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1.
Int J Environ Res Public Health ; 19(7)2022 Mar 25.
Article in English | MEDLINE | ID: covidwho-1798900

ABSTRACT

Disasters disrupt communication channels, infrastructure, and overburden health systems. This creates unique challenges to the functionality of surveillance tools, data collection systems, and information sharing platforms. The WHO Health Emergency and Disaster Risk Management (Health-EDRM) framework highlights the need for appropriate data collection, data interpretation, and data use from individual, community, and global levels. The COVID-19 crisis has evolved the way hazards and risks are viewed. No longer as a linear event but as a protracted hazard, with cascading and compound risks that affect communities facing complex risks such as climate-related disasters or urban growth. The large-scale disruptions of COVID-19 show that disaster data must evolve beyond mortality and frequency of events, in order to encompass the impact on the livelihood of communities, differentiated between population groups. This includes relative economic losses and psychosocial damage. COVID-19 has created a global opportunity to review how the scientific community classifies data, and how comparable indicators are selected to inform evidence-based resilience building and emergency preparedness. A shift into microlevel data, and regional-level information sharing is necessary to tailor community-level interventions for risk mitigation and disaster preparedness. Real-time data sharing, open governance, cross-organisational, and inter-platform collaboration are necessary not just in Health-EDRM and control of biological hazards, but for all natural hazards and man-made disasters.


Subject(s)
COVID-19 , Disaster Planning , Disasters , COVID-19/epidemiology , Emergencies , Humans , Risk Management
2.
Front Public Health ; 10: 846604, 2022.
Article in English | MEDLINE | ID: covidwho-1776058

ABSTRACT

The objectives of the study were to characterize events related to patient safety reported by medical imaging personnel in Finland in 2007-2017, the number and quality of reported injuries, the risk assessment, and the planned improvement of operations. The information was collected from a healthcare patient safety incident register system. The data contained information on the nature of the patient safety errors, harms and near-misses in medical imaging, the factors that lead to the events, the consequences for the patient, the level of risks, and future measures. The number of patient safety incident reports included in the study was 7,287. Of the incident reports, 75% concerned injuries to patients and 25% were near-misses. The most common consequence of adverse events and near-misses were minor harm (37.2%) related to contrast agent, or no harm (27.9%) related to equipment malfunction. Supervisors estimated the risks as low (47.7%) e.g., data management, insignificant (35%) e.g., verbal communication or moderate (15.7%) e.g., the use of contrast agent. The most common suggestion for learning from the incident was discussing it with the staff (58.1%), improving operations (5.7%) and submitting it to a higher authority (5.4%). Improving patient safety requires timely, accurate and clear reporting of various patient safety incidents. Based on incident reports, supervisors can provide feedback to staff, develop plans to prevent accidents, and monitor the impact of measures taken. Information on the development of occupational safety should be disseminated to all healthcare professionals so that the same mistakes are not repeated.


Subject(s)
Diagnostic Imaging , Patient Safety , Humans , Medical Staff , Risk Management/methods
3.
Int J Environ Res Public Health ; 19(6)2022 03 18.
Article in English | MEDLINE | ID: covidwho-1760601

ABSTRACT

BACKGROUND: The COVID-19 mass vaccination campaign posed new challenges not only from a healthcare perspective, but also in terms of distribution, logistics, and organization. Managing clinical risk in off-site vaccination centers during a pandemic provided a new opportunity for the training and acquisition of competencies through continuous learning from adverse events. The aim of this report, based on a review of activity, was to identify the most recurrent and high-risk failures of the vaccination process in a mass vaccination center. METHODS: Adverse events and near misses reported during the first 11 months of activity (February 2021-January 2022) in the mass vaccination center of Verona (Italy) were evaluated. RESULTS: From 15 February 2021 to 17 January 2022 the center administered about 460,000 doses to the population and nine adverse events and one near miss were reported. Most of the events were errors in vaccine administration, either in principle, dosage, or timing with respect to the indicated schedule. All events had minor outcomes. Communication errors, inadequate training, and general organizational issues were the most recurrent factors contributing to the events. CONCLUSIONS: Risk mitigation during mass vaccination in temporary sites is an essential element of a successful vaccination campaign. The reporting of adverse events should be encouraged in order to obtain as much information as possible for a continuous improvement of the activity.


