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1.
J Nurs Adm ; 52(2): 91-98, 2022 Feb 01.
Article in English | MEDLINE | ID: covidwho-1621706

ABSTRACT

Nurse staffing is linked to safety, quality, and experience outcomes. In the context of the COVID-19 pandemic, staffing has become more critical as overwhelming demand has met diminishing supply of healthy nurses, capacity for care, and the innovation necessary to deliver optimal quality and experience to patients and the people who care for them. Press Ganey data scientists, along with industry experts, sought to evaluate staffing before the pandemic and its effects on clinical quality, experience, and nurse engagement. Furthermore, interviews with expert nurse researchers and nursing leaders helped to identify the kind of innovation necessary to accommodate the variable demand in patient volumes, acuity, nurse availability, and teamwork. Valuable insights from this work will help healthcare leaders in their quest to optimize nursing care.


Subject(s)
Health Workforce , Models, Statistical , Nursing Staff, Hospital/organization & administration , Personnel Staffing and Scheduling/organization & administration , Databases, Factual , Humans , Outcome Assessment, Health Care , Quality of Health Care
2.
J Cyst Fibros ; 20 Suppl 3: 16-20, 2021 12.
Article in English | MEDLINE | ID: covidwho-1587336

ABSTRACT

BACKGROUND: Chronic care delivery models faced unprecedented financial pressures, with a reduction of in-person visits and adoption of telehealth during the COVID-19 pandemic. We sought to understand the reported financial impact of pandemic-related changes to the cystic fibrosis (CF) care model. METHODS: The U.S. CF Foundation State of Care surveys fielded in Summer 2020 (SoC1) and Spring 2021 (SoC2) included questions for CF programs on the impact of pandemic-related restrictions on overall finances, staffing, licensure, and reimbursement of telehealth services. Descriptive analyses were conducted based on program type. RESULTS: Among the 286 respondents (128 pediatric, 118 adult, 40 affiliate), the majority (62%) reported a detrimental financial impact to their CF care program in SoC1, though fewer (42%) reported detrimental impacts in SoC2. The most common reported impacts in SoC1 were redeployment of clinical staff (68%), furloughs (52%), hiring freezes (51%), decreases in salaries (34%), or layoffs (10%). Reports of lower reimbursement for telehealth increased from 30% to 40% from SoC1 to SoC2. Projecting towards the future, only a minority (17%) of program directors in SoC2 felt that financial support would remain below pre-pandemic levels. CONCLUSIONS: The COVID-19 pandemic resulted in financial strain on the CF care model, including challenges with reimbursement for telehealth services and reductions in staffing due to institutional changes. Planning for the future of CF care model needs to address these short-term impacts, particularly to ensure a lack of interruption in high-quality multi-disciplinary care.


Subject(s)
COVID-19 , Continuity of Patient Care , Cystic Fibrosis , Health Services Accessibility , Models, Organizational , Telemedicine , Adult , COVID-19/epidemiology , COVID-19/prevention & control , Child , Continuity of Patient Care/organization & administration , Continuity of Patient Care/standards , Costs and Cost Analysis , Cystic Fibrosis/economics , Cystic Fibrosis/epidemiology , Cystic Fibrosis/therapy , Health Services Accessibility/organization & administration , Health Services Accessibility/trends , Health Services Needs and Demand , Humans , Organizational Innovation , Personnel Staffing and Scheduling/organization & administration , Reimbursement Mechanisms/trends , SARS-CoV-2 , Telemedicine/economics , Telemedicine/methods , United States/epidemiology
3.
Psychosomatics ; 61(6): 662-671, 2020.
Article in English | MEDLINE | ID: covidwho-1386490

ABSTRACT

BACKGROUND: Patients with psychiatric illnesses are particularly vulnerable to highly contagious, droplet-spread organisms such as SARS-CoV-2. Patients with mental illnesses may not be able to consistently follow up behavioral prescriptions to avoid contagion, and they are frequently found in settings with close contact and inadequate infection control, such as group homes, homeless shelters, residential rehabilitation centers, and correctional facilities. Furthermore, inpatient psychiatry settings are generally designed as communal spaces, with heavy emphasis on group and milieu therapies. As such, inpatient psychiatry services are vulnerable to rampant spread of contagion. OBJECTIVE: With this in mind, the authors outline the decision process and ultimate design and implementation of a regional inpatient psychiatry unit for patients infected with asymptomatic SARS-CoV-2 and share key points for consideration in implementing future units elsewhere. CONCLUSION: A major takeaway point of the analysis is the particular expertise of trained experts in psychosomatic medicine for treating patients infected with SARS-CoV-2.


