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Acta Med Port ; 33(11): 716-719, 2020 Nov 02.
Artigo em Português | MEDLINE | ID: mdl-33026314


The possibility of a second wave of the COVID-19 pandemic coexisting with a simultaneous epidemic of influenza and the co-circulation of other seasonal respiratory viruses sets the stage for a perfect storm. Preparing for the Autumn-Winter of 2020/2021 is complex, requiring centralized guidance but local and regional solutions, with strong leadership and a high level of coordination. It is essential to act upstream of hospitals in order to reduce demand on emergency departments, minimizing the risk of transmission that occurs there and the team overload, as well as downstream to ensure capacity for hospitalization and in the hospital itself to optimize resources and organization. The failure of this plan will create unbearable pressure on hospital care. The authors describe the challenges lying ahead for hospitals and the most important measures that should be included in this plan to prepare the Autumn-Winter of 2020/2021 in Portugal.

Betacoronavirus , Infecções por Coronavirus/epidemiologia , Epidemias/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Influenza Humana/epidemiologia , Pneumonia Viral/epidemiologia , Estações do Ano , Infecções por Coronavirus/transmissão , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Administração Hospitalar , Número de Leitos em Hospital , Humanos , Influenza Humana/transmissão , Pandemias , Pneumonia Viral/transmissão , Portugal/epidemiologia
J Nurs Adm ; 50(10): 497-498, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32925659


When the coronavirus hit the United States earlier this year, hospitals across the country were forced to quickly convert to crisis mode. Overnight, health systems transformed clinical and administrative operations to care for rising numbers of COVID-19 patients. Now, as the country slowly reopens and we move back to "normal," hospitals again face a major reboot to regroup and recover. Those that meet this challenge successfully will survive. Many others will not. This month's Magnet Perspectives column examines how Magnet hospitals are uniquely positioned to ride the waves and manage the chaos. What are the components that helped them adapt and adjust when COVID-19 struck, and how are those elements facilitating response and recovery? The column also looks at how the Magnet Recognition Program itself responded to challenges posed by the coronavirus and altered some of its long-standing processes to meet customer needs.

Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/enfermagem , Administração Hospitalar , Enfermeiras Administradoras/psicologia , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/enfermagem , Credenciamento/estatística & dados numéricos , Humanos , Liderança , Equipe de Enfermagem/organização & administração , Estados Unidos/epidemiologia
Goiânia; SES-GO; 16 set. 2020. 1-3 p.
Não convencional em Português | LILACS, Coleciona SUS, CONASS, SES-GO | ID: biblio-1129294


Muitas alternativas de gestão de unidades públicas de saúde têm sido discutidas com o objetivo de aumentar a eficiência destas e garantir melhorias no atendimento e serviços prestados à população em geral. Dentre os diversos modelos de gerência atualmente em voga, como opção à administração direta tem-se: Fundações Públicas de direito público e as de direito privado, Autarquia, Consórcio Público, Empresa Estatal, vínculos paraestatais e de colaboração, Organização Social (OS), Organização da Sociedade Civil de Interesse Público (OSCIP) e Fundação de Apoio.

Many alternatives for the management of public health units have been discussed with the objective of increasing their efficiency and ensuring improvements in care and services provided to the general population. Among the various management models currently in vogue, as an option for direct administration are: Public Foundations of public law and those of private law, Municipality, Public Consortium, State Company, parastate and collaborative links, Social Organization (OS), Civil Society Organization of Public Interest (OSCIP) and Support Foundation.

Fundações/classificação , Organizações de Planejamento em Saúde/classificação , Administração Hospitalar/tendências
J Perinat Med ; 48(9): 892-899, 2020 Nov 26.
Artigo em Inglês | MEDLINE | ID: mdl-32892181


The global spread of the SARS-CoV-2 virus during the early months of 2020 was rapid and exposed vulnerabilities in health systems throughout the world. Obstetric SARS-CoV-2 disease was discovered to be largely asymptomatic carriage but included a small rate of severe disease with rapid decompensation in otherwise healthy women. Higher rates of hospitalization, Intensive Care Unit (ICU) admission and intubation, along with higher infection rates in minority and disadvantaged populations have been documented across regions. The operational gymnastics that occurred daily during the Covid-19 emergency needed to be translated to the obstetrics realm, both inpatient and ambulatory. Resources for adaptation to the public health crisis included workforce flexibility, frequent communication of operational and protocol changes for evaluation and management, and application of innovative ideas to meet the demand.

