Recruitment, Readiness, and Retention of Providers at a Field Hospital during the Pandemic

In response to the coronavirus disease 2019 (COVID-19) pandemic, the State of Maryland established a 250-bed emergency response field hospital at the Baltimore Convention Center to support the existing healthcare infrastructure. To operationalize this hospital with 65 full-time equivalent (FTE) clinicians in less than four weeks, more than 300 applications were reviewed, 186 candidates were interviewed, and 159 clinicians were credentialed and onboarded. The key steps to achieve this undertaking involved employing multidisciplinary teams with experienced personnel, mass outreach, streamlined candidate tracking, pre-interview screening, utilizing all available expertise, expedited credentialing, and focused onboarding. To ensure staff preparedness, the leadership developed innovative team models, applied principles of effective team building, and provided ‘just in time’ training on COVID-19 and non-COVID-19 related topics to the staff. The leadership focused on staff safety and well-being, offered appropriate financial remuneration and provided leadership opportunities that allowed retention of staff.

Đánh giá hiệu quả lọc máu hấp phụ cytokin trong điều trị bệnh nhân covid-19

TÓM TẮT Đặt vấn đề: Lọc máu hấp phụ được xem là một phương pháp điều trị ở bệnh nhân Covid-19 nặng do có khả năng loại bỏ cytokine viêm. Nghiên cứu này mục đích để đánh giá hiệu quả lọc máu hấp phụ theo phương thức lọc máu ngắt quãng (IHD) ở bệnh nhân Covid-19. Phương pháp nghiên cứu: Nghiên cứu can thiệp, thực hiện trên các bệnh nhân được chẩn đoán viêm phổi do Covid-19 mức độ nặng ở trung tâm hồi sức tích cực bệnh viện dã chiến số 14, thành phố Hồ Chí Minh. Bệnh nhân được điều trị với thuốc kháng virus, kháng sinh, kháng đông và corticoid và liệu pháp oxy và 3 lần lọc máu hấp phụ sử dụng máy lọc máu ngắt quãng. Các chỉ số lâm sàng và xét nghiệm được thu thập và so sánh ở thời điểm trước và sau lọc máu. Kết quả: Có 6 bệnh nhân nam và 4 bệnh nhân nữ ở độ tuổi trung bình 54,60 ± 14,00 điều trị lọc máu hấp phụ, có 7 bệnh nhân cải thiện và cai dần với liệu pháp oxy. Giá trị SpO2 tăng từ 92,00 ± 2,31% đến 94,40 ± 1,71% với p = 0,02. IL - 6 trong máu bệnh nhân giảm từ 110,80 ± 126,84 pg/mL xuống 26,55 ± 26,80 pg/ mL với p = 0,06, CRP giảm từ 139,90 ± 57,41mg/L xuống 56,10 ± 53,10mg/L với p = 0,03. Kết luận: Lọc máu hấp phụ có thể giúp cải thiện SpO2 và hỗ trợ cai liệu pháp oxy ở hầu hết bệnh nhân trong nhóm nghiên cứu. Tuy nhiên, trong tương lai cần có nghiên cứu đa trung tâm, có đối chứng trên nhiều bệnh nhân để có thể đánh giá chắc chắn hiệu quả lọc máu hấp phụ ở bệnh nhân Covid-19. ABSTRACT EFFECTIVENESS OF HEMOPERFUSION IN COID-19 PATIENTS Backgrounds: Extracorporeal blood purification has been proposed as one of the therapeutic approaches in patients with coronavirus infection, because of its beneficial impact on elimination of inflammatory cytokines. This study aims to evaluate the effectiveness of hemoperfusion in coid-19 patients. Methods: This experimental research has been conducted on severe COVID-19 pneumonia patients who admitted in field hospital in Ho Chi Minh city, receiving antiviral, antibacterial drugs, anticoagulant drugs and steroid, and different modalities of respiratory treatments. No randomization and blindness were considered. All of the participants underwent three sessions of resin-directed hemoperfusion using intermittent hemodialysis machine. Results: Six men and four women with a mean age of 54.60 ± 14.00 years has been enrolled in the study, and seven of them have improved after the intervention. Peripheral capillary oxygen saturation (SpO2) changed after cytokine removal therapy. Mean SpO2 before the three session of hemoperfusion was 92.00 ± 2.31% and increased to 94.40 ± 1.71% after them (p = 0.02). Serum IL - 6 showed a reduction from 110.80 ± 126.84 pg/mL to 26.55 ± 26.80 pg/mL p = 0.06; and C-reactive protein decreased from 139.90 ± 57.41mg/L to 56.10 ± 53.10mg/L p = 0.03. Conclusions: Extracorporeal hemoadsorption using intermittent dialyisis machine could improve the general condition in most of recruited patients with severe coronavirus disease, however, large prospective multicenter trials in carefully selected patients are needed to definitely evaluate the efficacy of hemoperfusion in COVID-19 patients. Keywords: Intermittent dialyisis machine, hemoperfusion, COVID-19 pneumonia.

