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1.
Ann Emerg Med ; 78(2): 201-211, 2021 08.
Article in English | MEDLINE | ID: mdl-34127308

ABSTRACT

STUDY OBJECTIVE: In a large-scale disaster, recruiting from all retired and nonworking registered nurses is one strategy to address surge demands in the emergency nursing workforce. The purpose of this research was to estimate the workforce capacity of all registered nurses who are not currently working in the nursing field in the United States by state of residence and to describe the job mobility of emergency nurses. METHODS: Weighted population estimates were calculated using the 2018 National Sample Survey of Registered Nurses. Estimates of all registered nurses, including nurse practitioners who were not actively working in nursing as well as only those who were retired, based on demographics, place of residence, and per 1,000 state population, were visualized on choropleth maps. Workforce mobility into and out of the emergency nursing specialty between 2016 and 2017 was quantified. RESULTS: Of the survey participants, 61% (weighted n=2,413,382) worked full time as registered nurses at the end of both 2016 and 2017. At the end of 2017, 17.3% (weighted n=684,675) were not working in nursing. The Great Lakes states and Maine demonstrated the highest per capita rate of those not working in nursing, including those who had retired. The largest proportion of those entering the emergency nursing specialty were newly licensed nurses (15%; weighted n=33,979). CONCLUSION: There is an additional and reserve capacity available for recruitment that may help to meet the workforce needs for nursing, specifically emergency nurses and nurse practitioners, across the United States under conditions of a large-scale disaster. The results from this study may be used by the emergency care sector leaders to inform policies, workforce recruitment, workforce geographic mobility, new graduate nurse training, and job accommodation strategies to fully leverage the potential productive human capacity in emergency department care for registered nurses who are not currently working.


Subject(s)
Emergency Nursing/statistics & numerical data , Employment/statistics & numerical data , Health Workforce/statistics & numerical data , Nurses/supply & distribution , Surge Capacity/statistics & numerical data , Adult , Aged , COVID-19/epidemiology , Career Mobility , Cross-Sectional Studies , Datasets as Topic , Disaster Planning/statistics & numerical data , Emergency Service, Hospital/organization & administration , Female , Humans , Male , Middle Aged , Nurse Practitioners/statistics & numerical data , Retirement/statistics & numerical data , Retrospective Studies , SARS-CoV-2 , United States/epidemiology
3.
Value Health ; 24(5): 648-657, 2021 05.
Article in English | MEDLINE | ID: mdl-33933233

ABSTRACT

OBJECTIVES: Coronavirus disease 2019 has put unprecedented pressure on healthcare systems worldwide, leading to a reduction of the available healthcare capacity. Our objective was to develop a decision model to estimate the impact of postponing semielective surgical procedures on health, to support prioritization of care from a utilitarian perspective. METHODS: A cohort state-transition model was developed and applied to 43 semielective nonpediatric surgical procedures commonly performed in academic hospitals. Scenarios of delaying surgery from 2 weeks were compared with delaying up to 1 year and no surgery at all. Model parameters were based on registries, scientific literature, and the World Health Organization Global Burden of Disease study. For each surgical procedure, the model estimated the average expected disability-adjusted life-years (DALYs) per month of delay. RESULTS: Given the best available evidence, the 2 surgical procedures associated with most DALYs owing to delay were bypass surgery for Fontaine III/IV peripheral arterial disease (0.23 DALY/month, 95% confidence interval [CI]: 0.13-0.36) and transaortic valve implantation (0.15 DALY/month, 95% CI: 0.09-0.24). The 2 surgical procedures with the least DALYs were placing a shunt for dialysis (0.01, 95% CI: 0.005-0.01) and thyroid carcinoma resection (0.01, 95% CI: 0.01-0.02). CONCLUSION: Expected health loss owing to surgical delay can be objectively calculated with our decision model based on best available evidence, which can guide prioritization of surgical procedures to minimize population health loss in times of scarcity. The model results should be placed in the context of different ethical perspectives and combined with capacity management tools to facilitate large-scale implementation.


