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1.
Ann R Coll Surg Engl ; 103(2): 88-95, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33559552

RESUMO

INTRODUCTION: COVID-19 remains a threat for a fear of a second pandemic. Emergency orthopaedic operations are still among the most commonly performed procedures with increased risk of transmission of SARS CoV-2 to the patients and the healthcare workers. The aim of this study was to present the evidence available into best practices limiting the spread of COVID-19 in healthcare setting during current and future pandemics. METHODS: A review of the literature was performed in multiple databases (PubMed, the Cochrane Library, Google Scholar, World Health Organization and Centers for Disease Control), using 'COVID-19' with other relevant keywords in different combinations. Owing to the limited and heterogenous evidence available, data were presented in a narrative manner. FINDINGS: From the evidence gathered it was noted that a multimodal approach to minimising pathogen transmission is required. This primarily comprises the wider engineering and administrative controls to reduce the concentration of the pathogen and to separate staff and patients from it. Theatre isolation and traffic control bundling, theatre flow and logistics, ventilation and waste management form a pivotal role in the environmental/engineering controls. Administrative measures include policies for both patients and staff. For patients, isolation and preoperative screening are of utmost value. For staff, testing for COVID-19, risk assessment, redeployment and provision of persona; protective equipment, together with the necessary training are important administrative controls. CONCLUSION: We believe these measures are likely to improve the sustainability of resources and can be carried to elective settings in order to return to some form of normality and help to mitigate the effects of future pandemics.


Assuntos
/prevenção & controle , Serviço Hospitalar de Limpeza , Controle de Infecções/métodos , Salas Cirúrgicas , Equipamento de Proteção Individual , Ventilação , Gerenciamento de Resíduos , Fluxo de Trabalho , Filtros de Ar , Humanos , Capacitação em Serviço , Admissão e Escalonamento de Pessoal , Medição de Risco , Medicina Estatal , Reino Unido
2.
Ann R Coll Surg Engl ; 103(2): 110-113, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33559551

RESUMO

INTRODUCTION: The weekend effect has been defined as a real or perceived decline in patient care provided on weekends and that provided on weekdays. The primary aim of this study was to investigate the association between day of surgery and length of stay for patients receiving elective lower limb joint arthroplasty in a large NHS teaching hospital. MATERIALS AND METHODS: Data were obtained from a prospectively collected database of consecutive patients undergoing elective primary total knee and hip arthroplasty. Patient and clinical variables were collected alongside length of hospital stay. Data were anonymised and analysed using a multiple linear regression model. RESULTS: A total of 3,544 knee and 3,277 hip replacements were included. No association was found between length of stay and day of surgery for either procedure. A significant association was noted between longer length of stay and increasing age, higher American Society of Anesthesiologists grade and male compared with female gender. DISCUSSION: No evidence of a weekend effect was identified. Certain patient factors predicted longer hospital stay and focussing additional resources on these patient groups may prove a useful strategy in reducing overall length of stay. CONCLUSIONS: Length of stay reduced across the time period included in this review while maintaining equality between the days of the week, which represents the successful management of weekend services.


Assuntos
Artroplastia de Quadril/estatística & dados numéricos , Artroplastia do Joelho/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Admissão e Escalonamento de Pessoal , Estudos Prospectivos , Fatores de Risco , Fatores de Tempo , Adulto Jovem
4.
J Nurs Adm ; 51(2): E1-E5, 2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33449602

RESUMO

AIM: To identify strategies that increase hospital bed capacity, material resources, and available nurse staffing during a national pandemic. BACKGROUND: The COVID-19 outbreak resulted in an influx of acutely ill patients requiring critical care. The volume and acuity of this patient population increased the demand for care and stretched hospitals beyond their capacity. While increasing hospital bed capacity and material resources are crucial, healthcare systems have noted one of the greatest limitations to rapid expansion has been the number of available medical personnel, particularly those trained in emergency and critical care nursing. EVALUATION: Program evaluation occurred on a daily basis with hospital throughput, focusing on logistics including our ability to expand bed volume, resource utilization, and the ability to meet staffing needs. CONCLUSION: This article describes how a quaternary care hospital in New York City prepared for the COVID-19 surge in patients by maximizing and shifting nursing resources to its most impacted services, the emergency department (ED) and the intensive care units (ICUs). A tier-based staffing model and rapid training were operationalized to address nurse-staffing shortages in the ICU and ED, identifying key factors for swift deployment. IMPLICATIONS FOR NURSING MANAGERS: Frequent communication between staff and leaders improves teamwork and builds trust and buy-in during normal operations and particularly in times of crisis.


