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2.
Eur J Gen Pract ; 27(1): 142-151, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1294616

ABSTRACT

BACKGROUND: The COVID-19 pandemic has resulted in the rapid reorganisation of health and social care services. Patients are already at significant risk of healthcare-associated harm and the wholesale disruption to service delivery during the pandemic stood to heighten those risks. OBJECTIVES: We explored the type and nature of patient safety incidents in French primary care settings during the COVID-19 first wave to make tentative recommendations for improvement. METHODS: A national patient safety incident reporting survey was distributed to General Practitioners (GPs) in France on 28 April 2020. Reports were coded using a classification system aligned to the WHO International Classification for Patient Safety (incident types, contributing factors, incident outcomes and severity of harm). Analysis involved data coding, processing, iterative generation of data summaries using descriptive statistical analysis. Clinicaltrials.gov: NCT04346121. RESULTS: Of 132 incidents, 58 (44%) related to delayed diagnosis, assessments and referrals. Cancellations of appointments, hospitalisations or procedures was reported in 22 (17%) of these incidents. Home confinement-related incidents accounted for 13 (10%) reports and inappropriate medication stopping for five (4%). Patients delayed attending or did not consult their general practitioner or other healthcare providers due to their fear of contracting COVID-19 infection at an in-person visit in 26 (10%) incidents or fear of burdening their GPs in eight (3%) incidents. CONCLUSION: Constraints from the first wave of the COVID-19 pandemic have contributed to patient safety incidents during non-COVID-19 care. Lessons from these incidents pinpoint where primary care services in France can focus resources to design safer systems for patients.


Subject(s)
COVID-19/epidemiology , Infection Control/organization & administration , Patient Safety/statistics & numerical data , Primary Health Care/organization & administration , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/prevention & control , COVID-19/transmission , Child , Child, Preschool , Communication , Delayed Diagnosis/statistics & numerical data , Female , France , Humans , Incidence , Infant , Male , Middle Aged , Referral and Consultation , Surveys and Questionnaires , Young Adult
3.
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
4.
Pediatr Neurol ; 122: 15-19, 2021 09.
Article in English | MEDLINE | ID: covidwho-1275629

ABSTRACT

BACKGROUND: We compared emergency department (ED) and overnight inpatient admission (admission) rates within eight weeks of home-based telemedicine visits during COVID-19 in 2020 with in-person visits (conventional visit) in 2019. This was a quality improvement project prompted by an adverse event after a telemedicine visit. METHODS: We reviewed all completed telemedicine and conventional visits from March 26 to June 1 of 2020 and 2019 to identify patients who required an ED visit or hospital admission within eight weeks after the visit. RESULTS: In 2020, the overall rate of ED visits of hospital admission within eight weeks of a neurology visit was less than 5%. Comparing 2020 with 2019: (1) cohorts were similar for age, payor, state of residence, medical complexity, recommendation for close follow-up, new medications, or new tests ordered; (2) it took longer to present to the ED (by 10 days) or to be hospitalized (by three days); (3) planned admissions were approximately 50% lower; (4) on multivariate analysis, risk factors for any ED/admission included a patient call within seven days before the ED/admission (P = 0.0004) or being seen by an epilepsy specialist (P = 0.02); (5) a presenting complaint of worsening symptoms had a lower odds ratio of subsequent ED visit/admission (P = 0.005). CONCLUSIONS: Telemedicine is safe, with a similar likelihood of ED or hospital admission during the pandemic in 2020 versus before the pandemic in 2019. In 2020, even if patients described worse symptoms at the time of their clinic visit, the odds of ED or hospital admission were lower than in 2019, but those who called after the telemedicine visit were more likely to be seen in ED or require hospitalization.


Subject(s)
COVID-19 , Emergency Service, Hospital/statistics & numerical data , Nervous System Diseases/therapy , Neurology/statistics & numerical data , Patient Admission/statistics & numerical data , Patient Safety/statistics & numerical data , Telemedicine/statistics & numerical data , Adult , Female , Humans , Male , Middle Aged , Quality Improvement , Risk Factors
6.
Hosp Pediatr ; 11(6): e95-e100, 2021 06.
Article in English | MEDLINE | ID: covidwho-1219639

