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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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

Pediatría y COVID-19 / Pediatrics and COVID-19

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COVID 19, una nueva etapa de liderazgo perdido / COVID 19, a new stage of lost leadership

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Considerations for development of pharmacy support models for COVID-19 alternate care sites.

PURPOSE: Guidance on alternate care site planning based on the experience of a health-system pharmacy department in preparing for an expected surge in coronavirus disease 2019 (COVID-19) cases is provided. SUMMARY: In disaster response situations such as the COVID-19 pandemic, healthcare institutions may be compelled to transition to a contingency care model in which staffing and supply levels are no longer consistent with daily practice norms and, while usual patient care practices are maintained, establishment of alternate care sites (eg, a convention center) may be necessitated by high patient volumes. Available resources to assist hospitals and health systems in alternate care site planning include online guidance posted within the COVID-19 resources section of the US Army Corps of Engineers website, which provides recommended medication and supply lists; and the Federal Healthcare Resilience Task Force's alternate care site toolkit, a comprehensive resource for all aspects of alternate care site planning, including pharmacy services. Important pharmacy planning issues include security and storage of drugs, state board of pharmacy and Drug Enforcement Administration licensing considerations, and staff credentialing, education, and training. Key medication management issues to be addressed in alternate site care planning include logistical challenges of supply chain maintenance, optimal workflow for compounded sterile preparations (eg, on-site preparation vs off-site preparation and delivery from a nearby hospital), and infusion pump availability and suitability to patient acuity levels. CONCLUSION: Planning for and operation of alternate care sites in disaster response situations should include involvement of pharmacists in key decision-making processes at the earliest planning stages.

Modelo de evaluación del plan de respuesta frente a la pandemia de COVID-19 en un hospital de tercer nivel / Assessment model for evaluating the preparedness plan for COVID-19 in a tertiary care hospital

ANTECEDENTES Y OBJETIVO: Durante la primera onda epidémica del SARS-CoV-2, los hospitales han soportado una importante presión asistencial. Este escenario de incertidumbre, baja evidencia científica y medios insuficientes ha generado una importante variabilidad de la práctica entre diferentes centros sanitarios. En este contexto, planteamos desarrollar un modelo basado en estándares para la evaluación del sistema de preparación y respuesta frente a la COVID-19 en un hospital terciario. MATERIALES Y MÉTODOS: El estudio se llevó a cabo en el Hospital Universitario Vall d'Hebron de Barcelona en dos fases: 1) desarrollo de modelo de estándares mediante revisión narrativa de la literatura, análisis de planes y protocolos del hospital, método Delphi por profesionales expertos y plan de actualización y 2) validación de aplicabilidad y utilidad del modelo mediante autoevaluación y auditoría. RESULTADOS: El modelo consta de 208 estándares distribuidos en nueve criterios: liderazgo y estrategia; prevención y control de la infección; gestión de profesionales y competencias; áreas públicas comunes; áreas asistenciales; áreas de apoyo asistencial; logística, tecnología y obras; comunicación y atención al paciente; sistemas de información e investigación. La evaluación alcanza un 85,2% de cumplimiento, y se identifican 42 áreas de mejora y 96 buenas prácticas. CONCLUSIONES: La implementación de un modelo basado en estándares es útil para identificar áreas de mejora y buenas prácticas en los planes de preparación y respuesta frente a la COVID-19 en un hospital. En el actual contexto, proponemos la conveniencia de adaptar esta metodología a otros ámbitos de atención sanitaria no hospitalaria o de salud pública

BACKGROUND AND PURPOSE: During the first wave of the epidemic caused by SARS-CoV-2, hospitals have come under significant pressure. This scenario of uncertainty, low scientific evidence, and insufficient resources, has generated significant variability in practice between different health organisations. In this context, it is proposed to develop a standards-based model for the evaluation of the preparedness and response system against COVID-19 in a tertiary hospital. MATERIALS AND METHODS: The study, carried out at the University Hospital of Vall d'Hebron in Barcelona (Spain), was designed in two phases: 1) development of the standards-based model, by means of a narrative review of the literature, analysis of plans and protocols implemented in the hospital, a review process by expert professionals from the centre, and plan of action, and 2) validation of usability and usefulness of the model through self-assessment and hospital audit. RESULTS: The model contains 208 standards distributed into nine criteria: leadership and strategy; prevention and infection control; management of professionals and skills; public areas; healthcare areas; areas of support for diagnosis and treatment; logistics, technology and works; communication and patient care; and information and research systems. The evaluation achieved 85.2% compliance, with 42 areas for improvement and 96 good practices identified. CONCLUSIONS: Implementing a standards-based model is a useful tool to identify areas for improvement and good practices in COVID-19 preparedness and response plans in a hospital. In the current context, it is recommended to repeat this methodology in other non-hospital and public health settings

