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Selvaraju JR, Nik Hisamuddin NAR. Determining the New Norm Elements in Emergency Departments in Malaysia During a Pandemic: A Fuzzy Delphi Method. Malays J Med Sci 2024; 31:241-255. [PMID: 39416733 PMCID: PMC11477466 DOI: 10.21315/mjms2024.31.5.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 06/07/2024] [Indexed: 10/19/2024] Open
Abstract
Background Emergency departments (EDs) have had to cope with various pandemics, such as HIN1, Ebola and the currently ongoing COVID-19. This study aimed to determine the elements of the new norm that has introduced changes into healthcare systems, particularly EDs, during the COVID-19 pandemic and to obtain consensus from the experts, the Emergency physicians in EDs across Malaysia. No previous study has been conducted on this topic. Methods This study used the fuzzy Delphi method (FDM) to acquire expert consensus. There were two phases in this study. The first involved extracting the elements to be assessed by the selected experts from a literature review. Three major domains were considered: infrastructure, governance and human resources. A total of 35 items were identified and divided into the three domains. In the second phase, the selected items were sent to a group of 15 ED physicians, who were asked to rate the items on a Likert-type scale. The data were then analysed using FDM. Results A total of 35 items were identified as possible new norms from a literature search for the three domains (governance, infrastructure and human resources). The first step of the FDM analysis showed that 9 out of the 35 items did not fulfil the initial requirement of the FDM, since the threshold value (d) must be lower than 0.2 (d 75%. Regarding the third requirement for FDM, only 1 out of the 35 items did not meet the criteria of an average fuzzy number (A value) of > 0.5. Finally, 25 items fulfilled all three requirements of FDM, so these were retained and the remaining 10 items were discarded. Conclusion The FDM used in this study had identified 25 items achieved the required level of agreement by the chosen experts. The results of this study can be used to guide EDs in Malaysia to utilise the new norms items in mitigating major outbreak affecting the ED services.
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Affiliation(s)
- Jivanya Raj Selvaraju
- Ministry of Health Malaysia, Federal Government Administrative Centre, Putrajaya, Malaysia
| | - Nik Ab Rahman Nik Hisamuddin
- Department of Emergency Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
- Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Kelantan, Malaysia
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Xu Z, Zhao B, Zhang Z, Wang X, Jiang Y, Zhang M, Li P. Prevalence and associated factors of secondary traumatic stress in emergency nurses: a systematic review and meta-analysis. Eur J Psychotraumatol 2024; 15:2321761. [PMID: 38426665 PMCID: PMC10911249 DOI: 10.1080/20008066.2024.2321761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 02/09/2024] [Indexed: 03/02/2024] Open
Abstract
Background: Nurses in emergency departments are at a high risk of experiencing secondary traumatic stress because of their frequent exposure to trauma patients and high-stress environments.Objective: This systematic review and meta-analysis aimed to determine the overall prevalence of secondary traumatic stress among emergency nurses and to identify the contributing factors.Method: We conducted a systematic search for cross-sectional studies in databases such as PubMed, Web of Science, Embase, CINAHL, Wanfang Database, and China National Knowledge Internet up to October 21, 2023. The Joanna Briggs Institute's appraisal checklists for prevalence and analytical cross-sectional studies were used for quality assessment. Heterogeneity among studies was assessed using Cochrane's Q test and the I2 statistic. A random effects model was applied to estimate the pooled prevalence of secondary traumatic stress, and subgroup analyses were performed to explore sources of heterogeneity. Descriptive analysis summarized the associated factors.Results: Out of 345 articles retrieved, 14 met the inclusion criteria, with 11 reporting secondary traumatic stress prevalence. The pooled prevalence of secondary traumatic stress among emergency nurses was 65% (95% CI: 58%-73%). Subgroup analyses indicated the highest prevalence in Asia (74%, 95% CI: 72%-77%), followed by North America (59%, 95% CI: 49%-72%) and Europe (53%, 95% CI: 29%-95%). Nine studies identified associated factors, including personal, work-related, and social factors. In the subgroup of divided by recruitment period, emergency department nurses in the COVID-19 outbreak period had a higher prevalence of secondary traumatic stress (70%, 95% CI: 62%-78%).Conclusions: Secondary traumatic stress prevalence is notably high among emergency department nurses, with significant regional variations and period differences. The factors affecting secondary traumatic stress also varied across studies. Future research should focus on improving research designs and sample sizes to pinpoint risk factors and develop prevention strategies.Registration: PROSPERO CRD42022301167.
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Affiliation(s)
- Zhiyong Xu
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, People’s Republic of China
- Department of Emergency, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People’s Republic of China
- Department of Nursing, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People’s Republic of China
- Nursing Theory & Practice Innovation Research Center, Cheeloo College of Medicine, Shandong University, Jinan, People’s Republic of China
| | - Bingnan Zhao
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, People’s Republic of China
| | - Zhen Zhang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, People’s Republic of China
- Department of Emergency, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People’s Republic of China
- Department of Nursing, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People’s Republic of China
- Nursing Theory & Practice Innovation Research Center, Cheeloo College of Medicine, Shandong University, Jinan, People’s Republic of China
| | - Xuan Wang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, People’s Republic of China
| | - Yifan Jiang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, People’s Republic of China
| | - Min Zhang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, People’s Republic of China
- Department of Emergency, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People’s Republic of China
- Department of Nursing, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People’s Republic of China
- Nursing Theory & Practice Innovation Research Center, Cheeloo College of Medicine, Shandong University, Jinan, People’s Republic of China
| | - Ping Li
- Department of Emergency, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People’s Republic of China
- Department of Nursing, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People’s Republic of China
- Nursing Theory & Practice Innovation Research Center, Cheeloo College of Medicine, Shandong University, Jinan, People’s Republic of China
- Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, Jinan, People’s Republic of China
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Elmohamady B, Omar M, El-Dakhakhny AS, Sayedahmed K, Ghazwani Y, Bin Hamri S, Alkhayal A, Alrabeeah K, Kamal W, Abbasy M, Farahat Y, Noureldin YA. Effects of first year COVID-19 pandemic on urology practice in three major Arab Countries: Sub-Analysis of a survey by Arab association of urology research group. PLoS One 2024; 19:e0293458. [PMID: 38236912 PMCID: PMC10796057 DOI: 10.1371/journal.pone.0293458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 10/13/2023] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The World Health Organization (WHO) declared the coronavirus disease-19 (COVID-19) pandemic on March 11, 2020. The health care system faced tremendous challenges in providing ethical and high-quality care. The impact of COVID-19 on urological practices varied widely worldwide, including in Arab countries. This study aimed to compare the influence of the COVID-19 pandemic on urology practice in Egypt, the KSA, and the UAE during the first year of the pandemic. METHODS This sub-analysis assessed the demographics and COVID-19's effects on urological practice in terms of adjustments to hospital policy, including outpatient consultations, the management of elective and urgent surgical cases, and the continuation of education across the three countries. The availability of personal protective equipment (PPE) and urologists' emotional, physical, and verbal intimidation during COVID-19 were also compared. RESULTS Regarding the impact on hospital policy, consultations replaced by telemedicine were significantly higher in the KSA (36.15%), followed by the UAE (33.3%), then Egypt (10.4%) (P = 0.008). Elective cases requiring ICU admission were 65.1% in Egypt, 45.2% in the KSA, and 58.2% in the UAE and were performed only in high-risk patients. PPE was freely available in 20.8% of the Egyptian hospitals compared to 83.3% in the KSA and 81.8% in the UAE. Online courses were significantly higher in Egypt (70.8%), followed by the UAE (53%) and the KSA (41.7%) (P = 0.02). Emotional intimidation was higher than verbal intimidation, representing 80%, 75.9%, and 76% in the UAE, KSA, and Egypt, respectively. CONCLUSION This sub-analysis outlined significant hospital policy changes across the three Arab countries. Exposure to emotional, verbal, and physical intimidation was observed. The development of teleconsultations and online platforms for educational purposes was observed.
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Affiliation(s)
- Basheer Elmohamady
- Department of Urology, Benha Faculty of Medicine, Benha University, Benha, Egypt
| | - Mohamed Omar
- Department of Urology, Menoufiya University Hospital, Menoufiya, Egypt
| | - Amr S. El-Dakhakhny
- Department of Urology, Benha Faculty of Medicine, Benha University, Benha, Egypt
| | - Khalid Sayedahmed
- Department of Urology, Menoufiya University Hospital, Menoufiya, Egypt
| | - Yahia Ghazwani
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, KSA
- Division of Urology, King Abdulaziz Medical City, MNGHA, Riyadh, KSA
| | - Saeed Bin Hamri
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, KSA
- Division of Urology, King Abdulaziz Medical City, MNGHA, Riyadh, KSA
| | - Abdullah Alkhayal
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, KSA
- Division of Urology, King Abdulaziz Medical City, MNGHA, Riyadh, KSA
| | - Khalid Alrabeeah
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, KSA
- Division of Urology, King Abdulaziz Medical City, MNGHA, Riyadh, KSA
| | - Wissam Kamal
- Department of Urology, King Fahd Hospital, Jeddah, KSA
| | - Mohamed Abbasy
- Emergency Medicine Department, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Yasser Farahat
- Department of Urology, Faculty of Medicine, Tanta University, Tanta, Egypt
- Urology Department, Sheikh Khalifa General Hospital, Umm Al Quwain, UAE
| | - Yasser A. Noureldin
- Department of Urology, Benha Faculty of Medicine, Benha University, Benha, Egypt
- Division of Urology, King Abdulaziz Medical City, MNGHA, Riyadh, KSA
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
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Misan N, Wilf-Miron R, Saban M. Comparing Emergency Nursing Measures Before and During COVID-19: A Retrospective Study of Assessment, Triage, and Workflow. SAGE Open Nurs 2024; 10:23779608241274766. [PMID: 39185504 PMCID: PMC11342315 DOI: 10.1177/23779608241274766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 06/25/2024] [Accepted: 07/18/2024] [Indexed: 08/27/2024] Open
Abstract
Background The COVID-19 pandemic significantly impacted emergency department (ED) operations and patient care. Understanding its effects on nursing processes, triage accuracy, and wait times is pivotal for optimizing outcomes. Objectives This study aimed to analyze the differences in nursing processes, triage accuracy, and wait times before and during the COVID-19 pandemic. Design A retrospective cohort study. Methods The study analyzed 224 electronic medical records from a single ED, with 120 records from the pre-pandemic period (January 2019-February 2020) and 104 records from the pandemic period (March 2020-March 2021). Dependent variables included missed nursing care per validated scales, triage accuracy per Emergency Severity Index, and wait times for nursing triage and physician examination. Independent factors encompassed sociodemographic, clinical characteristics, and organization dynamics. Results Sociodemographic and clinical profiles were comparable between periods. Triage accuracy remained high except for older patients. Nursing triage wait times differed little, yet physician examination and urgent case waits decreased amidst the pandemic. Nursing documentation completeness, such as recording patient status and mental state, augmented during this crisis period. Conclusion This evaluation identified differences in triage accuracy, wait times, and documentation completeness before and during the COVID-19 pandemic period at a single institution. Patient age and clinical status influenced some metrics. Lessons from comparing precrisis benchmarks to intra-pandemic nursing performance may guide pandemic preparedness strategies. Further research is warranted to optimize emergency processes and outcomes during public health emergencies, as well as examine strategies through multicenter investigations comparing prepandemic to intra-pandemic performance to provide broader insights into challenges and inform efforts to bolster emergency care through future crises.