ABSTRACT

BACKGROUND AND OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic has impacted hospitals, potentially affecting quality and safety. Our objective was to compare pediatric hospitalization safety events during the pandemic versus previous years. METHODS: In this retrospective cohort study of hospitalizations in the Pediatric Health Information System, we compared Pediatric Quality Indicator (PDI) rates from March 15 to May 31, 2017-2019 (pre-COVID-19), with those from March 15 to May 31, 2020 (during COVID-19). Generalized linear mixed-effects models with adjustment for patient characteristics (eg, diagnosis, clinical severity) were used. RESULTS: There were 399 113 discharges pre-COVID-19 and 88 140 during COVID-19. Unadjusted PDI rates were higher during versus pre-COVID-19 for overall PDIs (6.39 vs 5.05; P < .001). In adjusted analyses, odds of postoperative sepsis were higher during COVID-19 versus pre-COVID-19 (adjusted odds ratio 1.28 [95% confidence interval 1.04-1.56]). The remainder of the PDIs did not have increased adjusted odds during compared with pre-COVID-19. CONCLUSIONS: Postoperative sepsis rates increased among children hospitalized during COVID-19. Efforts are needed to improve safety of postoperative care for hospitalized children.


Subject(s)
COVID-19/epidemiology , Hospitals, Pediatric/statistics & numerical data , Patient Safety/statistics & numerical data , Postoperative Complications/epidemiology , Sepsis/epidemiology , Adolescent , Causality , Child , Child, Preschool , Cohort Studies , Comorbidity , Female , Hospitalization , Humans , Infant , Male , Pandemics , Retrospective Studies , SARS-CoV-2 , United States/epidemiology
7.
J Clin Pharm Ther ; 46(5): 1308-1311, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1220012

ABSTRACT

WHAT IS KNOWN AND OBJECTIVE: A pandemic can strain all aspects of the healthcare system, including the ability to monitor the safety of medication use. Reviewing the adequacy of medication safety practices during the COVID-19 pandemic is critical to informing responses to future pandemics. The purpose of this study was to evaluate medication safety practices at a height of both COVID-19 cases and hydroxychloroquine use. METHODS: This was a multicentre observational point prevalence study. Adult inpatients receiving hydroxychloroquine for COVID-19 between March 22 and 28, 2020 were included. The primary outcome was the percentage of patients receiving appropriate QTc monitoring. Secondary outcomes included QTc prolongation, early discontinuation of hydroxychloroquine and ventricular arrhythmias. RESULTS AND DISCUSSION: A total of 59% (167/284) of patients treated with hydroxychloroquine received appropriate QTc monitoring. QTc prolongation occurred in 25%. Hydroxychloroquine was prematurely discontinued in 1.4% of patients, all due to QTc prolongation. Ventricular arrhythmia occurred in 1.1%. WHAT IS NEW AND CONCLUSION: Medication safety practices were suboptimal with regard to hydroxychloroquine monitoring at the height of the COVID-19 pandemic. Preparation for future pandemics should devote considerable attention to medication safety.


Subject(s)
Arrhythmias, Cardiac/chemically induced , Arrhythmias, Cardiac/diagnosis , COVID-19/drug therapy , Electrocardiography/methods , Hydroxychloroquine/adverse effects , Patient Safety/statistics & numerical data , Enzyme Inhibitors/adverse effects , Enzyme Inhibitors/therapeutic use , Female , Humans , Hydroxychloroquine/therapeutic use , Male , Middle Aged , Pandemics , Prevalence , SARS-CoV-2
8.
Global Health ; 17(1): 42, 2021 04 08.
Article in English | MEDLINE | ID: covidwho-1175328

ABSTRACT

BACKGROUND: The ongoing pandemic of coronavirus disease 2019 (COVID-19) has the potential to reverse progress towards global targets. This study examines the risks that the COVID-19 pandemic poses to equitable access to essential medicines and vaccines (EMV) for universal health coverage in Africa. METHODS: We searched medical databases and grey literature up to 2 October 2020 for studies reporting data on prospective pathways and innovative strategies relevant for the assessment and management of the emerging risks in accessibility, safety, quality, and affordability of EMV in the context of the COVID-19 pandemic. We used the resulting pool of evidence to support our analysis and to draw policy recommendations to mitigate the emerging risks and improve preparedness for future crises. RESULTS: Of the 310 records screened, 134 were included in the analysis. We found that the disruption of the international system affects more immediately the capability of low- and middle-income countries to acquire the basket of EMV. The COVID-19 pandemic may facilitate dishonesty and fraud, increasing the propensity of patients to take substandard and falsified drugs. Strategic regional cooperation in the form of joint tenders and contract awarding, joint price negotiation and supplier selection, as well as joint market research, monitoring, and evaluation could improve the supply, affordability, quality, and safety of EMV. Sustainable health financing along with international technology transfer and substantial investment in research and development are needed to minimize the vulnerability of African countries arising from their dependence on imported EMV. To ensure equitable access, community-based strategies such as mobile clinics as well as fees exemptions for vulnerable and under-served segments of society might need to be considered. Strategies such as task delegation and telephone triage could help reduce physician workload. This coupled with payments of risk allowance to frontline healthcare workers and health-literate healthcare organization might improve the appropriate use of EMV. CONCLUSIONS: Innovative and sustainable strategies informed by comparative risk assessment are increasingly needed to ensure that local economic, social, demographic, and epidemiological risks and potentials are accounted for in the national COVID-19 responses.


