COVID-19: cómo transformar un ventilador de no invasiva en un ventilador de críticos / COVID-19: how to transform a noninvasive ventilation device in a critical care ventilator

La pandemia del COVID-19 ha hecho estragos, no solo en el número de víctimas fatales sino también en la infraestructura de los hospitales y unidades de cuidados intensivos. El número limitado de respiradores es una preocupación de toda la comunidad dada la demanda masiva y a muy corto plazo de estos equipos. Esta presentación tiene como fin dar soluciones sencillas para ventilar pacientes intubados de modo mandatorio utilizando equipos de ventilación no invasiva. Las soluciones propuestas permiten 2 estrategias claras frente al COVID-19: Reemplazar las máquinas de anestesia para disponer de ellas en pacientes. Usar la opción de equipos de ventilación no invasiva para pacientes con COVID-19 a modo de «puente» y a la espera de la liberación de un respirador específico en la unidad de cuidados críticos

COVID-19 pandemic caused not only many deaths around the world but also made evident technical limitations of hospital and intensive care units (ICU). The growing demand of ICU ventilators in a short lapse of time constitutes one of the main community concerns. The main goal of this communication is to give simple solutions to transform a noninvasive ventilator in an invasive one for intubated patients. The proposal can be applied in two well defined strategies for the COVID-19 pandemic: To replace anesthesia workstations, leaving those machines to be used in patients. To apply this option in COVID-19 patients by way of a therapeutic "bridge", waiting for the release of a ventilator in the ICU

Gestión enfermera durante la COVID-19: oportunidades y retos futuros / Nurse management during COVID-19: future opportunities and challenges

La pandemia COVID-19 ha representado un reto hasta ahora desconocido para nuestro sistema sanitario. Una parte significativa de la gestión de la crisis y adaptación durante este periodo ha correspondido a los mandos de enfermería. Este artículo muestra las dificultades y los éxitos de esta gestión, así como las oportunidades futuras que estos cambios pueden suponer para la profesión enfermera. Se realizó una encuesta telemática de 17 preguntas a las responsables de gestionar la adaptación de los servicios hospitalarios a la pandemia COVID-19, mediante la reestructuración de diferentes áreas: la comunicación interna con participación en la toma de decisiones, la formación para la seguridad de los pacientes, la dotación de materiales, la dotación y rotación de los profesionales y la actualización de los protocolos. Mediante el análisis de una encuesta realizada por responsables de enfermería de diversos hospitales públicos y mutuas laborales situados en Cataluña, hemos podido identificar las principales dificultades surgidas y las decisiones tomadas en un tiempo record para poder adaptar nuestros hospitales a la pandemia, preservando la seguridad del personal y dar una respuesta profesional y humana a nuestros pacientes. La crisis sanitaria vivida representa un incentivo para consolidar logros y proponer cambios que afiancen los aciertos, realizar autocrítica de los errores y devolver así a la sociedad, mediante cambios estructurales, aquello que hayamos aprendido. Defender este cambio supone impulsar perspectivas valientes en la redefinición de las enfermeras del futuro

The COVID-19 pandemic has represented a hitherto unknown challenge for our healthcare system. A significant part of management and adaptation during this period has been the responsibility of middle management nursing staff. This article shows the difficulties and successes of this management, in addition to the future opportunities that these changes, if they are known how to take advantage of, may represent for the nursing profession. An online survey was carried out with 17 questions to those responsible for managing the adaptation of various hospital services to the COVID-19 pandemic, through the internal communication redesign, the participation in the decision making process, the education for the patient's safety and the management of personnel, systems and materials. Through the analysis of a survey carried out by nursing managers from various public hospitals and labour mutual societies located in Catalonia, we have been able to identify the main difficulties encountered and the decisions taken in record time to be able to adapt our hospitals to the pandemic, preserving the safety of the staff and give a professional and humane response to our patients. The lived health crisis represents an incentive to consolidate achievements and propose changes that strengthen the successes, carry out self-criticism of mistakes and thus return to society, through structural changes, what we have learned. Defending this paradigm shift means promoting courageous perspectives in redefining the nurses of the future

Restoring Office-Based Surgical Facility Function Post-Hurricane Irma: Lessons Learned From Multiple Facilities.

Hurricane Irma made landfall in Southwest Florida on September 10, 2017, causing significant property damage, flooding, and power outages that lasted days to weeks during high heat and humidity. This created significant challenges for residents and businesses, as well as office-based surgical facilities in the area. Preparations in advance of hurricanes and other natural disasters for businesses should focus on staff, surroundings, space, systems, structure, and service. In the aftermath of a hurricane, assessment of the extent of the damage and the ability to perform restoration and mold remediation postflooding are the immediate goals. With the return of utility services, additional cleanup and assessment of equipment, medications, and sterile supplies with subsequent repair/recertification, replacement and reprocessing, as required, are necessary to bring operations back to normal.

