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2.
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
3.
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
4.
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
7.
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
9.
Eur J Cardiothorac Surg ; 58(5): 875-880, 2020 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-32964930

RESUMO

OBJECTIVES: Coronavirus disease 2019 is a new contagious disease that has spread rapidly across the world. It is associated with high mortality in those who develop respiratory complications and require admission to intensive care. Extracorporeal membrane oxygenation (ECMO) is a supportive therapy option for selected severely ill patients who deteriorate despite the best supportive care. During the coronavirus disease 2019 pandemic, extra demand led to staff reorganization; hence, cardiac surgery consultants joined the ECMO retrieval team. This article describes how we increased service provisions to adapt to the changes in activity and staffing. METHODS: The data were collected from 16 March 2020 to 8 May 2020. The patients were referred through a dedicated Web-based referral portal to cope with increasing demand. The retrieval team attended the referring hospital, reviewed the patients and made the final decision to proceed with ECMO. RESULTS: We reported 41 ECMO retrieval runs during this study period. Apart from staffing changes, other retrieval protocols were maintained. The preferred cannulation method for veno-venous ECMO was drainage via the femoral vein and return to the right internal jugular vein. There were no complications reported during cannulation or transport. CONCLUSIONS: Staff reorganization in a crisis is of paramount importance. For those with precise transferrable skills, experience can be gained quickly with appropriate supervision. Therefore, the team members were selected based on skill mix rather than on roles that are more traditional. We have demonstrated that an ECMO retrieval service can be reorganized swiftly and successfully to cope with the sudden increase in demand by spending cardiac surgeons services to supplement the anaesthetic-intensivist roles.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Cuidados Críticos/organização & administração , Oxigenação por Membrana Extracorpórea , Acesso aos Serviços de Saúde/organização & administração , Admissão e Escalonamento de Pessoal/organização & administração , Pneumonia Viral/terapia , Cirurgiões/organização & administração , Adulto , Idoso , Cardiologia/organização & administração , Cuidados Críticos/métodos , Estado Terminal , Oxigenação por Membrana Extracorpórea/métodos , Feminino , Necessidades e Demandas de Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Equipe de Assistência ao Paciente/organização & administração , Reino Unido
13.
PLoS One ; 15(8): e0237338, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32797093

RESUMO

OBJECTIVE: The study was aimed to explore patient safety culture of community pharmacists working in Dessie and Gondar towns, Northern Ethiopia. METHODS: A cross-sectional study was conducted from 1st to 31st March 2018. In this cross-sectional survey, the Pharmacy Survey on Patient Safety Culture (PSOPSC), developed by the Agency for Healthcare Research and Quality (AHRQ), was used to collect data. PSOPSC is a self-administered questionnaire. The questionnaire was distributed among staffs who work in community pharmacies of Dessie and Gondar towns. All staffs available on data collection period in the pharmacy were included. The Statistical Package for Social Science (SPSS) software version 25 was used to enter and analyze the data. RESULTS: A total of 120 participants were approached and completed the questionnaire. Results from the study showed that high positive response rate was demonstrated in the domains of "Teamwork" (90.2%) followed by physical space and environment (83.1%). On the other hand, the result also identified that there is an enormous problem related to mistake communication (44.8%) and work pressure (45%). In addition, significant difference of percent positive responses were obtained across towns and staff working hours. CONCLUSIONS: The patient safety culture of community pharmacists is appreciable especially with respect to their teamwork. Besides, urgent attention should be given to areas of weakness, mainly in the domain of "mistake communication" and "staffing and work pressure".


