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3.
Acad Med ; 96(6): 859-863, 2021 06 01.
Article in English | MEDLINE | ID: covidwho-1243523

ABSTRACT

PROBLEM: In accordance with guidelines from the Association of American Medical Colleges, medical schools across the United States suspended clerkships and transitioned preclinical courses online in March 2020 because of the COVID-19 pandemic. Hospitals and health systems faced significant burdens during this time, particularly in New York City. APPROACH: Third- and fourth-year medical students at the Icahn School of Medicine at Mount Sinai formed the COVID-19 Student WorkForce to connect students to essential roles in the Mount Sinai Hospital System and support physicians, staff members, researchers, and hospital operations. With the administration's support, the WorkForce grew to include over 530 medical and graduate students. A methodology was developed for clinical students to receive elective credit for these volunteer activities. OUTCOMES: From March 15, 2020, to June 14, 2020, student volunteers recorded 29,602 hours (2,277 hours per week) in 7 different task forces, which operated at 7 different hospitals throughout the health system. Volunteers included students from all years of medical school as well as PhD, master's, and nursing students. The autonomous structure of the COVID-19 Student WorkForce was unique and contributed to its ability to quickly mobilize students to necessary tasks. The group leaders collaborated with other medical schools in the New York City area, sharing best practices and resources and consulting on a variety of topics. NEXT STEPS: Going forward, the COVID-19 Student WorkForce will continue to collaborate with student leaders of other institutions and prevent volunteer burnout; transition select initiatives into structured, precepted student roles for clinical education; and maintain a state of readiness in the event of a second surge of COVID-19 infections in the New York City area.


Subject(s)
Burnout, Professional/prevention & control , COVID-19/prevention & control , Civil Defense/organization & administration , Students, Medical/statistics & numerical data , Workforce/organization & administration , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/virology , Clinical Clerkship/legislation & jurisprudence , Clinical Clerkship/methods , Education, Distance/legislation & jurisprudence , Education, Distance/methods , Guidelines as Topic , Health Resources , Hospitals , Humans , Medical Staff, Hospital/organization & administration , Medical Staff, Hospital/statistics & numerical data , New York City/epidemiology , Practice Guidelines as Topic , SARS-CoV-2/isolation & purification , Schools, Medical/organization & administration , Students, Medical/psychology , Volunteers
5.
Neurology ; 95(13): 583-592, 2020 09 29.
Article in English | MEDLINE | ID: covidwho-945310

ABSTRACT

In response to the COVID-19 pandemic epicenter in Bronx, NY, the Montefiore Neuroscience Center required rapid and drastic changes when considering the delivery of neurologic care, health and safety of staff, and continued education and safety for house staff. Health care leaders rely on principles that can be in conflict during a disaster response such as this pandemic, with equal commitments to ensure the best care for those stricken with COVID-19, provide high-quality care and advocacy for patients and families coping with neurologic disease, and advocate for the health and safety of health care teams, particularly house staff and colleagues who are most vulnerable. In our attempt to balance these principles, over 3 weeks, we reformatted our inpatient neuroscience services by reducing from 4 wards to just 1, in the following weeks delivering care to over 600 hospitalized patients with neuro-COVID and over 1,742 total neuroscience hospital bed days. This description from members of our leadership team provides an on-the-ground account of our effort to respond nimbly to a complex and evolving surge of patients with COVID in a large urban hospital network. Our efforts were based on (1) strategies to mitigate exposure and transmission, (2) protection of the health and safety of staff, (3) alleviation of logistical delays and strains in the system, and (4) facilitating coordinated communication. Each center's experience will add to knowledge of best practices, and emerging research will help us gain insights into an evidence-based approach to neurologic care during and after the COVID-19 pandemic.