Betacoronavirus , Infecções por Coronavirus/epidemiologia , Hospitais/estatística & dados numéricos , Obstetrícia/métodos , Pandemias , Pneumonia Viral/epidemiologia , Complicações Infecciosas na Gravidez/virologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/terapia , Cuidados Críticos/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Administração Hospitalar , Humanos , Recém-Nascido , Cidade de Nova Iorque/epidemiologia , Obstetrícia/estatística & dados numéricos , Equipamento de Proteção Individual/estatística & dados numéricos , Admissão e Escalonamento de Pessoal , Pneumonia Viral/complicações , Pneumonia Viral/terapia , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/terapia , Capacidade de Resposta ante Emergências/organização & administração , Capacidade de Resposta ante Emergências/estatística & dados numéricos
J Nurs Adm ; 50(10): 533-538, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32925664


There is a growing interest outside the United States in obtaining Magnet accreditation. King Fahad Specialist Hospital-Dammam became the 1st Ministry of Health hospital in the Kingdom of Saudi Arabia to be recognized as a Magnet-accredited institution. Understanding the return on investment of Magnet accreditation is important and speaks to the value of Magnet for international hospitals. Data from a peer hospital will aid nurse executives when presenting the business case for Magnet accreditation.

Acreditação , Administração Hospitalar , Internacionalidade , Humanos , Recursos Humanos de Enfermagem no Hospital , Segurança do Paciente , Arábia Saudita , Estados Unidos
Am J Disaster Med ; 15(2): 99-111, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32804390


OBJECTIVE: Identify operational lessons to support hospital and health system preparedness and response for sea-sonal and pandemic influenza based on firsthand experiences from the 2017-2018 influenza season. DESIGN: We conducted semistructured, retrospective interviews with New York City Health+Hospitals (NYCH+H) personnel to gather firsthand experiences from the 2017-2018 influenza season and evaluated stress data across four operational domains reported by NYCH+H hospitals during the 2017-2018 influenza season. SETTING: Frontline hospitals in the NYCH+H health system during and after the 2017-2018 influenza season. PARTICIPANTS: Interviews conducted with personnel from 5 NYCH+H frontline hospitals. Operational stress data re-ported by 11 NYCH+H hospitals during the 2017-2018 influenza season. MAIN OUTCOME MEASURES: Operational challenges and lessons from frontline hospitals responding to severe sea-sonal influenza. RESULTS: Operational stresses during the 2017-2018 influenza season varied over the influenza season, between facilities, and across operational domains. Patient surge and staff absenteeism pushed some facilities to their limits, and supply shortages highlighted shortcomings in existing procurement systems. Resources tied to pandemic influ-enza were unavailable without a pandemic declaration. CONCLUSION: Seasonal influenza poses dynamic operational stresses across health systems and cities, potentially causing major impacts outside of declared pandemics. Lessons from NYCH+H can help other hospitals and health systems anticipate operational challenges, but novel solutions are needed to mitigate effects of patient surge and per-sonnel and supply shortages during severe influenza seasons and pandemics. Improved data collection can help health systems better understand operational stresses and challenges across their facilities.

