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2.
Medicina (B Aires) ; 80 Suppl 4: 1-26, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-32897867

RESUMO

Treating an anticoagulated patient with vitamin K antagonists (VKA) remains a challenge, especially in areas where dicoumarins are still the first drug of choice due to the cost of other oral anticoagulants. Anticoagulation clinics have proven to be the most efficient and safe way to avoid thrombotic and hemorrhagic complications and to keep patients in optimal treatment range. However, they require adequate infrastructure and trained personnel to work properly. In this Argentine consensus we propose a series of guidelines for the effective management of the anticoagulation clinics. The goal is to achieve the excellence in both the clinical healthcare and the hemostasis laboratory for the anticoagulated patient. The criteria developed in the document were agreed upon by a large group of expert specialists in hematology and biochemistry from all over the country. The criteria presented here must always be considered when indicating VKA although they had to be adapted to the unequal reality of each center. Taking these premises into consideration will allow us to optimize the management of the anticoagulated patient with VKA and thus minimize thrombotic and hemorrhagic intercurrences, in order to honor our promise not to harm the patient.


Assuntos
Instituições de Assistência Ambulatorial/organização & administração , Anticoagulantes/uso terapêutico , Fibrinolíticos/uso terapêutico , Guias de Prática Clínica como Assunto , Vitamina K/antagonistas & inibidores , Administração Oral , Instituições de Assistência Ambulatorial/normas , Consenso , Humanos , Coeficiente Internacional Normatizado
3.
Plast Reconstr Surg ; 146(4): 913-919, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32970013

RESUMO

BACKGROUND: Even before seeing a physician, patients must first gain access to the hospital system. At large hospitals with high patient volumes, access to specialty care can pose a particular challenge. This study examines the effects of specific initiatives to increase clinic capacity, appointment use, and ease of scheduling on both patient satisfaction and hospital revenue. METHODS: In 2017, a task force at a large, multidisciplinary pediatric hospital instituted a number of initiatives to increase patient access to ambulatory specialty clinics. Clinic sessions were standardized to a 4-hour template, and unscheduled, "held" appointment slots were required to be made available ("flipped") 72 hours before the appointment. A patient-centered electronic scheduling platform was also implemented. Patient satisfaction was assessed using Press Ganey scores. Revenue estimates were calculated for increases in "new" and "return" patient appointments. RESULTS: Total new appointment slots increased by over 44 percent, with over 53,000 appointments added annually. The number of held appointment slots declined by 93 percent. A total of 17,996 annual appointments were added in surgical subspecialties, and an additional 14,756 more surgical appointments were completed. Over 2000 appointments were scheduled by means of the online patient portal. Press Ganey "ease-of-scheduling" scores increased from 57 percent to 72 percent over the intervention period. Hospitalwide, these initiatives generated an estimated $8.3 million in revenue opportunity. CONCLUSION: Standardizing clinic sessions and optimizing clinic availability generates new appointment opportunities, improves patient experience, and increases hospital revenue.


Assuntos
Instituições de Assistência Ambulatorial/economia , Instituições de Assistência Ambulatorial/organização & administração , Agendamento de Consultas , Eficiência Organizacional/economia , Hospitais Pediátricos/economia , Hospitais Pediátricos/organização & administração , Satisfação do Paciente/estatística & dados numéricos , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Criança , Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Estudos Retrospectivos
4.
J Med Internet Res ; 22(10): e22523, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-32936768