Subject(s)
COVID-19 Vaccines , COVID-19 , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Humans , Mass Vaccination , Risk Management , Vaccination
4.
Ther Innov Regul Sci ; 56(3): 415-422, 2022 05.
Article in English | MEDLINE | ID: covidwho-1719125

ABSTRACT

With the emergence of new technologies for data collection, the continued impact of the COVID-19 pandemic, and the increasing number of partially or fully decentralized clinical trials (DCTs), the importance of risk-based monitoring (RBM) and the larger risk-based quality management (RBQM) framework in clinical trial management is increasing. RBM and RBQM focus on the detection of events or trends that impact trial quality in terms of participant safety and data integrity. In 2019, the Association of Clinical Research Organizations (ACRO) began a landscape survey of RBM/RBQM implementation in ongoing clinical trials. Initial results of this survey, representing full-year data for 2019, were reported previously. Here, we present full-year landscape data for 2020 drawn from 5,987 clinical trials ongoing at the end of 2020, including 908 new studies started that year. Of these trials, 77% implemented at least one RBM/RBQM component, an increase from 47% for studies ongoing at the end of 2019. We also observed increased implementation for three of the five RBM components included in the survey. Centralized monitoring decreased nominally in 2020 compared with 2019. Although the percentages of 2020 trials incorporating reduced source data verification (SDV) and reduced source data review (SDR) increased from 2019 to 2020, these numbers are still low considering the large percentage of trials implementing at least one RBQM component. In the current clinical trial landscape, as more DCTs are launched and new data collection technologies are implemented, there remains a pressing need for greater use of centralized monitoring coupled with reductions in SDR/SDV and, ultimately, greater adoption of RBM and RBQM.


Subject(s)
COVID-19 , Pandemics , Clinical Trials as Topic , Humans , Risk Management , Surveys and Questionnaires
5.
PLoS One ; 17(2): e0263767, 2022.
Article in English | MEDLINE | ID: covidwho-1677594

ABSTRACT

BACKGROUND: The perception of the transmission risks of SARS-CoV-2 in social and educational settings by US healthcare providers have not been previously quantified. METHODS: Respondents completed an online survey between September and October 2020 to estimate the risk of SARS-CoV-2 transmission on a scale of 0-10 for different social and educational activities prior to the availability of the SARS-CoV-2 vaccines. Demographic information and experiences during the pandemic were also collected. The risk assessment was emailed to three listservs of healthcare providers, including national listservs of pediatric (PID) and adult infectious diseases (AID) providers, and a listserv of general pediatric practitioners in the St Louis, USA metropolitan area. RESULTS: Respondents identified the highest risk of SARS-CoV-2 transmission in spending time in a bar, eating at a restaurant, and attending an indoor sporting event. In the school setting, lower risk was identified in elementary and daycare students compared to high school or university-level students. Comparatively, the risk of transmission to students and teachers was lower than the identified high-risk social activities. Factors increasing risk perception in social activities included the absence of children in the respondent's household and female gender. For the school setting, AID providers perceived greater risk compared to PID providers or pediatric practitioners. CONCLUSIONS: Respondents identified high risk activities that were associated with a high density of participants in an indoor space where masks are removed for eating and drinking. Differences were apparent in the school setting where pediatric providers perceived lower risks when compared to adult providers.


Subject(s)
COVID-19 Vaccines/immunology , COVID-19/immunology , COVID-19/virology , Health Personnel , Risk Management , SARS-CoV-2/physiology , Adolescent , Child , Cross-Sectional Studies , Female , Humans , Linear Models , Male , Odds Ratio , Pandemics/prevention & control , Young Adult
6.
Texto & contexto enferm ; 30: e20210097, 2021. tab
Article in English | WHO COVID, LILACS (Americas) | ID: covidwho-1599695

