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1.
Artigo em Inglês | MEDLINE | ID: mdl-33800638

RESUMO

Background: The COVID-19 pandemic has had global effects; cases have been counted in the tens of millions, and there have been over two million deaths throughout the world. Health systems have been stressed in trying to provide a response to the increasing demand for hospital beds during the different waves. This paper analyzes the dynamic response of the hospitals of the Community of Madrid (CoM) during the first wave of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic in the period between 18 March and 31 May 2020. The aim was to model the response of the CoM's health system in terms of the number of available beds. Methods: A research design based on a case study of the CoM was developed. To model this response, we use two concepts: "bed margin" (available beds minus occupied beds, expressed as a percentage) and "flexibility" (which describes the ability to adapt to the growing demand for beds). The Linear Hinges Model allowed a robust estimation of the key performance indicators for capturing the flexibility of the available beds in hospitals. Three new flexibility indicators were defined: the Average Ramp Rate Until the Peak (ARRUP), the Ramp Duration Until the Peak (RDUP), and the Ramp Growth Until the Peak (RGUP). Results: The public and private hospitals of the CoM were able to increase the number of available beds from 18,692 on 18 March 2020 to 23,623 on 2 April 2020. At the peak of the wave, the number of available beds increased by 160 in 48 h, with an occupancy of 90.3%. Within that fifteen-day period, the number of COVID-19 inpatients increased by 200% in non-intensive care unit (non-ICU) wards and by 155% in intensive care unit (ICU) wards. The estimated ARRUP for non-ICU beds in the CoM hospital network during the first pandemic wave was 305.56 beds/day, the RDUP was 15 days, and the RGUP was 4598 beds. For the ICU beds, the ARRUP was 36.73 beds/day, the RDUP was 20 days, and the RGUP was 735 beds. This paper includes a further analysis of the response estimated for each hospital. Conclusions: This research provides insights not only for academia, but also for hospital management and practitioners. The results show that not all of the hospitals dealt with the sudden increase in bed demand in the same way, nor did they provide the same flexibility in order to increase their bed capabilities. The bed margin and the proposed indicators of flexibility summarize the dynamic response and can be included as part of a hospital's management dashboard for monitoring its behavior during pandemic waves or other health crises as a complement to other, more steady-state indicators.


Assuntos
Pandemias , Número de Leitos em Hospital , Humanos , Unidades de Terapia Intensiva
2.
Medicine (Baltimore) ; 100(14): e25311, 2021 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-33832104

RESUMO

ABSTRACT: The 2015 dengue outbreak in southern Taiwan turned into a public health emergency, resulting in a large-scale mobilization of personnel from the emergency department (ED) services operating in and near full capacity to assist with the outbreak. This study aimed to assess a rapid independent clinic-based service (RCS), which was set up and designed to relieve the overcrowding of the regular ambulatory and emergency services during an epidemic of dengue.This is a retrospective cross-sectional study.National Cheng Kung University Hospital, Tainan, Taiwan.Patients with positive test results were enrolled and reviewed to evaluate the efficacy of RCS implementation between August and October 2015. The case-treatment rates stratified by length of stay (LOS) were used to examine the performance of the RCS that was set up outside the ED and designed to relieve the overcrowding of the regular ambulatory and emergency services.Patients with dengue-like illnesses may arrive at the hospital and require optimal ED triage and management thereafter. Although the outbreak resulted in a shortage of spare space in the ED, a proper response from the hospital administration would ameliorate the work overload of the staff and would not decrease the quality of care for critical patients.An early and restrictive intensive intervention was beneficial to health care facilities during a dengue outbreak. Further planning and training of the RCS could be crucial for hospital preparedness for infectious disease outbreaks.


Assuntos
Instituições de Assistência Ambulatorial/organização & administração , Dengue/epidemiologia , Serviço Hospitalar de Emergência/organização & administração , Hemocultura , Estudos Transversais , Dengue/diagnóstico , Dengue/tratamento farmacológico , Diagnóstico por Imagem , Surtos de Doenças , Número de Leitos em Hospital , Hospitais de Ensino , Humanos , Tempo de Internação/estatística & dados numéricos , Reação em Cadeia da Polimerase em Tempo Real , Estudos Retrospectivos , Taiwan/epidemiologia , Centros de Atenção Terciária , Fatores de Tempo , Triagem/organização & administração
3.
BMC Med Inform Decis Mak ; 21(1): 138, 2021 04 27.
Artigo em Inglês | MEDLINE | ID: mdl-33906636

