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Karwa ML, Naqvi AA, Betchen M, Puri AK. In-Hospital Triage. Crit Care Clin 2024; 40:533-548. [PMID: 38796226 DOI: 10.1016/j.ccc.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2024]
Abstract
The intensive care unit (ICU) is a finite and expensive resource with demand not infrequently exceeding capacity. Understanding ICU capacity strain is essential to gain situational awareness. Increased capacity strain can influence ICU triage decisions, which rely heavily on clinical judgment. Having an admission and triage protocol with which clinicians are very familiar can mitigate difficult, inappropriate admissions. This article reviews these concepts and methods of in-hospital triage.
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Affiliation(s)
- Manoj L Karwa
- Division of Critical Care Medicine, Albert Einstein College of Medicine / Montefiore Medical Center, Weiler Hospital, 4th Floor, 1825 Eastchester Road, Bronx, NY 10461, USA.
| | - Ali Abbas Naqvi
- Division of Critical Care Medicine, Albert Einstein College of Medicine / Montefiore Medical Center, Moses Division, 111 East 210th Street, Gold Zone (Main Floor), Bronx, NY 10467, USA
| | - Melanie Betchen
- Division of Critical Care Medicine, Albert Einstein College of Medicine / Montefiore Medical Center, Moses Division, 111 East 210th Street, Gold Zone (Main Floor), Bronx, NY 10467, USA
| | - Ajay Kumar Puri
- Division of Critical Care Medicine, Albert Einstein College of Medicine / Montefiore Medical Center, Moses Division, 111 East 210th Street, Gold Zone (Main Floor), Bronx, NY 10467, USA
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Nates JL, Oropello JM, Badjatia N, Beilman G, Coopersmith CM, Halpern NA, Herr DL, Jacobi J, Kahn R, Leung S, Puri N, Sen A, Pastores SM. Flow-Sizing Critical Care Resources. Crit Care Med 2023; 51:1552-1565. [PMID: 37486677 PMCID: PMC11192408 DOI: 10.1097/ccm.0000000000005967] [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: 07/25/2023]
Abstract
OBJECTIVES To describe the factors affecting critical care capacity and how critical care organizations (CCOs) within academic centers in the U.S. flow-size critical care resources under normal operations, strain, and surge conditions. DATA SOURCES PubMed, federal agency and American Hospital Association reports, and previous CCO survey results were reviewed. STUDY SELECTION Studies and reports of critical care bed capacity and utilization within CCOs and in the United States were selected. DATA EXTRACTION The Academic Leaders in the Critical Care Medicine Task Force established regular conference calls to reach a consensus on the approach of CCOs to "flow-sizing" critical care services. DATA SYNTHESIS The approach of CCOs to "flow-sizing" critical care is outlined. The vertical (relation to institutional resources, e.g., space allocation, equipment, personnel redistribution) and horizontal (interdepartmental, e.g., emergency department, operating room, inpatient floors) integration of critical care delivery (ICUs, rapid response) for healthcare organizations and the methods by which CCOs flow-size critical care during normal operations, strain, and surge conditions are described. The advantages, barriers, and recommendations for the rapid and efficient scaling of critical care operations via a CCO structure are explained. Comprehensive guidance and resources for the development of "flow-sizing" capability by a CCO within a healthcare organization are provided. CONCLUSIONS We identified and summarized the fundamental principles affecting critical care capacity. The taskforce highlighted the advantages of the CCO governance model to achieve rapid and cost-effective "flow-sizing" of critical care services and provide recommendations and resources to facilitate this capability. The relevance of a comprehensive approach to "flow-sizing" has become particularly relevant in the wake of the latest COVID-19 pandemic. In light of the growing risks of another extreme epidemic, planning for adequate capacity to confront the next critical care crisis is urgent.
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Affiliation(s)
- Joseph L Nates
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | | | | | | | | | | | - Nitin Puri
- Cooper University Health Care, Camden, NJ
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Ravi SJ, Potter CM, Paina L, Merritt MW. Post-epidemic health system recovery: A comparative case study analysis of routine immunization programs in the Republics of Haiti and Liberia. PLoS One 2023; 18:e0292793. [PMID: 37847680 PMCID: PMC10581452 DOI: 10.1371/journal.pone.0292793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 09/28/2023] [Indexed: 10/19/2023] Open
Abstract
Large-scale epidemics in resource-constrained settings disrupt delivery of core health services, such as routine immunization. Rebuilding and strengthening routine immunization programs following epidemics is an essential step toward improving vaccine equity and averting future outbreaks. We performed a comparative case study analysis of routine immunization program recovery in Liberia and Haiti following the 2014-16 West Africa Ebola epidemic and 2010s cholera epidemic, respectively. First, we triangulated data between the peer-reviewed and grey literature; in-depth key informant interviews with subject matter experts; and quantitative metrics of population health and health system functioning. We used these data to construct thick descriptive narratives for each case. Finally, we performed a cross-case comparison by applying a thematic matrix based on the Essential Public Health Services framework to each case narrative. In Liberia, post-Ebola routine immunization coverage surpassed pre-epidemic levels, a feat attributable to investments in surveillance, comprehensive risk communication, robust political support for and leadership around immunization, and strong public-sector recovery planning. Recovery efforts in Haiti were fragmented across a broad range of non-governmental agencies. Limitations in funding, workforce development, and community engagement further impeded vaccine uptake. Consequently, Haiti reported significant disparities in subnational immunization coverage following the epidemic. This study suggests that embedding in-country expertise within outbreak response structures, respecting governmental autonomy, aligning post-epidemic recovery plans and policies, and integrating outbreak response assets into robust systems of primary care contribute to higher, more equitable levels of routine immunization coverage in resource-constrained settings recovering from epidemics.
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Affiliation(s)
- Sanjana J. Ravi
- The Johns Hopkins Center for Health Security, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Christina M. Potter
- The Johns Hopkins Center for Health Security, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Ligia Paina
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Maria W. Merritt
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Johns Hopkins Berman Institute of Bioethics, Baltimore, Maryland, United States of America
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Post ER, Sethi R, Adeniji AA, Lee CJ, Shea S, Metcalf R, Gaynes J, Tripp K, Kirsch TD. A Multisite Investigation of Areas for Improvement in COVID-19 Surge Capacity Management. Health Secur 2023; 21:333-340. [PMID: 37552816 PMCID: PMC10541923 DOI: 10.1089/hs.2023.0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/20/2023] [Accepted: 05/01/2023] [Indexed: 08/10/2023] Open
Abstract
The congressionally authorized National Disaster Medical System Pilot Program was created in December 2019 to strengthen the medical surge capability, capacity, and interoperability of affiliated healthcare facilities in 5 regions across the United States. The COVID-19 pandemic provided an unprecedented opportunity to learn how participating healthcare facilities handled medical surge events during an active public health emergency. We applied a modified version of the Barbisch and Koenig 4-S framework (staff, stuff, space, systems) to analyze COVID-19 surge management practices implemented by healthcare stakeholders at 5 pilot sites. In total, 32 notable practices were identified to increase surge capacity during the COVID-19 pandemic that have potential applications for other healthcare facilities. We found that systems was the most prevalent domain of surge capacity among the identified practices. Systems and staff were discussed across all 5 pilot sites and were the 2 domains co-occurring most often within each surge management practice. These results can inform strategies for scaling up and optimizing medical surge capability, capacity, and interoperability of healthcare facilities nationwide. This study also specifies areas of surge capacity worthy of strategic focus in the pilot's planning and implementation efforts while more broadly informing the US healthcare system's response to future large-scale, medical surge events.
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Affiliation(s)
- Emily R. Post
- Emily R. Post, PhD, is a Research Associate, at The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, supporting The National Center for Disaster Medicine and Public Health, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Reena Sethi
- Reena Sethi, DrPH, MHS, is a Senior Public Health Lead Researcher, at The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, supporting The National Center for Disaster Medicine and Public Health, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Adeteju A. Adeniji
- Adeteju A. Adeniji, MPH, is a Research Project Administrator, at The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, supporting The National Center for Disaster Medicine and Public Health, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Clark J. Lee
- Clark J. Lee, JD, MPH, is a Research Associate, at The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, supporting The National Center for Disaster Medicine and Public Health, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Sophia Shea
- Sophia Shea, MPH, is a Project Manager, Global Center for Health Security, University of Nebraska Medical Center, Omaha, NE
| | - Rebecca Metcalf
- Rebecca Metcalf, MPP, is a Senior Manager, Deloitte Consulting LPP, Arlington, VA
| | - Jamie Gaynes
- Jamie Gaynes, MPH, is a Manager, Deloitte Consulting LPP, Boston, MA
| | - Kila Tripp
- Kila Tripp is a Consultant, Deloitte Consulting LPP, Arlington, VA
| | - Thomas D. Kirsch
- Thomas D. Kirsch, MD, MPH, FACEP, was Director (Retired), at The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, supporting The National Center for Disaster Medicine and Public Health, Uniformed Services University of the Health Sciences, Bethesda, MD
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Yan X, Barbero F, Wunderlich R. [Preparing for Pandemics]. Anasthesiol Intensivmed Notfallmed Schmerzther 2023; 58:348-361. [PMID: 37385241 DOI: 10.1055/a-1972-1623] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
The current COVID-19 pandemic has contributed to millions of deaths globally and it is estimated that the hit to the global economy could reach more than twelve trillion US-dollars. Disease outbreaks have often pushed weak health systems to a breaking point, as witnessed during cholera, Ebola and Zika virus upsurges. The preparation of a plan involves the analysis of a scenario divided into the disaster cycle's four phases: preparation, response, recovery, and mitigation. Several levels of planning are recognised according to the goals to be reached: strategic plans are directed to define the organisational context and overall aims, operational plans with putting the strategy into place, tactical plans explain how resources will be allocated and managed, as well as provide essential instructions to the responders. The hospital surge capacity relies on the reorganisation of resources according to four categories: system, staff, stuff (supplies), and space. Each of these components needs to be analysed, implemented, and tested during the preparation phase to reduce the occurrence of a critical overrun of the response capabilities, as this will trigger the recourse of contingency plans. The response to pandemics must be associated with public health and social measures, as well as with initiatives to support the psycho-physical health of healthcare workers.
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McConnell P, Einav S. Resource allocation. Curr Opin Anaesthesiol 2023; 36:246-251. [PMID: 36815516 DOI: 10.1097/aco.0000000000001254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
PURPOSE OF REVIEW The coronavirus disease 2019 pandemic and recent global recessions have brought to the forefront of the medical-political discussion the fact that medical resources are finite and have focused a spotlight on fair allocation and prioritization of healthcare resources describe why this review is timely and relevant. RECENT FINDINGS This review presents past and present concepts related to the ethics of resource allocation. Included are discussions regarding the topics of who should determine resource allocation, what types of research require allocation, methods currently in use to determine what resources are appropriate and which should be prioritized.describe the main themes in the literature covered by the article. SUMMARY Models for resource allocation must differentiate between different types of resources, some of which may require early preparation or distribution. Local availability of specific resources, supplies and infrastructure must be taken into consideration during preparation. When planning for long durations of limited resource availability, the limitations of human resilience must also be considered. Preparation also requires information regarding the needs of the specific population at hand (e.g. age distributions, disease prevalence) and societal preferences must be acknowledged within possible limits.
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Affiliation(s)
- Paul McConnell
- Department of Anaesthesia and Critical Care, Royal Alexandra Hospital, Paisley, UK
| | - Sharon Einav
- Surgical ICU, Shaare Zedek Medical Centre and Hebrew University Faculty of Medicine, Jerusalem, Israel
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Phattharapornjaroen P, Carlström E, Holmqvist LD, Sittichanbuncha Y, Khorram-Manesh A. Assessing Thai Hospitals’ Evacuation Preparedness Using the Flexible Surge Capacity Concept and Its Collaborative Tool. INTERNATIONAL JOURNAL OF DISASTER RISK SCIENCE 2023; 14:52-63. [PMCID: PMC9930065 DOI: 10.1007/s13753-023-00468-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/27/2023] [Indexed: 08/16/2023]
Abstract
According to the concept of “flexible surge capacity,” hospitals may need to be evacuated on two occasions: (1) when they are exposed to danger, such as in war; and (2) when they are contaminated, such as during the Covid-19 pandemic. In the former, the entire hospital must be evacuated, while in the latter, the hospital becomes a pandemic center necessitating the transfer of its non-contaminated staff, patients, and routine activities to other facilities. Such occasions involve several degrees of evacuation—partial or total—yet all require deliberate surge planning and collaboration with diverse authorities. This study aimed to investigate the extent of hospital evacuation preparedness in Thailand, using the main elements of the flexible surge capacity concept. A mixed method cross-sectional study was conducted using a hospital evacuation questionnaire from a previously published multinational hospital evacuation study. The tool contained questions regarding evacuation preparedness encompassing surge capacity and collaborative elements and an open-ended inquiry to grasp potential perspectives. All 143 secondary care, tertiary care, and university hospitals received the questionnaire; 43 hospitals provided responses. The findings indicate glitches in evacuation protocols, particularly triage systems, the inadequacies of surge planning and multiagency collaboration, and knowledge limitations in community capabilities. In conclusion, the applications of the essential components of flexible surge capacity allow the assessment of hospital preparedness and facilitate the evaluation of guidelines and instructions through scenario-based training exercises.