Subject(s)
Coronavirus Infections , Hospital Departments/organization & administration , Medical Staff, Hospital/organization & administration , Neurology/organization & administration , Pandemics , Pneumonia, Viral , Ambulatory Care , Betacoronavirus , COVID-19 , Communication , Delivery of Health Care , Hospital Units/organization & administration , Hospitalization , Humans , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Neurology/education , Neuroscience Nursing , Nursing Staff, Hospital/organization & administration , Personal Protective Equipment , Personnel Staffing and Scheduling , SARS-CoV-2 , Telemedicine , Text Messaging
6.
Acta Orthop ; 91(6): 644-649, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-752301

ABSTRACT

Background and purpose - The COVID-19 pandemic has disrupted healthcare services around the world. We (1) describe the organizational changes at a level 1 trauma center, (2) investigate how orthopedic healthcare professionals perceived the immense amount of information and educational activities, and (3) make recommendations on how an organization can prepare for disruptive situations such as the COVID-19 pandemic in the future. Methods - We conducted a retrospective survey on the organizational restructuring of the orthopedic department and the learning outcomes of a needs-driven educational program. The educational activities were evaluated by a non-validated, 7-item questionnaire. Results - The hospital established 5 COVID-19 clusters, which were planned to be activated in sequential order. The orthopedic ward comprised cluster 4, where orthopedic nursing staff were teamed up with internal medicine physicians, while the orthopedic team were redistributed to manage minor and major injuries in the emergency department (ED). The mean learning outcome of the educational activities was high-very high, i.e., 5.4 (SD 0.7; 7-point Likert scale). Consequently, the staff felt more confident to protect themselves and to treat COVID-19 patients. Interpretation - Using core clinical competencies of the staff, i.e., redistribution of the orthopedic team to the ED, while ED physicians could use their competencies treating COVID-19 patients, may be applicable in other centers. In-situ simulation is an efficient tool to enhance non-technical and technical skills and to facilitate organizational learning in regard to complying with unforeseen changes.


Subject(s)
COVID-19 , Delivery of Health Care , Infection Control/organization & administration , Organizational Innovation , Orthopedics/trends , Trauma Centers , COVID-19/epidemiology , COVID-19/prevention & control , Delivery of Health Care/organization & administration , Delivery of Health Care/trends , Denmark/epidemiology , Health Care Surveys , Humans , Infection Control/methods , Medical Staff, Hospital/organization & administration , SARS-CoV-2 , Staff Development/methods , Staff Development/trends , Trauma Centers/organization & administration , Trauma Centers/trends
8.
Aust Health Rev ; 44(5): 741-747, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-735600

ABSTRACT

Objective A pilot study to: (1) describe the ability of emergency physicians to provide primary consults at an Australian, major metropolitan, adult emergency department (ED) during the COVID-19 pandemic when compared with historical performance; and (2) to identify the effect of system and process factors on productivity. Methods A retrospective cross-sectional description of shifts worked between 1 and 29 February 2020, while physicians were carrying out their usual supervision, flow and problem-solving duties, as well as undertaking additional COVID-19 preparation, was documented. Effect of supervisory load, years of Australian registration and departmental flow factors were evaluated. Descriptive statistical methods were used and regression analyses were performed. Results A total of 188 shifts were analysed. Productivity was 4.07 patients per 9.5-h shift (95% CI 3.56-4.58) or 0.43 patients per h, representing a 48.5% reduction from previously published data (P<0.0001). Working in a shift outside of the resuscitation area or working a day shift was associated with a reduction in individual patient load. There was a 2.2% (95% CI: 1.1-3.4, P<0.001) decrease in productivity with each year after obtaining Australian medical registration. There was a 10.6% (95% CI: 5.4-15.6, P<0.001) decrease in productivity for each junior physician supervised. Bed access had no statistically significant effect on productivity. Conclusions Emergency physicians undertake multiple duties. Their ability to manage their own patients varies depending on multiple ED operational factors, particularly their supervisory load. COVID-19 preparations reduced their ability to see their own patients by half. What is known about the topic? An understanding of emergency physician productivity is essential in planning clinical operations. Medical productivity, however, is challenging to define, and is controversial to measure. Although baseline data exist, few studies examine the effect of patient flow and supervision requirements on the emergency physician's ability to perform primary consults. No studies describe these metrics during COVID-19. What does this paper add? This pilot study provides a novel cross-sectional description of the effect of COVID-19 preparations on the ability of emergency physicians to provide direct patient care. It also examines the effect of selected system and process factors in a physician's ability to complete primary consults. What are the implications for practitioners? When managing an emergency medical workforce, the contribution of emergency physicians to the number of patients requiring consults should take into account the high volume of alternative duties required. Increasing alternative duties can decrease primary provider tasks that can be completed. COVID-19 pandemic preparation has significantly reduced the ability of emergency physicians to manage their own patients.