RESUMO

As the demand for telepsychiatry increases during the COVID-19 pandemic, the strengths and challenges of telepsychiatry implementation must be articulated to improve clinical practices in the long term. Currently, observations within US contexts are lacking; therefore, we report on the rapid implementation of telepsychiatry and workflow experiences in a psychiatric practice based within a large health care system in southeast Texas with a national catchment area. We discuss the logistics of the implementation, including modes of communication, scheduling, coordination, and capacity; the psychological effects of web-based services, including both the loss of the physical therapeutic environment and the unique interpersonal dynamics experienced in the virtual environment; and postadoption patterns of engagement with our services and with other clinical functions affected by the rapid adaptation to telemedicine. Our art therapy group programming serves as an applied case study, demonstrating the value of a well-managed web-based program (eg, patients were receptive and well-engaged, and they appreciated the continuity of accessible service) as well as the challenges (eg, the need for backup plans and technological fallbacks, managing interruptions and telecommunication learning curves, and working around the difference in resources for art and music therapy between a well-stocked clinical setting versus clients' home spaces). We conclude from our experience that the overall strengths of telepsychiatry include receptive and well-engaged responses from patients as well as the expansion of boundaries, which provides a directly contextualized view into patients' home lives. Challenges and corresponding recommendations include the need for more careful safety planning for high-risk patients; maintaining professional boundaries in the newly informal virtual setting; designing the physical space to both frame the patient encounter and maintain work-life balance for the therapist; allowing for delays and interruptions (including an initial acclimation session); and preserving interprofessional care team collaboration when the physical locations that normally facilitate such encounters are not accessible. We believe that careful observations of the strengths and challenges of telepsychiatry during this pandemic will better inform practices that are considering telepsychiatry adoption both within pandemic contexts and more broadly thereafter.


Assuntos
Instituições de Assistência Ambulatorial/organização & administração , Infecções por Coronavirus/epidemiologia , Pacientes Ambulatoriais , Pneumonia Viral/epidemiologia , Telemedicina/organização & administração , Betacoronavirus , Comunicação , Infecções por Coronavirus/psicologia , Assistência à Saúde/organização & administração , Recursos em Saúde , Humanos , Pandemias , Pneumonia Viral/psicologia , Texas/epidemiologia
5.
Artigo em Inglês | MEDLINE | ID: mdl-32737058

RESUMO

As the COVID-19 pandemic began, the residents from our ambulatory clinics were pulled to cover the increasing numbers of hospitalised patients. To provide care for our 40 000 patients, without resident support, we needed to develop quickly a new culture of communication and innovation. We accomplished this by regular, transparent meetings with senior leadership and key stakeholders who were empowered to make rapid decisions. We then convened regular meetings with clinic leadership and frontline providers to receive feedback and implement new practices. These rapid meeting cycles allowed for a nimble response to a changing landscape. We optimised our video-conferencing and telehealth services, reached out to our most vulnerable patients and engaged other providers and medical students who were not engaged in patient care due to social isolation practices. We discuss the implications of these innovations on our future practice.


Assuntos
Instituições de Assistência Ambulatorial/organização & administração , Infecções por Coronavirus/terapia , Assistência à Saúde , Internato e Residência/organização & administração , Pneumonia Viral/terapia , Betacoronavirus , Comunicação , Assistência à Saúde/métodos , Assistência à Saúde/organização & administração , Hospitais , Humanos , Pandemias , Médicos , Telemedicina , Comunicação por Videoconferência
7.
PLoS One ; 15(8): e0236169, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32745081

RESUMO

In line with the Sustainable Development Goals (SDGs) and the target for achieving Universal Health Coverage (UHC), state level initiatives to promote health with "no-one left behind" are underway in India. In Kerala, reforms under the flagship Aardram mission include upgradation of Primary Health Centres (PHCs) to Family Health Centres (FHCs, similar to the national model of health and wellness centres (HWCs)), with the proactive provision of a package of primary care services for the population in an administrative area. We report on a component of Aardram's monitoring and evaluation framework for primary health care, where tracer input, output, and outcome indicators were selected using a modified Delphi process and field tested. A conceptual framework and indicator inventory were developed drawing upon literature review and stakeholder consultations, followed by mapping of manual registers currently used in PHCs to identify sources of data and processes of monitoring. The indicator inventory was reduced to a list using a modified Delphi method, followed by facility-level field testing across three districts. The modified Delphi comprised 25 participants in two rounds, who brought the list down to 23 approved and 12 recommended indicators. Three types of challenges in monitoring indicators were identified: appropriateness of indicators relative to local use, lack of clarity or procedural differences among those doing the reporting, and validity of data. Further field-testing of indicators, as well as the revision or removal of some may be required to support ongoing health systems reform, learning, monitoring and evaluation.


