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Teng H, Wang Z, Yang X, Wu X, Chen Z, Wang Z, Chen G. The impact of COVID-19 on clinical outcomes in people undergoing neurosurgery: a systematic review and meta-analysis. Syst Rev 2023; 12:137. [PMID: 37550713 PMCID: PMC10405503 DOI: 10.1186/s13643-023-02291-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 07/17/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND The coronavirus disease-2019 (COVID-19) pandemic has created a global crisis unique to the healthcare system around the world. It also had a profound impact on the management of neurosurgical patients. In our research, we investigated the effect of the COVID-19 pandemic on clinical outcomes in people undergoing neurosurgery, particularly vascular and oncological neurosurgery. METHOD Two investigators independently and systematically searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrail.Gov, and Web of Science to identify relevant studies respecting the criteria for inclusion and exclusion published up to June 30, 2022. The outcomes of our research included mortality rate, length of stay, modified Rankin Score, delay in care, Glasgow outcome scale, and major complications. The risk of bias was assessed using the Methodological Index for Non-randomized Studies (MINORS) checklist. RESULTS Two investigators independently and systematically searched 1378 results from MEDLINE, EMBASE, Cochrane database, ClinicalTrail.Gov, and Web of Science and extracted the detailed data from 13 studies that met the review's eligibility criteria. Two articles reported on patients with intracerebral hemorrhages, five on patients with subarachnoid hemorrhages, four on patients undergoing surgery for neuro-oncology, and in two studies the patients' conditions were unspecified. A total of 26,831 patients were included in our research. The number who died was significantly increased in the COVID-19 pandemic group (OR 1.52, 95% CI 1.36-1.69, P < 0.001). No significant difference was found between the two groups in terms of length of stay (SMD - 0.88, 95% CI - 0.18-0.02, P = 0.111), but it differed between regions, according to our subgroup analysis. CONCLUSION Compared to the pre-pandemic group, the number who died was significantly increased in the COVID-19 pandemic group. Meanwhile, the effect of the pandemic on clinical outcomes in people undergoing neurosurgery might differ in different regions, according to our subgroup analysis.
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Affiliation(s)
- Haiying Teng
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu Province, China
- Suzhou Medical College of Soochow University, Suzhou, 215002, Jiangsu Province, China
| | - Zilan Wang
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu Province, China
| | - Xingyu Yang
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu Province, China
| | - Xiaoxiao Wu
- Suzhou Medical College of Soochow University, Suzhou, 215002, Jiangsu Province, China
| | - Zhouqing Chen
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu Province, China.
| | - Zhong Wang
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu Province, China.
| | - Gang Chen
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu Province, China
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2
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McLean J, Clark C, McKee A, Legue S, Cocking J, Lamarche A, Heerschap C, Morris S, Fletcher T, McKee C, Kennedy K, Gross L, Broeren A, Forder M, Barner W, Tebbutt C, Kings S, DiDiodato G. Pandemic Responsiveness in an Acute Care Setting: A Community Hospital's Utilization of Operational Resources During COVID-19. J Multidiscip Healthc 2022; 15:1309-1321. [PMID: 35726265 PMCID: PMC9206458 DOI: 10.2147/jmdh.s361896] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 06/02/2022] [Indexed: 11/23/2022] Open
Abstract
Background To ensure continuity of services while mitigating patient surge and nosocomial infections during the coronavirus disease 2019 (COVID-19) pandemic, acute care hospitals have been required to make significant operational adjustments. Here, we identify and discuss key administrative priorities and strategies utilized by a large community hospital located in Ontario, Canada. Methods Guided by a qualitative descriptive approach, we performed a thematic analysis of all COVID-19-related documentation discussed by the hospital’s emergency operation centre (EOC) during the pandemic’s first wave. We then solicited operational strategies from a multidisciplinary group of hospital leaders to construct a narrative for each theme. Results Seven recurrent themes critical to the hospital’s pandemic response emerged: 1) Organizational structure: a modified EOC structure was adopted to increase departmental interoperability and situational awareness; 2) Capacity planning: Design Thinking guided rapid infrastructure decisions to meet surge requirements; 3) Occupational health and workplace safety: a multidisciplinary team provided respirator fit-testing, critical absence adjudication, and wellness needs; 4) Human resources/workforce planning: new workforce planning, recruitment, and redeployment strategies addressed staffing shortages; 5) Personal protective equipment (PPE): PPE conservation required proactive sourcing from traditional and non-traditional suppliers; 6) Community response: local partnerships were activated to divert patients through a non-referral-based assessment and treatment centre, support long-term care and retirement homes, and establish a 70-bed field hospital; and 7) Corporate communication: a robust communication strategy provided timely and transparent access to rapidly evolving information. Conclusion A community hospital’s operational preparedness for COVID-19 was supported by inter-operability, leveraging internal and external expertise and partnerships, creative problem solving, and developing novel tools to support occupational health and community initiatives.
