should be always prepared for future emergencies.


Subject(s)
COVID-19/epidemiology , Hospitals/classification , Public Health Administration , SARS-CoV-2 , COVID-19/prevention & control , China/epidemiology , Emergencies , Hospital Administration , Humans , Infection Control/methods , Infection Control/standards , Mass Screening
19.
Ann Surg ; 274(1): 37-39, 2021 07 01.
Article in English | MEDLINE | ID: covidwho-1207364

ABSTRACT

COVID-19 has strained hospital capacity, detracted from patient care, and reduced hospital income. This article lays out a tested strategy that surgical and hospital leaders can use to overcome clinical and financial strain, emphasizing the experience at 2 leading North American medical centers. By classifying the time and resource needs of surgical patients and smoothing the flow of surgical admissions over all days of the week, hospitals can dramatically improve hospital efficiency, the quality of care and timely access to care for emergent and urgent surgeries. Through and beyond the time of COVID, smoothing the flow of surgical patients is a key means to restore hospital vitality and improve the care of all patients.


Subject(s)
COVID-19/prevention & control , Hospital Administration , Infection Control/organization & administration , Surgical Procedures, Operative , COVID-19/epidemiology , COVID-19/transmission , Hospital Bed Capacity , Hospitalization , Humans
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