ABSTRACT

ABSTRACT Objective: to translate and transculturally adapt the Risk assessment and management of exposure of health care workers in the context of COVID-19 questionnaire. Method: this is a methodological study. The translation, back-translation, synthesis, evaluation by experts committee and pre-test stages were followed. The participants were invited by electronic means and answered an online questionnaire. The data were collected between June and September 2020. Content validation by the experts committee was verified using the Content Validity Index. The pre-test participants assessed the instrument's applicability by means of the "Assessment of Instruments' Feasibility" questionnaire. Results: the study participants were four translators, eight evaluators in the experts committee and 35 professionals who answered the pre-test. The changes suggested by the experts committee were accepted and consensus was reached in two evaluation rounds, obtaining a content validity index higher than 0.80 for all items of the instrument. The pre-test version presented good applicability and satisfactory reliability (0.76). Conclusion: the instrument was adapted for use in Brazil, which will allow international comparison of the results and using the data obtained for assessment and decision-making in relation to workers' health. In addition to that, its use may be expanded to assess other situations of health professionals' exposure to the risk of contamination by infectious agents.


RESUMEN Objetivo: realizar la traducción y adaptación transcultural del instrumento Risk assessment and management of exposure of healthcare workers in the context of COVID-19. Método: estudio metodológico en el que se desarrollaron las siguientes etapas: traducción, retrotraducción, síntesis, evaluación a cargo de un comité de expertos y prueba previa (pre-test). Se invitó a los participantes a través de medios electrónicos para que respondieran un formulario en línea. Los datos se recolectaron entre junio y septiembre de 2020. La validación del contenido a cargo del comité de expertos se verificó por medio del Índice de Validez del Contenido. Los participantes de la prueba previa evaluaron la aplicabilidad del instrumento por medio del cuestionario "Evaluación de la Viabilidad de Instrumentos". Resultados: los participantes del estudio fueron cuatro traductores, ocho evaluadores en el comité de expertos y 35 profesionales que respondieron la prueba previa. Las modificaciones sugeridas por el comité de expertos fueron acatadas y se llegó a un consenso en dos evaluaciones, obteniéndose un Índice de Validez del Contenido superior a 0,80 para todos los ítems del instrumento. La versión de la prueba previa presentó buena aplicabilidad y confiabilidad satisfactoria (0,76). Conclusión: el instrumento fue adaptado para su uso en Brasil, lo que permitirá realizar una comparación internacional de los resultados y emplear los datos obtenidos con fines de evaluación y toma de decisiones en relación con la salud de los trabajadores. Además, se podrá expandir su utilización para evaluar otras situaciones de exposición de profesionales de la salud al riesgo de contaminación a raíz de agentes infecciosos.


RESUMO Objetivo: realizar a tradução e a adaptação transcultural do Risk assessment and management of exposure of healthcare workers in the context of COVID-19. Método: trata-se de estudo metodológico. Foram seguidas as etapas de tradução, retrotradução, síntese, avaliação por comitê de juízes e pré-teste. Os participantes foram convidados por meio eletrônico e responderam um formulário on-line. Os dados foram coletados entre junho e setembro de 2020. A validação de conteúdo pelo comitê de juízes foi verificada por meio do índice de validade de conteúdo. Os participantes do pré-teste avaliaram a aplicabilidade do instrumento por meio do questionário "Avaliação da Praticabilidade de Instrumentos". Resultados: participaram do estudo quatro tradutores, oito avaliadores no comitê de juízes e 35 profissionais responderam ao pré-teste. As modificações sugeridas pelo comitê de juízes foram acatadas e o consenso atingido em duas avaliações, obtendo índice de validade de conteúdo superior a 0,80 para todos os itens do instrumento. A versão pré-teste apresentou boa aplicabilidade e confiabilidade satisfatória (0,76). Conclusão: o instrumento foi adaptado para uso no Brasil, o que permitirá a comparação internacional dos resultados e o uso dos dados obtidos para a avaliação e tomada de decisão em relação à saúde do trabalhador. Além disso, seu uso poderá ser ampliado para avaliar outras situações de exposição de profissionais de saúde ao risco de contaminação por agentes infecciosos.