RESUMO

BACKGROUND: This paper describes a model for estimating COVID-19 related excess deaths that are a direct consequence of insufficient hospital ward bed and intensive care unit (ICU) capacity. METHODS: Compartmental models were used to estimate deaths under different combinations of ICU and ward care required and received in England up to late April 2021. Model parameters were sourced from publicly available government information and organisations collating COVID-19 data. A sub-model was used to estimate the mortality scalars that represent increased mortality due to insufficient ICU or general ward bed capacity. Three illustrative scenarios for admissions numbers, 'Optimistic', 'Middling' and 'Pessimistic', were modelled and compared with the subsequent observations to the 3rd February. RESULTS: The key output was the demand and capacity model described. There were no excess deaths from a lack of capacity in the 'Optimistic' scenario. Several of the 'Middling' scenario applications resulted in excess deaths-up to 597 deaths (0.6% increase) with a 20% reduction compared to best estimate ICU capacity. All the 'Pessimistic' scenario applications resulted in excess deaths, ranging from 49,178 (17.0% increase) for a 20% increase in ward bed availability, to 103,735 (35.8% increase) for a 20% shortfall in ward bed availability. These scenarios took no account of the emergence of the new, more transmissible, variant of concern (b.1.1.7). CONCLUSIONS: Mortality is increased when hospital demand exceeds available capacity. No excess deaths from breaching capacity would be expected under the 'Optimistic' scenario. The 'Middling' scenario could result in some excess deaths-up to a 0.7% increase relative to the total number of deaths. The 'Pessimistic' scenario would have resulted in significant excess deaths. Our sensitivity analysis indicated a range between 49,178 (17% increase) and 103,735 (35.8% increase). Given the new variant, the pessimistic scenario appeared increasingly likely and could have resulted in a substantial increase in the number of COVID-19 deaths. In the event, it would appear that capacity was not breached at any stage at a national level with no excess deaths. it will remain unclear if minor local capacity breaches resulted in any small number of excess deaths.


Assuntos
Cuidados Críticos , Inglaterra/epidemiologia , Número de Leitos em Hospital , Hospitais , Humanos , Unidades de Terapia Intensiva
4.
Rev Esp Salud Publica ; 952021 Mar 03.
Artigo em Espanhol | MEDLINE | ID: mdl-33654051

RESUMO

OBJECTIVE: In Spain, the number of persons that are in a surgery waiting list as well as the available surgery resources, differ across autonomous communities. The pandemic generated by COVID-19 has increased these waiting lists. In this study two objectives were pursued: on the one hand, to determine which are the resources that are determining the number of persons that are in a surgery waiting list per 1,000 inhabitants; on the other hand, to estimate the impact that the current pandemic has on the latter. METHODS: To estimate which are the resources that are having a greater impact on the waiting lists and to forecast the effect that the COVID-19 has on them, we use dynamic panel data models. The data on the surgery resources and on the waiting lists by autonomous communities is obtained from the Surveys on Health, Hospital Statistics and reports on waiting lists of the Ministry of Health, Consumption and Social Well Being and the Counsels. The sample period is 2012-2017 (last published year for surgery resources). In addition, a literature review is conducted and it shows the important and complexity of waiting list like a gestion tool of health system (Science, SciELO and Dialnet web data bases). RESULTS: COVID-19 will increase the waiting lists by approximately 7.6% to 19.14%, depending on the autonomous community. Not all the available surgery resources have the same relevance nor an equal effect on the reduction of the waiting lists. The most significant resources are the beds and operating rooms per 1,000 inhabitants. The hospital expenditure is not so relevant. CONCLUSIONS: The panel data models estimate the relation between the surgery resources and the waiting list. The latter is deemed complex and different across autonomous communities. In addition, these models allow to predict the expected increase in the waiting lists and are, thus, a useful instrument for their management.


