Description of a Multi-faceted COVID-19 Pandemic Physician Workforce Plan at a Multi-site Academic Health System.
COVID-19
delivery of healthcare
disease outbreaks
health workforce
Journal
Journal of general internal medicine
ISSN: 1525-1497
Titre abrégé: J Gen Intern Med
Pays: United States
ID NLM: 8605834
Informations de publication
Date de publication:
May 2021
May 2021
Historique:
received:
20
08
2020
accepted:
21
12
2020
pubmed:
11
2
2021
medline:
22
5
2021
entrez:
10
2
2021
Statut:
ppublish
Résumé
The evolving COVID-19 pandemic has and continues to present a threat to health system capacity. Rapidly expanding an existing acute care physician workforce is critical to pandemic response planning in large urban academic health systems. The Medical Emergency-Pandemic Operations Command (MEOC)-a multi-specialty team of physicians, operational leaders, and support staff within an academic Department of Medicine in Calgary, Canada-partnered with its provincial health system to rapidly develop a comprehensive, scalable pandemic physician workforce plan for non-ventilated inpatients with COVID-19 across multiple hospitals. The MEOC Pandemic Plan comprised seven components, each with unique structure and processes. In this manuscript, we describe MEOC's Pandemic Plan that was designed and implemented from March to May 2020 and re-escalated in October 2020. We report on the plan's structure and process, early implementation outcomes, and unforeseen challenges. Data sources included MEOC documents, health system, public health, and physician engagement implementation data. From March 5 to October 26, 2020, 427 patients were admitted to COVID-19 units in Calgary hospitals. In the initial implementation period (March-May 2020), MEOC communications reached over 2500 physicians, leading to 1446 physicians volunteering to provide care on COVID-19 units. Of these, 234 physicians signed up for hospital shifts, and 227 physicians received in-person personal protective equipment simulation training. Ninety-three physicians were deployed on COVID-19 units at four large acute care hospitals. The resurgence of cases in September 2020 has prompted re-escalation including re-activation of COVID-19 units. MEOC leveraged an academic health system partnership to rapidly design, implement, and refine a comprehensive, scalable COVID-19 acute care physician workforce plan whose components are readily applicable across jurisdictions or healthcare crises. This description may guide other institutions responding to COVID-19 and future health emergencies.
Sections du résumé
BACKGROUND
BACKGROUND
The evolving COVID-19 pandemic has and continues to present a threat to health system capacity. Rapidly expanding an existing acute care physician workforce is critical to pandemic response planning in large urban academic health systems.
INTERVENTION
METHODS
The Medical Emergency-Pandemic Operations Command (MEOC)-a multi-specialty team of physicians, operational leaders, and support staff within an academic Department of Medicine in Calgary, Canada-partnered with its provincial health system to rapidly develop a comprehensive, scalable pandemic physician workforce plan for non-ventilated inpatients with COVID-19 across multiple hospitals. The MEOC Pandemic Plan comprised seven components, each with unique structure and processes.
METHODS
METHODS
In this manuscript, we describe MEOC's Pandemic Plan that was designed and implemented from March to May 2020 and re-escalated in October 2020. We report on the plan's structure and process, early implementation outcomes, and unforeseen challenges. Data sources included MEOC documents, health system, public health, and physician engagement implementation data.
KEY RESULTS
RESULTS
From March 5 to October 26, 2020, 427 patients were admitted to COVID-19 units in Calgary hospitals. In the initial implementation period (March-May 2020), MEOC communications reached over 2500 physicians, leading to 1446 physicians volunteering to provide care on COVID-19 units. Of these, 234 physicians signed up for hospital shifts, and 227 physicians received in-person personal protective equipment simulation training. Ninety-three physicians were deployed on COVID-19 units at four large acute care hospitals. The resurgence of cases in September 2020 has prompted re-escalation including re-activation of COVID-19 units.
CONCLUSIONS
CONCLUSIONS
MEOC leveraged an academic health system partnership to rapidly design, implement, and refine a comprehensive, scalable COVID-19 acute care physician workforce plan whose components are readily applicable across jurisdictions or healthcare crises. This description may guide other institutions responding to COVID-19 and future health emergencies.
