Challenging Organizational Factors Associated With Admission Delay to Intensive Care Unit-A Novel Quality Indicator.

BACKGROUND: Delays in admitting patients to the intensive care unit (ICU) can defer the timely initiation of life-sustaining therapies and invasive monitoring, jeopardizing the success of the treatment. Nevertheless, the availability of research on interventions that reduce or minimize admission delays is limited. OBJECTIVES: The current study aimed to assess the factors related to delays in admission times of critically ill patients transferred to the ICU. METHODS: A software was designed to follow-up, compare and measure the defined intervals of the time to admission, implemented at the ICU for 6 months. Measurements included 5 time intervals, referral department, and work shift at admission. Data from 1004 patients admitted to the ICU between July 2017 and January 2020 were analyzed in a retrospective observational study. RESULTS: Precisely, 53.9% of total patients were referred from the hospital emergency department, and 44% were admitted during the evening shift. Significant differences were found in time intervals between shifts, showing the morning round had the longer total admission time (median: 67.8 min). Analysis showed that admission time was longer at times of full capacity compared to times of available bed (mean: 56.4 and 40.2 min, respectively; U = 68,722, p < .05). Findings demonstrated a significant shortening of time to admission after implementing a new time monitoring software by the Institutional Quality Control Commission (U = 5072, p < .001). CONCLUSIONS: Our study opens doors for potential studies on applying effective initiatives in critical care settings to improve patient care and outcomes. Additionally, it generates new insights regarding how clinicians and nursing teams can jointly develop and promote multidisciplinary interventions in intensive care work environments.

One-year dynamics of antibody titers after three doses of SARS-CoV-2 BNT162b2 vaccine.

BACKGROUND: A third dose of the BNT162b2 SARS-CoV-2 vaccine leads to a significant increase in antibody levels, however, concerns regarding the long-term persistence of this response exist. We assessed the humoral response for one year following vaccination. METHODS: A prospective study among immunocompetent healthcare workers (HCW) who received three doses of BNT162b2. anti-spike antibody titers were measured at six predefined timepoints, from before the second vaccine dose, and up to one year afterwards, which is 4-6 months after the third dose. HCW with a history of SARS-CoV-2 infection were excluded. RESULTS: Seventy-six HCW had all the six serological measurements. Antibody titers significantly increased shortly following the third vaccine dose, and while declining, remained higher from all previous measurements for up to six months. CONCLUSIONS: A third dose of BNT162b2 leads to a profound humoral response, which remains significantly higher than previous measurements, even after 6 months.

Workplace Violence against Hospital Workers during the COVID-19 Pandemic in Israel: Implications for Public Health.

Workplace violence (WPV) against healthcare workers, a serious public health problem with profound implications, has worsened during the COVID-19 pandemic. This study examined the incidence of different types of WPV in a public hospital in Israel during the pandemic and analyzes the factors associated with its occurrence. A cross-sectional study was performed via an online questionnaire with 486 workers at a government hospital in Israel. Data were collected about sociodemographic and occupational characteristics, exposure to different forms of WPV over the preceding six months, and the responsibility and reasons for WPV from the workers' perspective. Approximately 71% of respondents were exposed to WPV and 64% perceived that WPV escalated during the pandemic. The prevalence of verbal/psychological and physical WPV were 69 and 11%, respectively. The main reason for WPV was frustration over long wait times (70%). The escalation during the pandemic can be attributed to patients' or relatives' anxiety and mental states following the onset of the COVID-19 pandemic (72%), an increase in waiting time since the pandemic began (54%), lack of hospital resources to care for everyone (45%), and the inability to visit critically ill relatives with COVID-19 (44%). Increased exposure to WPV was attributed to lower seniority, working in emergency or internal departments, and being a nurse or a doctor. The findings raise an urgent need to develop strategies to reduce WPV in hospitals at all levels: national, organizational, and individual. Further research could focus on the effectiveness of innovative strategies and interventions to prevent violence against healthcare workers.

[DOCTORS' ATTITUDES TOWARDS EUTHANASIA].

BACKGROUND: Euthanasia is a highly controversial issue due to ethical, legal, religious, social and psychological aspects. OBJECTIVES: To examine the attitudes of physicians regarding euthanasia and the background variables related to these attitudes. METHODS: A survey was administered to 131 physicians working at Barzilai Medical Center. Physicians were queried about their attitudes regarding euthanasia. RESULTS: Most doctors have encountered terminally ill patients within their work or personal lives; 62% agreed that a person has the right to decide whether to expedite their own death; 56% thought they should accept a patient's request to prevent/stop life-preserving treatment; 53% agreed that euthanasia should be allowed, while about 20% thought that in any case, doctors should preserve the patient's life, even despite the patient's wishes to die. Forty percent of doctors faced the dilemma of ordering DNR (Do Not Resuscitate). Only half of the physicians had a familiarity with the law, and 41% didn't know if a DNR procedure exists in their department. Doctors specializing in internal professions held more positive attitudes toward euthanasia than other professions. In addition, the doctor's years of experience, level of secularity, and number of encounters with terminally ill patients each had a positive correlation with their respective attitudes towards euthanasia. DISCUSSION: Attitudes toward euthanasia are quite positive, although data shows a conflict of values: the sacredness of human life versus the desire to alleviate the patient's suffering and to respect their autonomy. It is recommended to re-discuss the law, and to inform physicians that the DNR procedure exists.