Assuntos
/epidemiologia , Cirurgia Geral/estatística & dados numéricos , Listas de Espera , Coleta de Dados , Número de Leitos em Hospital , Humanos , Internet , Salas Cirúrgicas , Espanha
5.
Am J Public Health ; 111(5): 923-926, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33734835

RESUMO

Objectives. To estimate the critical care bed capacity that would be required to admit all critical COVID-19 cases in a setting of unchecked SARS-CoV-2 transmission, both with and without elderly-specific protection measures.Methods. Using electronic health records of all 2432 COVID-19 patients hospitalized in a large hospital in Madrid, Spain, between February 28 and April 23, 2020, we estimated the number of critical care beds needed to admit all critical care patients. To mimic a hypothetical intervention that halves SARS-CoV-2 infections among the elderly, we randomly excluded 50% of patients aged 65 years and older.Results. Critical care requirements peaked at 49 beds per 100 000 on April 1-2 weeks after the start of a national lockdown. After randomly excluding 50% of elderly patients, the estimated peak was 39 beds per 100 000.Conclusions. Under unchecked SARS-CoV-2 transmission, peak critical care requirements in Madrid were at least fivefold higher than prepandemic capacity. Under a hypothetical intervention that halves infections among the elderly, critical care peak requirements would have exceeded the prepandemic capacity of most high-income countries.Public Health Implications. Pandemic control strategies that rely exclusively on protecting the elderly are likely to overwhelm health care systems.


Assuntos
Controle de Doenças Transmissíveis , Cuidados Críticos , Número de Leitos em Hospital/estatística & dados numéricos , Hospitalização , Adulto , Idoso , /transmissão , Registros Eletrônicos de Saúde , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Espanha/epidemiologia , Adulto Jovem
6.
J Hosp Med ; 16(4): 215-218, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33734977

RESUMO

Some hospitals have faced a surge of patients with COVID-19, while others have not. We assessed whether COVID-19 burden (number of patients with COVID-19 admitted during April 2020 divided by hospital certified bed count) was associated with mortality in a large sample of US hospitals. Our study population included 14,226 patients with COVID-19 (median age 66 years, 45.2% women) at 117 hospitals, of whom 20.9% had died at 5 weeks of follow-up. At the hospital level, the observed mortality ranged from 0% to 44.4%. After adjustment for age, sex, and comorbidities, the adjusted odds ratio for in-hospital death in the highest quintile of burden was 1.46 (95% CI, 1.07-2.00) compared to all other quintiles. Still, there was large variability in outcomes, even among hospitals with a similar level of COVID-19 burden and after adjusting for age, sex, and comorbidities.


Assuntos
/mortalidade , Número de Leitos em Hospital/estatística & dados numéricos , Mortalidade Hospitalar/tendências , Idoso , Comorbidade/tendências , Feminino , Hospitalização , Humanos , Masculino , Estados Unidos
7.
World Neurosurg ; 148: 251-255, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33770847

RESUMO

The COVID-19 pandemic has impacted neurosurgery in unforeseeable ways. Neurosurgical patient care, research, and education have undergone extraordinary modifications as medicine and mankind have adapted to overcome the challenges posed by this pandemic. Some changes will disappear as the situation slowly recovers to a prepandemic status quo. Others will remain: This pandemic has sparked some long-overdue systemic transformations across all levels of medicine, including in neurosurgery, that will be beneficial in the future. In this paper, we present some of the challenges faced across different levels of neurosurgical clinical care, research, and education, the changes that followed, and how some of these modifications have transformed into opportunities for improvement and growth in the future.


Assuntos
Pesquisa Biomédica/métodos , Assistência à Saúde/métodos , Neurocirurgia/métodos , Cuidados Críticos , Educação a Distância/métodos , Procedimentos Cirúrgicos Eletivos , Número de Leitos em Hospital , Humanos , Unidades de Terapia Intensiva , Neurocirurgia/educação , Procedimentos Neurocirúrgicos , Salas Cirúrgicas , Inovação Organizacional , Consulta Remota/métodos , Telemedicina/métodos
8.
J Stroke Cerebrovasc Dis ; 30(5): 105703, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33706194

RESUMO

OBJECTIVES: Decompressive hemicraniectomy can be life-saving for malignant middle cerebral artery acute ischemic stroke (AIS). However, utilization and outcomes for hemicraniectomy in the US are not known. We sought to analyze baseline characteristics and outcomes of patients receiving hemicraniectomy for AIS in the US. MATERIALS AND METHODS: We identified adults who received hemicraniectomy for AIS, identified with validated International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9) code in the Nationwide Readmissions Database 2014. We calculated 30-day readmission rates, reasons for readmission, and procedures performed. RESULTS: 2850 of 531,896 AIS patients (0.54%) received hemicraniectomy. Although patients receiving hemicraniectomy were more likely to be younger (57.0, 95% CI 56.0-58.0; vs 70.9, 95% CI 70.6-71.2; p < 0.0001) and male (40% vs 51.2% female; p<0.0001), 46.3% of patients who received hemicraniectomy were age 60 years and older. Patients 60 years or older receiving hemicraniectomy were more likely to die (29.9% vs 21.9%, p = 0.0081). Hemicraniectomy was more frequently performed at large hospitals (75.3% vs 57.7%; p < 0.0001) in urban areas (99.1% vs 90.3%; p < 0.0001) designated as metropolitan teaching hospitals (88.3% vs 63.4%; p < 0.0001). 30-day readmissions were most commonly due to infection (31.5%), non-infectious medical complications (17.7%), and surgical complications (13.8%). These readmissions were critical. CONCLUSIONS: Although hemicraniectomy is used more frequently in the treatment of younger, male, ischemic stroke patients, only half of the patients receiving hemicraniectomy in 2014 were <60 years old. Regardless of age, hemicraniectomy is a geographically segregated procedure, only being performed in large metropolitan teaching hospitals.