A Study of Relationships Between Content in Documents From Health Service Operational Plans and Documents From the Planning of New Healthcare Environments.

AIM: The aim was to investigate the content and quality of the governing documents created in the planning and design phase of new healthcare environments and in the related healthcare strategic and operational plans. BACKGROUND: Quality deficits in buildings can often be traced back to the initial stages in the planning and design phase. Although large investments have been made to improve the process of planning new healthcare environments and linking the requirements to health service strategies, healthcare organizations rarely relate their strategy goals to the built environment. METHOD: A retrospective review of documents created in the planning and design stages of new healthcare environments and the operational plans of the target organizations was conducted. RESULTS: The organizational operational plans did not contain any statements or information about the built environment or how a building could or should support the organization's goals. Important information was frequently absent from the documents governing the planning and design of buildings. The documents lacked information about what and how to follow-up and what to measure once a construction project had been completed. There were no references to evidence. CONCLUSIONS: Poor documentation might undermine the quality of the planning and design phase and ultimately the opportunity to create environments that support health outcomes. Therefore, more emphasis must be placed on the importance of documentation but above all to strengthen and clarify the relationship between the healthcare organization strategy to achieve an effective and efficient care process and the intention made in the planning and design process.

Decentralizing the Team Station: Simulation before Reality as a Best-Practice Approach.

The purpose of this article is to share the logistical planning requirements and simulation experience of one Canadian hospital as it prepared its staff for the change from a centralized inpatient unit model to the decentralized design planned for its new community hospital. With the commitment and support of senior leadership, project management resources and clinical leads worked collaboratively to design a decentralized prototype in the form of a pod-style environment in the hospital's current setting. Critical success factors included engaging the right stakeholders, providing an opportunity to test new workflows and technology, creating a strong communication plan and building on lessons learned as subsequent pod prototypes are launched.

Planning Staff and Space Capacity Requirements during Wartime.

Determining staff and space requirements for military medical centers can be challenging. Changing patient populations change the caseload requirements. Deployment and assignment rotations change the experience and education of clinicians and support staff, thereby changing the caseload capacity of a facility. During wartime, planning becomes increasingly more complex. What will the patient mix and caseload volume be by location? What type of clinicians will be available and when? How many beds are needed at each facility to meet caseload demand and match clinician supply? As soon as these factors are known, operations are likely to change and planning factors quickly become inaccurate. Soon, more beds or staff are needed in certain locations to meet caseload demand while other locations retain underutilized staff, waiting for additional caseload fluctuations. This type of complexity challenges the best commanders. As in so many other industries, supply and demand principles apply to military health, but very little is stable about military health capacity planning. Planning analysts build complex statistical forecasting models to predict caseload based on historical patterns. These capacity planning techniques work best in stable repeatable processes where caseload and staffing resources remain constant over a long period of time. Variability must be simplified to predict complex operations. This is counterintuitive to the majority of capacity planners who believe more data drives better answers. When the best predictor of future needs is not historical patterns, traditional capacity planning does not work. Rather, simplified estimation techniques coupled with frequent calibration adjustments to account for environmental changes will create the most accurate and most useful capacity planning and management system. The method presented in this article outlines the capacity planning approach used to actively manage hospital staff and space during Operations Iraqi Freedom and Enduring Freedom.

Health facilities humanisation: design guidelines supported by statistical evidence.

BACKGROUND: Healthcare building humanisation is currently a widely debated issue and the development of patient centered and evidence based design is growing worldwide. Many international health organizations and researchers understand the importance of Patient Centred Design and leading architects incorporate it into the design process. In Italy this design approach is still at an early stage. The article refers to research commissioned by the Italian Health Ministry and carried out by R. Del Nord (Università degli Studi di Firenze) and G. Peretti (Politecnico di Torino) with their collaborators. The scope of the research was the definition of design guidelines for healthcare facilities humanisation. METHOD: The methodology framework adopted is the well established need and performance approach in architectural design. The article deals with the results of statistical investigations for the definition and ranking of users' needs and the consistent expression of their requirements. The investigations were carried out with the cooperation of psychologists of the Università degli Studi di Torino and researchers of the Università degli Studi di Cagliari. The proposed evaluation system allows ranking of health facilities according to the level of humanisation achieved. RESULTS: The statistical investigation evidence collected allowed the definition of humanisation design guidelines for health-care facilities and for the assessment of their specific level of humanisation.

