Health Facility Planning: A Key Global Health Engagement Capability.

Health facility planning is a key global health engagement capability that assesses the health needs of a population and identifies the combination of services, equipment, facilities, and infrastructure necessary to support them. Collaboration with local health care and building professionals is essential to achieving local buy-in and sustainable solutions.

Regionalization of Critical Care in the United States: Current State and Proposed Framework From the Academic Leaders in Critical Care Medicine Task Force of the Society of Critical Care Medicine.

OBJECTIVES: The Society of Critical Care Medicine convened its Academic Leaders in Critical Care Medicine taskforce on February 22, 2016, during the 45th Critical Care Congress to develop a series of consensus papers with toolkits for advancing critical care organizations in North America. The goal of this article is to propose a framework based on the expert opinions of critical care organization leaders and their responses to a survey, for current and future critical care organizations, and their leadership in the health system to design and implement successful regionalization for critical care in their regions. DATA SOURCES AND STUDY SELECTION: Members of the workgroup convened monthly via teleconference with the following objectives: to 1) develop and analyze a regionalization survey tool for 23 identified critical care organizations in the United States, 2) assemble relevant medical literature accessed using Medline search, 3) use a consensus of expert opinions to propose the framework, and 4) create groups to write the subsections and assemble the final product. DATA EXTRACTION AND SYNTHESIS: The most prevalent challenges for regionalization in critical care organizations remain a lack of a strong central authority to regulate and manage the system as well as a lack of necessary infrastructure, as described more than a decade ago. We provide a framework and outline a nontechnical approach that the health system and their critical care medicine leadership can adopt after considering their own structure, complexity, business operations, culture, and the relationships among their individual hospitals. Transforming the current state of regionalization into a coordinated, accountable system requires a critical assessment of administrative and clinical challenges and barriers. Systems thinking, business planning and control, and essential infrastructure development are critical for assisting critical care organizations. CONCLUSIONS: Under the value-based paradigm, the goals are operational efficiency and patient outcomes. Health systems that can align strategy and operations to assist the referral hospitals with implementing regionalization will be better positioned to regionalize critical care effectively.

Respuesta de un centro de salud ante la pandemia COVID-19: percepciones de la plantilla médica / Response of a Health Centre to the COVID-19 pandemic: perceptions of the medical staff

INTRODUCCIÓN: La pandemia ocasionada por el SARS-CoV-2 ha supuesto una reestructuración sin precedentes de la asistencia sanitaria y también de los centros de salud. OBJETIVO: Conocer las percepciones del personal médico del Centro de Salud Albaycín sobre la respuesta del equipo de Atención Primaria ante la pandemia de la COVID-19 en los meses de marzo y abril de 2020. MÉTODOS: Estudio cualitativo, observacional de orientación fenomenológica mediante entrevistas individuales. El ámbito de estudio es el Centro de Salud Albaycín. La saturación teórica determinó el tamaño de la muestra (la totalidad de la plantilla médica). Se llevó a cabo un análisis narrativo del contenido. RESULTADOS: Los discursos muestran seis categorías de análisis: organización de la toma de decisiones, características de la respuesta dada, mantenimiento de los pilares de la Atención Primaria, cualidades del equipo potenciadas, rol de la docencia y nuevas dinámicas generadas. Los resultados describen una respuesta adecuada, coordinada con la comunidad y anticipada a las directrices institucionales. La toma de decisiones ha sido consensuada y horizontal, potenciándose las cualidades del equipo. A pesar de las limitaciones, se ha mantenido la accesibilidad y la longitudinalidad. Durante la pandemia se ha visto afectada la calidad asistencial y la actividad docente. DISCUSIÓN: Un liderazgo transformacional, que refuerza el vínculo entre profesionales y fomenta la participación activa también de los residentes, permite una respuesta satisfactoria ante una situación emergente. Contar con la participación de la comunidad puede generar confianza en la organización y mejorar los resultados en salud