Subject(s)
COVID-19/economics , Drugs, Essential/economics , Drugs, Essential/supply & distribution , Universal Health Care , Vaccines/economics , Vaccines/supply & distribution , Africa , Developing Countries , Health Services Accessibility/statistics & numerical data , Humans , Patient Safety/statistics & numerical data , Prospective Studies , Quality of Health Care/statistics & numerical data , SARS-CoV-2
9.
NASN Sch Nurse ; 36(3): 132-136, 2021 May.
Article in English | MEDLINE | ID: covidwho-1171772

ABSTRACT

School nurses are advocates, caregivers, and teachers. It is the responsibility of school nurses to understand current prevention and treatment options. In understanding how and why coronavirus disease 2019 (COVID-19) mRNA vaccines work, school nurses are in a trusted position to explain and advocate vaccination to students and their caregivers. The messenger ribonucleic acid (mRNA) vaccine is a product of the latest scientific and medical technology. A better understanding of how and why this vaccination is effective may prevent vaccination hesitancy and provide reassurance to those choosing to accept vaccination. In December 2020, the National Association of School Nurses publicized its support for vaccination against COVID-19. As the COVID-19 pandemic lingers school nurses will step toward the front line to aid in the abatement of poor public health outcomes that may be severely affecting their schools, students, and caregivers.


Subject(s)
COVID-19 Vaccines/therapeutic use , COVID-19/prevention & control , Health Education/organization & administration , School Nursing/organization & administration , Vaccination/statistics & numerical data , Humans , Patient Safety/statistics & numerical data
10.
Trials ; 21(1): 1019, 2020 Dec 11.
Article in English | MEDLINE | ID: covidwho-1146386

ABSTRACT

BACKGROUND: Burnout is an occupational syndrome that leads to mental health problems, job turnover, and patient safety events. Those caring for critically ill patients are especially susceptible due to high patient mortality, long hours, and regular encounters with trauma and ethical issues. Interventions to prevent burnout in this population are needed. Preliminary studies suggest debriefing sessions may reduce burnout. This study aims to assess whether participation in regular debriefing can prevent burnout in intensive care unit (ICU) clinicians. METHODS: A randomized controlled trial will be conducted in two large academic medical centers. Two hundred ICU clinicians will be recruited with target enrollment of 100 physicians and 100 non-physicians (nurses, pharmacists, therapists). Participants must have worked in the ICU for the equivalent of at least 1 full time work week in the preceding 4 weeks. Enrolled subjects will be randomized to virtually attend biweekly debriefing sessions facilitated by a psychotherapist for 3 months or to a control arm without sessions. Our debriefs are modeled after Death Cafés, which are informal discussions focusing on death, dying, loss, grief, and illness. These sessions allow for reflection on distressing events and offer community and collaboration among hospital employees outside of work. The primary outcome is clinician burnout as measured by the Maslach Burnout Inventory (MBI) Score. Secondary outcomes include depression and anxiety, as measured by the Patient Health Questionnaire 8 (PHQ-8) and Generalized Anxiety Disorder 7-item scale (GAD-7), respectively. Questionnaires will be administered prior to the intervention, at 1 month, at 3 months, and at 6 months after enrollment. These values will be compared between groups temporally. Qualitative feedback will also be collected and analyzed. DISCUSSION: With ICU clinician burnout rates exceeding 50%, Death Café debriefing sessions may prove to be an effective tool to avert this debilitating syndrome. With COVID-19 limiting social interactions and overloading ICUs worldwide, the virtual administration of the Death Café for ICU clinicians provides an innovative strategy to potentially mitigate burnout in this vulnerable population. TRIAL REGISTRATION: ClinicalTrials.gov NCT04347811 . Registered on 15 April 2020.


