Sidelined during COVID-19: a narrative inquiry into how simulationists experienced the pandemic

Background In the simulation community, colleagues who are no longer clinically practicing were often proximal to the COVID-19 response, not working in the frontlines of patient care. At the same time, their work as simulationists changed dramatically or was halted. This research explored the experiences of those simulationists who have clinical backgrounds but did not provide direct patient care during the initial pandemic response. The aim of this study was to allow those simulationists to share and have their stories heard. Methods This qualitative research used a narrative approach to answer the research question: What were the experiences of those in the simulation community who did not contribute to the frontline patient care response during the early stages of the pandemic? A semi-structured questionnaire aimed at eliciting a story was disseminated through online simulation discussion boards. Data was collected through PHONIC with options to type or speak responses. Responses were analyzed using an inductive analytical process to identify themes or patterns in the narratives. Results Thirty-six respondents completed the survey between August 1, 2020 and November 30, 2020. Narrative arcs were identified that illustrated the events, actions, thoughts and feelings representative of experiences shared by many simulationists. Two major themes emerged: Challenges and Opportunities. Challenges included feelings of guilt; frustration; overwhelmed, stressed and exhausted; being away from the action, being unused and underappreciated. Opportunities included leadership (evolution and innovation), personal development, and being a part of something. Conclusions The findings reflect a snapshot in time of how simulation was viewed and used in the world during a pandemic through the personal stories of simulationists with clinical backgrounds who did not provide direct patient care. Sharing these narratives may inform future simulation development; however, it is vitally important that the emotions are recognized and acknowledged. Managers should ensure mental health resources and support are available to all staff, including those not deployed to the frontline.

Course Model Redesign for Continuity of Instruction

The purpose of the chapter is to illustrate instructional models that were implemented by Samford University McWhorter School of Pharmacy to comply with COVID-19 social distancing restrictions. While the second half of Spring 2020 was completely online (statewide shutdown), the university remained open in a hybrid manner for the 2020-21 academic year. There are three sections in the chapter: didactic, interprofessional, and advanced pharmacy practice experiences. The didactic section discusses course delivery methods and active learning, office hours, remote testing, student feedback, and contingency planning. The interprofessional section illustrates some of the school's synchronous and asynchronous interprofessional learning activities before and during the COVID-pandemic, as well as interprofessional education assessment methods. The last section of the chapter discusses how advanced pharmacy practice experience “direct patient care” was redefined, examples of the experiences, and contingency plans that were put into place to ensure on-time graduation for the classes of 2020 and 2021 pharmacy students.

What Do We Know About Teamwork in Chinese Hospitals? A Systematic Review

Background and Objective: Improving quality of care is one of the primary goals in current Chinese hospital reforms. Teamwork can play an essential role. Characteristics of teamwork and interventions for improving teamwork in hospitals have been widely studied. However, most of these studies are from a Western context; evidence from China is scarce. Because of the contextual differences between China and Western countries, empirical evidence on teamwork from Western hospitals may have limited validity in China. This systematic review aims to advance the evidence base and understanding of teamwork in Chinese hospitals.Methods: Both English (i.e., Embase, Medline, and Web of Science) and Chinese databases (i.e., CNKI, CQVIP, and Wanfang) were searched for relevant articles until February 6, 2020. We included the studies that empirically researched teamwork in Chinese hospitals. Studies were excluded if they (1) were not conducted in hospitals in Mainland China, (2) did not research teamwork on team interventions, (3) were not empirical, (4) were not written in English or Chinese, (5) were not published in peer-reviewed journals, and (6) were not conducted in teams that provide direct patient care. Both deductive and inductive approaches were used to analyze data. The Mixed Methods Appraisal Tool (MMAT) was used to assess their methodological quality.Results: A total of 70 articles (i.e., 39 English articles and 31 Chinese articles) were included. The results are presented in two main categories: Teamwork components and Team interventions. The evidence regarding the relationships among inputs, processes, and outcomes is scarce and mostly inconclusive. The only conclusive evidence shows that females perceive better team processes than males. Similar types of training and tools were introduced as can be found in Western literature, all showing positive effects. In line with the Chinese health reforms, many of the intervention studies regard the introduction of multidisciplinary teams (MDTs). The evidence on the implementation of MDTs reveals that they have led to lower complication rates, shorter hospital stays, higher diagnosis accuracy, efficiency improvement, and a variety of better disease-specific clinical outcomes. Evidence on the effect on patient survival is inconclusive.Conclusion: The Chinese studies on teamwork components mainly focus on the input-process relationship. The evidence provided on this relationship is, however, mostly inconclusive. The intervention studies in Chinese hospitals predominantly focus on patient outcomes rather than organizational and employee outcomes. The introduction of training, tools, and MDTs generally shows promising results. The evidence from primary hospitals and rural areas, which are prioritized in the health reforms, is especially scarce. Advancing the evidence base on teamwork, especially in primary hospitals and rural areas, is needed and can inform policy and management to promote the health reform implementation.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020175069, identifier CRD42020175069.