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Affiliation(s)
- Nofar Misan
- Department of Health Promotion, School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rachel Wilf-Miron
- Department of Health Promotion, School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Gertner Institute for Health Policy and Epidemiology, Ramat-Gan, Israel
| | - Mor Saban
- Nursing Department, School of Health Professions, Faculty of Medicine, Tel-Aviv University, Tel-Aviv-Yafo, Israel
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Ibrahim BE, El-Amin RO, Abdulla STA. Evaluating the Triage of Suspected COVID-19 Cases in Sudan's Emergency Settings: A Clinical Audit. Open Access Emerg Med 2023; 15:373-382. [PMID: 37872979 PMCID: PMC10590591 DOI: 10.2147/oaem.s433240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/11/2023] [Indexed: 10/25/2023] Open
Abstract
Background The inevitable coronavirus disease 2019 global pandemic has severely affected Sudan's fragile healthcare system. The authors share the experience of COVID-19 triage in the emergency departments of five public hospitals in Khartoum state, Sudan. Methods A clinical audit was conducted in December 2020 using the Centers for Disease Control and Prevention Checklist and Monitoring Tool for Triage of Suspected COVID-19 Cases. The tool was categorised into 5 domains and 38 indicators. Results Only three hospitals had hand hygiene stations in their triage areas: Ibrahim Malik, Omdurman, and Al-Nau. Omdurman Teaching Hospital was the sole hospital with a designated respiratory waiting area. At Al-Nau and Omdurman Hospitals, all respiratory symptomatic patients wore a facemask or alternative. Ibrahim Malik and Bahri Teaching Hospitals had 60% and 50% compliance, respectively, while none at El-Tamayouz Hospital did. No posters or job aids were present in donning and doffing areas. Heavy duty gloves were worn only at Ibrahim Malik (50%) and Omdurman (20%). 100% of staff wore closed-toe footwear at Ibrahim Malik and Omdurman, 75% at El-Tamayouz, 63% at Bahri, and none at Al-Nau. Conclusion The healthcare facilities displayed significant shortcomings in preparedness and response to COVID-19, with variations across hospitals in infrastructure, human resources, and procedures. To better combat future outbreaks, systemic improvements and a focused approach on consistent staff training, standard triage algorithms, and adequate PPE availability are imperative.
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Affiliation(s)
- Bayan E Ibrahim
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
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Balakumar J, Pham MP, Mak S, Yip K. COVID-19 Incidence After Emergency Department Visit. Fed Pract 2023; 40:224-227. [PMID: 37868712 PMCID: PMC10588997 DOI: 10.12788/fp.0384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
Background The emergency department (ED) at the Veterans Affairs Greater Los Angeles Healthcare System (VAGLAHS) saw a decrease in the number of visits during the early stages of the COVID-19 pandemic. Little is known whether risk mitigation procedures may help reduce the spread of COVID-19 infections for veterans visiting the ED. Therefore, we reviewed patient visits to the ED for diagnoses other than COVID-19 to assess whether these patients had an increased COVID-19 positivity rate within 21 days of the initial visit. Observations Risk mitigation procedures instituted by the VAGLAHS ED included a COVID-19 outdoor testing tent, immediate isolation of persons under investigation for COVID-19, disinfection protocols between high-risk patient encounters, dedicated training in donning and doffing personal protective equipment, implementation of 2-physician airway teams for COVID-19 intubations, use of electronic tablets to communicate with COVID-19 patients, and implementation of social distancing initiatives in the waiting room to minimize COVID-19 exposures. The average positivity rate at the VAGLAHS ED during this time frame was 0% to 6.7%, compared with 6.9% to 33.3% within the wider VAGLAHS. Conclusions Implementing risk mitigation procedures in the VAGLAHS ED helped minimize exposure and subsequent diagnosis of COVID-19 for veterans who visited the VAGLAHS ED for symptoms not associated with COVID-19 infection. Seeking acute medical care in the ED did not put patients at higher risk of contracting COVID-19.
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Affiliation(s)
- Jonathan Balakumar
- Veterans Affairs Greater Los Angeles Healthcare System, California
- David Geffen School of Medicine, University of California, Los Angeles
| | - My-Phuong Pham
- Veterans Affairs Greater Los Angeles Healthcare System, California
| | - Selene Mak
- Veterans Affairs Greater Los Angeles Healthcare System, California
| | - Kathleen Yip
- Veterans Affairs Greater Los Angeles Healthcare System, California
- David Geffen School of Medicine, University of California, Los Angeles
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Ortíz-Barrios M, Jaramillo-Rueda N, Gul M, Yucesan M, Jiménez-Delgado G, Alfaro-Saíz JJ. A Fuzzy Hybrid MCDM Approach for Assessing the Emergency Department Performance during the COVID-19 Outbreak. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4591. [PMID: 36901601 PMCID: PMC10001734 DOI: 10.3390/ijerph20054591] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/15/2023] [Accepted: 02/28/2023] [Indexed: 06/18/2023]
Abstract
The use of emergency departments (EDs) has increased during the COVID-19 outbreak, thereby evidencing the key role of these units in the overall response of healthcare systems to the current pandemic scenario. Nevertheless, several disruptions have emerged in the practical scenario including low throughput, overcrowding, and extended waiting times. Therefore, there is a need to develop strategies for upgrading the response of these units against the current pandemic. Given the above, this paper presents a hybrid fuzzy multicriteria decision-making model (MCDM) to evaluate the performance of EDs and create focused improvement interventions. First, the intuitionistic fuzzy analytic hierarchy process (IF-AHP) technique is used to estimate the relative priorities of criteria and sub-criteria considering uncertainty. Then, the intuitionistic fuzzy decision making trial and evaluation laboratory (IF-DEMATEL) is employed to calculate the interdependence and feedback between criteria and sub-criteria under uncertainty, Finally, the combined compromise solution (CoCoSo) is implemented to rank the EDs and detect their weaknesses to device suitable improvement plans. The aforementioned methodology was validated in three emergency centers in Turkey. The results revealed that the most important criterion in ED performance was ER facilities (14.4%), while Procedures and protocols evidenced the highest positive D + R value (18.239) among the dispatchers and is therefore deemed as the main generator within the performance network.
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Affiliation(s)
- Miguel Ortíz-Barrios
- Department of Productivity and Innovation, Universidad de la Costa CUC, Barranquilla 081001, Colombia
| | - Natalia Jaramillo-Rueda
- Department of Productivity and Innovation, Universidad de la Costa CUC, Barranquilla 081001, Colombia
| | - Muhammet Gul
- School of Transportation and Logistics, Istanbul University, Istanbul 34320, Turkey
| | - Melih Yucesan
- Department of Emergency Aid and Disaster Management, Munzur University, Tunceli 62000, Turkey
| | - Genett Jiménez-Delgado
- Department of Industrial Engineering, Institución Universitaria de Barranquilla IUB, Barranquilla 080002, Colombia
| | - Juan-José Alfaro-Saíz
- Research Centre on Production Management and Engineering, Universitat Politècnica de València, 46022 Valencia, Spain
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Plusch J, Jane Muir K. "Doc in the Box": The impact of an emergency department move on interprofessional collaboration, patient care, and clinician job satisfaction. Int Emerg Nurs 2023; 67:101267. [PMID: 36863070 DOI: 10.1016/j.ienj.2023.101267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 01/12/2023] [Accepted: 01/24/2023] [Indexed: 03/04/2023]
Abstract
OBJECTIVE Health care organizations undergo unit space reconfiguration (e.g., expansion) projects in order to accommodate rising patient volumes with limited health care space. The purpose of this study was to describe the impact of an emergency department physical space move on clinician-perceived interprofessional collaboration, patient care delivery, and clinician job satisfaction. METHOD A secondary qualitative, descriptive data analysis of 39 in-depth interviews from an ethnography was conducted from August 2019 to February 2021 at an academic medical center emergency department with nurses, physicians, and patient care technicians in the Southeastern United States. The Social Ecological Model was a conceptual guide for the analysis. RESULTS Three study themes, "It's like an old dive bar", "spatial blind spot", and "privacy and aesthetic work environment" emerged from the 39 interviews. Clinicians perceived that the move from a centralized to decentralized work space impacted interprofessional collaboration through divided clinician work spaces. Increased square footage in the new emergency department was beneficial for patient satisfaction but contributed to difficulty monitoring patients for care escalation. However, increased space and individualized patient rooms increased perceived clinician job satisfaction. CONCLUSION Space reconfiguration projects inhealth carecan have positive implications for patient care, but may result in inefficiencies to the health care team and patient care that must be considered. Study findings inform health care work environment renovation projects on an international level.
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Affiliation(s)
- Jamie Plusch
- Medstar Georgetown University Hospital, Washington, DC 20007, USA.
| | - K Jane Muir
- National Clinician Scholars Program, University of Pennsylvania, Philadelphia, PA 19140, USA.
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Marcassoli A, Leonardi M, Passavanti M, De Angelis V, Bentivegna E, Martelletti P, Raggi A. Lessons Learned from the Lessons Learned in Public Health during the First Years of COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1785. [PMID: 36767152 PMCID: PMC9914715 DOI: 10.3390/ijerph20031785] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 06/18/2023]
Abstract
(1) Objectives: to investigate the main lessons learned from the public health (PH) response to COVID-19, using the global perspective endorsed by the WHO pillars, and understand what countries have learned from their practical actions. (2) Methods: we searched for articles in PubMed and CINAHL from 1 January 2020 to 31 January 2022. 455 articles were included. Inclusion criteria were PH themes and lessons learned from the COVID-19 pandemic. One hundred and forty-four articles were finally included in a detailed scoping review. (3) Findings: 78 lessons learned were available, cited 928 times in the 144 articles. Our review highlighted 5 main lessons learned among the WHO regions: need for continuous coordination between PH institutions and organisations (1); importance of assessment and evaluation of risk factors for the diffusion of COVID-19, identifying vulnerable populations (2); establishment of evaluation systems to assess the impact of planned PH measures (3); extensive application of digital technologies, telecommunications and electronic health records (4); need for periodic scientific reviews to provide regular updates on the most effective PH management strategies (5). (4) Conclusion: lessons found in this review could be essential for the future, providing recommendations for an increasingly flexible, fast and efficient PH response to a healthcare emergency such as the COVID-19 pandemic.
