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1.
J Med Libr Assoc ; 109(3): 497-502, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34629981

RESUMO

Background: Prior to 2020, library orientation for first-year medical students at Weill Cornell Medicine took the form of an on-site treasure hunt competition. Due to the COVID-19 pandemic, the orientation for the MD class of 2024 was shifted to an all-virtual format. This shift mandated a full redesign of the library orientation. Case Presentation: The Samuel J. Wood Library sought to preserve the excitement and fun of the treasure hunt in the new virtual format. The competition was redesigned as a Zoom meeting using breakout rooms, with library faculty and staff serving as team facilitators. Tasks were rewritten, shifting the focus from the library's physical spaces to its virtual services and online resources. The redesigned orientation was evaluated using two data sources: a postsession survey of student participants and a debriefing of the library employees who participated. Student evaluations were positive, while the faculty and staff provided numerous suggestions for improving future virtual orientations. Conclusions: A successful virtual library orientation requires careful preparation, including testing the competition tasks, full rehearsal with library facilitators, and a thoughtful approach to technology and logistics. We have chosen to share the materials we developed for other academic health sciences libraries that may wish to take a similar approach to their own virtual orientations.


Assuntos
COVID-19 , Educação de Graduação em Medicina/organização & administração , Bibliotecas Digitais/organização & administração , Bibliotecas Médicas/organização & administração , Estudos de Casos Organizacionais , Adulto , Feminino , Humanos , Masculino , New York , Pandemias , SARS-CoV-2 , Estudantes de Medicina , Adulto Jovem
2.
BMJ Open Qual ; 10(3)2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34244176

RESUMO

The globe is gripped by the COVID-19 pandemic. Mass population vaccination is seen as the solution. As vaccines become available, governments aim to deploy them as rapidly as possible. It is important, therefore, that the efficiency of vaccination processes is optimal.Operations management is concerned with improving processes and comprises systematic approaches such as Lean. Lean focuses explicitly on process efficiency through the elimination of non-value adding steps to optimise processes for those who use and depend on them.Technology-enhanced learning can be a strategy to build improvement capability at scale. A massive online programme to build capability in Lean has been developed by the regulator of England's National Health Service. Beta testing of this programme has been used by some test sites to refine their COVID-19 vaccination processes. The paper presents a case example of massive online learning supporting the use of Lean in the day-to-day operations management of COVID-19 vaccine processes.The case example illustrates the challenges that vaccination processes may present and the need for responsive and effective operations management. Building capability to respond rapidly and systematically in dynamic situations to optimise flow, safety and patient experience may be beneficial.Given the national imperative to achieve mass vaccination as rapidly as possible, systematic improvement methods such as Lean may have a contribution to make. Massive online programmes, such as that described here, may help with this effort by achieving timely knowledge transfer at large scale.


Assuntos
Tecnologia Biomédica , Vacinas contra COVID-19/uso terapêutico , COVID-19/prevenção & controle , Fortalecimento Institucional/métodos , Vacinação em Massa/organização & administração , Inglaterra , Humanos , Estudos de Casos Organizacionais , SARS-CoV-2 , Medicina Estatal
3.
WMJ ; 120(2): 137-141, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34255954

RESUMO

INTRODUCTION: The COVID-19 pandemic presented health care organizations with a unique challenge in determining effective management of a large-scale incident across an extended time period. CASE PRESENTATION: This report describes the response of a multisite integrated system to the COVID-19 pandemic through activation of the Hospital Incident Command System. DISCUSSION: A robust emergency response plan with multidisciplinary involvement can help to ensure clear lines of accountability and expedite decision-making. Consistent physician input across affected specialties allows for a robust understanding of impacted areas, peer-to-peer communication, and a sense of ownership across the medical staff. The necessity of effective communication with staff and patients during times of crisis cannot be understated. The potential for information overload in a pandemic is significant but can be overcome through consistent and transparent communication from leadership. CONCLUSION: Health systems should have a well-organized emergency response system prepared to launch in small-scale or large-scale situations. The threshold to implement the response system and accountability to make that decision must be a clearly defined organizational policy.


