Pandemic Preparedness: COVID-19 Lessons Learned in New York's Hospitals

Jarrett, Mark; Garrick, R.; Gaeta, Anna; Lombardi, Daniel; Mayo, R.M.; McNulty, Patrick H.; Panzer, Robert J.; Krahn, Wolf-Deiter

doi:10.1016/j.jcjq.2022.06.002

Cited by 6 publications

(6 citation statements)

References 16 publications

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Section: Discussionmentioning

confidence: 98%

“…This study adds to the emerging literature on tangible operational policies and interventions employed by hospitals during COVID surges to address major capacity and staffing strain. [12][13][14][15][16][17][18] Several prior studies examined the impact of procedural volume reduction on hospital capacity and patient outcomes. 5,13 Our findings complement these studies by demonstrating how redistribution of inpatients can help leverage the capacity generated by procedural reduction and reduce strain on GMS teams.…”

Section: Discussionmentioning

confidence: 99%

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Impact of a hospital policy to redistribute admission flow across clinical services for capacity relief during COVID‐19 surges

Safavi

Copenhaver

Moore

et al. 2023

Journal of Hospital Medicine

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Background: Increased hospital admissions due to COVID-19 place a disproportionate strain on inpatient general medicine service (GMS) capacity compared to other services.Objective: To study the impact on capacity and safety of a hospital-wide policy to redistribute admissions from GMS to non-GMS based on admitting diagnosis during surge periods. Design, Setting, and Participants: Retrospective case-controlled study at a large teaching hospital. The intervention included adult patients admitted to general care wards during two surge periods (January-February 2021 and 2022) whose admission diagnosis was impacted by the policy. The control cohort included admissions during a matched number of days preceding the intervention. Main Outcomes and Measures: Capacity measures included average daily admissions and hospital census occupied on GMS. Safety measures included length of stay (LOS) and adverse outcomes (death, rapid response, floor-to-intensive care unit transfer, and 30-day readmission).Results: In the control cohort, there were 365 encounters with 299 (81.9%) GMS admissions and 66 (18.1%) non-GMS versus the intervention with 384 encounters, including 94 (24.5%) GMS admissions and 290 (75.5%) non-GMS (p < .001). The average GMS census decreased from 17.9 and 21.5 during control periods to 5.5 and 8.5 during intervention periods. An interrupted time series analysis confirmed a decrease in GMS daily admissions (p < .001) and average daily hospital census (p = .014; p < .001). There were no significant differences in LOS (5.9 vs. 5.9 days, p = .059) or adverse outcomes (53, 14.5% vs. 63, 16.4%; p = .482). Conclusion:Admission redistribution based on diagnosis is a safe lever to reduce capacity strain on GMS during COVID-19 surges.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Impact of a hospital policy to redistribute admission flow across clinical services for capacity relief during COVID‐19 surges

Safavi

Copenhaver

Moore

et al. 2023

Journal of Hospital Medicine

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“…While there are general guidelines, the unprecedented pandemic overwhelmed existing infrastructure. Findings from studies show that unprepared healthcare systems and shortages of PPE/facilities increase the risk of infection among frontline workers ( 34 ). This is consistent with the results of the present study, which shows that the lack of personal equipment, improper ventilation, and non-standard space of wards and personnel rest rooms cause a double burden on the mental pressure that nurses suffer.…”

Section: Discussionmentioning

confidence: 99%

Nurses’ perception of work and life under COVID-19 pandemic conditions: a qualitative study

Maghsoodi,

Vanaki,

Mohammadi

2023

Front. Public Health

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ObjectivesAlthough nurses work and live in special and stressful conditions due to the nature of their profession, in periods of crises and pandemics, when the work pressure on nurses and the public’s need for professional services increases to extraordinary and incomparable levels compared to customary conditions, their work and life situation becomes entirely different. Therefore, what nurses experienced in the COVID-19 pandemic went beyond the typical challenges of their work environment. This study was conducted to discover nurses’ perceptions of work and life during the COVID-19 pandemic.MethodsThis qualitative study was conducted with a conventional content analysis approach on 16 nurses working in the inpatient wards during the COVID-19 pandemic in Iran. Data were collected through unstructured, individual, and in-depth interviews between August 2020 and June 2023 and were analyzed using content analysis with the conventional (inductive) approach of Granheim and Lundman.ResultsData analysis led to the extraction of 11 subcategories, namely, “feeling a lack of support and understanding from managers,” “team cooperation and communication challenges in difficult work conditions,” “shadow of burnout,” “shortage inequity,” “dissatisfaction with unfair wages and benefits,” “not having their work and sacrifices appreciated,” “suffering and fatigue of using personal protective equipment (PPE),” “deprivation of entertainment and rest,” “fear of illness and imminent death,” “low resilience,” and “deteriorating life conditions” These 11 subcategories led to the following themes: “unsafe work environment” and “the shadow of suffering and death.”ConclusionNurses working in COVID-19 wards in Iran worked in an unsafe work environment during the COVID-19 pandemic and had to deal with suffering and fear of death. It is necessary to pay attention to the needs and problems of nurses, and healthcare organizations must provide the required support to maintain the physical and mental health of nurses during epidemics.

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“…Notably, during the pandemic, the flexibility given to the CCSS, because it is a single and integrated healthcare system, distinguished it from fragmented ones (ie, many different health ‘subsystems’ coexist, providing care for different parts of a country’s population; each of these subsystems has its own way of financing and delivering healthcare, and each provides healthcare to different types of people), such as in New York, where challenges arose due to the lack of coordination across different health providers. 44 The CCSS Medical Manager mentioned the importance of network management of the system; for instance, ‘I saw what was happening in other places, for example, what the governor of New York said, that he would have liked all the hospitals in New York to operate at the same time and in the same way. At a certain moment, not only were some hospitals filled to the brim and others not as much, but they also belonged to different systems.…”

Section: Costa Rica’s Strategy To Maintain Ehssmentioning

confidence: 99%

Maintaining essential health services during a pandemic: lessons from Costa Rica’s COVID-19 response

Mora-García,

Pearson,

Prado

2024

BMJ Glob Health

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Studies on COVID-19 usually focus on health system responses to decrease the rate of COVID-19 infection and death, but patients with other diseases also require access to health services during the pandemic. This paper describes the structures and processes by which the Costa Rican Social Security Fund (CCSS) changed in response to the COVID-19 pandemic, which helped to sustain essential health services (EHSs). We conducted a desk review of the local literature and semistructured qualitative interviews with key informants from the CCSS. We found that the CCSS implemented changes in structure, such as creating a specialised COVID-19 centre and hiring additional interim health workers. The CCSS also implemented changes in processes, including leveraging its integrated network to optimise its resources and support alternative care modalities. These changes generated changes in outputs and outcomes that helped sustain EHSs for non-COVID-19 patients. These interventions were possible primarily due to Costa Rica’s underlying health system, particularly its integrated nature with a single institution in charge of healthcare provision financed through mandatory health insurance, a unique digital medical record system and a contingency fund.

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Pandemic Preparedness: COVID-19 Lessons Learned in New York's Hospitals

Cited by 6 publications

References 16 publications

Impact of a hospital policy to redistribute admission flow across clinical services for capacity relief during COVID‐19 surges

Impact of a hospital policy to redistribute admission flow across clinical services for capacity relief during COVID‐19 surges

Nurses’ perception of work and life under COVID-19 pandemic conditions: a qualitative study

Maintaining essential health services during a pandemic: lessons from Costa Rica’s COVID-19 response

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