Subject(s)
Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , Efficiency, Organizational/statistics & numerical data , Emergency Service, Hospital/organization & administration , Emergency Service, Hospital/trends , Medical Staff, Hospital/organization & administration , Patient-Centered Care/organization & administration , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , Adult , Aged , Aged, 80 and over , Appointments and Schedules , Australia , Betacoronavirus/pathogenicity , COVID-19 , Cross-Sectional Studies , Emergency Service, Hospital/statistics & numerical data , Female , Forecasting , Humans , Male , Medical Staff, Hospital/statistics & numerical data , Medical Staff, Hospital/trends , Middle Aged , Pandemics/statistics & numerical data , Patient-Centered Care/statistics & numerical data , Pilot Projects , Retrospective Studies , SARS-CoV-2
10.
Infect Control Hosp Epidemiol ; 41(12): 1443-1445, 2020 12.
Article in English | MEDLINE | ID: covidwho-656539

ABSTRACT

Reducing severe acute respiratory coronavirus virus 2 (SARS-CoV-2) infections among healthcare workers is critical. We ran Monte Carlo simulations modeling the spread of SARS-CoV-2 in non-COVID-19 wards, and we found that longer nursing shifts and scheduling designs in which teams of nurses and doctors co-rotate no more frequently than every 3 days can lead to fewer infections.


Subject(s)
COVID-19 , Health Workforce/organization & administration , Infection Control/methods , Medical Staff, Hospital , Personnel Staffing and Scheduling , Safety Management/standards , COVID-19/epidemiology , COVID-19/prevention & control , Connecticut/epidemiology , Humans , Medical Staff, Hospital/organization & administration , Medical Staff, Hospital/statistics & numerical data , Occupational Exposure/prevention & control , Organizational Innovation , Personnel Staffing and Scheduling/organization & administration , Personnel Staffing and Scheduling/standards , Personnel Staffing and Scheduling/trends , SARS-CoV-2 , Safety Management/organization & administration
11.
Crit Care Med ; 48(10): e846-e855, 2020 10.
Article in English | MEDLINE | ID: covidwho-636350

ABSTRACT

IMPORTANCE: Recent reports identify that among hospitalized coronavirus disease 2019 patients, 30% require ICU care. Understanding ICU resource needs remains an essential component of meeting current and projected needs of critically ill coronavirus disease 2019 patients. OBJECTIVES: This study queried U.S. ICU clinician perspectives on challenging aspects of care in managing coronavirus disease 2019 patients, current and anticipated resource demands, and personal stress. DESIGN, SETTING, AND PARTICIPANTS: Using a descriptive survey methodology, an anonymous web-based survey was administered from April 7, 2020, to April 22, 2020 (email and newsletter) to query members of U.S. national critical care organizations. MEASUREMENTS AND MAIN RESULTS: Through a 16-item descriptive questionnaire, ICU clinician perceptions were assessed regarding current and emerging critical ICU needs in managing the severe acute respiratory syndrome coronavirus 2 infected patients, resource levels, concerns about being exposed to severe acute respiratory syndrome coronavirus 2, and perceived level of personal stress. A total of 9,120 ICU clinicians responded to the survey, representing all 50 U.S. states, with 4,106 (56.9%) working in states with 20,000 or more coronavirus disease 2019 cases. The 7,317 respondents who indicated their profession included ICU nurses (n = 6,731, 91.3%), advanced practice providers (nurse practitioners and physician assistants; n = 334, 4.5%), physicians (n = 212, 2.9%), respiratory therapists (n = 31, 0.4%), and pharmacists (n = 30, 0.4%). A majority (n = 6,510, 88%) reported having cared for a patient with presumed or confirmed coronavirus disease 2019. The most critical ICU needs identified were personal protective equipment, specifically N95 respirator availability, and ICU staffing. Minimizing healthcare worker virus exposure during care was believed to be the most challenging aspect of coronavirus disease 2019 patient care (n = 2,323, 30.9%). Nurses report a high level of concern about exposing family members to severe acute respiratory syndrome coronavirus 2 (median score of 10 on 0-10 scale). Similarly, the level of concern reached the maximum score of 10 in ICU clinicians who had provided care to coronavirus disease 2019 patients. CONCLUSIONS: This national ICU clinician survey identifies continued concerns regarding personal protective equipment supplies with the chief issue being N95 respirator availability. As the pandemic continues, ICU clinicians anticipate a number of limited resources that may impact ICU care including personnel, capacity, and surge potential, as well as staff and subsequent family members exposure to severe acute respiratory syndrome coronavirus 2. These persistent concerns greatly magnify personal stress, offering a therapeutic target for professional organization and facility intervention efforts.


