scholarly journals 815 The Impact and Implications for The Workload for Vascular Surgery as A Result of the COVID-19 Lockdown

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
J Nicholls ◽  
C Stewart ◽  
J Coulston
Keyword(s):  
Critical Care ◽  
Vascular Surgery ◽  
Time Period ◽  
Care Capacity ◽  
The Impact ◽  
Second Wave ◽  
Surgical Unit

Abstract Introduction The emergence of the coronavirus pandemic and subsequent UK lockdown resulted in a significant reduction in elective vascular surgery to increase critical care capacity. We aimed to ascertain the impact of lockdown on the workload of a busy vascular surgical unit. Method Data on all major vascular procedures performed between March 2020 and June 2020 were collected prospectively. Comparison to the same time period over the last 6 years was performed using a prospectively maintained database. Results 92 major cases were performed, a reduction of 30% compared with cases performed during similar periods (803 cases total, mean 133), with an increased proportion of unplanned & emergency cases(35.9% & 31.5% vs 31.4% & 20.5%). There was a significant reduction in aortic procedures (19 vs mean 36). Despite the reduction in cases there was a similar number of amputations performed (9 vs mean 10). Conclusions The lockdown period resulted in a 30% reduction in cases performed with far fewer aortic procedure performed and a similar number of amputations. These pending cases will need consideration, especially with critical care capacity to ensure they are completed within a timely period. Considerations for capacity are also pertinent given the approach of winter and the possibility of a second wave.

scholarly journals A Data Driven Change-point Epidemic Model for Assessing the Impact of Large Gathering and Subsequent Movement Control Order on COVID-19 Spread in Malaysia

2020 ◽  
Author(s):  
Sarat C. Dass ◽  
Wai M. Kwok ◽  
Gavin J. Gibson ◽  
Balvinder S. Gill ◽  
Bala M. Sundram ◽  
...  
Keyword(s):  
Change Point ◽  
Movement Control ◽  
Disease Spread ◽  
Time Period ◽  
Before And After ◽  
Quantitative Understanding ◽  
Control Order ◽  
Short Time ◽  
The Impact ◽  
Second Wave

AbstractThe second wave of COVID-19 in Malaysia is largely attributed to a mass gathering held in Sri Petaling between February 27, 2020 and March 1, 2020, which contributed to an exponential rise of COVID-19 cases in the country. Starting March 18, 2020, the Malaysian government introduced four consecutive phases of a Movement Control Order (MCO) to stem the spread of COVID-19. The MCO was implemented through various non-pharmaceutical interventions (NPIs). The reported number of cases reached its peak by the first week of April and then started to reduce, hence proving the effectiveness of the MCO. To gain a quantitative understanding of the effect of MCO on the dynamics of COVID-19, this paper develops a class of mathematical models to capture the disease spread before and after MCO implementation in Malaysia. A heterogeneous variant of the Susceptible-Exposed-Infected-Recovered (SEIR) model is developed with additional compartments for asymptomatic transmission. Further, a change-point is incorporated to model the before and after disease dynamics, and is inferred based on data. Related statistical analyses for inference are developed in a Bayesian framework and are able to provide quantitative assessments of (1) the impact of the Sri Petaling gathering, and (2) the extent of decreasing transmission during the MCO period. The analysis here also quantitatively demonstrates how quickly transmission rates fall under effective NPI implemention within a short time period.

UK COVID-19 response will gain more urgency

2020 ◽  
Keyword(s):  
Critical Care ◽  
Scientific Community ◽  
Behavioural Change ◽  
Testing Strategy ◽  
Content Type ◽  
The United Kingdom ◽  
Hospital Patients ◽  
The Government ◽  
Care Capacity ◽  
The Impact

Subject UK COVID-19 response. Significance The United Kingdom has been pursuing a policy of gradual escalation to deal with the impact of the COVID-19 pandemic. This, in combination with its testing strategy which is now restricted to in-hospital patients only, departs from the WHO’s advice and contrasts with the more drastic social distancing approaches taken by governments elsewhere in Europe. London's strategy has generated significant backlash from parts of the scientific community. The government now accepts COVID-19 spread is faster than expected, and yesterday announced school and university closures. Impacts The full consequences of the government’s initially slower approach will become increasingly apparent over the upcoming weeks. The NHS is set to be overwhelmed by the surge of COVID-19 patients, especially its critical-care capacity. Confused communication and frequent changes in measures will hamper future efforts to bring about public behavioural change.

