scholarly journals The COVID Army: Experiences from the Deployment of Non-Hospitalist Physician Volunteers during the 2020 COVID Pandemic

2021 ◽  
pp. 1-15
Author(s):  
Kevin Hauck ◽  
Katherine Hochman ◽  
Mark Pochapin ◽  
Sondra Zabar ◽  
Jeffrey A Wilhite ◽  
...  
Keyword(s):  
New York ◽  
New York City ◽  
Medical Center ◽  
The United States ◽  
Lessons Learned ◽  
Front Line ◽  
Clinical Leadership ◽  
Team Members ◽  
Medical Centers ◽  
Hospitalist Physician

Abstract Objective New York City was the epicenter of the outbreak of the 2020 COVID-19 pandemic in the United States. As a large, quaternary care medical center, NYU Langone Medical Center was one of many New York medical centers that experienced an unprecedented influx of patients during this time. Clinical leadership effectively identified, oriented, and rapidly deployed a “COVID Army”, consisting of non-hospitalist physicians, to meet the needs of this patient influx. We share feedback from our providers on our processes and offer specific recommendations for systems experiencing a similar influx in the current and future pandemics. Methods In order to assess the experiences and perceived readiness of these physicians (n=183), we distributed a 32-item survey between March and June of 2020. Thematic analyses and response rates were examined in order to develop results. Results Responses highlighted varying experiences and attitudes of our front-line physicians during an emerging pandemic. Thematic analyses revealed a series of lessons learned, including the need to: (1) provide orientations, (2) clarify roles/ workflow, (3) balance team workload, (4) keep teams updated on evolving policies, (5) make team members feel valued, and (6) ensure they have necessary tools available. Conclusions Lessons from our deployment and assessment are scalable at other institutions.

scholarly journals Evolving oxygenation management reasoning in COVID-19

Diagnosis ◽  
2020 ◽  
Vol 7 (4) ◽  
pp. 381-383
Author(s):  
Steven Liu ◽  
Cara Sweeney ◽  
Nalinee Srisarajivakul-Klein ◽  
Amanda Klinger ◽  
Irina Dimitrova ◽  
...  
Keyword(s):  
United States ◽  
Intensive Care Unit ◽  
New York ◽  
New York City ◽  
Intensive Care ◽  
Initial Phase ◽  
The United States ◽  
Lessons Learned ◽  
Hypoxemic Respiratory Failure ◽  
Hospital Wards

AbstractThe initial phase of the SARS-CoV-2 pandemic in the United States saw rapidly-rising patient volumes along with shortages in personnel, equipment, and intensive care unit (ICU) beds across many New York City hospitals. As our hospital wards quickly filled with unstable, hypoxemic patients, our hospitalist group was forced to fundamentally rethink the way we triaged and managed cases of hypoxemic respiratory failure. Here, we describe the oxygenation protocol we developed and implemented in response to changing norms for acuity on inpatient wards. By reflecting on lessons learned, we re-evaluate the applicability of these oxygenation strategies in the evolving pandemic. We hope to impart to other providers the insights we gained with the challenges of management reasoning in COVID-19.

scholarly journals Antimicrobial stewardship perspectives from a New York City hospital during the COVID-19 pandemic: Challenges and opportunities

2021 ◽  
Author(s):  
Christine J Kubin ◽  
Angela S Loo ◽  
Jennifer Cheng ◽  
Brian Nelson ◽  
Monica Mehta ◽  
...  
Keyword(s):  
New York ◽  
New York City ◽  
Antimicrobial Stewardship ◽  
York City ◽  
Antibiotic Use ◽  
The United States ◽  
Lessons Learned ◽  
City Hospital ◽  
Challenges And Opportunities ◽  
Challenging Environment

