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1.
Yonsei Med J ; 62(12): 1098-1106, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34816640

RESUMO

PURPOSE: Intensive care unit (ICU) bed availability is key to critical patient care. In many countries, older patients generally account for a significant proportion of hospitalizations and ICU admissions. Therefore, considering the rapidly increasing aging population in South Korea, it is important to establish whether the demand for critical care is currently met by available ICU beds. MATERIALS AND METHODS: We evaluated a 9-year trend in ICU bed supply and ICU length of stay in South Korea between 2011 and 2019 in a population-based cross-sectional analysis, using data from the Korean Health Insurance Review & Assessment Service and Statistics database. We described the changes in ICU bed rates in adult (≥20 years) and older adult (≥65 years) populations. ICU length of stay was categorized similarly and was used to predict future ICU bed demands. RESULTS: The ICU bed rate per 100000 adults increased from 18.5 in 2011 to 19.5 in 2019. In contrast, the ICU bed rate per 100000 older adults decreased from 127.6 in 2011 to 104.0 in 2019. ICU length of stay increased by 43.8% for adults and 55.6% for older adults. In 2019, the regional differences in the ICU bed rate nearly doubled, and the ICU length of stay increased six-fold. The ICU bed occupancy rate in South Korea is expected to rise to 102.7% in 2030. CONCLUSION: The discrepancy between the demand and supply of ICU beds in South Korea requires urgent action to anticipate future ICU demands.


Assuntos
Ocupação de Leitos , Unidades de Terapia Intensiva , Idoso , Cuidados Críticos , Estudos Transversais , Humanos , Tempo de Internação , República da Coreia
2.
MMWR Morb Mortal Wkly Rep ; 70(46): 1613-1616, 2021 Nov 19.
Artigo em Inglês | MEDLINE | ID: mdl-34793414

RESUMO

Surges in COVID-19 cases have stressed hospital systems, negatively affected health care and public health infrastructures, and degraded national critical functions (1,2). Resource limitations, such as available hospital space, staffing, and supplies led some facilities to adopt crisis standards of care, the most extreme operating condition for hospitals, in which the focus of medical decision-making shifted from achieving the best outcomes for individual patients to addressing the immediate care needs of larger groups of patients (3). When hospitals deviated from conventional standards of care, many preventive and elective procedures were suspended, leading to the progression of serious conditions among some persons who would have benefitted from earlier diagnosis and intervention (4). During March-May 2020, U.S. emergency department visits declined by 23% for heart attacks, 20% for strokes, and 10% for diabetic emergencies (5). The Cybersecurity & Infrastructure Security Agency (CISA) COVID Task Force* examined the relationship between hospital strain and excess deaths during July 4, 2020-July 10, 2021, to assess the impact of COVID-19 surges on hospital system operations and potential effects on other critical infrastructure sectors and national critical functions. The study period included the months during which the highly transmissible SARS-CoV-2 B.1.617.2 (Delta) variant became predominant in the United States.† The negative binomial regression model used to calculate estimated deaths predicted that, if intensive care unit (ICU) bed use nationwide reached 75% capacity an estimated 12,000 additional excess deaths would occur nationally over the next 2 weeks. As hospitals exceed 100% ICU bed capacity, 80,000 excess deaths would be expected in the following 2 weeks. This analysis indicates the importance of controlling case growth and subsequent hospitalizations before severe strain. State, local, tribal, and territorial leaders could evaluate ways to reduce strain on public health and health care infrastructures, including implementing interventions to reduce overall disease prevalence such as vaccination and other prevention strategies, as well as ways to expand or enhance capacity during times of high disease prevalence.