Assuntos
Reforma dos Serviços de Saúde/organização & administração , Atenção Primária à Saúde/organização & administração , Indicadores de Qualidade em Assistência à Saúde , Desenvolvimento Sustentável , Cobertura Universal do Seguro de Saúde/organização & administração , Instituições de Assistência Ambulatorial/organização & administração , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Academias de Ginástica/organização & administração , Academias de Ginástica/estatística & dados numéricos , Reforma dos Serviços de Saúde/estatística & dados numéricos , Implementação de Plano de Saúde/organização & administração , Implementação de Plano de Saúde/estatística & dados numéricos , Promoção da Saúde/organização & administração , Promoção da Saúde/estatística & dados numéricos , Humanos , Índia , Atenção Primária à Saúde/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde/estatística & dados numéricos , Cobertura Universal do Seguro de Saúde/estatística & dados numéricos
8.
Am J Manag Care ; 26(8): e237-e238, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32835464

RESUMO

This article gives recommendations for individual hemodialysis centers worldwide to ensure the safety and effectiveness of patients receiving maintenance hemodialysis based on the experience of such a patient with coronavirus disease 2019 (COVID-19) in the Sichuan province of China.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Falência Renal Crônica/terapia , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Diálise Renal/estatística & dados numéricos , Centros de Atenção Terciária/organização & administração , Instituições de Assistência Ambulatorial/organização & administração , Betacoronavirus , China , Humanos
9.
Clin Appl Thromb Hemost ; 26: 1076029620947476, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32822220

RESUMO

The coronavirus disease of 2019 (COVID-19) has posed a major challenge for providers and patients. A large number of patients with atrial fibrillation, venous thromboembolism, or valvular heart disease are chronically anticoagulated with vitamin K antagonists and rely on frequent follow ups at anticoagulation clinics for management of their anticoagulation therapy. The need for isolation during COVID-19 pandemic can potentially limit access to health care including anticoagulation clinics and directly affect the care of patients on chronic anticoagulation. Therefore, we created a drive-through clinic to bridge the gap of continuation of care and preservation of social distancing precautions. In this manuscript, we report the steps in implementing such initiative which can be applied to other clinics during a pandemic.


Assuntos
Anticoagulantes/administração & dosagem , Transtornos da Coagulação Sanguínea/tratamento farmacológico , Transtornos da Coagulação Sanguínea/epidemiologia , Infecções por Coronavirus/epidemiologia , Controle de Infecções/organização & administração , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Assistência Ambulatorial/métodos , Instituições de Assistência Ambulatorial/organização & administração , Transtornos da Coagulação Sanguínea/diagnóstico , Comorbidade , Infecções por Coronavirus/prevenção & controle , Feminino , Seguimentos , Humanos , Illinois , Masculino , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Melhoria de Qualidade , Medição de Risco , Gestão da Segurança , Resultado do Tratamento
10.
Ann Afr Med ; 19(3): 153-163, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32820726

RESUMO

It is now known that thrombotic disorders such as venous thromboembolism, ischemic stroke, and myocardial infarction contribute significantly to global morbidity and mortality. Anticoagulation service must respond to this new development. Warfarin has continued to provide the backbone for anticoagulation service for decades but with considerable drawbacks. The introduction of nonVitamin K oral anticoagulants (NOACs) has created new challenges. This article seeks to discuss how the establishment of appropriate models of anticoagulation could contain the draw backs of the old anticoagulants and improve on the compliance, availability, affordability, and accessibility of newer anticoagulants. Successful anticoagulation has always been defined by a scientific balancing of the risk of thrombosis and the complication of hemorrhage. To be able to maintain such optimal anticoagulation requires rational drug prescription (physician factor), institutelization of monitoring of therapy (anticoagulation clinic factor) as well as active participation of patients receiving therapy (patient factor). New models of service can be created out of this triad in a bid to replace the old routine medical care model. New models of anticoagulation service should include appropriately trained professionals such as Physicians, Pharmacists, Clinical Pharmacologists, Nurses, and Laboratory Scientists who are knowledgeable in diagnostic, management, and monitoring of anticoagulation. The different models of anticoagulation service discussed in this article clearly demonstrate the need for restructuring of this life saving service particularly in the era of NOAC. Newer models of care that should provide safe, efficacious, and cost-effective services are needed.