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Affiliation(s)
- Phatthranit Phattharapornjaroen
- Institute of Clinical Sciences, Department of Surgery, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden
- Department of Emergency Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400 Thailand
| | - Eric Carlström
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, 40100 Gothenburg, Sweden
- Gothenburg Emergency Medicine Research Group, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden
- USN School of Business, University of South-Eastern Norway, 3603 Kongsberg, Norway
| | - Lina Dahlén Holmqvist
- Institute of Medicine, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska University Hospital, 40530 Gothenburg, Sweden
| | - Yuwares Sittichanbuncha
- Department of Emergency Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400 Thailand
| | - Amir Khorram-Manesh
- Institute of Clinical Sciences, Department of Surgery, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, 40100 Gothenburg, Sweden
- Gothenburg Emergency Medicine Research Group, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden
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Crisis Triage in the Era of COVID-19: Old Tools, New Approaches, and Unanswered Questions. Crit Care Med 2023; 51:148-150. [PMID: 36519991 PMCID: PMC9749941 DOI: 10.1097/ccm.0000000000005723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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DeGrande H, Seifert M, Painter E. The Experience of Working Nurses Attending Graduate School During COVID-19: A Hermeneutic Phenomenology Study. SAGE Open Nurs 2023; 9:23779608231186676. [PMID: 37435583 PMCID: PMC10331175 DOI: 10.1177/23779608231186676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 05/21/2023] [Accepted: 06/17/2023] [Indexed: 07/13/2023] Open
Abstract
Introduction There has been unprecedented uncertainty involved in the COVID-19 pandemic, especially for working nurses. Nurses working while attending graduate school faced additional unique challenges including working extended hours while also home-schooling young children, managing a family life while also navigating pandemic-related changes affecting students' educational paths. Objectives The purpose of this study was to explore the lived experiences of working nurses attending graduate school during the COVID-19 pandemic. The central research question was: What is the lived experience of working nurses attending graduate school during COVID-19? Methods The exploration of the lived experience of working nurses attending graduate school during a pandemic required a research methodology delving into the meaning of lived experience as it has been lived, temporally, and contextually (during a pandemic). Qualitative hermeneutic phenomenology was used to explore the meaning of lived experience from an interpretational stance. Results The overall meaning of the experience was a paradigm shift of existence across the three realms of work, home, and school. The themes associated with the shift were rapid change, uncertainty, fear, and support persons. Stress was a resulting overarching theme. Conclusions To support working nurses further their education during times of crisis, nurse leaders and educators should put processes in place to mitigate change and stress through strategic communication and supportive work environments.
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Affiliation(s)
- Heather DeGrande
- College of Nursing and Health Sciences, Texas A&M University-Corpus Christi, Corpus Christi, TX, USA
| | - Madison Seifert
- College of Nursing and Health Sciences, Texas A&M University-Corpus Christi, Corpus Christi, TX, USA
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Keniston A, Sakumoto M, Astik GJ, Auerbach A, Eid SM, Kangelaris KN, Kulkarni SA, Lee T, Leykum LK, Linker AS, Worster DT, Burden M. Adaptability on Shifting Ground: a Rapid Qualitative Assessment of Multi-institutional Inpatient Surge Planning and Workforce Deployment During the COVID-19 Pandemic. J Gen Intern Med 2022; 37:3956-3964. [PMID: 35319085 PMCID: PMC8939495 DOI: 10.1007/s11606-022-07480-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 03/03/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND During the initial wave of COVID-19 hospitalizations, care delivery and workforce adaptations were rapidly implemented. In response to subsequent surges of patients, institutions have deployed, modified, and/or discontinued their workforce plans. OBJECTIVE Using rapid qualitative methods, we sought to explore hospitalists' experiences with workforce deployment, types of clinicians deployed, and challenges encountered with subsequent iterations of surge planning during the COVID-19 pandemic across a collaborative of hospital medicine groups. APPROACH Using rapid qualitative methods, focus groups were conducted in partnership with the Hospital Medicine Reengineering Network (HOMERuN). We interviewed physicians, advanced practice providers (APP), and physician researchers about (1) ongoing adaptations to the workforce as a result of the COVID-19 pandemic, (2) current struggles with workforce planning, and (3) evolution of workforce planning. KEY RESULTS We conducted five focus groups with 33 individuals from 24 institutions, representing 52% of HOMERuN sites. A variety of adaptations was described by participants, some common across institutions and others specific to the institution's location and context. Adaptations implemented shifted from the first waves of COVID patients to subsequent waves. Three global themes also emerged: (1) adaptability and comfort with dynamic change, (2) the importance of the unique hospitalist skillset for effective surge planning and redeployment, and (3) the lack of universal solutions. CONCLUSIONS Hospital workforce adaptations to the COVID pandemic continued to evolve. While few approaches were universally effective in managing surges of patients, and successful adaptations were highly context dependent, the ability to navigate a complex system, adaptability, and comfort in a chaotic, dynamic environment were themes considered most critical to successful surge management. However, resource constraints and sustained high workload levels raised issues of burnout.
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Affiliation(s)
- Angela Keniston
- Division of Hospital Medicine, University of Colorado School of Medicine, 12401 E. 17th Avenue, Mail Stop F782, Aurora, CO, 80045, USA.
| | - Matthew Sakumoto
- Division of General Internal Medicine, University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Gopi J Astik
- Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Andrew Auerbach
- University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Shaker M Eid
- Division of Hospital Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Kirsten N Kangelaris
- Division of Hospital Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Shradha A Kulkarni
- Division of Hospital Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Tiffany Lee
- University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Luci K Leykum
- The University of Texas at Austin, Dell Medical School, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Anne S Linker
- Division of Hospital Medicine, Mount Sinai Hospital/Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Devin T Worster
- Section of Hospital Medicine, Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Marisha Burden
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA
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Alonso-Iñigo JM, Mazzinari G, Casañ-Pallardó M, Redondo-García JI, Viscasillas-Monteagudo J, Gutierrez-Bautista A, Ramirez-Faz J, Alonso-Pérez P, Díaz-Lobato S, Neto AS, Diaz-Cambronero O, Argente-Navarro P, Gama de Abreu M, Pelosi P, Schultz MJ. Pre-clinical validation of a turbine-based ventilator for invasive ventilation-The ACUTE-19 ventilator. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2022; 69:544-555. [PMID: 36244956 PMCID: PMC9639442 DOI: 10.1016/j.redare.2021.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 09/07/2021] [Indexed: 06/16/2023]
Abstract
BACKGROUND The Severe Acute Respiratory Syndrome (SARS)-Coronavirus 2 (CoV-2) pandemic pressure on healthcare systems can exhaust ventilator resources, especially where resources are restricted. Our objective was a rapid preclinical evaluation of a newly developed turbine-based ventilator, named the ACUTE-19, for invasive ventilation. METHODS Validation consisted of (a) testing tidal volume (VT) delivery in 11 simulated models, with various resistances and compliances; (b) comparison with a commercial ventilator (VIVO-50) adapting the United Kingdom Medicines and Healthcare products Regulatory Agency-recommendations for rapidly manufactured ventilators; and (c) in vivo testing in a sheep before and after inducing acute respiratory distress syndrome (ARDS) by saline lavage. RESULTS Differences in VT in the simulated models were marginally different (largest difference 33ml [95%-confidence interval (CI) 31-36]; P<.001ml). Plateau pressure (Pplat) was not different (-0.3cmH2O [95%-CI -0.9 to 0.3]; P=.409), and positive end-expiratory pressure (PEEP) was marginally different (0.3 cmH2O [95%-CI 0.2 to 0.3]; P<.001) between the ACUTE-19 and the commercial ventilator. Bland-Altman analyses showed good agreement (mean bias, -0.29, [limits of agreement, 0.82 to -1.42], and mean bias 0.56 [limits of agreement, 1.94 to -0.81], at a Pplat of 15 and 30cmH2O, respectively). The ACUTE-19 achieved optimal oxygenation and ventilation before and after ARDS induction. CONCLUSIONS The ACUTE-19 performed accurately in simulated and animal models yielding a comparable performance with a VIVO-50 commercial device. The acute 19 can provide the basis for the development of a future affordable commercial ventilator.
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Affiliation(s)
- J M Alonso-Iñigo
- Research Group in Perioperative Medicine, Department of Anesthesia, Critical Care and Pain Medicine, Hospital Universitario y Politécnico la Fe, Valencia, Spain.
| | - G Mazzinari
- Department of Anesthesia, Critical Care and Pain Medicine, Hospital General Universitario de Castellón, Castellón de la Plana, Castellón, Spain
| | - M Casañ-Pallardó
- Department of Anesthesia, Critical Care and Pain Medicine, Hospital General Universitario de Castellón, Castellón de la Plana, Castellón, Spain
| | - J I Redondo-García
- Department of Veterinary Anesthesia, Hospital Clínico Veterinario CEU, Universidad CEU Cardenal Herrera, Alfara del Patriarca, Valencia, Spain
| | - J Viscasillas-Monteagudo
- Department of Veterinary Anesthesia, Hospital Clínico Veterinario CEU, Universidad CEU Cardenal Herrera, Alfara del Patriarca, Valencia, Spain
| | - A Gutierrez-Bautista
- Department of Veterinary Anesthesia, Hospital Clínico Veterinario CEU, Universidad CEU Cardenal Herrera, Alfara del Patriarca, Valencia, Spain
| | - J Ramirez-Faz
- Department of Electrical Engineering, Universidad de Córdoba, Córdoba, Spain
| | - P Alonso-Pérez
- Department of Research and Innovation, Tecnikoa and C&T Fabrication S. L., Alicante, Spain
| | - S Díaz-Lobato
- Medical Division, Nippon Gases HealthCare & Oximesa NG, Madrid, Spain
| | - A S Neto
- Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brasil; Cardio-Pulmonary Department, Pulmonary Division, Instituto do Coração, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brasil; Department of Intensive Care & Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Academic Medical Center, Amsterdam, The Netherlands
| | - O Diaz-Cambronero
- Research Group in Perioperative Medicine, Department of Anesthesia, Critical Care and Pain Medicine, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - P Argente-Navarro
- Research Group in Perioperative Medicine, Department of Anesthesia, Critical Care and Pain Medicine, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - M Gama de Abreu
- Pulmonary Engineering Group, Department of Anesthesiology and Intensive Care Therapy, Technische Universität Dresden, Dresden, Germany; Outcome Research Consortiu, Cleveland Clinic, Cleveland, OH, USA
| | - P Pelosi
- Policlinico San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - M J Schultz
- Department of Intensive Care & Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Academic Medical Center, Amsterdam, The Netherlands; Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand; Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Milch V, Nelson AE, Austen M, Hector D, Turnbull S, Sathiaraj R, Der Vartanian C, Wang R, Anderiesz C, Keefe D. Conceptual Framework for Cancer Care During a Pandemic Incorporating Evidence From the COVID-19 Pandemic. JCO Glob Oncol 2022; 8:e2200043. [PMID: 35917484 PMCID: PMC9470141 DOI: 10.1200/go.22.00043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE With successive infection waves and the spread of more infectious variants, the COVID-19 pandemic continues to have major impacts on health care. To achieve best outcomes for patients with cancer during a pandemic, efforts to minimize the increased risk of severe pandemic infection must be carefully balanced against unintended adverse impacts of the pandemic on cancer care, with consideration to available health system capacity. Cancer Australia's conceptual framework for cancer care during a pandemic provides a planning resource for health services and policy-makers that can be broadly applied globally and to similar pandemics. METHODS Evidence on the impact of the COVID-19 pandemic on cancer care and health system capacity to June 2021 was reviewed, and the conceptual framework was developed and updated. RESULTS Components of health system capacity vary during a pandemic, and capacity relative to pandemic numbers and severity affects resources available for cancer care delivery. The challenges of successive pandemic waves and high numbers of pandemic cases necessitate consideration of changing health system capacity in decision making about cancer care. Cancer Australia’s conceptual framework provides guidance on continuation of care across the cancer pathway, in the face of challenges to health systems, while minimizing infection risk for patients with cancer and unintended consequences of delays in screening, diagnosis, and cancer treatment and backlogs because of service interruption. CONCLUSION Evidence from the COVID-19 pandemic supports continuation of cancer care wherever possible during similar pandemics. Cancer Australia's conceptual framework, underpinned by principles for optimal cancer care, informs decision making across the cancer care continuum. It incorporates consideration of changes in health system capacity and capacity for cancer care, in relation to pandemic progression, enabling broad applicability to different global settings.
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Affiliation(s)
- Vivienne Milch
- Cancer Australia, Sydney, New South Wales, Australia
- The University of Notre Dame, Sydney, New South Wales, Australia
| | - Anne E. Nelson
- Evidence Review Contractor, Sydney, New South Wales, Australia
| | | | - Debra Hector
- Cancer Australia, Sydney, New South Wales, Australia
| | | | | | | | - Rhona Wang
- Cancer Australia, Sydney, New South Wales, Australia
| | - Cleola Anderiesz
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- National Breast Cancer Foundation, Sydney, New South Wales, Australia
| | - Dorothy Keefe
- Cancer Australia, Sydney, New South Wales, Australia
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13
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Mackie BR, Weber S, Mitchell ML, Crilly J, Wilson B, Handy M, Wullschleger M, Sharpe J, McCaffery K, Lister P, Boyd M, Watkins N, Ranse J. Chemical, Biological, Radiological, or Nuclear Response in Queensland Emergency Services: A Multisite Study. Health Secur 2022; 20:222-229. [PMID: 35612425 DOI: 10.1089/hs.2021.0214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A disaster overwhelms the normal operating capacity of a health service. Minimal research exists regarding Australian hospitals' capacity to respond to chemical, biological, radiological, or nuclear (CBRN) disasters. This article, and the research supporting it, begins to fill that research gap. We conducted a descriptive quantitative study with 5 tertiary hospitals and 1 rural hospital in Queensland, Australia. The study population was the hospitals' clinical leaders for disaster preparedness. The 25-item survey consisted of questions relating to each hospital's current response capacity, physical surge capacity, and human surge capacity in response to a CBRN disaster. Data were analyzed using descriptive statistics. The survey data indicated that over the previous 12 months, each site reached operational capacity on average 66 times and that capacity to respond and create additional emergency, intensive care, or surgical beds varied greatly across the sites. In the previous 12 months, only 2 sites reported undertaking specific hospital-wide training to manage a CBRN disaster, and 3 sites reported having suitable personal protective equipment required for hazardous materials. There was a noted shortfall in all the hospitals' capacity to respond to a radiological disaster in particular. Queensland hospitals are crucial to CBRN disaster response, and they have areas for improvement in their response and capacity to surge when compared with international preparedness benchmarks. CBRN-focused education and training must be prioritized using evidence-based training approaches to better prepare hospitals to respond following a disaster event.
