Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 34
Filter
2.
Am J Otolaryngol ; 43(1): 103240, 2022.
Article in English | MEDLINE | ID: covidwho-1437392

ABSTRACT

PURPOSE: At the height of the COVID-19 pandemic, our institution instituted a Safe Tracheostomy Aftercare Taskforce (STAT) team to care for the influx of patients undergoing tracheostomies. This review was undertaken to understand this team's impact on outcomes of tracheostomy care. METHODS: We compared retrospective data collected from patients undergoing tracheostomies at our institution from February to June 2019, prior to creation of the STAT team, to prospectively collected data from tracheostomies performed from February to June 2020, while the STAT team was in place and performed statistical analysis on outcomes of care such as decannulation prior to discharge, timely tube change, and post-discharge follow-up. RESULTS: We found that the STAT team significantly increased rate of decannulation prior to discharge (P < 0.0005), performance of timely trach tube change when indicated (P < 0.05), and rates of follow-up for tracheostomy patients after discharge from the hospital (P < 0.0005). CONCLUSION: The positive impact of the STAT team on outcomes of patient care such as decannulation prior to discharge, timely tube change, and post-discharge follow-up makes a strong case for its continuation even in non-pandemic times.


Subject(s)
Aftercare/standards , COVID-19/therapy , Patient Care Team/standards , Tracheostomy/standards , Adult , Advisory Committees , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Pandemics , Patient Discharge , Retrospective Studies , SARS-CoV-2
4.
Am J Health Syst Pharm ; 77(18): 1510-1515, 2020 09 04.
Article in English | MEDLINE | ID: covidwho-1317902

ABSTRACT

PURPOSE: To describe our hospital pharmacy department's preparation for an influx of critically ill patients during the coronavirus disease 2019 (COVID-19) pandemic and offer guidance on clinical pharmacy services preparedness for similar crisis situations. SUMMARY: Personnel within the department of pharmacy at a medical center at the US epicenter of the COVID-19 pandemic proactively prepared a staffing and pharmacotherapeutic action plan in anticipation of an expected surge in admissions of critically ill patients with COVID-19 and expansion of acute care and intensive care unit (ICU) capacity. Guidance documents focusing on supportive care and pharmacotherapeutic treatment options were developed. Repurposing of non-ICU-trained clinical pharmacotherapy specialists to work collaboratively with clinician teams in ICUs was quickly implemented; staff were prepared for these duties through use of shared tools to facilitate education and practice standardization. CONCLUSION: As challenges were encountered at the initial peak of the pandemic, interdisciplinary collaboration and teamwork was crucial to ensure that all patients were proactively assessed and that their respective pharmacotherapeutic regimens were optimized.


Subject(s)
COVID-19/drug therapy , Medication Therapy Management/standards , Pharmacists/organization & administration , Pharmacy Service, Hospital/standards , COVID-19/epidemiology , Critical Care/organization & administration , Critical Care/standards , Critical Illness , Disaster Planning/organization & administration , Disaster Planning/standards , Emergencies , Humans , Intensive Care Units/organization & administration , Intensive Care Units/standards , Medication Therapy Management/organization & administration , Pandemics/prevention & control , Patient Care Team/organization & administration , Patient Care Team/standards , Pharmacy Service, Hospital/organization & administration , Practice Guidelines as Topic , Professional Role , Workforce/organization & administration , Workforce/standards
5.
Can J Aging ; 39(3): 333-343, 2020 09.
Article in English | MEDLINE | ID: covidwho-1261985

ABSTRACT

The COVID-19 pandemic and subsequent state of public emergency have significantly affected older adults in Canada and worldwide. It is imperative that the gerontological response be efficient and effective. In this statement, the board members of the Canadian Association on Gerontology/L'Association canadienne de gérontologie (CAG/ACG) and the Canadian Journal on Aging/La revue canadienne du vieillissement (CJA/RCV) acknowledge the contributions of CAG/ACG members and CJA/RCV readers. We also profile the complex ways that COVID-19 is affecting older adults, from individual to population levels, and advocate for the adoption of multidisciplinary collaborative teams to bring together different perspectives, areas of expertise, and methods of evaluation in the COVID-19 response.