Propuestas de la SECA para la recuperación del Sistema Nacional de Salud tras la pandemia por SARS-CoV-2 / Proposals by the Spanish Society of Quality in Healthcare (SECA) for the recovery of the National Health Service after the COVID-19 pandemic

JUSTIFICACIÓN: La pandemia por SARS-CoV-2 ha exigido respuestas para las que el Sistema Nacional de Salud (SNS) no estaba preparado. La Sociedad Española de Calidad Asistencial (SECA) tiene la misión de impulsar la calidad en el ámbito sanitario y de contribuir a su adecuado funcionamiento. OBJETIVO: Presentar recomendaciones de la SECA para asegurar la calidad y la seguridad de los pacientes en la recuperación del SNS tras el impacto de la pandemia por SARS-CoV-2 y ante la posibilidad de un rebrote. MÉTODO: Estudio cualitativo de búsqueda de consenso con participación de 49 representantes de los diferentes grupos de interés (pacientes, directivos, profesionales, académicos e investigadores). Las áreas a explorar fueron: lecciones aprendidas, gestión de nuevas demandas asistenciales de pacientes COVID-19, recomposición de plantillas, fortalecimiento de la resiliencia de los profesionales, nuevo rol del paciente y planes de contingencia. RESULTADOS: Se aportaron 428 recomendaciones. Una vez eliminadas las duplicidades y unificado similitudes se redujeron a 120. De estas, se priorizaron 60 recomendaciones que fueron agrupadas en 2 bloques: 1) para la recuperación del SNS (equidad, accesibilidad, efectividad, eficiencia, seguridad, experiencia de pacientes y moral laboral) y 2) para afrontar posibles rebrotes. CONCLUSIÓN: La SECA responde a su compromiso con la sociedad con recomendaciones para asegurar la calidad y seguridad de pacientes en la era COVID-19

BACKGROUND: The SARS-CoV-2 pandemic has demanded responses for which the National Health System (NHS) was not prepared. The Spanish Society for Quality in Healthcare (SECA) has the mission of promoting quality in healthcare and contributing to its proper functioning. OBJECTIVE: To present SECA recommendations to ensure the quality and safety of patients in the recovery of the NHS following the impact of the SARS-CoV-2 pandemic and the possibility of a resurgence. METHODS: Qualitative study to seek consensus with the participation of 49 representatives of the different stakeholders (patients, managers, professionals, academics and researchers). The areas to be explored were: lessons learned, management of new care demands from COVID-19 patients, recompositing of templates, strengthening the resilience of professionals, new role of patients and contingency plans. RESULTS: Four hundred and twenty-eight proposals were submitted. Once duplicates were deleted and similar proposals were merged, their number was reduced to 120. Of these, 60 proposals were prioritized and grouped into two categories of measures: (1) to recover the Health System (equity, accessibility, effectiveness, efficiency, safety, patient experience and work morale) and (2) to deal with possible outbreaks. CONCLUSION: SECA responds to its commitment to society with recommendations to ensure quality of healthcare and patient safety in the COVID-19 Era

La pandemia COVID-19 y su repercusión en la unidad de radiología intervencionista: nuestra experiencia / The COVID-19 pandemic and its repercussions in our interventional radiology unit

El objetivo del presente trabajo es mostrar la experiencia en una unidad de radiología intervencionista de un hospital de nuestro país muy afectado por la pandemia COVID-19. Para ello se ha realizado un estudio observacional prospectivo de una serie de casos consecutivos (n=20) de pacientes COVID-19, sometidos a 21 procedimientos intervencionistas, durante el periodo de 2 meses de estudio (13 marzo -11 mayo de 2020). Se exponen las medidas de reorganización del trabajo, medidas de protección; así como la repercusión de la situación en la actividad de la unidad total y por fases. La pandemia COVID-19ha supuesto un reto para el trabajo diario en nuestra unidad, pero siguiendo nuestra propia experiencia y las recomendaciones de SERVEI y SERAM, nos hemos adaptado a la situación de forma exitosa. Se ha observado una disminución de la actividad de tan sólo un 22% sobre el mismo periodo del año 2019