Subject(s)
Burnout, Professional/prevention & control , Intensive Care Units/statistics & numerical data , Occupational Stress/psychology , SARS-CoV-2/genetics , Terminal Care/psychology , Anxiety/diagnosis , Anxiety/epidemiology , Awareness/physiology , Burnout, Professional/epidemiology , COVID-19/epidemiology , COVID-19/virology , Case-Control Studies , Communication , Critical Illness/mortality , Critical Illness/psychology , Depression/diagnosis , Depression/epidemiology , Humans , Occupational Stress/epidemiology , Patient Health Questionnaire/statistics & numerical data , Patient Safety/statistics & numerical data , Personnel Turnover/statistics & numerical data , Surveys and Questionnaires , User-Computer Interface
11.
NASN Sch Nurse ; 36(3): 156-163, 2021 May.
Article in English | MEDLINE | ID: covidwho-1097064

ABSTRACT

School-located vaccination events (SLVE) have a long history in the United States and have successfully contributed to lower morbidity and mortality due to vaccine-preventable diseases. The school is an ideal place to reach children from all cultures, socioeconomic groups, and age-groups and is conveniently situated in communities for ease of accessibility for students, parents, and staff alike. School nurses play an important role in planning for SLVE and are ideally positioned to initiate this process and provide accurate information, dispelling myths about vaccines. Because school nurses are considered a trusted source of health information by the school community, they can provide valuable education on the impact of vaccination on student and staff attendance. Conducting a successful SLVE requires research, planning, and partnerships, and these partnerships are needed both within the school setting and outside this setting, within the community at large. The proliferation of the current COVID-19 pandemic and the subsequent vaccine production has caused school nurses to take the lead in preparing for mass vaccination clinics in order to help mitigate this serious public health threat. This manuscript describes the process a group of school nurses used to develop SLVE plans in response to a pandemic.


Subject(s)
COVID-19 Vaccines/therapeutic use , COVID-19/prevention & control , Health Education/organization & administration , School Nursing/organization & administration , Vaccination/statistics & numerical data , Humans , Patient Safety/statistics & numerical data
12.
Otolaryngol Clin North Am ; 53(6): 1159-1170, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-1027957

ABSTRACT

This review explores the changes to practice associated with COVID-19 for providers treating patients with head and neck cancer and laryngeal pathology. The aim of the review is to highlight some of the challenges and considerations associated with treating this patient population during the pandemic. Additionally, it seeks to discuss some of the areas of concern related to ramping up clinical volume.


Subject(s)
Coronavirus Infections/prevention & control , Elective Surgical Procedures/statistics & numerical data , Head and Neck Neoplasms/surgery , Infection Control/methods , Laryngectomy/methods , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Telemedicine/statistics & numerical data , Adult , Aged , COVID-19 , Coronavirus Infections/epidemiology , Elective Surgical Procedures/methods , Female , Head and Neck Neoplasms/diagnosis , Humans , Laryngectomy/adverse effects , Male , Middle Aged , Occupational Health/statistics & numerical data , Pandemics/statistics & numerical data , Patient Safety/statistics & numerical data , Personal Protective Equipment/statistics & numerical data , Pneumonia, Viral/epidemiology , Safety Management , Telemedicine/methods , United States
15.
J Healthc Risk Manag ; 40(4): 30-37, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1012192

ABSTRACT

On March 11, 2020, the novel coronavirus disease, COVID-19, was declared a pandemic by the World Health Organization (WHO).1 The pandemic evolved rapidly, forcing providers to face previously unconsidered health care delivery scenarios. Medical and dental professionals sought guidance. This article presents an overview of the questions, concerns, and requests physicians and dentists shared with patient safety risk management consultants (PSRMs) at a large medical professional liability company. During the first 5 months of the pandemic, PSRMs handled more than 1200 calls related to COVID-19. Analysis of call data provides insight into front line provider concerns as the pandemic evolved.


Subject(s)
COVID-19/prevention & control , Pandemics/statistics & numerical data , Patient Safety/statistics & numerical data , Risk Management/methods , Risk Management/statistics & numerical data , Adult , Aged , Aged, 80 and over , COVID-19/epidemiology , Female , Humans , Male , Middle Aged , SARS-CoV-2 , United States/epidemiology
17.
Eur J Cardiothorac Surg ; 58(6): 1222-1227, 2020 12 01.
Article in English | MEDLINE | ID: covidwho-910370