Assuntos
Craniectomia Descompressiva/tendências , Disparidades em Assistência à Saúde/tendências , Padrões de Prática Médica/tendências , Idoso , Bases de Dados Factuais , Craniectomia Descompressiva/efeitos adversos , Craniectomia Descompressiva/mortalidade , Feminino , Número de Leitos em Hospital , Hospitais de Ensino/tendências , Humanos , /mortalidade , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Estados Unidos
9.
J Clin Ethics ; 32(1): 73-76, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33656459

RESUMO

During the COVID-19 pandemic, the number of patients who require intensive care treatment may outnumber the number of intensive care beds, even in industrialized nations. Consequently, triage may become necessary. In Italy, France, and Spain, age has been used as a leading parameter to decide who is admitted to the intensive care unit, and who receives palliative care. Although age is an objective and easy-to-use parameter, it is ethically not ideal to withdraw ventilator therapy from elderly people who suffer from COVID-19. We have developed a simple and easy-to-use scoring system to allow for triage that is based upon scientific outcome data and, at the same time, fulfills ethical standards.


Assuntos
Ocupação de Leitos , Alocação de Recursos para a Atenção à Saúde/ética , Unidades de Terapia Intensiva , Pandemias , Triagem/ética , Idoso , França , Número de Leitos em Hospital , Humanos , Itália , Espanha , Triagem/métodos
10.
Med J (Ft Sam Houst Tex) ; (PB 8-21-01/02/03): 79-82, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33666916

RESUMO

BACKGROUND: Keller Army Community Hospital, a 12-bed community hospital located in the Hudson Valley of New York State, within the pandemic epicenter anticipated the surge of critically ill patients, which would overwhelm local resources during the coronavirus pandemic sweeping across the globe. In this facility, there were no Intensive Care Unit (ICU) beds and resources were mobilized in order to create a negative pressure Corona Virus Unit (CVU) consisting of seven ICU beds and two step-down beds. Although the creation of the CVU decreased the non-COVID inpatient capacity to five beds, the hospital also formulated a plan to expand overall bed capacity from 12 inpatient beds to 45 beds within 24 hours. OBJECTIVE: To create a ICU embedded within a CVU and implement a three day curriculum to prepare four mixed teams of critical care and non-critical care staff nurses to manage critically ill patients with the novel coronavirus disease 2019 (COVID-19). METHODS: Nursing leaders and hospital education staff developed a critical care curriculum utilizing Elsevier didactic, the DoD COVID-19 Practice Guide, and hands-on training for 34 nurses.1,2 Nurses had varied scope of practice levels from licensed practical nurses to advance practice nurses, with diverse critical care expertise to non-critical care nursing staff from the primary care medical home (PCMH), all of which participated in the cross-leveling to the CVU unit during the pandemic response. Educational elements included PPE donning and doffing, mechanical ventilation, central venous catheter maintenance, arterial catheter management, hemodynamics, and critical care pharmacotherapy. A medical model skills station with common critical care equipment such as ventilators allowed for instantaneous feedback and 13 hands-on skills training. RESULTS: A fully functional ICU and CVU was created with thirty-four nurses who completed training within seven days with a didactic completing rate of 94.65 % and 100% hands-on skills. The program endures with monthly tailored re-fresher training to improve efficiency and maintain critical competencies. The team maintained operational readiness through the surge and remain resolute for the next surge. CONCLUSIONS: On-going program execution and evaluation continues to develop new staff members due to permanent change of station, recent on-boarding, or because of evidence based clinical guideline changes. Training has continued, but shifted to include normal inpatient operations over the summer of 2020. Re-fresher classes covering the treatment and care of COVID patients continue with the anticipation of a second wave surge of COVID-19 cases emerges this fall based on epidemiology predictions.


