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Galiatsatos P, Garibaldi B, Yao D, Xu Y, Perin J, Shahu A, Jackson JW, Piggott D, Falade-Nwulia O, Shubella J, Michtalik H, Belcher HME, Hansel NN, Golden S. Lack of racial and ethnic disparities in mortality in minority patients hospitalised with COVID-19 in a mid-Atlantic healthcare system. BMJ Open Respir Res 2024; 11:e002310. [PMID: 38692710 PMCID: PMC11086483 DOI: 10.1136/bmjresp-2024-002310] [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: 01/12/2024] [Accepted: 04/11/2024] [Indexed: 05/03/2024] Open
Abstract
INTRODUCTION In the USA, minoritised communities (racial and ethnic) have suffered disproportionately from COVID-19 compared with non-Hispanic white communities. In a large cohort of patients hospitalised for COVID-19 in a healthcare system spanning five adult hospitals, we analysed outcomes of patients based on race and ethnicity. METHODS This was a retrospective cohort analysis of patients 18 years or older admitted to five hospitals in the mid-Atlantic area between 4 March 2020 and 27 May 2022 with confirmed COVID-19. Participants were divided into four groups based on their race/ethnicity: non-Hispanic black, non-Hispanic white, Latinx and other. Propensity score weighted generalised linear models were used to assess the association between race/ethnicity and the primary outcome of in-hospital mortality. RESULTS Of the 9651 participants in the cohort, more than half were aged 18-64 years old (56%) and 51% of the cohort were females. Non-Hispanic white patients had higher mortality (p<0.001) and longer hospital length-of-stay (p<0.001) than Latinx and non-Hispanic black patients. DISCUSSION In this large multihospital cohort of patients admitted with COVID-19, non-Hispanic black and Hispanic patients did not have worse outcomes than white patients. Such findings likely reflect how the complex range of factors that resulted in a life-threatening and disproportionate impact of incidence on certain vulnerable populations by COVID-19 in the community was offset through admission at well-resourced hospitals and healthcare systems. However, there continues to remain a need for efforts to address the significant pre-existing race and ethnicity inequities highlighted by the COVID-19 pandemic to be better prepared for future public health emergencies.
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Affiliation(s)
| | | | - Dapeng Yao
- Johns Hopkins University, Baltimore, Maryland, USA
| | - Yanxun Xu
- Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Jamie Perin
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Andi Shahu
- Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - John W Jackson
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Chakraborty LS, Le Maitre CL, Chahine NO, Fields AJ, Gawri R, Giers MB, Smith LJ, Tang SY, Zehra U, Haglund L, Samartzis D, Martin JT. Impact of the COVID-19 pandemic on the productivity and career prospects of musculoskeletal researchers. J Orthop Res 2024. [PMID: 38678396 DOI: 10.1002/jor.25866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 03/27/2024] [Accepted: 04/15/2024] [Indexed: 04/30/2024]
Abstract
Academic researchers faced a multitude of challenges posed by the COVID-19 pandemic, including widespread shelter-in-place orders, workplace closures, and cessation of in-person meetings and laboratory activities. The extent to which these challenges impacted musculoskeletal researchers, specifically, is unknown. We developed an anonymous web-based survey to determine the pandemic's impact on research productivity and career prospects among musculoskeletal research trainees and faculty. There were 116 musculoskeletal (MSK) researchers with varying demographic backgrounds who completed the survey. Of respondents, 48.3% (n = 56) believed that musculoskeletal funding opportunities decreased because of COVID-19, with faculty members more likely to hold this belief compared to nonfaculty researchers (p = 0.008). Amongst MSK researchers, 88.8% (n = 103) reported research activity was limited by COVID-19, and 92.2% (n = 107) of researchers reported their research was not able to be refocused on COVID-19-related topics, with basic science researchers less likely to be able to refocus their research compared to clinical researchers (p = 0.030). Additionally, 47.4% (n = 55) reported a decrease in manuscript submissions since the onset of the pandemic. Amongst 51 trainee researchers, 62.8% (n = 32) reported a decrease in job satisfaction directly attributable to the COVID-19 pandemic. In summary, study findings indicated that MSK researchers struggled to overcome challenges imposed by the pandemic, reporting declines in funding opportunities, research productivity, and manuscript submission. Trainee researchers experienced significant disruptions to critical research activities and worsening job satisfaction. Our findings motivate future efforts to support trainees in developing their careers and target the recovery of MSK research from the pandemic stall.
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Affiliation(s)
- Lauren S Chakraborty
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Christine L Le Maitre
- Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Nadeen O Chahine
- Department of Orthopedic Surgery, Columbia University, New York, New York, USA
| | - Aaron J Fields
- Department of Orthopaedic Surgery, University of California in San Francisco, San Francisco, California, USA
| | - Rahul Gawri
- Division of Orthopaedic Surgery, Department of Surgery, McGill University, Montréal, Quebec, Canada
| | - Morgan B Giers
- School of Chemical, Biological & Environmental Engineering, Oregon State University, Corvallis, Oregon, USA
| | - Lachlan J Smith
- Departments of Orthopaedic Surgery and Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Simon Y Tang
- Department of Orthopaedic Surgery, Washington University, St. Louis, Missouri, USA
| | - Uruj Zehra
- Department of Anatomy, University of Health Sciences, Lahore, Pakistan
| | - Lisbet Haglund
- Division of Orthopaedic Surgery, Department of Surgery, McGill University, Montréal, Quebec, Canada
| | - Dino Samartzis
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - John T Martin
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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Carter D, Rosen A, Applebaum JR, Southern WN, Crossman DJ, Shelton RC, Auerbach A, Schnipper JL, Adelman JS. National Survey of Patient Safety Experiences in Hospital Medicine During the COVID-19 Pandemic. Jt Comm J Qual Patient Saf 2024; 50:260-268. [PMID: 38087723 DOI: 10.1016/j.jcjq.2023.10.010] [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: 07/07/2023] [Revised: 10/21/2023] [Accepted: 10/23/2023] [Indexed: 05/07/2024]
Abstract
BACKGROUND During the COVID-19 pandemic, hospitals were caring for increasing numbers of patients with a novel and highly contagious respiratory illness, forcing adaptations in care delivery. The objective of this study was to understand the impact of these adaptations on patient safety in hospital medicine. METHODS The authors conducted a nationwide survey to understand patient safety challenges experienced by hospital medicine clinicians during the COVID-19 pandemic. The survey was distributed to members of the Society of Hospital Medicine via an e-mail listserv. It consisted of closed- and open-ended questions to elicit respondents' experience in five domains: error reporting and communication, staffing, equipment, personal protective equipment (PPE) and isolation practices, and infrastructure. Quantitative questions were reported as counts and percentages; qualitative responses were coded and analyzed for relevant themes. RESULTS Of 196 total responses, 167 respondents (85.2%) were attending physicians and 85 (43.8%) practiced at teaching hospitals. Safety concerns commonly identified included nursing shortages (71.0%), limiting patient interactions to conserve PPE (61.9%), and feeling that one was practicing in a more hazardous environment (61.4%). In free-text responses, clinicians described poor outcomes and patient decompensation due to provider and equipment shortages, as well as communication lapses and diagnostic errors resulting from decreased patient contact and the need to follow isolation protocols. CONCLUSION Efforts made to accommodate shortages in staff and equipment, adapt to limited PPE, and enforce isolation policies had unintended consequences that affected patient safety and created a more hazardous environment characterized by less efficient care, respiratory decompensations, diagnostic errors, and poor communication with patients.
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Kulkarni SA, Wachter RM. The Hospitalist Movement 25 Years Later. Annu Rev Med 2024; 75:381-390. [PMID: 37802086 DOI: 10.1146/annurev-med-051022-043301] [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: 10/08/2023]
Abstract
Hospitalists are generalists who specialize in the care of hospitalized patients. In the 25 years since the term hospitalist was coined, the field of hospital medicine has grown exponentially and established a substantial footprint in the medical community. There are now more hospitalists than practicing physicians in any other internal medicine subspecialty. Several key forces catalyzed the growth in the field of hospital medicine, including the quality, safety, and value movements; residency duty hour restrictions; the emergence of electronic health records; and the COVID-19 pandemic. Looking ahead, we see new opportunities in the realms of technology and telemedicine, and challenges persist in regard to balancing financial considerations with increasing workload and burnout. Hospitalists must remain nimble and seize emerging opportunities to continue supporting the field's prominence and growth.