Assuntos
COVID-19/epidemiologia , Sistemas de Apoio a Decisões Administrativas , Planejamento em Desastres , Planejamento Hospitalar , Comunicação , Humanos , Estudos de Casos Organizacionais , Política Organizacional , Pandemias , SARS-CoV-2 , Capacidade de Resposta ante Emergências , Wisconsin/epidemiologia
4.
Healthc Q ; 24(2): 33-37, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34297661

RESUMO

Physician engagement is an important factor in improving care quality and patient safety, but engaging physicians is not easy. Winston Churchill's famous assertion about never wasting a crisis has defined the approach taken by many leaders during the COVID-19 pandemic. This paper describes three case studies of successful physician engagement across the continuum of acute care, chronic care and primary care settings during the pandemic. These examples offer insights on physician engagement within unique settings by leveraging intrinsic motivators and Spurgeon's model of medical engagement.


Assuntos
COVID-19/epidemiologia , Atenção à Saúde/organização & administração , Médicos/organização & administração , Participação dos Interessados , COVID-19/terapia , Cuidados Críticos/organização & administração , Humanos , Ontário/epidemiologia , Estudos de Casos Organizacionais , Atenção Primária à Saúde/organização & administração
5.
Phys Ther ; 101(9)2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34174072

RESUMO

OBJECTIVE: The purpose of this case report is to describe the challenges that COVID-19 presented for therapists in a pediatric hospital and the response to these challenges. METHODS: The case report setting is a physical therapy and occupational therapy department (department) of an academic pediatric medical center that provides a range of health care services for children and youth. Challenges that COVID-19 presented to the department included (1) managing safety concerns for patients, their families, and staff; (2) continuing to provide high-quality therapy services within state-mandated restrictions; (3) triaging patients; and (4) keeping clinicians employed and working productively. RESULTS: The department therapists responded to these challenges by (1) increasing communication huddles; (2) developing procedures for staffing and triaging of patients; (3) developing procedures for telehealth therapy services; and (4) designing a remote work program for all department employees. The number of patients and staff on site were reduced by initiating telehealth services, triaging patients, and developing a remote work plan. Communication huddles, department meetings, and supervision meetings were converted to virtual meetings. Staffing rates, patient-care productivity, and department project work were maintained. CONCLUSION: In response to COVID-19, the department developed new protocols and provided information about the protocols, which might be helpful for other pediatric hospitals or outpatient settings when planning for future pandemics or other issues that challenge the ability to provide usual care. Increasing the frequency of verbal and written communication on operational topics is recommended. Primary sources of information from national organizations (eg, the American Physical Therapy Association and the American Occupational Therapy Association) can assist with determining the scope of practice and code of conduct during a pandemic. IMPACT: COVID-19 posed challenges to operations and delivery of patient care. Although this case report is specific to COVID-19, principles applied and lessons learned from this experience can be applied to other emergency situations.


Assuntos
COVID-19/prevenção & controle , Hospitais Pediátricos/organização & administração , Controle de Infecções/organização & administração , Serviço Hospitalar de Terapia Ocupacional/organização & administração , Serviço Hospitalar de Fisioterapia/organização & administração , Reabilitação/organização & administração , COVID-19/epidemiologia , COVID-19/transmissão , Protocolos Clínicos , Humanos , Massachusetts , Estudos de Casos Organizacionais , Seleção de Pacientes , Telemedicina/organização & administração , Triagem
6.
HERD ; 14(3): 34-48, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34075789

RESUMO

OBJECTIVE: This case study examines the implementation of inpatient telemedicine in COVID-19 intensive care units (ICUs) and explores the impact of shifting forms of visibility on the management of the unit, staff collaboration, and patient care. BACKGROUND: The COVID-19 crisis drove healthcare institutions to rapidly develop new models of care based on integrating digital technologies for remote care with transformations in the hospital-built environment. The Sheba Medical Center in Israel created COVID-19 ICUs in an underground structure with an open-ward layout and telemedicine control rooms to remotely supervise, communicate, and support the operations in the contaminated zones. One unit had a physical visual connection between the control room and the contaminated zone through a window, while the other had only a virtual connection with digital technologies. METHODS: The findings are based on semistructured interviews with Sheba medical staff, telemedicine companies, and the architectural design team and observations at the COVID-19 units during March-August 2020. RESULTS: The case study illustrates the implications of virtual and physical visibility on the management of the unit, staff collaboration, and patient care. It demonstrates the correlations between patterns of visibility and the users' sense of control, orientation in space, teamwork, safety, quality of care, and well-being. CONCLUSIONS: The case study demonstrates the limitations of current telemedicine technologies that were not designed for inpatient care to account for the spatial perception of the unit and the dynamic use of the space. It presents the potential of a hybrid model that balances virtual and physical forms of visibility and suggests directions for future research and development of inpatient telemedicine.


