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1.
Anaesthesist ; 69(10): 717-725, 2020 10.
Article in German | MEDLINE | ID: covidwho-1453673

ABSTRACT

BACKGROUND: Following the regional outbreak in China, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread all over the world, presenting the healthcare systems with huge challenges worldwide. In Germany the coronavirus diseases 2019 (COVID-19) pandemic has resulted in a slowly growing demand for health care with a sudden occurrence of regional hotspots. This leads to an unpredictable situation for many hospitals, leaving the question of how many bed resources are needed to cope with the surge of COVID-19 patients. OBJECTIVE: In this study we created a simulation-based prognostic tool that provides the management of the University Hospital of Augsburg and the civil protection services with the necessary information to plan and guide the disaster response to the ongoing pandemic. Especially the number of beds needed on isolation wards and intensive care units (ICU) are the biggest concerns. The focus should lie not only on the confirmed cases as the patients with suspected COVID-19 are in need of the same resources. MATERIAL AND METHODS: For the input we used the latest information provided by governmental institutions about the spreading of the disease, with a special focus on the growth rate of the cumulative number of cases. Due to the dynamics of the current situation, these data can be highly variable. To minimize the influence of this variance, we designed distribution functions for the parameters growth rate, length of stay in hospital and the proportion of infected people who need to be hospitalized in our area of responsibility. Using this input, we started a Monte Carlo simulation with 10,000 runs to predict the range of the number of hospital beds needed within the coming days and compared it with the available resources. RESULTS: Since 2 February 2020 a total of 306 patients were treated with suspected or confirmed COVID-19 at this university hospital. Of these 84 needed treatment on the ICU. With the help of several simulation-based forecasts, the required ICU and normal bed capacity at Augsburg University Hospital and the Augsburg ambulance service in the period from 28 March 2020 to 8 June 2020 could be predicted with a high degree of reliability. Simulations that were run before the impact of the restrictions in daily life showed that we would have run out of ICU bed capacity within approximately 1 month. CONCLUSION: Our simulation-based prognosis of the health care capacities needed helps the management of the hospital and the civil protection service to make reasonable decisions and adapt the disaster response to the realistic needs. At the same time the forecasts create the possibility to plan the strategic response days and weeks in advance. The tool presented in this study is, as far as we know, the only one accounting not only for confirmed COVID-19 cases but also for suspected COVID-19 patients. Additionally, the few input parameters used are easy to access and can be easily adapted to other healthcare systems.


Subject(s)
Coronavirus Infections/therapy , Critical Care/organization & administration , Hospital Bed Capacity , Hospitals, University/organization & administration , Intensive Care Units/organization & administration , Pneumonia, Viral/therapy , Betacoronavirus/isolation & purification , COVID-19 , Coronavirus Infections/epidemiology , Critical Care/statistics & numerical data , Germany , Hospitals, University/statistics & numerical data , Humans , Intensive Care Units/statistics & numerical data , Pandemics , Pneumonia, Viral/epidemiology , Prognosis , SARS-CoV-2
2.
Acad Med ; 96(9): 1263-1267, 2021 09 01.
Article in English | MEDLINE | ID: covidwho-1373679

ABSTRACT

The announcement of the closure of Philadelphia's Hahnemann University Hospital in June 2019 sent shock waves through the academic community. The closure had a devastating impact on the residents and fellows who trained there, the patients who had long received their care there, and faculty and staff who had provided care there for decades. Since its beginnings, the hospital, established as part of Hahnemann Medical College in 1885, was a major site for medical student education. The authors share the planning before and actions during the crisis that protected the educational experiences of third- and fourth-year medical students at Drexel University College of Medicine assigned to Hahnemann University Hospital. The lessons they learned can be helpful to leadership in academic health systems in the United States facing a diminishing number of clinical training sites for medical and other health professions students, a situation that is likely to worsen as the COVID-19 pandemic continues to weaken the health care ecosystem.


Subject(s)
Education, Medical, Undergraduate/organization & administration , Health Facility Closure/methods , Hospitals, University/organization & administration , Education, Medical, Undergraduate/methods , Faculty, Medical/organization & administration , Faculty, Medical/psychology , Humans , Interprofessional Relations , Philadelphia , Students, Medical/psychology
3.
S Afr Med J ; 110(10): 968-972, 2020 09 07.
Article in English | MEDLINE | ID: covidwho-1362733

ABSTRACT

The SARS-CoV-2 pandemic has challenged the provision of healthcare in ways that are unprecedented in our lifetime. Planning for the sheer numbers expected during the surge has required public hospitals to de-escalate all non-essential clinical services to focus on COVID-19. Western Cape Province was the initial epicentre of the COVID-19 epidemic in South Africa (SA), and the Cape Town metro was its hardest-hit geographical region. We describe how we constructed our COVID-19 hospital-wide clinical service at Groote Schuur Hospital, the University of Cape Town's tertiary-level teaching hospital. By describing the barriers and enablers, we hope to provide guidance rather than a blueprint for hospitals elsewhere in SA and in low-resource countries that face similar challenges now or during subsequent waves.