Subject(s)
Humans , Risk Management , Occupational Risks , Occupational Health , Validation Study , Personal Protective Equipment
7.
Aten Primaria ; 53 Suppl 1: 102217, 2021 Dec.
Article in Spanish | MEDLINE | ID: covidwho-1588291

ABSTRACT

OBJECTIVE: To analyse and compare the epidemiology of patient safety incidents reported in Primary Health Care, before and after the start of the COVID-19 pandemic. DESIGN AND SETTING: Analytical descriptive study comparing reported incidents from March 1st 2019 to February 28th 2020, and from March 1st 2020 to February 28th 2021, notified through the TPSC Cloud™ platform accessible from the Intranet corporative in 25 Primary Health Care centres from Tarragona district, in Catalonia (Spain). MEASUREMENTS: Data obtained from voluntary notifications, through electronic, standardized and anonymized forms. VARIABLES: Centre, professional, incident type, risk matrix, causal factors and contributing factors, and avoidability. STATISTICAL ANALYSIS: Every notification was included in descriptive analysis, and another one specifically for adverse events, comparing both periods. RESULTS: 2231 incidents were reported. Comparing both periods, during the pandemic a reduction in the number of reported incidents was observed (only represented 20% of the total). However, the percentage of reported notifications from health care professionals and adverse events that required observation were increased. Causal factors related to attendance and diagnosis were incremented whereas the causal factors related to medication were decreased. In addition, an increase in contributing factors related to the professional was observed. Avoidability was high (>95%) in both periods. CONCLUSIONS: During the pandemic, fewer patient safety incidents have been reported, but proportionally more adverse events, most of which are preventable. The professional himself becomes the main contributing factor.


Subject(s)
COVID-19 , Patient Safety , Humans , Pandemics , Primary Health Care , Risk Management , SARS-CoV-2
8.
Int J Environ Res Public Health ; 19(1)2021 Dec 21.
Article in English | MEDLINE | ID: covidwho-1580863

ABSTRACT

The syndemic framework proposed by the 2021-2030 World Health Organization (WHO) action plan for patient safety and the introduction of enabling technologies in health services involve a more effective interpretation of the data to understand causation. Based on the Systemic Theory, this communication proposes the "Systemic Clinical Risk Management" (SCRM) to improve the Quality of Care and Patient Safety. This is a new Clinical Risk Management model capable of developing the ability to observe and synthesize different elements in ways that lead to in-depth interventions to achieve solutions aligned with the sustainable development of health services. In order to avoid uncontrolled decision-making related to the use of enabling technologies, we devised an internal Learning Algorithm Risk Management (LARM) level based on a Bayesian approach. Moreover, according to the ethics of Job Well Done, the SCRM, instead of giving an opinion on events that have already occurred, proposes a bioethical co-working because it suggests the best way to act from a scientific point of view.


Subject(s)
COVID-19 , Bayes Theorem , Humans , Pandemics/prevention & control , Risk Management , SARS-CoV-2 , Syndemic
9.
Int J Environ Res Public Health ; 19(1)2021 Dec 30.
Article in English | MEDLINE | ID: covidwho-1580780

ABSTRACT

The COVID-19 pandemic is permanently changing modern social and economic coexistence. Most governments have declared infection control to be their top priority while citizens face great restrictions on their civil rights. A pandemic is an exemplary scenario in which political actors must decide about future, and thus uncertain, events. This paper tries to present a tool well established in the field of entrepreneurial and management decision making which could also be a first benchmark for political decisions. Our approach builds on the standard epidemiological SEIR model in combination with simulation techniques used in risk management. By our case study we want to demonstrate the opportunities that risk management techniques, especially risk analyses using Monte Carlo simulation, can provide to policy makers in general, and in a public health crisis in particular. Hence, our case study can be used as a framework for political decision making under incomplete information and uncertainty. Overall, we want to point out that a health policy that aims to provide comprehensive protection against infection should also be based on economic criteria. This is without prejudice to the integration of ethical considerations in the final political decision.


Subject(s)
COVID-19 , Pandemics , Decision Making , Germany/epidemiology , Humans , Pandemics/prevention & control , Risk Management , SARS-CoV-2 , Uncertainty
10.
Soc Work Public Health ; 37(4): 303-318, 2022 05 19.
Article in English | MEDLINE | ID: covidwho-1585307

ABSTRACT

Homeless individuals are at greater risk of death due to social inequalities during Covid-19 pandemic. Strategies taken for general population to prevent the spread of Covid-19, such as social distance, staying at home, and observing personal hygiene are not possible for this group of people. This is a scoping review on articles published and other credible resources published analyze studies done on homeless people during the COVID-19 pandemic. In this scoping review, for the first time, we studied published articles on the situation of the homeless during the Covid-19 epidemic and by extracting and categorizing vulnerabilities, risks, as well as risk management plans, Finally we presented, useful guidance for organizations providing health and social services during the spread of diseases.


