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5.
Res Nurs Health ; 44(5): 776-786, 2021 10.
Article in English | MEDLINE | ID: covidwho-1287388

ABSTRACT

The COVID-19 pandemic poses significant challenges to healthcare systems worldwide. A key consideration is the adverse psychological impact on healthcare workers (HCWs). This study aimed to investigate the variable levels of psychological distress, perceived safety, trust, and self- and collective-efficacy during the COVID-19 crisis amongst varied HCWs. A survey was disseminated to nurses, physicians, interns, and administrative and logistical staff at an acute-care hospital in Israel during the first wave of COVID-19. The survey consisted of items on a 5-point Likert scale, measuring HCW's perceptions concerning the aforementioned variables as well as demographic information. A total of 716 hospital personnel completed the survey. Nurses reported higher levels of psychological distress and lower levels of trust in the hospital's COVID-19 guidelines compared to physicians (2.3 vs. 2.0 and 3.7 vs. 4.0, respectively). Nurses and interns felt the least safe when working in the hospital. Nurses reported the highest levels of concern regarding fear of uncontrollable spread, infection, and family transmission of the virus. Interns reported the lowest levels of self- and collective-efficacy. In a regression model, the variables that predicted 32% of distress among nurses were age, gender, level of religiosity, indices of perceived safety, and self-efficacy. This study demonstrated differences in distress and perceived safety, trust, and efficacy between varied HCWs during COVID-19. This variability should be considered when designing policies to protect HCWs' wellbeing during future pandemics.


Subject(s)
COVID-19/complications , Health Personnel/psychology , Perception , Adult , Analysis of Variance , COVID-19/prevention & control , COVID-19/psychology , Cross-Sectional Studies , Female , Health Personnel/statistics & numerical data , Humans , Male , Middle Aged , Patient Safety/standards , Patient Safety/statistics & numerical data , Self Efficacy , Stress, Psychological , Surveys and Questionnaires , Trust/psychology
6.
Ann R Coll Surg Engl ; 103(7): 487-492, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1288676

ABSTRACT

INTRODUCTION: In response to the COVID-19 pandemic, our emergency general surgery (EGS) service underwent significant restructuring, including establishing an enhanced ambulatory service and undertaking nonoperative management of selected pathologies. The aim of this study was to compare the activity of our EGS service before and after these changes. METHODS: Patients referred by the emergency department were identified prospectively over a 4-week period beginning from the date our EGS service was reconfigured (COVID) and compared with patients identified retrospectively from the same period the previous year (Pre-COVID), and followed up for 30 days. Data were extracted from handover documents and electronic care records. The primary outcomes were the rate of admission, ambulation and discharge. RESULTS: There were 281 and 283 patients during the Pre-COVID and COVID periods respectively. Admission rate decreased from 78.7% to 41.7%, while there were increased rates of ambulation from 7.1% to 17.3% and discharge from 6% to 22.6% (all p<0.001). For inpatients, mean duration of admission decreased (6.9 to 4.8 days), and there were fewer operative or endoscopic interventions (78 to 40). There were increased ambulatory investigations (11 to 39) and telephone reviews (0 to 39), while early computed tomography scan was increasingly used to facilitate discharge (5% vs 34.7%). There were no differences in 30-day readmission or mortality. CONCLUSIONS: Restructuring of our EGS service in response to COVID-19 facilitated an increased use of ambulatory services and imaging, achieving a decrease of 952 inpatient bed days in this critical period, while maintaining patient safety.


Subject(s)
COVID-19/prevention & control , Emergency Service, Hospital/organization & administration , Emergency Treatment/statistics & numerical data , General Surgery/organization & administration , Surgery Department, Hospital/organization & administration , Adult , Aged , Ambulatory Surgical Procedures/statistics & numerical data , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/transmission , Conservative Treatment/statistics & numerical data , Emergency Service, Hospital/standards , Emergency Service, Hospital/statistics & numerical data , Emergency Treatment/methods , Emergency Treatment/standards , Female , Follow-Up Studies , General Surgery/standards , General Surgery/statistics & numerical data , Hospital Mortality , Humans , Infection Control/organization & administration , Infection Control/standards , Male , Middle Aged , Pandemics/prevention & control , Patient Readmission/statistics & numerical data , Patient Safety/standards , Prospective Studies , Referral and Consultation/organization & administration , Referral and Consultation/standards , Referral and Consultation/statistics & numerical data , Retrospective Studies , SARS-CoV-2/isolation & purification , Surgery Department, Hospital/standards , Surgery Department, Hospital/statistics & numerical data
7.
Nurs Adm Q ; 45(3): 226-233, 2021.
Article in English | MEDLINE | ID: covidwho-1211445

