Recent World Health Organization guidance has aimed to provide pragmatic guidance acknowledging the role of sequential nasopharyngeal swabs taken >24 hours apart for SARS‐CoV‐2 in high‐risk populations. Patients with chronic kidney disease (CKD) are known to have an altered immune milieu which may be associated with a delay in viral clearance. Here, a cross‐sectional observational study of 138 patients admitted with SARS‐CoV‐2 infection at two large regional hospitals in Scotland, UK examined the median time to two consecutive negative nasopharyngeal swabs for SARS‐CoV‐2 in an inpatient population. The median time from admission to the first of two consecutive negative nasopharyngeal swabs was 18 days (range = 1‐44) in patients with CKD, compared with 11 days (range: 1‐71) in patients without CKD (P = .0007). Multivariable linear regression analysis using explanatory variables of age, sex, SARS‐CoV‐2 disease severity, key comorbidities and renal function showed that declining estimated glomerular filtration rate was independently associated with prolonged time to viral clearance. Our data suggest that patients with CKD who are admitted to hospital with SARS‐CoV‐2 take longer to achieve sequential negative nasopharyngeal swab reverse transcription‐polymerase chain reaction results than those without CKD. This has implications for renal service provision, discharge planning and hospital capacity as well as a direct impact on patients due to extended hospital stay, anxiety and stigmatisation.
The large-scale relocation of a paediatric hospital is a significant undertaking. New environments change the system, and ways of working must adapt to maintain quality healthcare. There are risks to patients and staff well-being, with high anxiety around change. There is evidence for the efficacy of simulation as a tool for safe training and rehearsal of staff and teams [1] but less so on such a large scale. Simulation for many is still perceived as a test of performance and a threat. We connected with the international simulation community to design a hospital-wide programme of Patient Environment Simulations for Systems Integration (PESSI). This paper outlines challenges in establishing buy-in from stakeholders and departments, developing a framework for implementation and our reflections on delivery of large-scale simulation activities to assist a hospital move.How can simulation-based methodology be used to support clinical departments on a large scale to adapt/integrate/prepare in moving to a brand-new hospital?Collaboration with authors of PEARLS for system integration use [1], using it as the main framework for delivery and structure of PESSI. Stages of delivery were: pre-phase work, system testing day, debrief/reflection and evaluation. Immediate feedback of enjoyment and learning was collated from all participants. Three-month post-move feedback is planned to review ongoing impact/behaviour change plus analysis of safety incidents.Pre-phase work involved meeting stakeholders and establishing aims of testing. Ward managers were key departmental links, meeting with members of PESSI to plan scenarios. System testing days involved familiarizing themselves with the environment, followed by ‘day in the life’ simulations with a representation of the whole team. All participants were called ‘co-faculty’ and knew exactly what would happen. Debrief involved facilitated conversations with the whole team describing reactions, and deeper analysis of the key events, with concerted efforts by facilitators to give a balanced approach of positives and challenges. A short report was given back to the department detailing the findings teams would need solutions to. Solutions from simulation were implemented prior to the move, increasing staff confidence, with many feeling PESSI played a major role in feeling prepared for the new site. The PESSI framework is being utilized in adult services and we hope to publish our methodology to share with the wider simulation community.
Testing new healthcare systems, environments and processes using simulation-based methods is a rapidly growing topic in the literature. By testing systems in a safe and controlled environment, simulation for system integration allows operational and safety issues to be flagged up without risking patient care This study aims to explore the lived experience of change in nurses moving to a new hospital, and the impact of a simulation programme on their sense of preparedness.The Patient Environment Simulation for Systems Integration (PESSI) programme was developed to test new processes and environments to identify latent safety threats and systems issues prior to staff, patient and community use. A major PESSI project was commissioned to aid the transition of paediatric care in Edinburgh to a new hospital site. Simulation scenarios were developed to mimic an average working morning for each department using staff feedback on processes or factors that might be affected by the change in environment. Staff were invited to participate in departmental simulation days which included orientation in the new environment, a simulation scenario, and a professional debriefing. Following each session, a report was produced detailing key findings.The research team selected a constructivist phenomenological approach to the enquiry and using Bartunek’s et al.’s conceptual framework designed pre- and post-simulation semi-structured interviews (SSIs), and mid-intervention ‘headline reflections’ Results are currently being analysed following the hospital move in March this year. Early findings suggest ‘quality of communication’ and ‘opportunity for familiarization with the environment’ were key themes influencing participant’s feelings of preparedness prior to the move. While ‘recognition of voice’, ‘personal impact’ and ‘good leadership’ appear to be factors impacting participants’ feelings towards the change in working environment after the move. Early indications suggest that the inclusion of local staff groups as part of this simulation had a positive impact on the perception and preparedness of large-scale change.As simulation for system integration becomes more common, it is important that we tailor simulation programmes to best prepare not only the new systems but also the people working there. This can only be done through listening and learning from staff experiences. The research team will seek to publish these findings to help inform future simulation for systems integration programmes.
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