Subject(s)
COVID-19/complications , Computer Simulation , Population Health/statistics & numerical data , Surge Capacity/standards , Cohort Studies , Global Burden of Disease , Humans , Life Expectancy/trends , Probability Theory , Quality-Adjusted Life Years , Surge Capacity/statistics & numerical data
4.
J R Soc Med ; 114(3): 121-131, 2021 03.
Article in English | MEDLINE | ID: mdl-33557662

ABSTRACT

OBJECTIVES: We examined if the WHO International Health Regulations (IHR) capacities were associated with better COVID-19 pandemic control. DESIGN: Observational study. SETTING: Population-based study of 114 countries. PARTICIPANTS: General population. MAIN OUTCOME MEASURES: For each country, we extracted: (1) the maximum rate of COVID-19 incidence increase per 100,000 population over any 5-day moving average period since the first 100 confirmed cases; (2) the maximum 14-day cumulative incidence rate since the first case; (3) the incidence and mortality within 30 days since the first case and first COVID-19-related death, respectively. We retrieved the 13 country-specific International Health Regulations capacities and constructed linear regression models to examine whether these capacities were associated with COVID-19 incidence and mortality, controlling for the Human Development Index, Gross Domestic Product, the population density, the Global Health Security index, prior exposure to SARS/MERS and Stringency Index. RESULTS: Countries with higher International Health Regulations score were significantly more likely to have lower incidence (ß coefficient -24, 95% CI -35 to -13) and mortality (ß coefficient -1.7, 95% CI -2.5 to -1.0) per 100,000 population within 30 days since the first COVID-19 diagnosis. A similar association was found for the other incidence outcomes. Analysis using different regression models controlling for various confounders showed a similarly significant association. CONCLUSIONS: The International Health Regulations score was significantly associated with reduction in rate of incidence and mortality of COVID-19. These findings inform design of pandemic control strategies, and validated the International Health Regulations capacities as important metrics for countries that warrant evaluation and improvement of their health security capabilities.


Subject(s)
COVID-19 , Communicable Disease Control , Disease Transmission, Infectious/prevention & control , International Health Regulations , World Health Organization , COVID-19/epidemiology , COVID-19/prevention & control , Communicable Disease Control/legislation & jurisprudence , Communicable Disease Control/organization & administration , Cross-Sectional Studies , Global Health/statistics & numerical data , Humans , Incidence , International Health Regulations/organization & administration , International Health Regulations/standards , Mortality , SARS-CoV-2 , Surge Capacity/statistics & numerical data
5.
Hosp Top ; 99(1): 44-47, 2021.
Article in English | MEDLINE | ID: mdl-33357127

ABSTRACT

Pediatric Hospital Medicine (PHM) is a growing subspecialty with a broad scope. The Covid-19 pandemic demands flexible staffing models. Advanced practice providers (APPs) can be a valuable addition to hospital medicine teams, although there is no established training program for APPs within PHM. The authors' purpose is to describe how one institution rapidly established a PHM APP team by collaborating with experienced APPs working in other areas of the hospital. This APP team cared for 16% of the average daily census during the pilot period with no significant difference in length of stay compared to traditional teams.


Subject(s)
Advanced Practice Nursing/statistics & numerical data , Hospitals, Pediatric/trends , Advanced Practice Nursing/trends , COVID-19/nursing , Hospitals, Pediatric/organization & administration , Hospitals, Pediatric/statistics & numerical data , Humans , Pandemics/prevention & control , Pandemics/statistics & numerical data , Patient Care Team , Pilot Projects , Surge Capacity/standards , Surge Capacity/statistics & numerical data
7.
CMAJ Open ; 8(3): E593-E604, 2020.
Article in English | MEDLINE | ID: mdl-32963024

ABSTRACT

BACKGROUND: In pandemics, local hospitals need to anticipate a surge in health care needs. We examined the modelled surge because of the coronavirus disease 2019 (COVID-19) pandemic that was used to inform the early hospital-level response against cases as they transpired. METHODS: To estimate hospital-level surge in March and April 2020, we simulated a range of scenarios of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread in the Greater Toronto Area (GTA), Canada, using the best available data at the time. We applied outputs to hospital-specific data to estimate surge over 6 weeks at 2 hospitals (St. Michael's Hospital and St. Joseph's Health Centre). We examined multiple scenarios, wherein the default (R0 = 2.4) resembled the early trajectory (to Mar. 25, 2020), and compared the default model projections with observed COVID-19 admissions in each hospital from Mar. 25 to May 6, 2020. RESULTS: For the hospitals to remain below non-ICU bed capacity, the default pessimistic scenario required a reduction in non-COVID-19 inpatient care by 38% and 28%, respectively, with St. Michael's Hospital requiring 40 new ICU beds and St. Joseph's Health Centre reducing its ICU beds for non-COVID-19 care by 6%. The absolute difference between default-projected and observed census of inpatients with COVID-19 at each hospital was less than 20 from Mar. 25 to Apr. 11; projected and observed cases diverged widely thereafter. Uncertainty in local epidemiological features was more influential than uncertainty in clinical severity. INTERPRETATION: Scenario-based analyses were reliable in estimating short-term cases, but would require frequent re-analyses. Distribution of the city's surge was expected to vary across hospitals, and community-level strategies were key to mitigating each hospital's surge.