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Affiliation(s)
- Alessia Marcassoli
- Neurology, Public Health, Disability Unit and Coma Research Center, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Matilde Leonardi
- Neurology, Public Health, Disability Unit and Coma Research Center, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Marco Passavanti
- Neurology, Public Health, Disability Unit and Coma Research Center, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Valerio De Angelis
- Department of Clinical and Molecular Medicine, Sapienza University, 00189 Rome, Italy
| | - Enrico Bentivegna
- Department of Clinical and Molecular Medicine, Sapienza University, 00189 Rome, Italy
| | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University, 00189 Rome, Italy
| | - Alberto Raggi
- Neurology, Public Health, Disability Unit and Coma Research Center, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
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Impact of ICU strain on outcomes. Curr Opin Crit Care 2022; 28:667-673. [PMID: 36226707 DOI: 10.1097/mcc.0000000000000993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE OF REVIEW Acute surge events result in health capacity strain, which can result in deviations from normal care, activation of contingencies and decisions related to resource allocation. This review discusses the impact of health capacity strain on patient centered outcomes. RECENT FINDINGS This manuscript discusses the lack of validated metrics for ICU strain capacity and a need for understanding the complex interrelationships of strain with patient outcomes. Recent work through the coronavirus disease 2019 pandemic has shown that acute surge events are associated with significant increase in hospital mortality. Though causal data on the differential impact of surge actions and resource availability on patient outcomes remains limited the overall signal consistently highlights the link between ICU strain and critical care outcomes in both normal and surge conditions. SUMMARY An understanding of ICU strain is fundamental to the appropriate clinical care for critically ill patients. Accounting for stain on outcomes in critically ill patients allows for minimization of variation in care and an ability of a given healthcare system to provide equitable, and quality care even in surge scenarios.
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Marmo R, Pascale F, Diana L, Sicignano E, Polverino F. Lessons learnt for enhancing hospital resilience to pandemics: A qualitative analysis from Italy. INTERNATIONAL JOURNAL OF DISASTER RISK REDUCTION : IJDRR 2022; 81:103265. [PMID: 36061241 PMCID: PMC9419438 DOI: 10.1016/j.ijdrr.2022.103265] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 08/18/2022] [Accepted: 08/19/2022] [Indexed: 06/15/2023]
Abstract
The COVID-19 pandemic has outlined the need to strengthen the resilience of healthcare systems. It has cost millions of human lives and has had indirect health impacts too. Hospital buildings have undergone extensive modifications and adaptations to ensure infection control and prevention measures, and, as it is happened following past epidemics, the COVID-19 experience might change the design of hospital buildings in the future. This paper aims to capitalise on the knowledge developed by the stakeholders directly involved with the hospital response during the pandemic to generate new evidence that will enhance resilience of hospital buildings to pandemics. The research adopted qualitative research methods, namely literature review and interviews with Italian experts including doctors and facility managers to collect data which were analysed through a thematic analysis. The findings include the identification of new needs for hospital buildings and the related actions to be taken or already performed at hospital building and service level which are viable for long term implementation and are aimed at improving hospital resilience to pandemics. The results specify how to improve resilience by means of structural modifications (e.g. placing filter zones among different wards, ensuring the presence of airborne infection isolation rooms at least in the emergency departments), technological changes (e.g. oversizing capacity such as medical gases, information technology improvement for delivering healthcare services remotely), and operational measures (e.g. assessing the risk of infection before admission, dividing acute-care from low-care assets). The needs discussed in this paper substantiate the urge to renovate the Italian healthcare infrastructures and they can be considered useful elements of knowledge for enhancing hospital resilience to pandemics in the extended and in the post-COVID-19 era.
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Affiliation(s)
- Rossella Marmo
- Department of Civil Engineering, University of Salerno, 84084, Fisciano, Italy
| | - Federica Pascale
- Faculty of Science and Engineering, Anglia Ruskin University, CM1 1SQ, Chelmsford, UK
| | - Lorenzo Diana
- Department of Civil, Building and Environmental Engineering, University of Naples "Federico II", 80138, Naples, Italy
| | - Enrico Sicignano
- Department of Civil Engineering, University of Salerno, 84084, Fisciano, Italy
| | - Francesco Polverino
- Department of Civil, Building and Environmental Engineering, University of Naples "Federico II", 80138, Naples, Italy
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12
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Oprita B, Davidoiu A, Dinu AB, Oprita R. The Rescue of the Romanian Health System by the Emergency Departments during the Fourth Wave of COVID-19 Pandemic. Life (Basel) 2022; 12:1547. [PMID: 36294982 PMCID: PMC9605277 DOI: 10.3390/life12101547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 09/26/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022] Open
Abstract
The COVID-19 pandemic has led to the confrontation of the health system with the need to identify solutions for providing medical care to a very large number of patients. The main objective of our study was to describe the measures taken to provide optimal medical care to patients who presented themselves in one of the large emergency hospitals of Romania in the fourth wave of the COVID-19 pandemic. Material and Methods: We conducted a retrospective, observational study on a group of 1417 patients. The statistical analysis was performed using R. Results: The average length of stay of patients in the emergency departments was approximately 2.6 h, increasing to up to 15 days in some more severe cases. For rapid antigen tests, the highest positivity rate for SARS-CoV-2 was identified in patients aged >75 years (53%). Among the identified risk factors associated with the need for mechanical ventilation were advanced age (α < 0.001) and lack of vaccination against SARS-CoV-2 (α < 0.001). Discussion and conclusions: A method of saving the Romanian health system in full hospital bed occupancy conditions in the wards proved to be the provision of medical care in emergency departments.
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Affiliation(s)
- Bogdan Oprita
- Faculty of Medicine, University of Medicine and Pharmacy Carol Davila Bucharest, 050474 Bucharest, Romania
- Emergency Department, Clinical Emergency Hospital of Bucharest, 105402 Bucharest, Romania
| | - Andrei Davidoiu
- Emergency Department, Clinical Emergency Hospital of Bucharest, 105402 Bucharest, Romania
| | - Alexandru Bogdan Dinu
- Emergency Department, Clinical Emergency Hospital of Bucharest, 105402 Bucharest, Romania
| | - Ruxandra Oprita
- Faculty of Medicine, University of Medicine and Pharmacy Carol Davila Bucharest, 050474 Bucharest, Romania
- Gastroenterology Department, Clinical Emergency Hospital of Bucharest, 105402 Bucharest, Romania
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13
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Khilji MF, Al Jufaili M. Emergency Department Changes to Combat COVID-19 in Oman. Disaster Med Public Health Prep 2022; 16:2083-2090. [PMID: 33588958 PMCID: PMC8129689 DOI: 10.1017/dmp.2021.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 12/23/2020] [Accepted: 12/26/2020] [Indexed: 11/28/2022]
Abstract
Our hospital is one of the tertiary care hospitals in Oman receiving coronavirus disease (COVID-19; C19) patients. To meet the expected surge of patients, a number of changes was made to the emergency department (ED), especially regarding capacity building and patient flow. At first, few changes were made to the main ED, which mainly includes the addition of a COVID suspect room with the use of a separate resuscitation area. The major drawback of the abovementioned system was the inability to see more than 2 patients simultaneously. A later separate COVID emergency department (CED) was used. In the CED, pending admissions was the major problem, as the C19 ward and C19 intensive care unit were becoming full; this problem was solved through central command help. In the normal ED, the main problem was the presentation of C19-positive patients sometimes hiding their symptoms and reaching inside the main ED, exposing the staff and patients. In order to combat this problem, all patients with an acute respiratory problem, even if C19 is not suspected, were taken to the corner cubicle. In this report, the changes made in the ED to combat C19 spread are discussed.
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Affiliation(s)
- Muhammad Faisal Khilji
- Emergency Department, Royal Lancaster Infirmary, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, United Kingdom
| | - Mehmood Al Jufaili
- Department of Emergency Medicine, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman
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14
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Goel NN, Eschbach E, McConnell D, Beattie B, Hickey S, Rozehnal J, Leibner E, Oldenburg G, Mathews KS. Predictors of Respiratory Support Use in Emergency Department Patients With COVID-19-Related Respiratory Failure. Respir Care 2022; 67:1091-1099. [PMID: 35764346 PMCID: PMC9994335 DOI: 10.4187/respcare.09772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Given the known downstream implications of choice of respiratory support on patient outcomes, all factors influencing these decisions, even those not limited to the patient, warrant close consideration. We examined the effect of emergency department (ED)-specific system factors, such as work load and census, on the use of noninvasive versus invasive respiratory support. METHODS We conducted a multi-center retrospective cohort study of all adult subjects with severe COVID-19 requiring an ICU admission from 5 EDs within a single urban health care system. Subject demographics, severity of illness, and the type of respiratory support used were obtained. Using continuous measures of ED census, boarding, and active management, we estimated ED work load for each subjects' ED stay. The subjects were categorized by type(s) of respiratory support used: low-flow oxygen, noninvasive respiratory support (eg, noninvasive ventilation [NIV] and/or high-flow nasal cannula [HFNC]), invasive mechanical ventilation, or invasive mechanical ventilation after trial of NIV/HFNC. We used multivariable logistic regression to examine system factors associated with the type of respiratory support used in the ED. RESULTS A total of 634 subjects were included. Of these, 431 (70.0%) were managed on low-flow oxygen alone, 108 (17.0%) on NIV/HFNC, 54 (8.5%) on invasive mechanical ventilation directly, and 41 (6.5%) on NIV/HFNC prior to invasive mechanical ventilation in the ED. Higher severity of illness and underlying lung disease increased the odds of requiring invasive mechanical ventilation compared to low-flow oxygen (odds ratio 1.05 [95% CI 1.03-1.07] and odds ratio 3.47 [95% CI 1.37-8.78], respectively). Older age decreased odds of being on invasive mechanical ventilation compared to low-flow oxygen (odds ratio 0.96 [95% CI 0.94-0.99]). As ED work load increased, the odds for subjects to be managed initially with NIV/HFNC prior to invasive mechanical ventilation increased 6-8-fold. CONCLUSIONS High ED work load was associated with higher odds on HFNC/NIV prior to invasive mechanical ventilation.
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Affiliation(s)
- Neha N Goel
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Erin Eschbach
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Daniel McConnell
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Bryan Beattie
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sean Hickey
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - John Rozehnal
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Evan Leibner
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Gary Oldenburg
- Respiratory Care Services, Mount Sinai Hospital, New York, New York
| | - Kusum S Mathews
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; and Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
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15
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Cordeiro L, Gnatta JR, Ciofi-Silva CL, Price A, de Oliveira NA, Almeida RMA, Mainardi GM, Srinivas S, Chan W, Levin ASS, Padoveze MC. Personal protective equipment implementation in healthcare: A scoping review. Am J Infect Control 2022; 50:898-905. [PMID: 35908829 DOI: 10.1016/j.ajic.2022.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/22/2022] [Accepted: 01/24/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Adherence to infection prevention and control (IPC) measures, including the proper use of protective personal equipment (PPE), in health care is complex and is influenced by many factors. Isolated interventions do not have the potential to achieve optimal PPE adherence and appropriate provision, leading to incomplete PPE implementation. OBJECTIVE To map PPE implementation in health care with a focus on its barriers and facilitators. METHODS A scoping review was conducted across 14 electronic databases using the Joanna Briggs Institute methodology. RESULTS Seventy-four papers were included in the review. Findings were analyzed and synthesized into categories to match the Consolidated Framework for Implementation Research domains. The content was then synthesized into barriers for PPE implementation and interventions to address them. The main barriers were discomfort in clinical work; shortage, supply and logistics problems; inadequacies in facilities infrastructure, weakness in policies and communication procedures; and health workers' (HW) psychological issues and lack of preparedness. Implementation interventions reported were related to HW wellbeing assurance; work reorganization; IPC protocols; adoption of strategies to improve communication and HW training; and adoption of structural and organizational changes to improve PPE adherence. CONCLUSIONS PPE implementation, which is critical IPC programs, involves multilevel transdisciplinary complexity. It relies on the development of context-driven implementation strategies to inform and harmonize IPC policy in collaboration with local and international health bodies.