Assuntos
COVID-19/terapia , Unidades de Terapia Intensiva/organização & administração , Telemedicina/métodos , COVID-19/prevenção & controle , Arquitetura de Instituições de Saúde/métodos , Arquitetura de Instituições de Saúde/normas , Humanos , Controle de Infecções/métodos , Israel , Estudos de Casos Organizacionais , Isolamento de Pacientes/métodos , SARS-CoV-2 , Telemedicina/organização & administração
7.
Med Ref Serv Q ; 40(2): 188-204, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33970820

RESUMO

The UCLA Science Libraries improved upon our single service points by creating a team-based, tiered research assistance model to foster student employee skill development. This model was further developed to expand training for public services staff, enabling librarians and student research assistants to move beyond desk-based services. This multi-phased approach involved restructured training and the development of collaborative, tiered services. Librarians utilized train-the-trainer sessions, detailed documentation toolkits, and a robust outreach plan to ensure success. After initial implementation of this new model, librarians observed above average use of the service and excellent user feedback. Its versatility has also played a direct role in the successful transition from physical to virtual services in light of the COVID-19 pandemic.


Assuntos
COVID-19/epidemiologia , Bibliotecas Médicas/organização & administração , Biblioteconomia/educação , Modelos Organizacionais , Humanos , Capacitação em Serviço , Los Angeles/epidemiologia , Estudos de Casos Organizacionais , Admissão e Escalonamento de Pessoal , Desenvolvimento de Programas , Melhoria de Qualidade , SARS-CoV-2
8.
Med Ref Serv Q ; 40(2): 151-167, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33970824

RESUMO

Between 2018 and 2019, the librarians at the Strauss Health Sciences Library improved the efficiency and reach of their reference service by implementing four small-scale changes. These changes included revising the method of collecting statistics, creating FAQs, utilizing an appointment scheduler, and launching proactive chat. This case study will provide the background and research to support these changes, details on how the changes were implemented using Springshare tools, as well as the results and implications. Finally, the librarians will share their lessons learned along with recommendations for institutions interested in adopting similar changes.


Assuntos
Disseminação de Informação/métodos , Bibliotecas Médicas/organização & administração , Modelos Organizacionais , Colorado , Humanos , Estudos de Casos Organizacionais
9.
Public Health ; 194: 270-273, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34000651

RESUMO

OBJECTIVES: The aim of the report is to summarise the progress made during a six-month pilot project expanding arts therapies provision from an inpatient service to community services, in a National Health Service health board's Older Adult Mental Health Services, in response to the need for direct therapy with older adults who have severe cognitive impairment and communication difficulties arising from dementia and/or complex mental health difficulties. STUDY DESIGN: This is a case report on a pilot project. METHODS: The level of need for the service was explored, and indicators of effectiveness were gathered using evaluation forms-observer feedback forms and ARM-5 (Agnew Relationship Measure - 5) - to indicate the therapeutic alliance, team review and feedback from colleagues. RESULTS: To gather indications about the level of need, we recorded the following: number of referrals (n = 125) and waiting list numbers at the end of the project (n = 34). CONCLUSIONS: This pilot project indicates that there is need for psychological interventions in older adult community mental health services that arts therapies provision can help address. The number of referrals is one indicator of the level of need, and positive feedback from clients, families and colleagues, is an indicator that the team delivered effectively. The areas of client need addressed in sessions as documented in observer feedback forms indicate that for these clients, arts therapies was a valuable resource in addressing challenges arising from mental health difficulties and/or dementia.


Assuntos
Terapia pela Arte/organização & administração , Disfunção Cognitiva/terapia , Serviços Comunitários de Saúde Mental/organização & administração , Demência/terapia , Medicina Estatal/organização & administração , Idoso , Conselho Diretor , Humanos , Determinação de Necessidades de Cuidados de Saúde , Estudos de Casos Organizacionais , Projetos Piloto , Resultado do Tratamento , País de Gales
10.
J Gerontol Soc Work ; 64(6): 643-655, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33882782

RESUMO

Older adults' relationship to information and communications technology (ICT) is often discussed in terms of the digital divide or technology gap. Older persons, those 65 years of age and older, are seen as excluded or marginally represented in the digital sphere, even though data show their use of technology is increasing. Challenges in technology adoption and models for improving digital inclusion are both well-known, but the COVID pandemic and its general shift to digital life have created a critical need to increase digital inclusion of older persons. A case study of Older Adults Technology Services (OATS) and the organization's migration from in-person to virtual programming is used as an example of reframing the way the relationship of older adults to technology is seen in the field and in practice. Policy and programming implications of this new view of technology are discussed in the conclusion.


