Disaster Collaborative Exercises for Healthcare Teamwork in a Saudi Context

This study aimed to evaluate the development of healthcare teamwork during and after the collaboration tabletop exercises, through observation and interview methods. Integration and maturity theoretical models were employed to explain the collaborative challenges in teams that may suffer from unequally distributed power, hierarchies, and fragmentation. Using three-level collaboration tabletop exercises and the Command and control, Safety, Communication, Assessment, Treatment, Triage, Transport (CSCATTT) instrument, 100 healthcare workers were observed during each step in the implementation of the CSCATTT instrument using two simulated scenarios. The results show a lack of integration and team maturity among participants in the first scenario, leading to the delayed start of the activity, task distribution, and decision making. These shortcomings were improved in the second scenario. In-depth interviews with 20 participants in the second phase of the study revealed improved knowledge and practical skills, self-confidence, and ability in team building within trans-professional groups in the second scenario, which in concordance with the integration theory, was due to the attempts made in the first scenario. Additionally, there was an improvement in the team's maturity, which in concordance with the maturity theory, was due to the knowledge and practical skills during scenario plays. These results indicate the importance of continuous tabletop training, and the use of CSCATTT as a collaborative instrument, to promote the development of collaboration and to test the concept of preparedness.

Assessing Thai Hospitals' Evacuation Preparedness Using the Flexible Surge Capacity Concept and Its Collaborative Tool

According to the concept of "flexible surge capacity,” hospitals may need to be evacuated on two occasions: (1) when they are exposed to danger, such as in war;and (2) when they are contaminated, such as during the Covid-19 pandemic. In the former, the entire hospital must be evacuated, while in the latter, the hospital becomes a pandemic center necessitating the transfer of its non-contaminated staff, patients, and routine activities to other facilities. Such occasions involve several degrees of evacuation—partial or total—yet all require deliberate surge planning and collaboration with diverse authorities. This study aimed to investigate the extent of hospital evacuation preparedness in Thailand, using the main elements of the flexible surge capacity concept. A mixed method cross-sectional study was conducted using a hospital evacuation questionnaire from a previously published multinational hospital evacuation study. The tool contained questions regarding evacuation preparedness encompassing surge capacity and collaborative elements and an open-ended inquiry to grasp potential perspectives. All 143 secondary care, tertiary care, and university hospitals received the questionnaire;43 hospitals provided responses. The findings indicate glitches in evacuation protocols, particularly triage systems, the inadequacies of surge planning and multiagency collaboration, and knowledge limitations in community capabilities. In conclusion, the applications of the essential components of flexible surge capacity allow the assessment of hospital preparedness and facilitate the evaluation of guidelines and instructions through scenario-based training exercises. © 2023, The Author(s).

Lemierre's Syndrome in COVID Pandemic: Is there an Association?

Background: Lemierre's syndrome is an uncommon life-threatening condition characterized by septic thrombophlebitis of the internal jugular vein (IJV), anaerobic sepsis, and metastatic infections. Case description: A 57-year-old diabetic male presented to the emergency department with progressively increasing left-sided neck swelling. A contrast-enhanced computed tomography of the neck revealed an air-containing abscess showed a long-segment thrombus in the left internal jugular vein with septic embolization to the right upper lung. He was also positive for SARS-CoV-2 infection. He underwent emergency drainage of the abscess along with culture appropriate antibiotics. Two days postprocedure, he developed atrial fibrillation and received anticoagulation treatment for 3 months. Discussion(s): This case report adds to the growing body of literature of co-occurrence of Lemierre's syndrome in SARS-CoV-2 infection and discusses the possible associations between the two. Besides, it also highlights Klebsiella pneumoniae as an uncommon pathogen causing Lemierre's syndrome.Copyright © The Author(s). 2022 Open Access.

Revised workflow practices in the management of acute invasive fungal sinusitis during the coronavirus disease 2019 pandemic.

OBJECTIVE: To document changes in evaluation protocols for acute invasive fungal sinusitis during the coronavirus disease 2019 pandemic, and to analyse concordance between clinical and histopathological diagnoses based on new practice guidelines. METHODS: Protocols for the evaluation of patients with suspected acute invasive fungal sinusitis both prior and during the coronavirus disease 2019 period are described. A retrospective analysis of patients presenting with suspected acute invasive fungal sinusitis from 1 May to 30 June 2021 was conducted, with assessment of the concordance between clinical and final diagnoses. RESULTS: Among 171 patients with high clinical suspicion, 160 (93.6 per cent) had a final histopathological diagnosis of invasive fungal sinusitis, concordant with the clinical diagnosis, with sensitivity of 100 per cent, positive predictive value of 93.6 per cent and negative predictive value of 100 per cent. CONCLUSION: The study highlights a valuable screening tool with good accuracy, involving emphasis on 'red flag' signs in high-risk populations. This could be valuable in situations demanding the avoidance of aerosol-generating procedures and in resource-limited settings facilitating early referral to higher level care centres.

Rhino-orbito-cerebral mucormycosis: patient characteristics in pre-COVID-19 and COVID-19 period.