Identifiants
pubmed: 33564947
doi: 10.1007/s11606-020-06543-1
pii: 10.1007/s11606-020-06543-1
pmc: PMC7872510
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1310-1318Références
Coronavirus disease (COVID-19): outbreak update [Internet]. Ottawa, ON: Government of Canada; 2020 [cited 2020 Nov 1]. Available from: https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection.html#a1
COVID-19 Alberta Statistics [Internet]. Edmonton, AB: Government of Alberta; 2020 [cited 2020 Jun 15]. Available from: https://www.alberta.ca/stats/covid-19-alberta-statistics.htm
The COVID-19 Response: How is Canada doing and what should we be doing next? [Internet]. University of Calgary Centre for Health Informatics; [cited 2020 Mar 19]. Available from: https://www.chi-csm.ca
Donabedian A. The quality of care. JAMA J Am Med Assoc. 1988;260(12):1743–8.
doi: 10.1001/jama.1988.03410120089033
Ayanian JZ, Markel H. Donabedian’s Lasting Framework for Health Care Quality. N Engl J Med. 2016;375(3):205-207. https://doi.org/10.1056/NEJMp1605101 . N Engl J Med. 2016;375(3):205–7.
Ogrinc G, Davies L, Goodman D, Batalden P, Davidoff F, Stevens D. SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): revised publication guidelines from a detailed consensus process. BMJ Qual Saf. 2016 Dec;25(12):986–92.
doi: 10.1136/bmjqs-2015-004411
Alberta Health Services. Alberta Health Services Annual Report 2018-19 [Internet]. 2019 [cited 2020 Aug 15]. Available from: https://www.albertahealthservices.ca/assets/about/publications/2018-19-annual-report-web-version.pdf
University of Calgary Department of Medicine 2019 Annual Report [Internet]. University of Calgary; 2019 [cited 2020 Jun 15]. Available from: https://www.departmentofmedicine.com/wp-content/uploads/dom-annual-report-18-19.pdf
National Institute for Occupational Safety and Health, Occupational Safety and Health Association. Preventing worker fatigue among Ebola healthcare workers and responders. Washington (DC): National Institute for Occupational Safety and Health; 2015 p. 1–4.
Dai H, Milkman KL, Hofmann DA, Staats BR. The Impact of Time at Work and Time Off From Work on Rule Compliance: The Case of Hand Hygiene in Health Care. J Appl Psychol. 2015;100(3):846–62.
doi: 10.1037/a0038067
Barrett ES, Horton DB, Roy J, Gennaro ML, Brooks A, Tischfield J, et al. Prevalence of SARS-CoV-2 infection in previously undiagnosed health care workers at the onset of the U.S. COVID-19 epidemic [Internet]. Infectious Diseases (except HIV/AIDS); 2020 Apr [cited 2020 Jun 15]. Available from: http://medrxiv.org/lookup/doi/10.1101/2020.04.20.20072470
Bellizzi S, Fiamma M, Arru L, Farina G, Manca A. COVID-19: The daunting experience of healthcare workers in Sardinia, Italy. Infect Control Hosp Epidemiol. 2020 Apr 20;1–2.
Chirico F, Nucera G, Magnavita N. COVID-19: Protecting Healthcare Workers is a priority. Infect Control Hosp Epidemiol. 2020 Apr 17;1–1.
Dodgen DW. Office of the Assistant Secretary for Preparedness and Response: (658332011-001) [Internet]. American Psychological Association; 2011 [cited 2020 Jun 15]. Available from: http://doi.apa.org/get-pe-doi.cfm?doi=10.1037/e658332011-001
Gauss T, Pasquier P, Joannes-Boyau O, Constantin J-M, Langeron O, Bouzat P, et al. Preliminary pragmatic lessons from the SARS-CoV-2 pandemic in France. Anaesth Crit Care Pain Med. 2020 Jun;39(3):329–32.