Subject(s)
COVID-19 , Homeless Persons , Humans , Pandemics/prevention & control , Risk Management , Social Problems
11.
Harm Reduct J ; 18(1): 125, 2021 12 06.
Article in English | MEDLINE | ID: covidwho-1555202

ABSTRACT

BACKGROUND: Harm reduction programs often lack community-based support and can be controversial, despite data demonstrating effectiveness. This article describes one small Alaskan community's development of a harm reduction managed alcohol program (MAP) in the context of a city-run quarantine site for individuals experiencing homelessness. The MAP was developed to support quarantining by COVID-19-exposed or COVID-positive individuals who also experienced chronic homelessness, a severe alcohol use disorder, and heightened health risks related to potentially unsupported alcohol withdrawal. METHOD: Five interviews with key informants involved in planning or implementation of the MAP were conducted using rapid qualitative analysis and narrative analysis techniques. OUTCOME: This study documents the planning and implementation of an innovative application of a managed alcohol harm reduction intervention in the context of the COVID-19 pandemic. In this instance, a MAP was used specifically to limit hospital admissions for alcohol withdrawal during a surge of cases in the community, as well as to mitigate spread of the virus. Key informants report no residents enrolled in the MAP program as a part of quarantine required hospitalization for withdrawal or for COVID symptoms, and no shelter resident left the quarantine site while still contagious with COVID-19. Additionally, the level of community support for the program was much higher than originally expected by organizers. CONCLUSIONS: This program highlighted an example of how a community recognized the complexity and potential risk to individuals experiencing structural vulnerability related to homelessness and a severe AUD, and the community at large, and was able to create an alternative path to minimize those risks using a harm reduction strategy.


Subject(s)
Alcoholism , COVID-19 , Homeless Persons , Substance Withdrawal Syndrome , Alcoholism/epidemiology , Alcoholism/prevention & control , Harm Reduction , Humans , Pandemics , Risk Management , SARS-CoV-2
12.
PLoS One ; 16(11): e0259887, 2021.
Article in English | MEDLINE | ID: covidwho-1526687

ABSTRACT

BACKGROUND: After Action Review is a form of facilitated team learning and review of events. The methodology originated in the United States Army and forms part of the Incident Management Framework in the Irish Health Services. After Action Review has been hypothesized to improve safety culture and the effect of patient safety events on staff (second victim experience) in health care settings. Yet little direct evidence exists to support this and its implementation has not been studied. AIM: To investigate the effect of After Action Review on safety culture and second victim experience and to examine After Action Review implementation in a hospital setting. METHODS: A mixed methods study will be conducted at an Irish hospital. To assess the effect on safety culture and second victim experience, hospital staff will complete surveys before and twelve months after the introduction of After Action Review to the hospital (Hospital Survey on Safety Culture 2.0 and Second Victim Experience and Support Tool). Approximately one in twelve staff will be trained as After Action Review Facilitators using a simulation based training programme. Six months after the After Action Review training, focus groups will be conducted with a stratified random sample of the trained facilitators. These will explore enablers and barriers to implementation using the Theoretical Domains Framework. At twelve months, information will be collected from the trained facilitators and the hospital to establish the quality and resource implications of implementing After Action Review. DISCUSSION: The results of the study will directly inform local hospital decision-making and national and international approaches to incorporating After Action Review in hospitals and other healthcare settings.