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Affiliation(s)
- Shradha A Kulkarni
- Department of Medicine, University of California, San Francisco, California, USA; ,
| | - Robert M Wachter
- Department of Medicine, University of California, San Francisco, California, USA; ,
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5
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Wallace AS, Raaum SE, Johnson EP, Presson AP, Allen CM, Elliott M, Bristol AA, Elmore CE. Impact of COVID-19 visitation policies and hospital capacity on discharge readiness in medicine patients. DISCOVER HEALTH SYSTEMS 2023; 2:45. [PMID: 38045443 PMCID: PMC10689550 DOI: 10.1007/s44250-023-00060-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/23/2023] [Indexed: 12/05/2023]
Abstract
Background COVID-19 impacted the experience of being hospitalized with the widespread adoption of strict visitation policies to ensure healthcare worker safety. One result was decreased time of caregivers at the bedside of hospitalized patients. Objective To understand the impact of pandemic-related system effects on patient-reported discharge preparation. Design This mixed methods study included interviews with a sample of discharged patients during April 2020, and quantitative hospital data from April 2020 to February 2021. Participants 616 patients completed a measure of discharge readiness on their day of discharge and 38 patients completed interviews about their discharge experiences. Main measures Readiness for discharge (RHDS), visitation policies, ward structure changes, COVID-19-unit census, time into the COVID-19 pandemic, patient characteristics (age, sex, race/ethnicity), admission type (planned/unplanned, for COVID-19), and discharge destination (home, home health, skilled nursing). Key results Adult patients aged 30-45 (vs. young and older adult patients) and those being discharged to places other than home (e.g., skilled nursing facility) or to out-of-state residences report lower readiness (p < 0.05) on RHDS. Patient interviews revealed some gaps in discharge communication but, overall, patients expressed high discharge readiness and few concerns about how COVID-19 system changes impacted their discharge preparation. Conclusions While there is some evidence that visitation policies and unit census may impact patient perceptions of discharge preparation, personal characteristics contributed more significantly to discharge readiness than system changes during COVID-19. Participant interviews demonstrated agreement, as most participants were discharged home and identified strong personal feelings of readiness for discharge.Clinical trials registration: ClinicalTrials.gov ID NCT04248738, https://clinicaltrials.gov/ct2/show/NCT04248738. Supplementary Information The online version contains supplementary material available at 10.1007/s44250-023-00060-8.
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Affiliation(s)
- Andrea S. Wallace
- The University of Utah College of Nursing, Annette Poulson Cumming Building Rm 5345, 10 South 2000 East, Salt Lake City, UT 84112-5880 USA
| | - Sonja E. Raaum
- University of Utah School of Medicine, Salt Lake City, USA
| | | | | | | | - Mackenzie Elliott
- The University of Utah College of Nursing, Annette Poulson Cumming Building Rm 5345, 10 South 2000 East, Salt Lake City, UT 84112-5880 USA
| | - Alycia A. Bristol
- The University of Utah College of Nursing, Annette Poulson Cumming Building Rm 5345, 10 South 2000 East, Salt Lake City, UT 84112-5880 USA
| | - Catherine E. Elmore
- The University of Utah College of Nursing, Annette Poulson Cumming Building Rm 5345, 10 South 2000 East, Salt Lake City, UT 84112-5880 USA
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Hegde S, Larsen E, Torbett O, Ponnala S, Pohl E, Sze R, Schaeubinger MM. A proactive learning approach toward building adaptive capacity during COVID-19: A radiology case study. APPLIED ERGONOMICS 2023; 110:104009. [PMID: 36905728 PMCID: PMC9986132 DOI: 10.1016/j.apergo.2023.104009] [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: 09/09/2022] [Revised: 02/23/2023] [Accepted: 02/27/2023] [Indexed: 06/18/2023]
Abstract
The COVID-19 pandemic has challenged organizations to adapt under uncertainty and time pressure, with no pre-existing protocols or guidelines available. For organizations to learn to adapt effectively, there is a need to understand the perspectives of the frontline workforce involved in everyday operations. This study implemented a survey-tool to elicit narratives of successful adaptation based on the lived experiences frontline radiology staff at a large multispecialty pediatric hospital. Fifty-eight members of the radiology frontline staff responded to the tool between July and October of 2020. Qualitative analysis of the free-text data revealed five categories of themes that underpinned adaptive capacity of the radiology department during the pandemic: information flow, attitudes and initiative, new and adjusted workflows, availability and utilization of resources, and collaboration and teamwork. Enablers of adaptive capacity included timely and clear communication about procedures and policies from the leadership to frontline staff, and revised workflows with flexible work arrangements, such as remote patient screening. Responses to multiple choice questions in the tool helped identify the main categories of challenges faced by staff, factors that enabled successful adaptation, and resources used. The study demonstrates the use of a survey-tool to proactively identify frontline adaptations. The paper also reports a system-wide intervention resulting directly from a discovery enabled by the findings based on the use of RETIPS in the radiology department. In general, the tool could be used in concert with existing learning mechanisms, such as safety event reporting systems, to inform leadership-level decisions to support adaptive capacity.
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Affiliation(s)
| | | | | | | | - Erin Pohl
- Children's Hospital of Philadelphia, USA
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Auerbach AD, Astik GJ, O'Leary KJ, Barish PN, Kantor MA, Raffel KR, Ranji SR, Mueller SK, Burney SN, Galinsky J, Gershanik EF, Goyal A, Chitneni PR, Rastegar S, Esmaili AM, Fenton C, Virapongse A, Ngov LK, Burden M, Keniston A, Patel H, Gupta AB, Rohde J, Marr R, Greysen SR, Fang M, Shah P, Mao F, Kaiksow F, Sterken D, Choi JJ, Contractor J, Karwa A, Chia D, Lee T, Hubbard CC, Maselli J, Dalal AK, Schnipper JL. Prevalence and Causes of Diagnostic Errors in Hospitalized Patients Under Investigation for COVID-19. J Gen Intern Med 2023; 38:1902-1910. [PMID: 36952085 PMCID: PMC10035474 DOI: 10.1007/s11606-023-08176-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 03/13/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND The COVID-19 pandemic required clinicians to care for a disease with evolving characteristics while also adhering to care changes (e.g., physical distancing practices) that might lead to diagnostic errors (DEs). OBJECTIVE To determine the frequency of DEs and their causes among patients hospitalized under investigation (PUI) for COVID-19. DESIGN Retrospective cohort. SETTING Eight medical centers affiliated with the Hospital Medicine ReEngineering Network (HOMERuN). TARGET POPULATION Adults hospitalized under investigation (PUI) for COVID-19 infection between February and July 2020. MEASUREMENTS We randomly selected up to 8 cases per site per month for review, with each case reviewed by two clinicians to determine whether a DE (defined as a missed or delayed diagnosis) occurred, and whether any diagnostic process faults took place. We used bivariable statistics to compare patients with and without DE and multivariable models to determine which process faults or patient factors were associated with DEs. RESULTS Two hundred and fifty-seven patient charts underwent review, of which 36 (14%) had a diagnostic error. Patients with and without DE were statistically similar in terms of socioeconomic factors, comorbidities, risk factors for COVID-19, and COVID-19 test turnaround time and eventual positivity. Most common diagnostic process faults contributing to DE were problems with clinical assessment, testing choices, history taking, and physical examination (all p < 0.01). Diagnostic process faults associated with policies and procedures related to COVID-19 were not associated with DE risk. Fourteen patients (35.9% of patients with errors and 5.4% overall) suffered harm or death due to diagnostic error. LIMITATIONS Results are limited by available documentation and do not capture communication between providers and patients. CONCLUSION Among PUI patients, DEs were common and not associated with pandemic-related care changes, suggesting the importance of more general diagnostic process gaps in error propagation.