Assuntos
COVID-19/epidemiologia , Hospitais/estatística & dados numéricos , Mortalidade/tendências , Pandemias , Adulto , Ocupação de Leitos/estatística & dados numéricos , COVID-19/mortalidade , COVID-19/terapia , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Estados Unidos/epidemiologia
3.
PLoS One ; 16(10): e0257235, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34613981

RESUMO

During the early months of the current COVID-19 pandemic, social distancing measures effectively slowed disease transmission in many countries in Europe and Asia, but the same benefits have not been observed in some developing countries such as Brazil. In part, this is due to a failure to organise systematic testing campaigns at nationwide or even regional levels. To gain effective control of the pandemic, decision-makers in developing countries, particularly those with large populations, must overcome difficulties posed by an unequal distribution of wealth combined with low daily testing capacities. The economic infrastructure of these countries, often concentrated in a few cities, forces workers to travel from commuter cities and rural areas, which induces strong nonlinear effects on disease transmission. In the present study, we develop a smart testing strategy to identify geographic regions where COVID-19 testing could most effectively be deployed to limit further disease transmission. By smart testing we mean the testing protocol that is automatically designed by our optimization platform for a given time period, knowing the available number of tests, the current availability of ICU beds and the initial epidemiological situation. The strategy uses readily available anonymised mobility and demographic data integrated with intensive care unit (ICU) occupancy data and city-specific social distancing measures. Taking into account the heterogeneity of ICU bed occupancy in differing regions and the stages of disease evolution, we use a data-driven study of the Brazilian state of Sao Paulo as an example to show that smart testing strategies can rapidly limit transmission while reducing the need for social distancing measures, even when testing capacity is limited.


Assuntos
Ocupação de Leitos/estatística & dados numéricos , Teste para COVID-19 , COVID-19/diagnóstico , COVID-19/prevenção & controle , Cuidados Críticos , COVID-19/epidemiologia , Humanos , Pandemias/prevenção & controle
4.
PLoS One ; 16(10): e0258346, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34624057

RESUMO

INTRODUCTION: On psychiatric wards, aggressive behaviour displayed by patients is common and problematic. Understanding factors associated with the development of aggression offers possibilities for prevention and targeted interventions. This review discusses factors that contribute to the development of aggression on psychiatric wards. METHOD: In Pubmed and Embase, a search was performed aimed at: prevalence data, ward characteristics, patient and staff factors that are associated with aggressive behaviour and from this search 146 studies were included. RESULTS: The prevalence of aggressive behaviour on psychiatric wards varied (8-76%). Explanatory factors of aggressive behaviour were subdivided into patient, staff and ward factors. Patient risk factors were diagnosis of psychotic disorder or bipolar disorder, substance abuse, a history of aggression, younger age. Staff risk factors included male gender, unqualified or temporary staff, job strain, dissatisfaction with the job or management, burn-out and quality of the interaction between patients and staff. Staff protective factors were a good functioning team, good leadership and being involved in treatment decisions. Significant ward risk factors were a higher bed occupancy, busy places on the ward, walking rounds, an unsafe environment, a restrictive environment, lack of structure in the day, smoking and lack of privacy. CONCLUSION: Despite a lack of prospective quantitative data, results did show that aggression arises from a combination of patient factors, staff factors and ward factors. Patient factors were studied most often, however, besides treatment, offering the least possibilities in prevention of aggression development. Future studies should focus more on the earlier stages of aggression such as agitation and on factors that are better suited for preventing aggression such as ward and staff factors. Management and clinicians could adapt staffing and ward in line with these results.


Assuntos
Agressão/psicologia , Unidade Hospitalar de Psiquiatria , Ocupação de Leitos , Feminino , Pessoal de Saúde , Humanos , Masculino , Saúde Mental , Prevalência , Fatores de Risco , Transtornos Relacionados ao Uso de Substâncias/psicologia , Fatores de Tempo , Violência/psicologia
5.
Multimedia | Recursos Multimídia | ID: multimedia-9249

RESUMO

Com o objetivo de ampliar a divulgação de notícias sobre Covid-19 para pessoas com deficiências auditivas, a Coordenação de Comunicação Social (CCS/Fiocruz) lançou um programa semanal que reúne as principais notícias publicadas na Agência Fiocruz de Notícias (AFN) traduzidas para a Língua Brasileira de Sinais (Libras) e com áudio em português.