Abstract Purpose To share challenges and opportunities for antimicrobial stewardship programs based on one center’s experience during the early weeks of the coronavirus disease 2019 (COVID-19) pandemic. Summary In the spring of 2020, New York City quickly became a hotspot for the COVID-19 pandemic in the United States, putting a strain on local healthcare systems. Antimicrobial stewardship programs faced diagnostic and therapeutic uncertainties as well as healthcare resource challenges. With the lack of effective antivirals, antibiotic use in critically ill patients was difficult to avoid. Uncertainty drove antimicrobial use and thus antimicrobial stewardship principles were paramount. The dramatic influx of patients, drug and equipment shortages, and the need for prescribers to practice in alternative roles only compounded the situation. Establishing enhanced communication, education, and inventory control while leveraging the capabilities of the electronic medical record were some of the tools used to optimize existing resources. Conclusion New York City was a unique and challenging environment during the initial peak of the COVID-19 pandemic. Antimicrobial stewardship programs can learn from each other by sharing lessons learned and practice opportunities to better prepare other programs facing COVID-19 case surges.

scholarly journals Hospital Closure and Insights into Patient Dispersion

2015 ◽  
Vol 06 (01) ◽  
pp. 185-199 ◽  
Author(s):  
N. Garg ◽  
G. Husk ◽  
T. Nguyen ◽  
A. Onyile ◽  
S. Echezona ◽  
...  
Keyword(s):  
New York ◽  
New York City ◽  
York City ◽  
Information Exchange ◽  
Health Information Exchange ◽  
Medical Center ◽  
The United States ◽  
Hospital System ◽  
Hospital Closures ◽  
Hospital Closure

SummaryBackground: Hospital closures are becoming increasingly common in the United States. Patients who received care at the closing hospitals must travel to different, often farther hospitals for care, and nearby remaining hospitals may have difficulty coping with a sudden influx of patients.Objectives: Our objectives are to analyze the dispersion patterns of patients from a closing hospital and to correlate that with distance from the closing hospital for three specific visit types: emergency, inpatient, and ambulatory.Methods: In this study, we used data from a health information exchange to track patients from Saint Vincent’s Medical Center, a hospital in New York City that closed in 2010, to determine where they received emergency, inpatient, and ambulatory care following the closure.Results: We found that patients went to the next nearest hospital for their emergency and inpatient care, but ambulatory encounters did not correlate with distance.Discussion: It is likely that patients followed their ambulatory providers as they transitioned to another hospital system. Additional work should be done to determine predictors of impact on nearby hospitals when another hospital in the community closes in order to better prepare for patient dispersion.Citation: Garg N, Husk G, Nguyen T, Onyile A, Echezona S, Kuperman G, Shapiro JS. Hospital closure and insights into patient dispersion: the closure of Saint Vincent’s Catholic Medical Center in New York City. Appl Clin Inf 2015; 6: 185–199http://dx.doi.org/10.4338/ACI-2014-10-RA-0090

scholarly journals Psychiatric Care in a Novel Federal COVID-19 Treatment Center: Development of a Consultation-Liaison Psychiatry Service at the Javits New York Medical Station

2021 ◽  
Author(s):  
Alexander Kaplan ◽  
Colin M Smith ◽  
Olli Toukolehto ◽  
Gerrit van Schalkwyk
Keyword(s):  
New York ◽  
New York City ◽  
York City ◽  
The United States ◽  
Lessons Learned ◽  
Treatment Center ◽  
Medical Providers ◽  
Liaison Psychiatry ◽  
Convention Center ◽  
Consultation Liaison Psychiatry

ABSTRACT At the outset of the 2019 coronavirus disease (COVID-19) pandemic, New York City faced the highest burden of COVID-19 cases in the United States. In response, the U.S. Federal Government deployed medical providers from various uniformed services to treat patients with COVID-19 at the Jacob Javits Convention Center in New York City. There quickly arose a need for psychiatric services for patients with COVID-19 and psychological support for medical staff. Psychiatrists were tasked with establishing a consult-liaison psychiatry service in this unique environment. The authors detail the establishment of a novel consultation-liaison psychiatry service in a large convention center and explore lessons learned from this experience with the aim to empower uniformed psychiatrists to prepare for and deliver patient-focused care in pandemic settings.

