Hospital response challenges and strategies during COVID-19 pandemic: a qualitative study

Hospitalization dynamics during COVID-19: Insights into disease trends and patient outcomes

OBJECTIVES

To find the pattern of hospitalization pattern change in COVID-19 pandemic, we aimed to compare the admission and mortality rate of each disease in all wards before and during the pandemic.

METHODS

Data for all ICD-10 disease categories were collected from 17 shahrivar hospital database for 14922 patients before (23 July 2017-23 January 2020 (and 10941 patients during the pandemic (20 February 2020- 20 September 2022). We compared the age, sex, duration of hospitalization, the frequency of readmission and outcome of patients in these two periords. Also the number of patients in each ICD-10 category and in each ward was compared.

RESULTS

Comparing the two periods revealed a decrease in overall admission frequency (14,922 vs. 10,941 patients). During the pandemic, patients experienced significantly shorter hospital stays (P < 0.001). There was no significant difference in the number of patients entering remission or experiencing mortality (P = 0.063). Notably, admissions for neoplasms, blood disorders, nervous system conditions, eye disorders, circulatory and digestive system issues, genitourinary system disorders, congenital malformations, and poisoning significantly increased during the pandemic, while admissions for other conditions decreased. Admissions varied significantly across departments, with notable increases in the NICU, PICU, emergency, neonatal, and hematology departments during the pandemic (P < 0.001).

CONCLUSIONS

In conclusion, our findings highlight the impact of the COVID-19 pandemic on hospitalization patterns, equipping healthcare managers to improve resource allocation and readiness for future health challenges.

Characterizing pre-discharge interventions to reduce length of stay for older adults: A scoping review

BACKGROUND

Hospital pre-discharge interventions are becoming one of the leading strategies to promote early discharge. For older adult patients, it remains unclear what these interventions are and how they affect discharge outcomes.

OBJECTIVE

This scoping review categorizes pre-discharge interventions promoting early acute care hospital discharging or total hospital length of stay reductions among older adults, synthesizes contextual factors (e.g., cost, staffing) driving implementation, and assesses the perceived intervention's impact.

DESIGN

The review followed the five states of the Arksey and O'Malley framework and the PRISMA-ScR extension. The PubMed, Embase, and Scopus databases were searched from 1983 to 2020 for pre-discharge interventions designed or adapted to discharge older adults earlier in their stay from acute care hospitals. Potentially relevant articles were screened against eligibility criteria. Findings were extracted and collated in data charting forms followed by brief thematic analyses.

RESULTS

The search yielded 5,455 articles of which 91 articles were included. Eight pre-discharge intervention categories were identified: clinical management, diagnostic/risk assessment tools, staffing enhancements, drug administration, length of stay protocols, nutrition planning, and communication improvements. Leading motivations for intervention implementation included the nationwide drive to reduce care costs and hospitals' need to increase hospital profitability, improve quality of care, or optimize resource utilization. Discharge outcomes reported included hospitalization costs, readmission rates, mortality rates, resource utilization rates and costs, and length of stay. Mixed results were found regarding the effectiveness of early discharge interventions on discharge outcomes based on expressed author sentiment.

CONCLUSIONS

The drive for pre-discharge interventions that reduce older adult hospital stays and associated costs continues to stem primarily from economic and governmental policies. Follow-up studies may be required to emphasize patient perspectives and care trajectories to avoid unintentional costly and health-deteriorating consequences.

Strengthening Primary Health Care for Epidemic and Pandemic Response: A Scoping Review

AIMS

Epidemics strain healthcare systems and reduce care quality, making primary healthcare a crucial frontline component in combating pandemics. The aim of this paper was to explore the experiences of countries in strengthening primary health care to address epidemics and pandemics of infectious diseases.

DESIGN

It was a scoping review conducted in 2024. The research was qualitative in nature.

METHODS

Multiple databases were searched including PubMed, Scopus, and ProQuest. Upon screening the references, the Boyatzis approach to thematic analysis was utilised to analyse and categorise the acquired data based on the fundamental building blocks of healthcare systems as presented by the World Health Organisation (WHO).

RESULTS

Sixty-seven studies were included in the study, reporting widespread strategies and interventions implemented in primary healthcare systems around the globe. The majority of these strategies and interventions were within the context of service delivery, leadership/governance, and health workforce.

