Impact of COVID-19 on inpatient clinical emergencies: A single-center experience

Mitchell, Oscar; Neefe, Stacie; Ginestra, Jennifer C; Baston, Cameron; Frazer, Michael J.; Gudowski, Steven W; Min, Jin Sik; Ahmed, Nahreen; Pascual, José L.; Schweickert, William D.; Anderson, Brian J.; Anesi, George L; Falk, Scott A.; Shashaty, Michael G. S.

doi:10.1016/j.resplu.2021.100135

Cited by 7 publications

(9 citation statements)

References 5 publications

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“…This result could be indicative of an earlier RRT activation when the patients’ conditions are still less severe. The introduction of the PR-Team during the pandemic has also been aimed at optimizing patients’ access to the ICU in order to balance resources and requests [ 18 ]. In fact, our research showed a non-significant increase in ICU admission from 14% to 19.6% (p=0.13).…”

Section: Discussionmentioning

confidence: 99%

“…At the beginning of 2020, the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection caused severe problems to healthcare facilities all around the world, heavily impacting the organization and workload of emergency services and subsequently ICUs [ 15 - 18 ]. Additionally, an increase in intra-hospital emergencies and cardiac arrests with worsened outcomes was observed [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

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Impact of the Proactive Rounding Team on Rapid Response System During COVID-19 Pandemic: A Retrospective Study From an Italian Medical Center

Roasio¹,

Costanzo²,

Bergesio³

et al. 2022

Cureus

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Objective: During the coronavirus disease 2019 (COVID-19) pandemic a proactive rounding (PR) team was introduced in our clinical practice in order to recognize the clinical deterioration of the patient as soon as possible. This study aimed to evaluate the impact of the PR team on the rapid response system (RRS) workload with particular regard to the activity carried out, the mode of intervention, and the outcome of patients. Methods: In this retrospective study, the first period before the activation of the PR team (March 1, 2019, to February 29, 2020) and the second period after its activation (March 1, 2020, to March 1, 2021) were compared. Results: A total of 406 inpatient RRS activations were collected. The medical emergency team (MET) dose was 13 and 12.2 activations/1000 admitted patients per year while the incidence of unexpected cardiac arrests was 3.8 and 2.6 events/1000 admitted patients per year (p=0.10). MET response time was longer in the second period (3.5±1.6 minutes vs 4.5±2.6 minutes p<0.01). We recorded more RRS activations for medical patients than surgical ones; MET was activated more frequently by physicians than nurses and for less severe criteria. Patients admitted to the intensive care unit had lower Simplified Acute Physiology Score II (SAPS II) scores. Conclusions: The PR team introduced during the COVID-19 pandemic did not increase the RRS workload. In addition, it allowed an earlier activation of the MET, especially by physicians.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Impact of the Proactive Rounding Team on Rapid Response System During COVID-19 Pandemic: A Retrospective Study From an Italian Medical Center

Roasio¹,

Costanzo²,

Bergesio³

et al. 2022

Cureus

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“…Inadequate resources and training are challenges to implementing EWS that were heightened during the pandemic. Various medical devices are in shortage globally (19,20) and missed training opportunities created a gap in professional development, negatively impacting clinicians' confidence. (21,22).…”

Section: Discussionmentioning

confidence: 99%

“…(21,22). The surge in hospitalisation and escalation to ICU due to the COVID-19 pandemic necessitate the enforcement of national and international frameworks as a well emergency response to overcome the crisis (20,23,24). That came ahead of implementing a national EWS developed for ward patients when hospitals were more stable functionally.…”

Section: Discussionmentioning

confidence: 99%

Implementation of a digital early warning score (NEWS2) in a cardiac specialist and general hospital settings in the COVID-19 pandemic: A qualitative study

