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1.
J Health Organ Manag ; ahead-of-print(ahead-of-print)2021 Aug 31.
Article in English | MEDLINE | ID: covidwho-1722823

ABSTRACT

PURPOSE: Nurses working during the coronavirus disease 2019 (COVID-19) pandemic have reported elevated levels of anxiety, burnout and sleep disruption. Hospital administrators are in a unique position to mitigate or exacerbate stressful working conditions. The goal of this study was to capture the recommendations of nurses providing frontline care during the pandemic. DESIGN/METHODOLOGY/APPROACH: Semi-structured interviews were conducted during the first wave of the COVID-19 pandemic, with 36 nurses living in Canada and working in Canada or the United States. FINDINGS: The following recommendations were identified from reflexive thematic analysis of interview transcripts: (1) The nurses emphasized the need for a leadership style that embodied visibility, availability and careful planning. (2) Information overload contributed to stress, and participants appealed for clear, consistent and transparent communication. (3) A more resilient healthcare supply chain was required to safeguard the distribution of equipment, supplies and medications. (4) Clear communication of policies related to sick leave, pay equity and workload was necessary. (5) Equity should be considered, particularly with regard to redeployment. (6) Nurses wanted psychological support offered by trusted providers, managers and peers. PRACTICAL IMPLICATIONS: Over-reliance on employee assistance programmes and other individualized approaches to virtual care were not well-received. An integrative systems-based approach is needed to address the multifaceted mental health outcomes and reduce the deleterious impact of the COVID-19 pandemic on the nursing workforce. ORIGINALITY/VALUE: Results of this study capture the recommendations made by nurses during in-depth interviews conducted early in the COVID-19 pandemic.


Subject(s)
Burnout, Professional/psychology , COVID-19/nursing , Nursing Staff, Hospital/psychology , Occupational Health Services , Stress, Psychological/psychology , Adult , Burnout, Professional/prevention & control , Canada , Communication , Female , Humans , Interviews as Topic , Leadership , Male , Needs Assessment , Organizational Policy , Pandemics , Personal Protective Equipment , SARS-CoV-2 , Sick Leave , Stress, Psychological/prevention & control , United States , Workload
2.
J Forensic Nurs ; 17(1): 61-64, 2021.
Article in English | MEDLINE | ID: covidwho-1722672

ABSTRACT

ABSTRACT: Standard operating procedures drive everyday practice within any organization, including those within a forensic setting. In the event of unusual circumstances, organizations must respond rapidly to address the impact on operations while ensuring that the quality and safety outcomes of routine services are not affected. This case study illustrates how standard operating procedures can be newly developed or modified, and rapidly deployed and quickly revised, to address unusual circumstances. The response to the COVID-19 pandemic is used as an example in this case report.


Subject(s)
Forensic Sciences/organization & administration , Organizational Case Studies , Organizational Policy , Quality Control , COVID-19/epidemiology , Humans , Texas/epidemiology
3.
BMC Pregnancy Childbirth ; 22(1): 119, 2022 Feb 11.
Article in English | MEDLINE | ID: covidwho-1677496

ABSTRACT

BACKGROUND: The provision of care to pregnant persons and neonates must continue through pandemics. To maintain quality of care, while minimizing physical contact during the Severe Acute Respiratory Syndrome-related Coronavirus-2 (SARS-CoV2) pandemic, hospitals and international organizations issued recommendations on maternity and neonatal care delivery and restructuring of clinical and academic services. Early in the pandemic, recommendations relied on expert opinion, and offered a one-size-fits-all set of guidelines. Our aim was to examine these recommendations and provide the rationale and context to guide clinicians, administrators, educators, and researchers, on how to adapt maternity and neonatal services during the pandemic, regardless of jurisdiction. METHOD: Our initial database search used Medical subject headings and free-text search terms related to coronavirus infections, pregnancy and neonatology, and summarized relevant recommendations from international society guidelines. Subsequent targeted searches to December 30, 2020, included relevant publications in general medical and obstetric journals, and updated society recommendations. RESULTS: We identified 846 titles and abstracts, of which 105 English-language publications fulfilled eligibility criteria and were included in our study. A multidisciplinary team representing clinicians from various disciplines, academics, administrators and training program directors critically appraised the literature to collate recommendations by multiple jurisdictions, including a quaternary care Canadian hospital, to provide context and rationale for viable options. INTERPRETATION: There are different schools of thought regarding effective practices in obstetric and neonatal services. Our critical review presents the rationale to effectively modify services, based on the phase of the pandemic, the prevalence of infection in the population, and resource availability.