CONCLUSION

The strategies and interventions implemented by primary healthcare systems worldwide during the pandemic crisis are extensive and varied. Further research is required to provide a comprehensive understanding of the potential impacts of such interventions.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

There are numerous strategies and interventions reported in the literature for epidemic and pandemic response, which healthcare policymakers and managers can utilise to improve patient care during times of crisis.

IMPACT

The study examined challenges in primary healthcare during crises, such as pandemics. It identified various strategies and interventions aimed at addressing these challenges, primarily in service delivery, leadership/governance, and health workforce management. Healthcare policymakers and managers can leverage these findings to enhance patient care during crises.

REPORTING METHOD

PRISMA 2020 guideline for review studies.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

Cost-effectiveness of plasmapheresis and hemoperfusion in COVID-19 survivors: A six-month follow-up analysis after hospital discharge

INTRODUCTION

To evaluate the short- and long-term clinical and financial outcomes of apheresis in COVID-19 survivors after hospital discharge.

METHODS

Intensive care unit-discharged patients were followed for 6 months. Vital signs, laboratory markers, quality of life, and direct medical costs were analyzed to calculate incremental cost-effectiveness ratios (ICER) and to plot cost-effectiveness planes and acceptability curves.

RESULTS

A total of 68 patients (45 control, 18 plasmapheresis, and 5 hemoperfusion) were included. ICERs for plasmapheresis and hemoperfusion patients at discharge were $867.58 and $198.89 per quality-adjusted life years (QALY) gained, respectively. Respiration and blood pressure improved significantly at discharge. The improvements in oxygenation markers for plasmapheresis and hemoperfusion groups were lower than controls (8.56 ± 10.31 and 11.75 ± 16.88 vs. 11.37 ± 7.28 percent for SpO2, 11.15 ± 21.15 and 11.05 ± 24.95 vs. 16.03 ± 5.61 mm Hg for PaO2, respectively) However, the respiratory rate improvements corresponded to ICERs of $1034.77 and $269.94 for plasmapheresis and hemoperfusion, respectively. The ICERs for increasing mean arterial pressure were $24.83 and $30.94 per mm Hg, and plasmapheresis was more cost-effective than hemoperfusion in increasing serum calcium levels ($1649.35 per mg/dL). At 1-month post-discharge, both treatments showed worse outcomes compared to controls. At 6 months, the plasmapheresis ICER ($1884.95) exceeded the willingness-to-pay threshold. The ICER for plasmapheresis at 6 months was $112.83 per rehospitalization day avoided, while hemoperfusion remained less effective than controls.

CONCLUSION

While plasmapheresis and hemoperfusion improved some clinical outcomes, their high costs and limited long-term cost-effectiveness suggest that these interventions may not be economically justified for treating COVID-19 patients. Careful evaluation is needed when considering their use in clinical practice.

The effectiveness of COVID-19 vaccination in preventing hospitalisation and mortality: A nationwide cross-sectional study in Iran

Background

The pandemic of the coronavirus disease 2019 (COVID-19) led to a global health crisis, prompting widespread vaccination efforts to reduce severe outcomes. In this study, we assessed the impact of mass COVID-19 vaccination on hospitalisation and mortality rates in Iran, where over 83% of the vaccinated population received inactivated virus vaccines.

Methods

Using retrospective, cross-sectional analysis, we examined data from the Iran Health Insurance Organisation, covering 41 million individuals from 20 February 2020 to 20 March 2022. We analysed hospital records from 956 Iranian hospitals, focusing on inpatient stays, short-term hospitalisations, and emergency department visits. Study outcomes included COVID-19 hospital admissions and associated mortality. We used negative binomial regression to compare hospital admission rates between periods, while we used a poison regression model with a log link to assess mortality risks before and after vaccination.

Results

Among 806 076 hospital admissions, 57 599 deaths were recorded. COVID-19 hospitalisations increased with age, and women had slightly higher admission rates than men. Advanced age and male sex correlated with higher mortality rates. Hospital admissions rose to 1178.66 per million population per month post-vaccination compared to 459.78 pre-vaccination. The incidence rate ratio was 2.09 (95% confidence interval (CI) = 1.90-2.32, P < 0.001), mainly due to the Delta variant. In contrast, post-vaccination mortality rates decreased from 111.33 to 51.66 per 1000 admissions per month. Post-vaccination, COVID-19 mortality significantly decreased, with a relative risk being 0.61 (95% CI = 0.60-0.62, P < 0.001) across all age groups and sexes.