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Affiliation(s)
- Andrew D Auerbach
- Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
| | - Gopi J Astik
- Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kevin J O'Leary
- Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Peter N Barish
- Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Molly A Kantor
- Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Katie R Raffel
- Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Sumant R Ranji
- Division of Hospital Medicine, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Stephanie K Mueller
- Hospital Medicine Unit, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
| | | | | | - Esteban F Gershanik
- Hospital Medicine Unit, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
| | - Abhishek Goyal
- Hospital Medicine Unit, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
| | - Pooja R Chitneni
- Hospital Medicine Unit, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
| | | | - Armond M Esmaili
- Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Cynthia Fenton
- Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Anunta Virapongse
- Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Li-Kheng Ngov
- Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Marisha Burden
- Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Angela Keniston
- Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Hemali Patel
- Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Ashwin B Gupta
- Division of Hospital Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
- Division of Hospital Medicine, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Jeff Rohde
- Division of Hospital Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Ruby Marr
- Division of Hospital Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - S Ryan Greysen
- Section of Hospital Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Michele Fang
- Section of Hospital Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Pranav Shah
- Section of Hospital Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Frances Mao
- Section of Hospital Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Farah Kaiksow
- Division of Hospital Medicine, University of Wisconsin School of Medicine and Public Health, WI, Madison, USA
| | - David Sterken
- Division of Hospital Medicine, University of Wisconsin School of Medicine and Public Health, WI, Madison, USA
| | - Justin J Choi
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Jigar Contractor
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Abhishek Karwa
- Division of Hospital Medicine, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - David Chia
- Division of Hospital Medicine, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Tiffany Lee
- Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Colin C Hubbard
- Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Judith Maselli
- Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Anuj K Dalal
- Hospital Medicine Unit, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
| | - Jeffrey L Schnipper
- Hospital Medicine Unit, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
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Shen H, He R, Zhang P, He Y, Liu Y, Wang G, Li T. Risk factors for postoperative medical morbidity and 3-month mortality in elderly patients with hip fracture following hip arthroplasty during COVID-19 pandemic. J Orthop Surg Res 2023; 18:59. [PMID: 36683026 PMCID: PMC9867902 DOI: 10.1186/s13018-023-03511-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/06/2023] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The purpose of the current study was to investigate the incidence of postoperative medical complications and 3-month mortality in patients ≥ 70 years old with hip fracture following hip arthroplasty (HA) and independent risk factors associated with postoperative medical complications and 3-month mortality during the Coronavirus Disease 2019 (COVID-19) pandemic. METHODS A multicenter retrospective study was conducted, patients ≥ 70 years old with HA for hip fracture under general anesthesia were included during COVID-19 and before COVID-19 pandemic. The outcome was defined as postoperative medical complications and 3-month mortality. The baseline characteristics and risk factors were collected, multivariable logistic regression was used to identify independent risk factors for postoperative medical complications and 3-month mortality. RESULTS A total of 1096 patients were included during COVID-19 pandemic and 1149 were included before COVID-19 pandemic in the study. Patients ≥ 70 years with hip fracture for HA had longer fracture to operation duration (7.10 ± 3.52 vs. 5.31 ± 1.29, P < 0.001), and the incidence of postoperative medical complications (21.90% vs. 12.53%, P < 0.001) and 3-month mortality (5.20% vs. 3.22%, P = 0.025) was higher during COVID-2019 pandemic. Multivariate logistic regression analysis showed that dementia (OR 2.73; 95% CI 1.37-5.44; P = 0.004), chronic obstructive pulmonary disease (COPD) (OR 3.00; 95% CI 1.92-4.71; P < 0.001), longer fracture to operation duration (OR 1.24; 95% CI 1.19-1.30; P < 0.001) were associated with increased risk for postoperative medical complications. COPD (OR 2.10; 95% CI 1.05-4.17; P = 0.035), dementia (OR 3.00; 95% CI 1.11-7.94; P = 0.031), postoperative medical complications (OR 4.99; 95% CI 2.68-9.28; P < 0.001), longer fracture to operation duration (OR 1.11; 95% CI 1.04-1.19; P = 0.002) were associated with increased risk for 3-month mortality. CONCLUSIONS In conclusion, we found that postoperative medical morbidity and 3-month mortality in patients with hip fracture underwent HA were 21.90% and 5.20%, respectively, during the COVID-19. COPD, dementia and longer fracture to operation duration were associated with negative outcome in patients with hip fracture underwent HA during the COVID-19.
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Affiliation(s)
- Huarui Shen
- grid.488387.8Department of Joint Surgery, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, 646000 China
| | - Rui He
- grid.440164.30000 0004 1757 8829Department of Orthopedics, The Second People’s Hospital of Chengdu, Chengdu, 610021 People’s Republic of China
| | - Peng Zhang
- Department of Joint Surgery, Sichuan Province Orthopedic Hospital, Chengdu, 610045 People’s Republic of China
| | - Yue He
- Sichuan Provincial Ba-Yi Rehabilitation Center (Si Chuan Provincial Rehabilitation Hospital), Chengdu City, 631000 Sichuan Province People’s Republic of China
| | - Yingqi Liu
- Department of Spine Surgery, Chongqing Orthopedics Hospital of Traditional Chinese Medical, Chongqing, 400000 People’s Republic of China
| | - Guoyou Wang
- grid.488387.8Department of Joint Surgery, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, 646000 China
| | - Ting Li
- grid.410578.f0000 0001 1114 4286School of Pharmacy, Southwest Medical University, Luzhou, 646000 People’s Republic of China
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Ren M, Zhang H, Meltzer D, Arora VM, Prochaska M. Changes in Patient Perceptions of the Provider Most Involved in Care During COVID-19 and Corresponding Effects on Patient Trust. J Patient Exp 2023; 10:23743735231166501. [PMID: 37035096 PMCID: PMC10074613 DOI: 10.1177/23743735231166501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
During COVID-19 routine clinical operations were disrupted, including limits on the types of providers allowed to perform in-person care and frequency of times they could enter a patient's room. Whether these changes affected patients’ trust in the care they received during hospitalization is unknown. Hospitalized patients on the general medicine service were called after discharge and asked to identify who (attending, resident, etc.) was most involved in their inpatient care, and how much trust they had in the physician caring for them. During the pandemic patients were more likely to report attending physicians (29% to 34%) and nurses (30% to 35%), and less likely to report residents/interns (8.1% to 6.5%) or medical students (1.7% to 1.4%) as most involved in their care (chi-squared test, p = 0.04). Patients reporting their attending physician as most involved in their care were more likely to report trusting their doctor (chi-squared test, p < 0.01). As such, trends in medical education that limit trainees’ time in direct patient care may affect the development of clinical and interpersonal skills necessary to establish patient trust.
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Affiliation(s)
- Megan Ren
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Hui Zhang
- Department of Medicine, Section of Hospital Medicine, University of Chicago, Chicago, IL, USA
| | - David Meltzer
- Department of Medicine, Section of Hospital Medicine, University of Chicago, Chicago, IL, USA
| | - Vineet M. Arora
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Micah Prochaska
- Department of Medicine, Section of Hospital Medicine, University of Chicago, Chicago, IL, USA
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Terwilliger IA, Manojlovich M, Johnson JK, Williams MV, O’Leary KJ. Effect of COVID-19 on the implementation of a multifaceted intervention to improve teamwork and quality for hospitalized patients: a qualitative interview study. BMC Health Serv Res 2022; 22:1379. [DOI: 10.1186/s12913-022-08795-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/06/2022] [Indexed: 11/21/2022] Open
Abstract
Abstract
Background
Healthcare organizations made major adjustments to deliver care during the COVID pandemic, yet little is known about how these adjustments shaped ongoing quality and safety improvement efforts. We aimed to understand how COVID affected four U.S. hospitals’ prospective implementation efforts in an ongoing quality improvement initiative, the REdesigning SystEms to Improve Teamwork and Quality for Hospitalized Patients (RESET) project, which implemented complementary interventions to redesign systems of care for medical patients.
Methods
We conducted individual semi-structured interviews with 40 healthcare professionals to determine how COVID influenced RESET implementation. We used conventional qualitative content analysis to inductively code transcripts and identify themes in MAXQDA 2020.
Results
We identified three overarching themes and nine sub-themes. The three themes were (1) COVID exacerbated existing problems and created new ones. (2) RESET and other quality improvement efforts were not the priority during the pandemic. (3) Fidelity of RESET implementation regressed.
Conclusion
COVID had a profound impact on the implementation of a multifaceted intervention to improve quality and teamwork in four hospitals. Notably, COVID led to a diversion of attention and effort away from quality improvement efforts, like RESET, and sites varied in their ability to renew efforts over time. Our findings help explain how COVID adversely affected hospitals’ quality improvement efforts throughout the pandemic and support the need for research to identify elements important for fostering hospital resilience.
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11
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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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12
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Rojek AE, Schiller PT. Residents as Innovators on COVID-19 Respiratory Isolation Units. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:946-947. [PMID: 34554949 DOI: 10.1097/acm.0000000000004423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Alexandra E Rojek
- Resident physician, Department of Internal Medicine, University of Chicago Medical Center, Chicago, Illinois; ; Twitter: @AlexandraRojek
| | - Patrick T Schiller
- Resident physician, Department of Internal Medicine, University of Chicago Medical Center, Chicago, Illinois
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13
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Burden M, Chopra V. Web Exclusive. Annals for Hospitalists Inpatient Notes - COVID-19, Hospital Medicine, and a Way Forward. Ann Intern Med 2022; 175:HO2-HO3. [PMID: 35576595 DOI: 10.7326/m22-0993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Marisha Burden
- Division of Hospital Medicine, Department Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado (M.B., V.C.)
| | - Vineet Chopra
- Division of Hospital Medicine, Department Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado (M.B., V.C.)
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14
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Schmutz KE, Wallace AS, Bristol AA, Johnson EP, Raaum SE. Hospital Discharge During COVID-19: The Role of Social Resources. Clin Nurs Res 2022; 31:724-732. [PMID: 35168380 PMCID: PMC10186341 DOI: 10.1177/10547738221075760] [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: 01/19/2023]
Abstract
CLINICAL TRIAL REGISTRATION This study is a part of a parent study: Social Needs and Resources in the Evaluation and Enhancement of Discharge Support. The trial registry is clinicaltrials.gov, number NCT04248738. Initial release was 1/27/2020 and the first participant was enrolled on 2/4/2020. Link to the information on the registry: https://clinicaltrials.gov/ct2/show/NCT04248738.
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Affiliation(s)
| | | | | | | | - Sonja E Raaum
- University of Utah Department of Internal Medicine School of Medicine, Salt Lake City, USA
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15
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Davis B, Bankhead-Kendall BK, Dumas RP. A review of COVID-19’s impact on modern medical systems from a health organization management perspective. HEALTH AND TECHNOLOGY 2022; 12:815-824. [PMID: 35371904 PMCID: PMC8956330 DOI: 10.1007/s12553-022-00660-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 03/15/2022] [Indexed: 01/09/2023]
Abstract
The novel SARS-CoV-2 (COVID-19) disrupted many facets of the healthcare industry throughout the pandemic and has likely permanently altered modern healthcare delivery. It has been shown that existing healthcare infrastructure influenced national responses to COVID-19, but the current implications and resultant sequelae of the pandemic on the organizational framework of healthcare remains largely unknown. This paper aims to review how aspects of contemporary medical systems – the physical environment of care delivery, global healthcare supply chains, workforce structures, information and communication systems, scientific collaboration, as well as policy frameworks – evolved in the initial response to the COVID-19 pandemic.