Assistência à Saúde/organização & administração , Pessoal de Saúde/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Influenza Humana , Pacientes/estatística & dados numéricos , Absenteísmo , Pessoal de Saúde/psicologia , Planejamento em Saúde/organização & administração , Administração Hospitalar , Humanos , Influenza Humana/diagnóstico , Influenza Humana/epidemiologia , Entrevistas como Assunto , Cidade de Nova Iorque/epidemiologia , Pandemias , Estudos Retrospectivos , Estações do Ano
Am J Disaster Med ; 15(1): 7-22, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32804382


Hospitals, which care for some of the most vulnerable individuals, have been impacted by disasters in the past and are likely to be affected by future disasters. Yet data on hospital evacuations are infrequent and outdated, at best. This goal of this study was to determine the characteristics and frequency of disasters in the United States that have resulted in hospital evacuations by an appraisal of the literature from 2000 to 2017. There were 158 hospital evacuations in the United States over 18 years. The states with the highest number of evacuations were Florida (N = 39), California (N = 30), and. Texas (N = 15). The reason for the evacuation was "natura" in 114 (72.2 percent), made-man "intentional" 14 (8.9 percent), and man-made "unintentional" or technological related to internal hospital infrastructure 30 (19 percent).The most common natural threats were hurricanes (N = 65) (57 percent), wildfires (N = 21) (18.4 percent), floods (N = 10) (8.8 percent), and storms (N = 8) (7 percent). Bombs/bomb threats were the most common reason (N = 8) (57.1 percent) for a hospital evacuation result-ing from a man-made intentional disaster, followed by armed gunman (N = 4) (28.6 percent). The most frequent infrastruc-ture problems included hospital fires/smoke (N = 9) (30 percent), and chemical fumes (N = 7) (23.3 percent). Of those that reported the duration and number of evacuees, 30 percent of evacuations lasted over 24 h and the number of evacuees was >100 in over half (55.2 percent) the evacuations. This information regarding hospital evacuations should allow hospital administrators, disaster planners, and others to better prepare for disasters that result in the need for hospital evacuation.

Planejamento em Desastres/organização & administração , Desastres/estatística & dados numéricos , Hospitais , Transferência de Pacientes/estatística & dados numéricos , Transporte de Pacientes/estatística & dados numéricos , Tempestades Ciclônicas , Fogo , Inundações , Administração Hospitalar , Humanos , Estados Unidos
Healthc Q ; 23(2): 16-17, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32762814


As a chief nurse in Ontario during the severe acute respiratory syndrome (SARS) outbreak in 2003, I never thought I would experience anything even remotely similar, let alone exponentially worse, in my lifetime. Seventeen years and almost 17,000 km later, the COVID-19 crisis feels eerily similar in many ways, and completely different in others.

Infecções por Coronavirus , Surtos de Doenças/prevenção & controle , Pandemias , Pneumonia Viral , Síndrome Respiratória Aguda Grave , Austrália/epidemiologia , Betacoronavirus , Canadá/epidemiologia , Administração Hospitalar , Humanos , Administração em Saúde Pública/métodos , Quarentena/organização & administração
J Perinatol ; 40(Suppl 1): 36-46, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32859963


OBJECTIVES: To determine the relationship between the emergence of COVID-19 and neonatal intensive care unit (NICU) family presence as well as how NICU design affects these changes. STUDY DESIGN: A cross-sectional survey from April 21 to 30, 2020. We queried sites regarding NICU demographics, NICU restrictions on parental presence, and changes in ancillary staff availability. RESULTS: Globally, 277 facilities responded to the survey. NICU policies preserving 24/7 parental presence decreased (83-53%, p < 0.001) and of preserving full parental participation in rounds fell (71-32%, p < 0.001). Single-family room design NICUs best preserved 24/7 parental presence after the emergence of COVID-19 (single-family room 65%, hybrid-design 57%, open bay design 45%, p = 0.018). In all, 120 (43%) NICUs reported reductions in therapy services, lactation medicine, and/or social work support. CONCLUSIONS: Hospital restrictions have significantly limited parental presence for NICU admitted infants, although single-family room design may attenuate this effect.

