scholarly journals AN INTERDISCIPLINARY APPROACH TO THE MANAGEMENT OF CRITICALLY ILL PATIENTS DURING COVID-19 PANDEMIC; AN EXPERIENCE OF A UNIVERSITY HOSPITAL IN ENGLAND

2020 ◽  
Vol 73 (7) ◽  
pp. 1576-1579
Author(s):  
Tomasz Torliński ◽  
Lucas Rakasz ◽  
Barbara Wysota ◽  
Marcin Czyż ◽  
Catherine Snelson
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Clinical Pathways ◽  
Health Care Systems ◽  
Interdisciplinary Approach ◽  
University Hospital ◽  
Care Staff ◽  
Queen Elizabeth Hospital ◽  
Number Of Patients ◽  
Care Systems

COVID-19 pandemic presents significant challenges in delivering safe and efficient patient care, especially during the surges. In all health care systems, provision of available critical care facilities is a scarce resource, even in normal times. Problematic is not just the limitation of physical spaces in intensive care units, but also the availability of trained personnel. The critical care model, developed in Queen Elizabeth Hospital Birmingham to cope with the surge of COVID-19 patients, is based on early implementation of an interdisciplinary approach and extensive cooperation between the branches of practice, allowing to address both challenges. The main pillars are early upskilling of non-critical care staff, creation of safe, streamlined clinical pathways, adjustment of the physical layout of critical care units and comprehensive cross-town cooperation allowing to accommodate an increased number of patients, requiring intensive care. The model was well tested in clinical practice, enabling the hospital to increase the critical care footprint by more than 200% during the pandemic’s surge between March and May 2020.

scholarly journals The Ventilator Management Team: Repurposing Anesthesia Workstations and Personnel to Combat COVID-19

2020 ◽  
Vol 35 (9) ◽  
pp. 927-932
Author(s):  
Robert Canelli ◽  
Nicole Spence ◽  
Nisha Kumar ◽  
Gerardo Rodriguez ◽  
Mauricio Gonzalez
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Health Care Systems ◽  
Ventilatory Support ◽  
Management Team ◽  
Mechanical Ventilators ◽  
Care Services ◽  
Number Of Patients ◽  
Ventilator Management ◽  
Care Systems

The coronavirus disease 2019 pandemic resulted in unprecedented numbers of patients with respiratory failure requiring ventilatory support. The number of patients who required critical care quickly outpaced the availability of intensive care unit (ICU) beds. Consequently, health care systems had to creatively expand critical care services into alternative hospital locations with repurposed staff and equipment. Deploying anesthesia workstations to the ICU to serve as mechanical ventilators requires equipment preparation, multidisciplinary planning, and targeted education. We aim to contextualize this process, highlighting major differences between anesthesia workstations and ICU ventilators, and to share the insights gained from our experiences creating an anesthesia provider-based ventilator management team.

scholarly journals Predict Score: A New Biological and Clinical Tool to Help Predict Risk of Intensive Care Transfer for COVID-19 Patients

Biomedicines ◽  
2021 ◽  
Vol 9 (5) ◽  
pp. 566
Author(s):  
Mickael Gette ◽  
Sara Fernandes ◽  
Marion Marlinge ◽  
Marine Duranjou ◽  
Wijayanto Adi ◽  
...  
Keyword(s):  
Intensive Care ◽  
Health Care Systems ◽  
University Hospital ◽  
World Health ◽  
Biological Parameters ◽  
Clinical Tool ◽  
Neutrophil Lymphocyte Ratio ◽  
Reactive Protein ◽  
Baseline Group ◽  
Care Systems