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Affiliation(s)
- Luciana Cordeiro
- School of Nursing, University of Sao Paulo, Av. Dr. Enéas Carvalho de Aguiar, São Paulo, SP, Brazil.
| | - Juliana Rizzo Gnatta
- Stanford Anesthesia and Informatics Media Lab, Stanford School of Medicine, Palo Alto, CA, USA
| | | | - Amy Price
- Stanford Anesthesia and Informatics Media Lab, Stanford School of Medicine, Palo Alto, CA, USA
| | - Naila Albertina de Oliveira
- Graduate Program in Nursing, School of Nursing, Federal University of Sao Paulo, Rua Napoleão de Barros, São Paulo, SP, Brazil
| | | | - Giulia M Mainardi
- School of Nursing, University of Sao Paulo, Av. Dr. Enéas Carvalho de Aguiar, São Paulo, SP, Brazil
| | - Shrinidhy Srinivas
- Stanford Anesthesia and Informatics Media Lab, Stanford School of Medicine, Palo Alto, CA, USA
| | - Whitney Chan
- Stanford Anesthesia and Informatics Media Lab, Stanford School of Medicine, Palo Alto, CA, USA
| | - Anna Sara S Levin
- Clinical Hospital of Faculty of Medicine of University of Sao Paulo. R. Dr. Ovídio Pires de Campos, São Paulo, SP, Brazil
| | - Maria Clara Padoveze
- School of Nursing, University of Sao Paulo, Av. Dr. Enéas Carvalho de Aguiar, São Paulo, SP, Brazil
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16
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Bludau A, Heinemann S, Mardiko AA, Kaba HEJ, Leha A, von Maltzahn N, Mutters NT, Leistner R, Mattner F, Scheithauer S. Infection control strategies for patients and accompanying persons during the COVID-19 pandemic in German hospitals: a cross-sectional study in March-April 2021. J Hosp Infect 2022; 125:28-36. [PMID: 35413422 PMCID: PMC8994401 DOI: 10.1016/j.jhin.2022.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 03/31/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Patients are at risk of nosocomial COVID-19 infection. The role of accompanying persons/visitors as potential infection donors is not yet well researched, but the risk will be influenced by prevention measures recommended by infection control practitioners. AIM To collect information about COVID-19 infection control strategies for patients and accompanying persons from infection control practitioners in German hospitals. METHODS A cross-sectional questionnaire was developed, ethically approved, pre-tested and formatted as an online tool. Infection control practitioners in 987 randomly selected German hospitals were invited to participate in March and April 2021. For statistical analysis, the hospitals were categorized as small (0-499 beds) or large (≥500 beds). FINDINGS One hundred surveys were completed (response rate: 10%). A higher proportion of large (71%) than small (49%) hospitals let patients decide freely whether to wear medical or FFP2 masks. Most hospitals reported spatial separation for COVID-19 patients and non-COVID-19 cases (38%) or additionally for suspected COVID-19 cases (53%). A separation of healthcare teams for these areas existed in 54% of the hospitals. Accompaniment bans were more prevalent in large (52%) than in small hospitals (29%), but large hospitals granted more exemptions. CONCLUSION The decision as to whether to separate areas and teams seemed to depend on the hospital's structural conditions, therefore impairing the implementation of recommendations. Accompaniment regulations differ between hospital sizes and may depend on patient numbers, case type/severity and patients' requirements. In the dynamic situation of a pandemic, it can be difficult to stay up to date with findings and recommendations on infection control.
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Affiliation(s)
- A Bludau
- Institute of Infection Control and Infectious Diseases, University Medical Center Göttingen, Georg-August University Göttingen, Göttingen, Germany.
| | - S Heinemann
- Local Task Force of the Network University Medicine (NUM), University Medical Center Göttingen, Georg-August University Göttingen, Göttingen, Germany; Department of General Practice, University Medical Center Göttingen, Georg-August University Göttingen, Göttingen, Germany
| | - A A Mardiko
- Institute of Infection Control and Infectious Diseases, University Medical Center Göttingen, Georg-August University Göttingen, Göttingen, Germany
| | - H E J Kaba
- Institute of Infection Control and Infectious Diseases, University Medical Center Göttingen, Georg-August University Göttingen, Göttingen, Germany
| | - A Leha
- Department of Medical Statistics, University Medical Center Göttingen, Georg-August University Göttingen, Göttingen, Germany
| | - N von Maltzahn
- Institute for Medical Microbiology and Hospital Epidemiology, Medical School Hannover, Hannover, Germany
| | - N T Mutters
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | - R Leistner
- Institute for Hygiene and Environmental Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany; Medical Department, Division of Gastroenterology, Infectious Diseases and Rheumatology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - F Mattner
- Institute for Hygiene, Cologne Merheim Medical Centre, University Witten-Herdecke, Cologne, Germany
| | - S Scheithauer
- Institute of Infection Control and Infectious Diseases, University Medical Center Göttingen, Georg-August University Göttingen, Göttingen, Germany
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17
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Dawson LP, Smith K, Cullen L, Nehme Z, Lefkovits J, Taylor AJ, Stub D. Care Models for Acute Chest Pain That Improve Outcomes and Efficiency. J Am Coll Cardiol 2022; 79:2333-2348. [DOI: 10.1016/j.jacc.2022.03.380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/30/2022] [Accepted: 03/30/2022] [Indexed: 10/18/2022]
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Terning G, Brun EC, El-Thalji I. Modeling Patient Flow in an Emergency Department under COVID-19 Pandemic Conditions: A Hybrid Modeling Approach. Healthcare (Basel) 2022; 10:healthcare10050840. [PMID: 35627977 PMCID: PMC9140766 DOI: 10.3390/healthcare10050840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 04/18/2022] [Accepted: 04/25/2022] [Indexed: 11/16/2022] Open
Abstract
Emergency departments (EDs) had to considerably change their patient flow policies in the wake of the COVID-19 pandemic. Such changes affect patient crowding, waiting time, and other qualities related to patient care and experience. Field experiments, surveys, and simulation models can generally offer insights into patient flow under pandemic conditions. This paper provides a thorough and transparent account of the development of a multi-method simulation model that emulates actual patient flow in the emergency department under COVID-19 pandemic conditions. Additionally, a number of performance measures useful to practitioners are introduced. A conceptual model was extracted from the main stakeholders at the case hospital through incremental elaboration and turned into a computational model. Two agent types were mainly modeled: patient and rooms. The simulated behavior of patient flow was validated with real-world data (Smart Crowding) and was able to replicate actual behavior in terms of patient occupancy. In order to further the validity, the study recommends several phenomena to be studied and included in future simulation models such as more agents (medical doctors, nurses, beds), delays due to interactions with other departments in the hospital and treatment time changes at higher occupancies.
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Affiliation(s)
- Gaute Terning
- Department of Safety, Economics, and Planning, University of Stavanger, 4036 Stavanger, Norway;
- Correspondence:
| | - Eric Christian Brun
- Department of Safety, Economics, and Planning, University of Stavanger, 4036 Stavanger, Norway;
| | - Idriss El-Thalji
- Department of Mechanical and Structural Engineering and Materials Science, University of Stavanger, 4036 Stavanger, Norway;
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19
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A Rapid Transformation of an Existing Testing Facility Area for COVID-19 into a Fully Functional Pediatric Emergency in 72 Hours' Time-An Experience from a Tertiary Care Teaching Hospital. Indian J Pediatr 2022; 89:202-203. [PMID: 34787793 PMCID: PMC8595954 DOI: 10.1007/s12098-021-04015-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 10/27/2021] [Indexed: 11/06/2022]
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20
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Utomo P, Adhitya K, Bintara PA, Yudistira MB. Emergency Department Preparedness of Prof. Dr. R. Soeharso Orthopaedic Hospital against Coronavirus Disease-19 Pandemic: Understanding the Challenges. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.6616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The potential conditions for a worldwide pandemic have been caused by the new coronavirus disease (COVID-19). Since February 2020, the World Health Organization has determined the COVID-19 pandemic status. As a result, all countries in the world, including Indonesia, must adjust to the current global conditions. The Indonesian Ministry of Health has directed all hospitals in the nation to prepare and remodel all facilities to assist the effective handling of COVID-19. As the first line, the Emergency Department has fundamental principles for controlling and treating COVID-19 spread. The challenges should be understood, and the preparations for the COVID-19 pandemic redesign orthopedic and trauma cases.
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21
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Sarfraz Z, Sarfraz A, Sarfraz M, Chohan FA, Stringfellow C, Jain E, Hange N, Loh H, Felix M, Cherrez-Ojeda I. Lessons learnt from emergency medicine services during the COVID-19 pandemic: A case study of India and the United States. Ann Med Surg (Lond) 2022; 73:103197. [PMID: 34956642 PMCID: PMC8690280 DOI: 10.1016/j.amsu.2021.103197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 12/09/2021] [Accepted: 12/18/2021] [Indexed: 12/02/2022] Open
Abstract
India and the United States have both witnessed a high burden of COVID-19 infections since the pandemic was declared in early 2020. However, the COVID-19 restrictions have met with mixed responses in India and the US. Despite recommendations to continue social isolation and personal hygiene measures, India has not been able to curb the rise in daily cases. Our findings demonstrate the difference in the manner by which India and the US differ in their emergency handling of patients. We conducted a thorough review of the existing protocols and data concerning emergency responses in India and the US. The triage and care of suspected COVID-19 positive patients is different across India and the US. We find that there is a shortage of oxygenation, vaccination and other essential supplies in India. Further, the US is able to triage patients through telemedicine and EMS before suspected COVID-19 patients arrive, which is less prevalent in India. Our study identifies the importance of the emergency department (ED) as a critical contributor to the prevention and care of suspected and confirmed COVID-19 patients. Hospitals in India have been struggling to accommodate a huge influx of patients during its second wave with the ED playing a key link in their COVID-19 response.