ABSTRACT

New York City quickly became the epicenter of coronavirus disease-2019 (COVID-19) in early March of 2020. While hospitals were aware of the potential of COVID-19, the volume of critically ill patients that flooded the hospitals in the New York City area was clearly not anticipated. Hospital staff worked quickly to create COVID-19-free areas, but were overcome with the volume of COVID-positive critically ill patients. Many newly admitted patients required respiratory support with mechanical ventilation. As Governor Cuomo issued executive orders to stay at home in mid-March, some patients were afraid to go into hospitals despite symptoms of respiratory distress. Once these patients came to the hospital, they were often critically ill. Emergency departments and intensive care units filled rapidly, overwhelming staff and equipment needs with such things as pumps, dialysis machines, medications, and personal protective equipment. Plans for the day were disrupted with frequent rapid response calls and the need for additional beds. Key issues that confronted the COVID-19 response in critical care units at NYU Langone Health included communication, patient and staff safety.


Subject(s)
COVID-19/nursing , Critical Care Nursing/trends , Nurses/psychology , Critical Care Nursing/methods , Humans , New York , Nurses/statistics & numerical data , Patient Safety/standards , Personal Protective Equipment/standards , Personal Protective Equipment/supply & distribution
8.
Indian J Med Ethics ; VI(2): 1-10, 2021.
Article in English | MEDLINE | ID: covidwho-1206590

ABSTRACT

Covid-19 vaccines are a critical tool for controlling the pandemic. While safe and effective vaccines have been developed, research is expected to continue for many years regarding the optimal implementation of existing vaccines in specific settings, and the development of second-generation vaccines that may offer advantages in terms of either efficacy or ease of implementation. Given this context, some commentators have argued that new Covid vaccine trials should be able to use placebo controls, and that existing studies should be able to continue with blinded participants in order to collect high quality, unbiased data. Using international ethics guidance documents, this paper argues against placebo controls, given the existence of proven effective interventions, and against protracted blinding once safety and efficacy milestones have been met. Instead, it advocates for study designs that allow for direct comparison between approved and experimental vaccines, which facilitates both data collection and greater access to vaccines.


Subject(s)
Biomedical Research/standards , COVID-19 Vaccines/standards , COVID-19/prevention & control , Guidelines as Topic , Human Rights , Patient Safety/standards , Placebos/standards , Ethics, Medical , Humans , Pandemics , SARS-CoV-2
9.
Am J Med Qual ; 36(2): 84-89, 2021.
Article in English | MEDLINE | ID: covidwho-1172661

ABSTRACT

The posthospital discharge period is vulnerable for patients with coronavirus disease 2019 (COVID-19). The authors implemented a COVID-19 discharge pathway in the electronic medical record for UCHealth, a 12-hospital health care system, including an academic medical center (University of Colorado Hospital [UCH]), to improve patient safety by standardizing discharge processes for COVID-19 patients. There were 3 key elements: (1) building consensus on discharge readiness criteria, (2) summarizing discharge criteria for disposition locations, and (3) establishing primary care follow-up protocols. The discharge pathway was opened 821 times between April 20, 2020, and June 7, 2020. Of the 436 patients discharged from the hospital medicine service at UCH from April 20, 2020, and June 7, 2020, 18 (4%) were readmitted and 13 (3%) had a 30-day emergency department visit. The main trend observed was venous thromboembolism. This pathway allowed real-time integration of clinical guidelines and complex disposition requirements, decreasing cognitive burden and standardizing care for a complex population.