scholarly journals Adapting hospital capacity to meet changing demands during the COVID-19 pandemic

BMC Medicine ◽  
2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Ruth McCabe ◽  
Nora Schmit ◽  
Paula Christen ◽  
Josh C. D’Aeth ◽  
Alessandra Løchen ◽  
...  
Keyword(s):  
Critical Care ◽  
Medical Staff ◽  
Elective Surgery ◽  
The Other ◽  
Junior Doctors ◽  
Private Hospitals ◽  
Hospital Capacity ◽  
Treat All ◽  
Care Capacity ◽  
The Impact

Abstract Background To calculate hospital surge capacity, achieved via hospital provision interventions implemented for the emergency treatment of coronavirus disease 2019 (COVID-19) and other patients through March to May 2020; to evaluate the conditions for admitting patients for elective surgery under varying admission levels of COVID-19 patients. Methods We analysed National Health Service (NHS) datasets and literature reviews to estimate hospital care capacity before the pandemic (pre-pandemic baseline) and to quantify the impact of interventions (cancellation of elective surgery, field hospitals, use of private hospitals, deployment of former medical staff and deployment of newly qualified medical staff) for treatment of adult COVID-19 patients, focusing on general and acute (G&A) and critical care (CC) beds, staff and ventilators. Results NHS England would not have had sufficient capacity to treat all COVID-19 and other patients in March and April 2020 without the hospital provision interventions, which alleviated significant shortfalls in CC nurses, CC and G&A beds and CC junior doctors. All elective surgery can be conducted at normal pre-pandemic levels provided the other interventions are sustained, but only if the daily number of COVID-19 patients occupying CC beds is not greater than 1550 in the whole of England. If the other interventions are not maintained, then elective surgery can only be conducted if the number of COVID-19 patients occupying CC beds is not greater than 320. However, there is greater national capacity to treat G&A patients: without interventions, it takes almost 10,000 G&A COVID-19 patients before any G&A elective patients would be unable to be accommodated. Conclusions Unless COVID-19 hospitalisations drop to low levels, there is a continued need to enhance critical care capacity in England with field hospitals, use of private hospitals or deployment of former and newly qualified medical staff to allow some or all elective surgery to take place.

scholarly journals The introduction of regular group reflective practice sessions for junior doctors in a critical care setting during the second wave of COVID-19 pandemic – a Pilot

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S124-S124
Author(s):  
Itunuayo V Ayeni ◽  
Elizabeth Headon
Keyword(s):  
Critical Care ◽  
Reflective Practice ◽  
Care Setting ◽  
Critical Care Setting ◽  
Junior Doctors ◽  
Regular Group ◽  
Feedback Questionnaire ◽  
The Impact ◽  
Second Wave ◽  
Insight Into

AimsReflective practice is a core component of undergraduate as well as post graduate training. Reflective practice provides an opportunity for individuals to learn through their experience as well as gaining insight into themselves and their practice. If completed effectively, it has been shown to reduce stress and improve mental well-being. Our aim therefore was to provide regular group reflective practice sessions with the aim of supporting junior doctor's mental wellbeing during the second wave of the COVID-19 pandemic.MethodJunior doctors within a critical care setting were offered two-weekly group reflective practice sessions focusing on ‘difficult or challenging cases and encounters.’ The sessions were offered to all junior and middle grade doctors within a critical care department in a small district general hospital. Consultants were also able to attend. The groups were facilitated by a consultant liaison psychiatrist and an accredited balint group leader. Critical care doctors were provided a feedback questionnaire assessing the impact of the sessions and the levels of stress and burnout. The themes emerging from the sessions were also explored.ResultA total of six reflective practice sessions were offered during a three-month period. A total of four reflective practice sessions were completed; two sessions were cancelled due to high workload on the department. Each session lasted approximately 50mins. On average a total of 3-4 junior doctors attended each session. The sessions were conducted face to face in a socially distanced manner and with all participants wearing face masks. The sessions were predominately attended by foundation doctors and SHOs. There was occasional attendance by middle grades and a consultant.The predominant themes that emerged included: guilt, prolonged suffering, desensitisation, support and exhaustion. Despite the challenges associated with the pandemic and lockdown, many of the doctors also acknowledged the benefit of being at work during both waves of the pandemic. There was a sense of collectiveness and group belonging. The group found it beneficial to be able to share their experiences and challenges faced; this was most striking amongst the very junior members of the team.Questionnaires were also provided to gain additional insight into the wellbeing of the critical care doctors. Worryingly the results highlighted a significant proportion of doctors were experiencing signs of burnout including fatigue (77%), lack of energy (54%), cynicism (31%), frustration and irritability (45%) and detachment (38%). Many of the issues highlighted were in response to the demand created by the pandemic and a lack of medical staffing wth 69% of doctors requesting regular feedback on staffing issues.ConclusionBurnout and low morale were already highlighted in a significant number of junior doctors prior to the pandemic. COVID-19 has identified a clear need for NHS employers and medical leaders to provide emotional and psychological support to staff. It is vital that we create an open environment where individuals can express their feelings openly without fear that they will be judged. Group reflective practice provides an avenue to build on collectiveness created during both waves of the COVID-19 pandemic. This pilot has demonstrated that if introduced as part of a wellbeing support package, junior doctors within a critical care setting are able to utilise the sessions in an effective and productive manner.