Being Prepared During the Evolving COVID-19 Pandemic: A Neonatal Experience in Training and Simulation

Background: Rapid spread of the COVID-19 pandemic raised an urgent need for preparedness in the healthcare sector, including training of healthcare workers to cope with the burden of infected cases while ensuring proper protection of themselves. Improper infection prevention and control measures were key reasons for infection in healthcare workers during the early phase of the outbreak.Objectives/Methods: This paper describes the combined approach of 3 restructured hospitals in Singapore in preparing and training neonatal healthcare workers' during the COVID-19 pandemic crisis, as well as lessons learnt during this process.Results: Information sharing was conducted in the form of e-learning, emphasizing on topics like disease knowledge and infection prevention and control procedures. Skills and competency training were carried out in the form of simulation, with sessions scaled into 4 levels progressing from individual task training to larger group simulations involving multiple disciplines and departments. Challenges encountered included information fatigue by large amount of constantly changing information and multiple amendments to workflows as more information arose. Difficulties conducting training and simulation sessions included restriction of group size to mitigate infection risk amongst participants and the limited supply of personal protective equipment prioritized for direct patient care.Conclusion: Healthcare institutions should ensure adequate dissemination of conceptual knowledge as well as skills competency training of staff in infection control measures for the protection of healthcare workers and patient safety. Ongoing training for sustainability of knowledge and skills, while adapting to the rapidly evolving situation is important in the preparation for future outbreaks.

Evolution of SARS-CoV-2 Seroprevalence Among Employees of a United States Academic Children’s Hospital During the COVID-19 Pandemic

Objectives: Describe cumulative seroprevalence of SARS-CoV-2 antibodies during the COVID-19 pandemic among employees of a large pediatric healthcare system. Design, Setting, and Participants: Prospective observational cohort study open to adult employees at Children’s Hospital of Philadelphia, conducted April 20 – December 17, 2020. Methods: Employees were recruited starting with high-risk exposure groups, utilizing emails, flyers, and announcements at virtual town halls. At baseline, 1-month, 2-month, and 6-month timepoints, participants reported occupational and community exposures and gave a blood sample for SARS-CoV-2 antibody measurement by enzyme-linked immunosorbent assays (ELISAs). A post hoc Cox proportional hazards regression model was performed to identify factors associated with increased risk for seropositivity. Results: 1740 employees were enrolled. At 6-months, cumulative seroprevalence was 5.3%, below estimated community point seroprevalence; seroprevalence was 5.8% and 3.4% among employees with and without direct patient care, respectively. Most participants seropositive at baseline remained positive at follow-up assessments. In post hoc analysis, direct patient care (HR: 1.95, 95% CI: 1.03 to 3.68), Black race (HR: 2.70, 95% CI: 1.24 to 5.87), and exposure to a confirmed case in a non-healthcare setting (HR: 4.32, 95% CI: 2.71 to 6.88) were associated with statistically significant increased risk for seropositivity. Conclusions: Employee SARS-CoV-2 seroprevalence rates remained below the surrounding community’s point prevalence rates. Provision of direct patient care, Black race, and exposure to a confirmed case in non-healthcare setting conferred increased risk. These data can inform occupational protection measures to maximize protection of employees within the workplace during future COVID waves or other epidemics.

COVID-19 and medical education in Africa: a cross sectional analysis of the impact on medical students

Background The African continent currently experiences 25% of the global burden of disease with only 1.3% of the world’s healthcare workers. The COVID-19 pandemic has caused unprecedented disruption to medical education systems, increasing the strain on already-vulnerable regions. Our study examines the impact of COVID-19 on medical students across 33 countries in the African continent. Methods A 39-item anonymous electronic survey was developed and distributed to medical students across Africa through social networks to assess the impact of the COVID-19 pandemic on medical education. The survey assessed the domains of: class structure changes and timing, patient interactions, exam administration, learning environment satisfaction, mental health impacts, and volunteer opportunities/engagement. Results 694 students across 33 countries participated. 80% of respondents had their classes suspended for varied lengths of time during the pandemic, and from these students 59% of them resumed their classes. 83% of students felt they were in a supportive learning environment before the pandemic, which dropped to 32% since the start. The proportion of students taking exams online increased (6–26%, p<0.001) and there was a decrease in the proportion of students seeing patients as a part of their education (72–19%, p<0.001). Conclusions COVID-19 is harming medical students in Africa and is likely to worsen the shortage of the future’s healthcare workforce in the region. Pandemic-related impacts have led to a degradation of the learning environment of medical students. Medical schools have shifted online to differing degrees and direct patient-care in training of students has decreased. This study highlights the urgent need for flexible and innovative approaches to medical education in Africa.