Betacoronavirus , Infecções por Coronavirus , Administração Hospitalar , Unidades de Terapia Intensiva Neonatal/organização & administração , Pandemias , Pais , Pneumonia Viral , Visitas a Pacientes/estatística & dados numéricos , Estudos Transversais , Arquitetura Hospitalar , Humanos , Recém-Nascido , Política Organizacional , Quartos de Pacientes , Estados Unidos
J Med Syst ; 44(10): 177, 2020 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-32845385


BACKGROUND: The outbreak of Coronavirus disease (COVID-19) pandemic has become the most serious global health issue. Isolation policy in hospitals is one of the most crucial protocols to prevent nosocomial infection of COVID-19. It is important to monitor and assess the physical conditions of the patients in isolation. METHODS: Our institution has installed the novel non-contact wireless sensor for vital sign sensing and body movement monitoring for patients in COVID-19 isolation ward. RESULTS: We have collected and compared data between the radar record with the nurse's handover record of two patients, one recorded for 13 days and the other recorded for 5 days. The P value by Fisher's exact test were 0.139 (temperature, P > 0.05) and 0.292 (heart beat rate, P > 0.05) respectively. CONCLUSIONS: This is the first report about the application experience of this equipment. Therefore we attempted to share the experience and try to apply this equipment in COVID-19 patients in future to offer the more reliable and safe policy.

Infecções por Coronavirus/epidemiologia , Monitorização Fisiológica/instrumentação , Pneumonia Viral/epidemiologia , Radar/instrumentação , Telemetria/instrumentação , Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/prevenção & controle , Administração Hospitalar , Humanos , Movimento , Pandemias/prevenção & controle , Isolamento de Pacientes , Pneumonia Viral/prevenção & controle
Value Health ; 23(8): 994-1002, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32828227


OBJECTIVES: To evaluate the outbreak size and hospital cost effects of bacterial whole-genome sequencing availability in managing a large-scale hospital outbreak. METHODS: We built a hybrid discrete event/agent-based simulation model to replicate a serious bacterial outbreak of resistant Escherichia coli in a large metropolitan public hospital during 2017. We tested the 3 strategies of using whole-genome sequencing early, late (actual outbreak), or not using it and assessed their associated outbreak size and hospital cost. The model included ward dynamics, pathogen transmission, and associated hospital costs during a 5-month outbreak. Model parameters were determined using data from the Queensland Hospital Admitted Patient Data Collection (N = 4809 patient admissions) and local clinical knowledge. Sensitivity analyses were performed to address model and parameter uncertainty. RESULTS: An estimated 197 patients were colonized during the outbreak, with 75 patients detected. The total outbreak cost was A$460 137 (US$317 117), with 6.1% spent on sequencing. Without sequencing, the outbreak was estimated to result in 352 colonized patients, costing A$766 921 (US$528 547). With earlier detection from use of routine sequencing, the estimated outbreak size was 3 patients and cost A$65 374 (US$45 054). CONCLUSIONS: Using whole-genome sequencing in hospital outbreak management was associated with smaller outbreaks and cost savings, with sequencing costs as a small fraction of total hospital costs, supporting the further investigation of the use of routine whole-genome sequencing in hospitals.

Escherichia coli/genética , Administração Hospitalar/economia , Sequenciamento Completo do Genoma/economia , Redução de Custos , Infecção Hospitalar/microbiologia , Infecção Hospitalar/prevenção & controle , Surtos de Doenças , Hospitais com mais de 500 Leitos , Custos Hospitalares , Humanos , Queensland , Centros de Atenção Terciária
Enferm. foco (Brasília) ; 11(1,n.esp): 185-191, ago. 2020.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1116667


Objetivo: relatar a experiência de liderar a implantação de ações técnicas e assistenciais em hospital para atendimento da pandemia do COVID-19. Método: Relato de Experiência da atuação como gestora na implantação das ações no Hospital Israelita Albert Einstein para atendimento à pandemia do novo coronavírus. Resultados: Foi criado um Comitê de Gestão de Crise multiprofissional que estabeleceu ações como a formação de um Núcleo de Inteligência e um de Epidemiologia, bem como para padronização das boas práticas e uso dos recursos. Conclusão: A participação neste momento de pandemia na experiência de protagonizar ações visando o melhor atendimento foi importante, reafirmando o papel da Enfermagem e do Enfermeiro na gestão na área hospitalar. (AU)

