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3.
CJEM ; 22(4): 431-434, 2020 07.
Article in English | MEDLINE | ID: covidwho-698710

ABSTRACT

Emergency medical services (EMS) is called for a 65-year-old man with a 1-week history of cough, fever, and mild shortness of breath now reporting chest pain. Vitals on scene were HR 110, BP 135/90, SpO2 88% on room air. EMS arrives at the emergency department (ED). As the patient is moved to a negative pressure room, he becomes unresponsive with no palpable pulse. What next steps should be discussed in order to protect the team and achieve the best possible patient outcome?


Subject(s)
Cardiopulmonary Resuscitation , Coronavirus Infections/complications , Emergency Service, Hospital/organization & administration , Infection Control/organization & administration , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Out-of-Hospital Cardiac Arrest/therapy , Pneumonia, Viral/complications , Betacoronavirus , Humans , Pandemics , Patient Care Team/organization & administration , Personal Protective Equipment , Risk Factors
5.
Stroke ; 51(8): 2587-2592, 2020 08.
Article in English | MEDLINE | ID: covidwho-680789

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic has in some regions overwhelmed the capacity and staffing needs of healthcare systems, necessitating the provision of resources and staff from different disciplines to aid COVID treatment teams. Stroke centers have multidisciplinary clinical and procedural expertise to support COVID treatment teams. Staff safety and patient safety are essential, as are open lines of communication between stroke center leaders and hospital leadership in a pandemic where policies and procedures can change or evolve rapidly. Support needs to be allocated in a way that allows for the continued operation of a fully capable stroke center, with the ability to adjust if stroke center volume or staff attrition requires.


Subject(s)
Coronavirus Infections/therapy , Hospital Departments/organization & administration , Pandemics , Patient Care Team/organization & administration , Pneumonia, Viral/therapy , Communication , Delivery of Health Care , Humans , Leadership , Occupational Health , Organizational Policy , Personnel Staffing and Scheduling
6.
Anesth Analg ; 131(2): 351-364, 2020 08.
Article in English | MEDLINE | ID: covidwho-665311

ABSTRACT

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


Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections/therapy , Critical Care/organization & administration , Delivery of Health Care, Integrated/organization & administration , Health Resources/organization & administration , Health Services Accessibility/organization & administration , Infection Control/organization & administration , Pneumonia, Viral/therapy , Clinical Laboratory Techniques , Coronavirus Infections/diagnosis , Coronavirus Infections/transmission , Coronavirus Infections/virology , Health Services Needs and Demand/organization & administration , Humans , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Needs Assessment/organization & administration , Occupational Exposure/adverse effects , Occupational Exposure/prevention & control , Occupational Health , Pandemics , Patient Care Team/organization & administration , Pneumonia, Viral/diagnosis , Pneumonia, Viral/transmission , Pneumonia, Viral/virology , Point-of-Care Systems/organization & administration , Point-of-Care Testing/organization & administration , Risk Factors , Severity of Illness Index
8.
J Intensive Care Med ; 35(9): 927-932, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-654883

ABSTRACT

The coronavirus disease 2019 pandemic resulted in unprecedented numbers of patients with respiratory failure requiring ventilatory support. The number of patients who required critical care quickly outpaced the availability of intensive care unit (ICU) beds. Consequently, health care systems had to creatively expand critical care services into alternative hospital locations with repurposed staff and equipment. Deploying anesthesia workstations to the ICU to serve as mechanical ventilators requires equipment preparation, multidisciplinary planning, and targeted education. We aim to contextualize this process, highlighting major differences between anesthesia workstations and ICU ventilators, and to share the insights gained from our experiences creating an anesthesia provider-based ventilator management team.


Subject(s)
Anesthesia, General/instrumentation , Coronavirus Infections/therapy , Intensive Care Units/organization & administration , Patient Care Team/organization & administration , Pneumonia, Viral/therapy , Respiration, Artificial/instrumentation , Ventilators, Mechanical/supply & distribution , Betacoronavirus , Humans , Pandemics
11.
Am J Pharm Educ ; 84(6): ajpe8158, 2020 06.
Article in English | MEDLINE | ID: covidwho-646817

ABSTRACT

The novel coronavirus identified in 2019 (COVID-19) pandemic has impacted pharmacy graduate and postgraduate education. This crisis has resulted in a cosmic shift in the administration of these programs to ensure core values are sustained. Adjustments may be needed at a minimum to ensure that postgraduate trainees complete program requirements while maintaining safety. Moving forward, additional issues may arise that will need to be addressed such as admissions and program onboarding, acclimating students to new training environments, and managing inadequate resources for distance education, distance practice, and remote versus in-person research opportunities.


Subject(s)
Coronavirus Infections/epidemiology , Education, Graduate/organization & administration , Education, Pharmacy/organization & administration , Pneumonia, Viral/epidemiology , Betacoronavirus , Education, Distance , Education, Graduate/standards , Education, Pharmacy/standards , Humans , Interprofessional Relations , Pandemics , Patient Care Team/organization & administration , Pharmacy Residencies/organization & administration , Research/organization & administration , School Admission Criteria , Teaching/organization & administration , Telemedicine/organization & administration
12.
J Perioper Pract ; 30(7-8): 210-220, 2020 07.
Article in English | MEDLINE | ID: covidwho-636523

ABSTRACT

This article aims to describe the early experience of a large major trauma operating theatres department in the East of England during the outbreak of the coronavirus disease 2019 (COVID-19) pandemic. To date and to our knowledge, a small amount of reports describing a surgical department's response to this unprecedented pandemic have been published, but a well-documented account from within the United Kingdom (UK) has not yet been reported in the literature. We describe our preparation and response, including: operating theatres management during the COVID-19 pandemic, operational aspects and communication, leadership and support. The process review of measures presented covers approximately the two-month period between March and May 2020 and emphasises the fluidity of procedures needed. We discuss how significant challenges were overcome to secure implementation and reliable oversight. The visible presence of clinical leads well sighted on every aspect of the response guaranteed standardisation of procedures, while sustaining a vital feedback loop. Finally, we conclude that an effective response requires rapid analysis of the complex problem that is of providing care for patients intraoperatively during the COVID-19 pandemic, and that retrospective sense-making is essential to maintain adaptability.