Subject(s)
COVID-19/prevention & control , Communicable Disease Control/organization & administration , Delivery of Health Care/organization & administration , Maternal-Child Health Services/organization & administration , Perinatal Care , Practice Guidelines as Topic , Pregnancy Complications, Infectious/prevention & control , Academic Medical Centers , COVID-19/therapy , Canada , Female , Humans , Infant , Infant, Newborn , Inpatients , Organizational Policy , Outpatients , Pregnancy , Pregnancy Complications, Infectious/therapy , SARS-CoV-2
5.
Infect Control Hosp Epidemiol ; 42(11): 1307-1312, 2021 11.
Article in English | MEDLINE | ID: covidwho-1574178

ABSTRACT

OBJECTIVE: In response to the 2013-2016 Ebola virus disease outbreak, the US government designated certain healthcare institutions as Ebola treatment centers (ETCs) to better prepare for future emerging infectious disease outbreaks. This study investigated ETC experiences and critical care policies for patients with viral hemorrhagic fever (VHF). DESIGN: A 58-item questionnaire elicited information on policies for 9 critical care interventions, factors that limited care provision, and innovations developed to deliver care. SETTING AND PARTICIPANTS: The questionnaire was sent to 82 ETCs. METHODS: We analyzed ordinal and categorical data pertaining to the ETC characteristics and descriptive data about their policies and perceived challenges. Statistical analyses assessed whether ETCs with experience caring for VHF patients were more likely to have critical care policies than those that did not. RESULTS: Of the 27 ETCs who responded, 17 (63%) were included. Among them, 8 (47%) reported experience caring for persons under investigation or confirmed cases of VHF. Most felt ready to provide intubation, chest compressions, and renal replacement therapy to these patients. The factors most cited for limiting care were staff safety and clinical futility. Innovations developed to better provide care included increased simulation training and alternative technologies for procedures and communication. CONCLUSIONS: There were broad similarities in critical care policies and limitations among institutions. There were several interventions, namely ECMO and cricothyrotomy, which few institutions felt ready to provide. Future studies could identify obstacles to providing these interventions and explore policy changes after increased experience with novel infectious diseases, such as COVID-19.


Subject(s)
COVID-19 , Hemorrhagic Fever, Ebola , Critical Illness , Disease Outbreaks , Hemorrhagic Fever, Ebola/epidemiology , Hemorrhagic Fever, Ebola/therapy , Humans , Organizational Policy , SARS-CoV-2
6.
PLoS One ; 16(11): e0259858, 2021.
Article in English | MEDLINE | ID: covidwho-1526686

ABSTRACT

BACKGROUND: Professional burnout represents a significant threat to the American healthcare system. Organizational and individual factors may increase healthcare providers' susceptibility or resistance to burnout. We hypothesized that during the COVID-19 pandemic, 1) higher levels of perceived organizational support (POS) are associated with lower risk for burnout and anxiety, and 2) anxiety mediates the association between POS and burnout. METHODS: In this longitudinal prospective study, we surveyed healthcare providers employed full-time at a large, multihospital healthcare system monthly over 6 months (April to November 2020). Participants were randomized using a 1:1 allocation stratified by provider type, gender, and academic hospital status to receive one of two versions of the survey instrument formulated with different ordering of the measures to minimize response bias due to context effects. The exposure of interest was POS measured using the validated 8-item Survey of POS (SPOS) scale. Primary outcomes of interest were anxiety and risk for burnout as measured by the validated 10-item Burnout scale from the Professional Quality (Pro-QOL) instrument and 4-item Emotional Distress-Anxiety short form of the Patient Reported Outcome Measurement Information System (PROMIS) scale, respectively. Linear mixed models evaluated the associations between POS and both burnout and anxiety. A mediation analysis evaluated whether anxiety mediated the POS-burnout association. RESULTS: Of the 538 participants recruited, 402 (75%) were included in the primary analysis. 55% of participants were physicians, 73% 25-44 years of age, 73% female, 83% White, and 44% had ≥1 dependent. Higher POS was significantly associated with a lower risk for burnout (-0.23; 95% CI -0.26, -0.21; p<0.001) and lower degree of anxiety (-0.07; 95% CI -0.09, -0.06; p = 0.010). Anxiety mediated the associated between POS and burnout (direct effect -0.17; 95% CI -0.21, -0.13; p<0.001; total effect -0.23; 95% CI -0.28, -0.19; p<0.001). CONCLUSION: During a health crisis, increasing the organizational support perceived by healthcare employees may reduce the risk for burnout through a reduction in anxiety. Improving the relationship between healthcare organizations and the individuals they employ may reduce detrimental effects of psychological distress among healthcare providers and ultimately improve patient care.