Subject(s)
Aging , Communicable Disease Control/methods , Coronavirus Infections , Health Services for the Aged/organization & administration , Pandemics , Patient Care Management , Patient Care Team , Pneumonia, Viral , Aged , Aging/physiology , Aging/psychology , Betacoronavirus/isolation & purification , COVID-19 , Canada/epidemiology , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Health Services Needs and Demand , Humans , Interdisciplinary Communication , Mental Health , Patient Care Management/methods , Patient Care Management/standards , Patient Care Management/trends , Patient Care Team/organization & administration , Patient Care Team/standards , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , Quality Improvement , SARS-CoV-2
6.
Ann Emerg Med ; 78(5): 619-627, 2021 11.
Article in English | MEDLINE | ID: covidwho-1252440

ABSTRACT

STUDY OBJECTIVE: During the COVID-19 pandemic, health care workers have had the highest risk of infection among essential workers. Although personal protective equipment (PPE) use is associated with lower infection rates, appropriate use of PPE has been variable among health care workers, even in settings with COVID-19 patients. We aimed to evaluate the patterns of PPE adherence during emergency department resuscitations that included aerosol-generating procedures. METHODS: We conducted a retrospective, video-based review of pediatric resuscitations involving one or more aerosol-generating procedures during the first 3 months of the COVID-19 pandemic in the United States (March to June 2020). Recommended adherence (complete, inadequate, absent) with 5 PPE items (headwear, eyewear, masks, gowns, gloves) and the duration of potential exposure were evaluated for individuals in the room after aerosol-generating procedure initiation. RESULTS: Among the 345 health care workers observed during 19 resuscitations, 306 (88.7%) were nonadherent (inadequate or absent adherence) with the recommended use of at least 1 PPE type at some time during the resuscitation, 23 (6.7%) of whom had no PPE. One hundred and forty health care workers (40.6%) altered or removed at least 1 type of PPE during the event. The aggregate time in the resuscitation room for health care workers across all events was 118.7 hours. During this time, providers had either absent or inadequate eyewear for 46.4 hours (39.1%) and absent or inadequate masks for 35.2 hours (29.7%). CONCLUSION: Full adherence with recommended PPE use was limited in a setting at increased risk for SARS-CoV-2 virus aerosolization. In addition to ensuring appropriate donning, approaches are needed for ensuring ongoing adherence with PPE recommendations during exposure.


Subject(s)
COVID-19/prevention & control , Emergency Service, Hospital/standards , Guideline Adherence , Infection Control/standards , Pandemics , Personal Protective Equipment/standards , Resuscitation , COVID-19/epidemiology , COVID-19/transmission , Child , Hospitals, Pediatric , Humans , Infection Control/methods , Patient Care Team/standards , Practice Guidelines as Topic , Retrospective Studies , SARS-CoV-2
9.
Int J Qual Health Care ; 33(2)2021 Apr 28.
Article in English | MEDLINE | ID: covidwho-1189460

ABSTRACT

BACKGROUND: Newly intensified use of personal protective equipment (PPE) in emergency departments presents teamwork challenges affecting the quality and safety of care at the frontlines. OBJECTIVE: We conducted a qualitative study to categorize and describe barriers to teamwork posed by PPE and distancing in the emergency setting. METHODS: We conducted 55 semi-structured interviews between June 2020 and August 2020 with personnel from two emergency departments serving in a variety of roles. We then performed a thematic analysis to identify and construct patterns of teamwork challenges into themes. RESULTS: We discovered two types of challenges to teamwork: material barriers related to wearing masks, gowns and powered air-purifying respirators, and spatial barriers implemented to conserve PPE and limit coronavirus exposure. Both material and spatial barriers resulted in disrupted communication, roles and interpersonal relationships, but they did so in unique ways. Material barriers muffled information flow, impeded team member recognition and role/task division, and reduced belonging and cohesion while increasing interpersonal strain. Spatial barriers resulted in mediated communication and added physical and emotional distance between teammates and patients. CONCLUSION: Our findings identify specific aspects of how intensified PPE use disrupts teamwork and can inform efforts to ensure care quality and safety in emergency settings as PPE use continues during and, potentially beyond, the coronavirus disease-2019 pandemic.


