Managing critical care during COVID-19 pandemic: The experience of an ICU of a tertiary care hospital

Al‐Dorzi, Hasan M.; Al‐Dawood, Abdulaziz; Almatrood, Amal; Burrows, Victoria; Naidu, Brintha; Alchin, John; Alhumedi, Haifaa; Tashkandi, Nabeeha; Al‐Jahdali, Hamdan; Hussain, Arif; Harbi, Mohammed K Al; Zaibag, Muayed Al; Salih, Salih Bin; Shamrani, Majid M. Al; Alsaawi, Abdulmohsen; Arabi, Yaseen M.

doi:10.1016/j.jiph.2021.09.018

Cited by 27 publications

(23 citation statements)

References 20 publications

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“…Many national health authorities acted independently and adapted their strategies, evidencing that the countries of the European Union were not able to reach a collective consensus and to adopt common guidelines. The pandemic caused by Covid-19 has been confronting the healthcare landscape with new challenges [ 1 , 2 ]. In addition to the already highly burdened hospitals, the pandemic management required further considerable organizational efforts [ 3 – 5 ].…”

Section: Introductionmentioning

confidence: 99%

Orthopaedic, trauma surgery, and Covid-2019 pandemic: clinical panorama and future prospective in Europe

Migliorini

Weber

Pappalardo

et al. 2022

Eur J Trauma Emerg Surg

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Purpose This study investigated the impact of the Covid-19 pandemic in Europe on consultations, surgeries, and traumas in the field of orthopaedic and trauma surgery. Strategies to resume the clinical activities were also discussed. Methods This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the 2020 PRISMA statement. All the comparative studies reporting data on the impact of Covid-19 in the field of orthopaedic and trauma surgery in Europe were accessed. Only comparative clinical studies which investigated the year 2020 versus 2019 were eligible. Results 57 clinical investigations were included in the present study. Eight studies reported a reduction of the orthopaedic consultations, which decreased between 20.9 and 90.1%. Seven studies reported the number of emergency and trauma consultations, which were decreased between 37.7 and 74.2%. Fifteen studies reported information with regard to the reasons for orthopaedic and trauma admissions. The number of polytraumas decreased between 5.6 and 77.1%, fractures between 3.9 and 63.1%. Traffic accidents admissions dropped by up to 88.9%, and sports-related injuries dropped in a range of 59.3% to 100%. The overall reduction of the surgical interventions ranged from 5.4 to 88.8%. Conclusion The overall trend of consultations, surgeries, and rate of traumas and fragility fractures appear to decrease during the 2020 European COVID pandemic compared to the pre-pandemic era. Given the heterogeneities in the clinical evidence, results from the present study should be considered carefully. Level of evidence Level IV, systematic review.

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Section: Introductionmentioning

confidence: 99%

Orthopaedic, trauma surgery, and Covid-2019 pandemic: clinical panorama and future prospective in Europe

Migliorini

Weber

Pappalardo

et al. 2022

Eur J Trauma Emerg Surg

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“…In 2019, the hospital received the Healthcare Information and Management Systems Society (HIMSS) Outpatient-EMRAM Stage 7 accreditation ( https://www.ngha.med.sa/English/MediaCenter/News/Pages/MMXIXIVI.aspx ) , and in 2021 received the HIMSS Adoption Model for Analytics Maturity (AMAM) Stage 7 accreditation ( https://www.healthcareitnews.com/news/emea/two-medical-groups-saudi-arabia-achieve-stage-7-digital-maturity ). The EMR was also used to build an electronic alert system for sepsis that has been implemented throughout the 5 medical campuses, as part of a stepped-wedge randomized trial that included more than 60,000 hospitalized patients [ 19 , 20 ] Furthermore, the EMR has facilitated a quick efficient transformation during the COVID-19 pandemic with the implementation of new screening tools, tracking of patients, and monitoring of their medical care [ 21 – 23 ]. It also allowed rapid implementation of the concepts of virtual clinics and telehealth.…”

Section: Resultsmentioning

confidence: 99%

“…It also allowed rapid implementation of the concepts of virtual clinics and telehealth. Such an experience reflects the contribution of the EMR to the resilience of the healthcare system [ 21 – 23 ].…”