Subject(s)
COVID-19/epidemiology , Hospitalization/statistics & numerical data , Hospitals/statistics & numerical data , Intensive Care Units/statistics & numerical data , Surge Capacity/statistics & numerical data , COVID-19/diagnosis , COVID-19/transmission , COVID-19/virology , Canada/epidemiology , Forecasting/methods , Health Services Needs and Demand/trends , Hospitals/supply & distribution , Humans , Inpatients/statistics & numerical data , Models, Theoretical , SARS-CoV-2/genetics
8.
J Perinat Med ; 48(9): 892-899, 2020 Nov 26.
Article in English | MEDLINE | ID: mdl-32892181

ABSTRACT

The global spread of the SARS-CoV-2 virus during the early months of 2020 was rapid and exposed vulnerabilities in health systems throughout the world. Obstetric SARS-CoV-2 disease was discovered to be largely asymptomatic carriage but included a small rate of severe disease with rapid decompensation in otherwise healthy women. Higher rates of hospitalization, Intensive Care Unit (ICU) admission and intubation, along with higher infection rates in minority and disadvantaged populations have been documented across regions. The operational gymnastics that occurred daily during the Covid-19 emergency needed to be translated to the obstetrics realm, both inpatient and ambulatory. Resources for adaptation to the public health crisis included workforce flexibility, frequent communication of operational and protocol changes for evaluation and management, and application of innovative ideas to meet the demand.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Hospitals/statistics & numerical data , Obstetrics/methods , Pandemics , Pneumonia, Viral/epidemiology , Pregnancy Complications, Infectious/virology , COVID-19 , Coronavirus Infections/complications , Coronavirus Infections/therapy , Critical Care/statistics & numerical data , Emergency Service, Hospital/statistics & numerical data , Female , Hospital Administration , Humans , Infant, Newborn , New York City/epidemiology , Obstetrics/statistics & numerical data , Personal Protective Equipment/statistics & numerical data , Personnel Staffing and Scheduling , Pneumonia, Viral/complications , Pneumonia, Viral/therapy , Pregnancy , Pregnancy Complications, Infectious/epidemiology , Pregnancy Complications, Infectious/therapy , SARS-CoV-2 , Surge Capacity/organization & administration , Surge Capacity/statistics & numerical data
10.
Am J Disaster Med ; 15(2): 143-148, 2020.
Article in English | MEDLINE | ID: mdl-32804395

ABSTRACT

The Vancouver Convention Health Centre (VCHC) was rapidly set up as a part of the COVID-19 response in Brit-ish Columbia in order to create surge hospital capacity bed space. Multiple field hospitals were set up across the country in preparation for a possible surge and the VCHC utilized a non-traditional health care space and overlaid it with medical infrastructure. Maximum flexibility was required in planning for multiple patient populations and a novel four-box concept to plan for the requirements of the respective possible populations was developed. Key difficulties that needed to be overcome in planning COVID-19 medical care delivery in a non-traditional space included oxygen delivery, unknown future patient populations, and staffing. A clear recommendation can also now be made that healthcare provision should be considered during the design and build of new recreational or convention facilities in all communities.


