The load and capacity model of healthcare delivery: considerations for the crisis management of the COVID-19 pandemic

Performance evaluation of the introduction of full sample traceability system within the specimen collection process

OBJECTIVES

To evaluate the efficacy, safety and efficiency performances related to the introduction of innovative traceability platforms and integrated blood collection systems, for the improvement of a total testing process, thus also assessing the economic and organizational sustainability of these innovative technologies.

METHODS

A mixed-method approach was utilized. A key-performance indicators dashboard was created based on a narrative literature review and expert consensus and was assessed through a real-life data collection from the University Hospital of Padova, Italy, comparing three scenarios over time (2013, 2016, 2019) with varying levels of technological integration. The economic and organizational sustainability was determined considering all the activities performed from the tube check-in to the validation of the results, with the integration of the management of the prevalent errors occurred during the process.

RESULTS

The introduction of integrated venous blood collection and full sample traceability systems resulted in significant improvements in laboratory performance. Errors in samples collected in inappropriate tubes decreased by 42 %, mislabelled samples by 47 %, and samples with irregularities by 100 %. Economic analysis revealed a cost saving of 12.7 % per tube, equating to a total saving of 447,263.80 € over a 12-month period. Organizational efficiency improved with a reduction of 13,061.95 h in time spent on sample management, allowing for increased laboratory capacity and throughput.

CONCLUSIONS

Results revealed the strategic relevance of introducing integrated venous blood collection and full sample traceability systems, within the Laboratory setting, with a real-life demonstration of TLA economic and organizational sustainability, generating an overall improvement of the process efficiency.

Influence of respiratory infections pandemics on the mortality of the population of Ukraine

OBJECTIVE

Aim: To analyze the dynamics and structure of the excess mortality of the population of Ukraine for 76 years (1945-2021).

PATIENTS AND METHODS

Materials and Methods: An observational population study was conducted. Epidemiological methods were used, in particular, the method of graphical construction of time series, intensive, extensive indicators and indicators of excess mortality were calculated.

CONCLUSION

Conclusions: The coronavirus disease pandemic in Ukraine became the largest documented respiratory infection pandemic after 76 years, but did not outweigh the dramatic increase in mortality in the 1990s-2000s, in including death in 1995.

To introduce or not? Strategic analysis of hospital operations with telemedicine

Despite its efficiency in reducing the impact of pandemics (e.g., the COVID-19), whether to introduce telemedicine as an additional way to serve chronically ill patients remains controversial for hospitals in many countries. This paper builds a stylized model to investigate a hospital's telemedicine strategy and the corresponding impacts on its operations regarding outpatient management of chronic diseases. We implement our analysis from three key concerns of the hospital in the presence of a pandemic: the differences in medical consumption and reimbursement between in-person and telemedicine modalities and the effort cost of infection reduction resulting from the pandemic. We find that in the absence of the pandemic, the hospital prefers to introduce telemedicine when the differences in medical consumption and reimbursement are both small. In the presence of the pandemic, we find that the introduction of telemedicine does not always benefit the hospital and that it is better not to introduce telemedicine in some cases since it may exacerbate the negative influence of the pandemic on the hospital's total costs. Furthermore, we surprisingly find that the hospital may set greater in-person capacity but less telemedicine capacity in response to the outbreak of the pandemic under certain conditions, which contradicts public beliefs. Finally, we show that social welfare can be improved by introducing telemedicine when the effort cost of infection reduction and the difference in reimbursement are both of moderate size. The condition under which social welfare is improved tightens with a greater difference in medical consumption.

The collaborative research and service delivery partnership between the United States healthcare system and the U.S. Military Health System during the COVID-19 pandemic

OBJECTIVES

To examine the military-civilian collaborative efforts which addressed the unprecedented challenges of the COVID-19 pandemic, particularly in areas including provision of supplies, patient and provider support, and development and dissemination of new vaccine and drug candidates.

METHODS

We examined peer reviewed and grey literature from September 2020 to June 2021 to describe the relationship between the U.S. healthcare system and Military Health System (MHS). For analysis, we applied the World Health Organization framework for health systems, which consists of six building blocks.

RESULTS

The strongest collaborative efforts occurred in areas of medicine and technology, human resources, and healthcare delivery, most notably in the MHS supplying providers, setting up treatment venues, and participating in development of vaccines and therapeutics. Highlighting that the MHS, with its centralized structure and ability to deploy assets rapidly, is an important contributor to the nation's ability to provide a coordinated, large-scale response to health emergencies.

CONCLUSIONS

Continuing the relationship between the two health systems is vital to maintaining the nation's capability to meet future health challenges.

