Doubling Intensive Care Unit Capacity by Surging Onto Medical-Surgical Units During the COVID-19 Pandemic.

INTRODUCTION: The ability of an organization to accommodate a large influx of patients during a prolonged period is dependent on surge capacity. The aim of this article is to describe the surge experience with space, supplies, and staff training in response to COVID-19 and provide guidance to other organizations. BACKGROUND: A hospital's response to a large-scale event is greatly impacted by the ability to surge and, depending on the type of threat, to maintain a sustained response. To identify surge capacity, an organization must first consider the type of event to appropriately plan resources. PREPARATION PROCESS: An epidemic surge drill, conducted in 2012, served as a guide in planning for the COVID-19 pandemic. The principles of crisis standards of care and a hospital incident command structure were used to clearly define roles, open lines of communication, and inform our surge plan. Preparation began by collaborating with multidisciplinary groups to acquire the most appropriate space, as well as adequate supplies, and identify and train staff. IMPLEMENTATION: Teams were formed to identify the necessary resources to expand the intensive care unit (ICU) environment quickly and efficiently. Educational training was developed for redeployed staff. OUTCOMES: Beth Israel Deaconess Medical Center experienced the largest surge of ICU patients within a hospital system in the state of Massachusetts. The ICU capacity was expanded by 93% from 77 to 149 beds, and the surge was maintained for approximately 9 weeks. Shadowing experiences before the actual surge were extremely valuable. CONCLUSIONS: Planning for the surge of critically ill patients required a thoughtful, collaborative approach. Ongoing staff support and communication from nursing leadership were necessary to ensure safe, effective care for critically ill patients in a new and dynamic environment.

Nurse Project Consultant: Critical Care Nurses Move Beyond the Bedside to Affect Quality and Safety.

A nurse project consultant role empowered 3 critical care nurses to expand their scope of practice beyond the bedside and engage within complex health care delivery systems to reduce harms in the intensive care unit. As members of an interdisciplinary team, the nurse project consultants contributed their clinical expertise and systems knowledge to develop innovations that optimize care provided in the intensive care unit. This article discusses the formal development of and institutional support for the nurse project consultant role. The nurse project consultants' responsibilities within a group of quality improvement initiatives are described and their challenges and lessons learned discussed. The nurse project consultant role is a new model of engaging critical care nurses as leaders in health care redesign.

Building a Culture of Continuous Improvement and Employee Engagement Using a Daily Management System Part 1: Overview.

A daily management system (DMS) can be used to implement continuous quality improvement and advance employee engagement. It can empower staff to identify problems in the care environment that impact quality or workflow and to address them on a daily basis. Through DMS, improvement becomes the work of everyone, every day. The authors of this 2-part series describe their work to develop a DMS. Part 1 describes the background and organizing framework of the program.

Use of Surgisis for abdominal wall reconstruction in children with abdominal wall defects.

AIM: Abdominal wall defects in children can present a challenge to the pediatric surgeon. Despite the development of new materials and modifications of surgical technique, no single approach has been established. The purpose of this study was to evaluate the authors experience using porcine small intestine submucosa for abdominal closure. PATIENTS AND METHODS: A retrospective review of all patients with abdominal wall defects who underwent reconstruction with Surgisis at the authors' institution from 2004 to 2011 was performed. Patient demographics, cause of defect, recurrence, rate of infection, and length of follow-up were reviewed. RESULTS: A total of 24 patients were identified as having Surgisis implanted for abdominal wall defects. The most common etiology of abdominal defect was omphalocele. All patients went on to heal wounds. Four patients developed postoperative seroma formation and another two had wound infection. Two recurrences in the form of incisional hernia were observed. Both resolved spontaneously without intervention during the follow-up. The median follow-up period was 5 years (range 2-9 y). No significant predictors of complications were identified. CONCLUSIONS: Surgisis is an effective adjunct in the repair of abdominal wall defects in children. Complication rates remain low. In addition, recurrence may disappear spontaneously as the patch absorbed and replaced by scar tissues. Further studies are warranted.

Elevated progesterone in GnRH agonist down regulated in vitro fertilisation (IVFICSI) cycles reduces live birth rates but not embryo quality.

OBJECTIVE: To assess the impact of pre-hCG elevated progesterone on live birth outcomes during GnRH agonist long down regulated protocol assisted reproduction cycles. DESIGN: Retrospective cohort study. SETTING: Single Centre Private IVF Clinic. PATIENTS: A total of 582 consecutive cycles of IVF/ICSI in 2003. INTERVENTIONS: All patients underwent a long down-regulation protocol, controlled ovarian stimulation and IVF/ICSI. Serum progesterone concentrations were measured just prior to HCG administration. 253 patients were followed to 2009 for outcomes of their frozen embryo cycles. MAIN OUTCOME MEASURE: Live birth rate in fresh and frozen cycles. RESULTS: Patients in the upper quartile pre-hCG progesterone concentration (≥ 5.4 pmol/L) had a higher final estradiol level, more oocytes collected and more usable embryos, when compared to those with lower quartiles. They also had lower live birth rates per cycle started (21.9% vs. 15%, P < 0.05). However, live birth rates from frozen embryo cycles were not significantly different between the groups. CONCLUSIONS: Pre-hCG progesterone elevation leads to lower live birth rates in stimulated IVF cycles. Live birth rates achieved with frozen embryos in the high progesterone cycles suggest, that pre-hCG progesterone elevation negatively affects endometrial receptivity without adversely affecting embryo quality.

High clusterin expression correlates with a poor outcome in stage II colorectal cancers.

The role of clusterin in tumor growth and progression remains unclear. Overexpression of cytoplasmic clusterin has been studied in aggressive colon tumors; however, no correlation between clusterin expression and survival in colorectal cancer has been identified to date. We assessed levels of clusterin expression in a group of stage II colorectal cancer patients to assess its utility as a prognostic marker. The study included 251 patients with stage II colorectal cancer. Tissue microarrays were constructed and immunohistochemistry done and correlated with clinical features and long term outcome. Dual immunofluorescence and confocal microscopy were used with terminal deoxynucleotidyl-transferase-mediated dUTP nick-end labeling probes and clusterin antibody to assess the degree of co localization. Percentage epithelial cytoplasmic staining was higher in tumor compared with nonadjacent normal mucosa (P < 0.001). Within the stromal compartment, percentage cytoplamic staining and intensity was lower in tumor tissue compared with normal nonadjacent mucosa (P < or = 0.001). Survival was significantly associated with percentage epithelial cytoplasmic staining (P < 0.001), epithelial cytoplasmic staining intensity (P < 0.001), percentage stromal cytoplasmic staining (P = 0.002), and stromal cytoplasmic staining intensity (P < 0.001). Clusterin levels are associated with poor survival in stage II colorectal cancer.