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Affiliation(s)
- Bayli Davis
- Texas Tech University Health Sciences Center School of Medicine, 3601 4th St, Lubbock, TX 79430 USA
| | | | - Ryan P. Dumas
- University of Texas Southwestern School of Medicine, 5323 Harry Hines Blvd, Dallas, TX 75390 USA
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16
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Cunningham JM, Persoff J, Piper C, Burger A, Shinnar E, Cunnius P, Stella SA, Frank MG. A Framework for Hospital Medicine's Involvement in Disaster Preparedness and Response. Health Secur 2022; 20:172-176. [PMID: 35333614 DOI: 10.1089/hs.2021.0210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- John M Cunningham
- John M. Cunningham, MD, are Hospitalists and Medical Director of the Biocontainment Unit, Department of Medicine, Division of Hospital Medicine, Denver Health Hospital Authority and University of Colorado, School of Medicine
| | - Jason Persoff
- Jason Persoff, MD, is a Hospitalist, Department of Medicine, Division of Hospital Medicine, University of Colorado, School of Medicine; all in Aurora, CO
| | - Christi Piper
- Christi Piper, MLIS, is a Medical Librarian, Strauss Health Sciences Library, University of Colorado, Anschutz Medical Campus; all in Aurora, CO
| | - Alfred Burger
- Alfred Burger, MD, is a Hospitalist and Senior Associate Program Director for the Internal Medicine Residency Program, Department of Medicine, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Eliezer Shinnar
- Eliezer Shinnar, MD, is a Hospitalist, Department of Medicine, Phoenix Indian Medical Center, Indian Health Service, Phoenix, AZ
| | - Peter Cunnius
- Peter Cunnius, CRNP, is an Advanced Practice Provider, Division of Hospital Medicine, Penn State Health-St. Joseph Medical Center, Reading, PA
| | - Sarah A Stella
- Sarah A. Stella, MD, are Hospitalists and Medical Director of the Biocontainment Unit, Department of Medicine, Division of Hospital Medicine, Denver Health Hospital Authority and University of Colorado, School of Medicine
| | - Maria G Frank
- Maria G. Frank, MD, is a Hospitalist and Medical Director of the Biocontainment Unit, Department of Medicine, Division of Hospital Medicine, Denver Health Hospital Authority and University of Colorado, School of Medicine
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17
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Keshvani N, Mehta A, Alger HM, Rutan C, Williams J, Zhang S, Young R, Alhanti B, Chiswell K, Greene SJ, DeVore AD, Yancy CW, Fonarow GC, Pandey A. Heart Failure Quality of Care and In-Hospital Outcomes During the COVID-19 Pandemic Findings from the Get With The Guidelines-Heart Failure Registry. Eur J Heart Fail 2022; 24:1117-1128. [PMID: 35289038 PMCID: PMC9087396 DOI: 10.1002/ejhf.2484] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 03/07/2022] [Accepted: 03/10/2022] [Indexed: 11/08/2022] Open
Abstract
Aims To assess heart failure (HF) in‐hospital quality of care and outcomes before and during the COVID‐19 pandemic. Methods and results Patients hospitalized for HF with ejection fraction (EF) <40% in the American Heart Association Get With The Guidelines©‐HF (GWTG‐HF) registry during the COVID‐19 pandemic (3/1/2020–4/1/2021) and pre‐pandemic (2/1/2019–2/29/2020) periods were included. Adherence to HF process of care measures, in‐hospital mortality, and length of stay (LOS) were compared in pre‐pandemic vs. pandemic periods and in patients with vs. without COVID‐19. Overall, 42 004 pre‐pandemic and 37 027 pandemic period patients (median age 68, 33% women, 58% White) were included without observed differences across clinical characteristics, comorbidities, vital signs, or EF. Utilization of guideline‐directed medical therapy at discharge was comparable across both periods, with rates of implantable cardioverter defibrillator (ICD) placement or prescription lower during the pandemic (vs. pre‐pandemic period). In‐hospital mortality (3.0% vs. 2.5%, p <0.0001) and LOS (mean 5.7 vs. 5.4 days, p <0.0004) were higher during the pandemic vs. pre‐pandemic. The highest in‐hospital mortality during the pandemic was observed among patients hospitalized in the Northeast region (3.4%). Among patients concurrently diagnosed with COVID‐19 (n = 549; 1.5%), adherence to ICD placement or prescription, prescription of aldosterone antagonist or angiotensin‐converting enzyme inhibitor/angiotensin receptor blocker/angiotensin receptor–neprilysin inhibitor at discharge were lower, and in‐hospital mortality (8.2% vs. 3.0%, p <0.0001) and LOS (mean 7.7 vs. 5.7 days, p <0.0001) were higher than those without COVID‐19. Conclusion Among GWTG‐HF participating hospitals, patients hospitalized for HF with reduced EF during the pandemic received similar care quality but experienced higher in‐hospital mortality than the pre‐pandemic period.
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Affiliation(s)
- Neil Keshvani
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
| | - Anurag Mehta
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | | | | | | | | | | | | | | | - Stephen J Greene
- Duke Clinical Research Institute, Durham, NC.,Division of Cardiology, Duke University School of Medicine, Durham, NC
| | - Adam D DeVore
- Duke Clinical Research Institute, Durham, NC.,Division of Cardiology, Duke University School of Medicine, Durham, NC
| | - Clyde W Yancy
- Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Gregg C Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles, Los Angeles, CA
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
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18
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Chanchalani G, Arora N, Nasa P, Sodhi K, Bahrani MJA, Tayar AA, Hashmi M, Jaiswal V, Kantor S, Lopa AJ, Mansour B, Mudalige AD, Nadeem R, Shrestha GS, Taha AR, Türkoğlu M, Weeratunga D. Visiting and Communication Policy in Intensive Care Units during COVID-19 Pandemic: A Cross-sectional Survey from South Asia and the Middle East. Indian J Crit Care Med 2022; 26:268-275. [PMID: 35519910 PMCID: PMC9015923 DOI: 10.5005/jp-journals-10071-24091] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
PURPOSE The coronavirus disease-2019 (COVID-19) pandemic had affected the visiting or communicating policies for family members. We surveyed the intensive care units (ICUs) in South Asia and the Middle East to assess the impact of the COVID-19 pandemic on visiting and communication policies. MATERIALS AND METHOD A web-based cross-sectional survey was used to collect data between March 22, 2021, and April 7, 2021, from healthcare professionals (HCP) working in COVID and non-COVID ICUs (one response per ICU). The topics of the questionnaire included current and pre-pandemic policies on visiting, communication, informed consent, and end-of-life care in ICUs. RESULTS A total of 292 ICUs (73% of COVID ICUs) from 18 countries were included in the final analysis. Most (92%) of ICUs restricted their visiting hours, and nearly one-third (32.3%) followed a "no-visitor" policy. There was a significant change in the daily visiting duration in COVID ICUs compared to the pre-pandemic times (p = 0.011). There was also a significant change (p <0.001) in the process of informed consent and end-of-life discussions during the ongoing pandemic compared to pre-pandemic times. CONCLUSION Visiting and communication policies of the ICUs had significantly changed during the COVID-19 pandemic. Future studies are needed to understand the sociopsychological and medicolegal implications of revised policies. HOW TO CITE THIS ARTICLE Chanchalani G, Arora N, Nasa P, Sodhi K, Al Bahrani MJ, Al Tayar A, et al. Visiting and Communication Policy in Intensive Care Units during COVID-19 Pandemic: A Cross-sectional Survey from South Asia and the Middle East. Indian J Crit Care Med 2022;26(3):268-275.