Subject(s)
Hospitals , Medical Staff, Hospital , Organizational Culture , Safety Management , Computer Simulation , Hospital Administration , Humans , Ireland , Patient Care Team , Risk Management
14.
Ann Med ; 53(1): 1924-1934, 2021 12.
Article in English | MEDLINE | ID: covidwho-1493393

ABSTRACT

INTRODUCTION: The SARS-CoV-2 pandemic has forced healthcare providers to reorganize their activities to protect the population from infection, postponing or suspending many medical procedures. Patients affected by chronic conditions were among the most affected. In the case of catastrophes, women have a higher lifetime prevalence of post-traumatic stress disorder (PTSD), and those with endometriosis have higher anxiety levels, making them fragile in such circumstances. MATERIALS AND METHODS: In this cross-sectional study, conducted in May 2020, we considered all women aged ≥18 years, followed up at our referral centre for endometriosis. Patients were sent an anonymous 6-section questionnaire via email, containing different validated tools for the evaluation of anxiety levels and the risk of PTSD. A multivariable linear regression was performed to assess the impact of patients' characteristics on the distress caused by the SARS-COV-2 pandemic. RESULTS: Among the 468 women recruited, 68.8% were quite-to-extremely worried about not being able to access gynaecologic care, with almost one-third of them scoring ≥33 on the IES-R. Older age and increased levels of anxiety were associated with higher risks of PTSD (age: b = 0.28, 95% CI = 0.12 - 0.44; GAD-7: b = 1.71, 95% CI = 1.38 - 2.05), with up to 71.8% of patients with severe anxiety (GAD-7 > 15) having an IES-R score ≥33 suggestive for PTSD. Women who could leave home to work showed lower levels of PTSD (b = -4.79, 95% CI = -8.44 to - 1.15, ref. unemployed women). The implementation of telemedicine in routine clinical practice was favourably viewed by 75.6% of women. DISCUSSION: Women with endometriosis are particularly exposed to the risk of PTSD during the SARS-CoV-2 pandemic, especially if they are older or have higher levels of anxiety. Gynaecologists should resort to additional strategies, and telemedicine could represent a feasible tool to help patients cope with this situation.KEY MESSAGESThe COVID-19 pandemic significantly impacted the lives of women with endometriosis, who appeared to have a considerable risk of PTSD.Older age, higher anxiety levels and unemployment were independently associated with the risk of developing PTSD.Clinicians should develop successful alternative strategies to help patients cope with this situation, and telemedicine might represent an applicable and acceptable solution.


Subject(s)
Anxiety/epidemiology , COVID-19/prevention & control , Endometriosis/therapy , Health Services Accessibility/standards , Stress Disorders, Post-Traumatic/epidemiology , Adult , Age Factors , Anxiety/diagnosis , Anxiety/etiology , Anxiety/psychology , COVID-19/epidemiology , COVID-19/transmission , Communicable Disease Control/standards , Cross-Sectional Studies , Endometriosis/psychology , Female , Health Services Accessibility/organization & administration , Humans , Internet/statistics & numerical data , Male , Middle Aged , Pandemics/prevention & control , Prevalence , Risk Management , SARS-CoV-2/pathogenicity , Stress Disorders, Post-Traumatic/diagnosis , Stress Disorders, Post-Traumatic/etiology , Stress Disorders, Post-Traumatic/psychology , Surveys and Questionnaires/statistics & numerical data , Telemedicine/organization & administration , Telemedicine/standards , Young Adult
17.
Nurs Manag (Harrow) ; 29(1): 26-31, 2022 Feb 03.
Article in English | MEDLINE | ID: covidwho-1478428

ABSTRACT

One of the many consequences of the coronavirus disease 2019 (COVID-19) pandemic is that the psychological well-being of nurses and other healthcare staff has received greater attention. The Supporting Our Staff (SOS) service, set up in 2017 at Northampton General Hospital NHS Trust, provides psychological peer support to staff using the Trauma Risk Management (TRiM) model. TRiM is a psychological risk assessment and peer support model designed to mitigate the risks associated with exposure to traumatic events. It was initially developed and used in the UK armed forces but has started to be used in healthcare organisations. This article describes the development and expansion of the SOS service, the implementation of the TRiM model by the SOS team, and the significant part the service has played in the trust's response to the increased psychological support needs of its staff during the COVID-19 pandemic.