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Affiliation(s)
| | | | | | | | | | - Esha Jain
- Larkin Community Hospital, South Miami, FL, USA
| | | | - Hanyou Loh
- Larkin Community Hospital, South Miami, FL, USA
| | - Miguel Felix
- Universidad Espíritu Santo, Samborondón, Ecuador
- Respiralab, Respiralab Research Group, Guayaquil, Ecuador
| | - Ivan Cherrez-Ojeda
- Universidad Espíritu Santo, Samborondón, Ecuador
- Respiralab, Respiralab Research Group, Guayaquil, Ecuador
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22
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Cai Y, Kwek S, Tang SS, Saffari SE, Lum E, Yoon S, Ansah JP, Matchar DB, Kwa AL, Ang KA, Thumboo J, Ong ME, Graves N. Impact of the COVID-19 pandemic on a tertiary care public hospital in Singapore: Resources and economic costs. J Hosp Infect 2021; 121:1-8. [PMID: 34902499 PMCID: PMC8664721 DOI: 10.1016/j.jhin.2021.12.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/28/2021] [Accepted: 12/05/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND The COVID-19 pandemic has prompted hospitals to respond with stringent measures. Accurate estimates of costs and resources used in outbreaks can guide evaluations of responses. We report the financial expenditure associated with COVID-19, the bed-days used for COVID-19 patients and hospital services displaced due to COVID-19 in a Singapore tertiary hospital. METHODS We conducted a retrospective cost analysis from January to December 2020 in the largest public hospital in Singapore. Costs were estimated from the hospital perspective. We examined financial expenditures made in direct response to COVID-19; hospital admissions data related to COVID-19 inpatients; and the number of outpatient and emergency department visits, non-emergency surgeries, inpatient days in 2020, compared to preceding years of 2018 and 2019. Bayesian time-series was used to estimate the magnitude of displaced services. RESULTS USD$41.96 million was incurred in the hospital for COVID-19 related expenses. Facilities setup and capital assets counted for 51.6% of the expenditure; patient-care supplies comprised 35.1%. Out of the 19,611 inpatients tested for COVID-19 in 2020, 727 (3.7%) had COVID-19. The total inpatient- and ICU-days for COVID-19 patients in 2020 were 8,009 and 8 days respectively. A decline in all hospital services were observed from February following a raised disease outbreak alert level; most services quickly resumed when the lockdown was lifted in June. CONCLUSION COVID-19 has led to increase in healthcare expenses and displacement in hospital services. Our findings are useful for informing economic evaluations of COVID-19 response and provide some information about the expected costs of future outbreaks.
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Affiliation(s)
- Yiying Cai
- Programme in Health Services & Systems Research, Duke-NUS Medical School, Singapore
| | - Samuel Kwek
- MD Programme, Duke-NUS Medical School, Singapore
| | - Sarah Sl Tang
- Department of Pharmacy, Singapore General Hospital, Singapore
| | | | - Elaine Lum
- Programme in Health Services & Systems Research, Duke-NUS Medical School, Singapore
| | - Sungwon Yoon
- Programme in Health Services & Systems Research, Duke-NUS Medical School, Singapore
| | - John P Ansah
- Programme in Health Services & Systems Research, Duke-NUS Medical School, Singapore
| | - David B Matchar
- Programme in Health Services & Systems Research, Duke-NUS Medical School, Singapore
| | - Andrea L Kwa
- Department of Pharmacy, Singapore General Hospital, Singapore; SingHealth Duke-NUS Medicine Academic Clinical Programme, Singapore; Emerging Infectious Diseases, Duke-NUS Medical School, Singapore
| | - Kwok Ann Ang
- Finance Department, Singapore General Hospital, Singapore
| | - Julian Thumboo
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
| | - Marcus Eh Ong
- Programme in Health Services & Systems Research, Duke-NUS Medical School, Singapore; Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Nicholas Graves
- Programme in Health Services & Systems Research, Duke-NUS Medical School, Singapore.
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23
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Muir KJ, Keim-Malpass J, LeBaron VT. Examining the cultural impacts of an emergency department move using ethnography. Int Emerg Nurs 2021; 59:101082. [PMID: 34763250 DOI: 10.1016/j.ienj.2021.101082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 08/24/2021] [Accepted: 09/08/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The purpose of this ethnographic study was to evaluate the cultural impacts of an emergency department (ED) move from an old to new physical space. METHOD Fieldwork was conducted over 14 months at an academic medical center ED in the United States. Primary data sources included participant observations and semistructured interviews. RESULTS Over 720 h of participant observation and semi-structured interviews (n = 39) with emergency nurse, non-nurse clinicians, and unit administrators were collected and analyzed. One cross-cutting theme, "decisional power," and three supporting themes "inadequate move preparation," "change fatigue," and "lack of change standardization" were identified. "Decisional power" was the perceived influence certain ED groups had making move-related decisions over others. "Change fatigue" described the impact of frequent change implementation on participants' work processes, well-being, and job satisfaction. "Lack of change standardization" described power differentials between nurses striving to standardize new move-related processes and physicians implementing work styles discordant with such processes. CONCLUSION Findings can inform recommendations for health care policy and organizational operations such as: 1) including frontline stakeholder perspectives in move-related decisions; 2) allocating adequate time for clinician/employee training/education in the pre-move period; 3) assessing clinician/employee well-being throughout move implementation; 4) increasing unit administrator sensitivity to clinician change fatigue.
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Affiliation(s)
- K Jane Muir
- University of Virginia School of Nursing, Charlottesville, VA 22903, USA.
| | - Jessica Keim-Malpass
- University of Virginia School of Medicine, Department of Pediatrics, Charlottesville, VA 22903, USA.
| | - Virginia T LeBaron
- University of Virginia School of Nursing, Department of Acute and Specialty Care, Charlottesville, VA 22903, USA.
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24
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Pal A, Ali A, Young TR, Oostenbrink J, Prabhakar A, Prabhakar A, Deacon N, Arnold A, Eltayeb A, Yap C, Young DM, Tang A, Lakshmanan S, Lim YY, Pokarowski M, Kakodkar P. Comprehensive literature review on the radiographic findings, imaging modalities, and the role of radiology in the COVID-19 pandemic. World J Radiol 2021; 13:258-282. [PMID: 34630913 PMCID: PMC8473437 DOI: 10.4329/wjr.v13.i9.258] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 03/28/2021] [Accepted: 08/04/2021] [Indexed: 02/06/2023] Open
Abstract
Since the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, over 103214008 cases have been reported, with more than 2231158 deaths as of January 31, 2021. Although the gold standard for diagnosis of this disease remains the reverse-transcription polymerase chain reaction of nasopharyngeal and oropharyngeal swabs, its false-negative rates have ignited the use of medical imaging as an important adjunct or alternative. Medical imaging assists in identifying the pathogenesis, the degree of pulmonary damage, and the characteristic features in each imaging modality. This literature review collates the characteristic radiographic findings of COVID-19 in various imaging modalities while keeping the preliminary focus on chest radiography, computed tomography (CT), and ultrasound scans. Given the higher sensitivity and greater proficiency in detecting characteristic findings during the early stages, CT scans are more reliable in diagnosis and serve as a practical method in following up the disease time course. As research rapidly expands, we have emphasized the CO-RADS classification system as a tool to aid in communicating the likelihood of COVID-19 suspicion among healthcare workers. Additionally, the utilization of other scoring systems such as MuLBSTA, Radiological Assessment of Lung Edema, and Brixia in this pandemic are reviewed as they integrate the radiographic findings into an objective scoring system to risk stratify the patients and predict the severity of disease. Furthermore, current progress in the utilization of artificial intelligence via radiomics is evaluated. Lastly, the lesson from the first wave and preparation for the second wave from the point of view of radiology are summarized.
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Affiliation(s)
- Aman Pal
- School of Medicine, National University of Ireland Galway, Galway H91 TK33, Galway, Ireland
| | - Abulhassan Ali
- School of Medicine, National University of Ireland Galway, Galway H91 TK33, Galway, Ireland
| | - Timothy R Young
- School of Medicine, National University of Ireland Galway, Galway H91 TK33, Galway, Ireland
| | - Juan Oostenbrink
- School of Medicine, National University of Ireland Galway, Galway H91 TK33, Galway, Ireland
| | - Akul Prabhakar
- School of Medicine, National University of Ireland Galway, Galway H91 TK33, Galway, Ireland
| | - Amogh Prabhakar
- School of Medicine, National University of Ireland Galway, Galway H91 TK33, Galway, Ireland
| | - Nina Deacon
- School of Medicine, National University of Ireland Galway, Galway H91 TK33, Galway, Ireland
| | - Amar Arnold
- School of Medicine, National University of Ireland Galway, Galway H91 TK33, Galway, Ireland
| | - Ahmed Eltayeb
- School of Medicine, National University of Ireland Galway, Galway H91 TK33, Galway, Ireland
| | - Charles Yap
- School of Medicine, National University of Ireland Galway, Galway H91 TK33, Galway, Ireland
| | - David M Young
- Department of Computer Science, Yale University, New Haven, CO 06520, United States
| | - Alan Tang
- Department of Health Science, Duke University, Durham, NC 27708, United States
| | - Subramanian Lakshmanan
- School of Medicine, National University of Ireland Galway, Galway H91 TK33, Galway, Ireland
| | - Ying Yi Lim
- School of Medicine, National University of Ireland Galway, Galway H91 TK33, Galway, Ireland
| | - Martha Pokarowski
- The Hospital for Sick Kids, University of Toronto, Toronto M5S, Ontario, Canada
| | - Pramath Kakodkar
- School of Medicine, National University of Ireland Galway, Galway H91 TK33, Galway, Ireland
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25
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Abd Wahab M, Safaai S, Mohd Saiboon I. Impact of a binary triage system and structural reorganization of emergency department on health care workers exposed to suspected COVID-19 patients-a single-centre analysis. Int J Emerg Med 2021; 14:59. [PMID: 34556031 PMCID: PMC8460200 DOI: 10.1186/s12245-021-00384-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 09/07/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND A binary triage system based on infectivity and facilitated by departmental restructuring was developed to manage suspected COVID-19 patients with an aim to provide effective prevention and control of infection among health care workers (HCWs) in the emergency department. This study analyses the effectiveness of the new triage system and structural reorganization in response to the COVID-19 pandemic. METHODS A cross-sectional observational study was conducted in the Emergency and Trauma Department, Hospital Kuala Lumpur (ETDHKL). The implementation of a binary triage system separates patients with risk of COVID-19 who present with fever and respiratory symptoms from other patients. Data on exposed HCWs to COVID-19 patients were captured pre-restructuring and post-restructuring of the emergency department and analysed using descriptive statistics. RESULTS A total of 846 HCWs were involved in this study. Pre-restructuring reported 542 HCWs exposed to COVID-19 patients while post-restructuring reported 122. Using the four categorical exposure risks for HCWs which are no identifiable risk, low risk, medium risk, and high risk, the number of HCWs exposed during pre-restructuring were 15(1.8%), 504 (59.6%), 15 (1.8%), and 8 (0.9%), respectively, while post-restructuring the numbers were 122 (14.4%), 8 (0.9%), 109 (12.9%), and 5 (0.1%), respectively. There was a 77.5% reduction in the number of exposed HCWs after our implementation of the new system (542 vs 122). CONCLUSION A binary triage system based on severity and infectivity and supported with structural reorganization can be effective in reducing HCWs COVID-19 exposure.