Assuntos
Vacinas contra COVID-19/provisão & distribuição , Pesquisa Científica e Desenvolvimento Tecnológico , COVID-19/mortalidade , Criança , Adolescente , Ocupação de Leitos/estatística & dados numéricos , Notícias , e-Acessibilidade
6.
Multimedia | Recursos Multimídia | ID: multimedia-9119

RESUMO

Com o objetivo de ampliar a divulgação de notícias sobre Covid-19 para pessoas com deficiências auditivas, a Coordenação de Comunicação Social (CCS/Fiocruz) lançou um programa semanal que reúne as principais notícias publicadas na Agência Fiocruz de Notícias (AFN) traduzidas para a Língua Brasileira de Sinais (Libras) e com áudio em português.


Assuntos
Vacinas contra COVID-19/provisão & distribuição , Vacinas contra COVID-19/administração & dosagem , Ocupação de Leitos , Notícias , e-Acessibilidade
7.
BMC Med ; 19(1): 213, 2021 08 30.
Artigo em Inglês | MEDLINE | ID: mdl-34461893

RESUMO

BACKGROUND: The literature paints a complex picture of the association between mortality risk and ICU strain. In this study, we sought to determine if there is an association between mortality risk in intensive care units (ICU) and occupancy of beds compatible with mechanical ventilation, as a proxy for strain. METHODS: A national retrospective observational cohort study of 89 English hospital trusts (i.e. groups of hospitals functioning as single operational units). Seven thousand one hundred thirty-three adults admitted to an ICU in England between 2 April and 1 December, 2020 (inclusive), with presumed or confirmed COVID-19, for whom data was submitted to the national surveillance programme and met study inclusion criteria. A Bayesian hierarchical approach was used to model the association between hospital trust level (mechanical ventilation compatible), bed occupancy, and in-hospital all-cause mortality. Results were adjusted for unit characteristics (pre-pandemic size), individual patient-level demographic characteristics (age, sex, ethnicity, deprivation index, time-to-ICU admission), and recorded chronic comorbidities (obesity, diabetes, respiratory disease, liver disease, heart disease, hypertension, immunosuppression, neurological disease, renal disease). RESULTS: One hundred thirty-five thousand six hundred patient days were observed, with a mortality rate of 19.4 per 1000 patient days. Adjusting for patient-level factors, mortality was higher for admissions during periods of high occupancy (> 85% occupancy versus the baseline of 45 to 85%) [OR 1.23 (95% posterior credible interval (PCI): 1.08 to 1.39)]. In contrast, mortality was decreased for admissions during periods of low occupancy (< 45% relative to the baseline) [OR 0.83 (95% PCI 0.75 to 0.94)]. CONCLUSION: Increasing occupancy of beds compatible with mechanical ventilation, a proxy for operational strain, is associated with a higher mortality risk for individuals admitted to ICU. Further research is required to establish if this is a causal relationship or whether it reflects strain on other operational factors such as staff. If causal, the result highlights the importance of strategies to keep ICU occupancy low to mitigate the impact of this type of resource saturation.


Assuntos
Ocupação de Leitos/estatística & dados numéricos , COVID-19/mortalidade , Causas de Morte , Cuidados Críticos/estatística & dados numéricos , Mortalidade Hospitalar , Unidades de Terapia Intensiva , Ventiladores Mecânicos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Teorema de Bayes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , SARS-CoV-2 , Adulto Jovem
8.
Am J Med ; 134(11): 1380-1388.e3, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34343515

RESUMO

BACKGROUND: Whether the volume of coronavirus disease 2019 (COVID-19) hospitalizations is associated with outcomes has important implications for the organization of hospital care both during this pandemic and future novel and rapidly evolving high-volume conditions. METHODS: We identified COVID-19 hospitalizations at US hospitals in the American Heart Association COVID-19 Cardiovascular Disease Registry with ≥10 cases between January and August 2020. We evaluated the association of COVID-19 hospitalization volume and weekly case growth indexed to hospital bed capacity, with hospital risk-standardized in-hospital case-fatality rate (rsCFR). RESULTS: There were 85 hospitals with 15,329 COVID-19 hospitalizations, with a median hospital case volume was 118 (interquartile range, 57, 252) and median growth rate of 2 cases per 100 beds per week but varied widely (interquartile range: 0.9 to 4.5). There was no significant association between overall hospital COVID-19 case volume and rsCFR (rho, 0.18, P = .09). However, hospitals with more rapid COVID-19 case-growth had higher rsCFR (rho, 0.22, P = 0.047), increasing across case growth quartiles (P trend = .03). Although there were no differences in medical treatments or intensive care unit therapies (mechanical ventilation, vasopressors), the highest case growth quartile had 4-fold higher odds of above median rsCFR, compared with the lowest quartile (odds ratio, 4.00; 1.15 to 13.8, P = .03). CONCLUSIONS: An accelerated case growth trajectory is a marker of hospitals at risk of poor COVID-19 outcomes, identifying sites that may be targets for influx of additional resources or triage strategies. Early identification of such hospital signatures is essential as our health system prepares for future health challenges.


