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2.
Trials ; 21(1): 1019, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33308290

RESUMO

BACKGROUND: Burnout is an occupational syndrome that leads to mental health problems, job turnover, and patient safety events. Those caring for critically ill patients are especially susceptible due to high patient mortality, long hours, and regular encounters with trauma and ethical issues. Interventions to prevent burnout in this population are needed. Preliminary studies suggest debriefing sessions may reduce burnout. This study aims to assess whether participation in regular debriefing can prevent burnout in intensive care unit (ICU) clinicians. METHODS: A randomized controlled trial will be conducted in two large academic medical centers. Two hundred ICU clinicians will be recruited with target enrollment of 100 physicians and 100 non-physicians (nurses, pharmacists, therapists). Participants must have worked in the ICU for the equivalent of at least 1 full time work week in the preceding 4 weeks. Enrolled subjects will be randomized to virtually attend biweekly debriefing sessions facilitated by a psychotherapist for 3 months or to a control arm without sessions. Our debriefs are modeled after Death Cafés, which are informal discussions focusing on death, dying, loss, grief, and illness. These sessions allow for reflection on distressing events and offer community and collaboration among hospital employees outside of work. The primary outcome is clinician burnout as measured by the Maslach Burnout Inventory (MBI) Score. Secondary outcomes include depression and anxiety, as measured by the Patient Health Questionnaire 8 (PHQ-8) and Generalized Anxiety Disorder 7-item scale (GAD-7), respectively. Questionnaires will be administered prior to the intervention, at 1 month, at 3 months, and at 6 months after enrollment. These values will be compared between groups temporally. Qualitative feedback will also be collected and analyzed. DISCUSSION: With ICU clinician burnout rates exceeding 50%, Death Café debriefing sessions may prove to be an effective tool to avert this debilitating syndrome. With COVID-19 limiting social interactions and overloading ICUs worldwide, the virtual administration of the Death Café for ICU clinicians provides an innovative strategy to potentially mitigate burnout in this vulnerable population. TRIAL REGISTRATION: ClinicalTrials.gov NCT04347811 . Registered on 15 April 2020.


Assuntos
Esgotamento Profissional/prevenção & controle , Unidades de Terapia Intensiva/estatística & dados numéricos , Estresse Ocupacional/psicologia , Assistência Terminal/psicologia , Ansiedade/diagnóstico , Ansiedade/epidemiologia , Conscientização/fisiologia , Esgotamento Profissional/epidemiologia , /virologia , Estudos de Casos e Controles , Comunicação , Estado Terminal/mortalidade , Estado Terminal/psicologia , Depressão/diagnóstico , Depressão/epidemiologia , Humanos , Estresse Ocupacional/epidemiologia , Questionário de Saúde do Paciente/estatística & dados numéricos , Segurança do Paciente/estatística & dados numéricos , Reorganização de Recursos Humanos/estatística & dados numéricos , Inquéritos e Questionários , Interface Usuário-Computador
3.
Otolaryngol Clin North Am ; 53(6): 1159-1170, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33039099
4.
Arch. prev. riesgos labor. (Ed. impr.) ; 23(3): 343-356, jul.-sept. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-194120

RESUMO

OBJETIVO: Evaluar diferencias entre la detección de incidentes o eventos adversos (I/EA) en una mutua laboral, mediante una herramienta tipo Trigger Tool (TT) y una plataforma de notificación voluntaria (SNEA). MÉTODOS: La población de estudio es la población trabajadora atendida ambulatoriamente en una mutua laboral de Enero a Septiembre del 2016. Se seleccionaron los casos declarados como I/EA según si el evento no ha afectado al paciente o por el contrario le ha afectado, a través del SNEA (n = 21 casos). Por otro lado, se seleccionaron aleatoriamente 20 historias clínicas por mes donde se aplicó la herramienta TT (180 casos). Se adaptaron 11 triggers para detectar I/EA. Se revisaron las 201 historias clínicas buscando la existencia de triggers. Se obtuvo la concordancia entre el sistema SNEA y el TT utilizando la proporción de concordancia positiva (I/EA), proporción de concordancia negativa (no I/EA) e índice Kappa. RESULTADOS: TT detectó casos de I/EA en el 41,3% de las revisiones mientras que el SNEA 10,3% (p < 0,001). El índice Kappa ofreció un valor de concordancia baja (Kappa = 0,12) lo que denota la pequeña coincidencia de sucesos adversos detectados por ambos sistemas. La proporción de concordancia negativa fue mayor que la de concordancia positiva (74,5% frente a un 26,9%). El sistema SNEA detectó menos I/EA y sobre todo se trata de menos incidentes. Por el contrario, el sistema TT detectó mayor número de I/EA y especialmente EA. CONCLUSIONES: Trigger Tool es una herramienta recomendable para la detección de incidentes