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Affiliation(s)
- Jesse McLean
- Royal Victoria Regional Health Centre, Barrie, ON, Canada
| | - Cathy Clark
- Royal Victoria Regional Health Centre, Barrie, ON, Canada
| | - Aidan McKee
- Royal Victoria Regional Health Centre, Barrie, ON, Canada.,School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Suzanne Legue
- Royal Victoria Regional Health Centre, Barrie, ON, Canada
| | - Jane Cocking
- Royal Victoria Regional Health Centre, Barrie, ON, Canada
| | | | | | - Sarah Morris
- Royal Victoria Regional Health Centre, Barrie, ON, Canada
| | | | - Corey McKee
- Royal Victoria Regional Health Centre, Barrie, ON, Canada
| | | | - Leigh Gross
- Royal Victoria Regional Health Centre, Barrie, ON, Canada
| | - Andrew Broeren
- Royal Victoria Regional Health Centre, Barrie, ON, Canada
| | - Matthew Forder
- Royal Victoria Regional Health Centre, Barrie, ON, Canada
| | - Wendy Barner
- Royal Victoria Regional Health Centre, Barrie, ON, Canada
| | - Chris Tebbutt
- Royal Victoria Regional Health Centre, Barrie, ON, Canada
| | - Suzanne Kings
- Royal Victoria Regional Health Centre, Barrie, ON, Canada
| | - Giulio DiDiodato
- Royal Victoria Regional Health Centre, Barrie, ON, Canada.,Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, Canada
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3
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Barnes A, Crilly J. Review article: Impact of pandemics on rural emergency departments: A scoping review. Emerg Med Australas 2022; 34:312-321. [PMID: 35231959 DOI: 10.1111/1742-6723.13938] [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: 06/30/2021] [Revised: 12/04/2021] [Accepted: 01/10/2022] [Indexed: 11/27/2022]
Abstract
Pandemics can cause much distress to communities and present a major burden to the resources and functioning of hospitals. This scoping review aimed to identify, evaluate and summarise current literature regarding how pandemics impact rural EDs in terms of staff wellbeing, structure, function and resources. A systematic search of six databases using search terms including pandemic, ED and rural and remote was undertaken. Articles were included if they were peer-reviewed, written in English, original research, published between January 2010 and October 2021 and discussed the impact of pandemics on rural EDs. Articles were critically appraised using the Mixed Methods Appraisal Tool (MMAT). Three articles, one from Canada and two from the United States, met the inclusion criteria. The articles included were quantitative in design and fulfilled most of the MMAT critical analysis criteria. Pandemics reported on included H1N1 and COVID-19. These pandemics impacted rural EDs in terms of functioning and resourcing; no description of staff wellbeing or structure was identified. Rural ED functioning was affected in terms of input; with an increase in patient presentations and time to physician assessment during H1N1, but a decrease in patient presentations and transfers during COVID-19. Rural ED resources were impacted in regard to staffing, difficulty in obtaining stocks of personal protective equipment and medication, and community response. Further research to understand and address the short- and long-term impacts pandemics may have on rural EDs is required.
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Affiliation(s)
- Amber Barnes
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
| | - Julia Crilly
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,Department of Emergency Medicine, Gold Coast Health, Gold Coast, Queensland, Australia
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4
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Abstract
The purpose of this article was to demonstrate the difference between a pandemic plan’s textual prescription and its effective processing using graphical notation. Before creating a case study of the Business Process Model and Notation (BPMN) of the Czech Republic’s pandemic plan, we conducted a systematic review of the process approach in pandemic planning and a document analysis of relevant public documents. The authors emphasized the opacity of hundreds of pages of text records in an explanatory case study and demonstrated the effectiveness of the process approach in reengineering and improving the response to such a critical situation. A potential extension to the automation and involvement of SMART technologies or process optimization through process mining techniques is presented as a future research topic.