Emergency Management of Medical Wastewater in Hospitals Specializing in Infectious Diseases: A Case Study of Huoshenshan Hospital, Wuhan, China

Medical wastewater originating from hospitals specializing in infectious diseases pose a major risk to human and environmental health during pandemics. However, there have been few systematic studies on the management of this type of wastewater management. The function of the Huoshenshan Hospital as a designated emergency field hospital for the treatment of COVID-19 has provided lessons for the management measures of medical wastewater, mainly including: (1) Modern information technology, management schemes, and related standard systems provided the legislative foundation for emergency management of medical wastewater. (2) The three-tier prevention and control medical wastewater management system ensured the discharged wastewater met water quality standards, especially for the leak-proof sealed collection system of the first tier, and the biological and chemical treatment technology of the second tier. (3) The establishment of an effective three-tier medical wastewater quality monitoring accountability system. This system was particularly relevant for ensuring continuous data monitoring and dynamic analysis of characteristic indicators. (4) Information disclosure by government and public supervision promoted successful implementation of medical wastewater management and control measures. Public questionnaires (n = 212) further confirmed the effectiveness of information disclosure. The results of this study can act as methodological reference for the emergency management of wastewater in designated infectious disease hospitals under similar situations.

A COVID-19 field hospital in a conference centre – The Cape Town, South Africa experience

Background: The coronavirus pandemic has put extreme pressure on health care services in South Africa.Aim: To describe the design, patients and outcomes of a field hospital during the first wave of the coronavirus disease 2019 (COVID-19) pandemic.Setting: The Cape Town International Convention Centre was the first location in Cape Town to be commissioned as a field hospital that would serve as an intermediate care bed facility.Methods: This was a retrospective descriptive study of patients admitted to this facility between 8th June 2020 and 14th August 2020 using deidentified data extracted from patient records.Results: There were 1502 patients admitted, 56.4% female, with a mean age of 58.6 years (standard deviation [s.d.]: 14.2). The majority of patients (82.9%) had at least one comorbidity, whilst 15.4% had three or more. Nearly 80.0% (79.8%) of patients required oxygen and 63.5% received steroids, and only 5.7% of patients were required to be transferred for escalation of care. The mean length of stay was 6 days (s.d.: 4.8) with an overall mortality of 5.7%.Conclusion: This study highlights the role of a field hospital in providing surge capacity. Its use halved the predicted duration of stay at acute care hospitals, allowing them the capacity to manage more unstable and critical patients. Adaptability and responsivity as well as adequate referral platforms proved to be crucial. Daily communication with the whole health care service platform was a critical success factor. This study provides information to assist future health planning and strategy development in the current pandemic and future disease outbreaks.

Selecting the field hospital location for earthquakes: an application for Ankara Province in Turkey

PurposeThe authors present a location selection model for the field hospital to build after a possible earthquake in Ankara, Turkey using the VIKOR method.Design/methodology/approachCompanies or governments that make location selection decisions to improve their performance in new investment decisions for different service industries. On the other hand, disasters, especially earthquakes, force the governments to evaluate their existing potentialities and develop action plans to improve their middle and long-term preparations. This paper proposes a VIKOR method-based location selection model for the field hospital to build after a possible earthquake. Also, the authors present a methodology using the VIKOR method that how government agencies take action for the field hospital's location selection process via VIKOR methodology.FindingsThe modeling and application results show that the field hospital's location selection decision-making process improves considerably using the VIKOR model. This paper shows that the proposed VIKOR-based model can rank alternatives suitability at various criteria targeting to minimize the possible earthquake's impact and obtains a single overall ranking score to select the best alternative.Research limitations/implicationsThe study does not consider the uncertain nature of the field hospital selection problem. The application part is restricted to the Ankara case. But the proposed model can easily extend for different locations in the world.Originality/valueThis paper presents the multi-criteria decision-making (MCDM) framework study of the establishment of field hospitals and demonstrates its importance when criteria diversity is restricted.