Subject(s)
Asymptomatic Infections , Coronavirus Infections/complications , Hospital Design and Construction/methods , Hospital Units , Hospitalization , Infection Control/methods , Mental Disorders/therapy , Personnel Staffing and Scheduling/organization & administration , Pneumonia, Viral/complications , Betacoronavirus , COVID-19 , Humans , Involuntary Commitment , Mental Disorders/complications , Pandemics , Personal Protective Equipment , Psychiatric Department, Hospital , Psychotherapy, Group/methods , Recreation , SARS-CoV-2 , Ventilation/methods , Visitors to Patients
5.
Am J Health Syst Pharm ; 77(19): 1598-1605, 2020 09 18.
Article in English | MEDLINE | ID: covidwho-1317904

ABSTRACT

PURPOSE: To describe our medical center's pharmacy services preparedness process and offer guidance to assist other institutions in preparing for surges of critically ill patients such as those experienced during the coronavirus disease 2019 (COVID-19) pandemic. SUMMARY: The leadership of a department of pharmacy at an urban medical center in the US epicenter of the COVID-19 pandemic proactively created a pharmacy action plan in anticipation of a surge in admissions of critically ill patients with COVID-19. It was essential to create guidance documents outlining workflow, provide comprehensive staff education, and repurpose non-intensive care unit (ICU)-trained clinical pharmacotherapy specialists to work in ICUs. Teamwork was crucial to ensure staff safety, develop complete scheduling, maintain adequate drug inventory and sterile compounding, optimize the electronic health record and automated dispensing cabinets to help ensure appropriate prescribing and effective management of medication supplies, and streamline the pharmacy workflow to ensure that all patients received pharmacotherapeutic regimens in a timely fashion. CONCLUSION: Each hospital should view the COVID-19 crisis as an opportunity to internally review and enhance workflow processes, initiatives that can continue even after the resolution of the COVID-19 pandemic.


Subject(s)
COVID-19/drug therapy , Medication Therapy Management/organization & administration , Pharmacy Service, Hospital/organization & administration , Practice Guidelines as Topic , Academic Medical Centers/organization & administration , Academic Medical Centers/standards , COVID-19/epidemiology , Hospitals, Urban/organization & administration , Hospitals, Urban/standards , Humans , Leadership , New York/epidemiology , Pandemics/prevention & control , Personnel Staffing and Scheduling/organization & administration , Personnel Staffing and Scheduling/standards , Pharmacists/organization & administration , Pharmacy Service, Hospital/standards , Tertiary Care Centers/organization & administration , Tertiary Care Centers/standards , Workflow , Workforce/organization & administration , Workforce/standards
6.
Plast Reconstr Surg ; 148(1): 133e-139e, 2021 07 01.
Article in English | MEDLINE | ID: covidwho-1284960

