New Requirements for post-COVID-19 Hospital Inpatient Wards: Evidence, Design Recommendations and Assessment Tools.

Background: The evolution of hospital infrastructures highlights the need of its physical space to respond to new technological, societal and epidemiological transformations such as those following the COVID-19 pandemic experience. Although the new emerged needs of user-centeredness, comfort and wellbeing within specific functional areas, there is still a lack of measurable indications for addressing these challenges in-patient wards. Study Design: The objective of this study is therefore to provide specific guidelines for the design of the in-patient ward, through measurable criteria and indicators based on evidence from the scientific literature, and to develop an assessment tool for its evaluation. Methods: A five-step process has been followed: (i) performing a literature review about hospital wards and wellbeing strategies, (ii) conducting a best practice analysis and comparison of a selection of international contemporary healthcare facilities, (iii) defining some dimensional requirements from the comparison, (iv) developing an assessment tool based on extracted criteria, (v) testing the tool on an existing project. Results: Amongst the criteria, several aspects have been highlighted ranging from qualitative indicators, as the clarity of wayfinding or the level of privacy, to quantitative values, as the percentage of single inpatient rooms or the distance between rooms and nursing stations. The assessment tool is composed by 20 indicators, associated to thematic areas and referred to three environmental units of the inpatient ward. Two types of scoring system are proposed. Conclusions: Starting from those considerations and tool wider applications, the future design of hospital wards could follow guidelines addressing user-centeredness, comfort and wellbeing.

Variations in avoidable hospital admissions and emergency visits by primary care characteristics: an ecological study in Italy.

Background: Primary healthcare plays a central role in providing preventive care, managing chronic conditions and reducing inappropriate emergency presentations. The study aimed at providing population-level evidence on the correlation between the characteristics of primary healthcare across Italian regions and health outcomes included in the National Programs Outcomes of the National Agency for Regional Healthcare Services. Study Design: Ecological study. Methods: We analysed healthcare data from the National Agency for Regional Healthcare Services, the public lists of primary care doctors and the National Federation of Surgeons and Dentists and the National Institutes of Statistics referring to the 20 Italian regions. Pearson's correlation and Spearman's correlation were used to assess the relationships between primary healthcare characteristics and health outcomes. Results: Overall, across all Italian regions each general practitioner had on average 1447 patients and was 57.5 years old. The study found positive correlations between the number of patients per general practitioner and non-urgent Emergency Department visits among adult patients (Pearson's r = 0.58, p = 0.008), the number of residents aged 65+ per general practitioner and the rate of chronic obstructive pulmonary disease admissions (Pearson's r = 0.49, p = 0.029), and the age of general practitioners and lower-extremity amputations in diabetes patients (Pearson's r = 0.56, p = 0.011). A negative correlation was observed between the age of general practitioners and urinary tract infection admissions (Pearson's r = -0.76; p < 0.001). A non-linear negative correlation was found between the age of general practitioners and chronic obstructive pulmonary disease admissions (Spearman's ρ = -0.46, p = 0.041). Conclusions: The findings emphasise the importance of guaranteeing sufficient numbers of primary healthcare physicians to meet patients' needs, and for limiting avoidable hospitalisations and emergency presentations. General practitioners' age might also influence the provision of care, but more research is needed on possible mechanisms.

Challenges and Opportunities of Mass Vaccination Centers in COVID-19 Times: A Rapid Review of Literature.

A mass vaccination center is a location, normally used for nonhealthcare activities, set up for high-volume and high-speed vaccinations during infectious disease emergencies. The high contagiousness and mortality of COVID-19 and the complete lack of population immunity posed an extraordinary threat for global health. The aim of our research was to collect and review previous experiences on mass vaccination centers. On 4 April 2021, we developed a rapid review searching four electronic databases: PubMed/Medline, Scopus, EMBASE, Google Scholar and medRxiv. From a total of 2312 papers, 15 of them were included in the current review. Among them, only one article described a COVID-19 vaccination center; all of the others referred to other vaccinations, in particular influenza. The majority were conducted in the United States, and were simulations or single-day experiences to practice a mass vaccination after bioterrorist attacks. Indeed, all of them were published after September 11 attacks. Regarding staff, timing and performance, the data were highly heterogenous. Several studies used as a model the Center for Disease Control and Prevention guidelines. Results highlighted the differences around the definition, layout and management of a mass vaccination center, but some aspects can be considered as a core aspect. In light of this, we suggested a potential definition. The current review answers to the urgency of organizing a mass vaccination center during the COVID-19 pandemic, highlighting the most important organizational aspects that should be considered in the planning.