Subject(s)
Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , Hospitals, University/organization & administration , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , Tertiary Care Centers/organization & administration , Betacoronavirus , COVID-19 , Coronavirus Infections/epidemiology , Electronic Health Records/organization & administration , Emergency Service, Hospital/organization & administration , Humans , Intensive Care Units/organization & administration , Materials Management, Hospital , Pandemics , Patient Care Team , Pneumonia, Viral/epidemiology , SARS-CoV-2 , Secondary Care Centers , South Africa/epidemiology
4.
Medicine (Baltimore) ; 100(32): e26847, 2021 Aug 13.
Article in English | MEDLINE | ID: covidwho-1358517

ABSTRACT

ABSTRACT: Infectious disease pandemics has a great impact on the use of medical facilities. The purpose of this study was to analyze the effects of coronavirus disease 2019 (COVID-19) on the use of emergency medical facilities in the Republic of Korea. This single-center, retrospective observational study was conducted in a tertiary teaching hospital located in Incheon Metropolitan City, Republic of Korea. We set the pandemic period as February 19, 2020 to April 18, 2020, and the control period was set to the same period in 2018 and 2019. All consecutive patients who visited the emergency department (ED) during the study period were included. Patients were divided into 3 groups according to age (pediatric patients, younger adult patients and older adult patients). The total number, demographics, clinical data, and diagnostic codes of ED patients were analyzed. The total number of ED patients in the pandemic period was lower than that in the control period, which was particularly pronounced for pediatric patients. The proportion of patients who used the 119 ambulances increased in all 3 groups (P  = .002, P < .001, and P = .001), whereas the proportion of patients who visited on foot was decreased (P  = .006, P < .001, and P = .027). In terms of diagnostic codes, a significant decrease was observed in the proportion of certain infectious or parasitic diseases (A00-B99), and respiratory diseases (J00-J99) in the pediatric and younger adult patient groups (P < .001 and P < .001, respectively). The COVID-19 pandemic reduced the number of ED patients; however, the proportion of patients using ambulances increased. In particular, the proportion of patients with diagnostic codes for infectious and respiratory diseases significantly decreased during the pandemic period.


Subject(s)
COVID-19/prevention & control , Emergency Service, Hospital/statistics & numerical data , Patient Acceptance of Health Care/statistics & numerical data , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/transmission , Child , Child, Preschool , Emergency Service, Hospital/organization & administration , Female , Hospitals, University/organization & administration , Hospitals, University/statistics & numerical data , Humans , Infant , Male , Middle Aged , Republic of Korea , Retrospective Studies
5.
BMC Emerg Med ; 21(1): 74, 2021 06 28.
Article in English | MEDLINE | ID: covidwho-1286812

ABSTRACT

BACKGROUND: In March 2020 we faced a huge spread of the epidemic of SARS-CoV2 in northern Italy; the Emergency Departments (ED) and the Emergency Medical Services (EMS) were overwhelmed by patients requiring care. The hospitals were forced to reorganize their services, and the ED was the focal point of this challenge. As Emergency Department in a metropolitan area of the region most affected, we saw an increasing number of patients with COVID-19, and we made some structural and staff implementations according to the evolution of the epidemic. METHODS: We analysed in a narrative way the weaknesses and the point of strength of our response to COVID-19 first outbreak, focusing point by point on main challenges and minor details involved in our ED response to the pandemics. RESULTS: The main stems for our response to the pandemic were: use of clear and shared contingency plans, as long as preparedness to implement them; stockage of as much as useful material can be stocked; training of the personnel to be prepared for a fast response, trying to maintain divided pathway for COVID-19 and non-COVID-19 patients, well-done isolation is a key factor; preparedness to de-escalate as soon as needed. CONCLUSIONS: We evaluated our experience and analysed the weakness and strength of our first response to share it with the rest of the scientific community and colleagues worldwide, hoping to facilitate others who will face the same challenge or similar challenges in the future. Shared experience is the best way to learn and to avoid making the same mistakes.