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5
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The Current State of Infectious Disasters Preparedness Around the World: A Qualitative Systematic Review (2007-2019). Disaster Med Public Health Prep 2020; 16:753-762. [PMID: 33371908 DOI: 10.1017/dmp.2020.258] [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: 11/06/2022]
Abstract
Infectious disasters have specific features which require special approaches and facilities. The main challenge is the rate of spread, and their ability to traverse the Earth in a short time. The preparedness of hospitals to face these events is therefore of the utmost importance. This study was designed to assess the preparedness of countries facing biological events worldwide. A qualitative systematic review was done from PubMed (National Library of Medicine, Bethesda, MD), Scopus (Elsevier, Amsterdam, Netherlands), Web of Science (Thomson Reuters, New York, NY), ProQuest (Ann Arbor, MI), and Google Scholar (Google Inc, Mountain View, CA). Two journals were searched as key journals. The search period was from January 1, 2007 to December 30, 2018. Twenty-one (21) documents were selected including 7 (33%) from Asia, 7 (33%) from Europe, 4 (19%) from USA, 2 (10%) from Africa, and 1 (5%) multi-continental. Forty-six (46) common sub-themes were obtained and categorized into 13 themes (infection prevention control, risk perception, planning, essential support services, surveillance, laboratory, vulnerable groups, education and exercise and evaluation, human resource, clinical management of patients, risk communication, budget, and coordination). Not all articles discussed all the identified categories. There is an extended process required to reach complete preparedness for confronting biological events, including adequate and well-managed budget. Medical centers may have trouble dealing with such events, at least in some respects, but most developed countries seem to be more prepared in this regard.
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6
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Migone AR. Trust, but customize: federalism's impact on the Canadian COVID-19 response. POLICY & SOCIETY 2020; 39:382-402. [PMID: 35039727 PMCID: PMC8754695 DOI: 10.1080/14494035.2020.1783788] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This article explores how Canadian federalism, with its complex mix of competencies, and the country's punctuated gradualism policy style interface with urgent, complex decision-making like the COVID-19 pandemic. We find that while punctuated gradualism favors tailored responses to pandemic management it is weaker when coordination and resourcing are to be undertaken during non-crisis situations and that, while the level of cooperation among Canadian jurisdictions has progressively increased over the years, policy is still almost exclusively handled at the federal, provincial and territorial levels. Furthermore, the model appears to have critical 'blind spots' in terms of vulnerable communities that do not emerge as such until after a crisis hits.
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Affiliation(s)
- Andrea Riccardo Migone
- Department of Politics and Public Administration, JOR 724, Ryerson University, Toronto, ON, Canada
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Bajunaid K, Alqurashi A, Alatar A, Alkutbi M, Alzahrani AH, Sabbagh AJ, Alobaid A, Barnawi A, Alferayan AA, Alkhani AM, Salamah AB, Sheikh BY, Alotaibi FE, Alabbas F, Farrash F, Al-Jehani HM, Alhabib H, Alnaami I, Altweijri I, Khoja I, Taha M, Alzahrani M, Bafaquh MS, Binmahfoodh M, Algahtany MA, Al-Rashed S, Raza SM, Elwatidy S, Alomar SA, Al-Issawi W, Khormi YH, Ammar A, Al-Habib A, Baeesa SS, Ajlan A. Neurosurgical Procedures and Safety During the COVID-19 Pandemic: A Case-Control Multicenter Study. World Neurosurg 2020; 143:e179-e187. [PMID: 32702490 PMCID: PMC7370909 DOI: 10.1016/j.wneu.2020.07.093] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 07/14/2020] [Indexed: 12/20/2022]
Abstract
Objective Quantitative documentation of the effects of outbreaks, including the coronavirus disease 2019 (COVID-19) pandemic, is limited in neurosurgery. Our study aimed to evaluate the effects of the COVID-19 pandemic on neurosurgical practice and to determine whether surgical procedures are associated with increased morbidity and mortality. Methods A multicenter case-control study was conducted, involving patients who underwent neurosurgical intervention in the Kingdom of Saudi Arabia during 2 periods: pre-COVID-19 and during the COVID-19 pandemic. The surgical intervention data evaluated included diagnostic category, case priority, complications, length of hospital stay, and 30-day mortality. Results A total of 850 procedures were included, 36% during COVID-19. The median number of procedures per day was significantly lower during the COVID-19 period (5.5 cases) than during the pre-COVID-19 period (12 cases; P < 0.0001). Complications, length of hospital stay, and 30-day mortality did not differ during the pandemic. In a multivariate analysis comparing both periods, case priority levels 1 (immediate) (odds ratio [OR], 1.82; 95% confidence interval [CI], 1.24–2.67), 1 (1–24 h) (OR, 1.63; 95% CI, 1.10–2.41), and 4 (OR, 0.28; 95% CI, 0.19–0.42) showed significant differences. Conclusions During the early phase of the COVID-19 pandemic, the overall number of neurosurgical procedures declined, but the load of emergency procedures remained the same, thus highlighting the need to allocate sufficient resources for emergencies. More importantly, performing neurosurgical procedures during the pandemic in regions with limited effects of the outbreak on the health care system was safe. Our findings may aid in developing guidelines for acute and long-term care during pandemics in surgical subspecialties.