BACKGROUND: Rhino-orbito-cerebral-mucormycosis (ROCM), a rare and potentially fatal disease was seen in increasing numbers during the COVID-19 pandemic. This study describes and compares the patient characteristics and outcomes in COVID-19 associated mucormycosis (CAM) and non-COVID-19 mucormycosis (non-CAM). METHODOLOGY: CAM patients (24 cases) were recruited from the COVID-19 period and non-CAM (24 controls) from the pre-COVID-19 period. Clinical data of the CAM group was collected retrospectively with 3 month outcomes prospectively. The non-CAM group data was collected retrospectively. Patient characteristics were compared and risk factors for mortality in ROCM were assessed. RESULTS: Orbital symptoms [altered vision, restricted eye movements, ptosis] and intracranial involvement were higher in CAM patients on presentation. Similarly, the radiological involvement of orbit (orbital apex, superior orbital fissure) and intracranial cavity (intracranial thrombosis, cavernous sinus) was also higher in CAM patients. Newly detected diabetes was found only in CAM patients (29.2%). Although univariate analysis suggested an increased mortality risk in ROCM patients with orbital involvement, the multivariate analysis showed no increased risk with any of the parameters assessed, including COVID-19 positivity. CONCLUSIONS: Compared to the non-CAM, the disease presentation was severe in CAM with higher frequency of orbital and intracranial involvement. However, with early detection and treatment, the short term survival was comparable in both groups.

Organizational Changes Needed in Disasters and Public Health Emergencies: A Qualitative Study among Managers at a Major Hospital

Most hospitals have a contingency plan, based on all-risks and all-hazards assessment principles. However, emerging threats and risks often necessitate a flexible approach to emergency management at several levels of a disaster response system, for example, in hospitals. Sweden, and possibly other countries, has limited possibilities of surge capacity in the management of large-scale disasters and emergencies, which necessitates a local/national partnership and a flexible local disaster and contingency plan. This study evaluates the opinions of a selected managerial group, both at operative and strategic levels, regarding possible changes in a major hospital’s contingency plan during the ongoing COVID-19 pandemic. Semistructured interviews were conducted to explore the elements of surge capacity and an operational tool, consisting of command and control, safety, communication, assessment, triage, treatment, and transport. The results show a need to create feasible management methods that can be evaluated, establish clear leadership, put preparedness as a constant point on the highest managerial agenda, improve external monitoring, and create a regional coordinating center. Furthermore, the results emphasize the significant role played by the incident command system and qualified leadership to facilitate competent and crucial medical decision making, as well as to provide reliable communication, collaboration, and coordination in a multi-agency response system during dynamic and unexpected emergencies. These steps enable a constant connection between reactive contingency plans and the proactivity in continuous risk assessment and enhance the flexibility of the contingency plans. © 2022, The Author(s).

Community-based response to the COVID-19 pandemic: case study of a home isolation centre using flexible surge capacity.

OBJECTIVES: Coronavirus disease 2019 (COVID-19) has consumed many available resources within contingency plans, necessitating new capacity surges and novel approaches. This study aimed to explore the possibility of implementing the concept of flexible surge capacity to reduce the burden on hospitals by focussing on community resources to develop home isolation centres in Bangkok, Thailand. STUDY DESIGN: A qualitative study consisted of observational and semi-structured interview data. METHODS: The development and activities of home isolation centres were observed, and interviews were conducted with leaders and operational workforces. Data were deductively analysed and categorised based on the practical elements necessary in disaster and emergency management. RESULTS: Data were categorised into the seven collaborative elements of the major incident medical management and support model. The command-and-control category demonstrated four subcategories: (1) coordination and collaboration; (2) staff engagement; (3) responsibility clarification; and (4) sustainability. Safety presented two subcategories: (1) patients' information privacy and treatment; and (2) personnel safety and privacy. Communication showed internal and external communications subcategories. Assessment, triage, treatment and transport followed the processes of the COVID-19 treatment protocols according to the World Health Organisation (WHO) guidelines and hospital operations. Several supply- and patient-related challenges were identified and managed during centre development. CONCLUSIONS: The use of community resources, based on the flexible surge capacity concept, is feasible under restricted circumstances and reduced the burden on hospitals during the COVID-19 pandemic. Continuous education among multidisciplinary volunteer teams facilitated their full participation and engagement. The concept of flexible surge capacity may promote an alternative community-based care opportunity, irrespective of emergencies' aetiology.

Outcomes of establishing an urgent care centre in the same location as an emergency department

The emergency department (ED) is one of the busiest facilities in a hospital, and it is frequently described as a bottleneck that limits space and structures, jeopardising surge capacity during Major Incidents and Disasters (MIDs) and pandemics such as the COVID 19 outbreak. One remedy to facilitate surge capacity is to establish an Urgent Care Centre (UCC), i.e., a secondary ED, co-located and in close collaboration with an ED. This study investigates the outcome of treatment in an ED versus a UCC in terms of length of stay (LOS), time to physician (TTP) and use of medical services. If it was possible to make these parameters equal to or even less than the ED, UCCs could be used as supplementary units to the ED, improving sustainability. The results show reduced waiting times at the UCC, both in terms of TTP and LOS. In conclusion, creating a primary care-like facility in close proximity to the hospitals may not only relieve overcrowding of the hospital's ED in peacetime, but it may also provide an opportunity for use during MIDs and pandemics to facilitate the victims of the incident and society as a whole.