Subject(s)
Anxiety/epidemiology , Burnout, Professional/epidemiology , COVID-19/psychology , Health Personnel/psychology , Organizational Culture , Social Support/psychology , Adult , Aged , Female , Humans , Male , Middle Aged , Organizational Policy , Social Support/statistics & numerical data
7.
Eur J Clin Invest ; 51(11): e13678, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1501400

ABSTRACT

Strategies for the use of COVID-19 vaccines in children and young adults (in particular university students) are hotly debated and important to optimize. As of late August 2021, recommendations on the use of these vaccines in children vary across different countries. Recommendations are more uniform for vaccines in young adults, but vaccination uptake in this age group shows a large range across countries. Mandates for vaccination of university students are a particularly debated topic with many campuses endorsing mandates in the USA in contrast to European countries, at least as of August 2021. The commentary discusses the potential indirect impact of vaccination of youth on the COVID-19 burden of disease for other age groups and societal functioning at large, estimates of direct impact on reducing fatalities and nonlethal COVID-19-related events in youth, estimates of potential lethal and nonlethal adverse events from vaccines and differential considerations that may exist in the USA, European countries and nonhigh-income countries. Decision-making for deploying COVID-19 vaccines in young people is subject to residual uncertainty on the future course of the pandemic and potential evolution towards endemicity. Rational recommendations would also benefit from better understanding of the clinical and sociodemographic features of COVID-19 risk in young populations and from dissecting the role of re-infections and durability of natural vs. vaccine-induced immunity.


Subject(s)
COVID-19 Vaccines/therapeutic use , COVID-19/prevention & control , Organizational Policy , Practice Guidelines as Topic , Students , Universities , Adolescent , Age Distribution , COVID-19/epidemiology , Child , Humans , Risk Assessment , SARS-CoV-2 , Young Adult
9.
MMWR Morb Mortal Wkly Rep ; 70(39): 1372-1373, 2021 Oct 01.
Article in English | MEDLINE | ID: covidwho-1444554

ABSTRACT

CDC recommends universal indoor masking by students, staff members, faculty, and visitors in kindergarten through grade 12 (K-12) schools, regardless of vaccination status, to reduce transmission of SARS-CoV-2, the virus that causes COVID-19 (1). Schools in Maricopa and Pima Counties, which account for >75% of Arizona's population (2), resumed in-person learning for the 2021-22 academic year during late July through early August 2021. In mid-July, county-wide 7-day case rates were 161 and 105 per 100,000 persons in Maricopa and Pima Counties, respectively, and 47.6% of Maricopa County residents and 59.2% of Pima County residents had received at least 1 dose of a COVID-19 vaccine. School districts in both counties implemented variable mask policies at the start of the 2021-22 academic year (Table). The association between school mask policies and school-associated COVID-19 outbreaks in K-12 public noncharter schools open for in-person learning in Maricopa and Pima Counties during July 15-August 31, 2021, was evaluated.