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Affiliation(s)
- Khalid Bajunaid
- Department of Surgery, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia; Department of Neurology and Neurosurgery, Montreal Neurological Institute and hospital, McGill University, Montreal, Quebec, Canada
| | - Ashwag Alqurashi
- Neurosurgery Division, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah Alatar
- Neurosurgery Division, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohammad Alkutbi
- Department of Neurosurgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Anas H Alzahrani
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdulrahman J Sabbagh
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdullah Alobaid
- Department of Adult Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abdulwahed Barnawi
- Department of Neurosurgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | | | - Ahmed M Alkhani
- Division of Neurosurgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Ali Bin Salamah
- Department of Neurosurgery, King Saud Medical City, Riyadh, Saudi Arabia
| | - Bassem Yousef Sheikh
- Vascular Endovascular and Skull Base Neurosurgery, College of Medicine, Taibah University, Madinah, Saudi Arabia
| | - Fahad E Alotaibi
- Department of Pediatric Neurosurgery, National Neuroscience institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Faisal Alabbas
- Department of Neurosurgery, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Faisal Farrash
- Department of Neuroscience, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Hosam M Al-Jehani
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and hospital, McGill University, Montreal, Quebec, Canada; Department of Neurosurgery, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Husam Alhabib
- Department of Spine Surgery, Dr Sulaiman Alhabib Hospital, Khobar, Saudi Arabia
| | - Ibrahim Alnaami
- Division of Neurosurgery, Department of Surgery, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Ikhlass Altweijri
- Division of Neurosurgery, Department of Surgery, King Khalid University Hospital, Riyadh, Saudi Arabia
| | - Isam Khoja
- Department of Neurosurgery, International Medical Center, Jeddah, Saudi Arabia
| | - Mahmoud Taha
- Department of Neurosurgery, King Fahad specialist Hospital, Dammam, Saudi Arabia
| | - Moajeb Alzahrani
- Division of Neurosurgery, Department of Surgery, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Mohammed S Bafaquh
- Department of Adult Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mohammed Binmahfoodh
- Neurosciences Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Mubarak Ali Algahtany
- Division of Neurosurgery, Department of Surgery, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Sabah Al-Rashed
- Department of Neurosurgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Syed Muhammad Raza
- Department of Neurosurgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Sherif Elwatidy
- Neurosurgery Division, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Soha A Alomar
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Wisam Al-Issawi
- Department of Neurosurgery, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Yahya H Khormi
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Ahmad Ammar
- Department of Neurosurgery, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Amro Al-Habib
- Neurosurgery Division, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Saleh S Baeesa
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdulrazag Ajlan
- Neurosurgery Division, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
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Sharififar S, Jahangiri K, Zareiyan A, Khoshvaghti A. Factors affecting hospital response in biological disasters: A qualitative study. Med J Islam Repub Iran 2020; 34:21. [PMID: 32551310 PMCID: PMC7293813 DOI: 10.34171/mjiri.34.21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Indexed: 11/05/2022] Open
Abstract
Background: The fatal pandemics of infectious diseases and the possibility of using microorganisms as biological weapons are both rising worldwide. Hospitals are vital organizations in response to biological disasters and have a crucial role in the treatment of patients. Despite the advances in studies about hospital planning and performance during crises, there are no internationally accepted standards for hospital preparedness and disaster response. Thus, this study was designed to explain the effective factors in hospital performance during biological disasters. Methods: Qualitative content analysis with conventional approach was used in the present study. The setting was Ministry of Health and related hospitals, and other relevant ministries responsible at the time of biologic events in Islamic Republic of Iran (IR of Iran) in 2018. Participants were experts, experienced individuals providing service in the field of biological disaster planning and response, policymakers in the Ministry of Health, and other related organizations and authorities responsible for the accreditation of hospitals in IR of Iran. Data were collected using 12 semi-structured interviews in Persian language. Analysis was performed according to Graneheim method. Results: After analyzing 12 interviews, extraction resulted in 76 common codes, 28 subcategories, and 8 categories, which are as follow: detection; treatment and infection control; coordination, Resources; training and exercises; communication and information system; construction; and planning and assessment. Conclusion: Hospital management in outbreaks of infectious diseases (intentional or unintentional) is complex and requires different actions than during natural disasters. In such disasters, readiness to respond and appropriate action is a multifaceted operation. In IR of Iran, there have been few researches in the field of hospital preparation in biologic events, and the possibility of standardized assessment has be reduced due to lack of key skills in confronting biological events. It is hoped that the aggregated factors in the 8 groups of this study can evaluate hospital performance more coherently.