Subject(s)
Betacoronavirus , Coronavirus Infections/therapy , Disaster Planning , Health Resources/supply & distribution , Hospital Planning , Pandemics/prevention & control , Pneumonia, Viral/therapy , Surge Capacity/organization & administration , British Columbia/epidemiology , COVID-19 , Coronavirus Infections/epidemiology , Disease Outbreaks , Hospital Bed Capacity , Humans , Pneumonia, Viral/epidemiology , Public Health , SARS-CoV-2 , Surge Capacity/statistics & numerical data
11.
Medwave ; 20(5): e7935, 2020.
Article in English, Spanish | LILACS (Americas) | ID: biblio-1116639

ABSTRACT

La actual pandemia por COVID-19 tiene el potencial de sobrepasar la capacidad de hospitales y unidades de cuidados intensivos en Chile y América Latina. Por lo tanto, las autoridades locales tienen la obligación ética de estar preparadas mediante la implementación de medidas tendientes a evitar una situación de racionamiento de recursos sanitarios escasos, y a través de la definición de criterios éticamente aceptables y socialmente legítimos para la asignación de estos recursos. Este artículo presenta una respuesta a orientaciones éticas recientes emitidas por una institución académica chilena y analiza los principios éticos relevantes para la fundamentación ética de criterios de racionamiento. Se argumenta que, frente a circunstancias excepcionales como la actual pandemia, la moral centrada en el paciente de la medicina tradicional necesita ser ponderada con principios éticos formulados desde una perspectiva de salud pública, incluyendo los principios de utilidad social, justicia social y equidad, entre otros. Se concluye con algunas recomendaciones sobre cómo llegar a acuerdo sobre criterios de racionamiento y sobre la implementación de estos en la práctica clínica.


The current COVID-19 pandemic has the potential to overwhelm the capacity of hospitals and Intensive Care Units in Chile and Latin America. Thus local authorities have an ethical obligation to be prepared by implementing pertinent measures to prevent a situation of rationing of scarce healthcare resources, and by defining ethically acceptable and socially legitimate criteria for the allocation of these resources. This paper responds to recent ethical guidelines issued by a Chilean academic institution and discusses the main moral principles for the ethical foundations of criteria for rationing during the present crisis. It argues that under exceptional circumstances such as the current pandemic, the traditional patient-centered morality of medicine needs to be balanced with ethical principles formulated from a public health perspective, including the principles of social utility, social justice and equity, among others. The paper concludes with some recommendations regarding how to reach an agreement about rationing criteria and about their implementation in clinical practice.


Subject(s)
Humans , Health Care Rationing/ethics , Public Health/ethics , Surge Capacity/statistics & numerical data , COVID-19/therapy , Social Justice , Chile , Guidelines as Topic , Pandemics , COVID-19/epidemiology , Hospitals/statistics & numerical data , Hospitals/ethics , Intensive Care Units/statistics & numerical data , Intensive Care Units/ethics , Latin America
12.
Medwave ; 20(5): e7935, 2020 Jun 16.
Article in Spanish, English | MEDLINE | ID: mdl-32544150

ABSTRACT

The current COVID-19 pandemic has the potential to overwhelm the capacity of hospitals and Intensive Care Units in Chile and Latin America. Thus local authorities have an ethical obligation to be prepared by implementing pertinent measures to prevent a situation of rationing of scarce healthcare resources, and by defining ethically acceptable and socially legitimate criteria for the allocation of these resources. This paper responds to recent ethical guidelines issued by a Chilean academic institution and discusses the main moral principles for the ethical foundations of criteria for rationing during the present crisis. It argues that under exceptional circumstances such as the current pandemic, the traditional patient-centered morality of medicine needs to be balanced with ethical principles formulated from a public health perspective, including the principles of social utility, social justice and equity, among others. The paper concludes with some recommendations regarding how to reach an agreement about rationing criteria and about their implementation in clinical practice.


La actual pandemia por COVID-19 tiene el potencial de sobrepasar la capacidad de hospitales y unidades de cuidados intensivos en Chile y América Latina. Por lo tanto, las autoridades locales tienen la obligación ética de estar preparadas mediante la implementación de medidas tendientes a evitar una situación de racionamiento de recursos sanitarios escasos, y a través de la definición de criterios éticamente aceptables y socialmente legítimos para la asignación de estos recursos. Este artículo presenta una respuesta a orientaciones éticas recientes emitidas por una institución académica chilena y analiza los principios éticos relevantes para la fundamentación ética de criterios de racionamiento. Se argumenta que, frente a circunstancias excepcionales como la actual pandemia, la moral centrada en el paciente de la medicina tradicional necesita ser ponderada con principios éticos formulados desde una perspectiva de salud pública, incluyendo los principios de utilidad social, justicia social y equidad, entre otros. Se concluye con algunas recomendaciones sobre cómo llegar a acuerdo sobre criterios de racionamiento y sobre la implementación de estos en la práctica clínica.