Assuntos
/enfermagem , Cuidados Críticos/organização & administração , Unidades de Terapia Intensiva/organização & administração , Recursos Humanos de Enfermagem no Hospital/provisão & distribução , Admissão e Escalonamento de Pessoal/organização & administração , Número de Leitos em Hospital , Humanos , Avaliação de Resultados em Cuidados de Saúde
5.
J Drugs Dermatol ; 20(1): 10-16, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-33400419

RESUMO

The coronavirus pandemic (COVID-19) has served as a call-to-arms in preparing practices for the next disaster whether it is another infectious disease or a flood, hurricane, earthquake, a sustained power outage, or something else. A group of predominantly core aesthetic physicians discussed the various aspects of their office procedures that warrant consideration in a proactive approach to the next pandemic/disaster-related event. This guide does not set a standard of practice but contains recommendations that may avoid some of the "lessons learned" with the COVID-19 pandemic. In this paper, the board-certified core aesthetic physicians classified these recommendations into four generalized areas: Practice Management; Supplies and Inventory; Office Staffing Considerations and Protocols; and Patient Management Strategies. Proactive strategies are provided in each of these categories that, if implemented, may alleviate the processes involved with an efficient office closure and reopening process including, in the case of COVID-19, methods to reduce the risk of transmission to doctors, staff, and patients. These strategies also include being prepared for emergency-related notifications of employees and patients; the acquisition of necessary equipment and supplies such as personal protective equipment; and the maintenance and accessibility of essential data and contact information for patients, vendors, financial advisors, and other pertinent entities.J Drugs Dermatol. 2021;20(1):10-16. doi:10.36849/JDD.2021.5803.


Assuntos
/prevenção & controle , Defesa Civil/métodos , Planejamento em Desastres/métodos , Desastres/prevenção & controle , Gerenciamento Clínico , Papel do Médico , /epidemiologia , Defesa Civil/tendências , Planejamento em Desastres/tendências , Humanos , Admissão e Escalonamento de Pessoal/tendências
6.
Trials ; 22(1): 62, 2021 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-33461595

RESUMO

There is a dearth of literature on best practices for managing clinical trials, and little is understood on the role of the clinical trial manager. The COVID-19 pandemic has brought this into focus, and the continuance of clinical trials worldwide has been catapulted into a state of uncertainty as countries enter lockdown to manage the spread of the virus. Participant retention is an ongoing issue in clinical trials, and the concern is that in the current pandemic environment, attrition will be an issue which could potentially jeopardise trial completion. The current situation has necessitated timely problem solving by the trial manager to ensure trials remain open, and most importantly, that participant safety, paramount in clinical trials, is monitored. The purpose of our study is to highlight key issues arising in the management of clinical trials during a pandemic from first-hand experience in a clinical research facility managing both academic and commercial clinical trials. We offer some practical guidance on solution implementation.


Assuntos
Academias e Institutos/organização & administração , Ensaios Clínicos como Assunto/organização & administração , Pessoal Administrativo , Ensaios Clínicos Fase III como Assunto , Controle de Doenças Transmissíveis , Comunicação , Coleta de Dados , Hospitais Universitários , Humanos , Irlanda , Liderança , Pacientes Desistentes do Tratamento , Seleção de Pacientes , Admissão e Escalonamento de Pessoal , Política Pública , Pesquisadores , Sujeitos da Pesquisa
7.
Medicine (Baltimore) ; 100(2): e23670, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33466122

