About: Background: As we contend with the massive SARS-CoV-2 pandemic, preventing infections among healthcare workers (HCW) and patients is critical for delivering care to patients admitted for other purposes, and many standard scheduling practices require reassessment. In most academic hospitals in the United States, inpatient rotations are designed to deliver optimal patient care by staggering rotations of attendings and house-staff, and much emphasis is placed on healthcare worker (HCW) burnout, yet during a pandemic preventing further infection is the single most important factor. Our purpose was to model various inpatient rotation schedules of physicians and nurses to determine patterns associated with optimal workforce preservation and lower nosocomial infections in settings in which personal protective equipment is imperfect or unavailable. Results: We employed Monte-Carlo simulations. Universal model parameters for COVID-19 included incubation period distribution and latent period distribution. Situation-dependent COVID-19 model parameters included pre-admission infection probability, team member infection probability, physician-to-patient, nurse-to-patient, patient-to-physician, patient-to-nurse, and HCW-to-HCW transmission probabilities, team member absence after symptom onset, daily SARS-CoV-2 exposure probability of team members (e.g. via exposure to other staff), length of admission after COVID-19 symptoms, and length of simulation time. Model parameters that varied by hospital setting and service type included average patient load per team, average patient hospitalization, and number of physicians and nurses on a team and on duty. The primary outcome measure was probability of team failure, defined as the likelihood that at some point there are insufficient attendings, house-staff or nurses to staff a fully functioning floor. In all our simulations, physician and nurse rotation lengths of 1-3 days led to higher team failure rates. Nursing shifts of 12 versus 8 hours and avoiding staggering of physician rotations decreased the chance of team failure. When the patient stay is short, the advantage of un-staggered rotations is consistent and universal. Conclusions: Simple changes in staff scheduling, such as longer nursing shifts, co-rotation of physicians and groups of nurses no more frequently than every 3 days results in improved workforce preservation. These workforce distancing changes are easy to implement.   Goto Sponge  NotDistinct  Permalink

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  • Background: As we contend with the massive SARS-CoV-2 pandemic, preventing infections among healthcare workers (HCW) and patients is critical for delivering care to patients admitted for other purposes, and many standard scheduling practices require reassessment. In most academic hospitals in the United States, inpatient rotations are designed to deliver optimal patient care by staggering rotations of attendings and house-staff, and much emphasis is placed on healthcare worker (HCW) burnout, yet during a pandemic preventing further infection is the single most important factor. Our purpose was to model various inpatient rotation schedules of physicians and nurses to determine patterns associated with optimal workforce preservation and lower nosocomial infections in settings in which personal protective equipment is imperfect or unavailable. Results: We employed Monte-Carlo simulations. Universal model parameters for COVID-19 included incubation period distribution and latent period distribution. Situation-dependent COVID-19 model parameters included pre-admission infection probability, team member infection probability, physician-to-patient, nurse-to-patient, patient-to-physician, patient-to-nurse, and HCW-to-HCW transmission probabilities, team member absence after symptom onset, daily SARS-CoV-2 exposure probability of team members (e.g. via exposure to other staff), length of admission after COVID-19 symptoms, and length of simulation time. Model parameters that varied by hospital setting and service type included average patient load per team, average patient hospitalization, and number of physicians and nurses on a team and on duty. The primary outcome measure was probability of team failure, defined as the likelihood that at some point there are insufficient attendings, house-staff or nurses to staff a fully functioning floor. In all our simulations, physician and nurse rotation lengths of 1-3 days led to higher team failure rates. Nursing shifts of 12 versus 8 hours and avoiding staggering of physician rotations decreased the chance of team failure. When the patient stay is short, the advantage of un-staggered rotations is consistent and universal. Conclusions: Simple changes in staff scheduling, such as longer nursing shifts, co-rotation of physicians and groups of nurses no more frequently than every 3 days results in improved workforce preservation. These workforce distancing changes are easy to implement.
Subject
  • United States
  • Primary care
  • Safety engineering
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