Rapid ethnographic assessment of the COVID-19 pandemic April 2020 ‘surge’ and its impact on service delivery in an Acute Care Medical Emergency Department and Trauma Center

Abstract

ObjectivesAssess the impacts of the COVID-19 pandemic on service delivery by frontline healthcare providers in acute care medical and emergency department settings and identify strategies used to cope with pandemic-related physical and mental health demands.DesignRapid clinical ethnography of patient–provider encounters during an initial pandemic ‘surge’ conducted by a team of clinician–researchers using a structured protocol for qualitative data collection and analysis.SettingLevel 1 trauma centre at Harborview Hospital in Seattle Washington in April 2020.ParticipantsFrontline clinical providers serving as participant observers during performance of their clinical duties recorded observations and summaries of conversations with other providers and patients.ResultsWe identified four different kinds of impacts: procedural, provider, patient and overall. Each impact highlighted two or more levels of a socioecological model of services delivery: (1) the epidemiology of COVID-19, (2) outer setting, (3) inner or organisational setting and (4) individual patient and provider. Despite significant changes in procedures that included COVID-19 screening of all admitted patients, social distancing and use of personal protective equipment, as well as changes in patient and provider behaviour, the overall impact of the pandemic on the emergency department and acute care service delivery was minimal. This is attributed to having a smaller surge than expected, a quick response by the healthcare system to anticipated demands for service delivery and protection of patients and providers, adequate supplies and high provider morale.ConclusionsAlthough limited to one setting in one healthcare system in one community, the findings offer some important lessons for healthcare systems that have yet to be impacted as well as systems that have been more severely impacted. Each of the socioecological framework levels was found to impact service delivery to patients, and variations at each of these levels account for variations in that quality of care globally.

A Rapid Ethnographic Assessment of the Impact of the COVID-19 Pandemic on Mental Health Services Delivery in an Acute Care Medical Emergency Department and Trauma Center

“…Consistent with an earlier study of the impact of the pandemic on all acute care services (Palinkas et al, 2020 ), several challenges to providing mental and behavioral health services in an acute care setting were reported by POs during the April surge. Many of these challenges were related to community and institutional efforts to control the spread of the coronavirus, including social distancing, use of PPE, coronavirus testing availability, and sheltering in place.…”

“…Although the parent study was designed as a mixed methods study, the study reported in this manuscript was intended to be a qualitative study only because study investigators remained obligated to perform their clinical duties and thus were able to continue as participant observers at the study site and collect information on trauma center processes and activities that extended beyond the scope of the parent study. In the study reported here, RAPICE was utilized because the research team had already been trained in its use and had collected ethnographic data at the trauma center in the parent study prior to the COVID-19 outbreak (Palinkas et al, 2020 ). RAPICE was also previously utilized to describe the impact on of the COVID-19 pandemic on trauma care services in general (Palinkas et al, 2020 ) and the ethical tensions and coping strategies in the early days and weeks of the pandemic at the Trauma Center of Harborview Medical Center in Seattle WA (Moloney et al, 2020 ).…”

“…In the study reported here, RAPICE was utilized because the research team had already been trained in its use and had collected ethnographic data at the trauma center in the parent study prior to the COVID-19 outbreak (Palinkas et al, 2020 ). RAPICE was also previously utilized to describe the impact on of the COVID-19 pandemic on trauma care services in general (Palinkas et al, 2020 ) and the ethical tensions and coping strategies in the early days and weeks of the pandemic at the Trauma Center of Harborview Medical Center in Seattle WA (Moloney et al, 2020 ). The facility is the only designated Level I trauma and burn center in Washington state and is the regional trauma and burn referral center for Alaska, Montana, and Idaho.…”

Non-pharmaceutical interventions during the COVID-19 pandemic: A review

“…In the third and final subcategory we find surveys targeting both patients and practitioners in a variety of specializations. From remote management of geriatric patients with heart conditions [232] and the effects of NPIs on transplant recipients/donors [233] to the changes adopted by several hospitals in academic centers [235] , hearing and emergency care [231] , [234] . Overall the observations on patients point to the interim efficacy of telemedicine and to high level of awareness about the risk of infection.…”

Clinical ethnography in severe mental illness: a clinical method to tackle social determinants and structural racism in personalised care

“…Recent rapid ethnographies of COVID contexts in Macau and USA show how a narrow biomedical and quarantine-focused narrative can undermine broader health and well-being; and these studies reveal difficulties for patients and for clinicians in adapting to new routines and infection-prevention priorities. 27 , 28 Stark differences in the spread of COVID-19 and in health outcomes have exposed how racism engenders and reinforces these inequalities. As a consequence, there is a growing awareness that we must adapt health and social care to be, not only culturally competent, but also capable of tackling fundamental causes of inequalities, both the social determinants and racism.…”