Assuntos
/terapia , Fortalecimento Institucional/organização & administração , Cuidados Críticos/organização & administração , Currículo , Hospitais Militares , Capacidade de Resposta ante Emergências/organização & administração , /epidemiologia , Número de Leitos em Hospital , Hospitais Comunitários , Humanos , New York
11.
Sci Rep ; 11(1): 5806, 2021 03 11.
Artigo em Inglês | MEDLINE | ID: mdl-33707546

RESUMO

Determining the level of social distancing, quantified here as the reduction in daily number of social contacts per person, i.e. the daily contact rate, needed to maintain control of the COVID-19 epidemic and not exceed acute bed capacity in case of future epidemic waves, is important for future planning of relaxing of strict social distancing measures. This work uses mathematical modelling to simulate the levels of COVID-19 in North East London (NEL) and inform the level of social distancing necessary to protect the public and the healthcare demand from future COVID-19 waves. We used a Susceptible-Exposed-Infected-Removed (SEIR) model describing the transmission of SARS-CoV-2 in NEL, calibrated to data on hospitalised patients with confirmed COVID-19, hospital discharges and in-hospital deaths in NEL during the first epidemic wave. To account for the uncertainty in both the infectiousness period and the proportion of symptomatic infection, we simulated nine scenarios for different combinations of infectiousness period (1, 3 and 5 days) and proportion of symptomatic infection (70%, 50% and 25% of all infections). Across all scenarios, the calibrated model was used to assess the risk of occurrence and predict the strength and timing of a second COVID-19 wave under varying levels of daily contact rate from July 04, 2020. Specifically, the daily contact rate required to suppress the epidemic and prevent a resurgence of COVID-19 cases, and the daily contact rate required to stay within the acute bed capacity of the NEL system without any additional intervention measures after July 2020, were determined across the nine different scenarios. Our results caution against a full relaxing of the lockdown later in 2020, predicting that a return to pre-COVID-19 levels of social contact from July 04, 2020, would induce a second wave up to eight times the original wave. With different levels of ongoing social distancing, future resurgence can be avoided, or the strength of the resurgence can be mitigated. Keeping the daily contact rate lower than 5 or 6, depending on scenarios, can prevent an increase in the number of COVID-19 cases, could keep the effective reproduction number Re below 1 and a secondary COVID-19 wave may be avoided in NEL. A daily contact rate between 6 and 7, across scenarios, is likely to increase Re above 1 and result in a secondary COVID-19 wave with significantly increased COVID-19 cases and associated deaths, but with demand for hospital-based care remaining within the bed capacity of the NEL health and care system. In contrast, an increase in daily contact rate above 8 to 9, depending on scenarios, will likely exceed the acute bed capacity in NEL and may potentially require additional lockdowns. This scenario is associated with significantly increased COVID-19 cases and deaths, and acute COVID-19 care demand is likely to require significant scaling down of the usual operation of the health and care system and should be avoided. Our findings suggest that to avoid future COVID-19 waves and to stay within the acute bed capacity of the NEL health and care system, maintaining social distancing in NEL is advised with a view to limiting the average number of social interactions in the population. Increasing the level of social interaction beyond the limits described in this work could result in future COVID-19 waves that will likely exceed the acute bed capacity in the system, and depending on the strength of the resurgence may require additional lockdown measures.


Assuntos
/prevenção & controle , Modelos Teóricos , /mortalidade , Número de Leitos em Hospital , Humanos , Londres/epidemiologia
12.
Medicine (Baltimore) ; 100(8): e24755, 2021 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-33663091