Assuntos
Serviços Comunitários de Farmácia/organização & administração , Segurança do Paciente , Farmacêuticos/organização & administração , Gestão da Segurança/estatística & dados numéricos , Adulto , Serviços Comunitários de Farmácia/estatística & dados numéricos , Estudos Transversais , Etiópia , Feminino , Humanos , Relações Interprofissionais , Masculino , Pessoa de Meia-Idade , Admissão e Escalonamento de Pessoal/organização & administração , Admissão e Escalonamento de Pessoal/estatística & dados numéricos , Farmacêuticos/psicologia , Farmacêuticos/estatística & dados numéricos , Inquéritos e Questionários/estatística & dados numéricos , Carga de Trabalho/psicologia , Carga de Trabalho/estatística & dados numéricos , Adulto Jovem
14.
Psychosomatics ; 61(6): 662-671, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32800571

RESUMO

BACKGROUND: Patients with psychiatric illnesses are particularly vulnerable to highly contagious, droplet-spread organisms such as SARS-CoV-2. Patients with mental illnesses may not be able to consistently follow up behavioral prescriptions to avoid contagion, and they are frequently found in settings with close contact and inadequate infection control, such as group homes, homeless shelters, residential rehabilitation centers, and correctional facilities. Furthermore, inpatient psychiatry settings are generally designed as communal spaces, with heavy emphasis on group and milieu therapies. As such, inpatient psychiatry services are vulnerable to rampant spread of contagion. OBJECTIVE: With this in mind, the authors outline the decision process and ultimate design and implementation of a regional inpatient psychiatry unit for patients infected with asymptomatic SARS-CoV-2 and share key points for consideration in implementing future units elsewhere. CONCLUSION: A major takeaway point of the analysis is the particular expertise of trained experts in psychosomatic medicine for treating patients infected with SARS-CoV-2.


Assuntos
Infecções Assintomáticas , Infecções por Coronavirus/complicações , Arquitetura Hospitalar/métodos , Unidades Hospitalares , Hospitalização , Controle de Infecções/métodos , Transtornos Mentais/terapia , Admissão e Escalonamento de Pessoal/organização & administração , Pneumonia Viral/complicações , Betacoronavirus , Humanos , Internação Involuntária , Transtornos Mentais/complicações , Pandemias , Equipamento de Proteção Individual , Unidade Hospitalar de Psiquiatria , Psicoterapia de Grupo/métodos , Recreação , Ventilação/métodos , Visitas a Pacientes
15.
Eur Rev Med Pharmacol Sci ; 24(15): 8202-8209, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32767350

RESUMO

OBJECTIVE: The recent outbreak of SARS-CoV-2 infection in Italy has resulted in a sudden and massive flow of patients into emergency rooms, and a high number of hospitalizations with the need for respiratory isolation. Massive admission of patients to the Policlinico "Agostino Gemelli" Foundation of Rome, Italy, determined the need for reengineering the entire hospital. MATERIALS AND METHODS: In this article, we consider some of the structural and organizational changes that have been necessary to deal with the emergency, with particular reference to non-intensive medicine wards, and the preventive measures aimed at limiting the spread of SARS-CoV-2 infection among hospital staff and patients themselves. RESULTS: 577 staff members were subjected to molecular tests in 1-month period and 3.8% of the total were positive. 636 patients admitted to the COVID-19 pathway were included and analyzed: 45.4% were identified as SARS-CoV-2 positive. More SARS-CoV-2 negative patients were discharged in comparison to SARS-CoV-2 positive patients (59% vs. 41%, respectively). On the other hand, more SARS-CoV-2 positive patients were transferred to ICUs in comparison to SARS-CoV-2 negative patients (16% vs. 1%, respectively). Occurrence of death was similar between the two groups, 11% vs. 7%, for SARS-CoV-2 negative and positive patients, respectively. 25% of ≥80 years old SARS-CoV-2 positive patients died during the hospitalization, while death rate was lower in other age groups (5% in 70-79 years old patients and 0% in remaining age groups). CONCLUSIONS: Rapid hospital reengineering has probably had an impact on the management of patients with and without SARS-CoV-2 infection, and on in-hospital mortality rates over the reporting period.