Background: The COVID-19 crisis has strained world health care systems. This study aimed to develop an innovative prediction score using clinical and biological parameters (PREDICT score) to anticipate the need of intensive care of COVID-19 patients already hospitalized in standard medical units. Methods: PREDICT score was based on a training cohort and a validation cohort retrospectively recruited in 2020 in the Marseille University Hospital. Multivariate analyses were performed, including clinical, and biological parameters, comparing a baseline group composed of COVID-19 patients exclusively treated in standard medical units to COVID-19 patients that needed intensive care during their hospitalization. Results: Independent variables included in the PREDICT score were: age, Body Mass Index, Respiratory Rate, oxygen saturation, C-reactive protein, neutrophil–lymphocyte ratio and lactate dehydrogenase. The PREDICT score was able to correctly identify more than 83% of patients that needed intensive care after at least 1 day of standard medical hospitalization. Conclusions: The PREDICT score is a powerful tool for anticipating the intensive care need for COVID-19 patients already hospitalized in a standard medical unit. It shows limitations for patients who immediately need intensive care, but it draws attention to patients who have an important risk of needing intensive care after at least one day of hospitalization.

scholarly journals Impact of the COVID-19 Pandemic on Patients With Idiopathic Subglottic Stenosis

2020 ◽  
pp. 014556132097746
Author(s):  
Catherine Anderson ◽  
Guri Sandhu ◽  
Chadwan Al Yaghchi
Keyword(s):  
High Risk ◽  
Psychological Health ◽  
Clinical Pathways ◽  
Health Care Systems ◽  
Subglottic Stenosis ◽  
Local Health ◽  
Number Of Patients ◽  
Local Health Care ◽  
Care Systems ◽  
The Impact

Objectives: To determine the number of patients with idiopathic subglottic stenosis (iSGS) who have contracted coronavirus disease 2019 (COVID-19), the impact of the pandemic on patients’ attitudes on seeking help and attending hospitals, as well as the delays in the offer of treatment from the local health care systems. Methods: A 29-question survey was distributed to an international mailing list of patients with subglottic stenosis to assess the patient experience during the COVID-19 pandemic. Results: A total of 543 patients with iSGS participated. Fewer than 1 in 10 patients with iSGS have experienced COVID-19 symptoms, which were predominantly mild to moderate, with only 2 hospitalizations. Most patients with iSGS (80.0%) have not been advised they are high risk for COVID-19, despite 36.5% of patients with iSGS being obese (body mass index of 30+). Delays to surgeries and in-office procedures have impacted 40.1% of patients currently receiving treatment, with 38.8% of patients increasingly struggling to breathe as a result. Anxiety and stress are increasing among patients, with 3 in 4 (75.2%) reporting they are anxious about travelling by public transport, contracting the virus in hospital and infecting loved ones (69.0% and 71.9%, respectively). Of greater concern is that 23.1% with increasing dyspnea state they are staying away from hospital despite their deteriorating health. Conclusions: The COVID-19 pandemic has had an impact on the physical and psychological health of patients with iSGS. Surgeons managing cases of laryngotracheal stenosis need to offer appropriate support and communication to these high risk patients. During the pandemic, this should include self-isolation if they are dyspneic or on treatments that may have reduced their immunity. In addition, they should offer safe clinical pathways to airway assessment and treatments, if they become necessary. To minimize unnecessary travel, much of the clinical monitoring can be carried out remotely, using telephone or video-based consultations, in conjunction with local health professionals.

scholarly journals Community system of social support

2017 ◽  
Vol 127 (1) ◽  
pp. 37-40
Author(s):  
Krzysztof Włoch ◽  
Janusz Jaroszyński ◽  
Ewa Warchoł-Sławińska ◽  
Anna Jurek ◽  
Bartłomiej Drop ◽  
...  
Keyword(s):  
Social Support ◽  
Health Care ◽  
Health Care Systems ◽  
Family Doctors ◽  
Community System ◽  
Modern Health Care ◽  
Number Of Patients ◽  
The World ◽  
Care Systems ◽  
Is Evaluation