Section: Resultsmentioning

confidence: 99%

Electronic medical record implementation in a large healthcare system from a leadership perspective

Arabi

Ghamdi

Al-Moamary

et al. 2022

BMC Med Inform Decis Mak

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Background Information on the use of change management models to guide electronic medical records (EMR) implementation is limited. This case study describes the leadership aspects of a large-scale EMR implementation using Kotter’s change management model. Methods This case study presents the experience in implementing a new EMR system from the leadership perspective at King Abdulaziz Medical City, a large tertiary care hospital in Riyadh, Kingdom of Saudi Arabia. We described the process of implementation and outlined the challenges and opportunities, throughout the journey from the pre-implementation to the post-implementation phases. Results We described the corresponding actions to the eight domains of Kotter’s change management model: creating a sense of urgency, building the guiding team, developing a change vision and strategy, understanding and buy-in, removing obstacles, creating short-term wins, building on the change and anchoring the changes in corporate culture. Conclusions The case study highlights that EMR implementation is not a pure information technology project but rather is a technical-based complex social adaptive project that requires a specific set of leadership competencies that are central to its success. It demonstrates that change management models might be useful for large-scale EMR implementation.

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“…The study was launched in October 2019. During the study period in 2020–2021, and in response to the surge in the number of hospitalized patients with coronavirus disease-19 (COVID-19), some of the wards had to be converted to intensive care units (ICUs), making them ineligible for the study intervention [ 15 ]. These wards will be excluded from the ITT cohort while used as ICUs.…”

Section: Methodsmentioning

confidence: 99%

Statistical analysis plan for the Stepped-wedge Cluster Randomized trial of Electronic Early Notification of sepsis in hospitalized ward patients (SCREEN)

Arabi¹,

Vishwakarma

Al‐Dorzi³

et al. 2021

Trials

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Background It is unclear whether screening for sepsis using an electronic alert in hospitalized ward patients improves outcomes. The objective of the Stepped-wedge Cluster Randomized Trial of Electronic Early Notification of Sepsis in Hospitalized Ward Patients (SCREEN) trial is to evaluate whether an electronic screening for sepsis compared to no screening among hospitalized ward patients reduces all-cause 90-day in-hospital mortality. Methods and design This study is designed as a stepped-wedge cluster randomized trial in which the unit of randomization or cluster is the hospital ward. An electronic alert for sepsis was developed in the electronic medical record (EMR), with the feature of being active (visible to treating team) or masked (inactive in EMR frontend for the treating team but active in the backend of the EMR). Forty-five clusters in 5 hospitals are randomized into 9 sequences of 5 clusters each to receive the intervention (active alert) over 10 periods, 2 months each, the first being the baseline period. Data are extracted from EMR and are compared between the intervention (active alert) and control group (masked alert). During the study period, some of the hospital wards were allocated to manage patients with COVID-19. The primary outcome of all-cause hospital mortality by day 90 will be compared using a generalized linear mixed model with a binary distribution and a log-link function to estimate the relative risk as a measure of effect. We will include two levels of random effects to account for nested clustering within wards and periods and two levels of fixed effects: hospitals and COVID-19 ward status in addition to the intervention. Results will be expressed as relative risk with a 95% confidence interval. Conclusion The SCREEN trial provides an opportunity for a novel trial design and analysis of routinely collected and entered data to evaluate the effectiveness of an intervention (alert) for a common medical problem (sepsis in ward patients). In this statistical analysis plan, we outline details of the planned analyses in advance of trial completion. Prior specification of the statistical methods and outcome analysis will facilitate unbiased analyses of these important clinical data. Trial registration ClinicalTrials.gov NCT04078594. Registered on September 6, 2019

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Managing critical care during COVID-19 pandemic: The experience of an ICU of a tertiary care hospital

Cited by 27 publications

References 20 publications

Orthopaedic, trauma surgery, and Covid-2019 pandemic: clinical panorama and future prospective in Europe

Orthopaedic, trauma surgery, and Covid-2019 pandemic: clinical panorama and future prospective in Europe

Electronic medical record implementation in a large healthcare system from a leadership perspective

Statistical analysis plan for the Stepped-wedge Cluster Randomized trial of Electronic Early Notification of sepsis in hospitalized ward patients (SCREEN)

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