RAND Critical Care Surge Response Tool: An Excel-Based Model for Helping Hospitals Respond to the COVID-19 Crisis

Abir, Mahshid; Nelson, Christopher; Chan, Edward W.; Al-Ibrahim, Hamad; Cutter, Christina; Patel, Krunalkumar; Bogart, Andy

doi:10.7249/tla164-1

Cited by 5 publications

(4 citation statements)

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“…Health care organizations (HCOs) change intensive care unit (ICU) staffing and follow physical distancing policy during the COVID-19 pandemic to protect clinicians and patients [ 1 , 2 ]. For instance, many physical care activities before the COVID-19 pandemic have been transitioning to virtual systems, such as electronic health records (EHRs) or telehealth [ 3 - 5 ].…”

Section: Introductionmentioning

confidence: 99%

Assessing Neonatal Intensive Care Unit Structures and Outcomes Before and During the COVID-19 Pandemic: Network Analysis Study

Mannering¹,

Yan²,

Gong³

et al. 2021

J Med Internet Res

View full text Add to dashboard Cite

Background Health care organizations (HCOs) adopt strategies (eg. physical distancing) to protect clinicians and patients in intensive care units (ICUs) during the COVID-19 pandemic. Many care activities physically performed before the COVID-19 pandemic have transitioned to virtual systems during the pandemic. These transitions can interfere with collaboration structures in the ICU, which may impact clinical outcomes. Understanding the differences can help HCOs identify challenges when transitioning physical collaboration to the virtual setting in the post–COVID-19 era. Objective This study aims to leverage network analysis to determine the changes in neonatal ICU (NICU) collaboration structures from the pre– to the intra–COVID-19 era. Methods In this retrospective study, we applied network analysis to the utilization of electronic health records (EHRs) of 712 critically ill neonates (pre–COVID-19, n=386; intra–COVID-19, n=326, excluding those with COVID-19) admitted to the NICU of Vanderbilt University Medical Center between September 1, 2019, and June 30, 2020, to assess collaboration between clinicians. We characterized pre–COVID-19 as the period of September-December 2019 and intra–COVID-19 as the period of March-June 2020. These 2 groups were compared using patients’ clinical characteristics, including age, sex, race, length of stay (LOS), and discharge dispositions. We leveraged the clinicians’ actions committed to the patients’ EHRs to measure clinician-clinician connections. We characterized a collaboration relationship (tie) between 2 clinicians as actioning EHRs of the same patient within the same day. On defining collaboration relationship, we built pre– and intra–COVID-19 networks. We used 3 sociometric measurements, including eigenvector centrality, eccentricity, and betweenness, to quantify a clinician’s leadership, collaboration difficulty, and broad skill sets in a network, respectively. We assessed the extent to which the eigenvector centrality, eccentricity, and betweenness of clinicians in the 2 networks are statistically different, using Mann-Whitney U tests (95% CI). Results Collaboration difficulty increased from the pre– to intra–COVID-19 periods (median eccentricity: 3 vs 4; P<.001). Nurses had reduced leadership (median eigenvector centrality: 0.183 vs 0.087; P<.001), and neonatologists with broader skill sets cared for more patients in the NICU structure during the pandemic (median betweenness centrality: 0.0001 vs 0.005; P<.001). The pre– and intra–COVID-19 patient groups shared similar distributions in sex (~0 difference), race (4% difference in White, and 3% difference in African American), LOS (interquartile range difference in 1.5 days), and discharge dispositions (~0 difference in home, 2% difference in expired, and 2% difference in others). There were no significant differences in the patient demographics and outcomes between the 2 groups. Conclusions Management of NICU-admitted patients typically requires multidisciplinary care teams. Understanding collaboration structures can provide fine-grained evidence to potentially refine or optimize existing teamwork in the NICU.

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Section: Introductionmentioning

confidence: 99%

Assessing Neonatal Intensive Care Unit Structures and Outcomes Before and During the COVID-19 Pandemic: Network Analysis Study

Mannering¹,

Yan²,

Gong³

et al. 2021

J Med Internet Res

View full text Add to dashboard Cite

show abstract

“… 1 During the acute pandemic, shortages of personal protective equipment and uncertainties regarding equipment (eg, ventilators, intensive care beds) and staffing needs caused many health systems to rapidly implement protocols that diverted limited space, staff, and equipment to anticipated acute care needs. 2 , 3 As part of this effort, millions of elective procedures that are required for treating other diseases and improving patient quality of life were canceled, resulting in delayed patient care and accumulated demand for elective procedures. 4 – 12 Additionally, the loss of income from elective procedures caused financial strain on many health systems, resulting in cost-cutting layoffs and furloughs that may make it difficult to resume medical services after the pandemic is controlled.…”

Section: Introductionmentioning

confidence: 99%

Resuming Elective Surgery during Covid-19: Can Inpatient Hospitals Collaborate with Ambulatory Surgery Centers?

