Trends in US Surgical Procedures and Health Care System Response to Policies Curtailing Elective Surgical Operations During the COVID-19 Pandemic

Objective The coronavirus disease 2019 (COVID-19) pandemic requires clinicians to explore alternatives to routine patient management. Otolaryngologists caring for children commonly depend on physical examination, laboratory data, and ambulatory surgical procedures. Limiting patient care, mindful allocation of resources, and concern for safety have challenged all aspects of our health care system. This evidence-based clinical consensus is designed to guide practitioners of pediatric otolaryngology for common scenarios during this time. Data Sources Peer-reviewed literature, published reports, institutional guidelines, and expert consensus. Review Methods A clinical consensus on 6 common scenarios in pediatric otolaryngology developed with evidence-based strategies. Conclusions Providers should suspend all in-person nonessential office visits and elective surgical procedures. An emphasis on medical management and caregiver education will provide reasonable approaches to many of the common outpatient concerns. Surgery for chronic otitis media, obstructive sleep apnea, and acute rhinosinusitis should occur only in response to severe complications or failure of medical regimens. The approach to the pediatric neck mass focuses on timely management for oncologic etiologies and cautious surgical intervention for abscess drainage or tissue sampling. Finally, epistaxis and otorrhea must be triaged and addressed without the usual ambulatory procedures. Implications for Practice Adaptation of practice patterns during this unprecedented moment for our health care system requires thoughtful planning. The strategies described allow for safe handling of common pediatric otolaryngology diagnoses. Ultimately, otolaryngologists must be stewards of our global health community while advocating for the care of individual pediatric patients.

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Emergency Care Gap in Brazil: Geographical Accessibility as a Proxy of Response Capacity to Tackle COVID-19

Frontiers in Public Health ◽

10.3389/fpubh.2021.740284 ◽

2021 ◽

Vol 9 ◽

Author(s):

Lincoln Luís Silva ◽

Amanda de Carvalho Dutra ◽

Luciano de Andrade ◽

Pedro Henrique Iora ◽

Guilherme Luiz Rodrigues Ramajo ◽

...

Keyword(s):

Health Care ◽

Health Care System ◽

Emergency Care ◽

Northern Region ◽

Public Health Care ◽

System Response ◽

The North ◽

Hospital Beds ◽

Response Capacity ◽

Care System

Background: The new coronavirus disease (COVID-19) has claimed thousands of lives worldwide and disrupted the health system in many countries. As the national emergency care capacity is a crucial part of the COVID-19 response, we evaluated the Brazilian Health Care System response preparedness against the COVID-19 pandemic.Methods: A retrospective and ecological study was performed with data retrieved from the Brazilian Information Technology Department of the Public Health Care System. The numbers of intensive care (ICU) and hospital beds, general or intensivist physicians, nurses, nursing technicians, physiotherapists, and ventilators from each health region were extracted. Beds per health professionals and ventilators per population rates were assessed. A health service accessibility index was created using a two-step floating catchment area (2SFCA). A spatial analysis using Getis-Ord Gi* was performed to identify areas lacking access to high-complexity centers (HCC).Results: As of February 2020, Brazil had 35,682 ICU beds, 426,388 hospital beds, and 65,411 ventilators. In addition, 17,240 new ICU beds were created in June 2020. The South and Southeast regions have the highest rates of professionals and infrastructure to attend patients with COVID-19 compared with the northern region. The north region has the lowest accessibility to ICUs.Conclusions: The Brazilian Health Care System is unevenly distributed across the country. The inequitable distribution of health facilities, equipment, and human resources led to inadequate preparedness to manage the COVID-19 pandemic. In addition, the ineffectiveness of public measures of the municipal and federal administrations aggravated the pandemic in Brazil.

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Medical Quality Management

Mayo Clinic Preventive Medicine and Public Health Board Review ◽

10.1093/med/9780199743018.003.0018 ◽

2010 ◽

pp. 287-298

Author(s):

Andrew Majka ◽

Prathibha Varkey

Keyword(s):

Health Care ◽

Health Care System ◽

Improve Patient Care ◽

System Response ◽

Institute Of Medicine ◽

The Public ◽

Medical Quality ◽

Improve Patient ◽

Care System

The past 2 decades have seen unprecedented advances in medicine and technology. However, the health care system continues to perform far below acceptable levels for ensuring safety and addressing patient needs. The publication To Err Is Human: Building a Safer Health System from the Institute of Medicine galvanized health care system response and the public demand for change. Providers rely largely on paper tools, memory, and hard work to improve patient care. However, it is difficult to create reliable and sustained improvement in health care with use of traditional methods. Improvement often requires deliberate redesign of processes through human factors knowledge, as well as tools such as Lean and Six Sigma known to assist improvement. The clear ethical imperative to enhance the quality and safety of health care and meet external accreditation requirements and patient expectations calls providers to address quality of care issues.

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Planning a Coordinated Local Health Care System Response to a Pandemic Using an Accelerated Delphi Technique: Phase 1

Can J Public Health ◽

10.1007/bf03405496 ◽

2009 ◽

Vol 100 (1) ◽

pp. 65-69 ◽

Cited By ~ 1

Author(s):

Shelley A. Stalker ◽

Erica Weir ◽

Sandra L. Vessel ◽

Joyce Mikail

Keyword(s):

Health Care ◽

Health Care System ◽

Delphi Technique ◽

Phase 1 ◽

System Response ◽

Local Health ◽

Local Health Care ◽

Local Health Care System ◽

Care System

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A bivariate prediction approach for adapting the health care system response to the spread of COVID-19

PLoS ONE ◽

10.1371/journal.pone.0240150 ◽

2020 ◽

Vol 15 (10) ◽

pp. e0240150

Author(s):

Paolo Berta ◽

Paolo Paruolo ◽

Stefano Verzillo ◽

Pietro Giorgio Lovaglio

Keyword(s):

Health Care ◽

Health Care System ◽

System Response ◽

Prediction Approach ◽

Care System

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Teletinnitus Program at the VA Gulf Coast Veterans Health Care System

Perspectives on Telepractice ◽

10.1044/teles4.1.23 ◽

2014 ◽

Vol 4 (1) ◽

pp. 23-29

Author(s):

Constance Hilory Tomberlin

Keyword(s):

Health Care ◽

Patient Satisfaction ◽

Patient Care ◽

Health Care System ◽

Gulf Coast ◽

New Technology ◽

Cost Effective ◽

Veterans Health ◽

Potential Benefits ◽

Care System

There are a multitude of reasons that a teletinnitus program can be beneficial, not only to the patients, but also within the hospital and audiology department. The ability to use technology for the purpose of tinnitus management allows for improved appointment access for all patients, especially those who live at a distance, has been shown to be more cost effective when the patients travel is otherwise monetarily compensated, and allows for multiple patient's to be seen in the same time slots, allowing for greater access to the clinic for the patients wishing to be seen in-house. There is also the patient's excitement in being part of a new technology-based program. The Gulf Coast Veterans Health Care System (GCVHCS) saw the potential benefits of incorporating a teletinnitus program and began implementation in 2013. There were a few hurdles to work through during the beginning organizational process and the initial execution of the program. Since the establishment of the Teletinnitus program, the GCVHCS has seen an enhancement in patient care, reduction in travel compensation, improvement in clinic utilization, clinic availability, the genuine excitement of the use of a new healthcare media amongst staff and patients, and overall patient satisfaction.

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