Alhmoud

Bonicci

Patel

et al. 2022

Preprint

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Objectives: To evaluate implementation of EHR-integrated NEWS2 in a cardiac care setting and a general hospital setting in the COVID-19 pandemic. Design: Thematic analysis of qualitative semi-structured interviews with purposefully sampled nurses and managers, as well as online surveys. Settings: Specialist cardiac hospital (St Bartholomews Hospital) and General teaching hospital (University College London Hospital). Participants: Eleven nurses and managers from cardiology, cardiac surgery, oncology, and intensive care wards (St Bartholomews) and medical, haematology and intensive care wards (UCLH) were interviewed and sixty-seven were surveyed online. Results: Three main themes emerged: (i) Implementing NEWS2 challenges and supports; (ii) Value of NEWS2 to alarm, escalate, particularly during the pandemic; and (iii) Digitalisation: EHR integration and automation. The value of NEWS2 was partly positive in escalation, yet there were concerns by nurses who undervalued NEWS2 particularly in cardiac care. Challenges, like clinicians' behaviours, lack of resources and training and the perception of NEWS2 value, limit the success of this implementation. Changes in guidelines in the pandemic have led to overlooking NEWS2. EHR integration and automated monitoring are improvement solutions that are not fully employed yet. Conclusion: Whether in specialist or general medical settings, the health professionals implementing EWS in healthcare face cultural and systems related challenges to adopting NEWS2 and digital solutions. The validity of NEWS2 in specialised settings and complex conditions is not yet apparent and requires comprehensive validation. EHRs integration and automation are powerful tools to facilitate NEWS2 if its principles are reviewed and rectified, and resources and training are accessible. Further examination of implementation from the cultural and automation domains are needed.

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“… 23 As a result, appropriate, timely management of acutely ill patients declined. 24 25 Escalating care of an acutely ill patient must follow timely and careful assessment, then communicating the evaluation to the designated critical care professional for further intervention. Errors in detecting worsening of the condition and failure to communicate or intervene can hamper escalation of care and negatively impact clinical outcomes and National Early Warning Score (NEWS2) performance.…”

Section: Introductionmentioning

confidence: 99%

Evaluating a novel, integrative dashboard for health professionals’ performance in managing deteriorating patients:a quality improvement project

et al. 2022

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BackgroundThe quality of recording and documentation of deteriorating patient management by health professionals has been challenged during the COVID-19 pandemic. Non-adherence to escalation and documentation guidelines increases risk of serious adverse events. Electronic health record (EHR)-integrated dashboards are auditing tools of patients’ status and clinicians’ performance, but neither the views nor the performance of health professionals have been assessed, relating to management of deteriorating patients.ObjectiveTo develop and evaluate a real-time dashboard of deteriorating patients’ assessment, referral and therapy.SettingsFive academic hospitals in the largest National Health Service (NHS) trust in the UK (Barts Health NHS Trust).InterventionThe dashboard was developed from EHR data to investigate patients with National Early Warning Score (NEWS2)>5, assessment, and escalation of deteriorating patients. We adopted the Plan, Do, Study, Act model and Standards for Quality Improvement Reporting Excellence framework to evaluate the dashboard.DesignMixed methods: (1) virtual, face-to-face, interviews and (2) retrospective descriptive EHR data analysis.ResultsWe interviewed three nurses (two quality and safety and one informatics specialists). Participants perceived the dashboard as a facilitator for auditing NEWS2 recording and escalation of care to improve practice; (2) there is a need for guiding clinicians and adjusting data sources and metrics to enhance the functionality and usability. Data analysis (2019–2022) showed: (1) NEWS2 recording has gradually improved (May 2021–April 2022) from 64% to 83%;(2) referral and assessment completion increased (n: 170–6800 and 23–540, respectively).ConclusionThe dashboard is an effective real-time data-driven method for improving the quality of managing deteriorating patients. Integrating health systems, a wider analysis NEWS2 and escalation of care metrics, and clinicians’ learning digital solutions will enhance functionality and experience to boost its value. There is a need to examine the generalisability of the dashboard through further validation and quality improvement studies.

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Impact of COVID-19 on inpatient clinical emergencies: A single-center experience

Cited by 7 publications

References 5 publications

Impact of the Proactive Rounding Team on Rapid Response System During COVID-19 Pandemic: A Retrospective Study From an Italian Medical Center

Impact of the Proactive Rounding Team on Rapid Response System During COVID-19 Pandemic: A Retrospective Study From an Italian Medical Center

Implementation of a digital early warning score (NEWS2) in a cardiac specialist and general hospital settings in the COVID-19 pandemic: A qualitative study

Evaluating a novel, integrative dashboard for health professionals’ performance in managing deteriorating patients:a quality improvement project

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