Abstract Community System of Social Support is the basis of modern health care systems not only in Poland but all over the world in the prophylaxis-treatment-rehabilitation procedure. In Poland, family doctors, commune councils and territorial self-governments are involved in it. Family doctors perform a substantial function, whereas commune councils and territorial self-governments an administrative one. The principle of the system work is evaluation of its benefits. Its aim is the reduction of the number of patients who abuse alcohol and those who abuse alcohol despite treatment.

scholarly journals Separating the wheat from the chaff – COVID-19 in a German emergency department: A Case-control study

2020 ◽  
Author(s):  
David Fistera ◽  
Dirk Pabst ◽  
Annalena Härtl ◽  
Benedikt Michael Schaarschmidt ◽  
Lale Umutlu ◽  
...  
Keyword(s):  
Emergency Department ◽  
Health Care Systems ◽  
University Hospital ◽  
Nasopharyngeal Swab ◽  
Workflow Model ◽  
Manchester Triage System ◽  
Efficient Management ◽  
Care Systems ◽  
To Come ◽  
The University

Abstract Background: COVID-19 pandemia is a major challenge to worldwide health care systems. Whereas the majority of disease presents with mild symptoms that can be treated as outpatients, severely ill COVID-19 patients and patients presenting with similar symptoms cross their ways in the Emergency Department. Especially the variety of symptoms is challenging with primary triage. Are there parameters to distinguish between proven COVID-19 and without before? How can a safe and efficient management of these inpatients be achieved?Methods: We conducted a retrospective analysis of 314 consecutive inpatient patients who presented with possible symptoms of COVID-19 in a German emergency department between March and April 2020 and were tested with a SARS-Cov-2 nasopharyngeal swab. Clinical parameters, Manchester Triage System categories and lab results were compared between patients with positive and negative test results for SARS-Cov-2. Furthermore, we present the existing COVID-19 workflow model of the university hospital in Essen which proved to be efficient during pandemia.Results: 43 of the 314 patients (13.7%) were tested positive for COVID-19 by SARS-Cov-2 nasopharyngeal swab. We did not find any laboratory parameter to distinguish safely between patients with COVID-19 and those with similar symptoms. Dysgeusia was the only clinical symptom that was significantly more frequent among COVID-19 patients. Conclusion: Dysgeusia seems to be a typical symptom for COVID-19, which occurred in 14% of our COVID-19 patients. However, no valid parameters could be found to distinguish clinically between COVID-19 and other diseases with similar symptoms. Therefore, early testing, a strict isolation policy and proper personal protection are crucial to maintain workflow and safety of patients and ED staff for the months to come.Trial registration: URL: https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00021675

Sedation and delirium

2019 ◽  
pp. 145-160
Author(s):  
Nim Pathmanathan ◽  
Paul Nixon
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Case History ◽  
Critical Care Unit ◽  
Daily Practice ◽  
Care Staff ◽  
Evidence Based ◽  
Standard Textbook ◽  
Learning Points

This chapter is centred on a case study of sedation and delirium. This topic is one of the key challenging areas in critical care medicine and one that all intensive care staff will encounter. The chapter is based on a detailed case history, ensuring clinical relevance, together with relevant images, making this easily relatable to daily practice in the critical care unit. The chapter is punctuated by evidence-based, up-to-date learning points, which highlight key information for the reader. Throughout the chapter, a topic expert provides contextual advice and commentary, adding practical expertise to the standard textbook approach and reinforcing key messages.

scholarly journals Pakistan Registry of Intensive CarE (PRICE): Expanding a lower middle-income, clinician-designed critical care registry in South Asia

2018 ◽  
Vol 20 (3) ◽  
pp. 190-195 ◽  
Author(s):  
M Hashmi ◽  
A Beane ◽  
A Taqi ◽  
MI Memon ◽  
P Athapattu ◽  
...  
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Real Time ◽  
National Registry ◽  
Service Improvement ◽  
Intensive Care Society ◽  
Middle Income ◽  
Resource Limited ◽  
Care Systems ◽  
And Training