Assuntos
COVID-19/epidemiologia , Tecnologia Digital/educação , Relações Interpessoais , Interface Usuário-Computador , Comunicação por Videoconferência , Idoso , Idoso de 80 Anos ou mais , Empoderamento , Feminino , Humanos , Masculino , Estudos de Casos Organizacionais , SARS-CoV-2
11.
Emerg Radiol ; 28(4): 705-711, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33813649

RESUMO

PURPOSE: During the first peak of the COVID-19 pandemic, the activity of Emergency Departments worldwide changed dramatically, focusing on diagnosis and care of the Sars-Cov-2 associated disease. These major changes also involved the activity of the Emergency Radiology Department (ERD). This study aimed to analyse the impact of the COVID-19 pandemic on imaging studies, both in terms of the amount, frequency and subspecialty of different imaging modalities requested to the ERD of the Maggiore della Carità Hospital in Novara (Italy). METHODS: To this end, our observational study took into account the imaging studies requested by the emergency department during three-time spans. These were defined as phase 0 (pre-pandemic), phase 1 (pandemic peak with complete lockdown) and phase 2 (post-pandemic peak with partial lifting of restrictive measures), as derived from Italian urgent decrees by the President of the Council of Ministers (DPCM) which established the duration and entity of the lockdown measures throughout the pandemic. The dataset was processed and then compared with Pearson's chi-squared test. RESULTS: During the pandemic peak, our data showed a significant drop in the total number of studies requested and a significant rise in computed tomography (CT) studies. In particular, a statistically significant increase in chest CT studies was found, probably due to the high sensitivity of this imaging method in identifying pulmonary involvement during respiratory tract infection of possible viral etiology (SARS-Cov-2). Moreover, we observed a statistically significant decrease of X-ray (XR) and ultrasound (US) studies during phase 1 compared to phase 0 and phase 2 probably due to a reduction in the numbers of ER visits for minor traumas given the mobility restrictions and people hesitancy in visiting the ER due to fear of contagion. CONCLUSIONS: We can conclude that the activity of the ERD was heavily impacted by the SARS-Cov-2 pandemic. Further studies will be needed to estimate the impact of the pandemic on public health in terms of excess mortality related to delayed diagnosis and care of non-COVID diseases.


Assuntos
COVID-19/epidemiologia , Diagnóstico por Imagem/estatística & dados numéricos , Serviço Hospitalar de Emergência/organização & administração , Pneumonia Viral/epidemiologia , Necessidades e Demandas de Serviços de Saúde , Planejamento Hospitalar , Humanos , Itália/epidemiologia , Estudos de Casos Organizacionais , Pandemias , Pneumonia Viral/virologia , SARS-CoV-2
12.
Int J Prison Health ; ahead-of-print(ahead-of-print)2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33709638

RESUMO

PURPOSE: New South Wales (NSW) correctional system houses 30% of prisoners in Australia and at this time has only had a single documented case of COVID-19 amongst its prisoner population. The coordinated response by Justice Health and Forensic Mental Health Network (The Network) undertaken with the support of NSW Ministry of Health, in partnership with Corrective Services NSW (CSNSW), Youth Justice and private jails has ensured that the NSW correctional system has remained otherwise COVID-free. DESIGN/METHODOLOGY/APPROACH: A research study of how a range of partners which support the operations of NSW Correctional System developed an effective approach for the prevention a COVID-19 epidemic amongst its inmates. FINDINGS: Establishment of effective partnerships, early coordination of representatives from all aspects of the NSW correctional system, limited access to the correctional environment, reduced prison population and strict isolation of all new receptions have all contributed to maintaining this COVID-free status despite other NSW settings with similar risk profiles, such as aged care facilities and cruise ship arrivals, experiencing serious outbreaks. RESEARCH LIMITATIONS/IMPLICATIONS: Although Australia/New Zealand context of suppressed community infection rates for COVID-19 (which are approaching elimination in some jurisdictions) is in contrast to the situation in other parts of the world, the principles described in this paper will be useful to most other correctional systems. PRACTICAL IMPLICATIONS: Modelling was used to underline our approach and reinforced the veracity of following this approach. ORIGINALITY/VALUE: The Network and CSNSW has been able to mount an effective, integrated response to the COVID-19 pandemic, which has been sustainable through the first peak of COVID-19 cases. This case study catalogues the process of developing this response and details each intervention implemented with inventive use of tables to demonstrate the impact of the range of interventions used.