Assuntos
Infecções por Coronavirus/epidemiologia , Unidades Hospitalares/organização & administração , Controle de Infecções/organização & administração , Admissão e Escalonamento de Pessoal/organização & administração , Pneumonia Viral/epidemiologia , Centros de Atenção Terciária/organização & administração , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Infecções por Coronavirus/terapia , Infecções por Coronavirus/transmissão , Feminino , Pessoal de Saúde/educação , Número de Leitos em Hospital , Hospitais Especializados , Humanos , Controle de Infecções/métodos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Unidades de Terapia Intensiva , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Isolamento de Pacientes , Equipamento de Proteção Individual , Pneumonia Viral/terapia , Pneumonia Viral/transmissão
16.
Radiol Med ; 125(9): 894-901, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32654028

RESUMO

Preparedness for the ongoing coronavirus disease 2019 (COVID-19) and its spread in Italy called for setting up of adequately equipped and dedicated health facilities to manage sick patients while protecting healthcare workers, uninfected patients, and the community. In our country, in a short time span, the demand for critical care beds exceeded supply. A new sequestered hospital completely dedicated to intensive care (IC) for isolated COVID-19 patients needed to be designed, constructed, and deployed. Along with this new initiative, the new concept of "Pandemic Radiology Unit" was implemented as a practical solution to the emerging crisis, born out of a critical and urgent acute need. The present article describes logistics, planning, and practical design issues for such a pandemic radiology and critical care unit (e.g., space, infection control, safety of healthcare workers, etc.) adopted in the IC Hospital Unit for the care and management of COVID-19 patients.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/prevenção & controle , Arquitetura Hospitalar , Hospitais de Isolamento/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Serviço Hospitalar de Radiologia/organização & administração , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Humanos , Unidades de Terapia Intensiva/organização & administração , Itália/epidemiologia , Equipamento de Proteção Individual , Admissão e Escalonamento de Pessoal/organização & administração , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Radiografia , Tomografia Computadorizada por Raios X/instrumentação , Ultrassonografia
18.
Int J Surg ; 80: 162-167, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32679206

RESUMO

BACKGROUND: The COVID-19 outbreak was fraught with danger and despair as many medically necessary surgeries were cancelled to preserve precious healthcare resources and mitigate disease transmission. As the rate of infection starts to slow, healthcare facilities and economies attempt to return to normalcy in a graduated manner and the massive pent-up demand for surgeries needs to eventually be addressed in a systematic and equitable manner. MATERIALS AND METHODS: Guidelines from the Alliance of International Organizations of Orthopaedics and Traumatology, Orthopaedic Trauma Association, American College of Surgeons, American Society of Anaesthesiologists, Association of perioperative Registered Nurses, American Hospital Association, Centers for Medicare and Medicaid Services, World Health Organization and Centers for Disease Control and Prevention were evaluated and summarized into a working framework, relevant to orthopaedic surgeons. RESULTS: The guiding principles for restarting elective surgeries in a safe and acceptable manner include up-to-date disease awareness, projection and judicious management of equipment and facilities, effective human resource management, a fair and transparent system to prioritize cases, optimization of peri-operative workflows and continuous data gathering and clinical governance. CONCLUSION: The world was ill prepared for the initial COVID-19 outbreak. However, with effective forward planning, institutions can ramp-up elective surgical caseload in a safe and equitable manner.


Assuntos
Procedimentos Cirúrgicos Eletivos/métodos , Procedimentos Ortopédicos/métodos , Ortopedia/organização & administração , Admissão e Escalonamento de Pessoal/organização & administração , Fluxo de Trabalho , American Hospital Association , Anestesiologia , Betacoronavirus , Centers for Disease Control and Prevention, U.S. , Infecções por Coronavirus/epidemiologia , Humanos , Medicare , Pandemias , Enfermagem Perioperatória , Pneumonia Viral/epidemiologia , Guias de Prática Clínica como Assunto , Sociedades Médicas , Traumatologia , Estados Unidos/epidemiologia , Organização Mundial da Saúde
19.
World Neurosurg ; 142: e434-e439, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32688039