Introduction In resource-limited settings – with inequalities in access to and outcomes for trauma, surgical and critical care – intensive care registries are uncommon. Aim The Pakistan Society of Critical Care Medicine, Intensive Care Society (UK) and the Network for Improving Critical Care Systems and Training (NICST) aim to implement a clinician-led real-time national intensive care registry in Pakistan: the Pakistan Registry of Intensive CarE (PRICE). Method This was adapted from a successful clinician co-designed national registry in Sri Lanka; ICU information has been linked to real-time dashboards, providing clinicians and administrators individual patient and service delivery activity respectively. Output Commenced in August 2017, five ICU’s (three administrative regions – 104 beds) were recruited and have reported over 1100 critical care admissions to PRICE. Impact and future PRICE is being rolled out nationally in Pakistan and will provide continuous granular healthcare information necessary to empower clinicians to drive setting-specific priorities for service improvement and research.

scholarly journals Introducing teledermoscopy of possible skin cancers in general practice in Southern Denmark

2020 ◽  
Vol 37 (4) ◽  
pp. 513-518
Author(s):  
Tine Vestergaard ◽  
Sumangali C Prasad ◽  
Annette Schuster ◽  
Rasa Laurinaviciene ◽  
Anette Bygum ◽  
...  
Keyword(s):  
General Practice ◽  
Diagnostic Accuracy ◽  
Health Care Systems ◽  
Final Diagnosis ◽  
Skin Lesions ◽  
University Hospital ◽  
Predictive Values ◽  
Face To Face ◽  
Skin Cancers ◽  
Care Systems

Abstract Background The increasing incidence of skin cancers poses a burden to health care systems. General practitioners (GPs) play an important role in triaging these diseases and referring relevant patients to specialists. It is challenging to distinguish benign from malignant skin lesions, and GPs may benefit from diagnostic support from teledermoscopy (TD). Objectives To assess whether the introduction of TD in general practice was feasible and might reduce the number of unnecessary referrals to specialists and to assess the diagnostic accuracy and confidence of participating GPs. Methods Fifty general practices in Southern Denmark participated. Adult patients presenting to their GP with suspected skin cancer could be included. Images including dermoscopy were taken by the GP and sent for evaluation by specialized dermatologists at a university hospital. Patients were simultaneously referred for a face-to-face evaluation at the university hospital. Diagnoses proposed by the GPs and by TD were compared to the final diagnoses obtained by histopathology or, if not available, face-to-face evaluation. Results Five hundred and nineteen patients with 600 suspected skin cancers were included. The final diagnosis was benign in 72.3%. The photo quality was good or fair in 90.5%. GPs reported uncertainty about their diagnoses in 41.5% of cases. The GPs’ positive predictive values for any malignancy and for malignant melanoma were 49.5% and 26.3%, respectively. On evaluation by TD, 31.5% of lesions did not need further in-person assessment. Conclusion Useful images of suspicious skin lesions were obtained from general practice, and GPs could benefit from TD to improve their diagnostic accuracy and confidence.

Regional critical care delivery systems

2016 ◽  
Author(s):  
Theodore J. Iwashyna ◽  
Colin R. Cooke
Keyword(s):  
Critical Care ◽  
Systems Of Care ◽  
Care Delivery ◽  
Health Care Systems ◽  
Cost Effective ◽  
Design Decisions ◽  
Regional Systems ◽  
Regional System ◽  
Care Systems ◽  
Regionalization Of Care

A regional system of critical care is one in which hospitals are acknowledged to vary in their care of critically-ill patients, and procedures exist to systematically refer patients to a subset of those hospitals. Given scarcity in health care systems, regional systems of care are an attempt to rationalize differentiation among hospitals. There are several examples that suggest regionalization of care can result in cost-effective improvements in patient outcomes. Yet there are also numerous examples of regional systems of care that offer few benefits to patients, or that fail to actually concentrate patients despite the grand plans of their designers. This chapter suggests several key design decisions that can be used to help improve the effectiveness of regional system of care. Addressing all these issues may offer dramatic benefits for patients.

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