Rapid conversion of an in-patient hospital unit to accommodate COVID-19: An interdisciplinary human factors, ethnography, and infection prevention and control approach.
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2021
2021
Historique:
received:
23
10
2020
accepted:
23
12
2020
entrez:
22
1
2021
pubmed:
23
1
2021
medline:
3
2
2021
Statut:
epublish
Résumé
In response to the Coronavirus disease-19 (COVID-19) pandemic, in-patient units in hospitals around the world have altered their patient care routines and Infection Prevention and Control (IPC) practices. Our interdisciplinary team of applied Human Factors (HF), ethnography, and IPC experts assisted one Unit, normally serving general surgical and orthopedic patients, as it rapidly converted to deliver COVID-19-specific care. This paper describes the conversion experience of the Unit, and outlines broader lessons for other acute care teams faced with similar issues. We deployed walkthroughs, simulations, and ethnography to identify important safety gaps in care delivery processes on the Unit. These interventions were undertaken using interdisciplinary theories of implementation that combined systems-level HF perspectives, ethnographic approaches, and individual-level IPC perspectives. Timely recommendations were developed and delivered to Unit staff for feedback and implementation. We describe three interventions on the Unit: 1) the de-cluttering and re-organization of personal protective equipment (PPE); 2) the reconfiguring of designated 'dirty' tray tables and supplies; and 3) the redesign of handling pathways for 'dirty' linens and laundry. Each of these interventions was implemented to varying degrees, but all contributed to discussions of safety and IPC implementation that extended beyond the Unit and into the operations of the broader hospital. Leveraging our team's interdisciplinary expertise and blended approaches to implementation, the interventions assisted in the Unit's rapid conversion towards providing COVID-19-specific care. The deployment and implementation of the interventions highlight the potential of collaboration between HF, ethnography, and IPC experts to support frontline healthcare delivery under pandemic conditions in an effort to minimize nosocomial transmission potential in the acute healthcare setting.
Sections du résumé
BACKGROUND
In response to the Coronavirus disease-19 (COVID-19) pandemic, in-patient units in hospitals around the world have altered their patient care routines and Infection Prevention and Control (IPC) practices. Our interdisciplinary team of applied Human Factors (HF), ethnography, and IPC experts assisted one Unit, normally serving general surgical and orthopedic patients, as it rapidly converted to deliver COVID-19-specific care. This paper describes the conversion experience of the Unit, and outlines broader lessons for other acute care teams faced with similar issues.
METHODS
We deployed walkthroughs, simulations, and ethnography to identify important safety gaps in care delivery processes on the Unit. These interventions were undertaken using interdisciplinary theories of implementation that combined systems-level HF perspectives, ethnographic approaches, and individual-level IPC perspectives. Timely recommendations were developed and delivered to Unit staff for feedback and implementation.
RESULTS
We describe three interventions on the Unit: 1) the de-cluttering and re-organization of personal protective equipment (PPE); 2) the reconfiguring of designated 'dirty' tray tables and supplies; and 3) the redesign of handling pathways for 'dirty' linens and laundry. Each of these interventions was implemented to varying degrees, but all contributed to discussions of safety and IPC implementation that extended beyond the Unit and into the operations of the broader hospital.
CONCLUSIONS
Leveraging our team's interdisciplinary expertise and blended approaches to implementation, the interventions assisted in the Unit's rapid conversion towards providing COVID-19-specific care. The deployment and implementation of the interventions highlight the potential of collaboration between HF, ethnography, and IPC experts to support frontline healthcare delivery under pandemic conditions in an effort to minimize nosocomial transmission potential in the acute healthcare setting.
Identifiants
pubmed: 33481807
doi: 10.1371/journal.pone.0245212
pii: PONE-D-20-32458
pmc: PMC7822252
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0245212Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
Eur Rev Med Pharmacol Sci. 2020 Aug;24(15):8202-8209
pubmed: 32767350
West J Med. 2000 Jun;172(6):393-6
pubmed: 10854390
Eur J Emerg Med. 2020 Jun;27(3):161-162
pubmed: 32224710
BMJ Qual Saf. 2018 Oct;27(10):763-765
pubmed: 30007916
Appl Ergon. 2006 Jan;37(1):55-79
pubmed: 16139236
N Engl J Med. 2020 Oct 8;383(15):1483-1488
pubmed: 32706956
BMJ Glob Health. 2020 Jul;5(7):
pubmed: 32718949
Anaesthesia. 2020 Jul;75(7):928-934
pubmed: 32246838
Am J Emerg Med. 2020 Jul;38(7):1535-1537
pubmed: 32334896
Indian J Crit Care Med. 2020 Jun;24(6):385-392
pubmed: 32863628
J Popul Ther Clin Pharmacol. 2020 Jun 15;27(S Pt 1):e11-e13
pubmed: 32603562
CMAJ. 2020 Jun 29;192(26):E720-E726
pubmed: 32493744
CMAJ. 2020 May 25;192(21):E585-E586
pubmed: 32376644
CMAJ. 2020 May 11;192(19):E518-E520
pubmed: 32317277
Infect Control Hosp Epidemiol. 2019 Dec;40(12):1334-1343
pubmed: 31662139
CMAJ. 2020 Jun 15;192(24):E640-E646
pubmed: 32409519
J Pediatr. 2020 Jul;222:22-27
pubmed: 32380026
BMJ Qual Saf. 2014 Feb;23(2):99-105
pubmed: 24096894
BMJ Qual Saf. 2012 Oct;21(10):876-84
pubmed: 22543475
Am J Infect Control. 2017 Jun 1;45(6):648-651
pubmed: 28214161
Am J Emerg Med. 2020 Jul;38(7):1531-1532
pubmed: 32305159
Crit Care Med. 2010 Aug;38(8 Suppl):S269-81
pubmed: 20647784
Sociol Health Illn. 2016 Feb;38(2):216-32
pubmed: 26537016
Crit Care Nurse. 2020 Dec 1;40(6):e1-e16
pubmed: 32803240
BMJ Qual Saf. 2015 Mar;24(3):228-38
pubmed: 25616279
Qual Saf Health Care. 2003 Oct;12(5):326-7
pubmed: 14532360
Hum Factors. 2019 Aug;61(5):693-701
pubmed: 30884250
Acad Med. 2014 Sep;89(9):1245-51
pubmed: 24979285