Addressing decisions about new hospitals' siting: a multidimensional evaluation approach.

BACKGROUND: Site selection for urban facilities is a crucial topic in planning decision processes for the several side effects they produce and the multiple criteria involved, especially for healthcare facilities. Nevertheless, the location problem has been ignored by most of the existing evaluation systems. METHODS: Starting from a deep literature review and the analysis of hospitals in 10 European cities, the paper proposes an evaluation system divided into four macro-areas (Functional quality, Location quality, Environmental quality, Economical aspects), each in turn composed by criteria and sub-criteria. RESULTS: The evaluation system has been applied for the site selection of "La Città della Salute" in Milan, Italy. Furthermore, the ShOS (Selection hospitals' Site) Evaluation Tool has been defined, with the aim of assessing the land suitability for new healthcare structures. CONCLUSION: The ShOS evaluation tool improves the transparency and robustness of the decision-making process and it could be broadly applied.

An approach to plan and evaluate the location of radiotherapy services and its application in the New South Wales, Australia.

This paper proposes an integrated modelling approach for location planning of radiotherapy treatment services based on cancer incidence and road network-based accessibility. Previous research efforts have established travel distance/time barriers as a key factor affecting access to cancer treatment services, as well as epidemiological studies have shown that cancer incidence rates vary with population demography. Our study is built on the evidence that the travel distances to treatment centres and demographic profiles of the accessible regions greatly influence the uptake of cancer radiotherapy (RT) services. An integrated service planning approach that combines spatially-explicit cancer incidence projections, and the placement of new RT services based on road network based accessibility measures have never been attempted. This research presents a novel approach for the location planning of RT services, and demonstrates its viability by modelling cancer incidence rates for different age-sex groups in New South Wales, Australia based on observed cancer incidence trends; and estimations of the road network-based access to current NSW treatment centres. Using three indices (General Efficiency, Service Availability and Equity), we show how the best location for a new RT centre may be chosen when there are multiple competing locations.

Health care facilities resilient to climate change impacts.

Climate change will increase the frequency and magnitude of extreme weather events and create risks that will impact health care facilities. Health care facilities will need to assess climate change risks and adopt adaptive management strategies to be resilient, but guidance tools are lacking. In this study, a toolkit was developed for health care facility officials to assess the resiliency of their facility to climate change impacts. A mixed methods approach was used to develop climate change resiliency indicators to inform the development of the toolkit. The toolkit consists of a checklist for officials who work in areas of emergency management, facilities management and health care services and supply chain management, a facilitator's guide for administering the checklist, and a resource guidebook to inform adaptation. Six health care facilities representing three provinces in Canada piloted the checklist. Senior level officials with expertise in the aforementioned areas were invited to review the checklist, provide feedback during qualitative interviews and review the final toolkit at a stakeholder workshop. The toolkit helps health care facility officials identify gaps in climate change preparedness, direct allocation of adaptation resources and inform strategic planning to increase resiliency to climate change.

A conceptual model for healthcare facility design.

A conceptual model for healthcare facility design provides nurse leaders a framework for measuring the effect of specific or more global design features on patient, provider, and organizational outcomes. The model can help to explain relationships among variables of interest in facility design and be used to guide research studies or measures of change or improvement.

Los recursos médicos y de enfermería de los sistemas de emergencias médicas y centros de coordinación de urgencias en España / Emergency medical service staffing in Spain: physician, nurse and dispatch center resources

Objetivos: El objetivo de este trabajo es analizar la estructura y la dotación de recursos médicos y de enfermería de los sistemas de emergencias médicas (SEM) extrahospitalarias y los Centros de Coordinación de Urgencias (CCU) en España. Método: Diseño observacional retrospectivo que analiza los SEM y CCU de las 17 comunidades autónomas (CCAA) y las ciudades autónomas de Ceuta y Melilla en 2009 mediante búsqueda bibliográfica, encuesta estructurada y contacto con responsables del SEM. Resultados: La estructura cualitativa de recursos médicos y de enfermería es similar enlas CCAA con una correlación positiva significativa (R = 0,71, p < 0,006) entre las dotaciones médicas y de enfermeros de los SEM. Hay diferencias en la dotación cuantitativa de médicos en los SEM. Ceuta, Castilla-La Mancha, Canarias, Extremadura, Navarra y Rioja tienen una mayor dotación (p < 0,05), mientras que Murcia, Valencia, Cataluña, Euskadi, Galicia, el Principado de Asturias y Andalucía la tienen menor (p < 0,05). Hay diferencias en la dotación de personal de enfermería. Castilla La Mancha, Canarias, Extremadura, Ceuta y Melilla tienen una mayor dotación (p < 0,05), mientras que Valencia, Cantabria, Andalucía, el Principado de Asturias y Galicia la tienen menor(p < 0,05). La dotación de personal regulador en CCU, tanto médico como de enfermería, también muestra diferencias (p < 0,05) entre CCAA. Conclusiones: Los SEM españoles tienen dotaciones cuantitativas significativamente diferentes de personal médico y de enfermería asistencial y también de personal regulador. La relación entre dotación de personal médico y de enfermería en los SEM es razonablemente homogénea entre las CCAA (AU)

