563. Experience of a Private Hospital in the Treatment of COVID-19 Pneumonia in Veracruz, Mexico

Background Large mortality rates have been reported in the Mexican public health system, however in the experiences of private hospitals that have resources and infrastructure this is lower compared to the national average. Methods Descriptive and retrospective study. Adult patients treated for pneumonia due COVID-19 from April to December 2020 are entered into the study. Its general characteristics such as gender and age, comorbidities, influenza vaccination history, clinical characterization, laboratory and tomographic diagnosis of sars cov2 pneumonia are studied, as well as the drug and oxygen therapy treatments received and finally, its evolution and clinical outcome. Results 132 patients were studied, of which 51% were female. The main age groups affected were 65 and over (43.9%), 50-59 years (20.4%) and 25-44 years (16.6%). The main comorbidities found were: arterial hypertension (43.9%), Diabetes mellitus 2 (33.3%), heart disease (11.3%) and obesity (10.6%). 95.4% of the patients were not vaccinated against influenza. The main symptoms reported were: fever (92%), cough (87%), dyspnea (76%) and headache (52%). The diagnosis was confirmed with RT-PCR in 63%, reporting negative RT-PCR in 36%; the antigen test was positive in 1%. Regarding the findings of the chest computed tomography, CORADS 5 was reported in 30%, CORADS 6 in 3% and CORADS 4 in 20%. The main treatments used in patients with severe inflammatory pneumonia were: steroids (98%), enoxaparin (100%), tocilizumab (20%), baricitinib (60%), direct oral anticoagulants (10%), fibroquel (5%). 60% were treated with a combination of two or more drugs. The main oxygenation contributions were: 20% nasal tips - mask/reservoir, 60% high flow nasal cannula, 20% mechanical ventilation. In 95% the prone position was indicated. Regarding the clinical evolution, 65.1% were towards improvement, 17.4% died, 12.1% requested transfer to another unit and 5.3% requested voluntary discharge. Overall mortality was 17%. Medications in ICU Ventilation strategies Conclusion A hospital strategy that has the necessary resources and infrastructure as well as openness to the use of medication with emergency approvals for its use or off-label indications, can help limit morbidity and mortality in vulnerable populations and manifest risk factors such as Mexican population Disclosures All Authors: No reported disclosures

Hospital Response to COVID-19 A Consensus Report on Ain Shams University Hospital Strategy

Socioeconomically disadvantaged people are more frequent users of healthcare, as are the elderly. This situation is now disrupted with the rapid onset COVID-19 pandemic and its effect on the health system. Amidst a great deal of uncertainty and mixed messages from the WHO, Ministries of health and scientific communities, a methodology to keep the standard operating procedures of the school needs to be in place in order to allow the hospital to respond to its catchment area requirements. A number of focus groups and planning sessions were conducted using a purposeful sample of service providers in Ain Shams University Hospitals. A set of three guiding documents were generated and tested for agreeability and utility. All hospitals need to join forces to systematically organize the chaotic situation we are living with this post COVID-19 pandemic.

STRATEGI RUMAH SAKIT UMUM SWASTA DI PURWOKERTO DALAM MENGHADAPI AKREDITASI

Background: Accreditation is an obligation that must be done by every hospital in Indonesia. Purwokerto is the capital of Banyumas district, Central Java, Indonesia. Health services in Purwokerto are facilitated by 10 Public Hospitals and 7 are private public hospitals. Based on the preliminary study, of the seven general hospitals, get one hospital that has been accredited. How is the strategy of public private hospitals facing accreditation, becoming an interesting topic to learn. Objective: The purpose of this research is private hospital strategy in Purwokerto to face hospital accreditation. Methods: The research method used is qualitative with phenomenology approach. Analysis the data research by using IPA (Interpretative Phenomenological Analysis). Results: Based on the analysis of 5 informants, the theme of accreditation strategy for private hospitals that are human resources control, owner and management commitment, programmatic procedures, time management, process strategy, and building a comfortable working environment. Conclutions: To be able of accreditation of public private hospitals need the ability to build human resources, and other resources both physical, facilities, environment and time management. Further research is expected to be implemented in all hospitals whether public hospitals, specialty, or clinics. Keywords: Accreditation, hospital, strategy