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Affiliation(s)
- Simintaj Sharififar
- Department of Health in Disasters and Emergencies, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,School of Nursing, Aja University of Medical Sciences, Tehran, Iran
| | - Katayoun Jahangiri
- Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Health in Disasters and Emergencies, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Armin Zareiyan
- Department of Health in Disasters and Emergencies, School of Nursing, Aja University of Medical Sciences, Tehran, Iran
| | - Amir Khoshvaghti
- Infectious Diseases Research Center, Aerospace and Subaquatic Medicine Faculty, Aja University of Medical Sciences, Tehran, Iran
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9
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Beysard N, Yersin B, Meylan P, Hugli O, Carron PN. Impact of the 2014-2015 influenza season on the activity of an academic emergency department. Intern Emerg Med 2018; 13:251-256. [PMID: 28091839 DOI: 10.1007/s11739-017-1606-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 01/06/2017] [Indexed: 11/29/2022]
Abstract
The morbidity and mortality of the 2014-2015 influenza season were more important than those in previous years. We assessed the impact of the 2014-2015 influenza season on the length of stay (LOS) and workload in an academic emergency department (ED). This is a monocentric retrospective study. The database of the microbiology laboratory was used to identify influenza nasal swabs performed during the influenza seasons from 2010 to 2015. Patients admitted to the ED during these periods were identified through the administrative database and cross-checked with patients who underwent an influenza nasal swab in the ED. Median LOS was used to estimate the impact of the isolation procedures on ED LOS. Bed occupancy rate and mean LOS in the ED were calculated as proxy of the ED workload. During the 2014-2015 influenza season, 55.9% of ED patients (n = 123) with confirmed influenza were hospitalised. In terms of workload, despite that influenza patients represented only 2.2% of all ED patients during the season, they occupied 28% of ED beds with respiratory isolation during the delay to realise and obtain the test results, as well as during the delay before being discharged home or transferred to a hospital ward. The median ED LOS for influenza-confirmed patients was significantly longer in comparison with all ED patients (21.6 h vs 4.0 for ambulatory patients and 24.7 h vs 12.3 for hospitalised patients). The 2014-2015 influenza season had significant consequences in terms of ED LOS and bed use. It dramatically increased the workload in the ED.
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Affiliation(s)
- Nicolas Beysard
- Emergency Department, Centre Hospitalier Universitaire Vaudois, rue du Bugnon 46, 1011, Lausanne, Switzerland.