Subject(s)
COVID-19/epidemiology , COVID-19/prevention & control , Disease Outbreaks/prevention & control , Emergency Service, Hospital/organization & administration , Hospitals, University/organization & administration , Urban Health Services/organization & administration , COVID-19/diagnosis , COVID-19/therapy , Humans , Italy/epidemiology
6.
Nurs Adm Q ; 45(2): 94-101, 2021.
Article in English | MEDLINE | ID: covidwho-1165563

ABSTRACT

Novel coronavirus disease-2019 (COVID-19) is a new respiratory disease that has spread widely throughout the world. On February 20, 2020, the first Italian case of COVID-19 was reported. The infection rapidly spread across the country, and by August 11, 2020, a total of 250 566 official cases with 32 205 deaths (12.8%) were reported in Italy, counting a total of 96 884 positive cases and 16 833 deaths (17.3%) in the Lombardy region only. A huge demand to handle the COVID-19 outbreak challenged both the health care providers and the ordinary work in the hospital. From the beginning of the crisis, San Raffaele Scientific Institute, a 1318-bed tertiary care university hospital located in Lombardy, Northern Italy, has played a major role in supporting the national health care system for the treatment of COVID-19 cases, and a significant reorganization of the hospital was immediately required. The reorganization was carried out both structurally and with regard to the distribution of medical and nonmedical staff. This article aims to highlight the management strategies for the health care staff subsequent to the pandemic intense workload in San Raffaele Scientific Institute.


Subject(s)
COVID-19/nursing , Hospitals, University/organization & administration , Nursing Staff, Hospital/organization & administration , Personal Protective Equipment/supply & distribution , COVID-19/epidemiology , Humans , Italy/epidemiology , Pandemics , Physical Distancing , Professional-Family Relations , SARS-CoV-2
7.
J Healthc Qual Res ; 36(3): 136-141, 2021.
Article in Spanish | MEDLINE | ID: covidwho-1137459

ABSTRACT

INTRODUCTION: During the SARS-CoV-2 pandemic, elective surgical activity was reduced to a minimum. As both the number of cases and the hospitalization needs for this pathology decreased, we thought it appropriate to progressively recover scheduled surgical activity. This work describes how, even with the current alarm state, we were able to practically normalize this activity in a few weeks. METHODS: Two weeks before the intervention, the patients included in the waiting lists were contacted by telephone. After checking their health status and expressing their desire to undergo surgery, they were provided with recommendations to decrease the risk of coronavirus infection. Likewise, an exclusive circuit was established to carry out, 48 hours before the intervention, the detection of SARS-CoV-2 by means of exudates nasopharyngeal PCR. The results were evaluated by each surgical service and the anesthesiology service. In addition, asymptomatic Surgical Area professionals could undergo weekly screening for the early detection of coronavirus according to the recommendations of Occupational Health. RESULTS: In the midst of a pandemic, scheduled surgical activity was reduced by 85%. From the week of April 13, the operating rooms available were recovered, which allowed practically all surgical activity to be recovered the week of May 25. CONCLUSIONS: The creation of circuits and procedures to streamline surgical activity, still in full force of the state of alarm, has allowed us, in a few weeks, to recover almost all of it.


Subject(s)
COVID-19 , Elective Surgical Procedures , Hospitals, University/organization & administration , Pandemics , SARS-CoV-2 , Surgery Department, Hospital/organization & administration , Tertiary Care Centers/organization & administration , Anesthesiology/organization & administration , COVID-19/diagnosis , COVID-19/prevention & control , COVID-19/transmission , COVID-19 Nucleic Acid Testing , Cross Infection/prevention & control , Elective Surgical Procedures/statistics & numerical data , Hospitals, Urban/organization & administration , Humans , Infection Control/methods , Infectious Disease Transmission, Professional-to-Patient/prevention & control , Mass Screening , Nasopharynx/virology , Operating Rooms/statistics & numerical data , Personnel, Hospital , SARS-CoV-2/isolation & purification , Spain , Time-to-Treatment , Waiting Lists
8.
Ann Cardiol Angeiol (Paris) ; 70(2): 102-105, 2021 Apr.
Article in French | MEDLINE | ID: covidwho-1131068

ABSTRACT

The new coronavirus pandemic (COVID-19) is the main global health crisis of our time and the greatest threat we have faced in this century. According to the National Health Security Agency (ANSS), which is the national body responsible for managing epidemics and pandemics, 1927 cases of COVID-19 were confirmed, 11 deaths with more than 4000 contact subjects. The objective of this study was to assess the impact of the COVID-19 pandemic on the activities of the cardiology department of the Ignace Deen National Hospital at the Conakry University Hospital. This was a descriptive retrospective study from January 2020 to April 2020, focusing on consultation and hospitalisation activities in the cardiology department of Ignace Deen National Hospital at Conakry University Hospital. The study consisted of assessing the impact of the pandemic on patient use of the service during the first weeks of the pandemic. We recorded the frequency of consultations and hospitalisations from March to April 2020, which we compared to the frequency of consultations and hospitalisations in January and February 2020. During this study from March to April 2020, we identified 130 patients in consultation against 450 patients for the two months preceding the official declaration of the pandemic in Guinea, a drop of 71.1% (320 patients). The same remark was made in hospitalisation with a drop of 75% (35 patients against 140 for the two months preceding the pandemic). At the start of the COVID-19 pandemic in Guinea, it is clear that there has been a rapid and significant drop in the effective use of the cardiology service.