RESUMO

ABSTRACT: Patient safety is a fundamental aspect of a healthcare system. The aim of this study was to assess the perception and determinants of the patient safety culture of pharmacists in hospitals, in Riyadh, Saudi Arabia.A survey was conducted with pharmacists in the pharmacies of governmental, /military and private hospitals in Riyadh, Saudi Arabia. The pharmacy survey on patient safety culture questionnaire developed by Agency for Healthcare Research and Qualtity, a hard copy was distriuted to the pharmacists. The positive response rate (RR) was calculated and compared across hospitals using a chi-square test. The predictors of patient safety grades were identified using the generalized estimating equation. The data was analyzed using SAS.A total of 538 questionnaires were distributed, of which 411 responded (RR 76.4%). Of the participants, 229 (56%) were females. The majority 255 (62%) were in the 18 to 34 years age range, and 361 (88%) had a bachelor's degree. The majority of the sample 376 (92%) was a pharmacist. The Positive RR (PRR) ranged between (25.6%-74%). The highest PRR was observed in teamwork (74.4%), followed by 'staff, training and skills' (68%), and 'organizational learning continuous improvement' (66%). The lowest PRR was observed in 'staffing, work pressure, and pace' (25.5%). Comparing the PPR of the various healthcare sectors, the governmental hospitals scored the highest in all patient safety domains. Generalized Estimating Equation analysis showed that with increase in scores of all patient safety culture domains increased the likelihood of reporting a better patient safety grade, whereas respondents' demographic characteristics had no effect except the working experience years 6 years and above had odds of poor reporting of the patient safety grade (odds ratio = 2.54, 95% confience interval (1.543, 4.194), (P = .0003).The grades achieved in the various domains of patient safety culture by pharmacists in Riyadh are below the expected standard. The highest scores were achieved in teamwork, with the lowest scores in staffing, work pressure and pace. Overall, pharmacists in government hospital settings have a better perception of patient safety than their peers in other settings. These results provide the baseline evidence for developing future interventional studies aiming at improving patient safety culture in hospital pharmacy settings.


Assuntos
Cultura Organizacional , Segurança do Paciente/normas , Farmacêuticos/psicologia , Gestão da Segurança/organização & administração , Adolescente , Adulto , Idoso , Atitude do Pessoal de Saúde , Comunicação , Estudos Transversais , Feminino , Humanos , Capacitação em Serviço/organização & administração , Masculino , Erros de Medicação/prevenção & controle , Pessoa de Meia-Idade , Admissão e Escalonamento de Pessoal/organização & administração , Melhoria de Qualidade/organização & administração , Gestão da Segurança/normas , Arábia Saudita , Carga de Trabalho , Adulto Jovem
8.
BMC Health Serv Res ; 21(1): 87, 2021 Jan 26.
Artigo em Inglês | MEDLINE | ID: mdl-33499845

RESUMO

BACKGROUND: Longer wait time in ambulatory clinics can disrupt schedules and decrease satisfaction. We investigated factors associated with patient wait time (WT, check-in to examination room placement), approximate clinician time (ACT, completion of nurse assessment to check-out), and total appointment length (TAL, check-in to check-out). METHODS: A single-institution retrospective study was conducted of breast surgery clinic patients, 2017-2019, using actual encounter times. A before/after analysis compared a five-day 8 hour/day (from a four-day 10 hour/day) advanced practice provider (APP) work-week. Non-parametric tests were used, and medians with interquartile ranges (IQRs) reported. RESULTS: 15,265 encounters were identified. Overall WT was 15.0 minutes (IQR:6.0-32.0), ACT 49.0 minutes (IQR:31.0-79.0) and TAL 84.0 minutes (IQR:57.0-124.0). Trainees were associated with 30.0 minutes longer ACT (p < 0.0001); this increased time was greatest for follow-up appointments, least for new patients. Patients arriving > 5 minutes late (versus on-time) experienced shorter WT (11.0 vs. 15.0 minutes, p < 0.0001) and ACT (43.0 vs. 53.0 minutes, p < 0.0001). Busier days (higher encounter volume:APP ratios) demonstrated increased encounter times. After transitioning to a five-day APP work-week, ACT decreased. CONCLUSIONS: High-volume clinics and trainee involvement prolong ambulatory encounters. Increasing APP assistance, altering work schedules, and assigning follow-up appointments to non-trainees may decrease encounter time.