Patient outcomes and cost savings associated with hospital safe nurse staffing legislation: an observational study

ObjectiveTo evaluate variation in Illinois hospital nurse staffing ratios and to determine whether higher nurse workloads are associated with mortality and length of stay for patients, and cost outcomes for hospitals.DesignCross-sectional analysis of multiple data sources including a 2020 survey of nurses linked to patient outcomes data.Setting: 87 acute care hospitals in Illinois.Participants210 493 Medicare patients, 65 years and older, who were hospitalised in a study hospital. 1391 registered nurses employed in direct patient care on a medical–surgical unit in a study hospital.Main outcome measuresPrimary outcomes were 30-day mortality and length of stay. Deaths avoided and cost savings to hospitals were predicted based on results from regression estimates if hospitals were to have staffed at a 4:1 ratio during the study period. Cost savings were computed from reductions in lengths of stay using cost-to-charge ratios.ResultsPatient-to-nurse staffing ratios on medical-surgical units ranged from 4.2 to 7.6 (mean=5.4; SD=0.7). After adjusting for hospital and patient characteristics, the odds of 30-day mortality for each patient increased by 16% for each additional patient in the average nurse’s workload (95% CI 1.04 to 1.28; p=0.006). The odds of staying in the hospital a day longer at all intervals increased by 5% for each additional patient in the nurse’s workload (95% CI 1.00 to 1.09, p=0.041). If study hospitals staffed at a 4:1 ratio during the 1-year study period, more than 1595 deaths would have been avoided and hospitals would have collectively saved over $117 million.ConclusionsPatient-to-nurse staffing ratios vary considerably across Illinois hospitals. If nurses in Illinois hospital medical–surgical units cared for no more than four patients each, thousands of deaths could be avoided, and patients would experience shorter lengths of stay, resulting in cost-savings for hospitals.

The VA’s Long-Term Care Strike Team Supporting Florida’s Nursing Homes Workforce

In coordination with the Florida Department of Health, the VA Sunshine Healthcare Network (VISN 8) established Long-Term Care Strike Teams to provide services to the LTC facilities most affected by the COVID-19 pandemic across the state of Florida. Between April 2020 through September 2020, the Strike Teams provided direct patient care to community residents, infection control/ prevention education, and patient/staff COVID-19 swabbing. We encountered facilities with large numbers of staff infected with COVID-19 and agency staff that were refusing to come to “COVID-infected” facilities. Remaining staff, including the administrators, were under much psychological distress. However, our experience supporting the long-term care facilities also had a major impact on our own perceptions of nursing home care. The bravery, dedication, and caring that we witnessed reinforced that the health care workers in long-term care facilities are true heroes.

Strategies to Maintain Skilled Nursing Facility Staffing during COVID: Administrator Perspectives

As COVID-19 has resulted in a skilled nursing facility (SNF) staffing crisis, administrators attempt to maintain adequate staffing and stem decreasing patient census levels. We conducted four repeated interviews to date (n=130) at 3-month intervals with administrators from 40 SNFs in eight diverse healthcare markets across the United States. We used thematic analysis to examine their perspectives over time, including the perceived impact on staffing. Results include: 1) the impact of COVID-19 on staffing levels, and 2) strategies used in response to this crisis. Staffing levels have decreased throughout the pandemic, and struggles to maintain adequate staffing levels and patient census numbers have continued as the pipeline of potential new staff constricts. Facilities turned to agencies, many for the first time. Since agencies offer higher salaries, staff are drawn away from employment by SNFs, leading to a cycle of wage wars, and agencies are also challenged to provide staff. SNF administrators describe their responses to this crisis, such as flexible schedules, increased paid time off, sharing of non-direct-patient-care tasks, financial incentives (referral, sign-on, “no-call out”, and other general bonuses); wage analyses, and enhanced employee benefit packages. Some hire recruitment specialists, collaborate with nearby administrators, use creative advertising, or work with local schools. The vaccine mandate worries administrators; as one stated: “I can't afford to lose one person, let alone 20 because of this mandate...”. Given the dwindling pool of potential employees, we present NH administrators’ strategies to attract and retain staff.

Development and use of an innovative Gap Finding Tool to create Pharmaceutical Care Model within a paediatric oncology setting

Introduction A paediatric cancer ward is a setting where pharmacists participate in direct patient care, acting as coordinators between the patient, caregivers and healthcare professionals. The aim of the study was to develop a Gap Finding Tool to support the setting up of a pharmaceutical care model at a Paediatric-Adolescent Cancer Ward. Methods The Standards of Practice for Clinical Pharmacy Services by the Society of Hospital Pharmacists of Australia Committee of Specialty Practice in Clinical Pharmacy (2013), the American College of Clinical Pharmacy (2014) and the European Association of Hospital Pharmacists (2014) were used to compile the Gap Finding Tool. The developed Tool was tested for content validity by a panel of experts and subsequently implemented over 2 months. Results The Gap Finding Tool comprised of nine sections with an average of eight statements each about pharmacy services that should be provided at ward level. For each statement, the rater indicates whether these contributions are provided. When the Tool was implemented at the Paediatric-Adolescent Cancer Ward, four major gaps were identified, namely, absence of a clinical pharmacist, lack of medicines information, vetting of chemotherapy prescriptions by pharmacist with limited access to patient data and lack of pharmacist-input on medicines availability. Processes requiring optimisation included discharge medication advice and documentation processes. Conclusion The developed Gap Finding Tool is an innovative tool which is versatile and can be used in ward or ambulatory clinical settings to identify gaps in pharmaceutical processes and services and compare national or regional practices to international standards.