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Affiliation(s)
- Gunjan Chanchalani
- Department of Critical Care Medicine, Cumballa Hill Hospital, Mumbai, Maharashtra, India
| | - Nitin Arora
- Department of Intensive Care, University Hospitals Birmingham, Birmingham, West Midlands, United Kingdom
| | - Prashant Nasa
- Department of Critical Care Medicine, NMC Specialty Hospital, Dubai, United Arab Emirates
- Prashant Nasa, Department of Critical Care Medicine, NMC Specialty Hospital, Dubai, United Arab Emirates, Phone: +971501425022, e-mail:
| | | | - Maher J Al Bahrani
- Department of Anesthesiology and Critical Care Medicine, Royal Hospital, Muscat, Oman
| | - Ashraf Al Tayar
- Department of ICU, Security Force Hospital, Dammam, Saudi Arabia
| | - Madiha Hashmi
- Department of Critical Care Medicine, Ziauddin University and Dr Ziauddin Hospital, Karachi, Pakistan
| | - Vinod Jaiswal
- Department of Critical Care Medicine, Amina Hospital, Ajman, United Arab Emirates
| | - Sandeep Kantor
- Department of Critical Care Medicine, Royal Hospital, Muscat, Oman
| | - Ahsina J Lopa
- Department of Intensive Care Unit, MH Samorita Hospital and Medical College, Tejgaon, Dhaka, Bangladesh
| | - Bassam Mansour
- Department of Pulmonary Medicine and Critical Care Medicine, Zahraa Hospital University Medical Center/Lebanese University, Faculty of Medical Science, Beirut, Lebanon
| | - Anushka D Mudalige
- Department of Critical Care Medicine, North Colombo Teaching Hospital, Ragama, Sri Lanka
| | - Rashid Nadeem
- Department of Critical Care Medicine, Dubai Hospital, Dubai, United Arab Emirates
| | - Gentle S Shrestha
- Department of Critical Care Medicine, Tribhuvan University Teaching Hospital, Lalitpur, Nepal
| | - Ahmed R Taha
- Department of Critical Care Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Melda Türkoğlu
- Department of Internal Medicine, Division of Critical Care, Gazi University, Faculty of Medicine, Ankara, Turkey
| | - Dameera Weeratunga
- Department of Critical Care Medicine, National Hospital of Sri Lanka, Colombo, Sri Lanka
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19
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Keniston A, Patel V, McBeth L, Bowden K, Gallant A, Burden M. The impact of surge adaptations on hospitalist care teams during the COVID-19 pandemic utilizing a rapid qualitative analysis approach. Arch Public Health 2022; 80:57. [PMID: 35177114 PMCID: PMC8851813 DOI: 10.1186/s13690-022-00804-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 01/17/2022] [Indexed: 11/25/2022] Open
Abstract
Background Hospital systems have rapidly adapted to manage the influx of patients with COVID-19 and hospitalists, specialists in inpatient care, have been at the forefront of this response, rapidly adapting to serve the ever-changing needs of the community and hospital system. Institutional leaders, including clinical care team members and administrators, deployed many different strategies (i.e. adaptations) to manage the influx of patients. While many different strategies were utilized in hospitals across the United States, it is unclear how frontline care teams experienced these strategies and multifaceted changes. As these surge adaptations likely directly impact clinical care teams, we aimed to understand the perceptions and impact of these clinical care and staffing adaptations on hospitalists and care team members in order to optimize future surge plans. Methods Qualitative, semi-structured interviews and focus groups with hospitalist physicians, advanced practice providers (APPs), and hospital nursing and care management staff at a quaternary academic medical center. Interviews focused on the impact of COVID-19 surge practices on the following areas: (1) the experience of clinical care teams with the adaptations used to manage the surge (2) the perception and experience with the communication strategies utilized (3) the personal experience with the adaptations (i.e. how they impacted the individual) and (4) if participants had recommendations on strategies for future surges. We utilized rapid qualitative analysis methods to explore themes and subthemes. Results We conducted five focus groups and 21 interviews. Three themes emerged from the work including (1) dynamic clinical experience with a lot of uncertainty, (2) the importance of visible leadership with a focus on sense-making, and (3) the significant emotional toll on care team members. Subthemes included sufficient workforce, role delineation and training, information sharing, the unique dichotomy between the need for flexibility and the need for structure, the importance of communication, and the emotional toll not only on the provider but their families. Several recommendations came from this work. Conclusions COVID-19 surge practices have had direct impact on hospitalists and care team members. Several tactics were identified to help mitigate the many negative effects of COVID-19 on frontline hospitalist providers and care teams. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-022-00804-7.
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Affiliation(s)
- Angela Keniston
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, USA
| | | | - Lauren McBeth
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, USA
| | - Kasey Bowden
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, USA
| | - Alexandra Gallant
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, USA
| | - Marisha Burden
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, USA.
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20
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Money NM, Schroeder AR, Quinonez RA, Ho T, Marin JR, Wolf ER, Morgan DJ, Dhruva SS, Coon ER. 2021 Update on Pediatric Overuse. Pediatrics 2022; 149:184542. [PMID: 35059726 PMCID: PMC9004348 DOI: 10.1542/peds.2021-053384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/15/2021] [Indexed: 02/03/2023] Open
Abstract
This update on pediatric medical overuse identifies and provides concise summaries of 10 impactful articles related to pediatric medical overuse from the years 2019 to 2020.
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Affiliation(s)
- Nathan M. Money
- Department of Pediatrics, University of Utah School of Medicine, Primary Children’s Hospital, Salt Lake City, Utah
| | - Alan R. Schroeder
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Ricardo A. Quinonez
- Division of Pediatric Hospital Medicine, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas
| | - Timmy Ho
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Jennifer R. Marin
- Departments of Pediatrics, Emergency Medicine, and Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Elizabeth R. Wolf
- Department of Pediatrics, Virginia Commonwealth University, Richmond, Virginia
| | - Daniel J. Morgan
- University of Maryland School of Medicine and VA Maryland Health care System, Baltimore, Maryland
| | - Sanket S. Dhruva
- UCSF School of Medicine and San Francisco VA Medical Center, San Francisco, California
| | - Eric R. Coon
- Department of Pediatrics, University of Utah School of Medicine, Primary Children’s Hospital, Salt Lake City, Utah
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21
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Alhussaini A. Improve Communicating Uncertainty in Intensive Care Unit With Patient and Family (ICU-PF). Cureus 2021; 13:e20837. [PMID: 35111482 PMCID: PMC8794450 DOI: 10.7759/cureus.20837] [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] [Accepted: 12/29/2021] [Indexed: 11/23/2022] Open
Abstract
Communicating uncertainty with patients and families in the intensive care unit is challenging and requires time and skill to convey the information. This proposal aims to provide a structured path for identifying and communicating uncertainty with patients and families in the unit. The focus is to improve the quality of care and timely communication to meet the expectations and needs of families and patients. The project focuses on the first 24 hours of intensive care unit admission to improve communication of uncertainty. By utilizing the Plan-Do-Study-Act cycle, the workflow uses a screening tool to identify uncertainty and communicate using evidence-based recommendations and the mnemonic VALUE (Value family statements, Acknowledge emotions, Listen, Understand the patient as a person, Elicit questions) as the standard of care. The workflow can be incorporated during the routine rounds as part of the A-F liberation bundle. The outcome is to improve patient and family satisfaction scores using a validated Family Satisfaction with Care in the Intensive Care Unit (FS-ICU 24) questionnaire to achieve a score of 75 or more, which correlates with very good. Challenges and limitations are discussed in the proposal.
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22
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Redelmeier DA, Etchells EE, Najeeb U. Principles and Practice of Gossiping About Colleagues in Medicine. J Hosp Med 2021; 16:763-766. [PMID: 34798004 DOI: 10.12788/jhm.3702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/24/2021] [Indexed: 11/20/2022]
Affiliation(s)
- Donald A Redelmeier
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Ontario, Canada
| | - Edward E Etchells
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Ontario, Canada
| | - Umberin Najeeb
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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23
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Optimizing Highly Infectious Disease Isolation Unit Management: Experiences From the Infectious Diseases Isolation and Research Unit, Fort Portal, Uganda. Disaster Med Public Health Prep 2021; 17:e72. [PMID: 34819204 PMCID: PMC8886060 DOI: 10.1017/dmp.2021.339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Infectious disease outbreaks on the scale of the current coronavirus disease 2019 (COVID-19) pandemic are a new phenomenon in many parts of the world. Many isolation unit designs with corresponding workflow dynamics and personal protective equipment postures have been proposed for each emerging disease at the health facility level, depending on the mode of transmission. However, personnel and resource management at the isolation units for a resilient response will vary by human resource capacity, reporting requirements, and practice setting. This study describes an approach to isolation unit management at a rural Uganda Hospital and shares lessons from the Uganda experience for isolation unit managers in low- and middle-income settings.
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24
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Lee MS, Cheloff AZ, Jang YJ, Yin SH, Strauss AC, Kanjee Z. Providing social support for inpatients: Insights from a virtual medical student initiative. CLINICAL TEACHER 2021; 19:48-51. [PMID: 34786855 DOI: 10.1111/tct.13437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 10/21/2021] [Accepted: 10/27/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Although the COVID-19 pandemic increased social isolation among hospitalised patients given isolation precautions, visitor restrictions and curtailed interactions with healthcare teams, medical students had limited opportunities for involvement in the care of inpatients. APPROACH We designed a humanistic and narrative medicine intervention to engage medical students in combating social isolation in hospitalised patients during the COVID-19 pandemic at a tertiary care teaching hospital. In our programme, medical students provided virtual social support to hospitalised patients via phone by providing assistance connecting with family members, having informal conversations and check-ins and writing up patient life narratives. EVALUATION From April 2020 to March 2021, we received 126 referrals of potentially isolated patients from inpatient medical teams. Fifty patients accepted and received our intervention, including 26 who completed life narratives. Feedback was positive, demonstrating benefit to medical students in learning about humanism and connecting with patients through their life stories. In addition, patients and medical teams felt more supported. We share key operational lessons and resources to facilitate the implementation of this intervention elsewhere. IMPLICATIONS Our intervention allows medical students to meaningfully contribute to the care of inpatients, support beleaguered inpatient teams and learn important lessons about humanism in medicine. This educational and patient care intervention holds promise in other settings, including beyond the COVID-19 pandemic.