RESUMO

BACKGROUND: The severe acute respiratory syndrome coronavirus 2 pandemic has created challenges to neurosurgical patient care. Despite editorials evaluating neurosurgery responses to 2019 novel coronavirus disease (COVID-19), data reporting effects of COVID-19 on neurosurgical case volume, census, and resident illness are lacking. The aim of this study was to present a real-world analysis of neurosurgical volumes, resident deployment, and unique challenges encountered during the severe acute respiratory syndrome coronavirus 2 outbreak peak in New York City. METHODS: Daily census and case volume data were prospectively collected throughout the severe acute respiratory syndrome coronavirus 2 outbreak in spring 2020. Neurosurgical census was compared against COVID-19 system-wide data. Neurosurgical cases during the crisis were analyzed and compared with 7-week periods from 2019 and early 2020. Resident deployment and illness were reviewed. RESULTS: From March 16, 2020, to May 5, 2020, residents participated in 72 operations and 69 endovascular procedures compared with 448 operations and 253 endovascular procedures from January 2020 to February 2020 and 530 operations and 340 endovascular procedures from March 2019 to May 2019. There was a 59% reduction in neurosurgical census during the outbreak (median 24 patients, 2.75 average total cases daily). COVID-19 neurosurgical admissions peaked in concert with the system-wide pandemic. Three residents demonstrated COVID-19 symptoms (no hospitalizations occurred) for a total 24 workdays lost (median 7 workdays). CONCLUSIONS: These data provide real-world guidance on neurosurgical infrastructure needs during a COVID-19 outbreak. While redeployment to support the COVID-19 response was required, a significant need remained to continue to provide critical neurosurgical service.


Assuntos
Infecções por Coronavirus/epidemiologia , Internato e Residência , Neurocirurgia/educação , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Admissão e Escalonamento de Pessoal/organização & administração , Pneumonia Viral/epidemiologia , Adulto , Idoso , Betacoronavirus , Infecções por Coronavirus/terapia , Procedimentos Endovasculares/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neurocirurgia/organização & administração , Cidade de Nova Iorque/epidemiologia , Pandemias , Pneumonia Viral/terapia
20.
J Thorac Cardiovasc Surg ; 160(4): 937-947.e2, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32624303

RESUMO

BACKGROUND: The onset of the coronavirus disease 2019 (COVID-19) pandemic has forced our cardiac surgery program and hospital to enact drastic measures that has forced us to change how we care for cardiac surgery patients, assist with COVID-19 care, and enable support for the hospital in terms of physical resources, providers, and resident training. METHODS: In this review, we review the cardiovascular manifestations of COVID-19 and describe our system-wide adaptations to the pandemic, including the use of telemedicine, how a severe reduction in operative volume affected our program, the process of redeployment of staff, repurposing of residents into specific task teams, the creation of operation room intensive care units, and the challenges that we faced in this process. RESULTS: We offer a revised set of definitions of surgical priority during this pandemic and how this was applied to our system, followed by specific considerations in coronary/valve, aortic, heart failure and transplant surgery. Finally, we outline a path forward for cardiac surgery for the near future. CONCLUSIONS: We recognize that individual programs around the world will eventually face COVID-19 with varying levels of infection burden and different resources, and we hope this document can assist programs to plan for the future.


Assuntos
Centros Médicos Acadêmicos/organização & administração , Betacoronavirus , Procedimentos Cirúrgicos Cardíacos , Infecções por Coronavirus , Alocação de Recursos para a Atenção à Saúde , Acesso aos Serviços de Saúde/organização & administração , Pandemias , Assistência Perioperatória/métodos , Pneumonia Viral , Adulto , Betacoronavirus/isolamento & purificação , Procedimentos Cirúrgicos Cardíacos/tendências , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/terapia , Doenças Cardiovasculares/virologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Feminino , Alocação de Recursos para a Atenção à Saúde/métodos , Alocação de Recursos para a Atenção à Saúde/organização & administração , Humanos , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Unidades de Terapia Intensiva/organização & administração , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Salas Cirúrgicas/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Admissão e Escalonamento de Pessoal/organização & administração , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Telemedicina/métodos , Telemedicina/organização & administração
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