Assuntos
Agendamento de Consultas , Instituições de Assistência Ambulatorial , Feminino , Humanos , Satisfação do Paciente , Admissão e Escalonamento de Pessoal , Estudos Retrospectivos , Fatores de Tempo , Listas de Espera
10.
Rev Esp Anestesiol Reanim ; 68(2): 114-116, 2021 02.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33371977
12.
Vet Rec ; 187(12): 498, 2020 12 19.
Artigo em Inglês | MEDLINE | ID: mdl-33334996
13.
PLoS One ; 15(12): e0241077, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33370776

RESUMO

Under the background of excess capacity and energy saving in iron and steel enterprises, the hot rolling batch scheduling problem based on energy saving is a multi-objective and multi constraint optimization problem. In this paper, a hybrid multi-objective prize-collecting vehicle routing problem (Hybrid Price Collect Vehicle Routing Problem, HPCVRP) model is established to ensure minimum energy consumption, meet process rules, and maximize resource utilization. A two-phase Pareto search algorithm (2PPLS) is designed to solve this model. The improved MOEA/D with a penalty based boundary intersection distance (PBI) algorithm (MOEA/D-PBI) is introduced to decompose the HPCVRP in the first phase. In the second phase, the multi-objective ant colony system (MOACS) and Pareto local search (PLS) algorithm is used to generate approximate Pareto-optimal solutions. The final solution is then selected according to the actual demand and preference. In the simulation experiment, the 2PPLS is compared with five other algorithms, which shows the superiority of 2PPLS. Finally, the experiment was carried out on actual slab data from a steel plant in Shanghai. The results show that the model and algorithm can effectively reduce the energy consumption in the process of hot rolling batch scheduling.


Assuntos
Metalurgia/estatística & dados numéricos , Algoritmos , China , Simulação por Computador , Conservação de Recursos Energéticos/estatística & dados numéricos , Ferro , Admissão e Escalonamento de Pessoal/estatística & dados numéricos , Alocação de Recursos/estatística & dados numéricos , Aço
14.
Ann Acad Med Singap ; 49(11): 897-901, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33381783

RESUMO

The COVID-19 pandemic has had a major impact in healthcare systems across the world, with many hospitals having to come up with protocols and measures to contain the spread of the virus. This affects various specialties' clinical practices in many ways. Since early 2020 in Singapore, the Department of Otorhinolaryngology at Tan Tock Seng Hospital had to rapidly adapt to this pandemic as we provided services to the main healthcare facility combating the virus in our country. We had to design new workflows and also remain flexible in view of the ever-changing situation. There are 6 important domains for an otolaryngology department or any clinical department in general to consider when making adjustments to their practices in an outbreak: (1) clinical work, (2) education, (3) research, (4) safety of patients and staff, (5) morale of medical staff and (6) pandemic frontline work. We hope that the sharing of our experiences and the lessons learnt will be useful for both our local and international colleagues.


Assuntos
/epidemiologia , Assistência à Saúde/métodos , Otolaringologia/métodos , Assistência Ambulatorial , Pesquisa Biomédica , Educação Médica , Procedimentos Cirúrgicos Eletivos , Mão de Obra em Saúde , Humanos , Moral , Otolaringologia/educação , Procedimentos Cirúrgicos Otorrinolaringológicos , Equipamento de Proteção Individual , Admissão e Escalonamento de Pessoal , Singapura/epidemiologia , Fluxo de Trabalho
15.
World J Gastroenterol ; 26(38): 5749-5758, 2020 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-33132632

RESUMO

Since the outbreak of the coronavirus disease 2019 (COVID-19), various measures have been taken to protect against the infection. As droplet and contact transmission are the main routes of COVID-19 infection, endoscopy centers are considered to be high-risk areas for exposure to COVID-19. We have undertaken several countermeasures in our endoscopic center during the pandemic, and have gained significant experience in terms of prevention and control of COVID-19. We here present our experience and strategies adopted for preventing hospital infection in our endoscopy center during the COVID-19 pandemic. We describe our management of the environment, endoscope, patients, and medical staff, and our self-made masks.