scholarly journals COVID-19-Associated Critical Illness—Report of the First 300 Patients Admitted to Intensive Care Units at a New York City Medical Center

2020 ◽  
Vol 35 (10) ◽  
pp. 963-970 ◽  
Author(s):  
Sudham Chand ◽  
Sumit Kapoor ◽  
Deborah Orsi ◽  
Melissa J. Fazzari ◽  
Tristan G. Tanner ◽  
...  
Keyword(s):  
United States ◽  
New York ◽  
Mechanical Ventilation ◽  
New York City ◽  
Intensive Care ◽  
Critical Illness ◽  
Mortality Rate ◽  
York City ◽  
Medical Center ◽  
The United States

Background: The first confirmed case of novel coronavirus (2019-nCoV) infection in the United States was reported from the state of Washington in January, 2020. By March, 2020, New York City had become the epicenter of the outbreak in the United States. Methods: We tracked all patients with confirmed coronavirus-19 (COVID-19) infection admitted to intensive care units (ICU) at Montefiore Medical Center (Bronx, NY). Data were obtained through manual review of electronic medical records. Patients had at least 30 days of follow-up. Results: Our first 300 ICU patients were admitted March 10 through April 11, 2020. The majority (60.7%) of patients were men. Acute respiratory distress syndrome (ARDS) was documented in 91.7% of patients; 91.3% required mechanical ventilation. Prone positioning was employed in 58% of patients and neuromuscular blockade in 47.8% of mechanically-ventilated patients. Neither intervention was associated with decreased mortality. Vasopressors were required in 77.7% of patients. Acute kidney injury (AKI) was present on admission in 40.7% of patients, and developed subsequently in 36.0%; 50.9% of patients with AKI received renal replacement therapy (RRT). Overall 30-day mortality rate was 52.3%, and 55.8% among patients receiving mechanical ventilation. In univariate analysis, higher mortality rate was associated with increasing age, male sex, hypertension, obesity, smoking, number of comorbidities, AKI on presentation, and need for vasopressor support. A representative multivariable model for 30-day mortality is also presented, containing patient age, gender, body mass index, and AKI at admission. As of May 11, 2020, 2 patients (0.7%) remained hospitalized. Conclusions: Mortality in critical illness associated with COVID-19 is high. The majority of patients develop ARDS requiring mechanical ventilation, vasopressor-dependent shock, and AKI. The variation in mortality rates reported to date likely reflects differences in the severity of illness of the evaluated populations.

Educating Restaurant Workers About Paid Sick Leave: A Pilot Study From New York City

2018 ◽  
Vol 28 (2) ◽  
pp. 358-377
Author(s):  
Emma K. Tsui ◽  
Madeline Duffy ◽  
Sherry Baron
Keyword(s):  
New York ◽  
New York City ◽  
Sick Leave ◽  
York City ◽  
The United States ◽  
Lessons Learned ◽  
Coalition Building ◽  
The Public ◽  
Paid Sick Leave ◽  
Sick Leave Policies

Across the United States, cities, states, and counties are rapidly adopting paid sick leave laws. Paid sick leave policies for restaurant workers may be particularly beneficial, since these workers are less likely to have these benefits and have the potential to spread infection through food-handling and engagement with the public. In order for paid sick leave laws to work, workers and employers must be educated about these laws broadly and effectively. Focusing on New York City, we conducted a pilot research using key stakeholder interviews to learn about New York City’s successes and challenges in educating workers and businesses about the law. Our findings indicate several lessons learned, including allocating sufficient funding, combined use of coalition building and organizing models, and attention to the needs of immigrant restaurant workers. Findings also suggest that greater attention should be paid to proactively addressing workplace organization and practices that thwart paid sick leave use.