Subject(s)
Emergency Service, Hospital , Health Personnel/psychology , Patient Care Team/standards , Personal Protective Equipment , Physical Distancing , Quality of Health Care , Communication Barriers , Humans , Interpersonal Relations , Qualitative Research , Role , San Francisco/epidemiology
10.
Spine (Phila Pa 1976) ; 45(19): 1386-1394, 2020 Oct 01.
Article in English | MEDLINE | ID: covidwho-1109345

ABSTRACT

STUDY DESIGN: Case series. OBJECTIVE: For each of the most frequent clinical scenarios, the authors reached a consensus on how should be timing and indications be optimized to reduce risk while maintaining the expected outcomes under the Covid-19 pandemics. SUMMARY OF BACKGROUND DATA: The organization of health care has been changed by the Covid-19 pandemic with a direct impact on Spine Oncology Surgery. Emergency surgery is still a priority, but in case of spinal tumors it should be better defined which conditions require emergency treatment. METHODS: An expert panel with general spine surgeons, oncological spine surgeons, and radiation oncologists was formed to analyze the most frequent scenarios in spinal musculoskeletal oncology during Covid-19 pandemics. RESULTS: Spine metastases can be found incidentally during follow-up or can clinically occur by increasing pain, pathologic fracture, and/or neurological symptoms. Primary spine tumors are much more rare and very rarely present with acute onset. The first step is to suspect this rare condition, to avoid to treat a primary tumor as it were a metastasis. Most complex surgery, like en bloc resection, associated with high morbidity and mortality rate for the treatment of low grade malignancy like chordoma or chondrosarcomas, if intensive care unit availability is reduced, can be best delayed some weeks, as not impacting on prognosis, due to the slow growth rate of these conditions. The currently accepted protocols for Ewing sarcoma (ES) and osteogenic sarcoma must be performed for local and systemic disease control. For ES, after the first courses of chemotherapy, radiotherapy can be selected instead of surgery, during Covid-19, to the end of the full course of chemotherapy. In immunocompromised patients, (treated by chemotherapy), it is necessary to avoid contact with affected or exposed people. CONCLUSION: Even more than during normal times, a multidisciplinary approach is mandatory to share the decision to modify a treatment strategy. LEVEL OF EVIDENCE: 5.


Subject(s)
Betacoronavirus , Coronavirus Infections/surgery , Medical Oncology/standards , Pandemics , Pneumonia, Viral/surgery , Spinal Neoplasms/surgery , Surgeons/standards , Adult , COVID-19 , Clinical Decision-Making/methods , Coronavirus Infections/diagnostic imaging , Coronavirus Infections/epidemiology , Female , Humans , Male , Medical Oncology/methods , Middle Aged , Pandemics/prevention & control , Patient Care Team/standards , Pneumonia, Viral/diagnostic imaging , Pneumonia, Viral/epidemiology , Prognosis , Reconstructive Surgical Procedures/methods , Reconstructive Surgical Procedures/standards , SARS-CoV-2 , Spinal Neoplasms/diagnostic imaging , Spinal Neoplasms/epidemiology , Surgeons/psychology
11.
BMJ Open Qual ; 10(1)2021 02.
Article in English | MEDLINE | ID: covidwho-1084233

