Responding to COVID-19 Through Interhospital Resource Coordination: A Mixed-Methods Evaluation.
Responding to COVID-19 Through Interhospital Resource Coordination: A Mixed-Methods Evaluation.
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DOI：
10.1097/pts.0000000000000916
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发表时间：
2022-06-01
影响因子：
2.2
通讯作者：
Baum KD
中科院分区：
文献类型：
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作者：
Usher MG;Tignanelli CJ;Hilliard B;Kaltenborn ZP;Lupei MI;Simon G;Shah S;Kirsch JD;Melton GB;Ingraham NE;Olson APJ;Baum KD
新冠肺炎疫情给医院运营带来了压力，需要快速创新来应对需求的增长和专业化的新冠肺炎服务，同时保持获得以医院为基础的护理并促进专业知识的提供。我们的目标是描述一种新的医院系统方法来管理新冠肺炎大流行，包括多医院协调能力和将新冠肺炎患者转移到单一的专用医院。我们纳入了聚合酶链式反应检测SARS-CoV-2呈阳性的患者，他们住进了12家医院网络，其中包括一家专门的新冠肺炎医院。我们的主要结果是遵循当地指南，包括入院风险分层、抗凝和地塞米松治疗，在指南公布后通过差异分析进行评估。我们评估了结果和医护人员的满意度。最后，我们评估了安全转移的障碍，包括跨不同电子健康记录系统的转移。在研究期间，该系统总共接纳了1209名患者。在这些患者中，56.3%接受了转院，由医生领导的系统操作中心提供支持。转院的患者年龄较大(P=0.001)，风险调整后的死亡率相似。在接受转院：入院风险分层(P<；0.001)、抗凝(P<；0.001)和地塞米松治疗(P=0.003)的患者中，传播后指南的依从性更高。跨电子健康记录系统的传输被认为是安全和质量下降的障碍。供应商对我们的转让方式持积极态度。通过标准化的沟通，医院间转运可以成为一种安全有效的新冠肺炎患者队列方法，受到医护人员的欢迎，并有可能提高护理质量。
The COVID-19 pandemic stressed hospital operations, requiring rapid innovations to address rise in demand and specialized COVID-19 services while maintaining access to hospital-based care and facilitating expertise. We aimed to describe a novel hospital system approach to managing the COVID-19 pandemic, including multihospital coordination capability and transfer of COVID-19 patients to a single, dedicated hospital. We included patients who tested positive for SARS-CoV-2 by polymerase chain reaction admitted to a 12-hospital network including a dedicated COVID-19 hospital. Our primary outcome was adherence to local guidelines, including admission risk stratification, anticoagulation, and dexamethasone treatment assessed by differences-in-differences analysis after guideline dissemination. We evaluated outcomes and health care worker satisfaction. Finally, we assessed barriers to safe transfer including transfer across different electronic health record systems. During the study, the system admitted a total of 1209 patients. Of these, 56.3% underwent transfer, supported by a physician-led System Operations Center. Patients who were transferred were older (P = 0.001) and had similar risk-adjusted mortality rates. Guideline adherence after dissemination was higher among patients who underwent transfer: admission risk stratification (P < 0.001), anticoagulation (P < 0.001), and dexamethasone administration (P = 0.003). Transfer across electronic health record systems was a perceived barrier to safety and reduced quality. Providers positively viewed our transfer approach. With standardized communication, interhospital transfers can be a safe and effective method of cohorting COVID-19 patients, are well received by health care providers, and have the potential to improve care quality.