scholarly journals Oncology workload in a tertiary hospital during the COVID-19 pandemic

2021 ◽  
pp. 201010582110511
Author(s):  
Jianbang Chiang ◽  
Valerie Yang ◽  
Shuting Han ◽  
Qingyuan Zhuang ◽  
Siqin Zhou ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Emergency Department ◽  
General Surgery ◽  
Medical Oncology ◽  
Healthcare Providers ◽  
Healthcare Facility ◽  
Tertiary Hospital ◽  
Urgent Care ◽  
H1n1 Pandemic ◽  
Care Needs

Introduction Workload in oncology during a pandemic is expected to increase as manpower is shunted to other areas of need in combating the pandemic. This increased workload, coupled with the high care needs of cancer patients, can have negative effects on both healthcare providers and their patients. Methods This study aims to quantify the workload of medical oncologists compared to internal medicine physicians and general surgeons during the current COVID-19 pandemic, as well as the previous H1N1 pandemic in 2009. Results Our data showed decrease in inpatient and outpatient workload across all three specialties, but the decrease was least in medical oncology (medical oncology −18.5% inpatient and −3.8% outpatient, internal medicine −5.7% inpatient and −24.4% outpatient, general surgery −17.6% inpatient, and −39.1% outpatient). The decrease in general surgery workload was statistically significant. The proportion of emergency department admissions to medical oncology increased during the COVID-19 pandemic. Furthermore, the study compared the workload during COVID-19 with the prior H1N1 pandemic in 2009 and showed a more drastic decrease in patient numbers across all three specialties during COVID-19. Discussion We conclude that inpatient and outpatient workload in medical oncology remains high despite an ongoing COVID-19 pandemic. The inpatient medical oncology workload is largely contributed by the stable number of emergency department admissions, as patients who require urgent care will present to a healthcare facility, pandemic or not. Healthcare systems should maintain manpower in medical oncology to manage this vulnerable group of patients in light of the prolonged COVID-19 pandemic.

scholarly journals The Experience of a Mass Casualty Incident Call in a Tertiary Hospital after the 2018 Hualien Earthquake

2019 ◽  
Vol 34 (s1) ◽  
pp. s131-s131
Author(s):  
Hsing Chia Cheng ◽  
Kuang Yu Niu ◽  
Ming Han Ho
Keyword(s):  
Emergency Department ◽  
Healthcare Providers ◽  
Task Assignment ◽  
Tertiary Hospital ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Incident Command System ◽  
Incident Command ◽  
Efficiency And Effectiveness ◽  
Training Courses

Introduction:After a 6.0 magnitude earthquake struck Hualien on February 6, 2018, over one hundred and fifty patients crammed into the emergency department of a nearby tertiary hospital within two hours. The mass casualty incident (MCI) call was activated, and over 300 related personnel responded to the call and engaged with the MCI management.Aim:This research aimed to analyze the practice of an MCI call and to form the strategies to improve its efficiency and effectiveness.Methods:The research was conducted in a tertiary hospital in Hualien, Taiwan. Questionnaires regarding the practice of the MCI call were sent out to the healthcare providers in the emergency department who responded to that MCI operation.Results:Thirty-seven responders in the emergency department were involved in this study. 78% had participated in training courses for hospital incident command system (HICS) or MCI management before this event. On arrival at the emergency department, 69.4% of the responders were aware of the check-in station and received a clear task assignment and briefing. During the operation, 25.7% reported the lack of confidence carrying out the assigned tasks and 54.1% of the participants experienced great stress (stress score over 7 out of 10).Discussion:MCI is an uncommon event for hospital management. It is universally challenging owing to its unpredictable and time-sensitive nature. Furthermore, the administration could be further complicated by the associated disasters. Despite regular exercises and drills, there are still a significant number of participants experiencing stress and confusion during the operation. The chaotic situation may further compromise the performance of the participants. This study showed that optimizing task briefing and on-site directions may improve the performance of the MCI participants.

scholarly journals Urgent Care Needs Among Nonurgent Visits to the Emergency Department