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Affiliation(s)
| | | | | | - Sophia H Yin
- Harvard Medical School, Boston, Massachusetts, USA
| | - Adam C Strauss
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Zahir Kanjee
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Bracing for the Wave: a Multi-Institutional Survey Analysis of Inpatient Workforce Adaptations in the First Phase of COVID-19. J Gen Intern Med 2021; 36:3456-3461. [PMID: 34047919 PMCID: PMC8161717 DOI: 10.1007/s11606-021-06697-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 03/03/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Medical centers across the country have had to rapidly adapt clinician staffing strategies to accommodate large influxes of patients with the coronavirus disease 2019 (COVID-19). OBJECTIVE We sought to understand the adaptations and staffing strategies that US academic medical centers employed in the inpatient setting early in the spread of COVID-19, and to assess whether those changes were sustained during the first phase of the pandemic. DESIGN Cross-sectional survey assessing organization-level, team-level, and clinician-level inpatient workforce adaptations. PARTICIPANTS Hospital medicine leadership at 27 academic medical centers in the USA. KEY RESULTS Twenty-seven of 36 centers responded to the survey (75%). Widespread practices included frequent staffing reassessment, organization-level changes such as geographic cohorting and redeployment of non-hospitalists, and exempting high-risk healthcare workers from direct care of patients with COVID-19. Several practices were implemented but discontinued, such as reduction of non-essential services, indicating that they were less sustainable for large centers. CONCLUSION These findings provide guidance for inpatient leaders seeking to identify sustainable practices for COVID-19 inpatient workforce planning.
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Verderber S, Gray S, Suresh-Kumar S, Kercz D, Parshuram C. Intensive Care Unit Built Environments: A Comprehensive Literature Review (2005-2020). HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2021; 14:368-415. [PMID: 34000842 PMCID: PMC8597197 DOI: 10.1177/19375867211009273] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/15/2021] [Accepted: 03/23/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The intensive care environment in hospitals has been the subject of significant empirical and qualitative research in the 2005-2020 period. Particular attention has been devoted to the role of infection control, family engagement, staff performance, and the built environment ramifications of the recent COVID-19 global pandemic. A comprehensive review of this literature is reported summarizing recent advancements in this rapidly expanding body of knowledge. PURPOSE AND AIM This comprehensive review conceptually structures the recent medical intensive care literature to provide conceptual clarity and identify current priorities and future evidence-based research and design priorities. METHOD AND RESULT Each source reviewed was classified as one of the five types-opinion pieces/essays, cross-sectional empirical investigations, nonrandomized comparative investigations, randomized studies, and policy review essays-and into nine content categories: nature engagement and outdoor views; family accommodations; intensive care unit (ICU), neonatal ICU, and pediatric ICU spatial configuration and amenity; noise considerations; artificial and natural lighting; patient safety and infection control; portable critical care field hospitals and disaster mitigation facilities including COVID-19; ecological sustainability; and recent planning and design trends and prognostications. CONCLUSIONS Among the findings embodied in the 135 literature sources reviewed, single-bed ICU rooms have increasingly become the norm; family engagement in the ICU experience has increased; acknowledgment of the therapeutic role of staff amenities; exposure to nature, view, and natural daylight has increased; the importance of ecological sustainability; and pandemic concerns have increased significantly in the wake of the coronavirus pandemic. Discussion of the results of this comprehensive review includes topics noticeably overlooked or underinvestigated in the 2005-2020 period and priorities for future research.
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Affiliation(s)
- Stephen Verderber
- Centre for Design + Health Innovation, John H. Daniels Faculty of Architecture, Landscape and Design, University of Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Seth Gray
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Center for Safety Research, Toronto, Ontario, Canada
| | - Shivathmikha Suresh-Kumar
- John H. Daniels Faculty of Architecture, Landscape and Design, University of Toronto, Ontario, Canada
| | - Damian Kercz
- John H. Daniels Faculty of Architecture, Landscape and Design, University of Toronto, Ontario, Canada
| | - Christopher Parshuram
- Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Center for Safety Research, Toronto, Ontario, Canada
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Organization of a Hospital Ward Aimed at Admitting Patients with SARS-CoV-2: An Economic and Epidemiological Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189446. [PMID: 34574370 PMCID: PMC8469759 DOI: 10.3390/ijerph18189446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/02/2021] [Accepted: 09/03/2021] [Indexed: 11/16/2022]
Abstract
The SARS-CoV-2 epidemic requires dynamic action on the part of the entire health care system to provide infected patients whose condition requires hospitalization with access to appropriate medical care and infrastructure, including oxygen devices and ventilators. The demand for specialized inpatient care has increased rapidly and in many areas exceeds the resources available to date. Individual hospitals must make investment and organizational decisions to increase their capacity to handle patients with SARS-CoV-2. The aim of the article is to present the organizational and investment steps taken to establish and maintain an infectious hospital ward as well as the clinical and financial consequences of this decision. The study was conducted in a hospital ward that was launched at the end of October 2020 to care for patients with SARS-CoV-2. A case study method was used. The department was characterized taking into account its importance for: (1) the regional level of health coverage of the population, (2) the organization of the hospital's activities, (3) the financial and economic situation of the hospital.
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Lyman B, Horton MK, Oman A. Organizational learning during COVID-19: A qualitative study of nurses' experiences. J Nurs Manag 2021; 30:4-14. [PMID: 34414626 PMCID: PMC8420306 DOI: 10.1111/jonm.13452] [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: 04/12/2021] [Revised: 08/08/2021] [Accepted: 08/15/2021] [Indexed: 02/06/2023]
Abstract
Aim The aim of this study is to test the validity of the Organizational Learning in Hospitals model in the context of the COVID‐19 pandemic. Background Organizational learning is especially crucial in circumstances of intense, complex, enduring change, as with the COVID‐19 pandemic. Nurse managers need additional guidance for fostering organizational learning under such circumstances. The Organizational Learning in Hospitals model may be a helpful resource but requires additional validation. Methods Semi‐structured interviews were conducted to gather 19 nurses' first‐hand experiences of organizational learning during the COVID‐19 pandemic. Data were analysed using deductive thematic analysis. Results Nurses' experiences of organizational learning generally aligned with the tenets of the model. Specifically, effective organizational learning occurred when the contextual factors and mechanisms portrayed in the model converged. Model and contrary cases illustrate this phenomenon. Conclusions This study validates and adds context to the model. It offers practical examples of the contextual factors and mechanisms of organizational learning. Leaders can use the model to guide their efforts to foster organizational learning. Implications for Nursing Management This study reaffirms the importance of nurse leaders' central role in organizational learning. Nurse leaders can use the Organizational Learning in Hospitals model, and the practical examples provided, to foster organizational learning during challenging times.
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Affiliation(s)
- Bret Lyman
- College of Nursing, Brigham Young University, Provo, Utah, USA
| | - Morgan K Horton
- College of Nursing, Brigham Young University, Provo, Utah, USA
| | - Alyssa Oman
- College of Nursing, Brigham Young University, Provo, Utah, USA
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Tatineni S, Orlov NM, Riehm JM, Erondu A, Mozer CL, Cook DJ, Byron M, Mordell L, Dimitrov M, Arora VM. Objective Measures of Physical Distancing in the Hospital During the COVID-19 Pandemic. J Hosp Med 2021; 16:jhm.3666. [PMID: 34424197 DOI: 10.12788/jhm.3666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 06/07/2021] [Indexed: 11/20/2022]
Abstract
During the COVID-19 pandemic, hospitals published physical-distancing guidance and created dedicated respiratory isolation units (RIUs) for patients with COVID-19. The degree to which such distancing occurred between clinicians and patients is unknown. In this study, heat sensors from an existing hospital hand-hygiene monitoring system objectively tracked room entries as a proxy for physical distancing in both RIUs and general medicine units before and during the pandemic. The RIUs saw a 60.6% reduction in entries per room per day (from 85.7 to 33.8). General medicine units that cared for patients under investigation for COVID-19 and other patients experienced a 14.7% reduction in entries per room per day (from 76.9 to 65.1). While gradual extinction was observed in both units as COVID-19 cases declined, the RIUs had a higher degree of physical distancing. Although the optimal level of physical distancing is unknown, sustaining physical distancing in the hospital may require re-education and real-time monitoring.
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Affiliation(s)
- Swetha Tatineni
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | - Nicola M Orlov
- Section of Pediatric Hospital Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Joseph M Riehm
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | - Amarachi Erondu
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | - Christine L Mozer
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | - David J Cook
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | - Maxx Byron
- Section of General Internal Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Lisa Mordell
- Section of General Internal Medicine, University of Chicago Medical Center, Chicago, Illinois
| | | | - Vineet M Arora
- Section of General Internal Medicine, University of Chicago Medical Center, Chicago, Illinois
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Hand MW, Alexander C, Lyman B, Parchment J, Joseph ML, Chipps E. Filling the Knowledge Gap for Nurse Leaders: Next Steps Following COVID-19. ACTA ACUST UNITED AC 2021; 19:616-621. [PMID: 34335118 PMCID: PMC8316134 DOI: 10.1016/j.mnl.2021.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 07/20/2021] [Indexed: 12/04/2022]
Abstract
The purpose of this article is to share gaps in knowledge and research related to pandemic management identified by nurse leaders during the COVID-19 pandemic. As part of a larger Delphi study, nurse leaders responded to an open-ended question about gaps in research they saw as important following the pandemic. Responses were analyzed using directed content analysis. Results are presented as 4 supercategories: Organizational leadership preparedness, adaptive leadership in crisis, innovations in care delivery, and health, well-being, and resilience.
