Dataset Information

Bracing for the Storm: One Health Care System's Planning for the COVID-19 Surge.

ABSTRACT:

Problem

University of Washington Medicine (UW Medicine), an academic health system in Washington State, was at the epicenter of the first outbreak of the COVID-19 pandemic in the United States. The extent of emergency activation needed to adequately respond to this global pandemic was not immediately known, as the evolving situation differed significantly from any past disaster response preparations in that there was potential for exponential growth of infection, unproven mitigation strategies, serious risk to health care workers, and inadequate supply chains for critical equipment.

Approach

The rapid transition of the UW Medicine system to account for projected COVID-19 and usual patient care, while balancing patient and staff safety and conservation of resources, represents an example of an adaptive disaster response.

Key insights

Although our organization's ability to meet the needs of the public was uncertain, we planned and implemented changes to space, supply management, and staffing plans to meet the influx of patients across our clinical entities. The surge management plan called for specific actions to be implemented based on the level of activity. This article describes the approach taken by UW Medicine as we braced for the storm.

SUBMITTER: Kim CS

PROVIDER: S-EPMC7546945 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

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Bracing for the Storm: One Health Care System's Planning for the COVID-19 Surge.

Kim Christopher S CS Meo Nicholas N Little Danica D Morris Stephen C SC Brandenburg Lisa A LA Moratti Michelle M Dold Cynthia L CL Staiger Thomas O TO Sayre Cindy C Goss J Richard JR Dayao Jerome M JM Dellit Timothy H TH

Joint Commission journal on quality and patient safety 20201010

<h4>Problem</h4>University of Washington Medicine (UW Medicine), an academic health system in Washington State, was at the epicenter of the first outbreak of the COVID-19 pandemic in the United States. The extent of emergency activation needed to adequately respond to this global pandemic was not immediately known, as the evolving situation differed significantly from any past disaster response preparations in that there was potential for exponential growth of infection, unproven mitigation stra ...[more]

PMID: 33069619

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Project description:Background Based on the early international COVID-19 experience, it was anticipated that intensive care services and workforces in Australia would be placed under similar pressure. While surge capacity of medical and nursing workforces was estimated, little was known about baseline allied health staffing making it difficult to estimate surge capacity and coordinate planning. Objectives The purpose of this study was to 1) capture baseline allied health staffing levels in Australian adult ICUs prior to the COVID-19 pandemic emergence in Australia; and 2) describe the allied health pandemic planning and surge response in Australian ICUs during the early waves of the pandemic. Methods This was a cross-sectional, investigator-devised, prospective survey study. The survey was administered via the national chief allied health network to a convenience sample of senior ICU allied health clinicians at hospitals throughout Australia. Results A total of 40 responses were received from tertiary and metropolitan hospitals; physiotherapists 12 (30%) and occupational therapists eight (20%) were the most frequent respondents. Prior to the COVID-19 pandemic, 28 (70 %) of allied health respondents had a mean (IQR) of 1.74 (2.00) full-time equivalent (FTE) staff designated to the ICU, where these ICUs had a mean of 21.53 (15.00) ventilator beds. Few respondents serviced their ICU on a referral-only basis and did not have dedicated ICU FTE 12 (20%). Surge planning was mostly determined by discussion within the ICU, allied health department, and/or respective disciplines. This approach meant that allied health staffing and associated decision-making was ad hoc at a local level. Conclusions The baseline rate of allied health coverage in Australian ICUs remains unknown and the variability across allied health and within the specific disciplines is undetermined. Further research infrastructure to capture ICU allied health workforce data is urgently needed to guide future pandemic preparedness.

Project description:Background and objectivesAKI is a common complication of coronavirus disease 2019 (COVID-19) and is associated with high mortality. Palliative care, a specialty that supports patients with serious illness, is valuable for these patients but is historically underutilized in AKI. The objectives of this paper are to describe the use of palliative care in patients with AKI and COVID-19 and their subsequent health care utilization.Design, setting, participants, & measurementsWe conducted a retrospective analysis of New York University Langone Health electronic health data of COVID-19 hospitalizations between March 2, 2020 and August 25, 2020. Regression models were used to examine characteristics associated with receiving a palliative care consult.ResultsAmong patients with COVID-19 (n=4276; 40%), those with AKI (n=1310; 31%) were more likely than those without AKI (n=2966; 69%) to receive palliative care (AKI without KRT: adjusted odds ratio, 1.81; 95% confidence interval, 1.40 to 2.33; P<0.001; AKI with KRT: adjusted odds ratio, 2.45; 95% confidence interval, 1.52 to 3.97; P<0.001), even after controlling for markers of critical illness (admission to intensive care units, mechanical ventilation, or modified sequential organ failure assessment score); however, consults came significantly later (10 days from admission versus 5 days; P<0.001). Similarly, 66% of patients initiated on KRT received palliative care versus 37% (P<0.001) of those with AKI not receiving KRT, and timing was also later (12 days from admission versus 9 days; P=0.002). Despite greater use of palliative care, patients with AKI had a significantly longer length of stay, more intensive care unit admissions, and more use of mechanical ventilation. Those with AKI did have a higher frequency of discharges to inpatient hospice (6% versus 3%) and change in code status (34% versus 7%) than those without AKI.ConclusionsPalliative care was utilized more frequently for patients with AKI and COVID-19 than historically reported in AKI. Despite high mortality, consultation occurred late in the hospital course and was not associated with reduced initiation of life-sustaining interventions.PodcastThis article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2022_02_24_CJN11030821.mp3.

Dataset Information

Bracing for the Storm: One Health Care System's Planning for the COVID-19 Surge.

Problem

Approach

Key insights

Publications

Bracing for the Storm: One Health Care System's Planning for the COVID-19 Surge.

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