RESUMO

ABSTRACT: Health information technology (IT) is often proposed as a solution to fragmentation of care, and has been hypothesized to reduce readmission risk through better information flow. However, there are numerous distinct health IT capabilities, and it is unclear which, if any, are associated with lower readmission risk.To identify the specific health IT capabilities adopted by hospitals that are associated with hospital-level risk-standardized readmission rates (RSRRs) through path analyses using structural equation modeling.This STROBE-compliant retrospective cross-sectional study included non-federal U.S. acute care hospitals, based on their adoption of specific types of health IT capabilities self-reported in a 2013 American Hospital Association IT survey as independent variables. The outcome measure included the 2014 RSRRs reported on Hospital Compare website.A 54-indicator 7-factor structure of hospital health IT capabilities was identified by exploratory factor analysis, and corroborated by confirmatory factor analysis. Subsequent path analysis using Structural equation modeling revealed that a one-point increase in the hospital adoption of patient engagement capability latent scores (median path coefficient ß = -0.086; 95% Confidence Interval, -0.162 to -0.008), including functionalities like direct access to the electronic health records, would generally lead to a decrease in RSRRs by 0.086%. However, computerized hospital discharge and information exchange capabilities with other inpatient and outpatient providers were not associated with readmission rates.These findings suggest that improving patient access to and use of their electronic health records may be helpful in improving hospital performance on readmission; however, computerized hospital discharge and information exchange among clinicians did not seem as beneficial - perhaps because of the quality or timeliness of information transmitted. Future research should use more recent data to study, not just adoption of health IT capabilities, but also whether their usage is associated with lower readmission risk. Understanding which capabilities impact readmission risk can help policymakers and clinical stakeholders better focus their scarce resources as they invest in health IT to improve care delivery.


Assuntos
Hospitais/estatística & dados numéricos , Informática Médica/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Estudos Transversais , Registros Eletrônicos de Saúde/estatística & dados numéricos , Número de Leitos em Hospital , Humanos , Acesso dos Pacientes aos Registros/estatística & dados numéricos , Participação do Paciente/estatística & dados numéricos , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Características de Residência , Estudos Retrospectivos , Estados Unidos
13.
Indian J Public Health ; 65(1): 82-84, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33753697

RESUMO

Addressing oxygen requirements of rural India should aim at using a safe, low-cost, easily available, and replenishable source of oxygen of moderate purity. This may be possible with the provision of a self-sustaining oxygen concentrator (pressure swing adsorption with multiple molecular sieve technology) capable of delivering oxygen at high-flow rates, through a centralized distribution system to 100 or more bedded rural hospitals, with back up from an oxygen bank of 10 × 10 cylinders. This will provide a 24 × 7 supply of oxygen of acceptable purity (~93%) for the treatment of hypoxemic conditions and will enable hospitals to specifically provide for high-flow oxygen in at least 15% of the beds. It may also serve as a facility for a local refill of oxygen cylinders for emergency use within the hospital as well as to subsidiary primary health centers, subcenters, and ambulances, thereby nudging our health-care system toward self-sufficiency in oxygen generation and utilization.


Assuntos
Acesso aos Serviços de Saúde/organização & administração , Hospitais Rurais/organização & administração , Oxigênio/provisão & distribução , Serviços de Saúde Rural/organização & administração , Necessidades e Demandas de Serviços de Saúde/organização & administração , Número de Leitos em Hospital , Humanos , Índia , Unidades de Terapia Intensiva/organização & administração
14.
Medicine (Baltimore) ; 100(3): e24077, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33546011

RESUMO

ABSTRACT: This study aimed to systematically analyze the effect of Wuhan mobile cabin hospitals (WMCHs) on the novel coronavirus-caused pneumonia (COVID-19) prevention and control in China. Between February 5, 2020 and March 10, 2020, a total of 16 mobile cabin hospitals were constructed in 3 batches to offer over 13,000 beds and admitted more than 12,000 patients in Wuhan City. The strategy of implementing WMCHs in 3 batches played a key role in fighting against COVID-19 in China. (1) The first batch of WMCHs increased hospital admission capacity of COVID-19 patients in Wuhan, which showed initial effect on COVID-19 epidemic control. (2) The operation of the second batch of WMCHs greatly contributed to the rapid growth in discharged patients. (3) After launching the third batch of WMCHs, the COVID-19 epidemic situation in Wuhan improved considerably. The last batch of WMCHs made a substantial contribution to defeating the COVID-19 epidemic in Wuhan.


Assuntos
/epidemiologia , Política de Saúde , Unidades Móveis de Saúde/organização & administração , China/epidemiologia , Número de Leitos em Hospital , Hospitalização , Humanos
15.
PLoS One ; 16(2): e0247726, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33630972

RESUMO

Given the pressure on healthcare authorities to assess whether hospital capacity allows properly responding to outbreaks such as COVID-19, there is a need for simple, data-driven methods that may provide accurate forecasts of hospital bed demand. This study applies growth models to forecast the demand for Intensive Care Unit admissions in Italy during COVID-19. We show that, with only some mild assumptions on the functional form and using short time-series, the model fits past data well and can accurately forecast demand fourteen days ahead (the mean absolute percentage error (MAPE) of the cumulative fourteen days forecasts is 7.64). The model is then applied to derive regional-level forecasts by adopting hierarchical methods that ensure the consistency between national and regional level forecasts. Predictions are compared with current hospital capacity in the different Italian regions, with the aim to evaluate the adequacy of the expansion in the number of beds implemented during the COVID-19 crisis.