OBJECTIVE: To evaluate differences between the detection of incidents or adverse events (I/AE) using a Trigger Tool (TT) and voluntary notification platform (SNEA). METHODS: The study population is the working population attended on an outpatient basis in an Insurance Company ("mutua") from January to September 2016. The cases declared as Incident or Adverse Event (I / AE) were selected through the SNEA (21 cases), according to whether the event has not affected the patient or on the contrary has affected him. On the other hand, 20 clinical histories per month were randomly selected where the TT was applied (180 cases). The 201 clinical histories were reviewed looking for the existence of triggers. The agreement between the SNEA system and the TT was evaluated using proportion of positive agreement (I/EA), proportion of negative agreement (not I/EA) and Kappa index. RESULTS: TT detected I/EA cases in 41.3% of the revisions while the SNEA was 10.3% (p < 0.001). The Kappa index showed a low concordance value (Kappa = 0.12), which indicates the small coincidence of I/EA detected by both systems. The proportion of negative agreement was greater than that of positive agreement (74.5% versus 26.9%). The SNEA system detected less I/ EA and above all it deals with fewer incidents. On the contrary, the TT system detected a greater number of I EA and especially EA


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Pacientes Ambulatoriais/estatística & dados numéricos , Segurança do Paciente/estatística & dados numéricos , Gestão de Riscos/métodos , Gestão da Segurança/métodos , Gestão da Segurança/estatística & dados numéricos , Estudos Transversais
8.
Ultrasound Q ; 36(3): 200-205, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32890322

RESUMO

The coronavirus disease 2019 is caused by the severe acute respiratory syndrome coronavirus 2. The virus can be spread by close person-to-person contact primarily by respiratory droplets. Given the close proximity of the sonographer or sonologist with the patient during ultrasound examinations, special precautions should be taken to limit the exposure of radiology personnel to patients with coronavirus disease 2019 while still providing optimal patient care. Methods covered in this article include modified workflow, close scrutiny and prioritization of imaging orders, and design of targeted ultrasound protocols. These guidelines summarize the personal experience and insight of multiple colleagues who lead ultrasound sections or are experts in the field.


Assuntos
Infecções por Coronavirus/prevenção & controle , Controle de Infecções/normas , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Guias de Prática Clínica como Assunto , Serviço Hospitalar de Radiologia/normas , Ultrassonografia Doppler/normas , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Masculino , Saúde do Trabalhador , Avaliação de Resultados em Cuidados de Saúde , Pandemias/estatística & dados numéricos , Segurança do Paciente/estatística & dados numéricos , Pneumonia Viral/epidemiologia
9.
Am J Med Qual ; 35(6): 444-449, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32741195

RESUMO

During the coronavirus disease 2019 (COVID-19) pandemic, the study institution recognized the importance of providing preoperative COVID-19 testing and symptom screening to ensure patient safety. A multidisciplinary quality improvement team used Define, Measure, Analyze, Improve, and Control methodology to understand the issues, identify solutions, and streamline patient flow. The existing preoperative evaluation (POE) clinic was utilized as a centralized entity to provide COVID-19 testing, symptom screening, and infection prevention education in addition to routine preoperative medical optimization. With the new process, the percentage of patients with COVID-19 testing results returned before surgery increased from 10% to 100%. Of the 593 asymptomatic patients screened by the POE clinic, 2 were found to have positive results. These patients had their surgeries postponed until proper recovery. The study institution has extended this new process to all surgical patients, warranting facility readiness for the resumption of elective surgery.