Subject(s)
COVID-19/prevention & control , Disease Outbreaks/statistics & numerical data , Masks/statistics & numerical data , Organizational Policy , Schools/organization & administration , Adolescent , Arizona/epidemiology , COVID-19/epidemiology , Child , Child, Preschool , Humans
10.
Eur J Clin Invest ; 51(12): e13687, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1443255

ABSTRACT

BACKGROUND/OBJECTIVES: We investigated whether behavioral precautions adopted during Coronavirus disease (COVID-19) pandemic also influenced the spreading and multidrug resistance (MDR) of ESKAPEEc (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii [AB], Pseudomonas aeruginosa, Enterobacter spp and Escherichia Coli, [EC]) among Intensive Care Unit (ICU) patients. SUBJECTS/METHODS: We performed a single-center retrospective study in adult patients admitted to our COVID-19-free surgical ICU. Only patients staying in ICU for more than 48 hours were included. The ESKAPEEc infections recorded during the COVID-19 period (June 1, 2020 - February 28, 2021) and in the corresponding pre-pandemic period (June 1, 2019 - February 28, 2020) were compared. An interrupted time series analysis was performed to rule out possible confounders. RESULTS: Overall, 173 patients in the COVID-19 period and 132 in the pre-COVID-19 period were investigated. The ESKAPEEc infections were documented in 23 (13.3%) and 35 (26.5%) patients in the pandemic and the pre-pandemic periods, respectively (p = 0.005). Demographics, diagnosis, comorbidities, type of surgery, Simplified Acute Physiology Score II, length of mechanical ventilation, hospital and ICU length of stay, ICU death rate, and 28-day hospital mortality were similar in the two groups. In comparison with the pre-pandemic period, no AB was recorded during COVID-19 period, (p = 0.017), while extended-spectrum beta-lactamase-producing EC infections significantly decreased (p = 0.017). Overall, the ESKAPEEc isolates during pandemic less frequently exhibited multidrug-resistant (p = 0.014). CONCLUSIONS: These findings suggest that a robust adherence to hygiene measures together with human contact restrictions in a COVID-19 free ICU might also restrain the transmission of ESKAPEEc pathogens.


Subject(s)
COVID-19/prevention & control , Cross Infection/epidemiology , Gram-Negative Bacterial Infections/epidemiology , Gram-Positive Bacterial Infections/epidemiology , Infection Control , Acinetobacter Infections/epidemiology , Acinetobacter Infections/microbiology , Acinetobacter Infections/transmission , Acinetobacter baumannii , Aged , Cross Infection/microbiology , Cross Infection/transmission , Drug Resistance, Multiple, Bacterial , Enterobacter , Enterobacteriaceae Infections/epidemiology , Enterobacteriaceae Infections/microbiology , Enterobacteriaceae Infections/transmission , Enterococcus faecium , Escherichia coli Infections/epidemiology , Escherichia coli Infections/microbiology , Escherichia coli Infections/transmission , Female , Gram-Negative Bacterial Infections/microbiology , Gram-Negative Bacterial Infections/transmission , Gram-Positive Bacterial Infections/microbiology , Gram-Positive Bacterial Infections/transmission , Hand Disinfection , Humans , Intensive Care Units , Interrupted Time Series Analysis , Klebsiella Infections/epidemiology , Klebsiella Infections/microbiology , Klebsiella Infections/transmission , Klebsiella pneumoniae , Male , Methicillin-Resistant Staphylococcus aureus , Middle Aged , Organizational Policy , Personal Protective Equipment , Pseudomonas Infections/epidemiology , Pseudomonas Infections/microbiology , Pseudomonas Infections/transmission , Pseudomonas aeruginosa , Retrospective Studies , SARS-CoV-2 , Staphylococcal Infections/epidemiology , Staphylococcal Infections/microbiology , Staphylococcal Infections/transmission , Staphylococcus aureus , Visitors to Patients
11.
Int J Environ Res Public Health ; 18(19)2021 Sep 22.
Article in English | MEDLINE | ID: covidwho-1438586

ABSTRACT

Telemedicine use increased during the COVID-19 pandemic, but uptake was uneven and future use is uncertain. This study, then, examined the ability of personal and environmental variables to predict telemedicine adoption during the COVID-19 pandemic. A total of 230 physicians practicing in the U.S. completed questions concerning personal and environmental characteristics, as well as telemedicine use at three time points: pre-pandemic, during the pandemic, and anticipated future use. Associations between use and characteristics were determined to identify factors important for telemedicine use. Physicians reported that telemedicine accounted for 3.72% of clinical work prior to the pandemic, 46.03% during the pandemic, and predicted 25.44% after the pandemic ends. Physicians within hospitals reported less increase in telemedicine use during the pandemic than within group practice (p = 0.016) and less increase in use at hospitals compared to academic medical centers (p = 0.027) and group practice (p = 0.008). Greater telemedicine use was associated with more years in practice (p = 0.009), supportive organizational policies (p = 0.001), organizational encouragement (p = 0.003), expectations of greater patient volume (p = 0.003), and perceived higher quality of patient care (p = 0.032). Characteristics such as gender, number of physicians, and level of telemedicine training were not significant predictors. Organizations interested in supporting physicians to adopt telemedicine should encourage its use and create policies supporting its use. More senior physicians had a greater degree of telemedicine uptake, while training programs did not predict use, suggesting that efforts to develop telemedicine competency in younger physicians may be ineffective and should be re-examined.


