Rapid Development of Resident-Led Procedural Response Teams to Support Patient Care During the Coronavirus Disease 2019 Epidemic

Coons, Barbara E.; Tam, Sophia F.; Okochi, Shunpei

doi:10.1001/jamasurg.2020.1782

Cited by 22 publications

(27 citation statements)

References 4 publications

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“…Considering further the risk of an outbreak reactivation with a so-called “second surge,” sharing this experience among others is critical to help address present and future challenges due to COVID-19. 11 12…”

Section: Discussionmentioning

confidence: 99%

Prone Positioning for Severe Acute Respiratory Distress Syndrome in COVID-19 Patients by a Dedicated Team

et al. 2020

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Objective: The aim of this study was to define whether rapidly reallocating health care workers not experienced with PP for performing PP in ICU is feasible and safe. Summary Background Data: In the setting of severe acute respiratory distress syndrome (ARDS), the use of prone and supine positioning procedures (PP) has been associated with improved oxygenation resulting in decreased mortality. Nevertheless, applying PP is time consuming for ICU staffs that are at risk of mental of physical exhaustion, especially with the constant surge of admitted COVID-19 patients with severe ARDS. Methods: This prospective cohort study conducted at a single regional university hospital between March 27 and April 15, 2020. Among 117 patients admitted to ICU, 67 patients (57.3%) presented with proven SARS-CoV-2 infection with severe ARDS requiring PP. After accelerated simulation training, 109 volunteers including surgeons, physicians, nurses and physiotherapists, multiple dedicated teams performed daily multiple PP following a systematic checklist. Patient demographics and PP data were collected. Patient safety and health care workers safety were assessed. Results: Among 117 patients admitted to ICU, 67 patients (57.3%) required PP. Overall, 53 (79%) were male, with a median age of 68.5 years and median body mass index of 29.3 kg/m 2 . A total of 384 PP were performed. Overall, complication occurred in 34 PP (8.8%) and led to PP cancelation in 4 patients (1%). Regarding health care workers safety, four health care workers presented with potential COVID-19 related symptoms and none was positive. Conclusions: To overcome the surge of critically ill COVID-19 patients, reallocating health care workers to targeted medical tasks beyond their respective expertise such as PP was safe.

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Section: Discussionmentioning

confidence: 99%

Prone Positioning for Severe Acute Respiratory Distress Syndrome in COVID-19 Patients by a Dedicated Team

et al. 2020

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“…Two main factors may explain this observation: first that, as surgeons, proctologists have proved their resilience in continuing their practice while facing the emergency. In some instances, this has translated into alternating shifts in surgical wards and intensive care units [26,27]. Secondly, proctologists may have been exposed to further potential drivers of transmission (i.e.…”

Section: Discussionmentioning

confidence: 99%

“…Male gender was predominant and in line with previous reports within general surgery [22,23], suggesting that coloproctology has not largely met women's ambitions over the last two decades. into alternating shifts in surgical wards and intensive care units [26,27]. Secondly, proctologists may have been exposed to further potential drivers of transmission (i.e.…”

Section: Discussion and Con Clus I Onmentioning

confidence: 99%

A worldwide survey on proctological practice during COVID‐19 lockdown (ProctoLock 2020): a cross‐sectional analysis