Subject(s)
COVID-19 , Pandemics , Hospitals , Humans , Risk Management , SARS-CoV-2
18.
J Healthc Manag ; 66(4): 243-245, 2021 04 27.
Article in English | MEDLINE | ID: covidwho-1475896

Subject(s)
Research , Risk Management
19.
Addict Sci Clin Pract ; 16(1): 49, 2021 07 30.
Article in English | MEDLINE | ID: covidwho-1456010

ABSTRACT

BACKGROUND: The COVID-19 pandemic has created a crisis in access to addiction treatment. Programs with residential components have been particularly impacted as they try to keep infection from spreading in facilities and contributing to further community spread of the virus. This crisis highlights the ongoing daily trade-offs that organizations must weigh as they balance the risks and benefits of individual patients with those of the group of patients, staff and the community they serve. MAIN BODY: The COVID-19 pandemic has forced provider organizations to make individual facility level decisions about how to manage patients who are COVID-19 positive while protecting other patients, staff and the community. While guidance documents from federal, state, and trade groups aimed to support such decision making, they often lagged pandemic dynamics, and provided too little detail to translate into front line decision making. In the context of incomplete knowledge to make informed decisions, we present a way to integrate guidelines and local data into the decision process and discuss the ethical dilemmas faced by provider organizations in preventing infections and responding to COVID positive patients or staff. CONCLUSION AND COMMENTARY: Provider organizations need decision support on managing the risk of COVID-19 positive patients in their milieu. While useful, guidance documents may not be capable of providing support with the nuance that local data and simulation modeling may be able to provide.


Subject(s)
COVID-19/prevention & control , Occupational Exposure/prevention & control , Residential Treatment/organization & administration , Substance-Related Disorders/complications , Substance-Related Disorders/rehabilitation , Attitude of Health Personnel , COVID-19/epidemiology , Humans , Program Evaluation , Risk Management
20.
Chest ; 160(4): 1459-1470, 2021 10.
Article in English | MEDLINE | ID: covidwho-1442310

ABSTRACT

BACKGROUND: Limited existing data suggest that the novel COVID-19 may increase risk of VTE, but information from large, ethnically diverse populations with appropriate control participants is lacking. RESEARCH QUESTION: Does the rate of VTE among adults hospitalized with COVID-19 differ from matched hospitalized control participants without COVID-19? STUDY DESIGN AND METHODS: We conducted a retrospective study among hospitalized adults with laboratory-confirmed COVID-19 and hospitalized adults without evidence of COVID-19 matched for age, sex, race or ethnicity, acute illness severity, and month of hospitalization between January 2020 and August 2020 from two integrated health care delivery systems with 36 hospitals. Outcomes included VTE (DVT or pulmonary embolism ascertained using diagnosis codes combined with validated natural language processing algorithms applied to electronic health records) and death resulting from any cause at 30 days. Fine and Gray hazards regression was performed to evaluate the association of COVID-19 with VTE after accounting for competing risk of death and residual differences between groups, as well as to identify predictors of VTE in patients with COVID-19. RESULTS: We identified 6,319 adults with COVID-19 and 6,319 matched adults without COVID-19, with mean ± SD age of 60.0 ± 17.2 years, 46% women, 53.1% Hispanic, 14.6% Asian/Pacific Islander, and 10.3% Black. During 30-day follow-up, 313 validated cases of VTE (160 COVID-19, 153 control participants) and 1,172 deaths (817 in patients with COVID-19, 355 in control participants) occurred. Adults with COVID-19 showed a more than threefold adjusted risk of VTE (adjusted hazard ratio, 3.48; 95% CI, 2.03-5.98) compared with matched control participants. Predictors of VTE in patients with COVID-19 included age ≥ 55 years, Black race, prior VTE, diagnosed sepsis, prior moderate or severe liver disease, BMI ≥ 40 kg/m2, and platelet count > 217 k/µL. INTERPRETATION: Among ethnically diverse hospitalized adults, COVID-19 infection increased the risk of VTE, and selected patient characteristics were associated with higher thromboembolic risk in the setting of COVID-19.


Subject(s)
COVID-19/complications , Hospitals/statistics & numerical data , Pandemics , Venous Thromboembolism/ethnology , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/ethnology , California/epidemiology , Female , Humans , Male , Middle Aged , Retrospective Studies , Risk Management , SARS-CoV-2 , Venous Thromboembolism/etiology , Young Adult
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