Subject(s)
COVID-19/epidemiology , Patient Discharge/standards , Patient Safety/standards , Academic Medical Centers , Age Factors , Clinical Protocols , Comorbidity , Emergency Service, Hospital/statistics & numerical data , Female , Humans , Inflammation Mediators/blood , Male , Middle Aged , Patient Readmission/statistics & numerical data , Risk Assessment , SARS-CoV-2
10.
Am J Med Qual ; 36(2): 73-83, 2021.
Article in English | MEDLINE | ID: covidwho-1172660

ABSTRACT

The health care sector has made radical changes to hospital operations and care delivery in response to the coronavirus disease (COVID-19) pandemic. This article examines pragmatic applications of simulation and human factors to support the Quadruple Aim of health system performance during the COVID-19 era. First, patient safety is enhanced through development and testing of new technologies, equipment, and protocols using laboratory-based and in situ simulation. Second, population health is strengthened through virtual platforms that deliver telehealth and remote simulation that ensure readiness for personnel to deploy to new clinical units. Third, prevention of lost revenue occurs through usability testing of equipment and computer-based simulations to predict system performance and resilience. Finally, simulation supports health worker wellness and satisfaction by identifying optimal work conditions that maximize productivity while protecting staff through preparedness training. Leveraging simulation and human factors will support a resilient and sustainable response to the pandemic in a transformed health care landscape.


Subject(s)
COVID-19/epidemiology , Delivery of Health Care/organization & administration , Hospital Administration/standards , Simulation Training/organization & administration , Cost Savings , Delivery of Health Care/economics , Delivery of Health Care/standards , Humans , Job Satisfaction , Pandemics , Patient Safety/standards , Population Health , Quality Indicators, Health Care , SARS-CoV-2 , Simulation Training/standards , Workflow
11.
Rev Bras Enferm ; 74Suppl 1(Suppl 1): e20200657, 2021.
Article in English, Portuguese | MEDLINE | ID: covidwho-1130365

ABSTRACT

OBJECTIVE: To reflect on the safe care exercised by the pre-hospital care team by emergency ambulance in times of coronavirus infection. METHOD: A reflection and description of how to provide safe care to the patient and the professional during pre-hospital care in times of coronavirus infection. RESULTS: To ensure the health of all those involved in the care, health professionals who work in pre-hospital care by emergency ambulance should use the recommended Personal Protective Equipment (PPE), such as the use of surgical masks and N95, N99, N100, PFF2 or PFF3, the use of an apron or overall, goggles and face shield, gloves and a hat. The entire team must receive training and demonstrate the ability to use PPE correctly and safely. FINAL CONSIDERATIONS: The professional working in the pre-hospital care by ambulance is exposed to a series of occupational risks that need to be discussed and minimized through professional training.


Subject(s)
Ambulances/standards , COVID-19/prevention & control , Emergency Medical Services/standards , Emergency Medical Technicians/standards , Patient Safety/standards , Personal Protective Equipment/standards , Practice Guidelines as Topic , Transportation of Patients/standards , Adult , Ambulances/statistics & numerical data , Brazil , Female , Humans , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Male , Middle Aged , Patient Safety/statistics & numerical data , Personal Protective Equipment/statistics & numerical data , SARS-CoV-2 , Transportation of Patients/statistics & numerical data
15.
Best Pract Res Clin Anaesthesiol ; 35(3): 321-332, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1039303

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic has potentiated the need for implementation of strict safety measures in the medical care of surgical patients - and especially in cardiac surgery patients, who are at a higher risk of COVID-19-associated morbidity and mortality. Such measures not only require minimization of patients' exposure to COVID-19 but also careful balancing of the risks of postponing nonemergent surgical procedures and providing appropriate and timely surgical care. We provide an overview of current evidence for preoperative strategies used in cardiac surgery patients, including risk stratification, telemedicine, logistical challenges during inpatient care, appropriate screening capacity, and decision-making on when to safely operate on COVID-19 patients. Further, we focus on perioperative measures such as safe operating room management and address the dilemma over when to perform cardiovascular surgical procedures in patients at risk.


Subject(s)
COVID-19/prevention & control , Cardiac Surgical Procedures/standards , Patient Safety/standards , Perioperative Care/standards , COVID-19/epidemiology , COVID-19/surgery , Cardiac Surgical Procedures/trends , Humans , Pandemics/prevention & control , Perioperative Care/trends , Risk Factors
18.
Ann Biol Clin (Paris) ; 78(6): 609-616, 2020 Dec 01.
Article in French | MEDLINE | ID: covidwho-999891

ABSTRACT

Confronted with the COVID-19 crisis, healthcare professionals have had to tackle an epidemic crisis of a huge magnitude for which they were not prepared. Medical laboratories have been on the front line, from collecting samples to performing the analysis required to diagnose this new pathology. Responding to the needs and to the urgency of the situation, the authorities relied on the network of private laboratories. In France, private laboratory medicine represents 70% of overall activity, and with a network of more than 4,000 local laboratories, private laboratory medicine has been the cornerstone of the « screen-trace-isolate ¼ strategy. This article gives feedback from private laboratory medicine professionals, directly involved in the reorganization carried out at the pre-analytical, analytical and post-analytical stages, during the crisis from March to October 2020.


