US Hospital Capacity Managers' Experiences and Concerns Regarding Preparedness for Seasonal Influenza and Influenza-like Illness

Evaluation and comparison of hospital preparedness levels against mass-casualty disasters and the COVID-19 pandemic

BACKGROUND

Inadequate preparedness of hospitals is associated with negative outcomes in the treatment procedure. During the coronavirus disease 2019 (COVID-19) pandemic, healthcare systems faced many problems due to the widespread prevalence of the disease. This study was designed and conducted with the aim of investigating and comparing the preparedness levels of hospitals against mass-casualty disasters and the COVID-19 pandemic.

METHOD

This research was a cross-sectional, descriptive-analytical study conducted in January 2022 in five educational hospitals affiliated with Qom University of Medical Sciences, Qom, Iran, admitting COVID-19 patients. The National Hospital Preparedness Checklist and the Hospital Preparedness Checklist for the COVID-19 pandemic were used to collect the required data.

RESULTS

The total preparedness level against mass-casualty disasters was estimated to be 79.81 percent. The lowest and highest average preparedness scores were related to the dimensions of "Logistic and management of supplies" (74 percent) and "command and control" (96.66 percent), respectively. In addition, the overall preparedness level against COVID-19 was estimated to be 87.20 percent. The lowest and highest average percentage of preparedness scores were related to the fields of "supply management" (71.81 percent) and "laboratory services" (97.14 percent), respectively.

CONCLUSION

The duration of exposure to emergency situations and managerial perspectives are among the factors affecting the preparedness of -medical systems against disasters. It is assumed that some kind of adaptation exists in healthcare systems, which leads to an improvement in their preparedness level. In order to deal with crises, it is suggested to set up specialized hospitals (such as trauma centers), train crisis managers, and use them in the management of medical centers.

Resilience and preparedness of hospitals for pandemics: Lessons learned from COVID-19

Amidst the COVID-19 pandemic, health systems around the world took a lot of pressure, and the resilience of these systems has been addressed in thedisaster management and COVID-19 literature. However, little focus has been given to the resilience of hospitals in general. Therefore, the study assessed one hospital in the Free State province of South Africa as a preliminary study for a project that will look at all hospitals in the Free State province. The study assessed the following: (1) the preparedness and actionable strategies that were implemented across the waves of the COVID-19 pandemic; (2) the resilience plans of the hospitals and also determined (3) the resilience of the hospital amid the COVID-19 pandemic; (4) the vulnerabilities exposed by the COVID-19 pandemic in the hospital. Using the R statistical program and modelling, I found that the study hospital was not prepared holistically for the COVID-19 pandemic. The five generalised linear mixed models and the general linear models applied did not show significant differences for the most important variables used to measure resilience. The models showed the hospital to be less resilient to pandemics. Several vulnerabilities were recorded across the hospital.

Contribution

This study's findings suggest that the studied hospital is not resilient to pandemics and will be able to make recommendations to relevant government departments to work together to strengthen the resilience of the country's healthcare system once the project is completed.

Association of robotic surgery with early discharge, readmission, and complications in elective colectomy: an analysis of NSQIP data from 2012 to 2021

Background Early discharge (ED) after colectomy has become a target outcome for multiple reasons, but the factors associated with ED are not well characterized. This study investigated the factors associated with ED and evaluated the impact of ED on overall outcome. Methods Data from ACS-NSQIP were used to identify patients who underwent non-emergent colectomy from 2012 to 2021. ED was defined as length of stay ≤ 2 days. Unpaired t-tests, chi-square tests and adjusted multivariate logistic regression modeling were used to estimate associated factors for ED. Bounceback readmission was defined as readmission within 7 days of discharge. Results In this cohort of 282,490 patients, 43,137 (15.3%) met the criteria for ED. Robotic colectomy (OR 14.35; 95% CI [13.63-15.12]) was more strongly associated with ED than any other patient characteristic, including laparoscopic colectomy (6.82 [6.51-7.14], ref open colectomy). ED vs. non-ED patients had lower rates of 30-day (5.84 vs. 10.37%, p < 0.01) and bounceback (3.56 vs. 5.75%, p < 0.01) readmissions, overall complications (5.65 vs. 18.63%, p < 0.01) and post-discharge complications (4.21 vs. 7.49%, p < 0.01). Conclusions Robotic surgery was the variable most strongly associated with ED, with greater odds of ED compared to both laparoscopic and open colectomy. Patients who had ED after robotic surgery had lower rates of complications and readmission compared to non-ED patients.