Assuntos
Betacoronavirus , Infecções por Coronavirus/diagnóstico , Procedimentos Cirúrgicos Eletivos , Segurança do Paciente/estatística & dados numéricos , Pneumonia Viral/diagnóstico , Período Pré-Operatório , Técnicas de Laboratório Clínico , Humanos , Programas de Rastreamento/estatística & dados numéricos , Pandemias , Melhoria de Qualidade
10.
J Am Med Dir Assoc ; 21(7): 933-936, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32674822

RESUMO

OBJECTIVE: To assess the American Testing Guidance for Nursing Homes (NHs)-updated May 19, 2020-with a new COVID-19 case. DESIGN: Case investigation. SETTING AND SUBJECTS: All 79 residents and 34 health care personnel (HCP) of an NH. METHODS: Seven days after identification of a COVID-19 resident, all residents and HCP underwent real-time reverse-transcriptase polymerase chain reaction (rRT-PCR) testing for SARS-CoV-2 with nasopharyngeal swabs. This was repeated weekly in all previously negative subjects until the testing identified no new cases, and in all positive subjects until the testing was negative. COVID-19 infection prevention and control (IPC) measures were implemented in all residents and HCP with positive testing or with COVID-19 symptoms. Standard IPC was also implemented in all HCP. Six weeks after initial testing, all residents underwent testing for enzyme-linked immunosorbent assay-based IgG antibodies directed against the SARS-CoV-2. Symptoms were serially recorded in residents and HCP. RESULTS: A total of 36 residents had a positive rRT-PCR at baseline and 2 at day 7. Six HCP had a positive rRT-PCR at baseline and 2 at day 7. No new COVID-19 cases were diagnosed later. Among the SARS-CoV-2-positive cases, 6 residents (16%) and 3 HCP (37%) were asymptomatic during the 14 days before testing. Twenty-five residents (92.3%) and all 8 HCP (100%) with a positive rRT-PCR developed IgG antibodies against SARS-CoV-2. Among the residents and HCP always having tested negative, 2 (5%) and 5 (11.5%), respectively, developed IgG antibodies against SARS-CoV-2. These 2 residents had typical COVID-19 symptoms before and after testing and 2/5 HCP were asymptomatic before and after testing. CONCLUSIONS AND IMPLICATIONS: This study shows the validity of the updated American Testing Guidance for Nursing Homes (NHs). It suggests implementing COVID-19 IPC in both residents and HCP with positive testing or COVID-19 symptoms and warns that asymptomatic HCP with repeated negative rRT-PCR testing can develop antibodies against SARS-CoV-2.


Assuntos
Técnicas de Laboratório Clínico/métodos , Busca de Comunicante/estatística & dados numéricos , Surtos de Doenças/prevenção & controle , Pessoal de Saúde/estatística & dados numéricos , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Casas de Saúde/organização & administração , Anticorpos Antivirais/análise , Técnicas de Laboratório Clínico/estatística & dados numéricos , Busca de Comunicante/métodos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , DNA Viral/análise , Feminino , Humanos , Masculino , Saúde do Trabalhador/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde , Pandemias , Segurança do Paciente/estatística & dados numéricos , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Reação em Cadeia da Polimerase em Tempo Real/métodos , Instituições de Cuidados Especializados de Enfermagem/organização & administração , Estados Unidos/epidemiologia
14.
J Appl Gerontol ; 39(11): 1175-1183, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32697126

RESUMO

Background: The Theory of Planned Behavior (TPB) and the Health Belief Model (HBM) were used to examine the opinion and behaviors of older adults regarding Coronavirus Disease 2019 (COVID-19), social distancing practices, stay-at-home orders, and hypothetical public policy messaging strategies. Method: A convenience sample (N = 242) of adults 60 and older in the state of Maryland took part in an online survey. Respondents filled out questions regarding demographic information, political affiliation, current social distancing behaviors, and TPB and HBM constructs in our proposed model. Linear regression analysis and analysis of covariance (ANCOVA) were conducted to test the model. Results: Attitude toward social isolation was affected by perceived benefits and barriers to social distancing measures, perceived severity of COVID-19, and political affiliation. Behavior intention was influenced by attitude, subjective norms, political affiliation, and messaging strategies. Conclusion: The study provides support for the conceptual model and has public policy implications as authorities begin to lift stay-at-home orders.