Assuntos
COVID-19/epidemiologia , COVID-19/prevenção & controle , Controle de Infecções/organização & administração , Prisões/organização & administração , Adulto , Feminino , Humanos , Masculino , New South Wales/epidemiologia , Estudos de Casos Organizacionais , Pandemias , SARS-CoV-2
14.
J Prim Care Community Health ; 12: 21501327211000235, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33729044

RESUMO

BACKGROUND: To characterize the experience of converting a geriatrics clinic to telehealth visits in early stages of a pandemic. DESIGN: An organizational case study with mixed methods evaluation from the first 8 weeks of converting a geriatrics clinic from in-person visits to video and telephone visits. SETTING: Veteran's Health Administration in Northern California Participants Community-dwelling older Veterans receiving care at VA Palo Alto Geriatrics clinic. Veterans had a mean age of 85.7 (SD = 6.8) and 72.1% had cognitive impairment. INTERVENTION: Veterans with face-to-face appointments were converted to video or telephone visits to mitigate exposure to community spread of COVID-19. MEASUREMENTS: Thirty-two patient evaluations and 80 clinician feedback evaluations were completed. This provided information on satisfaction, care access during pandemic, and travel and time savings. RESULTS: Of the 62 scheduled appointments, 43 virtual visits (69.4%) were conducted. Twenty-six (60.5%) visits were conducted via video, 17 (39.5%) by telephone. Virtual visits saved patients an average of 118.6 minutes each. Patients and providers had similar, positive perceptions about telehealth to in-person visit comparison, limiting exposure, and visit satisfaction. After the telehealth appointment, patients indicated greater comfort with using virtual visits in the future. Thirty-one evaluations included comments for qualitative analysis. We identified 3 main themes of technology set-up and usability, satisfaction with visit, and clinical assessment and communication. CONCLUSION: During a pandemic that has limited the ability to safely conduct inperson services, virtual formats offer a feasible and acceptable alternative for clinically-complex older patients. Despite potential barriers and additional effort required for telehealth visits, patients expressed willingness to utilize this format. Patients and providers reported high satisfaction, particularly with the ability to access care similar to in-person while staying safe. Investing in telehealth services during a pandemic ensures that vulnerable older patients can access care while maintaining social distancing, an important safety measure.


Assuntos
Instituições de Assistência Ambulatorial/organização & administração , COVID-19/prevenção & controle , Geriatria/organização & administração , Telemedicina/organização & administração , Serviços de Saúde para Veteranos Militares/organização & administração , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/epidemiologia , California/epidemiologia , Demência/terapia , Acesso aos Serviços de Saúde , Humanos , Pessoa de Meia-Idade , Estudos de Casos Organizacionais , Atenção Primária à Saúde/organização & administração , Pesquisa Qualitativa , Telefone , Comunicação por Videoconferência
15.
Int J Health Plann Manage ; 36(S1): 58-70, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33647168

RESUMO

While policy-makers in many jurisdictions are paying increasing attention to health workforce issues, human resources remain at best only partially aligned with population health needs. This paper explores the governance of human resources during the pandemic, looking at the Quebec health system as a revelatory case. We identify three issues related to health human resource (HHR) policies: working conditions, recognition at work and scope of practice. We empirically probe these issues based on an analysis of popular media, policy reports and participant observation by the lead authors in various forums and research projects. Using an integrated model of HHR, we identify major vulnerabilities in this domain. Persistent labour shortages, endemic deficiencies in working environments and inequity across occupational categories limit the ability to address critical HHR issues. We propose three ways to eliminate HHR vulnerabilities: reorganize work through participatory initiatives, implement joint policy making to rebalance power across the health workforce, and invest in the development of capacities at all system levels.