ABSTRACT

Effective communication between members of the multidisciplinary team is imperative for patient safety. Within the Medicine for the Elderly wards at Royal Victoria Hospital (RVH) in Dundee, we identified an inefficient process of information-sharing between the orthopaedics outpatient department (OPD) at the main teaching hospital and our hospital's rehabilitation teams, and sought to improve this by introducing several changes to the work system. Our aim was for all patients who attended the OPD clinic to have a plan communicated to the RVH team within 24 hours.Before our intervention, clinic letters containing important instructions for ongoing rehabilitation were dictated by the OPD team, transcribed and uploaded to an electronic system before the RVH team could access them. We analysed clinic attendances over a 4-week period and found that it took 15 days on average for letters to be shared with the RVH teams. We worked with both teams to develop a clinical communication tool and new processes, aiming to expedite the sharing of key information. Patients attended the OPD with this form, the clinician completed it at the time of their appointment and the form returned with the patient to RVH on the same day.We completed multiple Plan-Do-Study-Act cycles; before our project was curtailed by the COVID-19 pandemic. During our study period, seven patients attended the OPD with a form, with all seven returning to RVH with a completed treatment plan documented by the OPD clinician. This allowed rehabilitation teams to have access to clinic instructions generated by orthopaedic surgeons almost immediately after a patient attended the clinic, essentially eliminating the delay in information-sharing.The introduction of a simple communication tool and processes to ensure reliable transfer of information can expedite information-sharing between secondary care teams and can potentially reduce delays in rehabilitation.


Subject(s)
COVID-19/rehabilitation , Health Services for the Aged/standards , Patient Care Team/standards , Quality Improvement , Secondary Care/standards , Aged , Aged, 80 and over , Communication , Female , Humans , Interprofessional Relations , Male , SARS-CoV-2 , Secondary Care/methods
12.
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
13.
Clin J Oncol Nurs ; 25(1): 56-60, 2021 Feb 01.
Article in English | MEDLINE | ID: covidwho-1041427

ABSTRACT

BACKGROUND: The COVID-19 pandemic placed challenges on interprofessional communication patterns among clinical care teams at a time when effective communication was greatly needed. The development of enhanced systems for communication that integrate the latest evidence and communication technologies can offer a solution to this crisis. OBJECTIVES: This article provides a framework for ways in which nursing teams can develop evidence-based enhanced interprofessional communication systems during a pandemic. METHODS: Based on communication models and related technologies, this article reviews strategies to enhance interprofessional communication. Two case studies are included that illustrate how nursing teams can enhance communication during a pandemic. FINDINGS: To improve communication during a pandemic, clinicians can incorporate interprofessional communication models in clinical practice and apply enhanced communication strategies.


Subject(s)
COVID-19/psychology , COVID-19/therapy , Evidence-Based Nursing/standards , Interdisciplinary Communication , Pandemics/prevention & control , Patient Care Team/standards , Practice Guidelines as Topic , Adult , Cooperative Behavior , Female , Humans , Male , Middle Aged , SARS-CoV-2
16.
J Am Geriatr Soc ; 69(2): 289-292, 2021 02.
Article in English | MEDLINE | ID: covidwho-960918

ABSTRACT

Ms. H is a 78-year-old woman with a history of congestive heart failure, chronic obstructive pulmonary disease, and recent stroke who was discharged 1 month ago from a subacute rehabilitation facility. She moved in with her son because she now requires a walker and cannot return to her third-floor apartment. One evening, Ms. H develops a low-grade fever and mild shortness of breath intermittently relieved by her albuterol inhaler. Her son is worried, but knows that his mom does not want to return to the hospital.