Subject(s)
COVID-19 , Physicians , Telemedicine , Demography , Humans , Organizational Policy , Pandemics , SARS-CoV-2
12.
Nat Hum Behav ; 6(1): 43-54, 2022 01.
Article in English | MEDLINE | ID: covidwho-1402076

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic caused a rapid shift to full-time remote work for many information workers. Viewing this shift as a natural experiment in which some workers were already working remotely before the pandemic enables us to separate the effects of firm-wide remote work from other pandemic-related confounding factors. Here, we use rich data on the emails, calendars, instant messages, video/audio calls and workweek hours of 61,182 US Microsoft employees over the first six months of 2020 to estimate the causal effects of firm-wide remote work on collaboration and communication. Our results show that firm-wide remote work caused the collaboration network of workers to become more static and siloed, with fewer bridges between disparate parts. Furthermore, there was a decrease in synchronous communication and an increase in asynchronous communication. Together, these effects may make it harder for employees to acquire and share new information across the network.


Subject(s)
COVID-19/prevention & control , Communication , Cooperative Behavior , Employment , Information Technology , Teleworking , Communicable Disease Control , Humans , Organizational Policy , SARS-CoV-2
13.
Can J Anaesth ; 68(10): 1474-1484, 2021 10.
Article in English | MEDLINE | ID: covidwho-1392019

ABSTRACT

PURPOSE: In response to the rapid spread of SARS-CoV-2, hospitals in Canada enacted temporary visitor restrictions to limit the spread of COVID-19 and preserve personal protective equipment supplies. This study describes the extent, variation, and fluctuation of Canadian adult intensive care unit (ICU) visitation policies before and during the first wave of the COVID-19 pandemic. METHODS: We conducted an environmental scan of Canadian hospital visitation policies throughout the first wave of the pandemic. We conducted a two-phased study analyzing both quantitative and qualitative data. RESULTS: We collected 257 documents with reference to visitation policies (preCOVID, 101 [39%]; midCOVID, 71 [28%]; and lateCOVID, 85 [33%]). Of these 257 documents, 38 (15%) were ICU-specific and 70 (27%) referenced the ICU. Most policies during the midCOVID/lateCOVID pandemic period allowed no visitors with specific exceptions (e.g., end-of-life). Framework analysis revealed five overarching themes: 1) reasons for restricted visitation policies; 2) visitation policies and expectations; 3) exceptions to visitation policy; 4) patient and family-centred care; and 5) communication and transparency. CONCLUSIONS: During the first wave of the COVID-19 pandemic, most Canadian hospitals had public-facing visitor restriction policies with specific exception categories, most commonly for patients at end-of-life, patients requiring assistance, or COVID-19 positive patients (varying from not allowed to case-by-case). Further studies are needed to understand the consistency with which visitation policies were operationalized and how they may have impacted patient- and family-centred care.


