ABSTRACT
The management of the COVID-19 epidemic has disrupted the organization of healthcare in hospitals. As part of a research project on the resilience of hospitals and their staff to the COVID-19 pandemic (HoSPiCOVID), we have documented their adaptation strategies in five countries (France, Mali, Brazil, Canada, Japan). In France, at the end of the first wave (June 2020), a team of researchers and health professionals from the Bichat Claude-Bernard Hospital organized focus groups to acknowledge these achievements and to share their experiences. One year later, further exchanges were held to discuss and validate the research results. The objective of this short contribution is to describe the insights of these interprofessional exchanges conducted at the Bichat Claude-Bernard Hospital. We show that these exchanges allowed: 1) to create spaces for professionals to speak, 2) to enrich and validate the data collected through a collective acknowledgment of salient aspects related to the experiences of the crisis, and 3) to account for the attitudes, interactions, and power dynamics for these professionals in a crisis management context.
La gestion de l'épidémie de COVID-19 a bouleversé l'organisation des soins dans les hôpitaux. Dans le cadre d'un projet de recherche portant sur la résilience des hôpitaux et des professionnel·le·s de santé face à la pandémie de COVID-19 (HoSPiCOVID), nous avons documenté leurs stratégies d'adaptation dans cinq pays (France, Mali, Brésil, Canada, Japon). En France, dès la fin de la première vague (juin 2020), une équipe de chercheur·se·s et des professionnel·le·s de santé de l'hôpital Bichat Claude-Bernard ont organisé des groupes de discussion pour prendre acte de ces accomplissements et pour partager leurs expériences vécues. Un an plus tard, d'autres échanges ont permis de discuter et de valider les résultats de la recherche. L'objectif de cette contribution courte est de décrire les apports de ces temps d'échanges interprofessionnels conduits à l'hôpital Bichat Claude-Bernard. Nous montrons que ceux-ci ont permis : 1) de créer des espaces de parole pour les professionnel·le·s, 2) d'enrichir et de valider les données collectées au travers d'une (re)connaissance collective d'aspects saillants relatifs aux vécus de la crise, et 3) de rendre compte des attitudes, interactions et rapports de pouvoir de ces professionnel·le·s dans un contexte de gestion de crise.
Subject(s)
COVID-19 , Humans , Pandemics , Health Personnel , Delivery of Health Care , HospitalsABSTRACT
Since the beginning of the COVID-19 pandemic, few studies have focused on crisis management of multiple services within one hospital over several waves of the pandemic. The purpose of this study was to provide an overview of the COVID-19 crisis response of a Parisian referral hospital which managed the first three COVID cases in France and to analyze its resilience capacities. Between March 2020 and June 2021, we conducted observations, semi-structured interviews, focus groups, and lessons learned workshops. Data analysis was supported by an original framework on health system resilience. Three configurations emerged from the empirical data: 1) reorganization of services and spaces; 2) management of professionals' and patients' contamination risk; and 3) mobilization of human resources and work adaptation. The hospital and its staff mitigated the effects of the pandemic by implementing multiple and varied strategies, which the staff perceived as having positive and/or negative consequences. We observed an unprecedented mobilization of the hospital and its staff to absorb the crisis. Often the mobilization fell on the shoulders of the professionals, adding to their exhaustion. Our study demonstrates the capacity of the hospital and its staff to absorb the COVID-19 shock by putting in place mechanisms for continuous adaptation. More time and insight will be needed to observe whether these strategies and adaptations will be sustainable over the coming months and years and to assess the overall transformative capacities of the hospital.
Subject(s)
COVID-19 , Humans , Pandemics , Referral and Consultation , HospitalsABSTRACT
BACKGROUND: According to French national recommendations, the detection of a patient colonized with glycopeptide-resistant enterococci (GRE) leads to interruption of new admissions and transfer of contact patients (CPs) to another unit or healthcare facility, with weekly screening of CPs. FINDINGS: We evaluated the medical and economic impact of a pragmatic adaptation of national guidelines associated with a real-time PCR (RTP) (Cepheid Xpert™ vanA/vanB) as part of the strategy for controlling GRE spread in two medical wards. Screening was previously performed using chromogenic selective medium (CSM). Turn around time (TAT), costs of tests and cost of missed patient days were prospectively collected. In February 2012, the identification of GRE in one patient in the diabetology ward led to the screening of 31 CPs using CSM; one secondary case was identified in a CP already transferred to the Nephrology ward. Awaiting the results of SCM (median TAT, 70.5 h), 41 potential patient days were missed, due to interruption of admissions. The overall cost (screening tests + missing patient.days) was estimated at 14, 302.20 . The secondary case led to screening of 22 CPs in the Nephrology ward using RTP. Because of a short median TAT of 4.6 h, we did not interrupt admissions and patients' transfers. Among 22 CPs, 19 (86%) were negative for vanA, 2 were positive for vanB and 3 had invalid results needing CSM. The overall cost of the strategy was estimated at 870.40 (cost of screening tests only), without missing patient days. CONCLUSION: The rapid PCR test for vanA-positive GRE detection both allowed rapid decision about the best infection control strategy and prevented loss of income due to discontinuation of patient transfers and admissions.