ABSTRACT

OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic has resulted in patient reluctance to seek care due to fear of contracting the virus, especially in New York City which was the epicentre during the surge. The primary objectives of this study are to evaluate the safety of patients who have undergone pulmonary resection for lung cancer as well as provider safety, using COVID-19 testing, symptoms and early patient outcomes. METHODS: Patients with confirmed or suspected pulmonary malignancy who underwent resection from 13 March to 4 May 2020 were retrospectively reviewed. RESULTS: Between 13 March and 4 May 2020, 2087 COVID-19 patients were admitted, with a median daily census of 299, to one of our Manhattan campuses (80% of hospital capacity). During this time, 21 patients (median age 72 years) out of 45 eligible surgical candidates underwent pulmonary resection-13 lobectomies, 6 segmentectomies and 2 pneumonectomies were performed by the same providers who were caring for COVID-19 patients. None of the patients developed major complications, 5 had minor complications, and the median length of hospital stay was 2 days. No previously COVID-19-negative patient (n = 20/21) or healthcare provider (n = 9: 3 surgeons, 3 surgical assistants, 3 anaesthesiologists) developed symptoms of or tested positive for COVID-19. CONCLUSIONS: Pulmonary resection for lung cancer is safe in selected patients, even when performed by providers who care for COVID-19 patients in a hospital with a large COVID-19 census. None of our patients or providers developed symptoms of COVID-19 and no patient experienced major morbidity or mortality.


Subject(s)
COVID-19/prevention & control , Carcinoma, Non-Small-Cell Lung/surgery , Infection Control/methods , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Lung Neoplasms/surgery , Pneumonectomy , Postoperative Complications/prevention & control , Adenocarcinoma/surgery , Adult , Aged , Aged, 80 and over , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/transmission , COVID-19 Testing , Cross Infection/diagnosis , Cross Infection/epidemiology , Cross Infection/prevention & control , Female , Follow-Up Studies , Health Services Accessibility , Hospitalization , Humans , Infectious Disease Transmission, Patient-to-Professional/statistics & numerical data , Male , Middle Aged , New York City/epidemiology , Pandemics , Patient Safety/statistics & numerical data , Patient Selection , Perioperative Care/methods , Postoperative Complications/diagnosis , Postoperative Complications/epidemiology , Retrospective Studies , Treatment Outcome
19.
Ultrasound Q ; 36(3): 200-205, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-744650

ABSTRACT

The coronavirus disease 2019 is caused by the severe acute respiratory syndrome coronavirus 2. The virus can be spread by close person-to-person contact primarily by respiratory droplets. Given the close proximity of the sonographer or sonologist with the patient during ultrasound examinations, special precautions should be taken to limit the exposure of radiology personnel to patients with coronavirus disease 2019 while still providing optimal patient care. Methods covered in this article include modified workflow, close scrutiny and prioritization of imaging orders, and design of targeted ultrasound protocols. These guidelines summarize the personal experience and insight of multiple colleagues who lead ultrasound sections or are experts in the field.


Subject(s)
Coronavirus Infections/prevention & control , Infection Control/standards , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Practice Guidelines as Topic , Radiology Department, Hospital/standards , Ultrasonography, Doppler/standards , COVID-19 , Coronavirus Infections/epidemiology , Female , Humans , Male , Occupational Health , Outcome Assessment, Health Care , Pandemics/statistics & numerical data , Patient Safety/statistics & numerical data , Pneumonia, Viral/epidemiology
20.
Am J Med Qual ; 35(6): 444-449, 2020 12.
Article in English | MEDLINE | ID: covidwho-692460

ABSTRACT

During the coronavirus disease 2019 (COVID-19) pandemic, the study institution recognized the importance of providing preoperative COVID-19 testing and symptom screening to ensure patient safety. A multidisciplinary quality improvement team used Define, Measure, Analyze, Improve, and Control methodology to understand the issues, identify solutions, and streamline patient flow. The existing preoperative evaluation (POE) clinic was utilized as a centralized entity to provide COVID-19 testing, symptom screening, and infection prevention education in addition to routine preoperative medical optimization. With the new process, the percentage of patients with COVID-19 testing results returned before surgery increased from 10% to 100%. Of the 593 asymptomatic patients screened by the POE clinic, 2 were found to have positive results. These patients had their surgeries postponed until proper recovery. The study institution has extended this new process to all surgical patients, warranting facility readiness for the resumption of elective surgery.


Subject(s)
Betacoronavirus , Coronavirus Infections/diagnosis , Elective Surgical Procedures , Patient Safety/statistics & numerical data , Pneumonia, Viral/diagnosis , Preoperative Period , COVID-19 , COVID-19 Testing , Clinical Laboratory Techniques , Humans , Mass Screening/statistics & numerical data , Pandemics , Quality Improvement , SARS-CoV-2
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