Conclusions

The Delta variant increased hospital admissions among vaccinated individuals, but widespread vaccination significantly reduced COVID-19-related mortality.

Qualitative Study on Emotional Experiences and Coping Strategies in Patients With COVID-19 During the Early Stage of Wuhan Crisis

Objective: In the early stage of COVID-19 pandemic from December 2019 to March 2020, COVID-19 patients endured huge mental stress combined with constant physiological suffering. We aimed to summarize the emotional experiences of patients with COVID-19 during the early stages of the Wuhan crisis and present the coping strategies they used during the extreme time. Methods: We did a qualitative study using an empirical phenomenology approach. COVID-19 patients with recovery and near discharge were recruited from the Dawu County Hospital of Traditional Chinese Medicine in Hubei province using purposive sampling. Semistructured face-to-face interviews were conducted by frontline medical staff and recorded by video and audio, then transcribed by two researchers separately. The Haase adapted version of the Colaizzi method was used to analyze the transcriptional data. Results: We included 18 adult survivors of COVID-19 (33% female, 67% male) within the age range of 27-83 (mean age 48), and the average duration of isolation was 31.17 days. In conjunction with clinical data, we meticulously delved into the emotional trajectory of each survivor, spanning from the onset of illness through the phases of decline, improvement, and eventual recovery. Three theme categories were obtained from data analysis, including negative emotions and sources, coping strategies, and positive emotions and sources. COVID-19 patients adopted self-management strategies and received support from different roles when confronting high level of negative emotions. Conclusions: Early survivors of COVID-19 experienced both negative and positive emotional experiences. Anxiety and other negative emotions were originated from both collective and individual concerns. The influence of the emotion sources differed at each stage of the disease. Patients coped with these stressors using external supports and self-adjustment. Still, comprehensive and targeted psychological services are needed.

To prescribe or not: a two-center retrospective observational study of antibiotics usage and outcomes of COVID-19 in Turkey

This retrospective cohort study conducted in Turkey between December 2020 and June 2022 aimed to assess antibiotic use, bacterial co-infections, and the associated factors on mortality in hospitalized patients with mild-to-severe COVID-19. Among the 445 patients, 80% received antibiotics, with fluoroquinolones being the most common choice, followed by beta-lactams and combinations. Various clinical and laboratory parameters, including symptoms, comorbidities, CCI, oxygen requirements, and CRP levels were observed to be elevated in the antibiotic group. Non-survivors had more ICU admissions and longer hospital stays compared to survivors. We conducted a multivariate Cox regression analysis to evaluate factors related to mortality. However, we did not find an association between antibiotic use and mortality [HR 2.7 (95% CI 0.4-20)]. The study identified significant factors associated with an antibiotic prescription, such as CCI (OR 1.6), CRP (OR 2.3), and ICU admission (OR 8.8), (p < 0.05). The findings suggest re-evaluating the necessity of antibiotics in COVID-19 cases based on clinical assessments, focusing on the presence of bacterial infections rather than empirical treatment. Further research is necessary to more accurately identify patients with bacterial co-infections who would benefit from antibiotic treatment.

COVID-19 Frequency in Hospitalized Psychiatric Patients: A Systematic Review

OBJECTIVE

The COVID-19 pandemic affected individuals in different contexts (e.g. long-term care facilities, schools, communities), including psychiatric hospitals. Thus, the objective of this systematic review, duly registered and approved on PROSPERO (CRD42023427835), is to assess the frequency of positive COVID-19 cases among patients hospitalized in psychiatric hospitals.

METHODS

A total of 4,922 articles were identified in the database searches, and 17 studies conducted in psychiatric hospitals from different regions of the world were selected.

RESULTS

The frequency of positive COVID-19 cases among patients hospitalized in psychiatric hospitals ranged from 1.8% to 98.8%. Out of a total of 19,573 patients hospitalized in psychiatric hospitals, the pooled mean frequency of positive COVID-19 cases was 11.9%. The majority of patients presented COVID-19 symptoms (e.g. cough, fever and others). The COVID-19 diagnosis was primarily conducted through RT-PCR testing in 88.9% of the studies.