Assuntos
Ocupação de Leitos/estatística & dados numéricos , COVID-19 , Número de Leitos em Hospital/estatística & dados numéricos , Unidades de Terapia Intensiva/estatística & dados numéricos , Mortalidade , Melhoria de Qualidade/organização & administração , COVID-19/mortalidade , COVID-19/terapia , Defesa Civil , Alocação de Recursos para a Atenção à Saúde/organização & administração , Alocação de Recursos para a Atenção à Saúde/normas , Mortalidade Hospitalar , Hospitalização/estatística & dados numéricos , Humanos , Avaliação de Resultados em Cuidados de Saúde , Sistema de Registros , Medição de Risco , SARS-CoV-2 , Triagem/organização & administração , Estados Unidos/epidemiologia
9.
Int J Qual Health Care ; 33(3)2021 Jul 14.
Artigo em Inglês | MEDLINE | ID: mdl-34219171

RESUMO

BACKGROUND: An established finding suggests that, in balancing variability in patient demand and length of stay, an average bed occupancy of 85% should be targeted for acute hospital wards. The notion is that higher figures result in excessive capacity breaches, while anything lower fails to make economic use of available resources. Although concerns have previously been raised regarding the generic use of the 85% target, there has been little research interest into alternative derivations that may better represent the diverse range of conditions that exist in practice. OBJECTIVE: To quantify a continuum of average occupancy targets for use within the acute hospital setting. METHODS: Computer simulation is used to model the process of acute patient admission and discharge. Patient arrivals are assumed to be independent of one another (i.e. random) with length of stay distributions obtained through fitting to patient-level data from all of England. RESULTS: Target average occupancy increases with ward size, ranging from 45% to 79% for a relatively small 15-bed ward to 64-84% for a relatively large 50-bed ward. Regarding ward speciality, for a typical 25-bed ward, values range from 57-58% for Gynaecology to 67-74% for Adult Mental Health. These increase to 62-63% and 75-82%, respectively, if the tolerance on breaching capacity is relaxed from 2% to 5% of days per year. CONCLUSION: An unconditional 85% target serves as an overestimate across the vast majority of settings that typically exist in practice. Hospital planners should consider ward size, speciality and capacity-breach tolerance in determining a more sensitive assessment of bed occupancy requirements. This study provides hospital planners with a means to reliably assess the operational performance and readily calculate optimal capacity requirements.


Assuntos
Ocupação de Leitos , Admissão do Paciente , Adulto , Simulação por Computador , Inglaterra , Número de Leitos em Hospital , Humanos , Tempo de Internação
10.
Crit Care Med ; 49(11): 1895-1900, 2021 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-34259660