Prevalence of depression and anxiety among male patients with COVID-19 in Lebsayyer Field Hospital, Qatar

Background: Depression and anxiety are major health problems found to be associated with various conditions. COVID-19 is a global pandemic that has a substantial effect on the worldwide population. This study aimed to assess the prevalence of depression and anxiety among male patients with COVID-19 and explore their relationship with participants’ characteristics. Methods: This cross-sectional study was conducted among expatriate male patients with COVID-19 admitted to Lebsayyer Field Hospital in Qatar with mild COVID-19 (according to World Health Organization classification) from July till August 2020. The sample size was calculated using Cochran's formula based on disease prevalence. All eligible patients were invited to participate until reaching 400 participants, who then completed an anonymous survey of sociodemographic questions, Patient Health Questionnaire-9, and Generalized Anxiety Disorder-7 questionnaire, which are validated screening tools for depression and anxiety, respectively. Results: Of the 400 participants, 148 (37.0%) and 77 (19.3%) reported depressive and anxiety symptoms, respectively. Depression was more prevalent among those 40–49 years old (p = 0.029), while anxiety was more prevalent among people aged ≥ 50 (p = 0.456). Both depression (p = 0.009) and anxiety (p = 0.042) were more prevalent among Bangladeshi, followed by Filipino participants. Depression was more prevalent among those with the highest income (> 15,000 QR; p = 0.004), in contrast to anxiety, which was more prevalent among those with the lowest monthly income ( < 2,000 QR; p = 0.039). Conclusion: The prevalence of depressive and anxiety symptoms is high among the study participants. Associated factors identified by the study were unsteady income, poor self-rated health, living with family, Southeast Asian ethnicity, and age group of 40–49 years.

Analysis of Characteristics and Clinical Outcomes for Crisis Management during the Four Waves of the COVID-19 Pandemic

This study aims to analyze the patient characteristics and factors related to clinical outcomes in the crisis management of the COVID-19 pandemic in a field hospital. We conducted retrospective analysis of patient clinical data from March 2020 to August 2021 at the first university-based field hospital in Thailand. Multivariable logistic regression models were used to evaluate the factors associated with the field hospital discharge destination. Of a total of 3685 COVID-19 patients, 53.6% were women, with the median age of 30 years. General workers accounted for 97.5% of patients, while 2.5% were healthcare workers. Most of the patients were exposed to coronavirus from the community (84.6%). At the study end point, no patients had died, 97.7% had been discharged home, and 2.3% had been transferred to designated high-level hospitals due to their condition worsening. In multivariable logistic regression analysis, older patients with one or more underlying diseases who showed symptoms of COVID-19 and whose chest X-rays showed signs of pneumonia were in a worse condition than other patients. In conclusion, the university-based field hospital has the potential to fill acute gaps and prevent public agencies from being overwhelmed during crisis events.

Navigating Pandemic Responsiveness in an Acute Care Setting: A Community Hospital’s Operational Experience with COVID-19

Background To ensure continuity of services while mitigating patient surge and nosocomial infections during the coronavirus disease 2019 (COVID-19) pandemic, acute care hospitals have been required to make significant operational adjustments. Here, we identify and discuss key administrative priorities and strategies used by a large community hospital located in Barrie, Ontario to manage COVID-19. Methods Guided by a qualitative descriptive approach, we conducted a thematic analysis of all COVID-19-related documentation discussed by the hospital’s Emergency Operations Centre (EOC) during the first pandemic wave. We solicited operational strategies from administrative leaders to construct a narrative for each theme. Results Seven recurrent themes critical to the hospital’s pandemic response emerged: 1) Organizational Structure: a modified EOC structure was adopted to increase departmental interoperability and situational awareness; 2) Capacity Planning: Design Thinking guided rapid infrastructure decisions to meet surge requirements; 3) Occupational Health and Workplace Safety: a multidisciplinary team provided respirator fit-testing, critical absence adjudication, and wellness needs; 4) Human Resources/Workforce Planning: new workforce planning, recruitment, and redeployment strategies addressed staffing shortages; 5) Personal Protective Equipment (PPE): PPE conservation required proactive sourcing from traditional and non-traditional suppliers; 6) Community Response: local partnerships were activated to divert patients through a non-referral-based assessment and treatment centre, support long-term care and retirement homes, and establish a 70-bed field hospital; and 7) Corporate Communication: a robust communication strategy provided timely and transparent access to rapidly evolving information. Conclusions The hospital benefited from an interconnected command structure that focused on inter-operability, communication, novel administrative tools, and community partnerships.