Objective: To analyze the structure of out-of-hospital emergency medical service (EMS) staffing in Spain, including physician, nurse, and dispatch center personnel. Methods: Retrospective observational study of the EMS staff and dispatch center personnel in 17 autonomous communities and the autonomous cites of Ceuta and Melilla in 2009. To obtain information, we searched the published literature and conducted a structured questionnaire survey followed by direct contact with EMS administrative supervisors for clarification. Results: The qualitative structure of physician and nurse staffing is similar in the different areas of Spain, with significant positive correlation (R=.71, P<.006) in physician and nurse resources between EMSs. EMS physicians differ in number in the different communities, however. Ceuta, Castile-La Mancha, the Canary Islands, Extremadura, Navarre, and Rioja have significantly more physicians (P<.05), while Murcia, Valencia, Catalonia, the Basque Country, Galicia, Asturias, and Andalusia have fewer (P<.05). The numbers of EMS nurses also differ. Castile-La Mancha, the Canary Islands, Extremadura, Ceuta, and Melilla have significantly more nurses (P<.05) nurses, while Valencia, Cantabria, Andalusia, Asturias, and Galicia have fewer (P<.05). Differences were also detected with respect to physician and nurse supervisory staffing of dispatch centers (P<.05).Conclusions: EMSs of some Spanish communities have more attending physicians and nurses than others. Dispatch center personnel resources also differ. The EMSs in different autonomous communities have reasonably similar ratios of physicians to nurses (AU)

Health systems engineering as an improvement strategy: a case example using location-allocation modeling.

Finding the optimal geographic location for a medical service is a common challenge for healthcare organizations. However, there is limited use or description of methods to determine the optimal location of a medical service. We describe a case study of how location-allocation techniques used by industrial engineers assisted a regional healthcare network develop a plan for optimal location of sleep medicine services within its network.

How to move a psychiatric facility.

A special challenge for the transition of Menninger/Kansas to Menninger/Texas was the preparation of suitable facilities for the relocated operations in Houston. The vice president of Facilities & Property Management recounts the tasks that were his responsibility and the process he went through to assure a successful move not only to Houston, but also within Houston planning for two major moves in less than a decade, an unprecedented challenge.

Finding evidence to support facility design decisions.

Nearly $200 billion of healthcare construction is expected by the year 2015, and nurse leaders must expand their knowledge and capabilities in healthcare design. The goal of this bimonthly department is to prepare the nurse leader in using the evidence-based design process to ensure that new, expanded, and renovated hospitals facilitate optimal patient outcomes, enhance the work environment for healthcare providers, and improve organizational performance. In this article, the author provides nurse leaders with examples of where to find data to guide decisions about the efficacy of specific design features in achieving desired outcomes.

Health facilities planning: determining infrastructure requirements for form and function from clinical and operational capabilities.

This article describes the practical application of documenting the operational concept and scope of services for military combat hospitals providing joint health service support during Operation Iraqi Freedom. Due to the rapid changes that take place in healthcare in general, and, in particular, in a large, rapidly maturing military theater of operations, a clear operational concept and accurate scope of services is essential for hospital commanders and medical planners. A highly structured, yet flexible collaborative approach to health facility requirements development begins with a clinical concept of operations (CONOPS). Initial, up-front investment of time in the requirements process, and subsequent reviews and revisions result in a definitive description of the clinical and operational requirements. Those requirements in turn become the authoritative source for space, building systems, equipment, functional arrangements, and financial justification. A recent case study highlights the utility of the CONOPS document in translating the necessary clinical capabilities and capacities into facility space and building systems required to support them in a very tight schedule driven process normally not associated with the military construction program and in particular medical projects.

Controlled chaos: managing your access control system for future success.

How a medical center's protective services department is keeping pace with and planning for future changes in the face of unprecedented rapid growth.