Assuntos
Desinfecção , Endoscopia Gastrointestinal/métodos , Planejamento Ambiental , Controle de Infecções/organização & administração , Admissão e Escalonamento de Pessoal , Betacoronavirus , China , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Humanos , Controle de Infecções/métodos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão
16.
Rev Esp Salud Publica ; 942020 Nov 12.
Artigo em Espanhol | MEDLINE | ID: mdl-33174539

RESUMO

The COVID-19 respiratory manifestations go from mild symptoms similar to those of a common cold to severe pneumonia with respiratory distress syndrome, septic shock and multiorgan failure. The disease is caused by the SARS-CoV-2 virus, whose transmission mechanism most relevant to dentistry is through respiratory droplets and possibly also aerosols, as well as direct contact with mucous membranes of the nose, mouth or eye via contaminated hands or objects. The professionals of the dental health units have a high risk exposure since they work at short distances (less than 1 m from the head of the patient) in the oral cavity, where a maximal expression of possible cell receptors for the virus has been reported. Also, most procedures in the dental cabinet imply aerosol generation. Cross-infection is possible during dental care, not only with diagnosed COVID-19-positive patients but also with patients who remain undetected due to asymptomatic or presymptomatic disease. For all these reasons, dental care in the primary health setting has had to change in order to adapt to the pandemic. The changes affect both the appointment scheduling and the care itself and imply the establishment of general and specific barrier protections as well as measures related to ventilation, cleaning, disinfection and sterilization, reinforced with additional infection prevention and control measures. This article summarizes the available scientific evidence about this adaptation.


Assuntos
Infecções por Coronavirus/prevenção & controle , Odontólogos , Controle de Infecções/métodos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Aerossóis , Betacoronavirus , Infecção Hospitalar/prevenção & controle , Odontologia/organização & administração , Humanos , Equipamento de Proteção Individual , Admissão e Escalonamento de Pessoal , Espanha/epidemiologia
17.
J Am Med Dir Assoc ; 21(11): 1563-1567, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33138938

RESUMO

During the surge of Coronavirus Disease 2019 (COVID-19) infections in March and April 2020, many skilled-nursing facilities in the Boston area closed to COVID-19 post-acute admissions because of infection control concerns and staffing shortages. Local government and health care leaders collaborated to establish a 1000-bed field hospital for patients with COVID-19, with 500 respite beds for the undomiciled and 500 post-acute care (PAC) beds within 9 days. The PAC hospital provided care for 394 patients over 7 weeks, from April 10 to June 2, 2020. In this report, we describe our implementation strategy, including organization structure, admissions criteria, and clinical services. Partnership with government, military, and local health care organizations was essential for logistical and medical support. In addition, dynamic workflows necessitated clear communication pathways, clinical operations expertise, and highly adaptable staff.


Assuntos
Comportamento Cooperativo , Infecções por Coronavirus/epidemiologia , Unidades Móveis de Saúde/organização & administração , Pandemias , Pneumonia Viral/epidemiologia , Idoso , Betacoronavirus , Boston/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Admissão e Escalonamento de Pessoal/organização & administração , Instituições de Cuidados Especializados de Enfermagem , Cuidados Semi-Intensivos
20.
Nephrol Nurs J ; 47(5): 457-460, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33107718

RESUMO

Making a business case to match staffing-to-patient care needs sometimes requires new approaches. Partnering with departments outside of nursing proved successful in one acute hemodialysis department. Working with Lean Six Sigma teammates to define our workflow processes and utilizing the resulting data led to developing a business case, which gained the department 2.5 additional full-time equivalent registered nurses. A staffing template was created to evaluate ongoing patient volumes against current staffing. This staffing template can be used by any hemodialysis unit to aid in determining ongoing staffing requirements.


Assuntos
Unidades Hospitalares/organização & administração , Recursos Humanos de Enfermagem no Hospital/organização & administração , Admissão e Escalonamento de Pessoal/organização & administração , Diálise Renal/enfermagem , Gestão da Qualidade Total/métodos , Humanos
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