2016 ◽  
Vol 176 (6) ◽  
pp. 852 ◽  
Author(s):  
Renee Y. Hsia ◽  
Ari B. Friedman ◽  
Matthew Niedzwiecki
Keyword(s):  
Emergency Department ◽  
Urgent Care ◽  
Care Needs

Initiating End-of-Life Care at the Emergency Department: An Observational Study

2019 ◽  
Vol 36 (11) ◽  
pp. 941-946 ◽  
Author(s):  
Wei Ping Daniel Chor ◽  
Sarah Yun Ping Wong ◽  
Muhammad Fadhli bin Mohamad Ikbal ◽  
Win Sen Kuan ◽  
Mui Teng Chua ◽  
...  
Keyword(s):  
Emergency Department ◽  
Observational Study ◽  
End Of Life ◽  
Symptomatic Relief ◽  
Symptom Burden ◽  
Tertiary Hospital ◽  
Care Bundle ◽  
Care Needs ◽  
Male Predominance ◽  
Epidemiological Characteristics

Objective: Terminally ill patients at their end-of-life (EOL) phase attending the emergency department (ED) may have complex and specialized care needs frequently overlooked by ED physicians. To tailor to the needs of this unique group, the ED in a tertiary hospital implemented an EOL pathway since 2014. The objective of our study is to describe the epidemiological characteristics, symptom burden and management of patients using a protocolized management care bundle. Methods: We conducted an observational study on the database of EOL patients over a 28-month period. Patients aged 21 years and above, who attended the ED and were managed according to these guidelines, were included. Clinical data were extracted from the hospital’s electronic medical records system. Results: Two hundred five patients were managed under the EOL pathway, with a slight male predominance (106/205, 51.7%) and a median age of 78 (interquartile range 69-87) years. The majority were chronically frail (42.0%) or diagnosed with cancer or other terminal illnesses (32.7%). The 3 most commonly experienced symptoms were drowsiness (66.3%), dyspnea (61.5%), and fever (29.7%). Through the protocolized management care bundle, 74.1% of patients with dyspnea and/or pain received opiates while 59.5% with copious secretions received hyoscine butylbromide for symptomatic relief. Conclusion: The institution of a protocolized care bundle is feasible and provides ED physicians with a guide in managing EOL patients. Though still suboptimal, considerable advances in EOL care at the ED have been achieved and may be further improved through continual education and enhancements in the care bundle.

scholarly journals Implementation of Telemedicine in a Tertiary Hospital–Based Ambulatory Practice in Detroit During the COVID-19 Pandemic: Observational Study (Preprint)

2020 ◽  
Author(s):  
Alpana Garg ◽  
Sachin Goyal ◽  
Rohit Thati ◽  
Neelima Thati
Keyword(s):  
Health Care ◽  
Health Care Services ◽  
Care Delivery ◽  
Clinical Care ◽  
Tertiary Hospital ◽  
University Hospital ◽  
Urgent Care ◽  
Care Needs ◽  
Telemedicine Service ◽  
Technical Problems