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Affiliation(s)
- Benjamin R Mackie
- Benjamin R. Mackie, PhD, MAdvPrac, MN, is a Senior Instructor, Army School of Health, Bonegilla, Victoria. Benjamin R. Mackie is also an Adjunct Associate Professor; at Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | - Sarah Weber
- Sarah Weber, RN, MPH, is a Clinical Nurse, Emergency Department, at Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Marion L Mitchell
- Marion L. Mitchell, PhD, BN, is an Emeritus Professor; at Menzies Health Institute Queensland, Griffith University, Queensland, Australia. Marion L. Mitchell is an Emeritus Professor, Intensive Care Department; at Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Julia Crilly
- Julia Crilly, OAM, RN, MEmergN, PhD, is a Professor; the Department of Emergency Medicine, Gold Coast Health, Gold Coast, Queensland, Australia
| | - Bridget Wilson
- Bridget Wilson, BN, is a Research Nurse; the Department of Emergency Medicine, Gold Coast Health, Gold Coast, Queensland, Australia
| | - Michael Handy
- Michael Handy, BNur, MNurSciNP, is Assistant Nursing Director, the Trauma Service, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Martin Wullschleger
- Martin Wullschleger, MD, PhD, FRACS, FACS, is Director of Trauma; the Trauma Service, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Joseph Sharpe
- Joseph Sharpe, RN, BN, CNC, is a Clinical Nurse Consultant, Trauma Service, Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Kevin McCaffery
- Kevin McCaffery, MD, is a Paediatric Intensivist, Queensland Children's Hospital, Queensland, Australia
| | - Paula Lister
- Paula Lister, MBBCh, PhD, is an Associate Professor, Griffith University, and Director, Paediatric Critical Care, Sunshine Coast University Hospital and Health Service, Queensland, Australia
| | - Matt Boyd
- Matt Boyd, RN, RM, is a Nurse Unit Manager, Emergency, Darling Downs Health Service, Queensland, Australia
| | - Nathan Watkins
- Nathan Watkins, MBChB, BPhty, FACEM, Emergency Senior Staff Specialist; the Department of Emergency Medicine, Gold Coast Health, Gold Coast, Queensland, Australia
| | - Jamie Ranse
- Jamie Ranse, RN, PhD, is an Associate Professor; at Menzies Health Institute Queensland, Griffith University, Queensland, Australia
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14
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Lowe AE, Garzon H, Lookadoo RE, Lawler JV, Duncan D, Schwedhelm S, Devereaux AV. Avoiding Crisis Conditions in the Healthcare Infrastructure: 2 Case Studies in Statewide Collaboration. Health Secur 2022; 20:S71-S84. [PMID: 35605056 DOI: 10.1089/hs.2021.0185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In fall 2020, COVID-19 infections accelerated across the United States. For many states, a surge in COVID-19 cases meant planning for the allocation of scarce resources. Crisis standards of care planning focuses on maintaining high-quality clinical care amid extreme operating conditions. One of the primary goals of crisis standards of care planning is to use all preventive measures available to avoid reaching crisis conditions and the complex triage decisionmaking involved therein. Strategies to stay out of crisis must respond to the actual experience of people on the frontlines, or the "ground truth," to ensure efforts to increase critical care bed numbers and augment staff, equipment, supplies, and medications to provide an effective response to a public health emergency. Successful management of a surge event where healthcare needs exceed capacity requires coordinated strategies for scarce resource allocation. In this article, we examine the ground truth challenges encountered in response efforts during the fall surge of 2020 for 2 states-Nebraska and California-and the strategies each state used to enable healthcare facilities to stay out of crisis standards of care. Through these 2 cases, we identify key tools deployed to reduce surge and barriers to coordinated statewide support of the healthcare infrastructure. Finally, we offer considerations for operationalizing key tools to alleviate surge and recommendations for stronger statewide coordination in future public health emergencies.
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Affiliation(s)
- Abigail E Lowe
- Abigail E. Lowe, MA, is an Assistant Professor, Global Center for Health Security, College of Allied Health Professions; at the University of Nebraska Medical Center, Omaha, NE
| | - Hernando Garzon
- Hernando Garzon, MD, is Director, Emergency Response, California Department of Public Health, Sacramento, CA
| | - Rachel E Lookadoo
- Rachel E. Lookadoo, JD, is Director of Legal and Public Health Preparedness, Center for Biosecurity, Biopreparedness, and Emerging Infectious Diseases, and an Instructor, Department of Epidemiology, College of Public Health; at the University of Nebraska Medical Center, Omaha, NE
| | - James V Lawler
- James V. Lawler, MD, MPH, is Director of International Programs and Innovation, Global Center for Health Security, Director of Clinical and Biodefense Research, and Associate Professor, Department of Internal Medicine; at the University of Nebraska Medical Center, Omaha, NE
| | - Dave Duncan
- Dave Duncan, MD, is Retired Director, California Emergency Medical Services Authority, Rancho Cordova, CA
| | - Shelly Schwedhelm
- Shelly Schwedhelm, MSN, RN, NEA-BC, is Executive Director, Emergency Management and Biopreparedness, Nebraska Medicine, and Executive Director, Emergency Management and Clinical Operations, Global Center for Health Security; at the University of Nebraska Medical Center, Omaha, NE
| | - Asha V Devereaux
- Asha V. Devereaux, MD, MPH, FCCP, is a Senior Medical Officer, California Emergency Services Authority/CAL-MAT, Rancho Cordova, CA, and a Clinician, Pulmonary Medicine, Sharp Coronado Hospital, Coronado, CA
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15
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Toledo P, Nelson LD, Stey A. Maternal Critical Care: The Story Behind the Numbers. Anesth Analg 2022; 134:578-580. [PMID: 35180176 DOI: 10.1213/ane.0000000000005823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Paloma Toledo
- From the Department of Anesthesiology.,Center for Health Services and Outcomes Research
| | | | - Anne Stey
- Center for Health Services and Outcomes Research.,Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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16
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Komenda M, Černý V, Šnajdárek P, Karolyi M, Hejný M, Panoška P, Jarkovský J, Gregor J, Bulhart V, Šnajdrová L, Májek O, Vymazal T, Blatný J, Dušek L. Control Centre for Intensive Care as a Tool for Effective Coordination, Real-Time Monitoring, and Strategic Planning During the COVID-19 Pandemic. J Med Internet Res 2022; 24:e33149. [PMID: 34995207 PMCID: PMC8852654 DOI: 10.2196/33149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 12/10/2021] [Accepted: 12/20/2021] [Indexed: 01/28/2023] Open
Abstract
In the Czech Republic, the strategic data-based and organizational support for individual regions and for providers of acute care at the nationwide level is coordinated by the Ministry of Health. At the beginning of the COVID-19 pandemic, the country needed to very quickly implement a system for the monitoring, reporting, and overall management of hospital capacities. The aim of this viewpoint is to describe the purpose and basic functions of a web-based application named "Control Centre for Intensive Care," which was developed and made available to meet the needs of systematic online technical support for the management of intensive inpatient care across the Czech Republic during the first wave of the pandemic in spring 2020. Two tools of key importance are described in the context of national methodology: one module for regular online updates and overall monitoring of currently free capacities of intensive care in real time, and a second module for online entering and overall record-keeping of requirements on medications for COVID-19 patients. A total of 134 intensive care providers and 927 users from hospitals across all 14 regions of the Czech Republic were registered in the central Control Centre for Intensive Care database as of March 31, 2021. This web-based application enabled continuous monitoring and decision-making during the mass surge of critical care from autumn 2020 to spring 2021. The Control Center for Intensive Care has become an indispensable part of a set of online tools that are employed on a regular basis for crisis management at the time of the COVID-19 pandemic.
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Affiliation(s)
- Martin Komenda
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic.,Department of Simulation Medicine, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Vladimír Černý
- Ministry of Health of the Czech Republic, Prague, Czech Republic.,Clinic of Anaesthesiology, Perioperative and Intensive Medicine, Masaryk Hospital in Ústí nad Labem, Ústí nad Labem, Czech Republic
| | - Petr Šnajdárek
- General Staff, Czech Armed Forces, Prague, Czech Republic
| | - Matěj Karolyi
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Miloš Hejný
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Petr Panoška
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Jiří Jarkovský
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Jakub Gregor
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Vojtěch Bulhart
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Lenka Šnajdrová
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Ondřej Májek
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Tomáš Vymazal
- Clinic of Anaesthesiology, Resuscitation and Intensive Medicine, University Hospital in Motol, Second Faculty of Medicine of Charles University, Prague, Czech Republic
| | - Jan Blatný
- Ministry of Health of the Czech Republic, Prague, Czech Republic.,Department of Paediatric Haematology and Biochemistry, University Hospital Brno, Brno, Czech Republic
| | - Ladislav Dušek
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
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17
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Stey AM, Kanzaria HK, Dudley RA, Bilimoria KY, Knudson MM, Callcut RA. Emergency Department Length of Stay and Mortality in Critically Injured Patients. J Intensive Care Med 2022; 37:278-287. [PMID: 33641512 DOI: 10.1177/0885066621995426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Multicenter data from 2 decades ago demonstrated that critically ill and injured patients spending more than 6 hours in the emergency department (ED) before transfer to the intensive care unit (ICU) had higher mortality rates. A contemporary analysis of ED length of stay in critically injured patients at American College of Surgeons' Trauma Quality Improvement Program (ACS-TQIP) centers was performed to test whether prolonged ED length of stay is still associated with mortality. METHODS This was an observational cohort study of critically injured patients admitted directly to ICU from the ED in ACS-TQIP centers from 2010-2015. Spending more than 6 hours in the ED was defined as prolonged ED length of stay. Patients with prolonged ED length of stay were matched to those with non-prolonged ED length of stay and mortality was compared. MAIN RESULTS A total of 113,097 patients were directly admitted from the ED to the ICU following injury. The median ED length of stay was 167 minutes. Prolonged ED length of stay occurred in 15,279 (13.5%) of patients. Women accounted for 29.4% of patients with prolonged ED length of stay but only 25.8% of patients with non-prolonged ED length of stay, P < 0.0001. Mortality rates were similar after matching-4.5% among patients with prolonged ED length of stay versus 4.2% among matched controls. Multivariable logistic regression of the matched cohorts demonstrated prolonged ED length of stay was not associated with mortality. However, women had higher adjusted mortality compared to men Odds Ratio = 1.41, 95% Confidence Interval 1.28 -1.61, P < 0.0001. CONCLUSION Prolonged ED length of stay is no longer associated with mortality among critically injured patients. Women are more likely to have prolonged ED length of stay and mortality.
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Affiliation(s)
- Anne M Stey
- Northwestern University Feinberg School of Medicine, IL, Chicago
| | - Hemal K Kanzaria
- University of California San Francisco, San Francisco, CA
- Zuckerberg San Francisco General Hospital, San Francisco, CA
| | | | - Karl Y Bilimoria
- Northwestern University Feinberg School of Medicine, IL, Chicago
| | - M Margaret Knudson
- University of California San Francisco, San Francisco, CA
- Zuckerberg San Francisco General Hospital, San Francisco, CA
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18
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Gibney RN, Blackman C, Gauthier M, Fan E, Fowler R, Johnston C, Jeremy Katulka R, Marcushamer S, Menon K, Miller T, Paunovic B, Tanguay T. COVID-19 pandemic: the impact on Canada’s intensive care units. Facets (Ott) 2022. [DOI: 10.1139/facets-2022-0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The COVID-19 pandemic has exposed the precarious demand-capacity balance in Canadian hospitals, including critical care where there is an urgent need for trained health care professionals to dramatically increase ICU capacity. The impact of the pandemic on ICUs varied significantly across the country with provinces that implemented public health measures later and relaxed them sooner being impacted more severely. Pediatric ICUs routinely admitted adult patients. Non-ICU areas were converted to ICUs and staff were redeployed from other essential service areas. Faced with a lack of critical care capacity, triage plans for ICU admission were developed and nearly implemented in some provinces. Twenty eight percent of patients in Canadian ICUs who required mechanical ventilation died. Surviving patients have required prolonged ICU admission, hospitalization and extensive ongoing rehabilitation. Family members of patients were not permitted to visit, resulting in additional psychological stresses to patients, families, and healthcare teams. ICU professionals also experienced extreme psychological stresses from caring for such large numbers of critically ill patients, often in sub-standard conditions. This resulted in large numbers of health workers leaving their professions. This pandemic is not yet over, and it is likely that new pandemics will follow. A review and recommendations for the future are provided.
