scholarly journals A novel ethical approach to moral distress during COVID 19 in New York

2020 ◽  
pp. 147775092097710
Author(s):  
Janet Dolgin ◽  
Renee McLeod-Sordjan ◽  
Walter Markowitz ◽  
Maria Sanmartin
Keyword(s):  
New York ◽  
Mixed Method ◽  
Decision Aid ◽  
Moral Distress ◽  
Lessons Learned ◽  
Allocation Strategy ◽  
Island Region ◽  
Hospital System ◽  
Hospital Executives ◽  
Innovative Work

The initial surge of COVID19 patients in New York, created a surge of unprecedented numbers in the largest integrated hospital system of the New York City and surrounding Long Island region. Due to innovation and clinician ingenuity ventilator allocation was going to have an easier solution than alleviating the moral distress of overworked and understaffed clinicians. Through the innovative work of clinicians, leadership and the leadership of Governor Cuomo and hospital executives, the need for triaging ventilators did not become a reality. Yet the need for ethicists to support and aid clinicians in the discernment and need for escalation for scarce ICU resources and personnel was key. The transition from an allocation strategy of ventilators organically occurred as rapidly as the surge of COVID19 as it became clear that addressing clinician distress was imperative to maintain the level of human capital. An allocation strategy was envisioned that would assess the urgency of need for intensive care resources utilizing established decision aid calculators. In a mixed method quantitative and qualitative review, this article utilizes descriptive data to illustrate the lessons learned from utilizing ethics consultants to review pandemic decision making and alleviate clinician moral distress.

Decision Support to Masters, Mates on Watch, and Pilots: The Piloting Expert System

1990 ◽  
Vol 43 (03) ◽  
pp. 364-384 ◽  
Author(s):  
Martha Grabowski
Keyword(s):  
Decision Making ◽  
New York ◽  
Decision Support ◽  
Expert System ◽  
Decision Aid ◽  
Decision Aids ◽  
Gulf Of Alaska ◽  
Lessons Learned ◽  
Simple Task ◽  
Cognitive Decision

Piloting large vessels in increasingly congested waterways is no simple task. As in many ‘decision-making under uncertainty’ scenarios, masters, mates and pilots engaged in piloting are inundated with much information and required to make crucial decisions in real time. Piloting is also an inherently judgmental activity. Pilots and ships' captains invariably develop heuristics for transiting particular waterways. As vessels become larger, cargoes more hazardous, and the waterways more congested, decision aid technology is being considered to improve piloting decision-making. This paper describes one approach to providing improved on-board decision support to masters, mates on watch, and pilots navigating in restricted waters. We discuss (1) the use of cognitive decision aids in piloting, (2) the design of such a decision aid developed for New York harbour, (3) simulator experiments evaluating the expert system, and (4) plans to apply the approach and ‘lessons learned’ to the development of an expert system for tankers transiting the Gulf of Alaska.

scholarly journals COVID-19 Pandemic Surge: After Action Report of a Coalition of Emergency Departments in New York City

2021 ◽  
pp. 1-18
Author(s):  
Christopher Tedeschi ◽  
Angela M. Mills ◽  
Rahul Sharma ◽  
Emme Deland ◽  
Benjamin Johnston ◽  
...  
Keyword(s):  
New York ◽  
New York City ◽  
Best Practices ◽  
Healthcare System ◽  
Metropolitan Area ◽  
York City ◽  
Emergency Departments ◽  
Lessons Learned ◽  
Hospital System ◽  
The U.S

Abstract The COVID-19 pandemic has stressed the U.S. healthcare system in unprecedented ways. In March and April 2020, emergency departments (EDs) throughout New York City experienced high volumes and acuity related to the pandemic. Here we present a structured after-action report of a coalition of nine EDs within a hospital system in the New York City metropolitan area, with an emphasis on best practices developed during the prolonged surge as well as specific opportunities for growth. We report our experience in six key areas using a framework built around lessons learned. This report represents the most salient concepts related to our institutional after-action report, and those seemingly most relevant to our peer institutions dealing with similar circumstances.