Subject(s)
COVID-19 , Cardiology/organization & administration , Hospital Departments/organization & administration , Hospitals, University/organization & administration , Guinea , Humans , Retrospective Studies
9.
BMJ Open ; 11(2): e043837, 2021 02 22.
Article in English | MEDLINE | ID: covidwho-1096994

ABSTRACT

OBJECTIVES: Healthcare personnel (HCP) are at an increased risk of acquiring COVID-19 infection especially in resource-restricted healthcare settings, and return to homes unfit for self-isolation, making them apprehensive about COVID-19 duty and transmission risk to their families. We aimed at implementing a novel multidimensional HCP-centric evidence-based, dynamic policy with the objectives to reduce risk of HCP infection, ensure welfare and safety of the HCP and to improve willingness to accept and return to duty. SETTING: Our tertiary care university hospital, with 12 600 HCP, was divided into high-risk, medium-risk and low-risk zones. In the high-risk and medium-risk zones, we organised training, logistic support, postduty HCP welfare and collected feedback, and sent them home after they tested negative for COVID-19. We supervised use of appropriate personal protective equipment (PPE) and kept communication paperless. PARTICIPANTS: We recruited willing low-risk HCP, aged <50 years, with no comorbidities to work in COVID-19 zones. Social distancing, hand hygiene and universal masking were advocated in the low-risk zone. RESULTS: Between 31 March and 20 July 2020, we clinically screened 5553 outpatients, of whom 3012 (54.2%) were COVID-19 suspects managed in the medium-risk zone. Among them, 346 (11.4%) tested COVID-19 positive (57.2% male) and were managed in the high-risk zone with 19 (5.4%) deaths. One (0.08%) of the 1224 HCP in high-risk zone, 6 (0.62%) of 960 HCP in medium-risk zone and 23 (0.18%) of the 12 600 HCP in the low-risk zone tested positive at the end of shift. All the 30 COVID-19-positive HCP have since recovered. This HCP-centric policy resulted in low transmission rates (<1%), ensured satisfaction with training (92%), PPE (90.8%), medical and psychosocial support (79%) and improved acceptance of COVID-19 duty with 54.7% volunteering for re-deployment. CONCLUSION: A multidimensional HCP-centric policy was effective in ensuring safety, satisfaction and welfare of HCP in a resource-poor setting and resulted in a willing workforce to fight the pandemic.


Subject(s)
COVID-19 , Infectious Disease Transmission, Patient-to-Professional , Medical Staff, Hospital , Occupational Diseases , Adult , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/therapy , COVID-19/transmission , Developing Countries , Female , Hospitals, University/organization & administration , Humans , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Male , Medical Staff, Hospital/statistics & numerical data , Models, Organizational , Occupational Diseases/epidemiology , Occupational Diseases/prevention & control , Organizational Policy , Personal Protective Equipment , Prospective Studies , Risk Assessment , Tertiary Care Centers/organization & administration
10.
Acta Anaesthesiol Scand ; 65(6): 755-760, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1096648

ABSTRACT

BACKGROUND: The initial wave of the Covid-19 pandemic has hit Italy, and Lombardy in particular, with violence, forcing to reshape all hospitals' activities; this happened even in pediatric hospitals, although the young population seemed initially spared from the disease. "Vittore Buzzi" Children's Hospital, which is a pediatric/maternal hospital located in Milan (Lombardy Region), had to stop elective procedures-with the exception of urgent/emergent ones-between February and May 2020 to leave space and resources to adults' care. We describe the challenges of reshaping the hospital's identity and structure, and restarting pediatric surgery and anesthesia, from May on, in the most hit area of the world, with the purpose to avoid and contain infections. Both patients and caregivers admitted to hospital have been tested for Sars-CoV-2 in every case. METHODS: Observational cohort study via review of clinical charts of patients undergoing surgery between 16th May and 30th September 2020, together with SARS-CoV -2 RT-PCR testing outcomes, and comparison to same period surgeries in 2019. RESULTS: An increase of approximately 70% in pediatric surgeries (OR 1.68 [1.33-2.13], P < .001) and a higher increase in the number of surgeries were reported (OR 1.75 (1.43-2.15), P < .001). Considering only urgent procedures, a significant difference in the distribution of the type of surgery was observed (Chi-squared P-value < .001). Sars-CoV-2-positive patients have been 0.8% of total number; 14% of these was discovered through caregiver's positivity. CONCLUSION: We describe our pathway for safe pediatric surgery and anesthesia and the importance of testing both patient and caregiver.