Subject(s)
Coronavirus Infections/therapy , Health Care Rationing/ethics , Pneumonia, Viral/therapy , Public Health/ethics , Surge Capacity/statistics & numerical data , COVID-19 , Chile , Coronavirus Infections/epidemiology , Guidelines as Topic , Hospitals/ethics , Hospitals/statistics & numerical data , Humans , Intensive Care Units/ethics , Intensive Care Units/statistics & numerical data , Latin America , Pandemics , Pneumonia, Viral/epidemiology , Social Justice
13.
Epidemiol Serv Saude ; 29(3): e2020226, 2020.
Article in English, Portuguese | MEDLINE | ID: mdl-32520108

ABSTRACT

OBJECTIVE: to describe the evolution of indicators and capacity for health care in the initial phase of the COVID-19 epidemic in the Northeast region of Brazil. METHODS: this was a descriptive study based on COVID-19 case epidemiological bulletins released by the Ministry of Health up until April 1st, 2020. The incidence rate, lethality and number of cumulative daily cases were calculated. RESULTS: 1,005 confirmed cases of COVID-19 were identified, most of them in Ceará and Bahia states. The incidence rate was 1.8/100,000 inhabitants and lethality was 2.7%. Ceará was the state with the highest number of cases, with 29.6 new cases per day on average. Average intensive care bed availability in the Northeast region (1.04/10,000 inhab.) was below the national average (2.8/10,000 inhab.). CONCLUSION: the indicators suggest that COVID-19 impact is heterogeneous and signal the challenges for health systems in the Northeast Region.


Subject(s)
Coronavirus Infections/epidemiology , Delivery of Health Care/statistics & numerical data , Pneumonia, Viral/epidemiology , Surge Capacity/statistics & numerical data , Brazil/epidemiology , COVID-19 , Coronavirus Infections/mortality , Coronavirus Infections/therapy , Humans , Incidence , Intensive Care Units/statistics & numerical data , Pandemics , Pneumonia, Viral/mortality , Pneumonia, Viral/therapy
14.
Medwave ; 20(3): e7871, 2020 Apr 08.
Article in Spanish | MEDLINE | ID: mdl-32469855

ABSTRACT

Using a mathematical model, we explore the problem of availability versus overdemand of critical hospital processes (e.g., critical beds) in the face of a steady epidemic expansion such as is occurring from the COVID-19 pandemic. In connection with the statistics of new cases per day, and the assumption of maximum quota, the dynamics associated with the variables number of hospitalized persons (critical occupants) and mortality in the system are explored. A parametric threshold condition is obtained, which involves a parameter associated with the minimum daily effort for not collapsing the system. To exemplify, we include some simulations for the case of Chile, based on a parameter of effort to be sustained with the purpose of lowering the daily infection rate.


Mediante un modelo matemático este trabajo explora la problemática de la disponibilidad versus sobredemanda de procesos críticos hospitalarias (por ejemplo, camas críticas) ante una fuerte expansión epidémica como la que está ocurriendo como consecuencia de la pandemia de COVID-19. En conexión con la estadística de nuevos casos diarios y el supuesto de cupo máximo, exploramos la dinámica asociada a las variables número de hospitalizados (ocupantes críticos) y mortalidad en el sistema. Obtenemos una condición paramétrica umbral que involucra un parámetro asociado al esfuerzo mínimo diario para el no colapso del sistema. En orden a ejemplificar, incluimos algunas simulaciones para el caso de Chile, en función de un parámetro de esfuerzo a sostener para bajar la tasa de infección diaria.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Health Services Needs and Demand/statistics & numerical data , Models, Theoretical , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , COVID-19 , Chile/epidemiology , Coronavirus Infections/transmission , Health Resources/supply & distribution , Hospital Bed Capacity/statistics & numerical data , Hospitalization/statistics & numerical data , Humans , Pneumonia, Viral/transmission , Reference Values , SARS-CoV-2 , Surge Capacity/statistics & numerical data
15.
Disaster Med Public Health Prep ; 14(5): 638-642, 2020 10.
Article in English | MEDLINE | ID: mdl-32418556