Assuntos
COVID-19 , Saúde Global , Mão de Obra em Saúde/organização & administração , Humanos , Estudos de Casos Organizacionais , Pandemias , Quebeque , SARS-CoV-2
16.
J Am Med Inform Assoc ; 28(7): 1555-1563, 2021 07 14.
Artigo em Inglês | MEDLINE | ID: mdl-33713131

RESUMO

OBJECTIVE: The study sought to develop an in-depth understanding of how hospitals with a long history of health information technology (HIT) use have responded to the COVID-19 (coronavirus disease 2019) pandemic from an HIT perspective. MATERIALS AND METHODS: We undertook interviews with 44 healthcare professionals with a background in informatics from 6 hospitals internationally. Interviews were informed by a topic guide and were conducted via videoconferencing software. Thematic analysis was employed to develop a coding framework and identify emerging themes. RESULTS: Three themes and 6 subthemes were identified. HITs were employed to manage time and resources during a surge in patient numbers through fast-tracked governance procedures, and the creation of real-time bed capacity tracking within electronic health records. Improving the integration of different hospital systems was identified as important across sites. The use of hard-stop alerts and order sets were perceived as being effective at helping to respond to potential medication shortages and selecting available drug treatments. Utilizing information from multiple data sources to develop alerts facilitated treatment. Finally, the upscaling/optimization of telehealth and remote working capabilities was used to reduce the risk of nosocomial infection within hospitals. DISCUSSION: A number of the HIT-related changes implemented at these sites were perceived to have facilitated more effective patient treatment and management of resources. Informaticians generally felt more valued by hospital management as a result. CONCLUSIONS: Improving integration between data systems, utilizing specialized alerts, and expanding telehealth represent strategies that hospitals should consider when using HIT for delivering hospital care in the context of the COVID-19 pandemic.


Assuntos
COVID-19/terapia , Administração Hospitalar , Sistemas de Informação Hospitalar/organização & administração , Informática Médica , Sistemas Computadorizados de Registros Médicos , Administração dos Cuidados ao Paciente , Atitude do Pessoal de Saúde , Registros Eletrônicos de Saúde , Humanos , Controle de Infecções , Entrevistas como Assunto , Estudos de Casos Organizacionais , Recursos Humanos em Hospital , Telemedicina , Reino Unido , Estados Unidos
17.
J Hosp Palliat Nurs ; 23(2): 120-127, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33633091

RESUMO

Outbreaks of COVID-19 among nursing homes, assisted living facilities, and other long-term care facilities in the United States have had devastating effects on residents. Restrictions such as banning visitors, sequestering residents, and testing health care staff have been implemented to mitigate the spread of the virus. However, consequences include a decline in mental and physical health, decompensation, and a sense of hopelessness among residents. We present and explore a case study at an assisted living facility addressing the ethical issues in balancing the management of the community versus the resident's right to autonomy and self-determination. A team of palliative care experts was brought into assisted living facilities to manage patients, care for well residents, and provide input in advance care planning and symptom management. The principles of self-determination and autonomy, stewardship, and distributive justice were explored. The use of nursing skills in triage and assessment, principles in public health, and the 8 domains of palliative care provided a comprehensive framework for structuring emergency operations. Palliative interventions and the role of palliative care nurses played an integral part in addressing ethical challenges in the containment of the virus and the deleterious effects of social isolation among the elderly.


Assuntos
Moradias Assistidas/ética , COVID-19/enfermagem , Surtos de Doenças , Enfermagem de Cuidados Paliativos na Terminalidade da Vida/ética , Saúde Pública/ética , Idoso , Moradias Assistidas/organização & administração , COVID-19/epidemiologia , Humanos , Assistência de Longa Duração/ética , Estudos de Casos Organizacionais , Estados Unidos/epidemiologia
18.
Perm J ; 25: 1, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33635780

RESUMO

None: Telehealth has been a well-established system of care delivery at Kaiser Permanente Northwest Pediatric Gastroenterology since before the COVID-19 era, where 54% of our completed pediatric gastroenterology encounters in the past year were virtual visits. Although it was previously limited in its use across the majority of health care in the US, telehealth is now a widely accepted system in the face of the COVID-19 pandemic. However, this unprecedented rapid expansion of telehealth within both new and established telehealth systems is not without challenges or quality concerns. In this report, we present our single-center experience from the past year where virtual care was already an integral part of our clinical practice in pediatric gastroenterology and review satisfaction data and quality measures from the COVID-19 era where our existing telehealth system expanded to nearly exclusive virtual care.