| | - Bertrand Yersin
- Emergency Department, Centre Hospitalier Universitaire Vaudois, rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Pascal Meylan
- Institute of Microbiology, Centre Hospitalier Universitaire Vaudois, rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Olivier Hugli
- Emergency Department, Centre Hospitalier Universitaire Vaudois, rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Pierre-Nicolas Carron
- Emergency Department, Centre Hospitalier Universitaire Vaudois, rue du Bugnon 46, 1011, Lausanne, Switzerland
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10
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Dewar B, Barr I, Robinson P. Hospital capacity and management preparedness for pandemic influenza in Victoria. Aust N Z J Public Health 2015; 38:184-90. [PMID: 24690058 DOI: 10.1111/1753-6405.12170] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Revised: 08/01/2013] [Accepted: 10/01/2013] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE This study was designed to investigate acute hospital pandemic influenza preparedness in Victoria, Australia, particularly focussing on planning and management efforts. METHODS A prospective study was conducted by questionnaire and semi-structured interview of health managers across the Victorian hospital system from July to October 2011. Participants with responsibility for emergency management, planning and operations were selected from every hospital in Victoria with an emergency department to complete a questionnaire (response rate 22/43 = 51%). Each respondent was invited to participate in a phone-based semi-structured interview (response rate 11/22 = 50%). RESULTS Rural/regional hospitals demonstrated higher levels of clinical (86%) and non-clinical (86%) staff contingency planning than metropolitan hospitals (60% and 40% respectively). Pandemic plans were not being sufficiently tested in exercises or drills, which is likely to undermine their effectiveness. All respondents reported hand hygiene and standard precautions programs in place, although only one-third (33%) of metropolitan respondents and no rural/regional respondents reported being able to meet patient needs with high levels of staff absenteeism. Almost half Victoria's healthcare workers were unvaccinated against influenza. CONCLUSIONS AND IMPLICATIONS Hospitals across Victoria demonstrated different levels of influenza pandemic preparedness and planning. If a more severe influenza pandemic than that of 2009 arose, Victorian hospitals would struggle with workforce and infrastructure problems, particularly in rural/regional areas. Staff absenteeism threatens to undermine hospital pandemic responses. Various strategies, including education and communication, should be included with in-service training to provide staff with confidence in their ability to work safely during a future pandemic.
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Affiliation(s)
- Ben Dewar
- School of Public Health and Human Biosciences, La Trobe University, Victoria
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11
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Reidy M, Ryan F, Hogan D, Lacey S, Buckley C. Preparedness of Hospitals in the Republic of Ireland for an Influenza Pandemic, an Infection Control Perspective. BMC Public Health 2015; 15:847. [PMID: 26335570 PMCID: PMC4557843 DOI: 10.1186/s12889-015-2025-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 07/06/2015] [Indexed: 11/24/2022] Open
Abstract
Background When an influenza pandemic occurs most of the population is susceptible and attack rates can range as high as 40–50 %. The most important failure in pandemic planning is the lack of standards or guidelines regarding what it means to be ‘prepared’. The aim of this study was to assess the preparedness of acute hospitals in the Republic of Ireland for an influenza pandemic from an infection control perspective. Methods This was a cross sectional study involving a questionnaire completed by infection control nurses, time period from June – July 2013, (3 weeks) from acute public and private hospitals in the Republic of Ireland. A total of 46 out of 56 hospitals responded to the questionnaire. Results From a sample of 46 Irish hospitals, it was found that Irish hospitals are not fully prepared for an influenza pandemic despite the 2009 Influenza A (H1N1) pandemic. In 2013, thirty five per cent of Irish hospitals have participated in an emergency plan or infectious disease exercise and have plans or been involved in local planning efforts to care for patients at non-health care facilities. Sixty per cent of Irish hospitals did not compile or did not know if the hospital had compiled a “lessons learned” from any exercise that were then used to revise emergency response plans. Fifty two per cent of hospitals have sufficient airborne isolation capacity to address routine needs and have an interim emergency plan to address needs during an outbreak. Fifty one percent of hospitals have taken specific measures to stockpile or have reserve medical supplies e.g. masks, ventilators and linen. Conclusions This is the first study carried out in the Republic of Ireland investigating the current preparedness for an influenza pandemic from an infection control perspective. Deficits exist in the provision of emergency planning committees, testing of emergency plans, airborne isolation facilities, stockpiling of personal protective equipment (PPE) and medical supplies and organisational schemes/incentives for healthcare workers to continue to work in a pandemic. While Irish standards are comparable to findings from international studies, the health care service needs to continue to enhance preparedness for an influenza pandemic and implement standard preparedness guidance for all Irish hospitals.
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Affiliation(s)
- Mary Reidy
- Bon Secours Hospital, Tralee, County Kerry, Ireland.
| | - Fiona Ryan
- Department of Public Health, Cork, Ireland.
| | - Dervla Hogan
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland.
| | - Sean Lacey
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland.
| | - Claire Buckley
- Department of Mathematics, Cork Institute of Technology, Cork, Ireland
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Apisarnthanarak A, Khawcharoenporn T, Woeltje KF, Warren DK. Hospital Flood Preparedness: A Survey of 15 Provinces in Central Thailand. Infect Control Hosp Epidemiol 2015; 33:952-4. [DOI: 10.1086/667394] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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