Discharge Home From Critical Care: Comparing Different Health Care Systems

Abstract Objectives Clinical laboratory analyses are essential part of critical care. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)/coronavirus disease 2019 (COVID-19)-confirmed cases were doubling in Germany every 3 days during March 2020. Health care systems are preparing for an epidemic crisis. Methods We outline a cohort-based emergency planning. The plan is based on three independent self-sufficient cohorts that maintain duty for 7 days, followed by quarantine-like rest for 14 days. COVID-19-infected and otherwise ill personnel will be replaced by a tactical reserve, which is again replaced by recovered staff. Results We switched to the outlined system when incidence of confirmed COVID-19 cases surpassed 50/100,000 residents. Our parameter spectrum was reduced to the essential analyses in agreement with our clinical colleagues. So far the system works well. In model calculations, the system is robust to maintain essential laboratory functionality even when incidence of COVID-19 is higher than that currently observed in the most severely hit countries. Conclusions We outline a cohort-based emergency planning to maintain essential functionality of a clinical laboratory while minimizing the risk of spreading infection with COVID-19 among our workforce during the COVID-19 epidemic faced in 2020.

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How can new technology be introduced, evaluated, and financed in critical care?

Clinical Chemistry ◽

10.1093/clinchem/36.8.1604 ◽

1990 ◽

Vol 36 (8) ◽

pp. 1604-1611 ◽

Cited By ~ 12

Author(s):

W J Sibbald ◽

M Escaf ◽

J E Calvin

Keyword(s):

United States ◽

Health Care ◽

Critical Care ◽

Health Care Systems ◽

New Technology ◽

The United States ◽

Care Systems

Abstract We briefly review issues impacting the introduction, evaluation, and cost of technology in critical care, providing a clinician's perspective. Where appropriate, we note important distinctions between health-care systems in Canada and the United States--primarily the result of significant differences in the methods for funding health care in the two countries. Finally, we discuss what processes might be reasonably considered for evaluating technology in critical care and discuss the probability of various consequences that will significantly affect the care we provide our patients if critical-care practitioners, industry, and health planners fail to jointly undertake this responsibility.

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American Academy of Nursing: Improving health and health care systems with advanced practice registered nurse practice in acute and critical care settings

Nursing Outlook ◽

10.1016/j.outlook.2014.07.003 ◽

2014 ◽

Vol 62 (5) ◽

pp. 366-370

Keyword(s):

Health Care ◽

Critical Care ◽

American Academy ◽

Registered Nurse ◽

Health Care Systems ◽

Advanced Practice ◽

Advanced Practice Registered Nurse ◽

Care Systems

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Applying Health-Six-Sigma Principles Helps Reducing the Variability of Length of Stay in the Emergency Department

International Journal for Quality in Health Care ◽

10.1093/intqhc/mzab086 ◽

2021 ◽

Author(s):

Ayala Kobo-Greenhut ◽

Keren Holzman ◽

Osnat Raviv ◽

Izhar Ben Shlomo ◽

Jakov Arad

Keyword(s):

Health Care ◽

Emergency Department ◽

Length Of Stay ◽

Six Sigma ◽

Medical Center ◽

Health Care Systems ◽

Discharge Home ◽

Care Systems ◽

Experienced Team

ABSTRACT Background Reducing length of stay (LOS) is one of the urgent problems in health care systems worldwide. Popular methods that are used to reduce LOS are the Lean and the 6 Sigma, which in practice result in limited improvements. In this paper we introduce and test a tailored method for implementing the 6 Sigma principles in healthcare (we call H-6S). Methods The study took place within the emergency department (ED) of the "Josephtal Medical Center" in Eilat, Israel. Our analysis focused on the processes of examining and treating patients from admission to ED until discharge home. The analysis was done during the second quarter of 2018. The implementation of the recommendations took place during Q3 2018. The reported results are from Q3 2018 to Q2 2019, compared to the corresponding period in 2017 (experienced team). Results In Q2 2017 LOS was 2.42h ± 2.07h (experienced team, N=9928). In Q2 2018, the LOS was 2.62h± 7.04h (before the H-6S, inexperienced team, N=9484). In Q2 2019 following the intervention it reached 2.3h±1.74h (N=7647). The differences between the SDs of the three periods are significant. Conclusion Implementing H-6S dropped variance of LOS within 3 months and remained low for the whole year. Each new team of physicians who enters the emergency department should be thoroughly instructed as to the routines and expectations of the system from them, which should narrow the differences of previous education between them.

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Family and Psychosocial Considerations in Critical Care

10.1093/oso/9780190077013.003.0012 ◽

2021 ◽

pp. 251-273

Author(s):

Macarena Gálvez Herrer ◽

Judy E. Davidson ◽

Gabriel Heras La Calle

Keyword(s):

Health Care ◽

Critical Care ◽

Health Care Systems ◽

International Perspective ◽

Health Care Managers ◽

The Core ◽

Care Managers ◽

The Family ◽

Care Systems ◽

Effective Service

This chapter discusses the expanding movement to humanize critical care and intensive care settings. An international perspective is provided with regard to how patients, families, and professionals, along with health care managers and authorities, can redesign health care systems to overcome the obstacles of dehumanization in hospitals and health centers, with social interest at the core. The authors maintain that caring for all parties, including the family, that coexist in the health care system is critical to building an excellent and effective service.

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