Subject(s)
Anesthesia Department, Hospital/organization & administration , Appointments and Schedules , COVID-19 Nucleic Acid Testing , COVID-19/epidemiology , Hospitals, Pediatric/organization & administration , Hospitals, University/organization & administration , Pandemics , SARS-CoV-2 , Surgery Department, Hospital/organization & administration , Surgical Procedures, Operative/statistics & numerical data , Tertiary Care Centers/organization & administration , Adolescent , COVID-19 Nucleic Acid Testing/statistics & numerical data , Caregivers , Child , Child, Preschool , Cohort Studies , Diagnosis-Related Groups , Elective Surgical Procedures/statistics & numerical data , Emergencies/epidemiology , Female , Hospital Bed Capacity/statistics & numerical data , Hospitals, Pediatric/statistics & numerical data , Hospitals, University/statistics & numerical data , Hospitals, Urban/organization & administration , Hospitals, Urban/statistics & numerical data , Humans , Infant , Infant, Newborn , Infection Control/methods , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Italy/epidemiology , Male , Nasopharynx/virology , Patients , SARS-CoV-2/isolation & purification , Symptom Assessment , Tertiary Care Centers/statistics & numerical data , Young Adult
11.
World Neurosurg ; 148: e172-e181, 2021 04.
Article in English | MEDLINE | ID: covidwho-1078227

ABSTRACT

BACKGROUND: The institution-wide response of the University of California San Diego Health system to the 2019 novel coronavirus disease (COVID-19) pandemic was founded on rapid development of in-house testing capacity, optimization of personal protective equipment usage, expansion of intensive care unit capacity, development of analytic dashboards for monitoring of institutional status, and implementation of an operating room (OR) triage plan that postponed nonessential/elective procedures. We analyzed the impact of this triage plan on the only academic neurosurgery center in San Diego County, California, USA. METHODS: We conducted a de-identified retrospective review of all operative cases and procedures performed by the Department of Neurosurgery from November 24, 2019, through July 6, 2020, a 226-day period. Statistical analysis involved 2-sample z tests assessing daily case totals over the 113-day periods before and after implementation of the OR triage plan on March 16, 2020. RESULTS: The neurosurgical service performed 1429 surgical and interventional radiologic procedures over the study period. There was no statistically significant difference in mean number of daily total cases in the pre-versus post-OR triage plan periods (6.9 vs. 5.8 mean daily cases; 1-tail P = 0.050, 2-tail P = 0.101), a trend reflected by nearly every category of neurosurgical cases. CONCLUSIONS: During the COVID-19 pandemic, the University of California San Diego Department of Neurosurgery maintained an operative volume that was only modestly diminished and continued to meet the essential neurosurgical needs of a large population. Lessons from our experience can guide other departments as they triage neurosurgical cases to meet community needs.


Subject(s)
COVID-19/epidemiology , Hospitals, University/organization & administration , Neurosurgery/organization & administration , Neurosurgical Procedures/statistics & numerical data , Academic Medical Centers/organization & administration , Brain Neoplasms/surgery , COVID-19/diagnosis , COVID-19 Nucleic Acid Testing , COVID-19 Serological Testing , California/epidemiology , Cerebrospinal Fluid Shunts/statistics & numerical data , Elective Surgical Procedures , Endovascular Procedures/statistics & numerical data , Hospital Bed Capacity , Hospital Departments/organization & administration , Humans , Infection Control , Information Dissemination/methods , Intensive Care Units , Laboratories, Hospital , Multi-Institutional Systems , Operating Rooms , Organizational Policy , Personal Protective Equipment/supply & distribution , Retrospective Studies , Risk Assessment , SARS-CoV-2 , Surge Capacity , Triage , Vascular Surgical Procedures/statistics & numerical data , Ventilators, Mechanical/supply & distribution , Wounds and Injuries/surgery
12.
Pan Afr Med J ; 37(Suppl 1): 43, 2020.
Article in English | MEDLINE | ID: covidwho-1069976

ABSTRACT

The corona virus disease 2019 (COVID-19) has stretched the resources of health facilities but there is a lack of context-specific reports across Africa. Since February, 2020, the university hospital, Kwame Nkrumah University of Science and Technology (KNUST), a district-level institution, has been at the forefront in contributing to efforts in Ghana to fight the global pandemic. As of 16th August, 2020, 1755 individual samples have been taken at the hospital for COVID-19 out of which 629 (35.8%) tested positive, 414 (65.9%) recoveries and 6 (0.95%) deaths. The hospital's out-patient attendance has reduced by almost 50% with attendant loss of revenue. Here in, we present a report on our activities, highlight lessons and recommendations that other health facilities can glean from.