BACKGROUND The COVID-19 pandemic, caused by SARS-CoV-2, has forced the health care delivery structure to change rapidly. The pandemic has further widened the disparities in health care and exposed vulnerable populations. Health care services caring for such populations must not only continue to operate but create innovative methods of care delivery without compromising safety. We present our experience of incorporating telemedicine in our university hospital–based outpatient clinic in one of the worst-hit areas in the world. OBJECTIVE Our goal is to assess the adoption of a telemedicine service in the first month of its implementation in outpatient practice during the COVID-19 pandemic. We also want to assess the need for transitioning to telemedicine, the benefits and challenges in doing so, and ongoing solutions during the initial phase of the implementation of telemedicine services for our patients. METHODS We conducted a prospective review of clinic operations data from the first month of a telemedicine rollout in the outpatient adult ambulatory clinic from April 1, 2020, to April 30, 2020. A telemedicine visit was defined as synchronous audio-video communication between the provider and patient for clinical care longer than 5 minutes or if the video visit converted to a telephone visit after 5 minutes due to technical problems. We recorded the number of telemedicine visits scheduled, visits completed, and the time for each visit. We also noted the most frequent billing codes used based on the time spent in the patient care and the number of clinical tasks (eg, activity suggested through diagnosis or procedural code) that were addressed remotely by the physicians. RESULTS During the study period, we had 110 telemedicine visits scheduled, of which 94 (85.4%) visits were completed. The average duration of the video visit was 35 minutes, with the most prolonged visit lasting 120 minutes. Of 94 patients, 24 (25.54%) patients were recently discharged from the hospital, and 70 (74.46%) patients were seen for urgent care needs. There was a 50% increase from the baseline in the number of clinical tasks that were addressed by the physicians during the pandemic. CONCLUSIONS There was a high acceptance of telemedicine services by the patients, which was evident by a high show rate during the COVID-19 pandemic in Detroit. With limited staffing, restricted outpatient work hours, a shortage of providers, and increased outpatient needs, telemedicine was successfully implemented in our practice.

scholarly journals Implementation of Telemedicine in a Tertiary Hospital–Based Ambulatory Practice in Detroit During the COVID-19 Pandemic: Observational Study

10.2196/21327 ◽  
2021 ◽  
Vol 7 (1) ◽  
pp. e21327
Author(s):  
Alpana Garg ◽  
Sachin Goyal ◽  
Rohit Thati ◽  
Neelima Thati
Keyword(s):  
Health Care ◽  
Health Care Services ◽  
Care Delivery ◽  
Clinical Care ◽  
Tertiary Hospital ◽  
University Hospital ◽  
Urgent Care ◽  
Care Needs ◽  
Telemedicine Service ◽  
Technical Problems

Background The COVID-19 pandemic, caused by SARS-CoV-2, has forced the health care delivery structure to change rapidly. The pandemic has further widened the disparities in health care and exposed vulnerable populations. Health care services caring for such populations must not only continue to operate but create innovative methods of care delivery without compromising safety. We present our experience of incorporating telemedicine in our university hospital–based outpatient clinic in one of the worst-hit areas in the world. Objective Our goal is to assess the adoption of a telemedicine service in the first month of its implementation in outpatient practice during the COVID-19 pandemic. We also want to assess the need for transitioning to telemedicine, the benefits and challenges in doing so, and ongoing solutions during the initial phase of the implementation of telemedicine services for our patients. Methods We conducted a prospective review of clinic operations data from the first month of a telemedicine rollout in the outpatient adult ambulatory clinic from April 1, 2020, to April 30, 2020. A telemedicine visit was defined as synchronous audio-video communication between the provider and patient for clinical care longer than 5 minutes or if the video visit converted to a telephone visit after 5 minutes due to technical problems. We recorded the number of telemedicine visits scheduled, visits completed, and the time for each visit. We also noted the most frequent billing codes used based on the time spent in the patient care and the number of clinical tasks (eg, activity suggested through diagnosis or procedural code) that were addressed remotely by the physicians. Results During the study period, we had 110 telemedicine visits scheduled, of which 94 (85.4%) visits were completed. The average duration of the video visit was 35 minutes, with the most prolonged visit lasting 120 minutes. Of 94 patients, 24 (25.54%) patients were recently discharged from the hospital, and 70 (74.46%) patients were seen for urgent care needs. There was a 50% increase from the baseline in the number of clinical tasks that were addressed by the physicians during the pandemic. Conclusions There was a high acceptance of telemedicine services by the patients, which was evident by a high show rate during the COVID-19 pandemic in Detroit. With limited staffing, restricted outpatient work hours, a shortage of providers, and increased outpatient needs, telemedicine was successfully implemented in our practice.

scholarly journals Adopt, adapt, or abandon technology-supported person-centred care initiatives: healthcare providers’ beliefs matter

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kari Dyb ◽  
Gro Rosvold Berntsen ◽  
Lisbeth Kvam
Keyword(s):  
Information Technologies ◽  
Scale Up ◽  
Healthcare Providers ◽  
Healthcare Services ◽  
Analytical Framework ◽  
Development Project ◽  
Technology Support ◽  
Care Needs ◽  
Term Care