INTRODUCTION: The SARS-CoV-2 pandemic has brought about an unprecedented restructuring of healthcare and health centers. OBJECTIVES: Learn the perceptions of medical staff from Albayzín Health Centre regarding the Primary Care team's response to the COVID-19 pandemic in March and April 2020. METHODS: Qualitative, observational study with a phenomenological approach conducted by means of individual interviews. The scope of the study is Albaycín Health Centre. The theoretical saturation determined sample size (the entire medical staff). Content was analysed in narrative terms. RESULTS: Conversations revealed six categories of analysis: organization of the decision-making process, characteristics of the response provided, maintaining the cornerstones of Primary Care, enhanced team qualities, role of teaching and new dynamics generated. The results report an adequate response, which was coordinated with the community and anticipated institutional guidelines. Decision-making was consensual and horizontal, which enhanced the team's qualities. Despite the limitations, accessibility and longitudinal configuration have been maintained. Both the quality of care and teaching have been affected during the pandemic. DISCUSSION: Transformational leadership, which strengthens the bond between professionals and encourages residents to participate actively, facilitates a satisfactory response to an emerging situation. Having the community participate can build trust in the organization and improve health outcomes

Soporte a la organización de las Unidades de Cuidados Intensivos durante la pandemia, a través de mapas creados a partir de los Sistemas de Información Clínica / Support to the organization of the Intensive Care Units during the pandemic through maps created from the Clinical Information Systems

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Con o sin pandemia, el paciente siempre en el foco de la educación médica / With or without pandemic, the patient always in the focus of medical education

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Prácticas clínicas seguras durante la pandemia por COVID-19 / Safe clinical practices during the COVID-19 pandemic

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Stroke management during the COVID-19 outbreak: challenges and results of a hub-center in Lombardy, Italy.

PURPOSE: We describe the reorganization carried out during the COVID-19 outbreak at one of the stroke centers in Italy and report on the clinical features and procedural variables of stroke patients in need of endovascular treatment. METHODS: From 1 March to 10 May 2020, we retrospectively analyzed data from stroke patients in need of urgent neurointerventional treatment. Clinical presentation, demographics, and clinical history were collected along with procedural variables (door-to-needle time, needle-to-mTiCi time). Each patient underwent a nasal swab (polymerase chain reaction test), clinical screening, and chest CT scan to assess the risk of SARS-CoV-2 infection. Technical success, procedural safety (including staff SARS-CoV-2 infection), and clinical outcome at discharge were retrieved. A comparison was made with the same patient population treated between 1 March and 10 May 2019 to highlight possible differences in the characteristics or outcomes of the patients. RESULTS: One hundred thirty-six ischemic stroke patients were admitted to our facility from 1 March to 10 May 2020. Of these, 12 patients (9%) were classified as "high risk" for SARS-CoV-2 infection. Radiological suspicion of COVID-19 was confirmed in all cases by pharyngeal swab. Five SARS-CoV-2 patients (42%) needed endovascular therapy. None of the staff members tested positive for IgG against SARS-CoV-2. Compared to the same period in 2019, an increase in the mean interval from the first symptoms to hospital arrival was observed (p < 0.05). CONCLUSION: Endovascular treatment of stroke presented several challenges during the COVID-19 outbreak. Within the hospital, special pathways can be used to maintain both procedural safety and procedural times.

Investigating the challenges and opportunities for medicines management in an NHS field hospital during the COVID-19 pandemic.

INTRODUCTION: Hospital admissions from COVID-19 initially increased rapidly within the UK. National Health Service (NHS) field hospitals are part of a capacity building response built at great scale and speed to respond to the anticipated increased demand the NHS faces during this time. NHS Nightingale Hospital Birmingham (NHB) is modelled to treat mild to moderate (non-critical care) COVID-19 disease, to provide step-down capacity for patients in recovery, or for palliating patients in the dying phase of their disease in the Midlands. Opportunities and challenges presented for optimal medicines management (MM) during the development of the NHB are investigated, and a framework developed to support future NHS field hospitals of this model. METHODS: A team, comprised of an associate medical director, trust chief pharmacist and senior pharmacists iteratively developed a framework to convert the large non-hospital setting into a functioning NHS field hospital with standardised MM processes adjusted appropriately to cope with operational constraints in the pandemic situation. NHB has, because of its repurposing, both challenges and advantages affecting MM that influence development of the framework. Throughout implementation, a 7-week period between announcement and opening, there was continuous evaluation, external stakeholder validation and peer review. RESULTS: The PESTLE model, a mechanism of analysis to identify elements of a project environment (Political, Environmental, Social, Technological, Legal and Economic), was applied to identify influencing factors and support detailed project planning. Compliance with medicines legislation was at the forefront of all MM process development for the NHB field hospital. Internal factors were identified by the core MM team, resulting in a workforce, education & training and clinical pharmacy MM plan. DISCUSSION: MM processes are extensive and integral to NHS field hospitals. The presented framework of influencing factors may support future NHS field hospital development. It is pertinent to have a broad team working approach to any large-scale project such as outlined here, and suggest the identified factors be used as a core framework for development of any future MM processes in NHS field hospitals.