Assuntos
Instituições de Assistência Ambulatorial/organização & administração , Anticoagulantes/uso terapêutico , Prescrições de Medicamentos , Tromboembolia/prevenção & controle , Varfarina/uso terapêutico , Administração Oral , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Anticoagulantes/administração & dosagem , Humanos , Qualidade da Assistência à Saúde , Tromboembolia/tratamento farmacológico , Resultado do Tratamento
11.
Nephrol Nurs J ; 47(3): 239-265, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32639125

RESUMO

Vitamin D deficiency is prevalent among patients with chronic kidney disease (CKD) and even more pronounced in patients with kidney failure who are undergoing peritoneal dialysis and hemodialysis. This project was a nurse practitioner-led quality improvement project conducted in an outpatient hemodialysis unit that focused on determining if educating providers and hemodialysis unit clinical staff on vitamin D guidelines increased the awareness and monitoring of patients on hemodialysis. The number of patients screened for vitamin D levels increased from 29% to 100%, and 70% of patients tested were deficient in vitamin D. While the follow-up monitoring yielded a result of only 32%, we recommend processes and structures for long-term sustainability, such as periodic re-education, reminders and prompts for conducting needed follow-up, continued outcome monitoring, and champions to support the ongoing processes and structures.


Assuntos
Instituições de Assistência Ambulatorial/organização & administração , Medicina Baseada em Evidências/organização & administração , Corpo Clínico/educação , Diálise Renal , Insuficiência Renal Crônica/terapia , Deficiência de Vitamina D/diagnóstico , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Programas de Rastreamento/estatística & dados numéricos , Profissionais de Enfermagem , Guias de Prática Clínica como Assunto , Melhoria de Qualidade/organização & administração , Insuficiência Renal Crônica/epidemiologia , Deficiência de Vitamina D/epidemiologia
13.
Scand J Gastroenterol ; 55(8): 917-919, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32663041

RESUMO

Coronavirus disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), has spread worldwide triggering a pandemic during the year 2020. The proportion of persons infected with SARS-CoV-2 whose infection remained subclinical is not known. However, such information is important to determine whether the control measures currently employed are sufficient to halt the spread of the virus. Current study has examined the seroprevalence of anti-SARS-CoV-2 antibodies in a population of 92 healthcare professionals working with patients with inflammatory bowel disease (IBD). The enzyme-linked immunosorbent assay (ELISA) test system for SARS-CoV-2 IgG from EUROIMMUN Medizinische Labordiagnostika AG (Germany) was used. Very low herd antibody-mediated immunity was proven, less than 2%, although we have been faced with the COVID-19 pandemic for several months. Anti-SARS-CoV-2 IgG antibody testing is currently unable to provide sufficient information about our anti-infectious immunity.


Assuntos
Instituições de Assistência Ambulatorial/organização & administração , Infecções por Coronavirus/prevenção & controle , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Doenças Inflamatórias Intestinais/terapia , Saúde do Trabalhador , Pandemias/estatística & dados numéricos , Pneumonia Viral/prevenção & controle , Anticorpos Antivirais/imunologia , Técnicas de Laboratório Clínico/métodos , Técnicas de Laboratório Clínico/estatística & dados numéricos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Surtos de Doenças/prevenção & controle , Ensaio de Imunoadsorção Enzimática , Feminino , Alemanha , Pessoal de Saúde , Humanos , Imunidade Coletiva , Imunoglobulina G/análise , Imunoglobulina G/imunologia , Doenças Inflamatórias Intestinais/epidemiologia , Doenças Inflamatórias Intestinais/imunologia , Masculino , Determinação de Necessidades de Cuidados de Saúde , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Medição de Risco , Estudos Soroepidemiológicos
14.
Am J Public Health ; 110(S2): S219-S221, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32663083

RESUMO

Universal screenings for social determinants of health (SDOH) are feasible at the health system level and enable institutions to identify unmet social needs that would otherwise go undiscovered. NewYork-Presbyterian Hospital implemented SDOH screenings together with clinical screenings in four outpatient primary care sites. Aligning SDOH screening with clinical screening was crucial for establishing provider buy-in and ensuring sustainability of screening for SDOH. Despite some challenges, universal screening for SDOH has allowed NewYork-Presbyterian Hospital to identify unmet needs to improve population health.