Squitieri

Brook

et al. 2021

Plastic and Reconstructive Surgery - Global Open

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Background: Little is known about the volume and scope of surgical procedures performed in ambulatory surgery centers (ASCs) and the resources that ASCs may provide to assist local health systems. The purpose of this study was to evaluate elective surgical procedures in the inpatient and outpatient ASC setting using currently available administrative claims data. Methods: We used the 2019 Medicare Point of Service (POS) file to evaluate the geographic distribution of Medicare-certified ASCs in the U.S. To evaluate the volume and scope of elective procedures in the inpatient and outpatient ASC setting, we used the 2016 Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS) and the 2018 California HHS Open Data Portal ambulatory surgery database. HCUP software programs were used to clinically categorize procedures and determine Elixhauser comorbidity profiles for each patient. Results: Among the 8,540 Medicare certified ASCs in 2019, the majority are freestanding (99.5%) and privately owned (92.9%). In the inpatient setting, 13.3% of elective operating room procedures occur in patients without any Elixhauser comorbidities and require < 2 days of hospital stay. However, the types of elective procedures performed in the inpatient setting are different from the types of procedures routinely performed in ASCs. Conclusions: Current administrative data lack robust facility, provider, and procedure level information to inform surge capacity protocols for elective surgery. Plastic surgeons are uniquely positioned to work with other specialties and local health systems to guide future development of surge capacity protocols that maintain and improve patient care.

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“…Health care organizations (HCOs) change intensive care unit (ICU) staffing and follow physical distancing policy during the COVID-19 pandemic to protect clinicians and patients [1,2]. For instance, many physical care activities before the COVID-19 pandemic have been transitioning to virtual systems, such as electronic health records (EHRs) or telehealth [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Assessing Neonatal Intensive Care Unit Structures and Outcomes Before and During the COVID-19 Pandemic: Network Analysis Study (Preprint)

Mannering¹,

Yan²,

Gong³

et al. 2021

Preprint

View full text Add to dashboard Cite

BACKGROUND Health care organizations (HCOs) adopt strategies (eg. physical distancing) to protect clinicians and patients in intensive care units (ICUs) during the COVID-19 pandemic. Many care activities physically performed before the COVID-19 pandemic have transitioned to virtual systems during the pandemic. These transitions can interfere with collaboration structures in the ICU, which may impact clinical outcomes. Understanding the differences can help HCOs identify challenges when transitioning physical collaboration to the virtual setting in the post–COVID-19 era. OBJECTIVE This study aims to leverage network analysis to determine the changes in neonatal ICU (NICU) collaboration structures from the pre– to the intra–COVID-19 era. METHODS In this retrospective study, we applied network analysis to the utilization of electronic health records (EHRs) of 712 critically ill neonates (pre–COVID-19, n=386; intra–COVID-19, n=326, excluding those with COVID-19) admitted to the NICU of Vanderbilt University Medical Center between September 1, 2019, and June 30, 2020, to assess collaboration between clinicians. We characterized pre–COVID-19 as the period of September-December 2019 and intra–COVID-19 as the period of March-June 2020. These 2 groups were compared using patients’ clinical characteristics, including age, sex, race, length of stay (LOS), and discharge dispositions. We leveraged the clinicians’ actions committed to the patients’ EHRs to measure clinician-clinician connections. We characterized a collaboration relationship (tie) between 2 clinicians as actioning EHRs of the same patient within the same day. On defining collaboration relationship, we built pre– and intra–COVID-19 networks. We used 3 sociometric measurements, including eigenvector centrality, eccentricity, and betweenness, to quantify a clinician’s leadership, collaboration difficulty, and broad skill sets in a network, respectively. We assessed the extent to which the eigenvector centrality, eccentricity, and betweenness of clinicians in the 2 networks are statistically different, using Mann-Whitney U tests (95% CI). RESULTS Collaboration difficulty increased from the pre– to intra–COVID-19 periods (median eccentricity: 3 vs 4; P<.001). Nurses had reduced leadership (median eigenvector centrality: 0.183 vs 0.087; P<.001), and neonatologists with broader skill sets cared for more patients in the NICU structure during the pandemic (median betweenness centrality: 0.0001 vs 0.005; P<.001). The pre– and intra–COVID-19 patient groups shared similar distributions in sex (~0 difference), race (4% difference in White, and 3% difference in African American), LOS (interquartile range difference in 1.5 days), and discharge dispositions (~0 difference in home, 2% difference in expired, and 2% difference in others). There were no significant differences in the patient demographics and outcomes between the 2 groups. CONCLUSIONS Management of NICU-admitted patients typically requires multidisciplinary care teams. Understanding collaboration structures can provide fine-grained evidence to potentially refine or optimize existing teamwork in the NICU.

show abstract

RAND Critical Care Surge Response Tool: An Excel-Based Model for Helping Hospitals Respond to the COVID-19 Crisis

Cited by 5 publications

References 0 publications

Assessing Neonatal Intensive Care Unit Structures and Outcomes Before and During the COVID-19 Pandemic: Network Analysis Study

Assessing Neonatal Intensive Care Unit Structures and Outcomes Before and During the COVID-19 Pandemic: Network Analysis Study

Resuming Elective Surgery during Covid-19: Can Inpatient Hospitals Collaborate with Ambulatory Surgery Centers?

Assessing Neonatal Intensive Care Unit Structures and Outcomes Before and During the COVID-19 Pandemic: Network Analysis Study (Preprint)

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