Luchando contra la COVID-19: labor asistencial de los médicos rehabilitadores españoles. Estudio transversal / Fighting against COVID-19: clinical activities of spanish rehabilitation physicians: a cross-sectional study

OBJETIVO: El objetivo de este estudio es analizar el impacto y la organización tanto asistencial como docente en los Servicios de Medicina Física y Rehabilitación de España ante el nuevo y cambiante escenario debido a la pandemia por la COVID-19. MÉTODOS: Se realiza una encuesta dirigida a los tutores de los Servicios de Rehabilitación. Un total de 31 preguntas divididas en 6 apartados: información general de los Servicios, adaptación del Servicio durante el periodo COVID, labor asistencial de los médicos rehabilitadores, abordaje rehabilitador de pacientes COVID, consecuencia de la pandemia sobre la salud de los rehabilitadores y labores de tutoría durante ese periodo. RESULTADOS: Se recibieron un total de 54 encuestas. Casi la mitad de los Servicios cancelaron todas las consultas presenciales (40%) y las salas de terapias se destinaron a camas de pacientes COVID (48%). En 30 hospitales (55,6%) los facultativos han trabajado en plantas COVID. La gran mayoría de los Servicios han elaborado material gráfico y audiovisual con ejercicios, así como protocolos de derivación y tratamiento rehabilitador de pacientes COVID ingresados. Casi la mitad de los Servicios encuestados han tenido algún caso de ansiedad en el personal médico. Las labores de tutoría se han anulado (40,7%) o disminuido (35,2%). CONCLUSIONES: La organización de los Servicios de Rehabilitación para hacer frente a la pandemia ha sido similar en todo el territorio español. La respuesta de los Servicios a la crisis sanitaria ha visualizado la versatilidad de trabajo de los médicos rehabilitadores

OBJECTIVE: The aim of this study was to analyse both the impact of the pandemic and clinical and teaching organisation in Spanish Physical Medicine and Rehabilitation Departments during the COVID-19 pandemic. METHODS: A survey was conducted of the tutors of rehabilitation departments. The questionnaire contained 31 questions divided into 6 parts about the following: general information on the department, adaptation of rehabilitation departments to the COVID pandemic, clinical work of rehabilitation physicians, the approach to rehabilitation in COVID patients, and the effects of the pandemic on the health and teaching activity of rehabilitation physicians during this period. RESULTS: A total of 54 responses were obtained. Almost half of the departments cancelled face-to-face medical consultations (40%) and 48% of the treatment rooms were turned into COVID beds. In 30 hospitals (55.6%), the physicians worked in COVID units. Most of the rehabilitation departments developed both graphic and audiovisual material with exercises, referral protocols and guidelines for the rehabilitation management and treatment of COVID 19 patients. Half of the departments reported some anxiety symptoms in medical staff. Tutorial work has been cancelled (40.7%) or reduced (35.2%). CONCLUSIONS: The organisation of Spanish rehabilitation departments in response to the COVID pandemic has been very similar throughout the country. The response of these departments to the healthcare crisis has revealed the versatility of rehabilitation physicians

COVID-19 y oportunidad de transformación digital / COVID-19 and occasion for digital transformation

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Más que internistas / More than just internists

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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

A Post-Merger Value Realization Framework for a Large Community Hospital.

To capture the value of the Scarborough Health Network amalgamation, a value realization framework (VRF) was developed, based on three themes and nine goals. Each goal was mapped to key strategies and indicators that signalled our delivery of value to the community. Value was achieved when indicators moved in the desired direction. The VRF acknowledged that integration is a journey and identified value in the short, medium and long term. Four quarterly VRF progress reports were completed, illustrating a positive story of the post-merger period. The VRF provided a standardized framework for tracking and monitoring strategies for a successful organizational transition.