et al. 2020

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Aim Proctology is one of the surgical specialties that has suffered the most during COVID‐19 pandemic. Using a cross‐sectional non‐incentivised World Wide Web survey, we aimed to snapshot the current status of proctological practice in six world regions. Method Surgeons affiliated to renowned scientific societies with an interest in coloproctology were invited to join the survey. Members of the ProctoLock Working Group enhanced recruitment by direct invitation. The predictive power of respondents’ and hospitals’ demographics on the change of status of surgical and outpatient activities was calculated. Results Respondents ( n = 1050) were mostly men (79%), with a mean age of 46.9 years, at consultant level (79%), practising in academic hospitals (53%) offering a dedicated proctology service (68%). A total of 119 (11%) tested positive for SARS‐CoV‐2. The majority (54%) came from Europe. Participants from Asia reported a higher proportion of unaltered practice (17%), while those from Europe had the highest proportion of fully stopped practice (20%). The likelihood of ongoing surgical practice was higher in men (OR 1.54, 95% CI 1.13–2.09; P = 0.006), in those reporting readily availability of personal protective equipment (PPE) (OR 1.40, 1.08–1.42; P = 0.012) and in centres that were partially or not at all involved in COVID‐19 care (OR 2.95, 2.14–4.09; P < 0.001). This chance decreased by 2% per year of respondent’s age ( P = 0.001). Conclusion Several factors including different screening policies and resource capacity affected the current status of proctological practice. This information may help health authorities to formulate effective preventive strategies to limit curtailment of care of these patients during the pandemic.

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“…These data were used to develop VAST. As opposed to other similar teams [20], we did not restrict ourselves to surgical specialities but chose members with complementary clinical skill-sets to minimise pressures on any speci c speciality that were required to maintain emergency services across the hospital. We believe that the diversity of the team resulted in improved process review, a wider discussion and better sharing of ideas that was needed to rapidly adapt to the challenging environment and the distinct patient cohort that was being treated.…”

Section: Discussionmentioning

confidence: 99%

Vascular Access Support Team: A Multi-Disciplinary Response to Optimise Patients’ Care during COVID-19 Pandemic

Sinha

Saha

Nabil

et al. 2020

Preprint

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Background: Vascular access support teams have been set up to help offload procedural tasks from critical care teams during the coronavirus disease 2019 (COVID-19) global pandemic. However, the impact of VAST on clinical outcomes and on workload has not been shown previously with no reports to date from the UK. Our aim was to evaluate clinical outcomes of a multidisciplinary vascular access support team (VAST) and the value of the service to critical care teams. Methods: Prospectively collected data on all patients requiring vascular access at St Thomas’ Hospital, London over a 5-week period during the first wave of the pandemic in the UK. At the end of study period, online anonymised questionnaire administered to critical care team members, including nursing and medical professionals, to evaluate their experience of the service. We report access-related complication until discharge from centre and description of results of online survey.Results: 122 patients aged 52.1 ± 13 years with high rate of pre-existing co-morbidities, underwent line insertion including 190 catheters (central venous n=182, arterial n=8). Median (range) number of 5 (0-17) lines were placed per day in patients of whom 90% tested positive for Severe Acute Respiratory Syndrome Coronavirus-type 2 pathogen (SARS-CoV-2). A single line (n=146) was inserted in 96 out of 122 patients (78.7%) and n=18 patients (14.7%) ‘double puncture’ technique used. 45 line insertions (24%) had complications with minor [bleeding (n=19), line infection (n=10)] and 2 lines (1%) with major complication. The survey respondents, n=54 professionals, highlighted ease of referral and timely access placement (>90% responses); with agreement that VAST service saved them precious time and allow them to focus on other jobs.Conclusions: We describe the successful deployment of a multidisciplinary vascular access team with low complication rates and high rates of satisfaction. We recommend similar models can be considered by health services to optimise patient care and ICU management.

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Rapid Development of Resident-Led Procedural Response Teams to Support Patient Care During the Coronavirus Disease 2019 Epidemic

Cited by 22 publications

References 4 publications

Prone Positioning for Severe Acute Respiratory Distress Syndrome in COVID-19 Patients by a Dedicated Team

Prone Positioning for Severe Acute Respiratory Distress Syndrome in COVID-19 Patients by a Dedicated Team

A worldwide survey on proctological practice during COVID‐19 lockdown (ProctoLock 2020): a cross‐sectional analysis

Vascular Access Support Team: A Multi-Disciplinary Response to Optimise Patients’ Care during COVID-19 Pandemic

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