Objective: to report the experience of leading the implementation of technical and assistance actions in a hospital to care for the pandemic of COVID-19. Method: Experience report of performance as a manager in the implementation of actions at Hospital Israelita Albert Einstein to attend the pandemic of the new coronavirus. Results: A multiprofessional Crisis Management Committee was created, which established actions such as the formation of an Intelligence Center and an Epidemiology Center, as well as for the standardization of good practices and the use of resources. Conclusion: Participation in this pandemic moment in the experience of leading actions aimed at better care was important, reaffirming the role of Nursing and Nurse in the management in the hospital area. (AU)

Objetivo: informar la experiencia de liderar la implementación de acciones técnicas y de asistencia en un hospital para atender la pandemia de COVID-19. Método: Informe de experiencia del desempeño como gerente en la implementación de acciones en el Hospital Israelita Albert Einstein para asistir a la pandemia del nuevo coronavirus. Resultados: se creó un Comité de Gestión de Crisis multiprofesional, que estableció acciones como la formación de un Centro de Inteligencia y un Centro de Epidemiología, así como para la estandarización de buenas prácticas y el uso de recursos. Conclusión: La participación en este momento pandémico en la experiencia de liderar acciones dirigidas a una mejor atención fue importante, reafirmando el papel de Enfermería y Enfermera en la gestión en el área hospitalaria. (AU)

Coronavirus , Enfermagem , Infecções por Coronavirus , Pandemias , Administração Hospitalar
Neurología (Barc., Ed. impr.) ; 35(6): 372-380, jul.-ago. 2020. tab, mapas
Artigo em Espanhol | IBECS | ID: ibc-189802


INTRODUCCIÓN: La sobrecarga asistencial y los cambios organizativos frente a la pandemia de COVID-19 podrían estar repercutiendo en la atención al ictus agudo en la Comunidad de Madrid. MÉTODOS: Encuesta estructurada en bloques: características del hospital, cambios en infraestructura y recursos, circuitos de código ictus, pruebas diagnósticas, rehabilitación y atención ambulatoria. Análisis descriptivo según el nivel de complejidad en la atención del ictus (disponibilidad o no de unidad de ictus y de trombectomía mecánica). RESULTADOS: De los 26 hospitales del SERMAS que atienden urgencias en adultos, 22 cumplimentaron la encuesta entre el 16 y 27 de abril. El 95% han cedido neurólogos para atender a pacientes afectados por la COVID-19. Se han reducido camas de neurología en el 89,4%, modificado los circuitos en urgencias para ictus en el 81%, con circuitos específicos para sospecha de infección por SARS-CoV2 en el 50%, y en el 42% de los hospitales los pacientes con ictus agudo positivos para SARS-CoV2 no ingresan en camas de neurología. Ha mejorado el acceso al tratamiento, con trombectomía mecánica las 24 h en el propio hospital en 10 hospitales, y se han reducido los traslados interhospitalarios secundarios. Se ha evitado el ingreso de pacientes con ataque isquémico transitorio o ictus leve (45%) y se han incorporado consultas telefónicas para seguimiento en el 100%. CONCLUSIONES: Los cambios organizativos de los hospitales de la Comunidad de Madrid frente a la pandemia por SARS-Co2 han modificado la dedicación de recursos humanos e infraestructuras de las unidades de neurología y los circuitos de atención del ictus, realización de pruebas diagnósticas, ingreso de los pacientes y seguimiento