Subject(s)
COVID-19/epidemiology , Clinical Laboratory Services/organization & administration , Pandemics , Private Sector/organization & administration , Specimen Handling/standards , COVID-19/diagnosis , Clinical Laboratory Services/standards , Clinical Laboratory Techniques/instrumentation , Clinical Laboratory Techniques/methods , Clinical Laboratory Techniques/standards , Cross Infection/epidemiology , Cross Infection/prevention & control , Equipment Safety/methods , Equipment Safety/standards , France/epidemiology , Hospital Units/organization & administration , Humans , Intersectoral Collaboration , Medical Staff/organization & administration , Medical Staff/standards , Patient Safety/standards , Pre-Analytical Phase/methods , Pre-Analytical Phase/standards , Private Sector/standards , SARS-CoV-2/isolation & purification , Specimen Handling/methods
19.
Asian Cardiovasc Thorac Ann ; 29(5): 361-368, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-962771

ABSTRACT

BACKGROUND: A project to benchmark the consensus statements, guidelines, and recommendations on surgical management in the course of the COVID-19 pandemic was developed to assess the methodology used. Standard and practical approaches for COVID-19 management in surgical patients to date are not accessible, despite the magnitude of the pandemic. A plethora of consensus statements, guidelines, and recommendations on surgical management in the course of COVID-19 epidemic have been rapidly published in the last three months. METHODS: Each manuscript was scored on a seven-point scale in the different items and domains with the Appraisal of Guidelines for Research and Evaluation II. RESULTS: Nine guidelines that met the inclusion criteria were assessed. Transnational cooperation produced only one guideline. Multivariable analysis showed that improved scores of stakeholders' involvement were related to internationally developed guidelines. Clarity of presentation was related to the contribution of scientific societies due to greater rigor of development. The rigor of development produced guidelines with a high overall value. Higher healthcare expenses did not produce superior guidelines. CONCLUSIONS: Evaluated by the Appraisal of Guidelines for Research and Evaluation II, the methodological characteristic of consensus statements, guidelines, and recommendations on surgical management during COVID-19 pandemic was relatively low. International development should be recommended as a model for the development of best methodological quality guidelines.


Subject(s)
COVID-19 , Delivery of Health Care/standards , Evidence-Based Medicine/standards , Practice Guidelines as Topic/standards , Surgical Procedures, Operative/standards , Benchmarking/standards , Clinical Decision-Making , Consensus , Humans , Patient Safety/standards , Risk Assessment , Risk Factors , Surgical Procedures, Operative/adverse effects
20.
Popul Health Manag ; 24(2): 166-173, 2021 04.
Article in English | MEDLINE | ID: covidwho-954100

ABSTRACT

The Philadelphia region responded to the shortage of health care resources imposed by the 2020 COVID-19 pandemic through the creation of the COVID-19 Surge Facility at Temple University's basketball arena. The facility was designed as an acute care medical unit capable of supporting COVID-19 patients who were stable enough to be released from the intensive care unit but not ready for discharge home. Safety was optimized through the application of recommendations from the Joint Commission and Centers for Disease Control and Prevention (CDC). The safety goals include those established by the Joint Commission with regard to patient identification, security, identification of patient safety threats, communication, fire safety, laboratory services, and pharmacologic services. COVID-19-specific goals outlined by the CDC also are addressed and include recommendations for facility layout, managing staff respite and personal protective equipment, patient care areas, supply storage, airflow, and patient hygiene. Although the goal was to meet all of these recommendations, some were not possible due to the austere environment of the arena. However, these shortcomings were met with innovative solutions that provided the next best options. By sharing these experiences, the authors hope to guide future alternate care facilities in their efforts to optimize safety.


Subject(s)
COVID-19/therapy , Facility Regulation and Control/organization & administration , Intensive Care Units/organization & administration , Patient Safety/standards , Urban Health Services/organization & administration , COVID-19/epidemiology , Humans , Philadelphia
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