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Affiliation(s)
- R.T. Noel Gibney
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2B7, Canada
| | - Cynthia Blackman
- Dr. Cynthia Blackman and Associates, Edmonton, AB M5R 3R8, Canada
| | - Melanie Gauthier
- Faculty of Nursing, McGill University, Montréal, QC Canada
- President, Canadian Association of Critical Care Nurses, Quebec, QC, Canada
| | - Eddy Fan
- Interdisciplinary Division of Critical Care Medicine, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada
- Department of Medicine, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Robert Fowler
- Interdisciplinary Division of Critical Care Medicine, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada
- Department of Medicine, Sunnybrook Hospital, Toronto, ON M5S 1A1, Canada
| | - Curtis Johnston
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2B7, Canada
- Intensive Care Unit, Royal Alexandra Hospital, Edmonton, AB T6G 2R3, Canada
| | - R. Jeremy Katulka
- Department of Medicine, Royal University Hospital, Saskatoon, SK S7N 0W8, Canada
| | - Samuel Marcushamer
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2B7, Canada
- Intensive Care Unit, Royal Alexandra Hospital, Edmonton, AB T6G 2R3, Canada
| | - Kusum Menon
- Paediatric Intensive Care Unit, Children’s Hospital of Eastern Ontario, Ottawa, ON K1N 6N5, Canada
- Paediatric Intensive Care Unit, Department of Pediatrics, University of Ottawa, Ottawa, ON T6G 2R3, Canada
| | - Tracey Miller
- Intensive Care Unit, Royal Columbian Hospital, New Westminster, BC V3L 3W7, Canada
| | - Bojan Paunovic
- Department of Medicine, Faculty of Medicine, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
- President, Canadian Critical Care Society, Winnipeg, MB R3T 2N2, Canada
| | - Teddie Tanguay
- Intensive Care Unit, Royal Alexandra Hospital, Edmonton, AB T6G 2R3, Canada
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19
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Rednor S, Eisen LA, Cobb JP, Evans L, Coopersmith CM. Critical Care Response During the COVID-19 Pandemic. Crit Care Clin 2022; 38:623-637. [PMID: 35667747 PMCID: PMC8747943 DOI: 10.1016/j.ccc.2022.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Queiroz MM, Ivanov D, Dolgui A, Fosso Wamba S. Impacts of epidemic outbreaks on supply chains: mapping a research agenda amid the COVID-19 pandemic through a structured literature review. ANNALS OF OPERATIONS RESEARCH 2022; 319:1159-1196. [PMID: 32836615 PMCID: PMC7298926 DOI: 10.1007/s10479-020-03685-7] [Citation(s) in RCA: 221] [Impact Index Per Article: 110.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
The coronavirus (COVID-19) outbreak shows that pandemics and epidemics can seriously wreak havoc on supply chains (SC) around the globe. Humanitarian logistics literature has extensively studied epidemic impacts; however, there exists a research gap in understanding of pandemic impacts in commercial SCs. To progress in this direction, we present a systematic analysis of the impacts of epidemic outbreaks on SCs guided by a structured literature review that collated a unique set of publications. The literature review findings suggest that influenza was the most visible epidemic outbreak reported, and that optimization of resource allocation and distribution emerged as the most popular topic. The streamlining of the literature helps us to reveal several new research tensions and novel categorizations/classifications. Most centrally, we propose a framework for operations and supply chain management at the times of COVID-19 pandemic spanning six perspectives, i.e., adaptation, digitalization, preparedness, recovery, ripple effect, and sustainability. Utilizing the outcomes of our analysis, we tease out a series of open research questions that would not be observed otherwise. Our study also emphasizes the need and offers directions to advance the literature on the impacts of the epidemic outbreaks on SCs framing a research agenda for scholars and practitioners working on this emerging research stream.
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Affiliation(s)
- Maciel M. Queiroz
- Postgraduate Program in Business Administration, Paulista University - UNIP, São Paulo, 04026-002 Brazil
| | - Dmitry Ivanov
- Supply Chain and Operations Management, Berlin School of Economics and Law, 10825 Berlin, Germany
| | - Alexandre Dolgui
- IMT Atlantique, LS2N - CNRS, La Chantrerie, 4 rue Alfred Kastler, 44307 Nantes, France
| | - Samuel Fosso Wamba
- Information, Operations and Management Sciences, TBS Business School, 1 Place Alphonse Jourdain, 31068 Toulouse, France
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21
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Gabbe BJ, Veitch W, Mather A, Curtis K, Holland AJA, Gomez D, Civil I, Nathens A, Fitzgerald M, Martin K, Teague WJ, Joseph A. Review of the requirements for effective mass casualty preparedness for trauma systems. A disaster waiting to happen? Br J Anaesth 2021; 128:e158-e167. [PMID: 34863512 DOI: 10.1016/j.bja.2021.10.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/14/2021] [Accepted: 10/19/2021] [Indexed: 01/06/2023] Open
Abstract
Mass casualty incidents (MCIs) are diverse, unpredictable, and increasing in frequency, but preparation is possible and necessary. The nature of MCIs requires a trauma response but also requires effective and tested disaster preparedness planning. From an international perspective, the aims of this narrative review are to describe the key components necessary for optimisation of trauma system preparedness for MCIs, whether trauma systems and centres meet these components and areas for improvement of trauma system response. Many of the principles necessary for response to MCIs are embedded in trauma system design and trauma centre function. These include robust communication networks, established triage systems, and capacity to secure centres from threats to safety and quality of care. However, evidence from the current literature indicates the need to strengthen trauma system preparedness for MCIs through greater trauma leader representation at all levels of disaster preparedness planning, enhanced training of staff and simulated disaster training, expanded surge capacity planning, improved staff management and support during the MCI and in the post-disaster recovery phase, clear provision for the treatment of paediatric patients in disaster plans, and diversified and pre-agreed systems for essential supplies and services continuity. Mass casualty preparedness is a complex, iterative process that requires an integrated, multidisciplinary, and tiered approach. Through effective preparedness planning, trauma systems should be well-placed to deliver an optimal response when faced with MCIs.
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Affiliation(s)
- Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Health Data Research UK, Swansea University Medical School, Swansea, UK.
| | - William Veitch
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Anne Mather
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Kate Curtis
- School of Medicine, University of Sydney, Sydney, Australia; Susan Wakil School of Nursing and Midwifery, University of Sydney, Sydney, Australia
| | - Andrew J A Holland
- Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney School of Medicine, Westmead, Australia
| | - David Gomez
- Division of General Surgery, St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, Canada
| | - Ian Civil
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Avery Nathens
- Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Mark Fitzgerald
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia; Trauma Service, The Alfred, Melbourne, Australia
| | - Kate Martin
- Department General Surgical Specialties, Royal Melbourne Hospital, Parkville, Australia
| | - Warwick J Teague
- Trauma Service, Royal Children's Hospital, Parkville, Australia; Surgical Research, Murdoch Children's Research Institute, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Anthony Joseph
- Royal North Shore Hospital Clinical School, School of Medicine, University of Sydney, St Leonards, Australia
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22
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Alonso-Iñigo J, Mazzinari G, Casañ-Pallardó M, Redondo-García J, Viscasillas-Monteagudo J, Gutierrez-Bautista A, Ramirez-Faz J, Alonso-Pérez P, Díaz-Lobato S, Neto A, Diaz-Cambronero O, Argente-Navarro P, Gama de Abreu M, Pelosi P, Schultz M. Validación preclínica de un respirador de turbina para la ventilación invasiva: el respirador ACUTE-19. REVISTA ESPAÑOLA DE ANESTESIOLOGÍA Y REANIMACIÓN 2021; 69:544-555. [PMID: 36337377 PMCID: PMC9617684 DOI: 10.1016/j.redar.2021.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 09/07/2021] [Indexed: 12/04/2022]
Abstract
Antecedentes La pandemia producida por el síndrome respiratorio agudo severo por coronavirus 2 puede agotar los recursos sanitarios, especialmente de respiradores, en situaciones de escasez de recursos sanitarios. Nuestro objetivo fue realizar una evaluación preclínica rápida de un prototipo de respirador de turbina para la ventilación invasiva denominado ACUTE-19. Métodos La validación consistió en: a) evaluación de la administración de un volumen corriente en 11 modelos pulmonares simulados, con diversas resistencias y compliancias; b) comparación con un ventilador comercial (VIVO-50) adaptando las recomendaciones de la Agencia Reguladora de Medicamentos y Productos Sanitarios del Reino Unido para ventiladores de fabricación rápida, y c) realización de pruebas in vivo en una oveja antes y después de inducir el síndrome de distrés respiratorio agudo mediante lavado salino. Resultados Las diferencias de volumen corriente en los modelos simulados fueron mínimamente diferentes (la mayor diferencia fue de 33 ml [IC 95%: 31 a 36]; p < 0,001). La presión de meseta no fue diferente (−0,3 cmH2O [IC 95%: −0,9 a 0,3]; p = 0,409), y la presión positiva al final de la espiración fue levemente diferente (0,3 cmH2O [IC 95%: 0,2 a 0,3]; p < 0,001) comparando el ACUTE-19 y el ventilador comercial. El análisis de Bland-Altman mostró una buena concordancia (sesgo medio −0,29 [límites de concordancia 0,82 a −1,42], y sesgo medio 0,56 [límites de concordancia 1,94 a −0,81], a una presión de meseta de 15 y 30 cmH2O, respectivamente). El ACUTE-19 consiguió una oxigenación y ventilación óptimas antes y después de la inducción del síndrome de distrés respiratorio agudo en el modelo animal. Conclusiones El ACUTE-19 se comportó con precisión en los modelos simulados y animales, con un rendimiento comparable al del dispositivo comercial VIVO-50. El ACUTE-19 puede servir de base para el desarrollo de un futuro ventilador comercial asequible.
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Dargin J, Stempek S, Lei Y, Gray A, Liesching T. The effect of a tiered provider staffing model on patient outcomes during the coronavirus disease 2019 pandemic: A single-center observational study. Int J Crit Illn Inj Sci 2021; 11:156-160. [PMID: 34760662 PMCID: PMC8547674 DOI: 10.4103/ijciis.ijciis_37_21] [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: 05/01/2021] [Accepted: 05/20/2021] [Indexed: 11/04/2022] Open
Abstract
Background During the coronavirus disease 2019 (COVID-19) pandemic, our hospital experienced a large influx of critically ill patients with acute respiratory failure. In order to increase intensive care unit (ICU) surge capacity, we adopted a "tiered model" for ICU provider staffing where multiple ICUs were staffed by noncritical care providers under the direction of an intensivist. We hypothesized that ICUs staffed with a tiered model would result in similar patient outcomes as ICU staffed with a traditional intensivist model. Methods We performed a single-center, observational study in seven ICUs at a tertiary care center. We included consecutive adults admitted to the ICU with acute respiratory distress syndrome (ARDS) due to COVID-19 infection. We collected baseline demographics, treatments, and outcomes of interest in traditionally staffed ICUs versus ICUs staffed with a tiered model. The primary outcome was inpatient mortality. All outcomes were censored at day 28. Results We included a total of 138 patients in our study: 66 patients were admitted to traditionally staffed ICUs and 52 were admitted to tiered staffing ICUs. Baseline characteristics were similar between groups. ARDS treatments were similar in traditionally staffed ICUs versus tiered staffing model ICUs, including daily mean tidal volume (6.2 mL/kg vs. 6.2 mL/kg, P = 0.95), median daily fluid balance (159 mL vs. 92 mL, P = 0.54), and use of prone ventilation (58% vs. 65%, P = 0.45). There was no difference in inpatient mortality between groups (50% vs. 42%, P = 0.46). We also found no difference in ventilator-free, ICU-free, vasopressor-free, and dialysis-free days between groups. Conclusions Our results suggest that patient outcomes are similar in ICUs with traditional staffing models when compared to ICUs with a tiered staffing mode during a pandemic.
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Affiliation(s)
- James Dargin
- Division of Pulmonary and Critical Care Medicine, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Susan Stempek
- Division of Pulmonary and Critical Care Medicine, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Yuxiu Lei
- Division of Pulmonary and Critical Care Medicine, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Anthony Gray
- Division of Pulmonary and Critical Care Medicine, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Timothy Liesching
- Division of Pulmonary and Critical Care Medicine, Lahey Hospital and Medical Center, Burlington, MA, USA
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Holthof N, Luedi MM. Considerations for acute care staffing during a pandemic. Best Pract Res Clin Anaesthesiol 2021; 35:389-404. [PMID: 34511227 PMCID: PMC7726522 DOI: 10.1016/j.bpa.2020.12.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 12/07/2020] [Indexed: 12/15/2022]
Abstract
The increase in interconnectedness of the global population has enabled a highly transmissible virus to spread rapidly around the globe in 2020. The COVID-19 (Coronavirus Disease 2019) pandemic has led to physical, social, and economic repercussions of previously unseen proportions. Although recommendations for pandemic preparedness have been published in response to previous viral disease outbreaks, these guidelines are primarily based on expert opinion and few of them focus on acute care staffing issues. In this review, we discuss how working in acute care medicine during a pandemic can affect the physical and mental health of medical and nursing staff. We provide ideas for limiting staff shortages and creating surge capacity in acute care settings, and strategies for sustainability that can help hospitals maintain adequate staffing throughout their pandemic response.