Pre-COVID-19 hospital quality and hospital response to COVID-19: examining associations between risk-adjusted mortality for patients hospitalised with COVID-19 and pre-COVID-19 hospital quality

OBJECTIVES

The extent to which care quality influenced outcomes for patients hospitalised with COVID-19 is unknown. Our objective was to determine if prepandemic hospital quality is associated with mortality among Medicare patients hospitalised with COVID-19.

DESIGN

This is a retrospective observational study. We calculated hospital-level risk-standardised in-hospital and 30-day mortality rates (risk-standardised mortality rates, RSMRs) for patients hospitalised with COVID-19, and correlation coefficients between RSMRs and pre-COVID-19 hospital quality, overall and stratified by hospital characteristics.

SETTING

Short-term acute care hospitals and critical access hospitals in the USA.

PARTICIPANTS

Hospitalised Medicare beneficiaries (Fee-For-Service and Medicare Advantage) age 65 and older hospitalised with COVID-19, discharged between 1 April 2020 and 30 September 2021.

INTERVENTION/EXPOSURE

Pre-COVID-19 hospital quality.

OUTCOMES

Risk-standardised COVID-19 in-hospital and 30-day mortality rates (RSMRs).

RESULTS

In-hospital (n=4256) RSMRs for Medicare patients hospitalised with COVID-19 (April 2020-September 2021) ranged from 4.5% to 59.9% (median 18.2%; IQR 14.7%-23.7%); 30-day RSMRs ranged from 12.9% to 56.2% (IQR 24.6%-30.6%). COVID-19 RSMRs were negatively correlated with star rating summary scores (in-hospital correlation coefficient -0.41, p<0.0001; 30 days -0.38, p<0.0001). Correlations with in-hospital RSMRs were strongest for patient experience (-0.39, p<0.0001) and timely and effective care (-0.30, p<0.0001) group scores; 30-day RSMRs were strongest for patient experience (-0.34, p<0.0001) and mortality (-0.33, p<0.0001) groups. Patients admitted to 1-star hospitals had higher odds of mortality (in-hospital OR 1.87, 95% CI 1.83 to 1.91; 30-day OR 1.46, 95% CI 1.43 to 1.48) compared with 5-star hospitals. If all hospitals performed like an average 5-star hospital, we estimate 38 000 fewer COVID-19-related deaths would have occurred between April 2020 and September 2021.

CONCLUSIONS

Hospitals with better prepandemic quality may have care structures and processes that allowed for better care delivery and outcomes during the COVID-19 pandemic. Understanding the relationship between pre-COVID-19 hospital quality and COVID-19 outcomes will allow policy-makers and hospitals better prepare for future public health emergencies.

An Adaptive Healthcare Organization Can Effectively Respond to Medical Crises

Healthcare systems are challenged by unexpected medical crises. Established frameworks and approaches to guide healthcare institutions during these crises are limited in their effectiveness. We propose an Adaptive Healthcare Organization (AHO) system as a framework focused on the dynamic nature of healthcare delivery. Based on seven key capabilities, the AHO framework can guide single and multi-institutional healthcare organizations to adapt in real time to an unexpected medical crisis and improve their efficiency and effectiveness.

Changes in Patient Experiences of Hospital Care During the COVID-19 Pandemic

Importance

It is important to assess how the COVID-19 pandemic was adversely associated with patients' care experiences.

Objective

To describe differences in 2020 to 2021 patient experiences from what would have been expected from prepandemic (2018-2019) trends and assess correlates of changes across hospitals.

Design, Setting, and Participants

This cohort study compared 2020 to 2021 data with 2018 to 2019 data from 3 900 887 HCAHPS respondents discharged from 3381 HCAHPS-participating US hospitals. The data were analyzed from 2022 to 2023.