ABSTRACT

SUMMARY: The coronavirus disease of 2019 pandemic became a global threat in a matter of weeks, with its future implications yet to be defined. New York City was swiftly declared the epicenter of the pandemic in the United States as case numbers grew exponentially in a matter of days, quickly threatening to overwhelm the capacity of the health care system. This burgeoning crisis led practitioners across specialties to adapt and mobilize rapidly. Plastic surgeons and trainees within the New York University Langone Health system faced uncertainty in terms of future practice, in addition to immediate and long-term effects on undergraduate and graduate medical education. The administration remained vigilant and adaptive, enacting departmental policies prioritizing safety and productivity, with early deployment of faculty for clinical support at the front lines. The authors anticipate that this pandemic will have far-reaching effects on the future of plastic surgery education, trends in the pursuit of elective surgical procedures, and considerable consequences for certain research endeavors. Undoubtedly, there will be substantial impact on the physical and mental well-being of health care practitioners across specialties. Coordinated efforts and clear lines of communication between the Department of Plastic Surgery and its faculty and trainees allowed a concerted effort toward the immediate challenge of tempering the spread of coronavirus disease of 2019 and preserving structure and throughput for education and research. Adaptation and creativity have ultimately allowed for early rebooting of in-person clinical and surgical practice. The authors present their coordinated efforts and lessons gleaned from their experience to inform their community's preparedness as this formidable challenge evolves.


Subject(s)
COVID-19/epidemiology , Communicable Disease Control/standards , Pandemics/prevention & control , Surgery, Plastic/trends , Academic Medical Centers/standards , Academic Medical Centers/statistics & numerical data , Academic Medical Centers/trends , COVID-19/prevention & control , COVID-19/transmission , Education, Medical, Graduate/organization & administration , Education, Medical, Graduate/standards , Education, Medical, Graduate/trends , Elective Surgical Procedures/education , Elective Surgical Procedures/standards , Elective Surgical Procedures/trends , Faculty/organization & administration , Faculty/psychology , Faculty/statistics & numerical data , Forecasting , Humans , Internship and Residency/statistics & numerical data , New York City/epidemiology , Personnel Staffing and Scheduling/organization & administration , Personnel Staffing and Scheduling/trends , Reconstructive Surgical Procedures/education , Reconstructive Surgical Procedures/standards , Reconstructive Surgical Procedures/trends , Surgeons/organization & administration , Surgeons/psychology , Surgeons/statistics & numerical data , Surgery, Plastic/education , Surgery, Plastic/organization & administration , Surgery, Plastic/standards , Surveys and Questionnaires/statistics & numerical data , Uncertainty , Universities/standards , Universities/statistics & numerical data , Universities/trends
7.
J Plast Reconstr Aesthet Surg ; 74(11): 3073-3079, 2021 11.
Article in English | MEDLINE | ID: covidwho-1270578

ABSTRACT

BACKGROUND: Ramifications of coronavirus disease 2019 (COVID-19) on the re-structuring of healthcare are widespread, including delivery of surgical services across all specialties, including plastic surgery. Re-deployment of personnel and cessation of elective services are commonplace. However, there is a continued need for both emergency and oncological surgery. A national review of practice was conducted during the COVID-19 pandemic, to assess impact on services, staffing and training. METHODS: Key aspects of current plastic surgery practice in the United Kingdom were examined in this cross-sectional study; operating capacity, location of theatre lists (national health service or outsourced private institutions (PIs)), differences across sub-specialties, change in anaesthesia practices, staffing, re-deployment, on-call provision and impact on training. RESULTS: Three-hundred and forty-four plastic surgeons in the United Kingdom provided practice data across 51 units. Theatre capacity and outpatient services were markedly reduced. Outsourcing of operating lists to PIs was widely utilised. Increased use of local anaesthetic hand procedures, the prioritisation of shorter operations with reduced microsurgery in both head and neck/lower limb and almost complete cessation of breast reconstruction were noted, together with marked regional variations. Re-deployment occurred at all staffing levels, whilst telemedicine played a critical role in both patient management and training. CONCLUSIONS: COVID-19 has enforced unprecedented changes to surgical care delivery and training, as identified by examination of plastic surgery nationally in the United Kingdom. Novel means to support continued elective and emergency services, including oncology have been identified. Lessons learned will allow phased return of services and improved preparation for the future.