Assuntos
Controle de Doenças Transmissíveis/organização & administração , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Isolamento de Pacientes/métodos , Segurança do Paciente/estatística & dados numéricos , Pneumonia Viral/prevenção & controle , Quarentena/métodos , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/epidemiologia , Estudos Transversais , Feminino , Avaliação Geriátrica , Política de Saúde , Humanos , Masculino , Maryland , Máscaras/estatística & dados numéricos , Pessoa de Meia-Idade , Pneumonia Viral/epidemiologia , Formulação de Políticas , Saúde Pública , Inquéritos e Questionários
15.
Surg Today ; 50(10): 1159-1167, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32720009

RESUMO

BACKGROUND: In March, 2020, the World Health Organization declared COVID-19 a pandemic. The absence of previous knowledge of COVID-19 has made decision-making difficult for all in health care, including surgical departments. We reviewed the management recommendations for surgical activity and changes to surgical practice, identifying concordances and discrepancies, based on the literature published in the early phase of the pandemic. METHOD: We searched the electronic datasets, PubMed Database, Google, and Google Scholar, using the keywords "SARS-CoV-2", "COVID-19", "surgery", "recommendations", "guideline", and "triage". The search was limited to the first 2 months after the pandemic began and was closed on May 6, 2020. RESULTS: Twenty papers were included in the analysis and their recommendations are divided into the following categories: 1. general aspects, such as maintaining the safety of health personnel and indications for surgery. 2. The preoperative phase, with recommendations about activating different care pathways for COVID-19 positive patients. 3. The operative phase, with recommendations about activating safety measures for aerosol-generating procedures. 4. The postoperative phase, with recommendations for managing operating theatres and patient transfers. CONCLUSION: The recommendations proposed in the revised documents are considered good practices aimed at keeping patients and healthcare professionals safe. However, these recommendations must be contextualized in each individual hospital.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecção Hospitalar/prevenção & controle , Procedimentos Cirúrgicos Eletivos/métodos , Cirurgia Geral/métodos , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Guias de Prática Clínica como Assunto , Infecções por Coronavirus/prevenção & controle , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Feminino , Cirurgia Geral/estatística & dados numéricos , Saúde Global , Humanos , Controle de Infecções/métodos , Masculino , Saúde do Trabalhador/estatística & dados numéricos , Pandemias/prevenção & controle , Segurança do Paciente/estatística & dados numéricos , Pneumonia Viral/prevenção & controle , Medição de Risco , Organização Mundial da Saúde
16.
J Surg Res ; 255: 339-345, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32599453

RESUMO

BACKGROUND: The Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act established a community care program allowing veterans to receive care outside Veteran Affairs Medical Centers (VAMCs). We sought to compare patient safety and satisfaction indicators from VAMCs and surrounding non-VAMCs (non-VAs). METHODS: We identified VAMCs with at least one non-VA acute care hospital within 25 miles in three geographic regions (West/Southwest, New England, and Deep South). Children's, specialty, and critical access hospitals were excluded. Using publicly available Hospital Compare data, we analyzed VAMC and surrounding non-VA performance in postsurgical patient safety indicator (PSI) events and Hospital Consumer Assessment of Healthcare Providers and Systems patient satisfaction scores and hospital star ratings. RESULTS: The 34 VAMCs performed better than 319 surrounding non-VAs in rates of wound dehiscence, accidental lacerations, and perioperative hemorrhage/hematoma as well as composite PSI rating (P < 0.05). VAMCs performed significantly better than non-VAs (18.0 versus 51.4 events per 1000 patients, P < 0.001) in composite surgery-specific PSIs. When comparing mean linear Hospital Consumer Assessment of Healthcare Providers and Systems score star ratings (1-5 scale), VAMCs had similar performance in overall hospital rating compared with non-VAs (3.28 versus 3.38, P = 0.48) and summary rating of hospital stays (2.87 versus 2.92, P = 0.69). When compiled patient satisfaction star ratings were compared, there was no difference (2.96 versus 2.97, P = 0.9). VAMCs performed worse than non-VAs in "would recommend" ratings (2.7 versus 3.13, P = 0.007). CONCLUSIONS: Across disparate regions, VAMCs match or outperform neighboring non-VAs in surgical quality metrics and patient satisfaction ratings. Veterans receiving surgical care at VAMCs may receive equivalent or better care than at non-VAs.