scholarly journals 1358 Does A COVID Protected Hospital Within A COVID Hospital Enable Elective Care and Training Opportunities?

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
H Rashid ◽  
T Gala ◽  
Q Ain ◽  
H Ashraf ◽  
S Vesamia ◽  
...  
Keyword(s):  
Critical Care ◽  
Training Environment ◽  
Informatics System ◽  
Surgical Trainees ◽  
Business Informatics ◽  
The Uk ◽  
The Impact ◽  
Second Wave ◽  
Training Opportunities ◽  
And Training

Abstract Introduction Elective care in the UK came to a standstill with the advent of the COVID-19 pandemic. A restart could only be enabled with ‘green site’ separation and a ‘covid protected’ zone. A ‘hospital within the hospital’ concept was developed including 9 elective theatres, 28 ring fenced elective beds, a surgical enhanced care unit, a canteen, and a separated entrance. This model was underpinned with PPE, enhanced infection control and guidance for staff. The study documented the ability to recover elective activity and therefore provide a training environment for surgical trainees. Method Data was collected weekly (7/20 to 1/21) through the business informatics system with regard to theatres cases completed compared to the activity achieved in the 11-theatre elective estate pre COVID-19. Results Pre COVID-19, an average of 263 cases were completed per week. In the first week of operation, 31% of theatre capacity was achieved. By week 7, 106% of pre COVID was recorded and 130% by week 11. This was maintained until the impact of the second wave where activity has reduced to 50% but is not anticipated to reduce further as local anaesthetic and blocks maybe utilised. Conclusions This ‘hospital within the hospital’ has enabled elective care to return to above normal levels, with increased efficiencies. This has enabled a rapid return to a training environment for trainees disheartened with deployment to critical care in the first wave.

scholarly journals SARS CoV2 Second Wave Onslaught in India and Mass Vaccination Prospects

2021 ◽  
Vol 6 (2) ◽  
Keyword(s):  
Critical Care ◽  
World Health Organisation ◽  
Mass Vaccination ◽  
World Health ◽  
The World ◽  
Care Capacity ◽  
Second Wave

In little over a year, in March 2020 the World Health Organisation declared COVID-19 a pandemic and on March 24, India went into the longest lockdown. On March 25, 2020, the number of new cases stood 121 and deaths were two. Contrast to that, in corresponding month this year, there are more than 53,000 cases daily and more than 250 deaths. It is still rising, doubling every 12-14 days. India is now the country with the highest number of daily infections and casualties. Unlike the first wave, the cases are currently much more widespread and has severely strained the country’s critical care capacity. This paper attempts to note the virus onslaught during Covid-19 second wave and India’s prospect at navigating the pandemic and foster for citizens early and reliable access to vaccines.

scholarly journals Percutaneous Dilational Tracheostomy at the Epicenter of the SARS-CoV-2 Pandemic: Impact on Critical Care Resource Utilization and Early Outcomes