This paper aims to describe our experience in an interventional radiology unit in a hospital in Spain that was severely affected by the COVID-19 pandemic. To this end, we did a prospective observational study of 20 consecutive patients with COVID-19 who underwent 21 interventional radiology procedures between March 13, 2020 and May 11, 2020. We describe the measures taken to reorganize the work and protective measures, as well as the repercussions of the situation on our unit's overall activity and activity in different phases. The COVID-19 pandemic has represented a challenge in our daily work, but learning from our own experience and the recommendations of the Spanish radiological societies (SERVEI and SERAM) has enabled us to adapt successfully. Our activity dropped only 22% compared to the same period in 2019

Psychiatrists as internists: some considerations following a COVID-19 redeployment experience / Psiquiatras como internistas: algunas reflexiones tras una experiencia de reconversión en COVID-19

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Reduction of Neonatal Mortality Requires Strengthening of the Health System: A Situational Analysis of Neonatal Care Services in Ballabgarh.

Background: Planning a comprehensive program addressing neonatal mortality will require a detailed situational analysis of available neonatal-specific health infrastructure. Methods: We identified facilities providing essential and sick neonatal care (ENC, SNC) by a snowballing technique in Ballabgarh Block. These were assessed for infrastructure, human resource and equipment along with self-rated competency of the staff and compared with facility-based or population-based norms. Results: A total of 35 facilities providing ENC and 10 facilities for SNC were identified. ENC services were largely in the public-sector domain (68.5% of births) and were well distributed in the block. SNC burden was largely being borne by the private sector (66% of admissions), which was urban-based. The private sector and nurses reported lower competency especially for SNC. Only 53.9% of government facilities and 17.5% of private facilities had a fully equipped newborn care corner. Conclusions: Serious efforts to reduce neonatal mortality would require major capacity strengthening of the health system, including that of the private sector.

[Potential of cooperative learning in project development : Relevance of cooperative participation procedure for the further development of generation-appropriate accomodation in structurally weak rural areas]. / Potenziale kooperativen Lernens in der Projektentwicklung : Relevanz kooperativer Beteiligungsverfahren für die Weiterentwicklung generationengerechter Wohnformen in strukturschwachen ländlichen Räumen.

BACKGROUND: A joint initiative of existing senior care organizations, the municipality of Meyenburg and the state of Brandenburg was further developed by affiliation of an institute of the Brandenburg University of Technology Cottbus-Senftenberg (ABV) in cooperation with members of the architecture and social work departments in 2014. MATERIAL AND METHODS: A cooperative process between different players was central to create an appropriate structure of services for this region. RESULTS: Cooperative projects are necessary to establish new forms of generation-appropriate living and care concepts in rural areas. CONCLUSION: Cooperative learning methods are needed to develop new forms of generation-appropriate living and care concepts in rural areas, which take the diversity of elderly people, the rural context, intergenerational residential arrangements and affordable accommodation that meets the requirements of the social security system into account. Furthermore, the project had to reflect the recent developments of the German care insurance. The article describes the participatory methods, the coordination process and the resulting concept.

Succession Planning and Management: The Backbone of the Radiology Group's Future.

The transition of leadership within radiology practices is often not a planned replacement process with formal development of potential future leaders. To ensure their ongoing success, however, practices need to develop comprehensive succession plans that include a robust developmental program for potential leaders consisting of mentoring, coaching, structured socialization, 360-degree feedback, developmental stretch assignments, job rotation, and formal education. Succession planning and leadership development will be necessary in the future for a practice to be successful in its business relationships and to be financially viable.

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.

Setting up a Nuchal Translucency Clinic: What Radiologists Need to Know.

The purpose of this article was to discuss the process of setting up a nuchal translucency (NT) screening clinic in clinical practice, how to interpret the information in combination with other clinical tests, what to do if abnormal results are obtained, and to illustrate some of the fetal anomalies that are associated with an increased NT. The NT was initially implemented to predict the likelihood of a fetus with Down syndrome. Maternal age can be combined with fetal NT and maternal serum biochemistry (free ß-hCG and PAPP-A) at 11 to 14 weeks to identify about 90% of affected fetuses. Setting up a clinic to perform the NT screening requires certified physicians and certified sonographers. Certification can be obtained for both physicians and sonographers through Nuchal Translucency Quality Review and Fetal Medicine Foundation. Cell-free DNA testing is now altering what our patients are choosing to evaluate fetuses at risk for chromosomal anomalies and congenital anomalies. Common pitfalls to performing, interpreting, and conveying results of the NT are illustrated in this article. Nasal bone measurement, fetal anatomy examination and fetal echocardiography are tools that add sensitivity to the detection of chromosomal abnormalities. Examples of fetal anomalies discovered during the NT screening are also illustrated. Screening for obstetric complications is an additional benefit to the NT clinic.