Subject(s)
Coronavirus Infections/epidemiology , Intensive Care Units/organization & administration , Medical Staff, Hospital/organization & administration , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Severe Acute Respiratory Syndrome/therapy , COVID-19 , Coronavirus Infections/prevention & control , Critical Illness/mortality , Critical Illness/therapy , Female , Hospital Mortality/trends , Humans , Interdisciplinary Communication , Male , Outcome Assessment, Health Care , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Severe Acute Respiratory Syndrome/diagnosis , Severe Acute Respiratory Syndrome/mortality , Surveys and Questionnaires , United States
12.
Injury ; 51(10): 2135-2141, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-623925

ABSTRACT

BACKGROUND: As the COVID-19 pandemic sweeps across the world, healthcare departments must adapt to meet the challenges of service provision and staff/patient protection. Unlike elective surgery, acute care surgery (ACS) workloads cannot be artificially reduced providing a unique challenge for administrators to balance healthcare resources between the COVID-19 surge and regular patient admissions. METHODS: An enhanced ACS (eACS) model of care is described with the aim of limiting COVID-19 healthcare worker and patient cross-infection as well as providing 24/7 management of emergency general surgical (GS) and trauma patients. The eACS service comprised 5 independent teams covering a rolling 1:5 24-hr call. Attempts to completely separate eACS teams and patients from the elective side were made. The service was compared to the existing ACS service in terms of clinical and efficiency outcomes. Finally, a survey of staff attitudes towards these changes, concerns regarding COVID-19 and psychological well-being was assessed. RESULTS: There were no staff/patient COVID-19 cross-infections. Compared to the ACS service, eACS patients had reduced overall length of stay (2-days), time spent in the Emergency Room (46 min) and time from surgery to discharge (2.4-hours). The eACS model of care saved financial resources and bed-days for the organisation. The changes were well received by team-members who also felt that their safety was prioritised. CONCLUSION: In healthcare systems not overwhelmed by COVID-19, an eACS model may assist in preserving psychological well-being for healthcare staff whilst providing 24/7 care for emergency GS and trauma patients.


Subject(s)
Coronavirus Infections/prevention & control , Cross Infection/prevention & control , Delivery of Health Care/methods , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Surgery Department, Hospital/organization & administration , Surgical Procedures, Operative , Adult , Aged , Attitude of Health Personnel , Betacoronavirus , COVID-19 , Emergency Service, Hospital , Female , Health Personnel , Humans , Infection Control , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Length of Stay , Male , Medical Staff, Hospital/organization & administration , Middle Aged , SARS-CoV-2 , Workflow
13.
Health Aff (Millwood) ; 39(8): 1426-1430, 2020 08.
Article in English | MEDLINE | ID: covidwho-594930

ABSTRACT

Confronted with the coronavirus disease 2019 (COVID-19) pandemic, New York City Health + Hospitals, the city's public health care system, rapidly expanded capacity across its eleven acute care hospitals and three new field hospitals. To meet the unprecedented demand for patient care, NYC Health + Hospitals redeployed staff to the areas of greatest need and redesigned recruiting, onboarding, and training processes. The hospital system engaged private staffing agencies, partnered with the Department of Defense, and recruited volunteers throughout the country. A centralized onboarding team created a single-source portal for medical care providers requiring credentialing and established new staff positions to increase efficiency. Using new educational tools focused on COVID-19 content, the hospital system trained twenty thousand staff members, including nearly nine thousand nurses, within a two-month period. Creation of multidisciplinary teams, frequent enterprisewide communication, willingness to shift direction in response to changing needs, and innovative use of technology were the key factors that enabled the hospital system to meet its goals.