Subject(s)
COVID-19/epidemiology , Hospitals, University/organization & administration , COVID-19/diagnosis , Ghana , Humans
13.
Ann Pharm Fr ; 79(4): 473-480, 2021 Jul.
Article in French | MEDLINE | ID: covidwho-1057208

ABSTRACT

With regard to the hospital drug supply chain, the safest system is the individual automated drug dispensing one provided by the pharmacy. For several years we have been trying to convince hospital decision-makers to set it up. In the meantime, to mitigate the risks of medication errors incurred by patients and caregivers, we have set up several work teams within the care units. These teams, made up of one pharmacist and one or two hospital pharmacy technicians, who notably manage the medicine cabinets in care units. The close collaboration with doctors and nurses developed over the years was a determining factor when it became necessary to provide the newly created additional intensive care units with drugs and medical devices (MDs) in order to cope with the crisis triggered by the SARS-CoV-2 epidemic. Daily monitoring of the drugs consumed by each patient, particularly neuromuscular blocking agents and MDs was a key element in managing stocks and anticipating changes of drugs, packaging and/or devices references. These facts give weight to the Claris report published in France which recognizes that the interactions of pharmacy technicians and pharmacists in the care units have positive effects in terms of quality and safety of patient care. They highlight the dangers to which patients and caregivers are exposed on Saturdays, Sundays and holidays when the pharmacy is closed. They legitimize the question of extending the opening of the pharmacy with a full team 365 days a year.


Subject(s)
COVID-19/drug therapy , Critical Care/methods , Medication Systems, Hospital/organization & administration , Pandemics , Patient Care Team , Pharmacy Service, Hospital/organization & administration , SARS-CoV-2 , Attitude of Health Personnel , Bed Conversion , COVID-19/epidemiology , COVID-19/prevention & control , Critical Care/organization & administration , Drug Storage/methods , France , Hospital Departments/organization & administration , Hospitals, University/organization & administration , Humans , Infection Control/methods , Infection Control/organization & administration , Intensive Care Units/organization & administration , Medication Errors/prevention & control , Neuromuscular Nondepolarizing Agents/supply & distribution , Night Care/organization & administration , Patient Care Team/organization & administration , Pharmacists , Pharmacy Technicians , Physicians/psychology , Prescriptions/statistics & numerical data , Recovery Room/organization & administration , Security Measures/organization & administration
15.
Front Public Health ; 8: 575029, 2020.
Article in English | MEDLINE | ID: covidwho-1045489

ABSTRACT

In March 2020, northern Italy became the second country worldwide most affected by Covid-19 and the death toll overtook that in China. Hospital staff soon realized that Covid-19 was far more severe than expected from the few data available at that time. The Covid-19 pandemic forced hospitals to adjust to rapidly changing circumstances. We report our experience in a general teaching hospital in Milan, the capital of Lombardy, the most affected area in Italy. First, we briefly describe Lombardy's regional Covid-19-related health organizational changes as well as general hospital reorganization. We also provide a multidisciplinary report of the main clinical, radiological and pathological Covid-19 findings we observed in our patients.


Subject(s)
COVID-19/epidemiology , Hospitals, University/organization & administration , Organizational Innovation , Patient Care Team/standards , Personal Protective Equipment/standards , COVID-19/pathology , COVID-19/physiopathology , Humans , Italy , Patient Care Team/organization & administration , SARS-CoV-2
16.
Curr Opin Anaesthesiol ; 34(1): 54-61, 2021 Feb 01.
Article in English | MEDLINE | ID: covidwho-1028307

ABSTRACT

PURPOSE OF REVIEW: The COVID-19 pandemic has driven transformation in every aspect of the healthcare delivery system. The unpredictable onset and magnitude of COVID-19 infections resulted in wide gaps in preparedness for healthcare systems. The development of protocols to address both scarcity of resources and staff protection continues to be essential for risk mitigation. RECENT FINDINGS: The northeast region of the United States had a rapid early surge of COVID-19 infections leading to the exhaustion of critical care capacity. In addition, northeastern hospitals experienced decrease in elective surgical interventions, including organ transplantation. Limited availability of COVID-19 testing and personal protective equipment further fueled the pandemic. This commentary highlights a comprehensive innovative approach to addressing the operating room and hospital demands, as well as the shortages in resources and staffing during the pandemic. SUMMARY: The VCU Department of Anesthesiology operated at 40% of its regular operating room volume throughout the COVID-19 pandemic because of the increased demand from emergency cases. The delay in the peak surge allowed Virginia Commonwealth University, Department of Anesthesiology to develop a comprehensive infrastructure resulting in resulting is maximal workforce risk mitigation.