Assuntos
Programas de Rastreamento/organização & administração , Atenção Primária à Saúde/organização & administração , Determinantes Sociais da Saúde/estatística & dados numéricos , Centros Médicos Acadêmicos , Instituições de Assistência Ambulatorial/organização & administração , Registros Eletrônicos de Saúde , Feminino , Letramento em Saúde , Humanos , Masculino , Grupos Minoritários , Cidade de Nova Iorque , Atenção Primária à Saúde/métodos
16.
Bull World Health Organ ; 98(6): 426-430, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-32514217

RESUMO

Problem: In Latvia, the move towards community-based mental health-care services has been slow. Approach: The hospital managers of the only psychiatric hospital in Riga decided to establish two community-based clinics that were financially and administratively integrated with the hospital. The clinics were established using a step-wise approach by redistributing resources, including psychiatrists, nurses and beds, from the hospital to the new clinics. In 2005, the Veldre clinic started outpatient consultations and day care admissions. In 2009, Pardaugava clinic opened as an outpatient clinic. In 2012, an open-door inpatient ward with 30 beds was transferred from the psychiatric hospital to Veldre. In 2013, Pardaugava clinic opened a day care clinic and an open-door inpatient ward, transferring 26 beds from the psychiatric hospital. Local setting: Latvians have worse mental health indicators than those of the average population in Europe. Mental care has traditionally focused on inpatient care. Relevant changes: The clinics are now providing most of the outpatient services and the number of inpatients treated at the hospital has declined from 5696 patients in 2004 to 4957 patients in 2018. Patients are treated in a more open and patient-centred environment. Lessons learnt: The administrative and financial integration of the new community-based clinics within the existing structures of the hospital is a successful approach. Transferring resources to the clinics seems to have improved the quality of care without requiring additional funding apart from the initial investment costs. Involving the staff members during the planning phase reduced resistance to the project.


Assuntos
Serviços Comunitários de Saúde Mental/organização & administração , Hospitais Psiquiátricos/organização & administração , Instituições de Assistência Ambulatorial/organização & administração , Humanos , Letônia , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia
17.
Gastrointest Endosc ; 92(4): 914-924, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32534053

RESUMO

BACKGROUND AND AIMS: As community-based ambulatory endoscopy centers (AECs) across the nation are trying to reopen and safely resume outpatient endoscopic procedures after the unprecedented lockdown related to the coronavirus disease 2019 (COVID-19) pandemic, guidelines recommend pretesting and screening for COVID-19 along with other mitigation measures for the safety of patients and staff. The impact of such changes in the workflow of AECs on throughput and other performance indicators is largely unknown, although a significant reduction in revenue stream is expected. METHODS: A discrete event simulation-based model was developed in the setting of a small to medium community-based single-specialty AEC to quantify the impact of COVID-19-related workflow changes on performance indicators and cost per case compared with the pre-COVID-19 baseline. RESULTS: In the simulation model, post-COVID-19 recommended workflow changes significantly impacted the operational and productivity metrics and, in turn, adversely affected financial metrics. Overall, there was a significant decrease in staff utilization and consequent increase in total facility time, waiting time for patients, and cost per case because of a bottleneck at the time of preprocedure COVID-19 screening and testing while practicing social distancing. Strategies to minimize this adverse impact on productivity were assessed. CONCLUSIONS: Pretesting and screening for COVID-19 as recommended by current guidelines will significantly impact the productivity and revenue stream of AECs. Urgent measures by payors are needed to adjust the facility reimbursement of endoscopy centers to ensure successful reopening and ramping up outpatient endoscopy services in these facilities already hit hard by the pandemic.