Impact of the First Phase of the COVID-19 Pandemic on the Acquisition of Goods and Services in the Italian Health System

The emergency caused by the escalation in the COVID-19 pandemic, which became widespread starting on 31 January 2020, put a strain on the Italian National Health System and forced purchasing centres to deviate from the ordinary general principles dictated by current legislation. The aim of this paper is to describe how Spedali Civili Hospital in Brescia challenged the crisis, structured itself optimally, followed simplified procedures, launched new processes, and opened up more Intensive Care Unit beds to accommodate the high number of COVID cases. From an analysis of the equipment variation in terms of increased purchases, subsequent installations, and tests carried out compared with the pre-pandemic period, we report the difficulties that hospitals had to face in the first phase of the pandemic and how they were able to respond to their needs. Our data clearly displayed how the pandemic situation led to a deep internal reorganisation and that the drafting of simpler, effective, and adaptable procedures represents a first key element to ensure receptivity and responsiveness in the management of ordinary and non-ordinary events such as this pandemic condition.

Identification of the high-risk residence communities and possible risk factors of COVID-19 in Wuhan, China☆

The coronavirus disease 2019 (COVID-19) has become a public health emergency of international concern. It is important to identify high-risk residence communities and the risk factors for decision making on targeted prevention and control measures. In this paper, the number of confirmed and suspected cases of COVID-19 in the residence communities in Wuhan, China was collected together with the characteristic variables of the residence communities and the distances between the residence communities and nearby crowded places. The correlation analysis was conducted between the number of confirmed cases and the characteristic/distance variables. Concerning the characteristic variables, there are significant positive correlations between the number of COVID-19 confirmed cases and the construction area, covered area, total number of houses, total number of buildings, volume ratio, property charge, and number of second-hand houses in the residence communities in Wuhan, while minor or no correlation is observed for the average price of houses, construction year, greening ratio, or number of sold houses. Concerning the distance variables, there are significant negative correlations between the number of confirmed cases and the distances from the residence communities to the nearest universities, business clusters, and railway stations, while minor or no correlation is observed for the Huanan Seafood Wholesale Market, kindergartens, primary schools, middle schools, shopping malls, cinemas, subway stations, bus stops, inter-city bus stations, airport, general hospitals, or appointed hospitals for COVID-19 pandemic. Therefore, the residence communities which are newly-built, where the volume ratio or property charge is high or the construction area, covered area, or total number of houses, buildings, second-hand houses, or sold houses is large, or which are close to universities, business clusters, subway stations, or railway stations are the high-risk ones where strict measures should be taken. This study provides the authorities with a valuable reference for precise disease prevention and control on the residence community level in similar cities in the world.

Developing statewide remdesivir use criteria

Purpose

This report describes our process of 4 health systems coming together to agree on standard use criteria for remdesivir as a coronavirus disease 2019 (COVID-19) treatment for patients in Utah. We hope our process provides a framework for remdesivir use in other states and insights on future use of other therapeutic agents that may also be in short supply, such as vaccines and monoclonal antibodies.

Summary

Emergency use authorization (EUA) criteria for COVID-19 treatments often allow for broad use of a treatment relative to limited supplies. Without national criteria, each health system must develop further rationing criteria. Health systems in Utah worked together as part of the state’s crisis standards of care workgroup to develop a framework for how to limit the EUA criteria for remdesivir to match available supplies. The 4 largest health systems were represented by infectious diseases specialists, chief medical officers, and pharmacists. The group met several times online and communicated via email over a 9-day period to develop the criteria. The clinicians agreed to use this framework to develop criteria for future therapeutics such as monoclonal antibodies.

Conclusion

The unique collaboration of the 4 health systems in Utah led to statewide criteria for use of remdesivir for patients with COVID-19, ensuring similar access to this limited resource for all patients in Utah.

'Strategy-as-practice' by hospital personnel in hospitals: a scoping review protocol

Background: Strategy in hospitals is based on distinct principles and rules which lead organisations to act on chosen priorities. Hospitals are struggling to cope with increasing service demands and activity and need to become more responsive to changing environments while demonstrating effective use of resources. Strategizing involves the active process of sensing, planning, implementing and evaluating strategy. Strategy-as-practice is concerned with what people do about strategy in an organisation, as opposed to the traditional focus on what the organisation has as a strategy. It is recognised that there is a disconnection between strategic planning and implementation, however little is known about how organisational context influences the strategic process or how hospital personnel engage in strategic activities. The aim of this scoping review is to explore the literature on strategizing by hospital personnel in hospitals, and will include literature for hospital both professional and managerial backgrounds, to establish the extent and breadth of strategizing or as it is often termed ‘strategy-as-practice’ in hospitals. Methods: The systematic scoping review will search the literature within the databases of PubMed, Embase, CINAHL, PsycINFO, ABI/INFORM (Proquest) and OpenGrey.net to explore the scientific evidence on strategizing in hospitals. The review will be based on the Arksey & O’Malley (2005) framework of five mandatory steps which was updated (Levac et al 2010, Colquhoun et al 2014 & Peters 2015) and is published online by the Joanna Briggs Institute. It will follow the PRISMA-ScP reporting guidelines. Conclusion: A scoping review methodology will provide a framework to explore strategizing in hospitals comprehensively and map the body of literature for this subject, which has not been conducted previously. This review will summarise the evidence on the use of strategy as practice in hospitals.  Based on the findings we will identify knowledge gaps and areas for future research.