RESUMO

OBJECTIVES: To determine whether the previously described trend of improving mortality in people with coronavirus disease 2019 in critical care during the first wave was maintained, plateaued, or reversed during the second wave in United Kingdom, when B117 became the dominant strain. DESIGN: National retrospective cohort study. SETTING: All English hospital trusts (i.e., groups of hospitals functioning as single operational units), reporting critical care admissions (high dependency unit and ICU) to the Coronavirus Disease 2019 Hospitalization in England Surveillance System. PATIENTS: A total of 49,862 (34,336 high dependency unit and 15,526 ICU) patients admitted between March 1, 2020, and January 31, 2021 (inclusive). INTERVENTIONS: Not applicable. MEASUREMENTS AND MAIN RESULTS: The primary outcome was inhospital 28-day mortality by calendar month of admission, from March 2020 to January 2021. Unadjusted mortality was estimated, and Cox proportional hazard models were used to estimate adjusted mortality, controlling for age, sex, ethnicity, major comorbidities, social deprivation, geographic location, and operational strain (using bed occupancy as a proxy). Mortality fell to trough levels in June 2020 (ICU: 22.5% [95% CI, 18.2-27.4], high dependency unit: 8.0% [95% CI, 6.4-9.6]) but then subsequently increased up to January 2021: (ICU: 30.6% [95% CI, 29.0-32.2] and high dependency unit, 16.2% [95% CI, 15.3-17.1]). Comparing patients admitted during June-September 2020 with those admitted during December 2020-January 2021, the adjusted mortality was 59% (CI range, 39-82) higher in high dependency unit and 88% (CI range, 62-118) higher in ICU for the later period. This increased mortality was seen in all subgroups including those under 65. CONCLUSIONS: There was a marked deterioration in outcomes for patients admitted to critical care at the peak of the second wave of coronavirus disease 2019 in United Kingdom (December 2020-January 2021), compared with the post-first-wave period (June 2020-September 2020). The deterioration was independent of recorded patient characteristics and occupancy levels. Further research is required to determine to what extent this deterioration reflects the impact of the B117 variant of concern.


Assuntos
COVID-19/mortalidade , Mortalidade Hospitalar/tendências , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Ocupação de Leitos , Comorbidade , Cuidados Críticos , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , SARS-CoV-2 , Reino Unido/epidemiologia , Adulto Jovem
11.
Intensive Crit Care Nurs ; 66: 103063, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34092453

RESUMO

OBJECTIVES: Staffing is the single biggest cost component in the critical care budgets. Due to the fluctuation in both bed occupancy and the level of care needs, nursing staff requirement can vary considerably from day to day. This makes the traditional 'fixed roster' staffing system inefficient, costly and potentially unsafe. In this study, we used the existing bed occupancy data to test the viability two 'dynamic' workforce management models. RESEARCH METHODOLOGY: Nursing requirement data were prospectively collected over one year at a thirty-two-bed critical care unit. Using mathematical models, we then tested the concept of two alternative workforce management models and compared the level of staffing, as well as the estimated cost per year. The first was an 'on-call' model, which was a two-tier roster with a standard staffing level and an additional on-call component; the second was a 'predictive' model, which estimated the staffing requirement based on the bed occupancy a few days prior. SETTING: Single centre study in a busy district general hospital with a 32-bed critical care unit. MAIN OUTCOME MEASURES: The number of days with safe staffing levels and the cost of the alternative workforce management models. RESULTS: Data were collected over 331 days. The on-call model was estimated to cost 16% less per year (£431,320, or 2,630 nurse-shift equivalent) compared to the fixed roster, while fulfilling the adequate staffing standards in 97% of the days. While the predictive model could also be used to improve the workforce efficiency, this was overall less efficient than the on-call model. CONCLUSION: The modelled data suggests that the implementation of an 'on-call' model in critical care nursing rostering could potentially improve coverage and appear to be cost effective.


Assuntos
Ocupação de Leitos , Recursos Humanos de Enfermagem no Hospital , Humanos , Unidades de Terapia Intensiva , Admissão e Escalonamento de Pessoal , Recursos Humanos
12.
BMC Health Serv Res ; 21(1): 566, 2021 Jun 09.
Artigo em Inglês | MEDLINE | ID: mdl-34107928