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 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.

scholarly journals Assessing a Decision Support Tool for SOC Analysts

2021 ◽  
Author(s):  
Jassim Happa ◽  
Ioannis Agrafiotis ◽  
Martin Helmhout ◽  
Thomas Bashford-Rogers ◽  
Michael Goldsmith ◽  
...  
Keyword(s):  
Decision Support ◽  
Mixed Method ◽  
User Study ◽  
Situational Awareness ◽  
Decision Support Tool ◽  
Lessons Learned ◽  
Visualization Tool ◽  
Support Tool ◽  
Response Strategies ◽  
Method Approach

In recent years, many tools have been developed to understand attacks that make use of visualization, but few examples aims to predict real-world consequences. We have developed a visualization tool that aims to improve decision support during attacks. Our tool visualizes propagation of risks from IDS and AV-alert data by relating sensor alerts to Business Process (BP) tasks and machine assets: an important capability gap present in many Security Operation Centres (SOCs) today. In this paper we present a user study in which we evaluate the tool's usability and ability to deliver situational awareness to the analyst. Ten analysts from seven SOCs performed carefully designed tasks related to understanding risks and prioritising recovery decisions. The study was conducted in laboratory conditions, with simulated attacks, and used a mixed-method approach to collect data from questionnaires, eyetracking and voice-recorded interviews. The findings suggest that providing analysts with situational awareness relating to business priorities can help them prioritise response strategies. Finally, we provide an in-depth discussion on the wider questions related to user studies in similar conditions as well as lessons learned from our user study and developing a visualization tool of this type.

Skull Base Aerosol Generating Cases Amidst the COVID-19 Pandemic: An Experience from the Epicenter

2021 ◽  
Author(s):  
Yosef Dastagirzada ◽  
Olga Klauberg ◽  
Kathleen Sheerin ◽  
Seth Lieberman ◽  
Richard Lebowitz ◽  
...  
Keyword(s):  
New York ◽  
New York City ◽  
Skull Base ◽  
World Health ◽  
Protective Equipment ◽  
Preoperative Testing ◽  
Hospital System ◽  
The World ◽  
Health Organization ◽  
Theoretical Risk

AbstractSoon after the World Health Organization declared the severe acute respiratory syndrome coronavirus 2 a global health emergency on January 30, 2020, New York City was plagued by the virus and its health system and economy pushed to their limits. The majority of the limited neurosurgical data in relation to COVID-19 is anecdotal and the higher theoretical risk of transmission of the virus among skull base aerosol generating (SBAG) cases has not been investigated or discussed in a neurosurgical population. We discuss a series of 13 patients who underwent 15 SBAG surgical procedures during the peak of COVID-19 in our hospital system and the protocols use perioperatively for their procedures. Our data support that with proper preoperative testing, a well-delineated surgical algorithm, and appropriate personal protective equipment, emergent/urgent cases can be done safely in hospitals that are currently experiencing high volumes of COVID-19 cases as we did in March to May of 2020.

scholarly journals PPE during a pandemic: The experience of obtaining PPE and lessons learned from a department of obstetrics and gynecology in New York city

2020 ◽  
Vol 44 (6) ◽  
pp. 151293
Author(s):  
Jacob K. Lauer ◽  
Karen P. Acker ◽  
Lisa Saiman ◽  
Arnold A. Advincula ◽  
Richard L. Berkowtiz
Keyword(s):  
New York ◽  
New York City ◽  
York City ◽  
Lessons Learned ◽  
Obstetrics And Gynecology

scholarly journals Interactive, Hands-On Training for Hospital Workers Increases Level of Special Pathogen Preparedness

Sci ◽  
2021 ◽  
Vol 3 (2) ◽  
pp. 29
Author(s):  
Syra Madad ◽  
Eleanor Tolf
Keyword(s):  
New York ◽  
New York City ◽  
Mixed Method ◽  
Hospital Workers ◽  
Department Of Health ◽  
Interactive Training ◽  
Hands On ◽  
Before And After ◽  
Question Survey

The purpose of this evaluation was to determine the effect of intensive, interactive training on hospital workers’ preparedness for special pathogen cases by utilizing the Frontline Facility Special Pathogens Training Course created by the Systemwide Special Pathogens Program at New York City Health + Hospitals (NYC H+H). An 8 h course was offered in 2018 and 2019 to healthcare employees throughout the Department of Health and Human Services Region 2, mostly from NYC H+H. Evaluation included multiple-choice pre and post exams, a 26-question survey about level of preparedness before and after the training, and follow-up interviews focused on changes in facility protocols. As a result, 61% of survey respondents indicated that they had never previously attended a hospital-sponsored special pathogen training. After the training, there was a 53.3% report rate of feeling “very prepared,” compared to 14.6% before the training. Additionally, there was an 11% improvement in test scores. Furthermore, 77% of respondents reported that their facility had changed protocols relating to topics of the course after their training date. Survey participants reported general satisfaction with the course, as well as an increased level of preparedness for special pathogen cases. Together, the results of the exams, survey, and interviews suggest that this interactive, mixed-method training increases special pathogen preparedness across different healthcare sectors. With the ongoing threat of special pathogens, the need for continued training and maintaining a state of readiness is paramount in healthcare.

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