Subject(s)
Anesthesia Department, Hospital/organization & administration , COVID-19/prevention & control , COVID-19 Testing/statistics & numerical data , Hospitals, University/organization & administration , Humans , Occupational Exposure/prevention & control , Pandemics , Personal Protective Equipment/supply & distribution , United States
17.
Cir Cir ; 88(5): 569-575, 2020.
Article in English | MEDLINE | ID: covidwho-1011873

ABSTRACT

Objective: To describe the clinical characteristics and management of severe COVID-19 patients. Method: Observational, descriptive, longitudinal, and retrospective study. Results: 56 patients were admitted, of whom 80.3% (n = 45) were males with a mean age of 58 years [46-67]. The main comorbidities were obesity, high blood pressure, and diabetes. Symptoms onset time at admittance to the ICU was 9 [7-14] days, of which the most frequent were dyspnea, fever, and dry cough. Laboratory data were lymphopenia; elevation of LDH, fibrinogen, D-dimer, ferritin and CRP. 100% of the patients required mechanical ventilation, the median mechanical ventilation time was 12 [6-17] days, and 66% (n= 37) required a prone position. The pharmacological treatment was mainly based on azithromycin, hydroxychloroquine, tocilizumab and steroids. The most frequent complications were acute kidney injury, venous thromboembolism and acute myocardial infarction. Mortality rate was 17.8% (n = 10). Conclusion: The characteristics of the critically ill patients in our hospital were mostly elderly and obese, with the variables of higher SOFA score and acute kidney injury associated with higher mortality.


Subject(s)
Betacoronavirus , Coronavirus Infections/therapy , Critical Care/methods , Intensive Care Units , Pandemics , Pneumonia, Viral/therapy , Acute Kidney Injury/epidemiology , Acute Kidney Injury/etiology , Adrenal Cortex Hormones/therapeutic use , Aged , Antibodies, Monoclonal, Humanized/therapeutic use , Antiviral Agents/therapeutic use , Azithromycin/therapeutic use , COVID-19 , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/etiology , Combined Modality Therapy , Comorbidity , Coronavirus Infections/blood , Coronavirus Infections/complications , Coronavirus Infections/drug therapy , Coronavirus Infections/epidemiology , Female , Hospital Mortality , Hospitals, University/organization & administration , Humans , Hydroxychloroquine/therapeutic use , Male , Mexico/epidemiology , Middle Aged , Organ Dysfunction Scores , Pneumonia, Viral/blood , Pneumonia, Viral/complications , Pneumonia, Viral/epidemiology , Respiration, Artificial , SARS-CoV-2 , Symptom Assessment
18.
Eur J Ophthalmol ; 31(2): NP4-NP7, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-947912

ABSTRACT

The Coronavirus disease 2019 (COVID-19) outbreak has imposed the adoption of strategies to limit the risk of contagion for cancer patients without compromising their healthcare. As well as cancers of other sites, the treatment of certain ocular and periocular malignancies is considered non-deferrable and should proceed despite the pandemic. Delays in treatment of these patients may result in negative outcomes. Herein, we provide some practical considerations deriving from our experience at the Ocular Oncology Unit of Careggi University Hospital (Florence, Italy).


Subject(s)
COVID-19/epidemiology , Delivery of Health Care/organization & administration , Eye Neoplasms/diagnosis , Eye Neoplasms/therapy , Hospitals, University/organization & administration , Medical Oncology/organization & administration , SARS-CoV-2 , Disease Outbreaks , Humans , Italy/epidemiology
19.
Gynecol Oncol ; 161(1): 89-96, 2021 04.
Article in English | MEDLINE | ID: covidwho-933534