2021 ◽  
pp. 000313482110586
Author(s):  
Leandra Krowsoski ◽  
Benjamin D. Medina ◽  
Charles DiMaggio ◽  
Charles Hong ◽  
Samantha Moore ◽  
...  
Keyword(s):  
Critical Care ◽  
Care Center ◽  
Tertiary Care ◽  
Case Series ◽  
Time Frame ◽  
Bleeding Complications ◽  
Percutaneous Dilational Tracheostomy ◽  
Icu Discharge ◽  
Care Capacity ◽  
The Impact

Background The COVID-19 pandemic overwhelmed New York City hospitals early in the pandemic. Shortages of ventilators and sedatives prompted tracheostomy earlier than recommended by professional societies. This study evaluates the impact of percutaneous dilational tracheostomy (PDT) in COVID+ patients on critical care capacity. Methods This is a single-institution prospective case series of mechanically ventilated COVID-19 patients undergoing PDT from April 1 to June 4, 2020 at a public tertiary care center. Results Fifty-five patients met PDT criteria and underwent PDT at a median of 13 days (IQR 10, 18) from intubation. Patient characteristics are found in Table 1 . Intravenous midazolam, fentanyl, and cisatracurium equivalents were significantly reduced 48 hours post-PDT ( Table 2 ). Thirty-five patients were transferred from the ICU and liberated from the ventilator. Median time from PDT to ventilator liberation and ICU discharge was 10 (IQR 4, 14) and 12 (IQR 8, 17) days, respectively. Decannulation occurred in 45.5% and 52.7% were discharged from acute inpatient care ( Figure 1 ). Median follow-up for the study was 62 days. Four patients had bleeding complications postoperatively and 11 died during the study period. Older age was associated with increased odds of complication (OR 1.12, 95% CI 1.04, 1.23) and death (OR=1.15, 95% CI 1.05, 1.30). All operators tested negative for COVID-19 during the study period. Conclusion These findings suggest COVID-19 patients undergoing tracheostomy within the standard time frame can improve critical care capacity in areas strained by the pandemic with low risk to operators. Long-term outcomes after PDT deserve further study.

Impact on physician workload and revenue following the creation of a specialty vein clinic within an academic vascular practice

2007 ◽  
Vol 22 (4) ◽  
pp. 164-170 ◽  
Author(s):  
M A Passman ◽  
J B Dattilo ◽  
R J Guzman ◽  
T C Naslund
Keyword(s):  
Vascular Surgery ◽  
Rapid Expansion ◽  
Time Period ◽  
Relative Value ◽  
Increasing Trend ◽  
Procedure Volume ◽  
Time Periods ◽  
The Impact ◽  
Academic Vascular Surgery ◽  
Physician Workload

Objective: To evaluate the impact of creating a new specialty vein clinic within an academic-based vascular practice on clinical volume, physician workload and financial parameters. Methods: All patients evaluated and treated for varicose vein related problems within an academic vascular surgery practice were identified from institutional billing databases. Data were stratified according to the time period prior to establishing a vein clinic (PRE-VC) (1999–2001) and after creation of a vein clinic (POST-VC) (2002–2004). Clinical volume, physician workload and financial parameters were evaluated. Comparisons were made between vein (VEIN) and overall vascular (VASC) practice trends. Results: Comparison of clinical volume, physician workload and financial parameters in both the clinic and operative settings showed larger and more rapid expansion of the VEIN practice than VASC practice between PRE-VC and POST-VC time periods (VEIN vs. VASC growth, respectively: new patient clinic volume +162 vs. +18%; clinic relative value units (RVUs) +131 vs. +1%, clinic revenue +201 vs. +44%; procedure volume +348 vs. +19%; procedure RVUs +129 vs. +11%; procedure revenue +93 vs. +10%). Comparing the beginning of PRE-VC to the end of POST-VC time periods, an increasing trend was also present for the percentage of VEIN practice accounting for the total VASC practice (%VEIN PRE-VC to POST-VC, respectively: new patient clinic volume 11.6–30.2%; clinic RVUs 3.2–48.2%; clinic revenue 17.6–31.2%; procedure volume 3.1–14.3%; procedure RVUs 2.8–9.8%; procedure revenue 3.3–11.7%). Conclusion: Establishing a specialty vein clinic within an academic vascular practice can lead to a rapid expansion of clinical volume with associated increase in physician workload and reimbursement at a rate greater than that for the overall vascular practice.