RESUMO

BACKGROUND: Predicting bed occupancy for hospitalised patients with COVID-19 requires understanding of length of stay (LoS) in particular bed types. LoS can vary depending on the patient's "bed pathway" - the sequence of transfers of individual patients between bed types during a hospital stay. In this study, we characterise these pathways, and their impact on predicted hospital bed occupancy. METHODS: We obtained data from University College Hospital (UCH) and the ISARIC4C COVID-19 Clinical Information Network (CO-CIN) on hospitalised patients with COVID-19 who required care in general ward or critical care (CC) beds to determine possible bed pathways and LoS. We developed a discrete-time model to examine the implications of using either bed pathways or only average LoS by bed type to forecast bed occupancy. We compared model-predicted bed occupancy to publicly available bed occupancy data on COVID-19 in England between March and August 2020. RESULTS: In both the UCH and CO-CIN datasets, 82% of hospitalised patients with COVID-19 only received care in general ward beds. We identified four other bed pathways, present in both datasets: "Ward, CC, Ward", "Ward, CC", "CC" and "CC, Ward". Mean LoS varied by bed type, pathway, and dataset, between 1.78 and 13.53 days. For UCH, we found that using bed pathways improved the accuracy of bed occupancy predictions, while only using an average LoS for each bed type underestimated true bed occupancy. However, using the CO-CIN LoS dataset we were not able to replicate past data on bed occupancy in England, suggesting regional LoS heterogeneities. CONCLUSIONS: We identified five bed pathways, with substantial variation in LoS by bed type, pathway, and geography. This might be caused by local differences in patient characteristics, clinical care strategies, or resource availability, and suggests that national LoS averages may not be appropriate for local forecasts of bed occupancy for COVID-19. TRIAL REGISTRATION: The ISARIC WHO CCP-UK study ISRCTN66726260 was retrospectively registered on 21/04/2020 and designated an Urgent Public Health Research Study by NIHR.


Assuntos
Ocupação de Leitos , COVID-19 , Inglaterra , Humanos , Tempo de Internação , SARS-CoV-2
14.
Am J Emerg Med ; 48: 177-182, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33964692

RESUMO

STUDY OBJECTIVE: To develop a novel predictive model for emergency department (ED) hourly occupancy using readily available data at time of prediction with a time series analysis methodology. METHODS: We performed a retrospective analysis of all ED visits from a large academic center during calendar year 2012 to predict ED hourly occupancy. Due to the time-of-day and day-of-week effects, a seasonal autoregressive integrated moving average with external regressor (SARIMAX) model was selected. For each hour of a day, a SARIMAX model was built to predict ED occupancy up to 4-h ahead. We compared the resulting model forecast accuracy and prediction intervals with previously studied time series forecasting methods. RESULTS: The study population included 65,132 ED visits at a large academic medical center during the year 2012. All adult ED visits during the first 265 days were used as a training dataset, while the remaining ED visits comprised the testing dataset. A SARIMAX model performed best with external regressors of current ED occupancy, average department-wide ESI, and ED boarding total at predicting up to 4-h-ahead ED occupancy (Mean Square Error (MSE) of 16.20, and 64.47 for 1-hr- and 4-h- ahead occupancy, respectively). Our 24-SARIMAX model outperformed other popular time series forecasting techniques, including a 60% improvement in MSE over the commonly used rolling average method, while maintaining similar prediction intervals. CONCLUSION: Accounting for current ED occupancy, average department-wide ESI, and boarding total, a 24-SARIMAX model was able to provide up to 4 h ahead predictions of ED occupancy with improved performance characteristics compared to other forecasting methods, including the rolling average. The prediction intervals generated by this method used data readily available in most EDs and suggest a promising new technique to forecast ED occupancy in real time.


Assuntos
Centros Médicos Acadêmicos , Ocupação de Leitos/tendências , Serviço Hospitalar de Emergência , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Aglomeração , Feminino , Previsões , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Adulto Jovem
15.
Sci Rep ; 11(1): 10526, 2021 05 18.
Artigo em Inglês | MEDLINE | ID: mdl-34006932

RESUMO

Despite the particular focus given to influenza since the 2009 influenza A(H1N1) pandemic, true burden of influenza-associated critical illness remains poorly known. The aim of this study was to identify factors influencing influenza burden imposed on intensive care units (ICUs) in a catchment population during recent influenza seasons. From 2008 to 2013, all adult patients admitted with a laboratory-confirmed influenza infection to one of the ICUs in the catchment area were prospectively included. A total of 201 patients (mean age: 63 ± 16, sex-ratio: 1.1) were included. The influenza-related ICU-bed occupancy rate averaged 4.3% over the five influenza seasons, with the highest mean occupancy rate (16.9%) observed during the 2012 winter. In-hospital mortality for the whole cohort was 26%. Influenza A(H1N1)pdm infections (pdm in the mentioned nomenclature refers to Pandemic Disease Mexico 2009), encountered in 51% of cases, were significantly associated with neither longer length of stay nor higher mortality (ICU and hospital) when compared to infections with other virus subtypes. SOFA score (OR, 1.12; 95% CI, 1.04-1.29) was the only independent factor significantly associated with a prolonged hospitalization. These results highlight both the frequency and the severity of influenza-associated critical illness, leading to a sustained activity in ICUs. Severity of the disease, but not A(H1N1)pdm virus, appears to be a major determinant of ICU burden related to influenza.