ABSTRACT

OBJECTIVES: Italy has been one of the first countries to implement mitigation measures to curb the coronavirus disease 2019 (COVID-19) pandemic. There is currently a debate on when and how such measures should be loosened. To forecast the demand for hospital intensive care unit (ICU) and non-ICU beds for COVID-19 patients from May to September, we developed 2 models, assuming a gradual easing of restrictions or an intermittent lockdown. METHODS: We used a compartmental model to evaluate 2 scenarios: (A) an intermittent lockdown; (B) a gradual relaxation of the lockdown. Predicted ICU and non-ICU demand was compared with the peak in hospital bed use observed in April 2020. RESULTS: Under scenario A, while ICU demand will remain below the peak, the number of non-ICU will substantially rise and will exceed it (133%; 95% confidence interval [CI]: 94-171). Under scenario B, a rise in ICU and non-ICU demand will start in July and will progressively increase over the summer 2020, reaching 95% (95% CI: 71-121) and 237% (95% CI: 191-282) of the April peak. CONCLUSIONS: Italian hospital demand is likely to remain high in the next months. If restrictions are reduced, planning for the next several months should consider an increase in health-care resources to maintain surge capacity across the country.


Subject(s)
COVID-19/complications , Health Services Needs and Demand/statistics & numerical data , Pandemics/prevention & control , Quarantine/methods , Surge Capacity/standards , COVID-19/epidemiology , Hospitalization/statistics & numerical data , Hospitals/statistics & numerical data , Humans , Intensive Care Units/organization & administration , Intensive Care Units/statistics & numerical data , Italy/epidemiology , Pandemics/statistics & numerical data , Quarantine/standards , Quarantine/statistics & numerical data , Surge Capacity/statistics & numerical data
16.
Head Neck ; 42(7): 1420-1422, 2020 Jul.
Article in English | MEDLINE | ID: mdl-32415869

ABSTRACT

The novel coronavirus disease 2019 (COVID-19) pandemic continues to have extensive effects on public health as it spreads rapidly across the globe. Patients with head and neck cancer are a particularly susceptible population to these effects, and we expect there to be a potential surge in patients presenting with head and neck cancers after the surge in COVID-19. Furthermore, the impact of social distancing measures could result in a shift toward more advanced disease at presentation. With appropriate anticipation, multidisciplinary head and cancer teams could potentially minimize the impact of this surge and plan for strategies to provide optimal care for patients with head and neck cancer.


Subject(s)
Coronavirus Infections/epidemiology , Head and Neck Neoplasms/epidemiology , Health Planning/methods , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Surge Capacity/statistics & numerical data , COVID-19 , Comorbidity , Female , Humans , Incidence , Interdisciplinary Communication , Male , Otolaryngology/organization & administration , Predictive Value of Tests , United States/epidemiology , World Health Organization
18.
Ann Thorac Surg ; 110(6): 2020-2025, 2020 12.
Article in English | MEDLINE | ID: mdl-32376350

ABSTRACT

Background: The coronavirus disease 2019 (COVID-19) pandemic has dramatically reduced adult cardiac surgery case volumes as institutions and surgeons curtail nonurgent operations. There will be a progressive increase in deferred cases during the pandemic that will require completion within a limited time frame once restrictions ease. We investigated the impact of various levels of increased postpandemic hospital operating capacity on the time to clear the backlog of deferred cases. Methods: We collected data from 4 cardiac surgery programs across 2 health systems. We recorded case rates at baseline and during the COVID-19 pandemic and created a mathematical model to quantify the cumulative surgical backlog based on the projected pandemic duration. We then used the model to predict the time required to clear the backlog depending on the level of increased operating capacity. Results: Cardiac surgery volumes fell to 54% of baseline after restrictions were implemented. Assuming a service restoration date of either June 1 or July 1, we calculated the need to perform 216% or 263% of monthly baseline volume, respectively, to clear the backlog in 1 month. The actual duration required to clear the backlog highly depends on hospital capacity in the post-COVID period, and ranges from 1 to 8 months, depending on when services are restored and the degree of increased capacity. Conclusions: Cardiac surgical operating capacity during the COVID-19 recovery period will have a dramatic impact on the time to clear the deferred cases backlog. Inadequate operating capacity may cause substantial delays and increase morbidity and mortality. If only prepandemic capacity is available, the backlog will never clear.