scholarly journals Modelling the impact of interventions on the progress of the COVID-19 outbreak including age segregation

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248243
Author(s):  
Jorge Rodríguez ◽  
Mauricio Patón ◽  
Joao M. Uratani ◽  
Juan M. Acuña
Keyword(s):  
Critical Care ◽  
Time Course ◽  
Social Impact ◽  
Model Simulation ◽  
The Elderly ◽  
Age Segregation ◽  
Care Capacity ◽  
High Degree ◽  
The Impact ◽  
Epidemiological Information

In this work, a SEIR-type mathematical model of the COVID-19 outbreak was developed that describes individuals in compartments by infection stage and age group. The model assumes a close well-mixed community with no migrations. Infection rates and clinical and epidemiological information govern the transitions between stages of the disease. The impact of specific interventions (including the availability of critical care) on the outbreak time course, the number of cases and the outcome of fatalities were evaluated. Data available from the COVID-19 outbreak from Spain as of mid-May 2020 was used. Key findings in our model simulation results indicate that (i) universal social isolation measures appear effective in reducing total fatalities only if they are strict and the number of daily interpersonal contacts is reduced to very low numbers; (ii) selective isolation of only the elderly (at higher fatality risk) appears almost as effective as universal isolation in reducing total fatalities but at a possible lower economic and social impact; (iii) an increase in the number of critical care capacity directly avoids fatalities; (iv) the use of personal protective equipment (PPE) appears to be effective to dramatically reduce total fatalities when adopted extensively and to a high degree; (v) extensive random testing of the population for more complete infection recognition (accompanied by subsequent self-isolation of infected aware individuals) can dramatically reduce the total fatalities only above a high percentage threshold that may not be practically feasible.

scholarly journals Comparing COVID-19 Critical Care Admissions by Minority Populations to Pre-COVID-19 Critical Care Utilization

2020 ◽  
Author(s):  
Panagis Galiatsatos ◽  
Kathleen Page ◽  
Souvik Chatterjee ◽  
Joyce Maygers ◽  
Sauradeep Sarkar ◽  
...  
Keyword(s):  
Critical Care ◽  
African American ◽  
Urban Region ◽  
Care Utilization ◽  
Minority Populations ◽  
Patient Admissions ◽  
Time Period ◽  
Critical Care Resource ◽  
The Impact ◽  
Ethnic Distribution

Abstract Background: Several months into the COVID-19 pandemic, reassessing intensive care unit (ICU) utilization, specifically with regional impact on diverse populations, should be a priority for hospitals planning for critical care resource allocation. In our study, we reviewed the impact of COVID-19 on a community hospital serving an urban region, comparing the sociodemographic distribution of ICU admissions before and during the pandemic. Methods: We executed a time sensitive analysis to see if COVID-19 ICU admissions reflect regional sociodemographic populations as well as ICU admission trends prior to the current pandemic. Collected sociodemographic variables included sex, race, ethnicity, and age of adult patients (age 18 and older) admitted to the hospital’s medical and cardiac ICUs, which were converted to COVID-19 ICUs. The time period selected was 18-months, which was then dichotomized into pre-COVID-19 admissions (December 1, 2018 to March 13, 2020) and COVID-19 ICU admissions (March 14, 2020 to May 31, 2020). Variables were compared using Fisher’s exact tests and Wilcoxon tests when appropriate.Results: During the 18-month period, 1861 patients were admitted to the aforementioned ICUs. The mean age of the 1861 patients was 62.75 + 15.57 years old, with the majority of these patients being male (52.23%), White (64.43%), and non-Hispanic/Latinx (95.75%). There were differences in racial and ethnic distribution comparing pre-COVID-19 admissions to the COVID-19 admissions. Compared to pre-COVID-19 ICU admissions, there was an increase in African American versus White admissions (p=0.01) and an increase in Hispanic/Latinx versus non-Hispanic/Latinx admissions (p<0.01), during the COVID-19 pandemic.Discussion: During the first three months of admissions to COVID-19 ICUs, there was a rise in admissions among Hispanic/Latinx and African-American patients, while non-Hispanic/Latinx and White patient admissions declined compared to the previous pre-COVID year. These findings support development of strategies to enhance allocation of resources to bolster novel, equitable strategies to mitigate the incidence of COVID-19 in minority populations.

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