Assuntos
/terapia , Número de Leitos em Hospital , Unidades de Terapia Intensiva , /epidemiologia , Previsões , Humanos , Itália/epidemiologia
16.
J Biomed Inform ; 116: 103715, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33610878

RESUMO

Data quality is essential to the success of the most simple and the most complex analysis. In the context of the COVID-19 pandemic, large-scale data sharing across the US and around the world has played an important role in public health responses to the pandemic and has been crucial to understanding and predicting its likely course. In California, hospitals have been required to report a large volume of daily data related to COVID-19. In order to meet this need, electronic health records (EHRs) have played an important role, but the challenges of reporting high-quality data in real-time from EHR data sources have not been explored. We describe some of the challenges of utilizing EHR data for this purpose from the perspective of a large, integrated, mixed-payer health system in northern California, US. We emphasize some of the inadequacies inherent to EHR data using several specific examples, and explore the clinical-analytic gap that forms the basis for some of these inadequacies. We highlight the need for data and analytics to be incorporated into the early stages of clinical crisis planning in order to utilize EHR data to full advantage. We further propose that lessons learned from the COVID-19 pandemic can result in the formation of collaborative teams joining clinical operations, informatics, data analytics, and research, ultimately resulting in improved data quality to support effective crisis response.


Assuntos
/epidemiologia , Registros Eletrônicos de Saúde , Pandemias , /mortalidade , California/epidemiologia , Confiabilidade dos Dados , Prestação Integrada de Cuidados de Saúde/estatística & dados numéricos , Registros Eletrônicos de Saúde/estatística & dados numéricos , Troca de Informação em Saúde/estatística & dados numéricos , Número de Leitos em Hospital/estatística & dados numéricos , Humanos , Disseminação de Informação/métodos , Informática Médica , Pandemias/estatística & dados numéricos
17.
JAMA Netw Open ; 4(2): e2036297, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33533928

RESUMO

Importance: Given that 40% of hand function is achieved with the thumb, replantation of traumatic thumb injuries is associated with substantial quality-of-life benefits. However, fewer replantations are being performed annually in the US, which has been associated with less surgical expertise and increased risk of future replantation failures. Thus, understanding how interfacility transfers and hospital characteristics are associated with outcomes warrants further investigation. Objective: To assess the association of interfacility transfer, patient characteristics, and hospital factors with thumb replantation attempts and success. Design, Setting, and Participants: This cross-sectional study used data from the US National Trauma Data Bank from 2009 to 2016 for adult patients with isolated traumatic thumb amputation injury who underwent revision amputation or replantation. Data analysis was performed from May 4, 2020, to July 20, 2020. Exposures: Interfacility transfer, defined as transfer of a patient from 1 hospital to another to obtain care for traumatic thumb amputation. Main Outcomes and Measures: Replantation attempt and replantation success, defined as having undergone a replantation without a subsequent revision amputation during the same hospitalization. Multilevel logistic regression models were used to assess the associations of interfacility transfer, patient characteristics, and hospital factors with replantation outcomes. Results: Of 3670 patients included in this analysis, 3307 (90.1%) were male and 2713 (73.9%) were White; the mean (SD) age was 45.8 (16.5) years. A total of 1881 patients (51.2%) were transferred to another hospital; most of these patients were male (1720 [91.4%]) and White (1420 [75.5%]). After controlling for patient and hospital characteristics, uninsured patients were less likely to have thumb replantation attempted (odds ratio [OR], 0.61; 95% CI, 0.47-0.78) or a successful replantation (OR, 0.64; 95% CI, 0.49-0.84). Interfacility transfer was associated with increased odds of replantation attempt (OR, 1.34; 95% CI, 1.13-1.59), with 13% of the variation at the hospital level. Interfacility transfer was also associated with increased replantation success (OR, 1.23; 95% CI, 1.03-1.47), with 14% of variation at the hospital level. Conclusions and Relevance: In this cross-sectional study, interfacility transfer and particularly hospital-level variation were associated with increased thumb replantation attempts and successes. These findings suggest a need for creating policies that incentivize hospitals with replantation expertise to provide treatment for traumatic thumb amputations, including promotion of centralization of replantation care.