RéSUMé: OBJECTIF: En réponse à la propagation rapide du SRAS-CoV-2, les hôpitaux du Canada ont adopté des restrictions temporaires pour les visites afin de limiter la propagation de la COVID-19 et de préserver les stocks d'équipements de protection individuelle. Cette étude décrit l'ampleur, les variations et fluctuations des politiques canadiennes concernant les visites aux unités de soins intensifs (USI) pour adultes avant et pendant la première vague de la pandémie de COVID-19. MéTHODE: Nous avons réalisé une étude de milieu des politiques hospitalières canadiennes concernant les visites tout au long de la première vague de la pandémie. Nous avons mené une étude en deux phases analysant des données quantitatives et qualitatives. RéSULTATS: Nous avons recueilli 257 documents faisant référence aux politiques de visites (pré-COVID, 101 [39 %]; mid-COVID, 71 [28 %]; et COVID-tardif, 85 [33 %]). Sur ces 257 documents, 38 (15 %) étaient spécifiques aux USI et 70 (27 %) faisaient référence aux USI. La plupart des politiques au cours de la période pandémique mid-COVID/COVID-tardif ne permettaient aucune visite sauf exception spécifique (p. ex., fin de vie). L'analyse du cadre a révélé cinq thèmes généraux : 1) les raisons des restrictions des politiques de visites; 2) les politiques et attentes en matière de visites; 3) les exceptions aux politiques de visites; 4) les soins aux patients et centrés sur la famille; et 5) la communication et la transparence. CONCLUSION: Au cours de la première vague de la pandémie de COVID-19, la plupart des hôpitaux canadiens avaient des politiques de restriction des visites s'appliquant au public avec des catégories d'exception spécifiques, le plus souvent pour les patients en fin de vie, les patients nécessitant de l'aide ou les patients COVID-positifs (variant d'une interdiction au cas par cas). D'autres études sont nécessaires pour comprendre l'uniformité avec laquelle les politiques de visites ont été mises en œuvre et comment elles ont pu avoir une incidence sur les soins centrés sur le patient et la famille.


Subject(s)
COVID-19 , Pandemics , Adult , Canada , Humans , Intensive Care Units , Organizational Policy , Policy , SARS-CoV-2 , Visitors to Patients
14.
Lancet Public Health ; 6(10): e760-e770, 2021 10.
Article in English | MEDLINE | ID: covidwho-1345513

ABSTRACT

BACKGROUND: Residents of prisons have experienced disproportionate COVID-19-related health harms. To control outbreaks, many prisons in the USA restricted in-person activities, which are now resuming even as viral variants proliferate. This study aims to use mathematical modelling to assess the risks and harms of COVID-19 outbreaks in prisons under a range of policies, including resumption of activities. METHODS: We obtained daily resident-level data for all California state prisons from Jan 1, 2020, to May 15, 2021, describing prison layouts, housing status, sociodemographic and health characteristics, participation in activities, and COVID-19 testing, infection, and vaccination status. We developed a transmission-dynamic stochastic microsimulation parameterised by the California data and published literature. After an initial infection is introduced to a prison, the model evaluates the effect of various policy scenarios on infections and hospitalisations over 200 days. Scenarios vary by vaccine coverage, baseline immunity (0%, 25%, or 50%), resumption of activities, and use of non-pharmaceutical interventions (NPIs) that reduce transmission by 75%. We simulated five prison types that differ by residential layout and demographics, and estimated outcomes with and without repeated infection introductions over the 200 days. FINDINGS: If a viral variant is introduced into a prison that has resumed pre-2020 contact levels, has moderate vaccine coverage (ranging from 36% to 76% among residents, dependent on age, with 40% coverage for staff), and has no baseline immunity, 23-74% of residents are expected to be infected over 200 days. High vaccination coverage (90%) coupled with NPIs reduces cumulative infections to 2-54%. Even in prisons with low room occupancies (ie, no more than two occupants) and low levels of cumulative infections (ie, <10%), hospitalisation risks are substantial when these prisons house medically vulnerable populations. Risks of large outbreaks (>20% of residents infected) are substantially higher if infections are repeatedly introduced. INTERPRETATION: Balancing benefits of resuming activities against risks of outbreaks presents challenging trade-offs. After achieving high vaccine coverage, prisons with mostly one-to-two-person cells that have higher baseline immunity from previous outbreaks can resume in-person activities with low risk of a widespread new outbreak, provided they maintain widespread NPIs, continue testing, and take measures to protect the medically vulnerable. FUNDING: Horowitz Family Foundation, National Institute on Drug Abuse, Centers for Disease Control and Prevention, National Science Foundation, Open Society Foundation, Advanced Micro Devices.