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Affiliation(s)
- Mikel W Hand
- Associate Professor of Nursing, College of Nursing and Health Professions, University of Southern Indiana, Evansville, IN
| | - Catherine Alexander
- Performance Improvement Analyst, San Francisco VA Medical Center, San Francisco, CA
| | - Bret Lyman
- Associate Professor College of Nursing, Brigham Young University, Provo, UT
| | - Joy Parchment
- Adjunct Faculty University of Central Florida, College of Nursing, Orlando. FL
| | - M Lindell Joseph
- Clinical Professor and Director, Health Systems/Administration Program, University of Iowa, Iowa City, IA
| | - Esther Chipps
- Professor of Clinical Nursing, Clinical Nurse Scientist, The Ohio State University College of Nursing, The Ohio State University Wexner Medical Center, Columbus, OH
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Greysen SR, Auerbach AD, Mitchell MD, Goldstein JN, Weiss R, Esmaili A, Kuye I, Manjarrez E, Bann M, Schnipper JL. Discharge Practices for COVID-19 Patients: Rapid Review of Published Guidance and Synthesis of Documents and Practices at 22 US Academic Medical Centers. J Gen Intern Med 2021; 36:1715-1721. [PMID: 33835314 PMCID: PMC8034037 DOI: 10.1007/s11606-021-06711-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/09/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND There are currently no evidence-based guidelines that provide standardized criteria for the discharge of COVID-19 patients from the hospital. OBJECTIVE To address this gap in practice guidance, we reviewed published guidance and collected discharge protocols and procedures to identify and synthesize common practices. DESIGN Rapid review of existing guidance from US and non-US public health organizations and professional societies and qualitative review using content analysis of discharge documents collected from a national sample of US academic medical centers with follow-up survey of hospital leaders SETTING AND PARTICIPANTS: We reviewed 65 websites for major professional societies and public health organizations and collected documents from 22 Academic Medical Centers (AMCs) in the US participating in the HOspital MEdicine Reengineering Network (HOMERuN). RESULTS We synthesized data regarding common practices around 5 major domains: (1) isolation and transmission mitigation; (2) criteria for discharge to non-home settings including skilled nursing, assisted living, or homeless; (3) clinical criteria for discharge including oxygenation levels, fever, and symptom improvement; (4) social support and ability to perform activities of daily living; (5) post-discharge instructions, monitoring, and follow-up. LIMITATIONS We used streamlined methods for rapid review of published guidance and collected discharge documents only in a focused sample of US academic medical centers. CONCLUSION AMCs studied showed strong consensus on discharge practices for COVID-19 patients related to post-discharge isolation and transmission mitigation for home and non-home settings. There was high concordance among AMCs that discharge practices should address COVID-19-specific factors in clinical, functional, and post-discharge monitoring domains although definitions and details varied.
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Affiliation(s)
- S Ryan Greysen
- Penn Medicine Center for Evidence-based Practice, Section of Hospital Medicine, Division of General Internal Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
- Center for Evidence-based Practice, University of Pennsylvania Health System, Philadelphia, USA.
| | - Andrew D Auerbach
- Division of Hospital Medicine, University of California San Francisco, San Francisco, USA
| | - Matthew D Mitchell
- Center for Evidence-based Practice, University of Pennsylvania Health System, Philadelphia, USA
| | | | - Rachel Weiss
- Division of Hospital Medicine, University of California San Francisco, San Francisco, USA
- University of Virginia, Charlottesville, VA, USA
| | - Armond Esmaili
- Division of Hospital Medicine, University of California San Francisco, San Francisco, USA
| | - Ifedayo Kuye
- Division of Hospital Medicine, University of California San Francisco, San Francisco, USA
- Johns Hopkins University, Baltimore, MD, USA
| | | | - Maralyssa Bann
- Division of General Internal Medicine, University of Washington, Seattle, WA, USA
| | - Jeffrey L Schnipper
- Hospital Medicine Unit, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Perra N. Non-pharmaceutical interventions during the COVID-19 pandemic: A review. PHYSICS REPORTS 2021; 913:1-52. [PMID: 33612922 PMCID: PMC7881715 DOI: 10.1016/j.physrep.2021.02.001] [Citation(s) in RCA: 204] [Impact Index Per Article: 68.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 02/08/2021] [Indexed: 05/06/2023]
Abstract
Infectious diseases and human behavior are intertwined. On one side, our movements and interactions are the engines of transmission. On the other, the unfolding of viruses might induce changes to our daily activities. While intuitive, our understanding of such feedback loop is still limited. Before COVID-19 the literature on the subject was mainly theoretical and largely missed validation. The main issue was the lack of empirical data capturing behavioral change induced by diseases. Things have dramatically changed in 2020. Non-pharmaceutical interventions (NPIs) have been the key weapon against the SARS-CoV-2 virus and affected virtually any societal process. Travel bans, events cancellation, social distancing, curfews, and lockdowns have become unfortunately very familiar. The scale of the emergency, the ease of survey as well as crowdsourcing deployment guaranteed by the latest technology, several Data for Good programs developed by tech giants, major mobile phone providers, and other companies have allowed unprecedented access to data describing behavioral changes induced by the pandemic. Here, I review some of the vast literature written on the subject of NPIs during the COVID-19 pandemic. In doing so, I analyze 348 articles written by more than 2518 authors in the first 12 months of the emergency. While the large majority of the sample was obtained by querying PubMed, it includes also a hand-curated list. Considering the focus, and methodology I have classified the sample into seven main categories: epidemic models, surveys, comments/perspectives, papers aiming to quantify the effects of NPIs, reviews, articles using data proxies to measure NPIs, and publicly available datasets describing NPIs. I summarize the methodology, data used, findings of the articles in each category and provide an outlook highlighting future challenges as well as opportunities.
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Affiliation(s)
- Nicola Perra
- Networks and Urban Systems Centre, University of Greenwich, London, UK
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Hauck KD, Hochman KA, Pochapin MB, Zabar SR, Wilhite JA, Glynn G, Bosworth BP. The COVID-19 Army: Experiences From the Deployment of Non-Hospitalist Physician Volunteers During the COVID-19 Pandemic. Disaster Med Public Health Prep 2021; 16:1-5. [PMID: 33820584 PMCID: PMC8134896 DOI: 10.1017/dmp.2021.109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 03/08/2021] [Accepted: 03/22/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE New York City was the epicenter of the outbreak of the 2019 coronavirus disease (COVID-19) pandemic in the United States. As a large, quaternary care medical center, NYU Langone Medical Center was one of many New York medical centers that experienced an unprecedented influx of patients during this time. Clinical leadership effectively identified, oriented, and rapidly deployed a "COVID Army," consisting of non-hospitalist physicians, to meet the needs of the patient influx. We share feedback from our providers on our processes and offer specific recommendations for systems experiencing a similar influx in the current and future pandemics. METHODS To assess the experiences and perceived readiness of these physicians (n = 183), we distributed a 32-item survey between March and June of 2020. Thematic analyses and response rates were examined to develop results. RESULTS Responses highlighted varying experiences and attitudes of our frontline physicians during an emerging pandemic. Thematic analyses revealed a series of lessons learned, including the need to (1) provide orientations, (2) clarify roles/workflow, (3) balance team workload, (4) keep teams updated on evolving policies, (5) make team members feel valued, and (6) ensure they have necessary tools available. CONCLUSIONS Lessons from our deployment and assessment are scalable at other institutions.
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Affiliation(s)
- Kevin D. Hauck
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Katherine A. Hochman
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Mark B. Pochapin
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Sondra R. Zabar
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
- New York City Health and Hospitals, New York, NY, USA
| | - Jeffrey A. Wilhite
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Gretchen Glynn
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Brian P. Bosworth
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
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Alam W, Bouferraa Y, Haibe Y, Mukherji D, Shamseddine A. Management of colorectal cancer in the era of COVID-19: Challenges and suggestions. Sci Prog 2021; 104:368504211010626. [PMID: 33878982 PMCID: PMC10358474 DOI: 10.1177/00368504211010626] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The Coronavirus (COVID-19) pandemic had a huge impact on all sectors around the world. In particular, the healthcare system has been subject to an enormous pressure that has surpassed its ability in many instances. Additionally, the pandemic has called for a review of our daily medical practices, including our approach to colorectal cancer management where treatment puts patients at high risk of virus exposure. Given their higher median age, patients are at an increased risk for severe symptoms and complications in cases of infection, especially in the setting of immunosuppression. Therefore, a review of the routine colorectal cancer practices is needed to minimize risk of exposure. Oncologists should weigh risk of exposure versus the patient's oncologic benefits when approaching management. In addition, treatment protocols should be modified to minimize hospital visits and admissions while maintaining the same treatment efficacy. In this review, we will focus on challenges that colorectal cancer patients face during the pandemic, while highlighting the priority in each case. We will also discuss the evidence for potential modifications to existing treatment plans that could reduce infectious exposure without compromising care. Finally, we will discuss the impact of the socio-economic difficulties faced by Lebanese patients due to a poor economy toppled by an unexpected pandemic.