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Affiliation(s)
- Mahathar Abd Wahab
- Emergency and Trauma Department, Kuala Lumpur Hospital, Jalan Pahang, 50586, Kuala Lumpur, Malaysia
| | - Sufian Safaai
- Emergency and Trauma Department, Kuala Lumpur Hospital, Jalan Pahang, 50586, Kuala Lumpur, Malaysia.
| | - Ismail Mohd Saiboon
- Department of Emergency Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia (UKM), Jalan Yaacob Latif Bandar Tun Razak, Cheras, 56000, Kuala Lumpur, Malaysia
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Chhibber A, Kharat A, Kneale D, Welch V, Bangpan M, Chaiyakunapruk N. Assessment of health equity consideration in masking/PPE policies to contain COVID-19 using PROGRESS-plus framework: a systematic review. BMC Public Health 2021; 21:1682. [PMID: 34525995 PMCID: PMC8443429 DOI: 10.1186/s12889-021-11688-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/29/2021] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION There is increasing evidence that COVID-19 has unmasked the true magnitude of health inequity worldwide. Policies and guidance for containing the infection and reducing the COVID-19 related deaths have proven to be effective, however the extent to which health inequity factors were considered in these policies is rather unknown. The aim of this study is to measure the extent to which COVID-19 related policies reflect equity considerations by focusing on the global policy landscape around wearing masks and personal protection equipment (PPE). METHODS A systematic search for published documents on COVID-19 and masks/PPE was conducted across six databases: PubMed, EMBASE, CINAHL, ERIC, ASSIA and Psycinfo. Reviews, policy documents, briefs related to COVID-19 and masks/PPE were included in the review. To assess the extent of incorporation of equity in the policy documents, a guidance framework known as 'PROGRESS-Plus': Place of residence, Race/ethnicity, Occupation, Gender/sex, Religion, Education, Socioeconomic status, Social capital, Plus (age, disability etc.) was utilized. RESULTS This review included 212 policy documents. Out of 212 policy documents, 190 policy documents (89.62%) included at least one PROGRESS-plus component. Most of the policy documents (n = 163, 85.79%) focused on "occupation" component of the PROGRESS-plus followed by personal characteristics associated with discrimination (n = 4;2.11%), place of residence (n = 2;1.05%) and education (n = 1;0.53%). Subgroup analysis revealed that most of the policy documents (n = 176, 83.01%) were focused on "workers" such as healthcare workers, mortuary workers, school workers, transportation workers, essential workers etc. Of the remaining policy documents, most were targeted towards whole population (n = 30; 14.15%). Contrary to "worker focused" policy documents, most of the 'whole population focused' policy documents didn't have a PROGRESS-plus equity component rendering them equity limiting for the society. CONCLUSION Our review highlights even if policies considered health inequity during the design/implementation, this consideration was often one dimensional in nature. In addition, population wide policies should be carefully designed and implemented after identifying relevant equity related barriers in order to produce better outcomes for the whole society.
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Affiliation(s)
| | - Aditi Kharat
- School of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Dylan Kneale
- The Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre), UCL Social Research Institute, University College London, London, UK
| | - Vivian Welch
- Bruyere Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Mukdarut Bangpan
- The Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre), UCL Social Research Institute, University College London, London, UK
| | - Nathorn Chaiyakunapruk
- School of Pharmacy, University of Utah, Salt Lake City, UT, USA.
- School of Pharmacy, Monash University, Subang Jaya, Malaysia.
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Ahmad IA, Osei E. Occupational Health and Safety Measures in Healthcare Settings during COVID-19: Strategies for Protecting Staff, Patients and Visitors. Disaster Med Public Health Prep 2021; 17:e48. [PMID: 34517932 PMCID: PMC8523969 DOI: 10.1017/dmp.2021.294] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/21/2021] [Accepted: 09/05/2021] [Indexed: 02/07/2023]
Abstract
The COVID-19 (SARS-CoV-2) pandemic has profoundly impacted almost every aspect of healthcare systems worldwide, placing the health and safety of frontline healthcare workers at risk, and it still continues to remain an important public health challenge. Several hospitals have put in place strategies to manage space, staff, and supplies in order to continue to deliver optimum care to patients while at the same time protecting the health and safety of staff and patients. However, the emergence of the second and third waves of the virus with the influx of new cases continue to add an additional level of complexity to the already challenging situation of containing the spread and lowering the rate of transmission, thus pushing healthcare systems to the limit. In this narrative review paper, we describe various strategies including administrative controls, environmental controls, and use of personal protective equipment, implemented by occupational health and safety departments for the protection of healthcare workers, patients, and visitors from SARS-CoV-2 virus infection. The protection and safeguard of the health and safety of healthcare workers and patients through the implementation of effective infection control measures, adequate management of possible outbreaks and minimization of the risk of nosocomial transmission is an important and effective strategy of SARS-CoV-2 pandemic management in any healthcare facility. High quality patient care hinges on ensuring that the care providers are well protected and supported so they can provide the best quality of care to their patients.
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Affiliation(s)
- Isra Asma Ahmad
- Department of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Ernest Osei
- Department of Medical Physics, Grand River Regional Cancer Centre, Kitchener, ON, Canada
- Department of Physics and Astronomy, University of Waterloo, Waterloo, ON, Canada
- Department of Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ONCanada
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28
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Anand SV, Shuy YK, Lee PSS, Lee ES. One Year on: An Overview of Singapore's Response to COVID-19-What We Did, How We Fared, How We Can Move Forward. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9125. [PMID: 34501718 PMCID: PMC8431401 DOI: 10.3390/ijerph18179125] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 07/30/2021] [Accepted: 08/20/2021] [Indexed: 01/28/2023]
Abstract
Background-One year has passed since the first COVID-19 case in Singapore. This scoping review commemorates Singaporean researchers that have expanded the knowledge on this novel virus. We aim to provide an overview of healthcare-related articles published in peer-reviewed journals, authored by the Singapore research community about COVID-19 during the first year of the pandemic. Methods-This was reported using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) protocol. It included healthcare-related articles about COVID-19 published between 23 January 2020 and 22 January 2021 with a Singapore-affiliated author. MEDLINE, Embase, Scopus, Web of Science, CINAHL, PsycINFO, Google Scholar, and local journals were searched. The articles were screened independently by two reviewers. Results-The review included 504 articles. Most of the articles narrated the changes to hospital practice (210), while articles on COVID-19 pathology (94) formed most of the non-narrative papers. Publications on public health (61) and the indirect impacts to clinical outcomes (45) were other major themes explored by the research community. The remaining articles detailed the psychological impact of the pandemic (35), adaptations of medical education (30), and narratives of events (14). Conclusion-Amidst a resurgence of community cases involving variant COVID-19 strains, the resources from the research community will provide valuable guidance to navigate these uncertain times.
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Affiliation(s)
- S Vivek Anand
- Ministry of Health Holdings, Singapore 099253, Singapore;
| | - Yao Kang Shuy
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308207, Singapore;
| | - Poay Sian Sabrina Lee
- Clinical Research Unit, National Healthcare Group Polyclinics, Singapore 138543, Singapore;
| | - Eng Sing Lee
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308207, Singapore;
- Clinical Research Unit, National Healthcare Group Polyclinics, Singapore 138543, Singapore;
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29
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Choi A, Kim HY, Cho A, Noh J, Park I, Chung HS. Efficacy of a four-tier infection response system in the emergency department during the coronavirus disease-2019 outbreak. PLoS One 2021; 16:e0256116. [PMID: 34383840 PMCID: PMC8360518 DOI: 10.1371/journal.pone.0256116] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 07/31/2021] [Indexed: 12/23/2022] Open
Abstract
Introduction The coronavirus disease (COVID-19) pandemic has delayed the management of other serious medical conditions. This study presents an efficient method to prevent the degradation of the quality of diagnosis and treatment of other critical diseases during the pandemic. Methods We performed a retrospective observational study. The primary outcome was ED length of stay (ED LOS). The secondary outcomes were the door-to-balloon time in patients with suspected ST-segment elevation myocardial infarction and door-to-brain computed tomography time for patients with suspected stroke. The outcome measures were compared between patients who were treated in the red and orange zones designated as the changeable isolation unit and those who were treated in the non-isolation care unit. To control confounding factors, we performed propensity score matching, following which, outcomes were analyzed for non-inferiority. Results The mean ED LOS for hospitalized patients in the isolation and non-isolation care units were 406.5 min (standard deviation [SD], 237.9) and 360.2 min (SD, 226.4), respectively. The mean difference between the groups indicated non-inferiority of the isolation care unit (p = 0.037) but not in the patients discharged from the ED (p>0.999). The mean difference in the ED LOS for patients admitted to the ICU between the isolation and non-isolation care units was -22.0 min (p = 0.009). The mean difference in the door-to-brain computed tomography time between patients with suspected stroke in the isolation and non-isolation care units was 7.4 min for those with confirmed stroke (p = 0.013), and -20.1 min for those who were discharged (p = 0.012). The mean difference in the door-to-balloon time between patients who underwent coronary angiography in the isolation and non-isolation care units was -2.1 min (p<0.001). Conclusions Appropriate and efficient handling of a properly planned ED plays a key role in improving the quality of medical care for other critical diseases during the COVID-19 outbreak.
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Affiliation(s)
- Arom Choi
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Ha Yan Kim
- Department of Biomedical Systems Informatics, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea
| | - Ara Cho
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Jiyoung Noh
- Center for Disaster Relief, Training, and Research, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Incheol Park
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyun Soo Chung
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, South Korea
- Center for Disaster Relief, Training, and Research, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
- * E-mail:
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30
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Khajehnasiri F, Zaroushani V, Poursadeqiyan M. Macro ergonomics and health workers during the COVID-19 pandemic. Work 2021; 69:713-714. [PMID: 34180448 DOI: 10.3233/wor-210412] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Farahnaz Khajehnasiri
- Department of Community Medicine, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Vida Zaroushani
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Disease, Qazvin University of Medical Sciences, Qazvin, Iran.,Department of Occupational Health Engineering, Faculty of Health, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Mohsen Poursadeqiyan
- Social Determinants of Health Research Center, Ardabil University of Medical Sciences, Ardabil, Iran.,Department of Occupational Health Engineering, School of Health, Ardabil University of Medical Sciences, Ardabil, Iran
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Wee LE, Venkatachalam I, Sim XYJ, Tan KBK, Wen R, Tham CK, Gan WH, Ko KKK, Ho WQ, Kwek GTC, Conceicao EP, Sng CYE, Ng XHJ, Ong JY, Chiang JL, Chua YY, Ling ML, Tan TT, Wijaya L. Containment of COVID-19 and reduction in healthcare-associated respiratory viral infections through a multi-tiered infection control strategy. Infect Dis Health 2021; 26:123-131. [PMID: 33386294 PMCID: PMC7667403 DOI: 10.1016/j.idh.2020.11.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 11/06/2020] [Accepted: 11/08/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND During the ongoing COVID-19 pandemic, healthcare-associated transmission of respiratory viral infections (RVI) is a concern. To reduce the impact of SARS-CoV-2 and other respiratory viruses on patients and healthcare workers (HCWs) we devised and evaluated a multi-tiered infection control strategy with the goal of preventing nosocomial transmission of SARS-CoV2 and other RVIs across a large healthcare campus. METHODS From January-June 2020, a multi-tiered infection control strategy was implemented across a healthcare campus in Singapore, comprising the largest acute tertiary hospital as well as four other subspecialty centres, with more than 10,000 HCWs. Drawing on our institution's experience with an outbreak of Severe Acute Respiratory Syndrome (SARS) in 2003, this strategy included improved patient segregation and distancing, and heightened infection prevention and control (IPC) measures including universal masking. All symptomatic patients were tested for COVID-19 and common RVIs. RESULTS A total of 16,162 admissions campus-wide were screened; 7.1% (1155/16,162) tested positive for COVID-19. Less than 5% of COVID-19 cases (39/1155) were initially detected outside of isolation wards in multi-bedded cohorted wards. Improved distancing and enhanced IPC measures successfully mitigated onward spread even amongst COVID-19 cases detected outside of isolation. COVID-19 rates amongst HCWs were kept low (0.13%, 17/13,066) and reflected community acquisition rather than nosocomial spread. Rates of healthcare-associated-RVI amongst inpatients fell to zero and this decrease was sustained even after the lifting of visitor restrictions. CONCLUSION This multi-tiered infection control strategies can be implemented at-scale to successfully mitigate healthcare-associated transmission of respiratory viral pathogens.