Assuntos
Instituições de Assistência Ambulatorial/organização & administração , Assistência Ambulatorial/organização & administração , Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Endoscopia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Fluxo de Trabalho , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Humanos , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão
18.
World J Pediatr ; 16(4): 326-332, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32588213

RESUMO

During the COVID-19 epidemic, it is important for ensuring infection prevention and control in the pediatric respiratory clinics. Herein, we introduced the practice of infection prevention and control in pediatric respiratory clinics in China. Triage measures for patients who visit respiratory clinics, quality control for pediatric respiratory clinics and other preventive measures for related examinations and treatment have been introduced in this review article.


Assuntos
Assistência Ambulatorial/organização & administração , Controle de Doenças Transmissíveis/organização & administração , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Guias de Prática Clínica como Assunto , Doenças Respiratórias/terapia , Adolescente , Instituições de Assistência Ambulatorial/organização & administração , Criança , Pré-Escolar , China/epidemiologia , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Controle de Infecções/organização & administração , Masculino , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Doenças Respiratórias/diagnóstico , Doenças Respiratórias/epidemiologia
19.
Sociol Health Illn ; 42(5): 972-986, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32406081

RESUMO

With significant relevance to the Covid-19 pandemic, this paper contributes to emerging 'aerographic' research on the socio-materialities of air and breath, based on an in-depth empirical study of three hospital-based lung infection clinics treating people with cystic fibrosis. We begin by outlining the changing place of atmosphere in hospital design from the pre-antibiotic period and into the present. We then turn to the first of three aerographic themes where air becomes a matter of grasping and visualising otherwise invisible airborne infections. This includes imagining patients located within bodily spheres or 'cloud bodies', conceptually anchored in Irigaray's thoughts on the 'forgetting of the air' and Sloterdijk's immunitary 'spherology' of the body. Our second theme explores the material politics of air, air conditioning, window design and the way competing 'air regimes' come into conflict with each other at the interface of buildings, bodies and the biotic. Our final theme attends to the 'cost of air', the aero-economic problem of atmospheric scarcity within modern high-rise, deep-density healthcare architectures.


Assuntos
Ar , Instituições de Assistência Ambulatorial/organização & administração , Fibrose Cística/epidemiologia , Respiração , Infecções Respiratórias/epidemiologia , Microbiologia do Ar , Instituições de Assistência Ambulatorial/normas , Antibacterianos/uso terapêutico , Arquitetura de Instituições de Saúde , Comportamentos Relacionados com a Saúde , Humanos , Infecções Respiratórias/tratamento farmacológico
20.
Laryngorhinootologie ; 99(8): 552-560, 2020 08.
Artigo em Alemão | MEDLINE | ID: mdl-32464670

RESUMO

The SARS-CoV-2 pandemic poses major challenges for the entire medical care system. Especially in university institutions as maximum care providers, a higher exposure to potentially infectious patients or actual COVID-19 patients is to be expected. In a short period of time, an operational concept had to be developed regarding the current hygiene recommendations of the Robert Koch Institute (RKI), the leading medical societies and the internal hospital hygiene plan. Here, patient safety and employee protection are equally important.In cooperation with the Institute for Medical Microbiology and Hospital Hygiene and the occupational medical service, interventions were defined to develop solutions to minimize the COVID-19 transmission risk for examiners and patients despite limited diagnostic and equipment resources. For this purpose, an operational concept was developed, consisting of various individual actions, e. g. the reduction of outpatient treatment to emergencies, life-threatening diseases and urgent aftercare, a double triage of patients and the introduction of treatment teams.The newly developed operational concept was successfully implemented within a few days. After the initial rollout and several "hygiene inspections" only minor improvements to the concept were necessary. All measures were documented in the internal quality handbook and are accessible to all employees. Since the SARS-CoV-2 pandemic is a dynamic process with regular changes in the development and information status, the operational concept is regularly reviewed for validity and adjusted as necessary.


Assuntos
Instituições de Assistência Ambulatorial/organização & administração , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Infecções por Coronavirus/transmissão , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Otorrinolaringopatias/terapia , Pneumonia Viral/transmissão
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