Subject(s)
Civil Defense/organization & administration , Coronavirus Infections/epidemiology , Infection Control/organization & administration , Operating Rooms/organization & administration , Pneumonia, Viral/epidemiology , Trauma Centers/organization & administration , Betacoronavirus/isolation & purification , Coronavirus Infections/prevention & control , Disease Outbreaks/prevention & control , Female , Humans , Male , Pandemics/prevention & control , Patient Care Team/organization & administration , Pneumonia, Viral/prevention & control , Safety Management , United Kingdom/epidemiology
13.
J Am Med Inform Assoc ; 27(6): 853-859, 2020 06 01.
Article in English | MEDLINE | ID: covidwho-631869

ABSTRACT

OBJECTIVE: To describe the implementation of technological support important for optimizing clinical management of the COVID-19 pandemic. MATERIALS AND METHODS: Our health system has confirmed prior and current cases of COVID-19. An Incident Command Center was established early in the crisis and helped identify electronic health record (EHR)-based tools to support clinical care. RESULTS: We outline the design and implementation of EHR-based rapid screening processes, laboratory testing, clinical decision support, reporting tools, and patient-facing technology related to COVID-19. DISCUSSION: The EHR is a useful tool to enable rapid deployment of standardized processes. UC San Diego Health built multiple COVID-19-specific tools to support outbreak management, including scripted triaging, electronic check-in, standard ordering and documentation, secure messaging, real-time data analytics, and telemedicine capabilities. Challenges included the need to frequently adjust build to meet rapidly evolving requirements, communication, and adoption, and to coordinate the needs of multiple stakeholders while maintaining high-quality, prepandemic medical care. CONCLUSION: The EHR is an essential tool in supporting the clinical needs of a health system managing the COVID-19 pandemic.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Electronic Health Records , Medical Records Systems, Computerized , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Telemedicine , User-Computer Interface , Academic Medical Centers/organization & administration , California/epidemiology , Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , Databases, Factual , Decision Support Systems, Clinical , Humans , Medical Informatics , Patient Care Team/organization & administration , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy
19.
J Am Med Dir Assoc ; 21(7): 943-947, 2020 07.
Article in English | MEDLINE | ID: covidwho-526532

ABSTRACT

Residents in long-term care settings are particularly vulnerable to COVID-19 infections and, compared to younger adults, are at higher risk of poor outcomes and death. Given the poor prognosis of resuscitation outcomes for COVID-19 in general, the specter of COVID-19 in long-term care residents should prompt revisiting goals of care. Visitor restriction policies enacted to reduce the risk of transmission of COVID-19 to long-term care residents requires advance care planning discussions to be conducted remotely. A structured approach can help guide discussions regarding the diagnosis, expected course, and care of individuals with COVID-19 in long-term care settings. Information should be shared in a transparent and comprehensive manner to allay the increased anxiety that families may feel during this time. To achieve this, we propose an evidence-based COVID-19 Communication and Care Planning Tool that allows for an informed consent process and shared decision making between the clinician, resident, and their family.


Subject(s)
Coronavirus Infections/prevention & control , Decision Making, Shared , Health Planning/organization & administration , Long-Term Care/organization & administration , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Skilled Nursing Facilities/organization & administration , Adult , Advance Care Planning/organization & administration , Coronavirus Infections/epidemiology , Female , Humans , Infection Control/organization & administration , Interdisciplinary Communication , Male , Middle Aged , Pandemics/statistics & numerical data , Patient Care Team/organization & administration , Pneumonia, Viral/epidemiology , Program Development , Survival Analysis , United States
20.
J Aging Soc Policy ; 32(4-5): 387-395, 2020.
Article in English | MEDLINE | ID: covidwho-436493

ABSTRACT

Older adults with COVID-19 who survive hospitalizations and return to their homes confront substantial health challenges and an unpredictable future. While understanding of the unique needs of COVID-19 survivors is developing, components of the evidence-based Transitional Care Model provide a framework for taking a more immediate, holistic response to caring for these individuals as they moved back into the community. These components include: increasing screening, building trusting relationships, improving patient engagement, promoting collaboration across care teams, undertaking symptom management, increasing family caregiver care/education, coordinating health and social services, and improving care continuity. Evidence generated from rigorous testing of these components reveal the need for federal and state policy solutions to support the following: employment/redeployment of nurses, social workers, and community health workers; training and reimbursement of family caregivers; widespread access to research-based transitional care tools; and coordinated local efforts to address structural barriers to effective transitions. Immediate action on these policy options is necessary to more effectively address the complex issues facing these older adults and their family caregivers who are counting on our care system for essential support.


Subject(s)
Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Transitional Care/organization & administration , Aged , Betacoronavirus , Cooperative Behavior , Family , Humans , Mass Screening/organization & administration , Pandemics , Patient Care Team/organization & administration , Patient Participation , Social Support , Social Work/organization & administration
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