doi: 10.1016/j.accpm.2020.05.005
Brooks A, Lack L. A brief afternoon nap following nocturnal sleep restriction: which nap duration is most recuperative? Sleep. 2006 Jun;29(6):831–40.
doi: 10.1093/sleep/29.6.831
Mednick SC, Cai DJ, Kanady J, Drummond SPA. Comparing the benefits of caffeine, naps and placebo on verbal, motor and perceptual memory. Behav Brain Res. 2008 Nov 3;193(1):79–86.
doi: 10.1016/j.bbr.2008.04.028
Rajaratnam SMW, Howard ME, Grunstein RR. Sleep loss and circadian disruption in shift work: health burden and management. Med J Aust. 2013 Oct 21;199(8):S11-15.
pubmed: 24138359
Rosekind MR, Smith RM, Miller DL, Co EL, Gregory KB, Webbon LL, et al. Alertness management: strategic naps in operational settings. J Sleep Res. 1995 Dec;4(S2):62–6.
doi: 10.1111/j.1365-2869.1995.tb00229.x
Well Doc Alberta COVID-19 Physician Wellness Resources [Internet]. 2020 [cited 2020 Jun 15]. Available from: https://www.welldocalberta.org/covid-19-updates
Government of Alberta. Number of Physicians by Specialty Within Alberta Health Services Geographic Zones [Internet]. 2020 [cited 2020 Nov 2]. Available from: https://open.alberta.ca/opendata/number-of-physicians-by-specialty-within-alberta-health-services-geographic-zones
Shapiro SD, Rothman PB. How Academic Health Systems Can Move Forward Once COVID-19 Wanes. J Am Med Assoc [Internet]. 2020 May 20 [cited 2020 May 26]; Available from: https://jamanetwork.com/journals/jama/fullarticle/2766527
DeVoe JE, Cheng A, Krist A. Regional Strategies for Academic Health Centers to Support Primary Care During the COVID-19 Pandemic: A Plea From the Front Lines. JAMA Health Forum. 2020 Apr;
Sprung CL, Zimmerman JL, Christian MD, Joynt GM, Hick JL, Taylor B, et al. Recommendations for intensive care unit and hospital preparations for an influenza epidemic or mass disaster: summary report of the European Society of Intensive Care Medicine’s Task Force for intensive care unit triage during an influenza epidemic or mass disaster. Intensive Care Med. 2010 Mar;36(3):428–43.
doi: 10.1007/s00134-010-1759-y
Harris GH, Baldisseri MR, Reynolds BR, Orsino AS, Sackrowitz R, Bishop JM. Design for Implementation of a System-Level ICU Pandemic Surge Staffing Plan. Crit Care Explor. 2020 Jun;2(6):e0136.
doi: 10.1097/CCE.0000000000000136
Aziz S, Arabi YM, Alhazzani W, Evans L, Citerio G, Fischkoff K, et al. Managing ICU surge during the COVID-19 crisis: rapid guidelines. Intensive Care Med. 2020 Jul;46(7):1303–25.
doi: 10.1007/s00134-020-06092-5
Griffin KM, Karas MG, Ivascu NS, Lief L. Hospital Preparedness for COVID-19: A Practical Guide from a Critical Care Perspective. Am J Respir Crit Care Med. 2020 Jun 1;201(11):1337–44.
doi: 10.1164/rccm.202004-1037CP
Chowdhury JM, Patel M, Zheng M, Abramian O, Criner GJ. Mobilization and Preparation of a Large Urban Academic Center During the COVID-19 Pandemic. Ann Am Thorac Soc. 2020 Apr 21;AnnalsATS.202003-259PS.
Frost DW, Shah R, Melvin L, Galán de Juana M, MacMillan TE, Abdelhalim T, et al. Principles for clinical care of patients with COVID-19 on medical units. Can Med Assoc J. 2020 Jun 3;cmaj.200855.
Kim CS, Lynch JB, Cohen S, Neme S, Staiger TO, Evans L, et al. One Academic Health System’s Early (and Ongoing) Experience Responding to COVID-19: Recommendations From the Initial Epicenter of the Pandemic in the United States. Acad Med. 2020 Apr;1.