INTRODUCTION: The overload of the healthcare system and the organisational changes made in response to the COVID-19 pandemic may be having an impact on acute stroke care in the Region of Madrid. METHODS: We conducted a survey with sections addressing hospital characteristics, changes in infrastructure and resources, code stroke clinical pathways, diagnostic testing, rehabilitation, and outpatient care. We performed a descriptive analysis of results according to the level of complexity of stroke care (availability of stroke units and mechanical thrombectomy). RESULTS: The survey was completed by 22 of the 26 hospitals in the Madrid Regional Health System that attend adult emergencies, between 16 and 27 April 2020. Ninety-five percent of hospitals had reallocated neurologists to care for patients with COVID-19. The numbers of neurology ward beds were reduced in 89.4% of hospitals; emergency department stroke care pathways were modified in 81%, with specific pathways for suspected SARS-CoV2 infection established in 50% of hospitals; and SARS-CoV2-positive patients with acute stroke were not admitted to neurology wards in 42%. Twenty-four hour on-site availability of mechanical thrombectomy was improved in 10 hospitals, which resulted in a reduction in the number of secondary hospital transfers. The admission of patients with transient ischaemic attack or minor stroke was avoided in 45% of hospitals, and follow-up through telephone consultations was implemented in 100%. CONCLUSIONS: The organisational changes made in response to the SARS-Co2 pandemic in hospitals in the Region of Madrid have modified the allocation of neurology department staff and infrastructure, stroke units and stroke care pathways, diagnostic testing, hospital admissions, and outpatient follow-up

Humanos , Adulto , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Betacoronavirus , Pandemias , Prioridades em Saúde , Acidente Vascular Cerebral/terapia , Administração Hospitalar , Neurologia/organização & administração , Teleneurologia , Espanha
Assist Inferm Ric ; 39(2): 66-108, 2020.
Artigo em Italiano | MEDLINE | ID: mdl-32686776


. The covid-19 emergency in the words of the nurses . This special issue of AIR is dedicated to the direct professional experiences and personal testimonies of a sample of the nursing personnel during the most dramatic phase of the covid-19 pandemia in the most severely affected regions of Northern Italy (Lombardy, Piedmont, Veneto, Friuli, Trentino, Emilia Romagna Regions). The decision to adopt a research strategy aimed to give visibility and voice to colleagues representing some of the key hospitals of the regions obliged to a radical reorganisation of their structures and organisation of care, was adopted to catch from inside the crisis scenarios the expected mix of intense emotions (from anxiety, to fatigue, to personal and professional uncertainty, to the burden of impotence), and of needed technical creativity and efficiency which were requested to face a totally unexpected situation where guidelines could hardly be of help. The interview/diaries/focus groups were carefully planned not so much in terms of the contents, but with attention to the acceptance of the interviewed to enter in a free dialogue, with no Q&A, to be recorded, and to last for the time felt to be by both sides appropriate. The texts which are reported in this dossier are fragments of the recordings (overall more then 30 hours), without adjustments. It has been agreed that while all the names of the participants are provided as 'authors', the individual contributions are anonymous (not out of privacy consideration!) as they are part of a collective narrative, which reflects the great variability of the languages and of the perceived-expressed experiences and memories. The material has been organised in sections which are conceived as 'verbal snapshots' taken from the networks of care settings, but at the same time of the places and houses where the colleagues were literally full-time living, to assure unaccountable overtime working hours, and the requested 'safety distances' and lockdowns. The titles of the 8 sections coincide somehow with the principal components of the chain of activities and challenges which had to be faced: The changes in everyday's care, How to be prepared to the emergency, The teamwork, The loneliness and the isolation of the patients, The loneliness of the nurses, The difficult choices, The organization of the work and of the wards, change after covid-19. The core of the dossier is framed by boxes which provide also a minimum background of the administrative and epidemiological data on the pandemia in the regions of interest (it is interesting to remind that the central-southern areas of Italy have been far less affected), and a brief concluding reflection on reflection on the post-pandemia from the nursing point of view.

Atitude do Pessoal de Saúde , Atitude Frente a Saúde , Infecções por Coronavirus , Enfermeiras e Enfermeiros/psicologia , Pandemias , Pneumonia Viral , Tomada de Decisão Clínica , Emergências , Administração Hospitalar , Humanos , Itália , Solidão , Enfermagem/métodos , Enfermagem/organização & administração , Equipe de Enfermagem , Isolamento de Pacientes