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Affiliation(s)
- Liang En Wee
- Singhealth Infectious Diseases Residency, Singapore; Department of Infectious Diseases, Singapore General Hospital, Singapore.
| | - Indumathi Venkatachalam
- Department of Infectious Diseases, Singapore General Hospital, Singapore; Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Xiang Ying Jean Sim
- Department of Infectious Diseases, Singapore General Hospital, Singapore; Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | | | - Ruan Wen
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Chee Kian Tham
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Wee Hoe Gan
- Department of Occupational and Environmental Medicine, Singapore General Hospital, Singapore
| | - Kwan Ki Karrie Ko
- Molecular Laboratory, Department of Pathology, Singapore General Hospital, Singapore
| | - Wan Qi Ho
- Division of Medicine, Singapore General Hospital, Singapore
| | | | - Edwin Philip Conceicao
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Chong Yu Edwin Sng
- Singhealth Infectious Diseases Residency, Singapore; Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - Xin Hui Jorin Ng
- Division of Preparedness and Response, Singapore General Hospital, Singapore
| | - Jie Yi Ong
- Division of Preparedness and Response, Singapore General Hospital, Singapore
| | - Juat Lan Chiang
- Division of Nursing, Singapore General Hospital, Singapore; Department of Facilities and Infrastructure Development, Singapore General Hospital, Singapore
| | - Ying Ying Chua
- Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - Moi Lin Ling
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Thuan Tong Tan
- Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - Limin Wijaya
- Department of Infectious Diseases, Singapore General Hospital, Singapore
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Chen JYH, Chang FY, Lin CS, Wang CH, Tsai SH, Lee CC, Chen SJ. Impact of the COVID-19 Pandemic on the Loading and Quality of an Emergency Department in Taiwan: Enlightenment from a Low-Risk Country in a Public Health Crisis. J Clin Med 2021; 10:jcm10061150. [PMID: 33801792 PMCID: PMC7999504 DOI: 10.3390/jcm10061150] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/07/2021] [Accepted: 03/08/2021] [Indexed: 02/07/2023] Open
Abstract
The impact of the coronavirus disease 2019 (COVID-19) pandemic on health-care quality in the emergency department (ED) in countries with a low risk is unclear. This study aimed to explore the effects of the COVID-19 pandemic on ED loading, quality of care, and patient prognosis. Data were retrospectively collected from 1 January 2018 to 30 September 2020 at the ED of Tri-service general hospital. Analyses included day-based ED loading, quality of care, and patient prognosis. Data on triage assessment, physiological states, disease history, and results of laboratory tests were collected and analyzed. The number of daily visits significantly decreased after the pandemic, leading to a reduction in the time to examination. Admitted patients benefitted from the pandemic with a reduction of 0.80 h in the length of stay in the ED, faster discharge without death, and reduced re-admission. However, non-admitted visits with chest pain increased the risk of mortality after the pandemic. In conclusion, the COVID-19 pandemic led to a significant reduction in low-acuity ED visits and improved prognoses for hospitalized patients. However, clinicians should be alert about patients with chest pain due to their increased risk of mortality in subsequent admission.
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Affiliation(s)
- Jamie Yu-Hsuan Chen
- Medical Informatics Office, Tri-Service General Hospital, National Defense Medical Center, Taipei City 11490, Taiwan;
- School of Public Health, National Defense Medical Center, Taipei City 11490, Taiwan
| | - Feng-Yee Chang
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei City 11490, Taiwan;
| | - Chin-Sheng Lin
- Division of Cardiology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei City 11490, Taiwan;
| | - Chih-Hung Wang
- Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei City 11490, Taiwan;
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei City 11490, Taiwan
| | - Shih-Hung Tsai
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei City 11490, Taiwan;
| | - Chia-Cheng Lee
- Medical Informatics Office, Tri-Service General Hospital, National Defense Medical Center, Taipei City 11490, Taiwan;
- Division of Colorectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei City 11490, Taiwan
- Correspondence: (C.-C.L.); (S.-J.C.)
| | - Sy-Jou Chen
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei City 11490, Taiwan;
- Graduate Institute of Injury Prevention and Control, College of Public Health and Nutrition, Taipei Medical University, Taipei City 11490, Taiwan
- Correspondence: (C.-C.L.); (S.-J.C.)
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Nadarajan GD, Omar E, Abella BS, Hoe PS, Do Shin S, Ma MHM, Ong MEH. A conceptual framework for Emergency department design in a pandemic. Scand J Trauma Resusc Emerg Med 2020; 28:118. [PMID: 33334364 PMCID: PMC7745175 DOI: 10.1186/s13049-020-00809-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/24/2020] [Indexed: 12/12/2022] Open
Abstract
Background The current COVID-19 pandemic is highlighting gaps around the world in the design and workflow of Emergency Departments (ED). These gaps have an impact on both patient care and staff safety and represent a risk to public health. There is a need for a conceptual framework to guide ED design and workflow to address these challenges. Such a framework is important as the ED environment will always remain vulnerable to infectious diseases outbreaks in the future. Aims This paper aims to address issues and principles around ED design and workflow amidst the COVID-19 pandemic. We propose a conceptual framework and checklist for EDs to be prepared for future outbreaks as well. Methods A scoping literature review was conducted, of the experiences of EDs in managing outbreaks such as SARS, H1N1 and COVID-19. The combined experiences of the authors and the experiences from the literature were grouped under common themes to develop the conceptual framework. Results Four key principles were derived- (1) situational awareness, surveillance and perimeter defence, (2) ED staff protection, (3) surge capacity management and (4) ED recovery. The findings were integrated in a proposed conceptual framework to guide ED design in response to an infectious disease outbreak. There are various elements which need to be considered at ED input, throughput and output. These elements can be categorised into (1) system (workflow, protocols and communication), (2) staff (human resources), (3) space (infrastructure), and (4) supply (logistics) and are placed in a checklist for pragmatic use. Conclusion The ED needs to be in a constant state of preparedness. A framework can be useful to guide ED design and workflow to achieve this. As all ED systems are different with varying capabilities, our framework may help EDs across the world prepare for infectious disease outbreaks.
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Affiliation(s)
- Gayathri Devi Nadarajan
- Department of Emergency Medicine, Singapore General Hospital, 1 Outram Road, Singapore City, 169608, Singapore.
| | - Eunizar Omar
- Department of Emergency Medicine, Sengkang General Hospital, Sengkang, Singapore
| | - Benjamin S Abella
- Center for Resuscitation Science and Department of Emergency Medicine, University of Pennsylvania, Philadelphia, USA
| | - Pei Shan Hoe
- Duke-NUS Graduate Medical School, Singapore City, Singapore
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Matthew Huei-Ming Ma
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei City, Taiwan.,Department of Emergency Medicine, National Taiwan University Hospital Yunlin Branch, Douliou City, Taiwan
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, 1 Outram Road, Singapore City, 169608, Singapore.,Health Services and Systems Research (HSSR), Duke-NUS Medical School, Singapore City, Singapore
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34
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Tan BS, Dunnick NR, Gangi A, Goergen S, Jin ZY, Neri E, Nomura CH, Pitcher RD, Yee J, Mahmood U. RSNA International Trends: A Global Perspective on the COVID-19 Pandemic and Radiology in Late 2020. Radiology 2020; 299:E193-E203. [PMID: 33289616 PMCID: PMC7734846 DOI: 10.1148/radiol.2020204267] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The coronavirus disease 2019 pandemic has challenged and changed health care systems around the world. There has been a heterogeneity of disease burden, health care resources, and nonimaging testing availability, both geographically and over time. In parallel, there has been a continued increase in understanding how the disease affects patients, effectiveness of therapeutic options, and factors that modulate transmission risk. In this report, radiology experts in representative countries from around the world share insights gained from local experience. These insights provide a guidepost to help address management challenges as cases continue to rise in many parts of the world and suggest modifications in workflow that are likely to continue after this pandemic subsides.
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Affiliation(s)
- Bien Soo Tan
- From the Department of Vascular and Interventional Radiology, Singapore General Hospital, 20 College Rd, Academia Level 4, Singapore 169856 (B.S.T.); Department of Radiology, University of Michigan Medical Center, Ann Arbor, Mich (N.R.D.); Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France (A.G.); Department of Imaging, School of Clinical Sciences, Monash University, Clayton, Australia (S.G.); Department of Radiology, Peking Union Medical College Hospital, Beijing, China (Z.Y.J.); Department of Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy (E.N.); Department of Radiology, Hospital Sírio-Libanês, University of São Paulo, São Paulo, Brazil (C.H.N.); Department of Medical Imaging and Clinical Oncology, Stellenbosch University, Cape Town, South Africa (R.D.P.); Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY (J.Y.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (U.M.)
| | - N Reed Dunnick
- From the Department of Vascular and Interventional Radiology, Singapore General Hospital, 20 College Rd, Academia Level 4, Singapore 169856 (B.S.T.); Department of Radiology, University of Michigan Medical Center, Ann Arbor, Mich (N.R.D.); Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France (A.G.); Department of Imaging, School of Clinical Sciences, Monash University, Clayton, Australia (S.G.); Department of Radiology, Peking Union Medical College Hospital, Beijing, China (Z.Y.J.); Department of Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy (E.N.); Department of Radiology, Hospital Sírio-Libanês, University of São Paulo, São Paulo, Brazil (C.H.N.); Department of Medical Imaging and Clinical Oncology, Stellenbosch University, Cape Town, South Africa (R.D.P.); Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY (J.Y.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (U.M.)
| | - Afshin Gangi
- From the Department of Vascular and Interventional Radiology, Singapore General Hospital, 20 College Rd, Academia Level 4, Singapore 169856 (B.S.T.); Department of Radiology, University of Michigan Medical Center, Ann Arbor, Mich (N.R.D.); Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France (A.G.); Department of Imaging, School of Clinical Sciences, Monash University, Clayton, Australia (S.G.); Department of Radiology, Peking Union Medical College Hospital, Beijing, China (Z.Y.J.); Department of Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy (E.N.); Department of Radiology, Hospital Sírio-Libanês, University of São Paulo, São Paulo, Brazil (C.H.N.); Department of Medical Imaging and Clinical Oncology, Stellenbosch University, Cape Town, South Africa (R.D.P.); Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY (J.Y.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (U.M.)