Assuntos
Gastroenterologia/organização & administração , Pediatria/organização & administração , Telemedicina/organização & administração , COVID-19 , Criança , Pesquisas sobre Serviços de Saúde , Humanos , Estudos de Casos Organizacionais , Satisfação do Paciente/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Telemedicina/estatística & dados numéricos , Estados Unidos/epidemiologia
19.
JMIR Public Health Surveill ; 7(3): e24795, 2021 03 04.
Artigo em Inglês | MEDLINE | ID: mdl-33630746

RESUMO

BACKGROUND: COVID-19 presented great challenges for not only those in the field of health care but also those undergoing medical training. The burden on health care services worldwide has limited the educational opportunities available for medical students due to social distancing requirements. OBJECTIVE: In this paper, we describe a strategy that combines telehealth and medical training to mitigate the adverse effects of the COVID-19 pandemic. METHODS: A toll-free telescreening service, Telecoronavirus, began operations in March 2020. This service was operated remotely by supervised medical students and was offered across all 417 municipalities (14.8 million inhabitants) in the Brazilian state of Bahia. Students recorded clinical and sociodemographic data by using a web-based application that was simultaneously accessed by medical volunteers for supervision purposes, as well as by state health authorities who conducted epidemiological surveillance and health management efforts. In parallel, students received up-to-date scientific information about COVID-19 via short educational videos prepared by professors. A continuously updated triage algorithm was conceived to provide consistent service. RESULTS: The program operated for approximately 4 months, engaging 1396 medical students and 133 physicians. In total, 111,965 individuals residing in 343 municipalities used this service. Almost 70,000 individuals were advised to stay at home, and they received guidance to avoid disease transmission, potentially contributing to localized reductions in the spread of COVID-19. Additionally, the program promoted citizenship education for medical students, who were engaged in a real-life opportunity to fight the pandemic within their own communities. The objectives of the education, organization, and assistance domains of the Telecoronavirus program were successfully achieved according to the results of a web-based post-project survey that assessed physicians' and students' perceptions. CONCLUSIONS: In a prolonged pandemic scenario, a combination of remote tools and medical supervision via telehealth services may constitute a useful strategy for maintaining social distancing measures while preserving some practical aspects of medical education. A low-cost tool such as the Telecoronavirus program could be especially valuable in resource-limited health care scenarios, in addition to offering support for epidemiological surveillance actions.


Assuntos
COVID-19 , Educação Médica/organização & administração , Estudantes de Medicina/psicologia , Telemedicina/organização & administração , Brasil/epidemiologia , Humanos , Aprendizagem , Estudos de Casos Organizacionais , Participação Social
20.
J Am Board Fam Med ; 34(Suppl): S196-S202, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33622838

RESUMO

INTRODUCTION: Our university hospital-based primary care practices transitioned a budding interest in telehealth to a largely telehealth-based approach in the face of the COVID-19 pandemic. INITIAL WORK: Implementation of telehealth began in 2017. Health system barriers, provider and patient reluctance, and inadequate reimbursement prevented widespread adoption at the time. COVID-19 served as the catalyst to accelerate telehealth efforts. IMPLEMENTATION: COVID-19 resulted in the need for patient care with "social distancing." In addition, due to the pandemic, the Centers for Medicare and Medicaid Services and other insurers began expanded reimbursement for telehealth. More than 2000 providers received virtual health training in less than 2 weeks. In March 2020, we provided 2376 virtual visits, and in April 5293, which was more than 75 times the number provided in February; 73% of all visits in April were virtual (up from 0.5% in October 2019). As COVID-19 cases receded in May, June, and July, patient demand for virtual visits decreased, but 28% of visits in July were still virtual. LESSONS LEARNED: Several key lessons are important for future efforts regarding clinical implementation: (1) prepare for innovation, (2) cultivate an innovation mindset, (3) standardize (but not too much), (4) technological innovation is necessary but not sufficient, and (5) communicate widely and often.


Assuntos
COVID-19/epidemiologia , Atenção Primária à Saúde/organização & administração , Telemedicina/estatística & dados numéricos , Colorado/epidemiologia , Humanos , Estudos de Casos Organizacionais , Pandemias , Distanciamento Físico , Atenção Primária à Saúde/economia , SARS-CoV-2 , Telemedicina/economia , Telemedicina/tendências , Estados Unidos
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