Abstract Background Technology support and person-centred care are the new mantra for healthcare programmes in Western societies. While few argue with the overarching philosophy of person-centred care or the potential of information technologies, there is less agreement on how to make them a reality in everyday clinical practice. In this paper, we investigate how individual healthcare providers at four innovation arenas in Scandinavia experienced the implementation of technology-supported person-centred care for people with long-term care needs by using the new analytical framework nonadoption, abandonment, and challenges to the scale-up, spread, and sustainability (NASSS) of health and care technologies. We also discuss the usability and sensitivity of the NASSS framework for those seeking to plan, implement, and evaluate technology-supported healthcare programmes. This study is part of an interdisciplinary research and development project called Patients and Professionals in Partnership (2016–2020). It originates at one of ten work packages in this project. Method The main data consist of ethnographic field observations at the four innovation arenas and 29 interviews with involved healthcare providers. To ensure continuous updates and status on work in the four innovation arenas, we have also participated in a total of six annual network meetings arranged by the project. Results While the NASSS framework is very useful for identifying and communicating challenges with the adoption and spread of technology-supported person-centred care initiatives, we found it less sensitive towards capturing the dedication, enthusiasm, and passion for care transformation that we found among the healthcare providers in our study. When it comes to technology-supported person-centred care, the point of no return has passed for the involved healthcare providers. To them, it is already a definite part of the future of healthcare services. How to overcome barriers and obstacles is pragmatically approached. Conclusion Increased knowledge about healthcare providers and their visions as potential assets for care transformation might be critical for those seeking to plan, implement, and evaluate technology-supported healthcare programmes.

scholarly journals Qualitative investigation of trace-based communication: how are traces conceptualised in healthcare teamwork?

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e038406
Author(s):  
Sayra Cristancho ◽  
Emily Field
Keyword(s):  
Internal Medicine ◽  
Healthcare Providers ◽  
Constructivist Grounded Theory ◽  
Teaching Hospitals ◽  
Secondary Outcome ◽  
Qualitative Investigation ◽  
Qualitative Nature ◽  
Saving Face ◽  
Critical Process ◽  
Biological Literature

ObjectivesThis interview-based qualitative study aims to explore how healthcare providers conceptualise trace-based communication and considers its implications for how teams work. In the biological literature, trace-based communication refers to the non-verbal communication that is achieved by leaving ‘traces’ in the environment and other members sensing them and using them to drive their own behaviour. Trace-based communication is a key component of swam intelligence and has been described as a critical process that enables superorganisms to coordinate work and collectively adapt. This paper brings awareness to its existence in the context of healthcare teamwork.DesignInterview-based study using Constructivist Grounded Theory methodology.SettingThis study was conducted in multiple team contexts at one of Canada’s largest acute-care teaching hospitals.Participants25 clinicians from across professions and disciplines. Specialties included surgery, anesthesiology, psychiatry, internal medicine, geriatrics, neonatology, paramedics, nursing, intensive care, neurology and emergency medicine.InterventionNot relevant due to the qualitative nature of the study.Primary and secondary outcomeNot relevant due to the qualitative nature of the study.ResultsThe dataset was analysed using the sensitising concept of ‘traces’ from Swarm Intelligence. This study brought to light novel and unique elements of trace-based communication in the context of healthcare teamwork including focused intentionality, successful versus failed traces and the contextually bounded nature of the responses to traces. While participants initially felt ambivalent about the idea of using traces in their daily teamwork, they provided a variety of examples. Through these examples, participants revealed the multifaceted nature of the purposes of trace-based communication, including promoting efficiency, preventing mistakes and saving face.ConclusionsThis study demonstrated that clinicians pervasively use trace-based communication despite differences in opinion as to its implications for teamwork and safety. Other disciplines have taken up traces to promote collective adaptation. This should serve as inspiration to at least start exploring this phenomenon in healthcare.

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