Assuntos
Área Programática de Saúde , Estado Terminal , Influenza Humana/epidemiologia , Idoso , Ocupação de Leitos/estatística & dados numéricos , Estudos de Coortes , Feminino , França/epidemiologia , Humanos , Vírus da Influenza A/isolamento & purificação , Vírus da Influenza B/isolamento & purificação , Influenza Humana/virologia , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estações do Ano
16.
Pediatr Crit Care Med ; 22(8): 683-691, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-33935270

RESUMO

OBJECTIVES: Healthcare workload has emerged as an important metric associated with poor outcomes. To measure workload, studies have used bed occupancy as a surrogate. However, few studies have examined frontline provider (fellows, nurse practitioners, physician assistants) workload and outcomes. We hypothesize frontline provider workload, measured by bed occupancy and staffing, is associated with poor outcomes and unnecessary testing. DESIGN: A retrospective single-center, time-stamped orders, ordering provider identifiers, and patient data were collected. Regression was performed to study the influence of occupancy on orders, length of stay, and mortality, controlling for age, weight, admission type, Society of Thoracic Surgery-European Association for Cardio-Thoracic Surgery Congenital Heart Surgery Mortality score, diagnosis, number of surgeries, orders, provider staffing, attending experience, and time fixed effects. SETTING: Twenty-seven bed tertiary cardiac ICU in a free-standing children's hospital. PATIENTS: Patients (0-18 yr) admitted to the pediatric cardiac ICU, January 2018 to December 2019. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: There were 16,500 imaging and 73,113 laboratory orders among 1,468 patient admissions. Median age 6 months (12 d to 5 yr), weight 6.2 kg (3.7-16.2 kg); 840 (57.2%) surgical and 628 (42.8%) medical patients. ICU teams consisted of 16 attendings and 31 frontline providers. Mortality 4.4%, median stay 5 days (2-11 d), and median bed occupancy 89% (78-93%). Every 10% increase in bed occupancy had 7.2% increase in imaging orders per patient (p < 0.01), 3% longer laboratory turn-around time (p = 0.015), and 3 additional days (p < 0.01). Higher staffing (> 3 providers) was associated with 6% less imaging (p = 0.03) and 3% less laboratory orders (p = 0.04). The number of "busy days" (bed occupancy > 89%) was associated with longer stays (p < 0.01), and increased mortality (p < 0.01). CONCLUSIONS: Increased bed occupancy and lower staffing were associated with increased mortality, length of stay, imaging orders, and laboratory turn-around time. The data demonstrate performance of the cardiac ICU system is exacerbated during high occupancy and low staffing.


Assuntos
Unidades de Terapia Intensiva , Carga de Trabalho , Ocupação de Leitos , Criança , Mortalidade Hospitalar , Humanos , Lactente , Unidades de Terapia Intensiva Pediátrica , Tempo de Internação , Estudos Retrospectivos
17.
Pediatr Ann ; 50(4): e172-e177, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34039174

RESUMO

Severe acute respiratory syndrome coronavirus 2, the virus causing the pandemic illness coronavirus disease 2019, was first detected in the United States in January 2020. As the illness spread across the country, all aspects and venues of health care were significantly impacted. This article explores the challenges and response of one children's emergency medicine division related to surge planning, personal protective equipment, screening, testing, staffing, and other operational challenges, and describes the impact and implications thus far. [Pediatr Ann. 2021;50(4):e172-e177.].