Ifema hospital model. Implementation and start-up of the Pharmacy Department.

On the 20th of March 2020, triggered by the public health emergency declared,  the Health Authorities in Madrid reported a legal instruction (Orden 371/2020)  indicating the organization of a provisional hospital to admit patients with  COVID-19 at the Trade Fair Institution (IFEMA). Several pharmacists working in  the Pharmacy and Medical Devices Department of the Madrid Regional Health  Service were called to manage the Pharmacy Department of the  abovementioned hospital. Required permissions to set up a PD were here  authorized urgently. Tackling human and material resources, and computer  systems for drug purchase and electronic prescription, were some of the initial  issues that hindered the pharmaceutical provision required for patients from the  very day one. Once the purchase was assured, mainly by direct purchase from suppliers, drug dispensing up to 1,250 hospitalized patients (25 nursing units) and 8 ICU patients was taken on. Dispensing was carried out  through either drug stocks in the nursing units or individual patient dispensing  for certain drugs. Moreover, safety issues related to prescription were  considered, and as the electronic prescription was implemented we attained  100% prescriptions review and validation. The constitution of a multidisciplinary  Pharmacy and Therapeutics Committee let agree to a pharmacotherapy guide,  pres cription protocols, therapeutic equivalences, interactions, and drug  dispensing circuits. The Pharmacy Department strategy was to ensure a very  quick response to basic tasks keeping the aim to offer a pharmaceutical care of  the highest quality whenever possible. Working under a health emergency  situation, with many uncertainties and continuous pressure was a plight.  However, the spirit of collaboration in and out of the Pharmacy Department was  aligned with the whole hospital motivation to offer the highest quality of  healthcare. These were possibly the keys to allow caring for almost 4,000  patients during the 42 days that the hospital lasted.

El día 20 de marzo de 2020 la Consejería de Sanidad publicó una Orden  (371/2020) para la apertura de un centro hospitalario provisional para atender a  pacientes COVID-19 en la Institución Ferial de Madrid (IFEMA), por razón de  emergencia sanitaria. Se dispuso un equipo de farmacéuticos de la Subdirección  General de Farmacia y Productos Sanitarios para la apertura de un Servicio de  Farmacia, que obtuvo la autorización correspondiente por el órgano competente, con carácter de urgencia. La gestión de recursos humanos,  materiales y de herramientas informáticas para la adquisición y prescripción  electrónica fueron unas de las primeras dificultades que se solaparon con el  primer reto de garantizar la prestación farmacéutica a los pacientes que atendía  el hospital desde el mismo día uno. Asegurada la adquisición, fundamentalmente  mediante la compra directa a proveedores, se planteó la  dispensación para un máximo de 1.250 pacientes de hospitalización (25  controles de enfermería) y una Unidad de Cuidados Intensivos de 8 pacientes;  se establecieron botiquines en las unidades de enfermería y circuitos  individualizados de dispensación para determinados medicamentos. A su vez,  desde el primer momento se trabajó en la seguridad en la prescripción, llegando  a la revisión y validación del 100% de los tratamientos, una vez instaurada la  prescripción electrónica. La creación de una  Comisión de Farmacia y Terapéutica multidisciplinar permitió consensuar la guía farmacoterapéutica, protocolos de  prescripción, equivalencias terapéuticas, interacciones y circuitos de  dispensación de medicamentos. La estrategia del Servicio de Farmacia se basó  en asegurar una respuesta rápida en las funciones básicas, sin perder la visión  de incorporar una atención farmacéutica de la máxima calidad posible a medida  que iba siendo factible. A pesar de un escenario adverso, de incertidumbre y  presión continuas por la emergencia sanitaria, se ha mantenido un espíritu de  colaboración y contribución dentro y fuera del Servicio de Farmacia, alineado con un objetivo común de trabajo en equipo para brindar una atención sanitaria rápida y de la mayor calidad posible. Posiblemente éstas han sido las claves del  éxito que han permitido atender a casi 4.000 pacientes en los 42 días de vida  del hospital.

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