STRATEGI RUMAH SAKIT UMUM SWASTA DI PURWOKERTO DALAM MENGHADAPI AKREDITASI

Background: Accreditation is an obligation that must be done by every hospital in Indonesia. Purwokerto is the capital of Banyumas district, Central Java, Indonesia. Health services in Purwokerto are facilitated by 10 Public Hospitals and 7 are private public hospitals. Based on the preliminary study, of the seven general hospitals, get one hospital that has been accredited. How is the strategy of public private hospitals facing accreditation, becoming an interesting topic to learn.Objective: The purpose of this research is private hospital strategy in Purwokerto to face hospital accreditation. Methods: The research method used is qualitative with phenomenology approach. Analysis the data research by using IPA (Interpretative Phenomenological Analysis). Results: Based on the analysis of 5 informants, the theme of accreditation strategy for private hospitals that are human resources control, owner and management commitment, programmatic procedures, time management, process strategy, and building a comfortable working environment. Conclutions: To be able of accreditation of public private hospitals need the ability to build human resources, and other resources both physical, facilities, environment and time management. Further research is expected to be implemented in all hospitals whether public hospitals, specialty, or clinics. Keywords: Accreditation, hospital, strategy

Kythe Flying: A Strategy for Donor Retention

Amount raised: $21,765.00 (2016 to 2018/$1:Php51.00). Background and context: Kythe Foundation Inc. is an NGO which supports the Child Life Program for children with cancer in eight partner-hospitals. Aside from acquiring grants, the foundation needs to raise unrestricted funds to support operation costs. It is a challenge to recruit donors, but what is more challenging, is how to retain these donors. Aim: Kythe Flying was conceptualized in 2016 to retain corporations who have engaged Kythe in previous years. The corporations who participate in Kythe Flying have either donated cash, or conducted corporate social responsibility activities in and out of the hospital. Strategy/Tactics: The strategy is to invite corporations to buy a big corporate kite for $295.00. Prior to flying the kites, they are given an opportunity to play outdoor games with the children, which serves as a team-building activity for the corporation as well. Program process: The Kythe team gets a list of corporations from its database. Marketing letters are sent, and upon receiving $295.00 with their company logo, the Kythe team forward the logo to the kite manufacturer. Other corporations are invited to give away their products (e.g., water bottles). On the day itself, 60 children from partner-hospitals go to Amoranto stadium, and are given lunch and snacks. After which, they are assigned to each corporation. Kythe core volunteers facilitate the games. After an hour of outdoor activity, each corporation is called, and given the go signal to fly their corporate kites, together with the children. Photos of each corporation´s activities are then posted on Kythe's social media platforms. Costs and returns: There are at least 20 corporations who join the event per year. An average cash amount of $6274 is raised annually, less $2940.00 to cover logistical costs, for a total of $3334. In-kind donations like water bottles, ice cream, toys, etc. amount to $3921. We are therefore able to raise an average of $7255 a year. What was learned: In 2016, we implemented the project in July. There was a typhoon and we almost cancelled the event. We have moved up the event to the first quarter of the year ever since. Here are some feedback from our participating donors in the 2018 Kythe Flying event: “Our synchrony volunteers who joined last Saturday are still raving about the wonderful time they had with the kids at the kite-flying event”- Christine Briones Plata, AVP Synchrony Financial. “I look forward to seeing you and the team next year, but hopefully before, for a hospital visit”- Ian Wilson Country Manager, Cormant Technology. To enjoin more corporations, Kythe in the future, will collaborate with hot air balloon festival organizers. This will entail at least one year planning due to its scale. This is challenging but quite exciting!

Detecting Delirium in Hospitalized Elderly Patients: A Review of Practice Compliance

Background: The Ontario Senior Friendly Hospital Strategy recognizes delirium prevention and management as a top priority and recommends implementation of delirium screening as well as management protocols. This strategy proposes that hospitals monitor 2 specific indicators: (1) rate of baseline delirium screening and (2) rate of hospital-acquired delirium. Objective: To (1) determine compliance with the Ontario Senior Friendly Hospital Strategy indicators; (2) describe the use of pharmacological and nonpharmacological interventions for management of delirious patients; and (3) identify predictors of screening compliance. Methods: We conducted a retrospective review of patients aged ≥65 years admitted to 4 different inpatient units for ≥48 hours. Data were extracted for 7 two-month time blocks chosen between September 2010 and October 2013, following the implementation of various geriatric and delirium related initiatives at the hospital. Results: A total of 786 patients met study inclusion criteria. Overall, 68.2% had baseline delirium screening (indicator 1), with screening rates increasing over time ( P < .001). Inpatient unit and year of study were both statistically significant predictors of delirium screening. Among those screened, the overall rate of hospital-acquired delirium was 17.2% (indicator 2). Early mobilization and device removal were the most common nonpharmacological interventions, while initiation of an antipsychotic and discontinuation of benzodiazepines were the most common pharmacological interventions. Conclusions: Although the rates of baseline delirium screening have significantly increased over the sampled time period, rates are still below the averages referenced in other literature. Our study suggests we need additional efforts to improve compliance with delirium screening in our institution.