Assuntos
COVID-19/diagnóstico , COVID-19/terapia , Serviço Hospitalar de Emergência , Ocupação de Leitos/estatística & dados numéricos , Criança , Humanos , Equipamento de Proteção Individual , Admissão e Escalonamento de Pessoal , SARS-CoV-2 , Estados Unidos
18.
S Afr Med J ; 111(3): 240-244, 2021 03 02.
Artigo em Inglês | MEDLINE | ID: mdl-33944745

RESUMO

BACKGROUND: The COVID-19 pandemic has impacted on the global surgery landscape. OBJECTIVES: To analyse and describe the initial impact of the COVID-19 pandemic on orthopaedic surgery at Groote Schuur Hospital, a tertiary academic hospital in South Africa. METHODS: The number of orthopaedic surgical cases, emergency theatre patient waiting times, and numbers of outpatient clinic visits, ward admissions, bed occupancies and total inpatient days for January - April 2019 (pre-COVID-19) were compared with the same time frame in 2020 (COVID-19). The COVID-19 timeframe included initiation of a national 'hard lockdown' from 26 March 2020, in preparation for an increasing volume of COVID-19 cases. RESULTS: April 2020, the time of the imposed hard lockdown, was the most affected month, although the number of surgical cases had started to decrease slowly during the 3 preceding months. The total number of surgeries, outpatient visits and ward admissions decreased significantly during April 2020 (55.2%, 69.1% and 60.6%, respectively) compared with April 2019 (p<0.05). Trauma cases were reduced by 40% in April 2020. Overall emergency theatre patient waiting time was 30% lower for April 2020 compared with 2019. CONCLUSIONS: COVID-19 and the associated lockdown has heavily impacted on both orthopaedic inpatient and outpatient services. Lockdown led to a larger reduction in the orthopaedic trauma burden than in international centres, but the overall reduction in surgeries, outpatient visits and hospital admissions was less. This lesser reduction was probably due to local factors, but also to a conscious decision to avoid total collapse of our surgical services.


Assuntos
COVID-19/epidemiologia , Procedimentos Ortopédicos/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Assistência Ambulatorial/estatística & dados numéricos , Ocupação de Leitos/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Hospitais Urbanos , Humanos , Tempo de Internação/estatística & dados numéricos , Pandemias , SARS-CoV-2 , África do Sul/epidemiologia , Centros de Atenção Terciária , Listas de Espera
20.
Rev Esp Quimioter ; 34(3): 238-244, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33829722

RESUMO

OBJECTIVE: In some patients the immune response triggered by SARS-CoV-2 is unbalanced, presenting an acute respiratory distress syndrome which in many cases requires intensive care unit (ICU) admission. The limitation of ICU beds has been one of the major burdens in the management around the world; therefore, clinical strategies to avoid ICU admission are needed. We aimed to describe the influence of tocilizumab on the need of transfer to ICU or death in non-critically ill patients. METHODS: A retrospective study of 171 patients with SARS-CoV-2 infection that did not qualify as requiring transfer to ICU during the first 24h after admission to a conventional ward, were included. The criteria to receive tocilizumab was radiological impairment, oxygen demand or an increasing of inflammatory parameters, however, the ultimate decision was left to the attending physician judgement. The primary outcome was the need of ICU admission or death whichever came first. RESULTS: A total of 77 patients received tocilizumab and 94 did not. The tocilizumab group had less ICU admissions (10.3% vs. 27.6%, P=0.005) and need of invasive ventilation (0 vs 13.8%, P=0.001). In the multivariable analysis, tocilizumab remained as a protective variable (OR: 0.03, CI 95%: 0.007-0.1, P=0.0001) of ICU admission or death. CONCLUSIONS: Tocilizumab in early stages of the inflammatory flare could reduce an important number of ICU admissions and mechanical ventilation. The mortality rate of 10.3% among patients receiving tocilizumab appears to be lower than other reports. This is a non-randomized study and the results should be interpreted with caution.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , COVID-19/mortalidade , Hospitalização/estatística & dados numéricos , Unidades de Terapia Intensiva/estatística & dados numéricos , Ocupação de Leitos , COVID-19/imunologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Respiração Artificial/estatística & dados numéricos , Estudos Retrospectivos , SARS-CoV-2
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