Subject(s)
Home Care Services/standards , Homebound Persons/rehabilitation , Patient Care Team/standards , Quality Assurance, Health Care/standards , Quality Indicators, Health Care/standards , Aged , COVID-19 , Female , Humans , Quality of Health Care/standards , United States
17.
Acta Neurol Scand ; 143(5): 489-496, 2021 May.
Article in English | MEDLINE | ID: covidwho-941602

ABSTRACT

BACKGROUND AND OBJECTIVE: Specialized multidisciplinary ALS care has been shown to extend survival and improve patient's and caregiver's quality of life. During the COVID-19 pandemic, the management of patients suddenly changed and telemedicine has been proven to be as effective as outpatient care. We elaborate the experience with Telemedicine of a Tertiary ALS Center from an Italian geographical area with high infectious risk during the COVID-19 pandemic. METHODS: 19 patients were evaluated in telemedicine by a multidisciplinary team including a neurologist (clinical evaluation, intercurrent events, and drug prescriptions); a dietician (diet and weight monitoring); a psychologist (psychological assessment and support); and a physiotherapist (physiotherapy treatment and device prescription). Telemedicine was performed using the online platform "IoMT Connected Care Platform (Ticuro Reply)." RESULTS: All patients reported a positive perception of talking face to face with healthcare professionals and were satisfied with how the team understood their problems. During video televisits, there was a change in the patient's medication regimen in 11/19; 2/19 required pneumological evaluation and started NIV; and 9/16 patients required prescription of devices. The mean monthly decline of ALSFRS-R before televisit was 0.88 (SD 1.17) and during televisit of 0.49 (SD 0.75). Bodyweight and daily caloric content remain stable. Reduction in HADS scores and stability in ALSAQ-40 were observed. DISCUSSION: Our study positively reproduced the multidisciplinary approach currently used with ALS patients, trying to stabilize the functional and metabolic status and improving the psychological one. Future directions include a personalized telemedicine program according to the patient's needs.


Subject(s)
Amyotrophic Lateral Sclerosis/epidemiology , Amyotrophic Lateral Sclerosis/therapy , COVID-19/epidemiology , Pandemics , Patient Satisfaction , Telemedicine/methods , Adult , Amyotrophic Lateral Sclerosis/psychology , COVID-19/psychology , Female , Follow-Up Studies , Humans , Italy/epidemiology , Male , Middle Aged , Patient Care Team/standards , Quality of Life/psychology , Telemedicine/standards
18.
Oncologist ; 26(2): e338-e341, 2021 02.
Article in English | MEDLINE | ID: covidwho-893248

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic may have affected cancer management. We aimed to evaluate changes in every oncology care pathway essential step, from screening to treatment, during the pandemic. Monthly oncological activity differences between 2019 and 2020 (screening tests, histopathological analyzes, multidisciplinary tumor board meetings (MTBMs), diagnostic announcement procedures (DAPs), and treatments were calculated in two French areas experiencing different pandemic intensity (Reims and Colmar). COVID-19 has had a dramatic impact in terms of screening (-86% to -100%), diagnosis (-39%), and surgical treatment (-30%). This global decrease in all essential oncology care pathway steps contrasted with the relative stability of chemotherapy (-9%) and radiotherapy use (-16%). Outbreak occurred earlier and with more intensity in Colmar but had a comparable impact in both areas regarding MTMBs and DAPs. The current ONCOCARE-COV study is still in progress and with a longer follow-up to analyze postlockdown situation.


Subject(s)
COVID-19/prevention & control , Infection Control/standards , Medical Oncology/trends , Neoplasms/therapy , Pandemics/prevention & control , COVID-19/epidemiology , COVID-19/immunology , COVID-19/virology , COVID-19 Testing/standards , Critical Pathways/standards , Critical Pathways/statistics & numerical data , Critical Pathways/trends , France/epidemiology , Humans , Mass Screening/standards , Mass Screening/statistics & numerical data , Mass Screening/trends , Medical Oncology/organization & administration , Medical Oncology/standards , Medical Oncology/statistics & numerical data , Neoplasms/diagnosis , Neoplasms/immunology , Patient Care Team/organization & administration , Patient Care Team/standards , Patient Care Team/statistics & numerical data , SARS-CoV-2/isolation & purification , SARS-CoV-2/pathogenicity , Telemedicine/standards
SELECTION OF CITATIONS
SEARCH DETAIL