Assuntos
Hospitais de Veteranos/estatística & dados numéricos , Segurança do Paciente/estatística & dados numéricos , Satisfação do Paciente/estatística & dados numéricos , Humanos , Indicadores de Qualidade em Assistência à Saúde , Estados Unidos
18.
Med Care ; 58(7): 594-600, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32520835

RESUMO

BACKGROUND: Prior research has found that adverse events have significant negative consequences for the patients (first victim) and caregivers (second victim) involved such as burnout. However, research has yet to examine the consequences of adverse events on members of caregiving units. We also lack research on the effects of the personal and job resources that shape the context of how adverse events are experienced. OBJECTIVES: We test the relationship between job demands (the number of adverse events on a hospital nursing unit) and nurses' experience of burnout. We further explore the ways in which personal (workgroup identification) and job (safety climate) resources amplify or dampen this relationship. Specifically, we examine whether, and the conditions under which, adverse events affect nurse burnout. RESEARCH DESIGN: Cross-sectional analyses of survey data on nurse burnout linked to hospital incident reporting system data on adverse event rates for the year before survey administration and survey data on workgroup identification and safety climate. SUBJECTS: Six hundred three registered nurses from 30 nursing units in a large, urban hospital in the Midwest completed questionnaires. RESULTS: Multilevel regression analysis indicated that adverse events were positively associated with nurse burnout. The effects of adverse events on nurse burnout were amplified when nurses exhibited high levels of workgroup identification and attenuated when safety climate perceptions were higher. CONCLUSIONS: Adverse events have broader negative consequences than previously thought, widely affecting nurse burnout on caregiving units, especially when nurses strongly identify with their workgroup. These effects are mitigated when leaders cultivate safety climate.


Assuntos
Esgotamento Profissional/etiologia , Enfermeiras e Enfermeiros/psicologia , Gestão da Segurança/normas , Identificação Social , Local de Trabalho/psicologia , Adulto , Esgotamento Profissional/complicações , Esgotamento Profissional/psicologia , Estudos Transversais , Feminino , Humanos , Satisfação no Emprego , Masculino , Erros Médicos/psicologia , Erros Médicos/estatística & dados numéricos , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros/estatística & dados numéricos , Cultura Organizacional , Segurança do Paciente/estatística & dados numéricos , Análise de Regressão , Gestão da Segurança/estatística & dados numéricos , Inquéritos e Questionários , Local de Trabalho/normas , Local de Trabalho/estatística & dados numéricos
20.
Rev Lat Am Enfermagem ; 28: e3273, 2020.
Artigo em Português, Espanhol, Inglês | MEDLINE | ID: mdl-32491122

RESUMO

OBJECTIVE: to verify the relationship between the socio-demographic and work profile of the nursing professionals and the patient safety climate in a public emergency hospital. METHOD: a cross-sectional study carried out with 177 nursing professionals from a public emergency hospital. For data collection, the Safety Attitudes Questionnaire - Short Form 2006 was used, validated and cross-culturally adapted to the Portuguese language. To check the factors related to the instrument's domains, bivariate and multivariate analyses were performed. RESULTS: working in the medical and surgical clinic or emergency room, on a night shift, and having the intention to leave nursing, reduced the general safety climate in the multiple regression analysis. The younger professionals, with less than four years in the institution, and those who worked in the night shift had a lower safety climate related to the perception of the management. On the other hand, having a work contract with a hired worker improved the general safety climate and workplace satisfaction. CONCLUSION: identifying predictors on patient safety scores is an important management tool that allows diagnosing, planning and executing activities from the domains that need to be improved.


Assuntos
Serviço Hospitalar de Emergência/normas , Recursos Humanos de Enfermagem no Hospital/psicologia , Segurança do Paciente/normas , Gestão da Segurança/normas , Adulto , Atitude do Pessoal de Saúde , Estudos Transversais , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Satisfação no Emprego , Masculino , Segurança do Paciente/estatística & dados numéricos , Fatores Socioeconômicos , Inquéritos e Questionários , Fatores de Tempo , Local de Trabalho/psicologia
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