| | - Stacy Goergen
- From the Department of Vascular and Interventional Radiology, Singapore General Hospital, 20 College Rd, Academia Level 4, Singapore 169856 (B.S.T.); Department of Radiology, University of Michigan Medical Center, Ann Arbor, Mich (N.R.D.); Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France (A.G.); Department of Imaging, School of Clinical Sciences, Monash University, Clayton, Australia (S.G.); Department of Radiology, Peking Union Medical College Hospital, Beijing, China (Z.Y.J.); Department of Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy (E.N.); Department of Radiology, Hospital Sírio-Libanês, University of São Paulo, São Paulo, Brazil (C.H.N.); Department of Medical Imaging and Clinical Oncology, Stellenbosch University, Cape Town, South Africa (R.D.P.); Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY (J.Y.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (U.M.)
| | - Zheng-Yu Jin
- From the Department of Vascular and Interventional Radiology, Singapore General Hospital, 20 College Rd, Academia Level 4, Singapore 169856 (B.S.T.); Department of Radiology, University of Michigan Medical Center, Ann Arbor, Mich (N.R.D.); Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France (A.G.); Department of Imaging, School of Clinical Sciences, Monash University, Clayton, Australia (S.G.); Department of Radiology, Peking Union Medical College Hospital, Beijing, China (Z.Y.J.); Department of Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy (E.N.); Department of Radiology, Hospital Sírio-Libanês, University of São Paulo, São Paulo, Brazil (C.H.N.); Department of Medical Imaging and Clinical Oncology, Stellenbosch University, Cape Town, South Africa (R.D.P.); Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY (J.Y.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (U.M.)
| | - Emanuele Neri
- From the Department of Vascular and Interventional Radiology, Singapore General Hospital, 20 College Rd, Academia Level 4, Singapore 169856 (B.S.T.); Department of Radiology, University of Michigan Medical Center, Ann Arbor, Mich (N.R.D.); Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France (A.G.); Department of Imaging, School of Clinical Sciences, Monash University, Clayton, Australia (S.G.); Department of Radiology, Peking Union Medical College Hospital, Beijing, China (Z.Y.J.); Department of Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy (E.N.); Department of Radiology, Hospital Sírio-Libanês, University of São Paulo, São Paulo, Brazil (C.H.N.); Department of Medical Imaging and Clinical Oncology, Stellenbosch University, Cape Town, South Africa (R.D.P.); Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY (J.Y.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (U.M.)
| | - Cesar Higa Nomura
- From the Department of Vascular and Interventional Radiology, Singapore General Hospital, 20 College Rd, Academia Level 4, Singapore 169856 (B.S.T.); Department of Radiology, University of Michigan Medical Center, Ann Arbor, Mich (N.R.D.); Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France (A.G.); Department of Imaging, School of Clinical Sciences, Monash University, Clayton, Australia (S.G.); Department of Radiology, Peking Union Medical College Hospital, Beijing, China (Z.Y.J.); Department of Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy (E.N.); Department of Radiology, Hospital Sírio-Libanês, University of São Paulo, São Paulo, Brazil (C.H.N.); Department of Medical Imaging and Clinical Oncology, Stellenbosch University, Cape Town, South Africa (R.D.P.); Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY (J.Y.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (U.M.)
| | - R D Pitcher
- From the Department of Vascular and Interventional Radiology, Singapore General Hospital, 20 College Rd, Academia Level 4, Singapore 169856 (B.S.T.); Department of Radiology, University of Michigan Medical Center, Ann Arbor, Mich (N.R.D.); Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France (A.G.); Department of Imaging, School of Clinical Sciences, Monash University, Clayton, Australia (S.G.); Department of Radiology, Peking Union Medical College Hospital, Beijing, China (Z.Y.J.); Department of Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy (E.N.); Department of Radiology, Hospital Sírio-Libanês, University of São Paulo, São Paulo, Brazil (C.H.N.); Department of Medical Imaging and Clinical Oncology, Stellenbosch University, Cape Town, South Africa (R.D.P.); Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY (J.Y.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (U.M.)
| | - Judy Yee
- From the Department of Vascular and Interventional Radiology, Singapore General Hospital, 20 College Rd, Academia Level 4, Singapore 169856 (B.S.T.); Department of Radiology, University of Michigan Medical Center, Ann Arbor, Mich (N.R.D.); Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France (A.G.); Department of Imaging, School of Clinical Sciences, Monash University, Clayton, Australia (S.G.); Department of Radiology, Peking Union Medical College Hospital, Beijing, China (Z.Y.J.); Department of Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy (E.N.); Department of Radiology, Hospital Sírio-Libanês, University of São Paulo, São Paulo, Brazil (C.H.N.); Department of Medical Imaging and Clinical Oncology, Stellenbosch University, Cape Town, South Africa (R.D.P.); Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY (J.Y.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (U.M.)
| | - Umar Mahmood
- From the Department of Vascular and Interventional Radiology, Singapore General Hospital, 20 College Rd, Academia Level 4, Singapore 169856 (B.S.T.); Department of Radiology, University of Michigan Medical Center, Ann Arbor, Mich (N.R.D.); Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France (A.G.); Department of Imaging, School of Clinical Sciences, Monash University, Clayton, Australia (S.G.); Department of Radiology, Peking Union Medical College Hospital, Beijing, China (Z.Y.J.); Department of Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy (E.N.); Department of Radiology, Hospital Sírio-Libanês, University of São Paulo, São Paulo, Brazil (C.H.N.); Department of Medical Imaging and Clinical Oncology, Stellenbosch University, Cape Town, South Africa (R.D.P.); Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY (J.Y.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (U.M.)
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Lapić I, Komljenović S, Knežević J, Rogić D. COVID-19 Pandemic Once Again Exposes the Weakest Link in Laboratory Services: Specimen Delivery. Lab Med 2020; 51:e83-e86. [PMID: 32929507 PMCID: PMC7543418 DOI: 10.1093/labmed/lmaa081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Objective Reorganization of the emergency department (ED) during the COVID-19 pandemic implied closure of the ED-dedicated laboratory and manual transport of all specimens to the dislocated central laboratory. The impact of such reorganization on laboratory turnaround time (TAT) was examined. Methods The TAT from blood sampling to specimen reception (TAT1), from specimen reception to test reporting (TAT2), and from sampling to test reporting (TAT3) were compared between the pandemic peak month in 2020 and the same month in 2019. We evaluated whether TAT2 fulfills the recommended 60-minute criteria. Results A statistically significant difference was observed for all comparisons (P <.001), with TAT1 prominently contributing to TAT3 prolongation (from 48 minutes to 108 minutes) and exceeding the recommended 60-minute criteria. The TAT2 was extended from 33 minutes to 49 minutes. Conclusion An ED reorganization compromised the usual laboratory services for patients in the ED, with manual specimen delivery being the main cause for TAT prolongation.
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Affiliation(s)
- Ivana Lapić
- Department of Laboratory Diagnostics, University Hospital Center Zagreb, Zagreb, Croatia
| | - Sven Komljenović
- Department of Laboratory Diagnostics, University Hospital Center Zagreb, Zagreb, Croatia
| | - Josip Knežević
- Department of Laboratory Diagnostics, University Hospital Center Zagreb, Zagreb, Croatia
| | - Dunja Rogić
- Department of Laboratory Diagnostics, University Hospital Center Zagreb, Zagreb, Croatia
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Llorente-Parrado C, Mejon-Berges R, Cossio-Gil Y, Romea-Lecumberri MS, Roman-Broto A, Barba-Flores MA, Salazar-Soler A. [Assessment model for evaluating the preparedness plan for COVID-19 in a tertiary care hospital]. J Healthc Qual Res 2020; 35:339-347. [PMID: 33127345 PMCID: PMC7547629 DOI: 10.1016/j.jhqr.2020.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/01/2020] [Accepted: 10/01/2020] [Indexed: 11/25/2022]
Abstract
Antecedentes y objetivo Durante la primera onda epidémica del SARS-CoV-2, los hospitales han soportado una importante presión asistencial. Este escenario de incertidumbre, baja evidencia científica y medios insuficientes ha generado una importante variabilidad de la práctica entre diferentes centros sanitarios. En este contexto, planteamos desarrollar un modelo basado en estándares para la evaluación del sistema de preparación y respuesta frente a la COVID-19 en un hospital terciario. Materiales y métodos El estudio se llevó a cabo en el Hospital Universitario Vall d’Hebron de Barcelona en dos fases: 1) desarrollo de modelo de estándares mediante revisión narrativa de la literatura, análisis de planes y protocolos del hospital, método Delphi por profesionales expertos y plan de actualización y 2) validación de aplicabilidad y utilidad del modelo mediante autoevaluación y auditoría. Resultados El modelo consta de 208 estándares distribuidos en nueve criterios: liderazgo y estrategia; prevención y control de la infección; gestión de profesionales y competencias; áreas públicas comunes; áreas asistenciales; áreas de apoyo asistencial; logística, tecnología y obras; comunicación y atención al paciente; sistemas de información e investigación. La evaluación alcanza un 85,2% de cumplimiento, y se identifican 42 áreas de mejora y 96 buenas prácticas. Conclusiones La implementación de un modelo basado en estándares es útil para identificar áreas de mejora y buenas prácticas en los planes de preparación y respuesta frente a la COVID-19 en un hospital. En el actual contexto, proponemos la conveniencia de adaptar esta metodología a otros ámbitos de atención sanitaria no hospitalaria o de salud pública.
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Affiliation(s)
- C Llorente-Parrado
- Dirección de Sistemas de Información, Unidad de Apoyo a las Acreditaciones, Hospital Universitario Vall d'Hebron, Barcelona, España; Grupo de investigación en Servicios Sanitarios, Hospital Universitario Vall d'Hebron, Barcelona, España.
| | - R Mejon-Berges
- Dirección de Sistemas de Información, Unidad de Apoyo a las Acreditaciones, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - Y Cossio-Gil
- Dirección de Sistemas de Información, Unidad de Apoyo a las Acreditaciones, Hospital Universitario Vall d'Hebron, Barcelona, España; Grupo de investigación en Servicios Sanitarios, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - M S Romea-Lecumberri
- Grupo de investigación en Servicios Sanitarios, Hospital Universitario Vall d'Hebron, Barcelona, España; Dirección de Procesos, Calidad e Innovación, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - A Roman-Broto
- Grupo de investigación en Servicios Sanitarios, Hospital Universitario Vall d'Hebron, Barcelona, España; Dirección Asistencial, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - M A Barba-Flores
- Dirección de Enfermería, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - A Salazar-Soler
- Grupo de investigación en Servicios Sanitarios, Hospital Universitario Vall d'Hebron, Barcelona, España; Dirección Gerencia, Hospital Universitario Vall d'Hebron, Barcelona, España
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