Subject(s)
Communicable Disease Control/organization & administration , Coronavirus Infections/epidemiology , Hospitals, Public/supply & distribution , Medical Staff, Hospital/organization & administration , Pneumonia, Viral/epidemiology , Workforce/statistics & numerical data , COVID-19 , Coronavirus Infections/prevention & control , Disease Outbreaks/statistics & numerical data , Female , Humans , Interdisciplinary Communication , Male , New York City , Organizational Innovation , Outcome Assessment, Health Care , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Strategic Stockpile/organization & administration
16.
Int J Surg ; 79: 43-46, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-276448

ABSTRACT

The COVID-19 pandemic resulted in significant changes in health care systems worldwide, with low- and middle-income countries (LMIC) sustaining important repercussions. Specifically, alongside cancellation and postponements of non-essential surgical services, emergency and essential surgical care delivery may become affected due to the shift of human and material resources towards fighting the pandemic. For surgeries that do get carried through, new difficulties arise in protecting surgical personnel from contracting SARS-CoV-2. This scarcity in LMIC surgical ecosystems may result in higher morbidity and mortality, in addition to the COVID-19 toll. This paper aims to explore the potential consequences of COVID-19 on the emergency and essential surgical care in LMICs, to offer recommendations to mitigate damages and to reflect on preparedness for future crises. Reducing the devastating consequences of the COVID-19 pandemic on LMIC emergency and essential surgical services can be achieved through empowering communities with accurate information and knowledge on prevention, optimizing surgical material resources, providing quality training of health care personnel to treat SARS-CoV-2, and ensuring adequate personal protection equipment for workers on the frontline. While LMIC health systems are under larger strain, the experience from previous outbreaks may aid in order to innovate and adapt to the current pandemic. Protecting LMIC surgical ecosystems will be a pivotal process in ensuring that previous health system strengthening efforts are preserved, comprehensive care for populations worldwide are ensured, and to allow for future developments beyond the pandemic.


Subject(s)
Coronavirus Infections/transmission , Developing Countries , Emergency Service, Hospital/organization & administration , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Pandemics , Pneumonia, Viral/transmission , Surgery Department, Hospital/organization & administration , Betacoronavirus , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Humans , Infection Control , Medical Staff, Hospital/organization & administration , Pandemics/prevention & control , Personal Protective Equipment , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , Poverty Areas , SARS-CoV-2
17.
Int J Surg ; 79: 31-35, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-276339

ABSTRACT

IMPORTANCE: Although Singapore was one of the first countries outside of China to be affected by COVID-19, for the first 2.5 months since its first reported case on January 23, 2020, it remained one of the few nations with successful containment of spread of the pandemic with little mortality and zero intra-hospital transmissions, without instituting a major lockdown of the country. In times of an infectious epidemic where medical subspecialties lead the frontline, a surgeon's role becomes rather vague. However, the only obstacle that stands in between the surgeon and fighting in the frontline of an infectious disease outbreak, is the traditional perception of what a surgeon can do. By presenting the strategies employed by our institution and its surgical unit, which remains the epicenter of the COVID-19 fight in Singapore, together with our medical counterparts, we hope to be able to improve our practices to respond and prevent the pandemic from escalating further as a collective community of surgeons across the globe. OBSERVATIONS: Contingencies should be in place for prioritization of existing patients, triaging and treatment of suspected patients, infection control, manpower management and novel strategies for inter-disciplinary communications and education in a hospital's surgical unit during a pandemic. Working in a high risk environment with manpower and resource limitations for prolonged periods of time has effect on morale and affects surgeon burn-out. Transparent communication, avenues to address psychological needs of surgeons and leadership by example are key strategies in ensuring a sustainable fight against the pandemic. CONCLUSIONS AND RELEVANCE: With the varies strategies implemented, every surgical discipline and every surgeon should be unified and place their desire to operate aside. There should not be any differentiation between surgeon and physician, but instead, everyone has to work together as one united health care front battling the common enemy - COVID-19.


Subject(s)
Coronavirus Infections/epidemiology , Infection Control , Pandemics/prevention & control , Physician's Role , Pneumonia, Viral/epidemiology , Surgeons , Surgery Department, Hospital/organization & administration , Betacoronavirus , COVID-19 , Cohort Studies , Communication , Coronavirus Infections/prevention & control , Humans , Interprofessional Relations , Medical Staff, Hospital/education , Medical Staff, Hospital/organization & administration , Pneumonia, Viral/prevention & control , SARS-CoV-2 , Singapore/epidemiology , Triage
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