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Affiliation(s)
- Niels Holthof
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Markus M Luedi
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Hendel S, d'Arville A. Reimagining health preparedness in the aftermath of COVID-19. Br J Anaesth 2021; 128:e100-e103. [PMID: 34565522 PMCID: PMC8752170 DOI: 10.1016/j.bja.2021.08.020] [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: 08/08/2021] [Revised: 08/23/2021] [Accepted: 08/26/2021] [Indexed: 12/03/2022] Open
Abstract
Efficiency is an essential part of sustainable healthcare, especially in emergency and acute care (including surgical) settings. Waste minimisation, streamlined processes, and lean principles are all important for responsible stewardship of finite health resources. However, the promotion of efficiency above all else has effectively subordinated preparedness as a form of waste. Investment in preparedness is an essential part of resilient healthcare. The ongoing COVID-19 pandemic has exposed the gap between efficient processes and resilient systems in many health settings. In anticipation of future pandemics, natural disasters, and mass casualty incidents, health systems, and individual healthcare workers, must prioritise preparedness to be ready for the unexpected or for crises. This requires a reframing of priorities to view preparedness as crucial insurance against system failure during disasters, by taking advantage of lessons learnt preparing for war and mass casualty incidents.
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Affiliation(s)
- Simon Hendel
- Department of Anaesthesiology and Perioperative Medicine, Alfred Healthoo, Australia; Central Clinical School, Monash University, Australia; Trauma Service, Alfred Health, Australia; National Trauma Research Institute, Monash University, The Alfred, Australia.
| | - Asha d'Arville
- Department of Anaesthesiology and Perioperative Medicine, Alfred Healthoo, Australia
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Dichter JR, Devereaux AV, Sprung CL, Mukherjee V, Persoff J, Baum KD, Ornoff D, Uppal A, Hossain T, Henry KN, Ghazipura M, Bowden KR, Feldman HJ, Hamele MT, Burry LD, Martland AMO, Huffines M, Tosh PK, Downar J, Hick JL, Christian MD, Maves RC. Mass Critical Care Surge Response During COVID-19: Implementation of Contingency Strategies - A Preliminary Report of Findings From the Task Force for Mass Critical Care. Chest 2021; 161:429-447. [PMID: 34499878 PMCID: PMC8420082 DOI: 10.1016/j.chest.2021.08.072] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/05/2021] [Accepted: 08/19/2021] [Indexed: 01/25/2023] Open
Abstract
Background After the publication of a 2014 consensus statement regarding mass critical care during public health emergencies, much has been learned about surge responses and the care of overwhelming numbers of patients during the COVID-19 pandemic. Gaps in prior pandemic planning were identified and require modification in the midst of severe ongoing surges throughout the world. Research Question A subcommittee from The Task Force for Mass Critical Care (TFMCC) investigated the most recent COVID-19 publications coupled with TFMCC members anecdotal experience in order to formulate operational strategies to optimize contingency level care, and prevent crisis care circumstances associated with increased mortality. Study Design and Methods TFMCC adopted a modified version of established rapid guideline methodologies from the World Health Organization and the Guidelines International Network-McMaster Guideline Development Checklist. With a consensus development process incorporating expert opinion to define important questions and extract evidence, the TFMCC developed relevant pandemic surge suggestions in a structured manner, incorporating peer-reviewed literature, “gray” evidence from lay media sources, and anecdotal experiential evidence. Results Ten suggestions were identified regarding staffing, load-balancing, communication, and technology. Staffing models are suggested with resilience strategies to support critical care staff. ICU surge strategies and strain indicators are suggested to enhance ICU prioritization tactics to maintain contingency level care and to avoid crisis triage, with early transfer strategies to further load-balance care. We suggest that intensivists and hospitalists be engaged with the incident command structure to ensure two-way communication, situational awareness, and the use of technology to support critical care delivery and families of patients in ICUs. Interpretation A subcommittee from the TFMCC offers interim evidence-informed operational strategies to assist hospitals and communities to plan for and respond to surge capacity demands resulting from COVID-19.
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Affiliation(s)
| | | | | | | | | | | | | | - Amit Uppal
- Grossman School of Medicine, New York University, New York, NY
| | - Tanzib Hossain
- Grossman School of Medicine, New York University, New York, NY
| | | | - Marya Ghazipura
- Grossman School of Medicine, New York University, New York, NY
| | | | - Henry J Feldman
- Beth Israel Deaconess Medical Center, Boston, MA; Harvard Medical School, Cambridge, MA
| | - Mitchell T Hamele
- Uniformed Services University, Bethesda, MD; Tripler Army Medical Center, Honolulu, HI
| | | | | | | | | | | | - John L Hick
- University of Minnesota, Minneapolis, MN; Hennepin Health Care, Minneapolis, MN
| | - Michael D Christian
- Research & Clinical Effectiveness Lead/HEMS Doctor, London's Air Ambulance, Bart's NHS Health Trust, London, England
| | - Ryan C Maves
- Uniformed Services University, Bethesda, MD; Wake Forest School of Medicine, Winston-Salem, NC
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Watts RD, Bowles DC, Fisher C, Li IW. Who comes when the world goes Code Blue? A novel method of exploring job advertisements for COVID-19 in health care. Nurs Open 2021; 8:1108-1114. [PMID: 34482654 DOI: 10.1002/nop2.721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 11/09/2020] [Indexed: 11/07/2022] Open
Abstract
AIM To explore the health workforce responses to COVID-19. DESIGN Analysis of job advertisements. METHODS We collected advertisements for healthcare jobs which were caused by and in response to COVID-19 between 4 March-17 April 2020 for the United States, Canada, United Kingdom, Australia and New Zealand. We collected information on the date of the advertisement, position advertised and location. We categorized job positions into three categories: frontline, coordination and decision support. RESULTS We found 952 job advertisements, 72% of which were from the United States. There was a lag period between reported COVID-19-confirmed cases and job advertisements by several weeks. Nurses were the most advertised position in every country. Frontline workers were substantially more demanded than coordination or decision-support roles. Job advertisements are a novel data source which leverages a readily available information about how workforces respond to a pandemic. The initial phases of the response emphasise the importance of frontline workers, especially nurses.
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Affiliation(s)
- Rory D Watts
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Devin C Bowles
- Australian National University, Canberra, ACT, Australia.,Council of Academic Public Health Institutions Australasia, Canberra, ACT, Australia
| | - Colleen Fisher
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Ian W Li
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
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Cardona M, Dobler CC, Koreshe E, Heyland DK, Nguyen RH, Sim JPY, Clark J, Psirides A. A catalogue of tools and variables from crisis and routine care to support decision-making about allocation of intensive care beds and ventilator treatment during pandemics: Scoping review. J Crit Care 2021; 66:33-43. [PMID: 34438132 DOI: 10.1016/j.jcrc.2021.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/15/2021] [Accepted: 08/06/2021] [Indexed: 01/16/2023]
Abstract
PURPOSE This scoping review sought to identify objective factors to assist clinicians and policy-makers in making consistent, objective and ethically sound decisions about resource allocation when healthcare rationing is inevitable. MATERIALS AND METHODS Review of guidelines and tools used in ICUs, hospital wards and emergency departments on how to best allocate intensive care beds and ventilators either during routine care or developed during previous epidemics, and association with patient outcomes during and after hospitalisation. RESULTS Eighty publications from 20 countries reporting accuracy or validity of prognostic tools/algorithms, or significant correlation between prognostic variables and clinical outcomes met our eligibility criteria: twelve pandemic guidelines/triage protocols/consensus statements, twenty-two pandemic algorithms, and 46 prognostic tools/variables from non-crisis situations. Prognostic indicators presented here can be combined to create locally-relevant triage algorithms for clinicians and policy makers deciding about allocation of ICU beds and ventilators during a pandemic. No consensus was found on the ethical issues to incorporate in the decision to admit or triage out of intensive care. CONCLUSIONS This review provides a unique reference intended as a discussion starter for clinicians and policy makers to consider formalising an objective a locally-relevant triage consensus document that enhances confidence in decision-making during healthcare rationing of critical care and ventilator resources.
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Affiliation(s)
- Magnolia Cardona
- Institute for Evidence-Based Healthcare, Bond University Gold Coast, Queensland, Australia; Gold Coast University Hospital Evidence-Based Practice Professorial Unit, Southport, Queensland, Australia.
| | - Claudia C Dobler
- Institute for Evidence-Based Healthcare, Bond University Gold Coast, Queensland, Australia; Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, MN, USA; The University of New South Wales, South Western Sydney Clinical School, NSW, Australia
| | - Eyza Koreshe
- InsideOut Institute, Central Clinical School, The University of Sydney, NSW, Australia
| | - Daren K Heyland
- Department of Critical Care Medicine, Queens University, Kingston, Ontario, Canada
| | - Rebecca H Nguyen
- The University of New South Wales, South Western Sydney Clinical School, NSW, Australia
| | - Joan P Y Sim
- The University of New South Wales, South Western Sydney Clinical School, NSW, Australia
| | - Justin Clark
- Institute for Evidence-Based Healthcare, Bond University Gold Coast, Queensland, Australia
| | - Alex Psirides
- Intensive Care Unit, Wellington Regional Hospital, Wellington, New Zealand
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Lief L, Griffin KM. Variation in Strategies to Increase Critical Care Services During the COVID-19 Pandemic. Chest 2021; 160:391-392. [PMID: 34366020 PMCID: PMC8339399 DOI: 10.1016/j.chest.2021.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 04/10/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
- Lindsay Lief
- Pulmonary and Critical Care Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center Ringgold standard institution, New York, NY.
| | - Kelly M Griffin
- Pulmonary and Critical Care Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center Ringgold standard institution, New York, NY
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Kim KC, Tadrous M, Kane-Gill SL, Barbash IJ, Rothenberger S, Suda KJ. Changes in Purchases for Intensive Care Medicines During the COVID-19 Pandemic: A Global Time Series Study. Chest 2021; 160:2123-2134. [PMID: 34389295 PMCID: PMC8421073 DOI: 10.1016/j.chest.2021.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Drug supply disruptions have increased during the COVID-19 pandemic, especially for medicines used in the intensive care unit (ICU). Despite reported shortages in wealthy countries, global analyses of ICU drug purchasing during COVID-19 are limited. RESEARCH QUESTION Has COVID-19 impacted global drug purchases of first, second- and third-choice agents used in intensive care? STUDY DESIGN AND METHODS We conducted a cross-sectional time series study in a global pharmacy sales dataset comprising approximately 60% of the world's population. We analyzed pandemic-related changes in units purchased per 1,000 population for 69 ICU agents. Interventional autoregressive integrated moving average (ARIMA) models tested for significant changes when the pandemic was declared (March 2020) and during its first stage from April to August 2020, globally and by development status. RESULTS Relative to 2019, ICU drug purchases increased by 23.6% (95% CI: 7.9-37.9%) in March 2020 (P-value<0.001), and then decreased by 10.3% (95% CI:-16.9 to -3.5%) from April to August (P-value=0.006). Purchases for second-choice medicines changed the most, especially in developing countries (e.g.: 45.8% increase in March 2020). Despite similar relative changes (P-value=0.88), absolute purchasing rates in developing nations remained low. The observed decrease from April to August 2020 was only significant in developed countries (-13.1%; 95% CI: -17.4 to -4.4%; P-value< 0.001). Country-level variation appeared unrelated to expected demand and healthcare infrastructure. INTERPRETATION Purchases for intensive care medicines increased globally in the month of the COVID-19 pandemic declaration, but prior to peak infection rates. These changes were most pronounced for second-choice agents, suggesting that inexpensive, generic medicines may be more easily purchased in anticipation of pandemic-related ICU surges. Nevertheless, disparities in access persisted. Trends appeared unrelated to expected demand, and decreased purchasing from April to August 2020 may suggest over-buying. National and international policies are needed to ensure equitable drug purchasing during future pandemics.
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Affiliation(s)
- Katherine Callaway Kim
- University of Pittsburgh School of Medicine, Department of General Internal Medicine Pittsburgh, PA, USA; University of Pittsburgh Graduate School of Public Health, Department of Health Policy and Management Pittsburgh, PA, USA.
| | - Mina Tadrous
- Leslie Dan Faculty of Pharmacy, University of Toronto Toronto, ON, Canada; Women's College Research Institute Toronto, ON, Canada
| | | | - Ian J Barbash
- University of Pittsburgh School of Medicine, Department of General Internal Medicine Pittsburgh, PA, USA; CRISMA Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine Pittsburgh, PA, USA
| | - Scott Rothenberger
- University of Pittsburgh School of Medicine, Department of General Internal Medicine Pittsburgh, PA, USA
| | - Katie J Suda
- University of Pittsburgh School of Medicine, Department of General Internal Medicine Pittsburgh, PA, USA; Center of Health Equity Research and Promotion, VA Pittsburgh Healthcare System Pittsburgh, PA, USA
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31
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Collins CD, West N, Sudekum DM, Hecht JP. Perspectives from the frontline: A pharmacy department's response to the COVID-19 pandemic. Am J Health Syst Pharm 2021; 77:1409-1416. [PMID: 34279579 PMCID: PMC7449257 DOI: 10.1093/ajhp/zxaa176] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Purpose The global coronavirus 2019 (COVID-19) pandemic has created unprecedented strains on healthcare systems around the world. Challenges surrounding an overwhelming influx of patients with COVID-19 and changes in care dynamics prompt the need for care models and processes that optimize care in this medically complex patient population. The purpose of this report is to describe our institution’s strategy to deploy pharmacy resources and standardize pharmacy processes to optimize the management of patients with COVID-19. Methods This retrospective, descriptive report characterizes documented pharmacy interventions in the acute care of patients admitted for COVID-19 during the period April 1 to April 15, 2020. Patient monitoring, interprofessional communication, and intervention documentation by pharmacy staff was facilitated through the development of a COVID-19–specific care bundle integrated into the electronic medical record. Results A total of 1,572 pharmacist interventions were documented in 197 patients who received a total of 15,818 medication days of therapy during the study period. The average number of interventions per patient was 8. The most common interventions were regimen simplification (15.9%), timing and dosing adjustments (15.4%), and antimicrobial therapy and COVID-19 treatment adjustments (15.2%). Patients who were admitted to an intensive care unit care at any point during their hospital stay accounted for 66.7% of all interventions documented. Conclusion A pharmacy department’s response to the COVID-19 pandemic was optimized through standardized processes. Pharmacists intervened to address a wide scope of medication-related issues, likely contributing to improved management of COVID-19 patients. Results of our analysis demonstrate the vital role pharmacists play as members of multidisciplinary teams during times of crisis.