Subject(s)
COVID-19 , Pandemics , Practice Patterns, Physicians'/statistics & numerical data , Reconstructive Surgical Procedures/statistics & numerical data , Cross-Sectional Studies , Humans , Operating Rooms/organization & administration , Personnel Staffing and Scheduling/organization & administration , Surgery, Plastic , Surveys and Questionnaires , United Kingdom
10.
JAMA Netw Open ; 4(5): e2110071, 2021 05 03.
Article in English | MEDLINE | ID: covidwho-1227701

ABSTRACT

Importance: Nursing homes and other long-term care facilities have been disproportionately impacted by the COVID-19 pandemic. Strategies are urgently needed to reduce transmission in these high-risk populations. Objective: To evaluate COVID-19 transmission in nursing homes associated with contact-targeted interventions and testing. Design, Setting, and Participants: This decision analytical modeling study developed an agent-based susceptible-exposed-infectious (asymptomatic/symptomatic)-recovered model between July and September 2020 to examine SARS-CoV-2 transmission in nursing homes. Residents and staff of a simulated nursing home with 100 residents and 100 staff split among 3 shifts were modeled individually; residents were split into 2 cohorts based on COVID-19 diagnosis. Data were analyzed from September to October 2020. Exposures: In the resident cohorting intervention, residents who had recovered from COVID-19 were moved back from the COVID-19 (ie, infected with SARS-CoV-2) cohort to the non-COVID-19 (ie, susceptible and uninfected with SARS-CoV-2) cohort. In the immunity-based staffing intervention, staff who had recovered from COVID-19 were assumed to have protective immunity and were assigned to work in the non-COVID-19 cohort, while susceptible staff worked in the COVID-19 cohort and were assumed to have high levels of protection from personal protective equipment. These interventions aimed to reduce the fraction of people's contacts that were presumed susceptible (and therefore potentially infected) and replaced them with recovered (immune) contacts. A secondary aim of was to evaluate cumulative incidence of SARS-CoV-2 infections associated with 2 types of screening tests (ie, rapid antigen testing and polymerase chain reaction [PCR] testing) conducted with varying frequency. Main Outcomes and Measures: Estimated cumulative incidence proportion of SARS-CoV-2 infection after 3 months. Results: Among the simulated cohort of 100 residents and 100 staff members, frequency and type of testing were associated with smaller outbreaks than the cohorting and staffing interventions. The testing strategy associated with the greatest estimated reduction in infections was daily antigen testing, which reduced the mean cumulative incidence proportion by 49% in absence of contact-targeted interventions. Under all screening testing strategies, the resident cohorting intervention and the immunity-based staffing intervention were associated with reducing the final estimated size of the outbreak among residents, with the immunity-based staffing intervention reducing it more (eg, by 19% in the absence of testing) than the resident cohorting intervention (eg, by 8% in the absence of testing). The estimated reduction in transmission associated with these interventions among staff varied by testing strategy and community prevalence. Conclusions and Relevance: These findings suggest that increasing the frequency of screening testing of all residents and staff, or even staff alone, in nursing homes may reduce outbreaks in this high-risk setting. Immunity-based staffing may further reduce spread at little or no additional cost and becomes particularly important when daily testing is not feasible.


Subject(s)
COVID-19/prevention & control , COVID-19/transmission , Homes for the Aged , Nursing Homes , Personnel Staffing and Scheduling/organization & administration , Adaptive Immunity , Aged , COVID-19/diagnosis , COVID-19/virology , COVID-19 Nucleic Acid Testing , COVID-19 Serological Testing , Decision Support Techniques , Humans , Personal Protective Equipment , Viral Load , Vulnerable Populations
11.
Enferm Clin (Engl Ed) ; 31: S12-S17, 2021 Feb.
Article in Spanish | MEDLINE | ID: covidwho-1172424

ABSTRACT

At the international level, the enormous demand to manage the COVID-19 pandemic has posed a challenge both in the provision of personnel and in supplies and sanitary material. There is no precedent or publication related to the management and leadership of nursing services in Spain within the emergency plan for the COVID-19 pandemic. This article describes the experience of the Hospital Clinico de Barcelona in the current extraordinary circumstances that undoubtedly constitute a nursing management of enormous magnitude and unprecedented due to the high number of people affected and the extraordinary risk of healthcare personnel. Following national and international guidelines to alleviate the pandemic, protect health and prevent the spread of the outbreak. The ability to work as a team, emotional management and respect for organizational decisions have made it possible to face the challenges that the pandemic has put in place and that the Nursing Department can lead in a calm and orderly manner the different actions to perform. Lastly, it will be necessary to continue with an in-depth analysis of the situation and of the actions carried out in order to identify the areas for improvement as well as to evaluate the overall nature of the process.