Gerald H. Thayer's ornithological work in St Vincent and the Grenadines, Lesser Antilles

2018 ◽  
Vol 45 (1) ◽  
pp. 21-39 ◽  
Author(s):  
James W. Wiley
Keyword(s):  
New York ◽  
New York City ◽  
West Indies ◽  
The United States ◽  
Lesser Antilles ◽  
American Museum ◽  
The West ◽  
Comparative Zoology ◽  
North And South America ◽  
North And South

Gerald Handerson Thayer (1883–1939) was an artist, writer and naturalist who worked in North and South America, Europe and the West Indies. In the Lesser Antilles, Thayer made substantial contributions to the knowledge and conservation of birds in St Vincent and the Grenadines. Thayer observed and collected birds throughout much of St Vincent and on many of the Grenadines from January 1924 through to December 1925. Although he produced a preliminary manuscript containing interesting distributional notes and which is an early record of the region's ornithology, Thayer never published the results of his work in the islands. Some 413 bird and bird egg specimens have survived from his work in St Vincent and the Grenadines and are now housed in the American Museum of Natural History (New York City) and the Museum of Comparative Zoology (Cambridge, Massachusetts). Four hundred and fifty eight specimens of birds and eggs collected by Gerald and his father, Abbott, from other countries are held in museums in the United States.

Applying the Devil's Works in a Holy Cause: Working-Class Popular Culture and the Salvation Army in the United States, 1879-1900

1997 ◽  
Vol 7 (2) ◽  
pp. 195-223
Author(s):  
Lillian Taiz
Keyword(s):  
United States ◽  
New York ◽  
New York City ◽  
Popular Culture ◽  
York City ◽  
The United States ◽  
Salvation Army ◽  
Public Meeting ◽  
The Many ◽  
Sunday Evening

Forty-eight hours after they landed in New York City in 1880, a small contingent of the Salvation Army held their first public meeting at the infamous Harry Hill's Variety Theater. The enterprising Hill, alerted to the group's arrival from Britain by newspaper reports, contacted their leader, Commissioner George Scott Railton, and offered to pay the group to “do a turn” for “an hour or two on … Sunday evening.” In nineteenth-century New York City, Harry Hill's was one of the best known concert saloons, and reformers considered him “among the disreputable classes” of that city. His saloon, they said, was “nothing more than one of the many gates to hell.”

scholarly journals Preparedness and response to an emerging health threat—Lessons learned from Candida auris outbreaks in the United States

2021 ◽  
pp. 1-6
Author(s):  
Diane Meyer ◽  
Elena K. Martin ◽  
Syra Madad ◽  
Priya Dhagat ◽  
Jennifer B. Nuzzo
Keyword(s):  
United States ◽  
New York ◽  
Qualitative Interviews ◽  
The United States ◽  
Lessons Learned ◽  
Infection Prevention And Control ◽  
Healthcare Organizations ◽  
Candida Auris ◽  
Term Care ◽  
Healthcare Facilities

Abstract Objective: Candida auris infections continue to occur across the United States and abroad, and healthcare facilities that care for vulnerable populations must improve their readiness to respond to this emerging organism. We aimed to identify and better understand challenges faced and lessons learned by those healthcare facilities who have experienced C. auris cases and outbreaks to better prepare those who have yet to experience or respond to this pathogen. Design: Semi-structured qualitative interviews. Setting: Health departments, long-term care facilities, acute-care hospitals, and healthcare organizations in New York, Illinois, and California. Participants: Infectious disease physicians and nurses, clinical and environmental services, hospital leadership, hospital epidemiology, infection preventionists, emergency management, and laboratory scientists who had experiences either preparing for or responding to C. auris cases or outbreaks. Methods: In total, 25 interviews were conducted with 84 participants. Interviews were coded using NVivo qualitative coding software by 2 separate researchers. Emergent themes were then iteratively discussed among the research team. Results: Key themes included surveillance and laboratory capacity, inter- and intrafacility communication, infection prevention and control, environmental cleaning and disinfection, clinical management of cases, and media concerns and stigma. Conclusions: Many of the operational challenges noted in this research are not unique to C. auris, and the ways in which we address future outbreaks should be informed by previous experiences and lessons learned, including the recent outbreaks of C. auris in the United States.

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