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Affiliation(s)
- Curtis D Collins
- Department of Pharmacy Services, St. Joseph Mercy Health System, Ann Arbor, MI
| | - Nina West
- Department of Pharmacy Services, St. Joseph Mercy Health System, Ann Arbor, MI
| | - David M Sudekum
- Department of Pharmacy Services, St. Joseph Mercy Health System, Ann Arbor, MI
| | - Jason P Hecht
- Department of Pharmacy Services, St. Joseph Mercy Health System, Ann Arbor, MI
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The Feasibility of Implementing the Flexible Surge Capacity Concept in Bangkok: Willing Participants and Educational Gaps. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157793. [PMID: 34360083 PMCID: PMC8345441 DOI: 10.3390/ijerph18157793] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 11/24/2022]
Abstract
The management of emergencies consists of a chain of actions with the support of staff, stuff, structure, and system, i.e., surge capacity. However, whenever the needs exceed the present resources, there should be flexibility in the system to employ other resources within communities, i.e., flexible surge capacity (FSC). This study aimed to investigate the possibility of creating alternative care facilities (ACFs) to relieve hospitals in Bangkok, Thailand. Using a Swedish questionnaire, quantitative data were compiled from facilities of interest and were completed with qualitative data obtained from interviews with key informants. Increasing interest to take part in a FSC system was identified among those interviewed. All medical facilities indicated an interest in offering minor treatments, while a select few expressed interest in offering psychosocial support or patient stabilization before transport to major hospitals and minor operations. The non-medical facilities interviewed proposed to serve food and provide spaces for the housing of victims. The lack of knowledge and scarcity of medical instruments and materials were some of the barriers to implementing the FSC response system. Despite some shortcomings, FSC seems to be applicable in Thailand. There is a need for educational initiatives, as well as a financial contingency to grant the sustainability of FSC.
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Rushton CH, Reller N, Swoboda SM. Applying E-PAUSE to Ethical Challenges in a Pandemic. AACN Adv Crit Care 2021; 31:334-339. [PMID: 32693405 DOI: 10.4037/aacnacc2020216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Cynda Hylton Rushton
- Cynda Hylton Rushton is Anne and George L. Bunting Professor of Clinical Ethics, Johns Hopkins University School of Nursing and Berman Institute of Bioethics, 525 N Wolfe St, Box 420, Baltimore, MD 21205
| | - Nancy Reller
- Nancy Reller is President, Sojourn Communications, McLean, Virginia
| | - Sandra M Swoboda
- Sandra M. Swoboda is Department of Surgery Research Program Coordinator and Pre-licensure Masters Entry Program Simulation Coordinator/Educator, Johns Hopkins University Schools of Medicine and Nursing, Baltimore, Maryland
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Mathews KS, Seitz KP, Vranas KC, Duggal A, Valley TS, Zhao B, Gundel S, Harhay MO, Chang SY, Hough CL. Variation in Initial U.S. Hospital Responses to the Coronavirus Disease 2019 Pandemic. Crit Care Med 2021; 49:1038-1048. [PMID: 33826584 PMCID: PMC8217146 DOI: 10.1097/ccm.0000000000005013] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The coronavirus disease 2019 pandemic has strained many healthcare systems. In response, U.S. hospitals altered their care delivery systems, but there are few data regarding specific structural changes. Understanding these changes is important to guide interpretation of outcomes and inform pandemic preparedness. We sought to characterize emergency responses across hospitals in the United States over time and in the context of local case rates early in the coronavirus disease 2019 pandemic. DESIGN We surveyed hospitals from a national acute care trials group regarding operational and structural changes made in response to the coronavirus disease 2019 pandemic from January to August 2020. We collected prepandemic characteristics and changes to hospital system, space, staffing, and equipment during the pandemic. We compared the timing of these changes with county-level coronavirus disease 2019 case rates. SETTING AND PARTICIPANTS U.S. hospitals participating in the Prevention and Early Treatment of Acute Lung Injury Network Coronavirus Disease 2019 Observational study. Site investigators at each hospital collected local data. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Forty-five sites participated (94% response rate). System-level changes (incident command activation and elective procedure cancellation) occurred at nearly all sites, preceding rises in local case rates. The peak inpatient census during the pandemic was greater than the prior hospital bed capacity in 57% of sites with notable regional variation. Nearly half (49%) expanded ward capacity, and 63% expanded ICU capacity, with nearly all bed expansion achieved through repurposing of clinical spaces. Two-thirds of sites adapted staffing to care for patients with coronavirus disease 2019, with 48% implementing tiered staffing models, 49% adding temporary physicians, nurses, or respiratory therapists, and 30% changing the ratios of physicians or nurses to patients. CONCLUSIONS The coronavirus disease 2019 pandemic prompted widespread system-level changes, but front-line clinical care varied widely according to specific hospital needs and infrastructure. Linking operational changes to care delivery processes is a necessary step to understand the impact of the coronavirus disease 2019 pandemic on patient outcomes.
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Affiliation(s)
- Kusum S. Mathews
- Division of Pulmonary, Critical Care, & Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kevin P. Seitz
- Division of Pulmonary, Allergy, and Critical Care Medicine, Vanderbilt University, Nashville, Tennessee
| | - Kelly C. Vranas
- Health Services Research & Development, VA Portland Health Care System, Portland, Oregon
- Division of Pulmonary and Critical Care , Oregon Health & Science University, Portland, Oregon
- Palliative and Advanced Illness Research (PAIR) Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Abhijit Duggal
- Department of Critical Care, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - Thomas S. Valley
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan
| | - Bo Zhao
- Department of Geography, University of Washington, Seattle, Washington
| | - Stephanie Gundel
- Department of Medicine, University of Washington, Seattle, Washington
| | - Michael O. Harhay
- Department of Critical Care, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Steven Y. Chang
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Ronald Reagan-UCLA Medical Center, Los Angeles, California
| | - Catherine L. Hough
- Division of Pulmonary and Critical Care , Oregon Health & Science University, Portland, Oregon
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Capacity Strain and Response During Coronavirus Disease 2019: One Size Does Not Fit All, and One Size Does Not Fit One. Crit Care Med 2021; 49:1189-1192. [PMID: 33826585 DOI: 10.1097/ccm.0000000000005040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Provision of critical care in austere conditions: staff, supplies and space. Intensive Care Med 2021; 47:1050-1051. [PMID: 34143246 PMCID: PMC8211949 DOI: 10.1007/s00134-021-06456-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2021] [Indexed: 12/05/2022]
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Sinha R, Aramburo A, Deep A, Bould EJ, Buckley HL, Draper ES, Feltbower R, Mitting R, Mahoney S, Alexander J, Playfor S, Chan-Dominy A, Nadel S, Suntharalingam G, Fraser J, Ramnarayan P. Caring for critically ill adults in paediatric intensive care units in England during the COVID-19 pandemic: planning, implementation and lessons for the future. Arch Dis Child 2021; 106:548-557. [PMID: 33509793 PMCID: PMC7844931 DOI: 10.1136/archdischild-2020-320962] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 12/30/2020] [Accepted: 01/14/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To describe the experience of paediatric intensive care units (PICUs) in England that repurposed their units, equipment and staff to care for critically ill adults during the first wave of the COVID-19 pandemic. DESIGN Descriptive study. SETTING Seven PICUs in England. MAIN OUTCOME MEASURES (1) Modelling using historical Paediatric Intensive Care Audit Network data; (2) space, staff, equipment, clinical care, communication and governance considerations during repurposing of PICUs; (3) characteristics, interventions and outcomes of adults cared for in repurposed PICUs. RESULTS Seven English PICUs, accounting for 137 beds, repurposed their space, staff and equipment to admit critically ill adults. Neighbouring PICUs increased their bed capacity to maintain overall bed numbers for children, which was informed by historical data modelling (median 280-307 PICU beds were required in England from March to June). A total of 145 adult patients (median age 50-62 years) were cared for in repurposed PICUs (1553 bed-days). The vast majority of patients had COVID-19 (109/145, 75%); the majority required invasive ventilation (91/109, 85%). Nearly, a third of patients (42/145, 29%) underwent a tracheostomy. Renal replacement therapy was provided in 20/145 (14%) patients. Twenty adults died in PICU (14%). CONCLUSION In a rapid and unprecedented effort during the first wave of the COVID-19 pandemic, seven PICUs in England were repurposed to care for adult patients. The success of this effort was underpinned by extensive local preparation, close collaboration with adult intensivists and careful national planning to safeguard paediatric critical care capacity.
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Affiliation(s)
- Ruchi Sinha
- Department of Paediatric Intensive Care, Division of Women and Children's Services, Imperial College Healthcare NHS Trust, London, UK
| | - Angela Aramburo
- Paediatric Intensive Care Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Akash Deep
- Paediatric Intensive Care Unit, King's College Hospital NHS Foundation Trust, London, UK
| | - Emma-Jane Bould
- Paediatric Intensive Care Unit, Barts Health NHS Trust, London, UK
| | | | | | | | - Rebecca Mitting
- Department of Paediatric Intensive Care, Division of Women and Children's Services, Imperial College Healthcare NHS Trust, London, UK
| | - Sarah Mahoney
- Paediatric Intensive Care Unit, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - John Alexander
- Paediatric Intensive Care Unit, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | | | - Amy Chan-Dominy
- Paediatric Intensive Care Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK
- Adult Intensive Care Unit, Royal Brompton Hospital, London, UK
| | - Simon Nadel
- Department of Paediatric Intensive Care, Division of Women and Children's Services, Imperial College Healthcare NHS Trust, London, UK
| | - Ganesh Suntharalingam
- Adult Intensive Care Unit, North West London Hospitals NHS Trust, Harrow, UK
- Intensive Care Society, London, UK
| | - James Fraser
- Paediatric Intensive Care Unit, Bristol Royal Hospital for Children, Bristol, UK
- Paediatric Intensive Care Society, London, UK
| | - Padmanabhan Ramnarayan
- Department of Paediatric Intensive Care, Division of Women and Children's Services, Imperial College Healthcare NHS Trust, London, UK
- Paediatric Intensive Care Society, London, UK
- Children's Acute Transport Service, Great Ormond Street Hospital for Children NHS Foundation Trust and NIHR Biomedical Research Centre, London, UK
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Ramachandran P, Swamy L, Kaul V, Agrawal A. Response. Chest 2021; 158:2236-2237. [PMID: 33160539 PMCID: PMC7610135 DOI: 10.1016/j.chest.2020.06.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 06/24/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Lakshmana Swamy
- Pulmonary & Critical Care, Boston Medical Center, Boston, MA
| | - Viren Kaul
- Crouse Health, SUNY Upstate Medical University, Syracuse, NY
| | - Abhinav Agrawal
- Section of Pulmonary and Critical Care/ Interventional Pulmonology, Department of Medicine, University of Chicago, Chicago, IL
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Schmid B, Lang CN, Danner T, Kramer K, Hans FP, Busch HJ. [How can an emergency department be strengthened against a pandemic?]. Dtsch Med Wochenschr 2021; 146:657-666. [PMID: 33957687 DOI: 10.1055/a-1226-8701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The emergency department (ED) is one of the crucial parts of the hospital infrastructure during all phases of the pandemic. The ED plays an important part in detecting an increasing number of new contagious diseases, which could potentially lead to an epidemic or pandemic.During a pandemic, the ED's main task is to detect infected individuals. These patients then need to be isolated and an adequate treatment is required. The ED must be prepared in order to perform well in such a situation. One major part for readiness is communication in an open manner to all partners within the department, as well as with emergency medical services and other departments of the hospital.The ED must be restructured to withstand the rising number of infected patients. These patients must be separated from other critically ill patients. Strategies for a diagnostic workup depending on the kind of infection have to be put in place. Pathways for the outpatient and inpatient management must be defined to avoid overcrowding in the ED. Depending on the number of patients, escalation and de-escalation strategies have to be set up within the hospital.Over the whole course of the pandemic, all staff members are the key resources for the ED and the entire hospital. The ED can only cope with a pandemic situation if staff are working together as a whole. This implies several important steps to get the staff prepared: Recurring, open conversations about fears, problems, and successes are critical for staff morale. Training must be continually provided, and protection strategies implemented. In the chronic phase of the pandemic the focus should shift more towards strategies on how to create possibilities for recuperation, domestic support measures, and mental health care for staff.