Assuntos
Amputação Traumática/cirurgia , Hospitais/estatística & dados numéricos , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Transferência de Pacientes/estatística & dados numéricos , Reimplante , Polegar/lesões , Adulto , Fatores Etários , Certificação , Estudos Transversais , Feminino , Traumatismos dos Dedos/cirurgia , Número de Leitos em Hospital/estatística & dados numéricos , Hospitais Comunitários/estatística & dados numéricos , Hospitais de Ensino/estatística & dados numéricos , Hospitais Universitários/estatística & dados numéricos , Humanos , Seguro Saúde , Modelos Logísticos , Masculino , Corpo Clínico Hospitalar/estatística & dados numéricos , Medicare , Pessoa de Meia-Idade , Análise Multinível , Razão de Chances , Cirurgiões Ortopédicos/provisão & distribução , Centros de Traumatologia/estatística & dados numéricos , Resultado do Tratamento , Estados Unidos
18.
Comput Math Methods Med ; 2021: 8853787, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33574887

RESUMO

This paper puts forward a decision model for allocation of intensive care unit (ICU) beds under scarce resources in healthcare systems during the COVID-19 pandemic. The model is built upon a portfolio selection approach under the concepts of the Utility Theory. A binary integer optimization model is developed in order to find the best allocation for ICU beds, considering candidate patients with suspected/confirmed COVID-19. Experts' subjective knowledge and prior probabilities are considered to estimate the input data for the proposed model, considering the particular aspects of the decision problem. Since the chances of survival of patients in several scenarios may not be precisely defined due to the inherent subjectivity of such kinds of information, the proposed model works based on imprecise information provided by users. A Monte-Carlo simulation is performed to build a recommendation, and a robustness index is computed for each alternative according to its performance as evidenced by the results of the simulation.


Assuntos
Técnicas de Apoio para a Decisão , Número de Leitos em Hospital , Unidades de Terapia Intensiva , Pandemias , Ocupação de Leitos , Simulação por Computador , Alocação de Recursos para a Atenção à Saúde , Humanos , Método de Monte Carlo , Alocação de Recursos
20.
Ann Hematol ; 100(4): 941-952, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33560468

RESUMO

Splenectomy is one of the treatments of immune thrombocytopenia (ITP) with a high response rate. However, it is an irreversible procedure that can be associated with morbidity in this setting. Our aim was to study the trends of splenectomy in adults with ITP, and the factors associated with splenectomy and resource utilization during these hospitalizations. We used the National (Nationwide) Inpatient Sample (NIS) to identify hospitalizations for adult patients with a principal diagnosis of ITP between 2007 and 2017. The primary outcome was the splenectomy trend. Secondary outcomes were (1) incidence of ITP trend, (2) in-hospital mortality, length of stay, and total hospitalization costs after splenectomy trend, and (3) independent predictors of splenectomy, length of stay, and total hospitalization costs. A total of 36,141 hospitalizations for ITP were included in the study. The splenectomy rate declined over time (16% in 2007 to 8% in 2017, trend p < 0.01) and so did the in-hospital mortality after splenectomy. Of the independent predictors of splenectomy, the strongest was elective admissions (adjusted odds ratio [aOR]: 22.1, 95% confidence interval [CI]:17.8-27.3, P < 0.01), while recent hospitalization year, older age, and Black (compared to Caucasian) race were associated with lower odds of splenectomy. Splenectomy tends to occur during elective admissions in urban medical centers for patients with private insurance. Despite a stable ITP hospitalization rate over the past decade and despite listing splenectomy as a second-line option for management of ITP in major guidelines, splenectomy rates consistently declined over time.


Assuntos
Púrpura Trombocitopênica Idiopática/cirurgia , Esplenectomia , Adulto , Fatores Etários , Procedimentos Cirúrgicos Eletivos , Seguimentos , Número de Leitos em Hospital , Custos Hospitalares , Mortalidade Hospitalar , Hospitalização , Hospitais de Ensino/estatística & dados numéricos , Hospitais Urbanos/estatística & dados numéricos , Humanos , Renda , Tempo de Internação/estatística & dados numéricos , Utilização de Procedimentos e Técnicas , Púrpura Trombocitopênica Idiopática/economia , Estudos Retrospectivos , Esplenectomia/economia , Esplenectomia/métodos , Esplenectomia/estatística & dados numéricos , Esplenectomia/tendências , Resultado do Tratamento , Estados Unidos
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