Subject(s)
COVID-19/epidemiology , COVID-19/virology , Disease Outbreaks , Prisons , SARS-CoV-2/isolation & purification , Adolescent , Adult , Aged , COVID-19/prevention & control , COVID-19/transmission , COVID-19 Vaccines/administration & dosage , California/epidemiology , Female , Humans , Male , Middle Aged , Models, Theoretical , Organizational Policy , Prisons/organization & administration , Risk Assessment , Vaccination/statistics & numerical data , Young Adult
18.
Can J Anaesth ; 68(10): 1474-1484, 2021 10.
Article in English | MEDLINE | ID: covidwho-1290444

ABSTRACT

PURPOSE: In response to the rapid spread of SARS-CoV-2, hospitals in Canada enacted temporary visitor restrictions to limit the spread of COVID-19 and preserve personal protective equipment supplies. This study describes the extent, variation, and fluctuation of Canadian adult intensive care unit (ICU) visitation policies before and during the first wave of the COVID-19 pandemic. METHODS: We conducted an environmental scan of Canadian hospital visitation policies throughout the first wave of the pandemic. We conducted a two-phased study analyzing both quantitative and qualitative data. RESULTS: We collected 257 documents with reference to visitation policies (preCOVID, 101 [39%]; midCOVID, 71 [28%]; and lateCOVID, 85 [33%]). Of these 257 documents, 38 (15%) were ICU-specific and 70 (27%) referenced the ICU. Most policies during the midCOVID/lateCOVID pandemic period allowed no visitors with specific exceptions (e.g., end-of-life). Framework analysis revealed five overarching themes: 1) reasons for restricted visitation policies; 2) visitation policies and expectations; 3) exceptions to visitation policy; 4) patient and family-centred care; and 5) communication and transparency. CONCLUSIONS: During the first wave of the COVID-19 pandemic, most Canadian hospitals had public-facing visitor restriction policies with specific exception categories, most commonly for patients at end-of-life, patients requiring assistance, or COVID-19 positive patients (varying from not allowed to case-by-case). Further studies are needed to understand the consistency with which visitation policies were operationalized and how they may have impacted patient- and family-centred care.


RéSUMé: OBJECTIF: En réponse à la propagation rapide du SRAS-CoV-2, les hôpitaux du Canada ont adopté des restrictions temporaires pour les visites afin de limiter la propagation de la COVID-19 et de préserver les stocks d'équipements de protection individuelle. Cette étude décrit l'ampleur, les variations et fluctuations des politiques canadiennes concernant les visites aux unités de soins intensifs (USI) pour adultes avant et pendant la première vague de la pandémie de COVID-19. MéTHODE: Nous avons réalisé une étude de milieu des politiques hospitalières canadiennes concernant les visites tout au long de la première vague de la pandémie. Nous avons mené une étude en deux phases analysant des données quantitatives et qualitatives. RéSULTATS: Nous avons recueilli 257 documents faisant référence aux politiques de visites (pré-COVID, 101 [39 %]; mid-COVID, 71 [28 %]; et COVID-tardif, 85 [33 %]). Sur ces 257 documents, 38 (15 %) étaient spécifiques aux USI et 70 (27 %) faisaient référence aux USI. La plupart des politiques au cours de la période pandémique mid-COVID/COVID-tardif ne permettaient aucune visite sauf exception spécifique (p. ex., fin de vie). L'analyse du cadre a révélé cinq thèmes généraux : 1) les raisons des restrictions des politiques de visites; 2) les politiques et attentes en matière de visites; 3) les exceptions aux politiques de visites; 4) les soins aux patients et centrés sur la famille; et 5) la communication et la transparence. CONCLUSION: Au cours de la première vague de la pandémie de COVID-19, la plupart des hôpitaux canadiens avaient des politiques de restriction des visites s'appliquant au public avec des catégories d'exception spécifiques, le plus souvent pour les patients en fin de vie, les patients nécessitant de l'aide ou les patients COVID-positifs (variant d'une interdiction au cas par cas). D'autres études sont nécessaires pour comprendre l'uniformité avec laquelle les politiques de visites ont été mises en œuvre et comment elles ont pu avoir une incidence sur les soins centrés sur le patient et la famille.


Subject(s)
COVID-19 , Pandemics , Adult , Canada , Humans , Intensive Care Units , Organizational Policy , Policy , SARS-CoV-2 , Visitors to Patients
19.
N Engl J Med ; 384(24): 2267-2269, 2021 Jun 17.
Article in English | MEDLINE | ID: covidwho-1279934
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