Subject(s)
Betacoronavirus , Cardiac Surgical Procedures/statistics & numerical data , Coronavirus Infections/epidemiology , Infection Control/organization & administration , Pneumonia, Viral/epidemiology , Surge Capacity/statistics & numerical data , COVID-19 , Coronavirus Infections/prevention & control , Elective Surgical Procedures/statistics & numerical data , Humans , Models, Statistical , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Procedures and Techniques Utilization , SARS-CoV-2
19.
J Pediatr ; 222: 22-27, 2020 Jul.
Article in English | MEDLINE | ID: mdl-32380026

ABSTRACT

OBJECTIVE: To describe the rapid implementation of an adult coronavirus disease 2019 (COVID-19) unit using pediatric physician and nurse providers in a children's hospital and to examine the characteristics and outcomes of the first 100 adult patients admitted. STUDY DESIGN: We describe our approach to surge-in-place at a children's hospital to meet the local demands of the COVID-19 pandemic. Instead of redeploying pediatric providers to work with internist-led teams throughout a medical center, pediatric physicians and nurses organized and staffed a 40-bed adult COVID-19 treatment unit within a children's hospital. We adapted internal medicine protocols, developed screening criteria to select appropriate patients for admission, and reorganized staffing and equipment to accommodate adult patients with COVID-19. We used patient counts and descriptive statistics to report sociodemographic, system, and clinical outcomes. RESULTS: The median patient age was 46 years; 69% were male. On admission, 78 (78%) required oxygen supplementation. During hospitalization, 13 (13%) eventually were intubated. Of the first 100 patients, 14 are still admitted to a medical unit, 6 are in the intensive care unit, 74 have been discharged, 4 died after transfer to the intensive care unit, and 2 died on the unit. The median length of stay for discharged or deceased patients was 4 days (IQR 2, 7). CONCLUSIONS: Our pediatric team screened, admitted, and cared for hospitalized adults by leveraging the familiarity of our system, adaptability of our staff, and high-quality infrastructure. This experience may be informative for other healthcare systems that will be redeploying pediatric providers and nurses to address a regional COVID-19 surge elsewhere.


Subject(s)
Coronavirus Infections/therapy , Critical Care/organization & administration , Hospitals, Pediatric/organization & administration , Intensive Care Units/organization & administration , Pneumonia, Viral/therapy , Surge Capacity/statistics & numerical data , Adult , Betacoronavirus , COVID-19 , Critical Care/standards , Female , Hospitalization/statistics & numerical data , Humans , Internal Medicine/standards , Male , Middle Aged , New York City , Outcome Assessment, Health Care , Pandemics , Respiration, Artificial , SARS-CoV-2
20.
Eur Heart J Acute Cardiovasc Care ; 9(3): 222-228, 2020 Apr.
Article in English | MEDLINE | ID: mdl-32375487

ABSTRACT

Hospitals play a critical role in providing communities with essential medical care during all types of disaster. Depending on their scope and nature, disasters can lead to a rapidly increasing service demand that can overwhelm the functional capacity and safety of hospitals and the healthcare system at large. Planning during the community outbreak of coronavirus disease 2019 (Covid-19) is critical for maintaining healthcare services during our response. This paper describes, besides general measures in times of a pandemic, also the necessary changes in the invasive diagnosis and treatment of patients presenting with different entities of acute coronary syndromes including structural adaptations (networks, spokes and hub centres) and therapeutic adjustments.


Subject(s)
Acute Coronary Syndrome/epidemiology , Betacoronavirus/isolation & purification , Coronavirus Infections/complications , Emergency Service, Hospital/organization & administration , Pneumonia, Viral/complications , Acute Coronary Syndrome/diagnosis , Acute Coronary Syndrome/therapy , COVID-19 , Civil Defense/organization & administration , Cross Infection/epidemiology , Cross Infection/prevention & control , Delivery of Health Care/organization & administration , Delivery of Health Care/statistics & numerical data , Disasters , Disease Outbreaks/statistics & numerical data , Emergencies/epidemiology , Emergency Service, Hospital/statistics & numerical data , Facilities and Services Utilization/statistics & numerical data , Facilities and Services Utilization/trends , Hospitals , Humans , Pandemics , SARS-CoV-2 , Safety , Surge Capacity/statistics & numerical data
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