Main Outcomes and Measures

The primary outcome was an HCAHPS summary score (HCAHPS-SS), which averaged 10 HCAHPS measures. The primary analysis estimated whether HCAHPS scores from patients discharged from 2020 to 2021 differed from scores that would be expected based on quarterly and linear trends from 2018 to 2019 discharges. Secondary analyses stratified hospitals by prepandemic overall star ratings and staffing levels.

Results

Of the 3 900 887 HCAHPS 2020 to 2021 respondents, 59% were age 65 years or older, and 35% (11%) were in the surgical (maternity) service lines. Compared with trends expected based on prepandemic (2018-2019) data, HCAHPS-SS was 1.2 percentage points (pp) lower for quarter (Q) 2/2020 discharges and -1.9 to -2.0 pp for Q3/2020 to Q1/2021, which then declined to -3.6 pp by Q4/2021. The most affected measures (Q4/2021) were staff responsiveness (-5.6 pp) and cleanliness (-4.9 pp); the least affected were discharge information (-1.6 pp) and quietness (-1.8 pp). Overall rating and hospital recommendation measures initially exhibited smaller-than-average decreases, but then fell as much as the more specific experience measures by Q2/2021. Quietness did not decline until Q2/2021. The HCAHPS-SS fell most for hospitals with the lowest prepandemic staffing levels; hospitals with bottom-quartile staffing showed the largest decrements, whereas top-quartile hospitals showed smaller decrements in most quarters. Hospitals with better overall prepandemic quality showed consistently smaller HCAHPS-SS drops, with effects for 5-star hospitals about 25% smaller than for 1-star and 2-star hospitals.

Conclusions and Relevance

The results of this cohort study of HCAHPS-participating hospitals found that patient experience scores declined during 2020 to 2021. By Q4/2021, the HCAHPS-SS was 3.6 pp lower than would have been expected, a medium effect size. The most affected measures (staff responsiveness and cleanliness) showed large effect sizes, possibly reflecting high illness-associated hospital workforce absenteeism. Hospitals that were lower performing and less staffed prepandemic may have been less resilient to reduced staff availability and other pandemic-associated challenges. However, by Q4/2021, even prepandemic high-performing hospitals had similar declines.

Nurse Faculty Provide Essential Support to Graduate Nursing Students During COVID-19 Pandemic

Nurses in formal and informal leadership roles have been stretched to fulfill duties in their own role and be pulled into staffing. These emerging leaders have little energy to pursue an advanced academic degree when they are already considering leaving the profession. In a health care industry filled with ambiguity and volatility, continued efforts to support, retain, and recruit nurses in graduate leadership programs are essential. This article describes how graduate nursing faculty provided support to graduate students in unprecedented times.

Capacity and Organisation of Madrid’s Community Hospitals During First Wave of COVID-19 Pandemic

Introduction and objectives

The first wave of the SARS-CoV-2 pandemic exerted enormous stress on the healthcare system. Community of Madrid hospitals responded by restructuring and scaling their capacity to adapt to the high demand for care.

Methods

This was a retrospective observational study conducted between 18 March and 21 June 2020 with data from public and private hospitals in CoM, Spain. Absolute and relative frequencies were calculated for inpatients with and without COVID-19, available and occupied beds in intensive care unit (ICU) and non-ICU wards, daily new admissions (NA), individuals awaiting hospitalisation in the emergency department (ED), and discharges.

Results

Compared to pre-pandemic years, during the maximum care pressure period (18 March–17 April 2020), the average number of total available and occupied beds increased by 27% and 36%, respectively. Also, the average number of available and occupied ICU beds increased by 174% and 257% respectively, and average occupancy was 81%. The average daily NAs were 1,503 (90% from the ED) and 949 (63% due to COVID-19), and of these, 61 (6.4%) were admitted to the ICU. On average, at 6:00 p.m., 1112 patients were waiting in the ED to be admitted and 299 (26.8%) patients waited for more than 24 h. Discharges due to death for COVID-19 inpatients in the non-ICU and ICU wards were 16% and 36%, respectively.

Conclusions

This study confirmed the critical role of the ICU and ED, especially in the care of patients before being hospitalizated, in pandemic or health crisis scenarios.