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Affiliation(s)
- Walid Alam
- Department of Internal Medicine, Division of Hematology-Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Youssef Bouferraa
- Department of Internal Medicine, Division of Hematology-Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Yolla Haibe
- Department of Internal Medicine, Division of Hematology-Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Deborah Mukherji
- Department of Internal Medicine, Division of Hematology-Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali Shamseddine
- Department of Internal Medicine, Division of Hematology-Oncology, American University of Beirut Medical Center, Beirut, Lebanon
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Auerbach AD, Greysen SR. A Rising Tide: No Hospital Is an Island Unto Itself in the Era of COVID-19. J Hosp Med 2021; 16:254. [PMID: 33822713 PMCID: PMC8025588 DOI: 10.12788/jhm.3592] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 01/17/2021] [Indexed: 11/20/2022]
Affiliation(s)
- Andrew D Auerbach
- Division of Hospital Medicine, University of California, San Francisco School of Medicine, San Francisco, California
- Corresponding Author: Andrew D Auerbach, MD, MPH; Andrew. ; Twitter: @ADAuerbach
| | - S Ryan Greysen
- Section of Hospital Medicine, University of Pennsylvania Health System, Philadelphia, Pennsylvania
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Janke AT, Mei H, Rothenberg C, Becher RD, Lin Z, Venkatesh AK. Analysis of Hospital Resource Availability and COVID-19 Mortality Across the United States. J Hosp Med 2021; 16:211-214. [PMID: 33496664 PMCID: PMC8025594 DOI: 10.12788/jhm.3539] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 09/21/2020] [Indexed: 11/20/2022]
Abstract
Although the impact of COVID-19 has varied greatly across the United States, there has been little assessment of hospital resources and mortality. We examine hospital resources and death counts among hospital referral regions from March 1 to July 26, 2020. This was an analysis of American Hospital Association data with COVID-19 data from the New York Times. Hospital-based resource availabilities were characterized per COVID-19 case. Death count was defined by monthly confirmed COVID-19 deaths. Geographic areas with fewer intensive care unit beds (incident rate ratio [IRR], 0.194; 95% CI, 0.076-0.491), nurses (IRR, 0.927; 95% CI, 0.888-0.967), and general medicine/surgical beds (IRR, 0.800; 95% CI, 0.696-0.920) per COVID-19 case were statistically significantly associated with an increased incidence rate of death in April 2020. This underscores the potential impact of innovative hospital capacity protocols and care models to create resource flexibility to limit system overload early in a pandemic.
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Affiliation(s)
- Alexander T Janke
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
- Corresponding Author: Alexander T Janke, MD; ; Telephone: 203-737-2644
| | - Hao Mei
- Center for Outcomes Research and Evaluation, Yale University, New Haven, Connecticut
| | - Craig Rothenberg
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Robert D Becher
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Zhenqiu Lin
- Center for Outcomes Research and Evaluation, Yale University, New Haven, Connecticut
| | - Arjun K Venkatesh
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
- Center for Outcomes Research and Evaluation, Yale University, New Haven, Connecticut
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Onizuka N, Topor LN, Schroder LK, Switzer JA. Outcomes of COVID-19 Negative Hip Fracture Patients During the Acute and Subacute Pandemic. Geriatr Orthop Surg Rehabil 2021; 12:21514593211006692. [PMID: 33868768 PMCID: PMC8012779 DOI: 10.1177/21514593211006692] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 12/18/2022] Open
Abstract
Objectives: To better elucidate how the COVID-19 pandemic has affected the operatively treated geriatric hip fracture population and how the health care system adapted to pandemic dictated procedures. Design: Retrospective cohort study. Setting: A community hospital. Participants: Individuals ≥65 years of age presented with a proximal femoral fracture from a low-energy mechanism undergoing operative treatment from January 17, 2020 to July 2, 2020 (N = 125). Measurements: We defined 3 phases of healthcare system response: pre-COVID-19, acute phase, and subacute phase. Thirty-day mortality, time to operating room (OR), length of stay, time to start physical therapy, perioperative complications, delirium rate, hospice admission rate, discharge dispositions, readmission rate, and the reason of surgery delay were assessed. Results: The number of hip fractures has remained constant during the pandemic. The 30-day mortality rate, time to OR, and length of stay were higher in the pandemic compared to the pre-pandemic. Those who had a longer wait time to OR (≥ 24 hours) had more complications and increased 30-day mortality rates. Some of the surgery delays were related to OR unavailability as a consequence of the COVID-19 pandemic. Surgery was delayed in 3 patients who were on direct oral anticoagulants (DOACs) in pandemic but none for pre-pandemic period. Conclusion: This is the first study to compare the effect of the acute and subacute phases of the pandemic on uninfected hip fracture patients. In the age of COVID-19, to provide the best care for the vulnerable geriatric orthopedic populations, the healthcare system must adopt new protocols. We should still aim to promote prompt surgical care when indicated. It is important to ensure adequate resource availability, such as OR time and staff so that hip fracture patients may continue to receive rapid access to surgery. A multidisciplinary approach remains the key to the management of fragility hip fracture patients during the pandemic.
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Affiliation(s)
- Naoko Onizuka
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA.,Department of Orthopaedic Surgery, Methodist Hospital, Saint Louis Park, MN, USA
| | - Lauren N Topor
- University of Minnesota Medical School, Minneapolis, MN, USA
| | - Lisa K Schroder
- Department of Orthopaedic Surgery, Regions Hospital, St. Paul, MN, USA
| | - Julie A Switzer
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA.,Department of Orthopaedic Surgery, Methodist Hospital, Saint Louis Park, MN, USA
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Villanueva-Lozano H, Treviño-Rangel RDJ, González GM, Ramírez-Elizondo MT, Lara-Medrano R, Aleman-Bocanegra MC, Guajardo-Lara CE, Gaona-Chávez N, Castilleja-Leal F, Torre-Amione G, Martínez-Reséndez MF. Outbreak of Candida auris infection in a COVID-19 hospital in Mexico. Clin Microbiol Infect 2021; 27:S1198-743X(20)30790-4. [PMID: 33429028 PMCID: PMC7835657 DOI: 10.1016/j.cmi.2020.12.030] [Citation(s) in RCA: 107] [Impact Index Per Article: 35.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/12/2020] [Accepted: 12/23/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Hiram Villanueva-Lozano
- Universidad Autónoma de Nuevo León, School of Medicine, Department of Microbiology, Monterrey, Nuevo León, Mexico
| | - Rogelio de J Treviño-Rangel
- Universidad Autónoma de Nuevo León, School of Medicine, Department of Microbiology, Monterrey, Nuevo León, Mexico
| | - Gloria M González
- Universidad Autónoma de Nuevo León, School of Medicine, Department of Microbiology, Monterrey, Nuevo León, Mexico
| | - María Teresa Ramírez-Elizondo
- Hospital San José-Tec Salud, Epidemiological Surveillance Unit, Monterrey, Nuevo León, Mexico; Instituto Tecnológico y de Estudios Superiores de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo León, Mexico
| | - Reynaldo Lara-Medrano
- Hospital San José-Tec Salud, Epidemiological Surveillance Unit, Monterrey, Nuevo León, Mexico
| | | | - Claudia E Guajardo-Lara
- Laboratory of Clinical Microbiology, Hospital San José-TecSalud, Monterrey, Nuevo León, Mexico
| | - Natalia Gaona-Chávez
- Hospital San José-Tec Salud, Epidemiological Surveillance Unit, Monterrey, Nuevo León, Mexico
| | - Fernando Castilleja-Leal
- Instituto Tecnológico y de Estudios Superiores de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo León, Mexico
| | - Guillermo Torre-Amione
- Instituto Tecnológico y de Estudios Superiores de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo León, Mexico
| | - Michel F Martínez-Reséndez
- Hospital San José-Tec Salud, Epidemiological Surveillance Unit, Monterrey, Nuevo León, Mexico; Instituto Tecnológico y de Estudios Superiores de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo León, Mexico.
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39
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Lagu T, Artenstein AW, Werner RM. Fool Me Twice: The Role for Hospitals and Health Systems in Fixing the Broken PPE Supply Chain. J Hosp Med 2020; 15:570-571. [PMID: 32853144 PMCID: PMC7489798 DOI: 10.12788/jhm.3489] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/09/2020] [Accepted: 06/12/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Tara Lagu
- Institute for Healthcare Delivery and Population Science, Baystate Health, Springfield, Massachusetts
- Department of Medicine, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts
| | - Andrew W Artenstein
- Department of Medicine, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts
| | - Rachel M Werner
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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