ABSTRACT

INTRODUCTION: During the SARS-CoV-2 pandemic, the majority of healthcare resources of the affected Italian regions were allocated to COVID-19 patients. Due to lack of resources and high risk of death, most cancer patients have been shifted to non-surgical treatments. The following reports our experience of a Gynaecologic Oncology Unit's reallocation of resources in a COVID-19 free surgical oncologic hub in order to guarantee standard quality of surgical activities. MATERIALS AND METHODS: This is a prospective observational study performed in the Gynaecologic Oncology Unit, on the outcomes of the reallocation of surgical activities outside the University Hospital of Bologna, Italy, during the Italian lockdown period. Here, we described our COVID-19 free surgical oncologic pathway, in terms of lifestyle restrictions, COVID-19 screening measures, and patient clinical, surgical and follow up outcomes. RESULTS: During the lockdown period (March 9th - May 4th, 2020), 83 patients were scheduled for oncological surgery, 51 patients underwent surgery. Compared to pre-COVID period, we performed the same activities: number of cases scheduled for surgery, type of surgery and surgical and oncological results. No cases of COVID-19 infection were recorded in operated patients and in medical staff. Patients were compliant and well accepted the lifestyle restrictions and reorganization of the care. CONCLUSIONSONCLUSIONS: Our experience showed that the prioritization of oncological surgical care and the allocation of resources during a pandemic in COVID-19 free surgical hubs is an appropriate choice to guarantee oncological protocols.


Subject(s)
COVID-19/prevention & control , Genital Neoplasms, Female/surgery , Health Care Rationing/organization & administration , Health Services Accessibility/organization & administration , Infection Control/organization & administration , Adult , Aged , COVID-19/epidemiology , Disease Outbreaks , Female , Gynecologic Surgical Procedures , Health Care Rationing/methods , Hospitals, University/organization & administration , Humans , Infection Control/methods , Italy/epidemiology , Middle Aged , Pandemics , Prospective Studies
20.
Strahlenther Onkol ; 196(12): 1080-1085, 2020 12.
Article in English | MEDLINE | ID: covidwho-928408

ABSTRACT

PURPOSE: The described work aimed to avoid cancellations of indispensable treatments by implementing active patient flow management practices and optimizing infrastructure utilization in the radiation oncology department of a large university hospital and regional COVID-19 treatment center close to the first German SARS-CoV­2 hotspot region Heinsberg in order to prevent nosocomial infections in patients and personnel during the pandemic. PATIENTS AND METHODS: The study comprised year-to-date intervention analyses of in- and outpatient key procedures, machine occupancy, and no-show rates in calendar weeks 12 to 19 of 2019 and 2020 to evaluate effects of active patient flow management while monitoring nosocomial COVID-19 infections. RESULTS: Active patient flow management helped to maintain first-visit appointment compliance above 85.5%. A slight appointment reduction of 10.3% daily (p = 0.004) could still significantly increase downstream planning CT scheduling (p = 0.00001) and performance (p = 0.0001), resulting in an absolute 20.1% (p = 0.009) increment of CT performance while avoiding overbooking practices. Daily treatment start was significantly increased by an absolute value of 18.5% (p = 0.026). Hypofractionation and acceleration were significantly increased (p = 0.0043). Integrating strict testing guidelines, a distancing regimen for staff and patients, hygiene regulations, and precise appointment scheduling, no SARS-CoV­2 infection in 164 tested radiation oncology service inpatients was observed. CONCLUSION: In times of reduced medical infrastructure capacities and resources, controlling infrastructural time per patient as well as optimizing facility utilization and personnel workload during treatment evaluation, planning, and irradiation can help to improve appointment compliance and quality management. Avoiding recurrent and preventable exposure to healthcare infrastructure has potential health benefits and might avert cross infections during the pandemic. Active patient flow management in high-risk COVID-19 regions can help Radiation Oncologists to continue and initiate treatments safely, instead of cancelling and deferring indicated therapies.


Subject(s)
Appointments and Schedules , COVID-19/prevention & control , Cross Infection/prevention & control , Hospitals, University/organization & administration , Infection Control/organization & administration , Neoplasms/radiotherapy , Outpatient Clinics, Hospital/organization & administration , Pandemics , Radiation Oncology/organization & administration , Radiology Department, Hospital/organization & administration , SARS-CoV-2/isolation & purification , Workflow , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/transmission , COVID-19 Testing/statistics & numerical data , Cross Infection/epidemiology , Dose Fractionation, Radiation , Germany/epidemiology , Hospitals, University/statistics & numerical data , Humans , Infection Control/methods , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Infectious Disease Transmission, Professional-to-Patient/prevention & control , Neoplasms/surgery , Outpatient Clinics, Hospital/statistics & numerical data , Personal Protective Equipment , Procedures and Techniques Utilization , Radiology Department, Hospital/statistics & numerical data , Radiosurgery/statistics & numerical data , Radiotherapy/statistics & numerical data , Triage/methods , Triage/standards
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