Subject(s)
COVID-19/epidemiology , Hospital Administration , Leadership , Nursing Service, Hospital/organization & administration , Pandemics , SARS-CoV-2 , Advisory Committees/organization & administration , Bed Conversion , COVID-19/therapy , Checklist , Clinical Protocols , Emergencies/epidemiology , Health Personnel/education , Home Care Services/organization & administration , Humans , Nurse's Role , Personal Protective Equipment , Personnel Staffing and Scheduling/organization & administration , Spain/epidemiology , Triage/organization & administration
13.
J Microbiol Immunol Infect ; 54(3): 349-358, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1157513

ABSTRACT

The radiology department was categorized as a "high risk area" during the severe acute respiratory syndrome (SARS) outbreak in 2003 and is similarly considered a "high risk area" during the current coronavirus (COVID-19) pandemic. The purpose of infection control is to isolate patients with suspected or confirmed COVID-19 from uninfected people by utilizing separate equipment, spaces, and healthcare workers. Infection control measures should be prioritized to prevent the nosocomial spread of infection. We established a COVID-19 infection control team in our radiology department. The team's responsibilities include triaging patients with confirmed or suspected COVID-19, performing imaging and reporting, using dedicated equipment, disinfecting the equipment and the immediate environment, and staff scheduling.


Subject(s)
COVID-19/prevention & control , Cross Infection/prevention & control , Infection Control/methods , Practice Guidelines as Topic , Radiology Department, Hospital/organization & administration , Health Personnel , Humans , Patient Care/methods , Patient Care Planning , Patient Safety , Personal Protective Equipment/standards , Personnel Staffing and Scheduling/organization & administration , Program Evaluation
15.
J Nurs Adm ; 51(4): 177-178, 2021 Apr 01.
Article in English | MEDLINE | ID: covidwho-1140038

ABSTRACT

The COVID-19 pandemic exhausted the nursing workforce, casting doubt that future supply will meet demand. To preserve their workforces, nursing leaders are offering emotional support to the frontline. Although these efforts are essential, leaders are overlooking an untapped opportunity to safeguard staffing levels: creating a more flexible nursing workforce. In this article, the authors discuss flexible nurse staffing and suggest 4 key opportunities for improvement.


Subject(s)
COVID-19/nursing , Nursing Staff/supply & distribution , Personnel Staffing and Scheduling/organization & administration , Health Workforce/organization & administration , Humans
18.
J Am Board Fam Med ; 34(Suppl): S217-S221, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-1099985

ABSTRACT

The University of Colorado family medicine residency watched along with the rest of the nation as the first cases of COVID-19 were being reported in the United States in March 2020. Concern grew as epidemiological models began to predict alarming hospital bed shortages for the state. Massive scheduling adjustments were needed as faculty and residents found themselves in groups at high risk for severe COVID-19 and residents found themselves dismissed from nonessential learning experiences in an effort to conserve personal protective equipment and limit exposures. A dedicated surge team was formed to tackle these issues while continuing to support our goals of maximizing patient safety, resident education, and physician wellness. The surge team created a plan that was implemented in 2 main phases. Phase 1 assumed business as usual with increased layers of backup for both residents and faculty. Phase 2 redistributed unassigned residents and inpatient faculty to increase capacity for adult medicine and COVID-19 patients on our essential services. Lessons learned from these surge efforts may help inform similar decisions being made by other residency programs presently and in the future.


Subject(s)
COVID-19/therapy , Capacity Building , Family Practice/education , Internship and Residency/organization & administration , COVID-19/epidemiology , Colorado/epidemiology , Humans , Interdisciplinary Communication , Pandemics , Personnel Staffing and Scheduling/organization & administration , SARS-CoV-2
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