CONCLUSION

In conclusion, there is discrepancy in the methodology of the studies assessing the frequency of positive COVID-19 cases in psychiatric hospitals. However, this review allowed us to understand how the COVID-19 pandemic has impacted the population hospitalized in psychiatric hospitals.

Mortality analysis of patients with acute coronary syndrome receiving comprehensive cardiac care (KOS-Zawal) during the COVID-19 pandemic period

Introduction

Due to the SARS-CoV-2 pandemic, there have been fundamental changes to the delivery and operation of healthcare facilities across the world, significantly impacting how patients with a variety of diseases are treated. We aimed to assess the impact of the COVID-19 pandemic on patient management outcomes among patients with acute coronary syndromes (ACS) and explore the differences in patients who were treated within and outside the coordinated care programme for patients after ACS (KOS-Zawal).

Material and methods

We analysed 472,996 medical records of patients after ACS from 2017 to 2022. The study examined information on deaths in two groups of patients: those included and those not included in the KOS-Zawal programme.

Results

Before the COVID-19 pandemic a significantly higher mortality rate was observed in the group of patients not covered by the KOS-Zawal benefit compared with covered patients (25.5% vs. 15.8%; p < 0.0001). During the COVID-19 pandemic a significantly higher incidence of death was noted in the group of patients not covered by KOS-Zawal compared with patients covered by the programme (18% vs. 7.9%; p < 0.0001). Compared to the time before and during COVID-19, the number of deaths among patients not covered (25.5% vs. 18%; p < 0.0001) and covered by KOS-Zawal (15.8% vs. 7.9%, p < 0.0001) decreased significantly.

Conclusions

Patients not covered by KOS-Zawal had a significantly higher mortality rate compared to those covered by the programme during the pandemic. The pandemic significantly affected patients under KOS-Zawal care, with a reduced mortality rate.

Makkah healthcare cluster response, challenges, and interventions during COVID-19 pandemic: A qualitative study

BACKGROUND

The global COVID-19 crisis has underscored the critical role of effective decision-making in healthcare systems. Saudi Arabia has shown resilience by implementing comprehensive testing, tracing, and vaccination measures. Given the unique cultural and religious characteristics of Makkah, specific challenges have prompted efforts to uncover local pandemic responses. This qualitative assessment aims to delineate the challenges faced by decision-makers during COVID-19 in Makkah and identify key interventions implemented by the Makkah healthcare cluster to manage and coordinate care.

METHOD

Utilizing a purposive sampling approach, executive leaders within the Makkah Healthcare Cluster were invited for semi-structured interviews during the COVID-19 period. Thematic analysis was carried out in five steps, ensuring rigor and trustworthiness through multiple checks, and employing a critical and collaborative approach.

RESULT

Throughout the COVID-19 outbreak in Makkah, participants revealed Several factors that have hindered healthcare organizations' ability to effectively manage the pandemic, including testing difficulties, resource shortages, vaccination misconceptions, continuity of care issues, infections among healthcare workers, and the need for consistent protocols. The participant leaders in Makkah's healthcare cluster specified implemented strategies that helped in overcoming the encountered challenges, such as adopting new technologies, enhancing communication, managing supply and demand, and improving workforce adaptability and development. Their experience in managing Hajj and Umrah provided valuable insights for handling the pandemic effectively.

CONCLUSION

The study emphasizes the significance of technology adoption, effective communication, supply management, workforce development, and lessons from managing religious events. Its findings have implications for healthcare systems globally, emphasizing the importance of preparedness, response, and resilience in diverse cultural contexts.

Utilizing disease transmission and response capacities to optimize covid-19 control in Malaysia

OBJECTIVES

Public Health Social Measures (PHSM) such as movement restriction movement needed to be adjusted accordingly during the COVID-19 pandemic to ensure low disease transmission alongside adequate health system capacities based on the COVID-19 situational matrix proposed by the World Health Organization (WHO). This paper aims to develop a mechanism to determine the COVID-19 situational matrix to adjust movement restriction intensity for the control of COVID-19 in Malaysia.