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Gottenborg E, Yu A, Naderi R, Keniston A, McBeth L, Morrison K, Schwartz D, Burden M. COVID-19's impact on faculty and staff at a School of Medicine in the US: what is the blueprint for the future? BMC Health Serv Res 2021; 21:395. [PMID: 33910541 PMCID: PMC8079230 DOI: 10.1186/s12913-021-06411-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 04/19/2021] [Indexed: 11/25/2022] Open
Abstract
Background The Coronavirus Disease 2019 (COVID-19) caused unprecedented challenges within medical centers, revealing inequities embedded in the medical community and exposing fragile social support systems. While faculty and staff faced extraordinary demands in workplace duties, personal responsibilities also increased. The goal of this study was to understand the impact of the COVID-19 pandemic on personal and professional activities of faculty and staff in order to illuminate current challenges and explore solutions. Methods Qualitative, semi-structured group interviews involved faculty and staff at four affiliate sites within the Department of Medicine at the University of Colorado, School of Medicine. Focus groups addressed the impact of COVID-19 on (1) Changes to roles and responsibilities at work and at home, (2) Resources utilized to manage these changes and, (3) Potential strategies for how the Department could assist faculty and staff. Thematic analysis was conducted using an inductive method at the semantic level to form themes and subthemes. Results Qualitative analysis of focus group transcripts revealed themes of: (1) Challenges and disparities experienced during the pandemic, (2) Disproportionate impact on women personally and professionally, (3) Institutional factors that contributed to wellness and burnout, and (4) Solutions and strategies to support faculty and staff. Within each of these themes were multiple subthemes including increased professional and personal demands, concern for personal safety, a sense of internal guilt, financial uncertainty, missed professional opportunities, and a negative impact on mentoring. Solutions were offered and included an emphasis on addressing preexisting inequities, the importance of community, and workplace flexibility. Conclusions The COVID-19 pandemic created burdens for already challenged faculty and staff in both their personal and professional lives. Swift action and advocacy by academic institutions is needed to support the lives and careers of our colleagues now and in the future.
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Affiliation(s)
- Emily Gottenborg
- Department of Medicine, Division of Hospital Medicine, University of Colorado School of Medicine, 12401 E. 17th Avenue, Aurora, CO, 80045, USA. .,Department of Medicine, University of Colorado School of Medicine, 12605 E. 16th Avenue, Aurora, CO, 80045, USA.
| | - Amy Yu
- Department of Medicine, Division of Hospital Medicine, University of Colorado School of Medicine, 12401 E. 17th Avenue, Aurora, CO, 80045, USA.,Department of Medicine, University of Colorado School of Medicine, 12605 E. 16th Avenue, Aurora, CO, 80045, USA
| | - Roxana Naderi
- Department of Medicine, Division of Hospital Medicine, University of Colorado School of Medicine, 12401 E. 17th Avenue, Aurora, CO, 80045, USA.,Department of Medicine, University of Colorado School of Medicine, 12605 E. 16th Avenue, Aurora, CO, 80045, USA
| | - Angela Keniston
- Department of Medicine, Division of Hospital Medicine, University of Colorado School of Medicine, 12401 E. 17th Avenue, Aurora, CO, 80045, USA.,Department of Medicine, University of Colorado School of Medicine, 12605 E. 16th Avenue, Aurora, CO, 80045, USA
| | - Lauren McBeth
- Department of Medicine, Division of Hospital Medicine, University of Colorado School of Medicine, 12401 E. 17th Avenue, Aurora, CO, 80045, USA.,Department of Medicine, University of Colorado School of Medicine, 12605 E. 16th Avenue, Aurora, CO, 80045, USA
| | - Katherine Morrison
- Department of Medicine, University of Colorado School of Medicine, 12605 E. 16th Avenue, Aurora, CO, 80045, USA.,Department of Medicine, Division of General Internal Medicine, University of Colorado, 12605 E. 16th Avenue, Aurora, CO, 80045, USA
| | - David Schwartz
- Department of Medicine, University of Colorado School of Medicine, 12605 E. 16th Avenue, Aurora, CO, 80045, USA.,Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, Aurora, USA
| | - Marisha Burden
- Department of Medicine, Division of Hospital Medicine, University of Colorado School of Medicine, 12401 E. 17th Avenue, Aurora, CO, 80045, USA.,Department of Medicine, University of Colorado School of Medicine, 12605 E. 16th Avenue, Aurora, CO, 80045, USA
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Lebreton G, Schmidt M, Ponnaiah M, Folliguet T, Para M, Guihaire J, Lansac E, Sage E, Cholley B, Mégarbane B, Cronier P, Zarka J, Da Silva D, Besset S, Morichau-Beauchant T, Lacombat I, Mongardon N, Richard C, Duranteau J, Cerf C, Saiydoun G, Sonneville R, Chiche JD, Nataf P, Longrois D, Combes A, Leprince P. Extracorporeal membrane oxygenation network organisation and clinical outcomes during the COVID-19 pandemic in Greater Paris, France: a multicentre cohort study. THE LANCET RESPIRATORY MEDICINE 2021; 9:851-862. [PMID: 33887246 PMCID: PMC8055207 DOI: 10.1016/s2213-2600(21)00096-5] [Citation(s) in RCA: 141] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/03/2021] [Accepted: 02/09/2021] [Indexed: 01/08/2023]
Abstract
Background In the Île-de-France region (henceforth termed Greater Paris), extracorporeal membrane oxygenation (ECMO) for severe acute respiratory distress syndrome (ARDS) was considered early in the COVID-19 pandemic. We report ECMO network organisation and outcomes during the first wave of the pandemic. Methods In this multicentre cohort study, we present an analysis of all adult patients with laboratory-confirmed SARS-CoV-2 infection and severe ARDS requiring ECMO who were admitted to 17 Greater Paris intensive care units between March 8 and June 3, 2020. Central regulation for ECMO indications and pooling of resources were organised for the Greater Paris intensive care units, with six mobile ECMO teams available for the region. Details of complications (including ECMO-related complications, renal replacement therapy, and pulmonary embolism), clinical outcomes, survival status at 90 days after ECMO initiation, and causes of death are reported. Multivariable analysis was used to identify pre-ECMO variables independently associated with 90-day survival after ECMO. Findings The 302 patients included who underwent ECMO had a median age of 52 years (IQR 45−58) and Simplified Acute Physiology Score-II of 40 (31−56), and 235 (78%) of whom were men. 165 (55%) were transferred after cannulation by a mobile ECMO team. Before ECMO, 285 (94%) patients were prone positioned, median driving pressure was 18 cm H2O (14−21), and median ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen was 61 mm Hg (IQR 54−70). During ECMO, 115 (43%) of 270 patients had a major bleeding event, 27 of whom had intracranial haemorrhage; 130 (43%) of 301 patients received renal replacement therapy; and 53 (18%) of 294 had a pulmonary embolism. 138 (46%) patients were alive 90 days after ECMO. The most common causes of death were multiorgan failure (53 [18%] patients) and septic shock (47 [16%] patients). Shorter time between intubation and ECMO (odds ratio 0·91 [95% CI 0·84−0·99] per day decrease), younger age (2·89 [1·41−5·93] for ≤48 years and 2·01 [1·01−3·99] for 49–56 years vs ≥57 years), lower pre-ECMO renal component of the Sequential Organ Failure Assessment score (0·67, 0·55−0·83 per point increase), and treatment in centres managing at least 30 venovenous ECMO cases annually (2·98 [1·46–6·04]) were independently associated with improved 90-day survival. There was no significant difference in survival between patients who had mobile and on-site ECMO initiation. Interpretation Beyond associations with similar factors to those reported on ECMO for non-COVID-19 ARDS, 90-day survival among ECMO-assisted patients with COVID-19 was strongly associated with a centre's experience in venovenous ECMO during the previous year. Early ECMO management in centres with a high venovenous ECMO case volume should be advocated, by applying centralisation and regulation of ECMO indications, which should also help to prevent a shortage of resources. Funding None.
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Affiliation(s)
- Guillaume Lebreton
- Department of Cardiovascular and Thoracic Surgery, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, Paris, France; Sorbonne University, INSERM UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Paris, France.
| | - Matthieu Schmidt
- Intensive Care Unit, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, Paris, France; Sorbonne University, INSERM UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Paris, France
| | - Maharajah Ponnaiah
- Sorbonne University, INSERM UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Paris, France
| | - Thierry Folliguet
- Department of Cardiac Surgery, Henri Mondor Hospital, AP-HP, University Paris Est Créteil, Créteil, France
| | - Marylou Para
- Department of Cardiovascular Surgery and Transplantation, Bichat Hospital, AP-HP, Paris, France; University of Paris, UMR 1148, Laboratory of Vascular Translational Science, Paris, France
| | - Julien Guihaire
- Department of Cardiac Surgery, Marie-Lannelongue Hospital, Groupe Hospitalier Paris Saint Joseph, Le Plessis-Robinson, France
| | - Emmanuel Lansac
- Department of Cardiac Surgery, Institut Mutualiste Montsouris, Paris, France
| | - Edouard Sage
- Department of Thoracic Surgery and Lung Transplantation, Hôpital Foch, Suresnes, France
| | - Bernard Cholley
- Department of Anesthesiology and Intensive Care, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - Bruno Mégarbane
- Department of Medical and Toxicological Critical Care, Lariboisière Hospital, AP-HP, Paris University, INSERM UMRS-1144, Paris, France
| | - Pierrick Cronier
- Intensive Care Unit, Grand Hôpital du Sud Francilien, Corbeil, France
| | - Jonathan Zarka
- Intensive Care Unit, Grand Hôpital de l'Est Francilien, Jossigny, France
| | - Daniel Da Silva
- Medical Intensive Care Unit, Hôpital Delafontaine, Saint Denis, France
| | - Sebastien Besset
- Intensive Care Unit, Louis Mourier Hospital, AP-HP, Colombes, France
| | | | - Igor Lacombat
- Intensive Care Unit, Jacques Cartier Hospital, Massy, France
| | - Nicolas Mongardon
- Department of Anesthesiology and Intensive Care, Henri Mondor Hospital, AP-HP, University Paris Est Créteil, Créteil, France
| | - Christian Richard
- Intensive Care Unit, Bicêtre Hospital, AP-HP, Paris Saclay University, France
| | - Jacques Duranteau
- Department of Anesthesiology and Intensive care, Bicêtre Hospital, AP-HP, Paris Saclay University, France
| | - Charles Cerf
- Intensive Care Unit, Hôpital Foch, Suresnes, France
| | - Gabriel Saiydoun
- Department of Cardiac Surgery, Henri Mondor Hospital, AP-HP, University Paris Est Créteil, Créteil, France
| | - Romain Sonneville
- Intensive Care Unit, Bichat Hospital, AP-HP, Paris, France; University of Paris, UMR 1148, Laboratory of Vascular Translational Science, Paris, France
| | | | - Patrick Nataf
- Department of Cardiovascular Surgery and Transplantation, Bichat Hospital, AP-HP, Paris, France
| | - Dan Longrois
- University of Paris, UMR 1148, Laboratory of Vascular Translational Science, Paris, France; Department of Anaesthesia and Intensive Care, Bichat-Claude Bernard Hospital, AP-HP, INSERM U1148, Paris, France
| | - Alain Combes
- Intensive Care Unit, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, Paris, France; Sorbonne University, INSERM UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Paris, France
| | - Pascal Leprince
- Department of Cardiovascular and Thoracic Surgery, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, Paris, France; Sorbonne University, INSERM UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Paris, France
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Moorer A, Klatt E, Thornton O, Groves TN, Eisenach B, Soholt K, Haylett WJ, Hessler KL, Zwink J. SOS in a pandemic: Staffing strategies for COVID-19. Nurs Manag (Harrow) 2021; 52:22-30. [PMID: 33789329 DOI: 10.1097/01.numa.0000733628.46685.bc] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Amanda Moorer
- In Colo., Amanda Moorer is a nurse residency program manager at UCHealth in Aurora, Elizabeth Klatt is an oncology/gynecologic-oncology/medicine unit nurse manager at the University of Colorado Hospital in Aurora, Olivia Thornton is a medical ICU and wound care associate nurse manager at the University of Colorado Hospital in Aurora, Thu-Nhi Groves is a resource office nurse manager at the University of Colorado Hospital in Aurora, Bree Eisenach is a resource management center nurse manager at the Medical Center of the Rockies in Loveland, Kate Soholt is a float pool/PRN pool/women and family support team nurse manager at Poudre Valley Hospital in Fort Collins, Wendy J. Haylett is a research nurse scientist at UCHealth in Aurora, Karen L. Hessler is a research nurse scientist at UCHealth in Windsor, and Jennifer Zwink is the vice president of nursing and ACNO at the University of Colorado Hospital in Aurora
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Sarman A, Tuncay S. Principles of approach to suspected or infected patients related Covid-19 in newborn intensive care unit and pediatric intensive care unit. Perspect Psychiatr Care 2021; 57:957-964. [PMID: 33184910 DOI: 10.1111/ppc.12643] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 09/08/2020] [Accepted: 09/30/2020] [Indexed: 12/17/2022] Open
Abstract
PURPOSE In this study, it was aimed to evaluate physical and mental health (MH) effects of children and their parents in newborn intensive care unit and pediatric intensive care unit due to Covid-19. CONCLUSIONS Children are less likely to develop severe illness than adults. It may benefit from medical and psychological/behavioral interventions. Prevent negative MH outcomes for babies/children/caregivers affected by Covid-19. PRACTICE IMPLICATIONS It is useful to clarify the clinical course of children (treatment, care procedures, psychosocial effects, etc.). The establishment of mental health expert nursing teams, psychological counseling (synchronous telemedicine services for support purposes, telepsychiatry for parents, etc.) may have helped prevent negative mental health of Covid-19 outcomes. Continuous updating of medical staff's knowledge and skills for the prevention of Covid-19 is expected to slow the spread of the disease.