METHODS

Several epidemiological indicators were selected based on the WHO PHSM interim guidance report and validated individually and in several combinations to estimate the community transmission level (CT) and health system response capacity (RC) variables. Correlation analysis between CT and RC with COVID-19 cases was performed to determine the most appropriate CT and RC variables. Subsequently, the CT and RC variables were combined to form a composite COVID-19 situational matrix (SL). The SL matrix was validated using correlation analysis with COVID-19 case trends. Subsequently, an automated web-based system that generated daily CT, RC, and SL was developed.

RESULTS

CT and RC variables were estimated using case incidence and hospitalization rate; Hospital bed capacity and COVID-19 ICU occupancy respectively. The estimated CT and RC were strongly correlated [ρ = 0.806 (95% CI 0.752, 0.848); and ρ = 0.814 (95% CI 0.778, 0.839), p < 0.001] with the COVID-19 cases. The estimated SL was strongly correlated with COVID-19 cases (ρ = 0.845, p < 0.001) and responded well to the various COVID-19 case trends during the pandemic. SL changes occurred earlier during the increase of cases but slower during the decrease, indicating a conservative response. The automated web-based system developed produced daily real-time CT, RC, and SL for the COVID-19 pandemic.

CONCLUSIONS

The indicators selected and combinations formed were able to generate validated daily CT and RC levels for Malaysia. Subsequently, the CT and RC levels were able to provide accurate and sensitive information for the estimation of SL which provided valuable evidence on the progression of the pandemic and movement restriction adjustment for the control of Malaysia.

A qualitative study of leaders' experiences of handling challenges and changes induced by the COVID-19 pandemic in rural nursing homes and homecare services

BACKGROUND

The COVID-19 pandemic had a major impact on healthcare services globally. In care settings such as small rural nursing homes and homes care services leaders were forced to confront, and adapt to, both new and ongoing challenges to protect their employees and patients and maintain their organization's operation. The aim of this study was to assess how healthcare leaders, working in rural primary healthcare services, led nursing homes and homecare services during the COVID-19 pandemic. Moreover, the study sought to explore how adaptations to changes and challenges induced by the pandemic were handled by leaders in rural nursing homes and homecare services.

METHODS

The study employed a qualitative explorative design with individual interviews. Nine leaders at different levels, working in small, rural nursing homes and homecare services in western Norway were included.

RESULTS

Three main themes emerged from the thematic analysis: "Navigating the role of a leader during the pandemic," "The aftermath - management of COVID-19 in rural primary healthcare services", and "The benefits and drawbacks of being small and rural during the pandemic."

CONCLUSIONS

Leaders in rural nursing homes and homecare services handled a multitude of immediate challenges and used a variety of adaptive strategies during the COVID-19 pandemic. While handling their own uncertainty and rapidly changing roles, they also coped with organizational challenges and adopted strategies to maintain good working conditions for their employees, as well as maintain sound healthcare management. The study results establish the intricate nature of resilient leadership, encompassing individual resilience, personality, governance, resource availability, and the capability to adjust to organizational and employee requirements, and how the rural context may affect these aspects.

The Impact of COVID-19 on Trauma Emergency Patients in Southeastern Iran

Objective

With the COVID-19 outbreak in countries around the world, the countries' healthcare systems underwent an unprecedented shock. This study aimed to examine the resilience of the medical service delivery system in providing emergency services during the Covid-19 pandemic.

Methods

This study was conducted in a reference hospital in Kerman that provided emergency services to trauma patients. It compared service delivery before and after COVID-19, as well as during the COVID-19 peak and non-peak periods. The compared variables were the number of trauma patients admitted to the hospital and the ICU, the number of patients who died in the hospital due to trauma, and the length of stay in the hospital and the ICU.

Results

The pre- and post-COVID-19 comparisons showed no significant difference in the number of daily hospital admissions, ICU admissions, and patient deaths. The median length of stay in the ICU was significantly reduced by almost 2 days during the COVID-19 outbreak. However, the length of stay at the hospital was almost the same. Furthermore, a comparison of the COVID-19 peaks and non-peak periods indicated no statistically significant difference in the number of admissions in the ICU, hospital and ICU length of stay, and trauma-induced mortality.

Conclusion

Despite the substantial workload imposed by COVID-19 on hospitals, especially during the peak periods of the disease, the provision of medical services to emergency trauma patients did not drop significantly, and the quality of services provided to patients was within the acceptable range.