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Affiliation(s)
- Abdullah Sarman
- Department of Medical Services and Techniques, Vocational School of Health Services, Bingol University, Bingol, Turkey
| | - Suat Tuncay
- Department of Pediatric Nursing, Bingol University, Bingol, Turkey
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Edwards CJ, Miller A, Cobb JP, Erstad BL. The pharmacist's role in disaster research response. Am J Health Syst Pharm 2021; 77:1054-1059. [PMID: 32350533 DOI: 10.1093/ajhp/zxaa093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE The need for high-quality research during disaster responses has been well described in the literature, and such research is supported by efforts at the federal level through the National Institutes of Health Disaster Research Response (DR2) Program. This article describes the fourth DR2 workshop with a specific focus on opportunities for pharmacists to get involved with disaster research efforts. SUMMARY Pharmacists have historically played a significant role in disaster planning and response, and there are a number of opportunities for pharmacists to bring their unique perspective, positioning, and skills to disaster research response (ie, onsite and other research on the medical and public health aspects of disasters and public health emergencies). In February 2019, the fourth DR2 workshop was held in Tucson, AZ, in conjunction with the University of Arizona College of Medicine-Tucson, the university's Mel and Enid Zuckerman College of Public Health, University of Arizona College of Pharmacy, and the university's Bio5 Institute to explore clinical and population-based research in a simulated disaster setting. This article describes the workshop and discusses several opportunities for pharmacists to design, lead, and support research efforts during disaster scenarios through involvement in research areas including clinical, operational, educational, and logistic aspects of pharmacy practice. CONCLUSION Due to their positioning throughout health systems, unique perspective, training, and skills, pharmacists are uniquely situated to play an important role in disaster research response.
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Affiliation(s)
- Christopher J Edwards
- Department of Pharmacy Practice & Science, University of Arizona College of Pharmacy, Tucson, AZ
| | | | - J Perren Cobb
- Keck Medicine of USC, University of Southern California, Los Angeles, CA
| | - Brian L Erstad
- Department of Pharmacy Practice & Science, University of Arizona College of Pharmacy, Tucson, AZ
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Gallagher JJ, Adamski J. Mass Casualties and Disaster Implications for the Critical Care Team. AACN Adv Crit Care 2021; 32:76-88. [PMID: 33725109 DOI: 10.4037/aacnacc2021235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Preparing for disasters both natural and anthropogenic requires assessment of risk through hazard vulnerability analysis and formulation of facility and critical care-specific disaster plans. Disaster surge conditions often require movement from conventional to contingency or crisis-level operations to meet the needs of the many under our care. Predisaster planning for modification of critical care space, staffing, and supplies is essential to successful execution of operations during a surge. Expansion of intensive care unit beds to nonconventional units such as perioperative areas, general care units, and even external temporary units may be necessary. Creative, tiered staffing models as well as just-in-time education of noncritical care clinicians and support staff are important to multiply capable personnel under surge conditions. Finally, anticipation of demand for key equipment and supplies is essential to maintain stockpiles, establish supply chains, and sustain operations under prolonged disaster scenarios.
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Affiliation(s)
- John J Gallagher
- John J. Gallagher is Professor, Department of Acute & Tertiary Care, School of Nursing, University of Pittsburgh, 3500 Victoria Street, Pittsburgh, PA 15213
| | - Jennifer Adamski
- Jennifer Adamski is Adult-Gerontology Acute Care Nurse Practitioner Program Director and Assistant Professor, Emory University, Atlanta, GA; and Critical Care Nurse Practitioner, Critical Care Flight Team, Cleveland Clinic, Cleveland, Ohio
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46
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Rosen JM, Adams LV, Geiling J, Curtis KM, Mosher RE, Ball PA, Grigg EB, Hebert KA, Grodan JR, Jurmain JC, Loucks C, Macedonia CR, Kun L. Telehealth's New Horizon: Providing Smart Hospital-Level Care in the Home. Telemed J E Health 2021; 27:1215-1224. [PMID: 33656918 DOI: 10.1089/tmj.2020.0448] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
During the COVID-19 pandemic, medical providers have expanded telehealth into daily practice, with many medical and behavioral health care visits provided remotely over video or through phone. The telehealth market was already facilitating home health care with increasing levels of sophistication before COVID-19. Among the emerging telehealth practices, telephysical therapy; teleneurology; telemental health; chronic care management of congestive heart failure, chronic obstructive pulmonary disease, diabetes; home hospice; home mechanical ventilation; and home dialysis are some of the most prominent. Home telehealth helps streamline hospital/clinic operations and ensure the safety of health care workers and patients. The authors recommend that we expand home telehealth to a comprehensive delivery of medical care across a distributed network of hospitals and homes, linking patients to health care workers through the Internet of Medical Things using in-home equipment, including smart medical monitoring devices to create a "medical smart home." This expanded telehealth capability will help doctors care for patients flexibly, remotely, and safely as a part of standard operations and during emergencies such as a pandemic. This model of "telehomecare" is already being implemented, as shown herein with examples. The authors envision a future in which providers and hospitals transition medical care delivery to the home just as, during the COVID-19 pandemic, students adapted to distance learning and adults transitioned to remote work from home. Many of our homes in the future may have a "smart medical suite" as well as a "smart home office."
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Affiliation(s)
- Joseph M Rosen
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.,Thayer School of Engineering, Hanover, New Hampshire, USA
| | - Lisa V Adams
- Department of Medicine and Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.,Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - James Geiling
- Department of Medicine and Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Kevin M Curtis
- Connected Care/Center for Telehealth, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Robyn E Mosher
- Department of Medicine and Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Perry A Ball
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Eliot B Grigg
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA.,Seattle Children's Hospital, Seattle, Washington, USA
| | - Kendra A Hebert
- Geisel School of Medicine at Dartmouth, Biomedical Research, Hanover, New Hampshire, USA
| | | | | | - Charles Loucks
- John Picard & Associates, Orem, Utah, USA.,Taurean Holdings, LLC, Orem, Utah, USA
| | - Christian R Macedonia
- Lancaster Maternal-Fetal Medicine, Lancaster General Hospital, Lancaster, Pennsylvania, USA
| | - Luis Kun
- William Perry Center for Hemispheric Defense Studies, National Defense University, Washington, District of Columbia, USA
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Harris GH, Rak KJ, Kahn JM, Angus DC, Mancing OR, Driessen J, Wallace DJ. US Hospital Capacity Managers' Experiences and Concerns Regarding Preparedness for Seasonal Influenza and Influenza-like Illness. JAMA Netw Open 2021; 4:e212382. [PMID: 33739431 PMCID: PMC7980097 DOI: 10.1001/jamanetworkopen.2021.2382] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
IMPORTANCE The 2017-2018 influenza season in the US was marked by a high severity of illness, wide geographic spread, and prolonged duration compared with recent previous seasons, resulting in increased strain throughout acute care hospital systems. OBJECTIVE To characterize self-reported experiences and views of hospital capacity managers regarding the 2017-2018 influenza season in the US. DESIGN, SETTING, AND PARTICIPANTS In this qualitative study, semistructured telephone interviews were conducted between April 2018 and January 2019 with a random sample of capacity management administrators responsible for throughput and hospital capacity at short-term, acute care hospitals throughout the US. MAIN OUTCOMES AND MEASURES Each participant's self-reported experiences and views regarding high patient volumes during the 2017-2018 influenza season, lessons learned, and the extent of hospitals' preparedness planning for future pandemic events. Interviews were recorded and transcribed and then analyzed using thematic content analysis. Outcomes included themes and subthemes. RESULTS A total of 53 key hospital capacity personnel at 53 hospitals throughout the US were interviewed; 39 (73.6%) were women, 48 (90.6%) had a nursing background, and 29 (54.7%) had been in the occupational role for more than 4 years. Participants' experiences were categorized into several domains: (1) perception of strain, (2) effects of influenza and influenza-like illness on staff and patient care, (3) immediate staffing and capacity responses to influenza and influenza-like illness, and (4) future staffing and capacity preparedness for influenza and influenza-like illness. Participants reported experiencing perceived strain associated with concerns about preparedness for seasonal influenza and influenza-like illness as well as concerns about staffing, patient care, and capacity, but future pandemic planning within hospitals was not reported as being a high priority. CONCLUSIONS AND RELEVANCE The findings of this qualitative study suggest that during the 2017-2018 influenza season, there were systemic vulnerabilities as well as a lack of hospital preparedness planning for future pandemics at US hospitals. These issues should be addressed given the current coronavirus disease 2019 pandemic.
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Affiliation(s)
- Gavin H. Harris
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Kimberly J. Rak
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Jeremy M. Kahn
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Derek C. Angus
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Olivia R. Mancing
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Julia Driessen
- Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - David J. Wallace
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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48
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Supply Chain Operations Management in Pandemics: A State-of-the-Art Review Inspired by COVID-19. SUSTAINABILITY 2021. [DOI: 10.3390/su13052504] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Pandemics cause chaotic situations in supply chains (SC) around the globe, which can lead towards survivability challenges. The ongoing COVID-19 pandemic is an unprecedented humanitarian crisis that has severely affected global business dynamics. Similar vulnerabilities have been caused by other outbreaks in the past. In these terms, prevention strategies against propagating disruptions require vigilant goal conceptualization and roadmaps. In this respect, there is a need to explore supply chain operation management strategies to overcome the challenges that emerge due to COVID-19-like situations. Therefore, this review is aimed at exploring such challenges and developing strategies for sustainability, and viability perspectives for SCs, through a structured literature review (SLR) approach. Moreover, this study investigated the impacts of previous epidemic outbreaks on SCs, to identify the research objectives, methodological approaches, and implications for SCs. The study also explored the impacts of epidemic outbreaks on the business environment, in terms of effective resource allocation, supply and demand disruptions, and transportation network optimization, through operations management techniques. Furthermore, this article structured a framework that emphasizes the integration of Industry 4.0 technologies, resilience strategies, and sustainability to overcome SC challenges during pandemics. Finally, future research avenues were identified by including a research agenda for experts and practitioners to develop new pathways to get out of the crisis.
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49
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Meiry G, Alkaher D, Mintz Y, Eran Y, Kohn A, Kornblau G, Shneorson Z, Alkaher S, Sonkin R, Jaffe E. The rapid development of AmboVent: a simple yet sustainable ventilation solution for use in a pandemic. MINIM INVASIV THER 2021; 31:556-566. [PMID: 33586579 DOI: 10.1080/13645706.2021.1881797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION COVID-19 (SARS-CoV-2) emerged at the end of 2019, generating a rapidly evolving pandemic, raising serious global health implications. Among them was the fear of a mechanical ventilator shortage due to COVID-19's high contagion rate and pathophysiology. Fears of a ventilator shortage unleashed a wave of innovations. MATERIAL AND METHOD This manuscript describes the AmboVent, a ventilator, rapidly developed with a sense of urgency, by a group of Israeli volunteers. RESULTS Using a decentralized approach, we worked extensively and managed within ten days to create a working ventilator. It utilizes a 64-year-old technological concept, the bag valve mask (BVM), sometimes known by the proprietary name Ambu bag, which we transformed into an automatic, controlled, and feature-rich ventilator by endowing it with contemporary computing technology. CONCLUSIONS Applying a functional rather than a commercial-oriented approach can result in the ad hoc development of lifesaving solutions during a rapidly spreading pandemic.
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Affiliation(s)
- Gideon Meiry
- Galilee Medical Center, NanoMedTech, Nahariya, Israel
| | | | - Yoav Mintz
- Hadassah Hebrew-University Medical Center, Jerusalem, Israel.,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yuval Eran
- FIRST (For Inspiration and Recognition of Science and Technology), Israel.,Magen David Adom, Tel Aviv-Jaffo, Israel
| | - Aryeh Kohn
- Tel Aviv Sourasky Medical Center, Tel Aviv-Jaffo, Israel
| | - Giora Kornblau
- FIRST (For Inspiration and Recognition of Science and Technology), Israel.,Terra Ventures, Yoqneam, Israel
| | - Zeev Shneorson
- FIRST (For Inspiration and Recognition of Science and Technology), Israel.,NovoCogito, Raanana, Israel
| | - Shlomo Alkaher
- Israeli Association for Development and Promotion of Life-saving Solutions, Haifa, Israel
| | | | - Eli Jaffe
- Magen David Adom, Tel Aviv-Jaffo, Israel.,Ben Gurion University of the Negev, Beer Sheva, Israel
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50
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Abstract
PURPOSE OF REVIEW The recent COVID-19 outbreak has clearly shown how epidemics/pandemics can challenge developed countries' healthcare systems. Proper management of equipment and human resources is critical to provide adequate medical care to all patients admitted to the hospital and the ICU for both pandemic-related and unrelated reasons. RECENT FINDINGS Appropriate separate paths for infected and noninfected patients and prompt isolation of infected critical patients in dedicated ICUs play a pivotal role in limiting the contagions and optimizing resources during pandemics. The key to handle these challenging events is to learn from past experiences and to be prepared for future occurrences. Hospital space should be redesigned to quickly increase medical and critical care capacity, and healthcare workers (critical and noncritical) should be trained in advance. SUMMARY A targeted improvement of hospital and ICU protocols will increase medical care quality for patients admitted to the hospital for any clinical reasons during a pandemic.
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Affiliation(s)
- Gaetano Florio
- Department of Pathophysiology and Transplantation, University of Milan
| | - Alberto Zanella
- Department of Pathophysiology and Transplantation, University of Milan
- Dipartimento di Anestesia, Rianimazione ed Emergenza-Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Antonio Pesenti
- Department of Pathophysiology and Transplantation, University of Milan
- Dipartimento di Anestesia, Rianimazione ed Emergenza-Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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