Offering the latest news in health care quality and safety, the ISQua blog also features guest posts from the best and brightest in the industry.
India is a country of countries. Don’t get surprised. It is made of 28 States and 8 Union Territories, a total of 36 entities. Each of these are different in culture, culinary, language, outfit, style of living, weather and health systems. Each one of these are like different countries. However, each one is tightly bonded with each other for several reasons. We truly represent ‘unity within diversity’. COVID-19 has perhaps further brought all of them together to fight with this deadly disease.
In a world where data fluctuates between showing the impact of accreditation on healthcare institutions and negating it, we, at the Health Care Accreditation Council (HCAC), were intrigued to look into whether accredited healthcare institutions in Jordan were more ready to deal with the requirements of COVID-19 or not?
In the current context of the pandemic that we are currently experiencing, it seemed interesting to me, not to comment on current events, but to offer some landmarks and references on the concept of resilience.
According to Boris Cyrulnik, French doctor, neurologist and psychiatrist, resilience is the art of sailing torrents; it is also the ability to live, to succeed, to develop despite adversity.
The challenging time we are all facing during the COVID-19 pandemic is incontestable. During the last few weeks, people and communities have shown solidarity worldwide like never before, and the human, social and moral values seem to have gotten back on the right track as everybody realised that we are in this fight together.
Globally, corona virus (COVID19) pandemic has become the most significant crisis to challenge the health, economy and the wellbeing of the humans affecting nearly all the countries. The world governments are taking radical mitigation measures to counter the health impact of the virus, which on the other hand has severe economic and financial consequences on the lives of the people around the world. Thus, the COVID-19 has become more than a health crisis for all countries with critical social, economic and political consequences.
In the past few weeks healthcare professionals have been fully focussed caring for enormous numbers of people infected with COVID-19. They did an amazing job. Not in the least because healthcare professionals and leaders have been using continues improvement as part of their accreditation program for many years.
The challenges for health care continue to grow and in the 21st century healthcare policymakers and providers will need to respond to the developing impact of global warming and the environmental impact of healthcare service delivery. This cannot be viewed apart from the current Coronavirus disease (COVID-19) pandemic, which is likely to be linked to the climate crisis.
Picture the scene in full PPE, with limited opportunity to rest and reflect, how do we all learn and change in response the patients’ needs and the new environment when caring for Covid19 positive patients. Within, NHSScotland we are testing a system where change and improvement is actioned at every opportunity from the bedside to the board. In this blog I will share how that these processes are designed and driven by the front line.
This short document focuses on the response of health services and facilities to the expected spread of COVID-19 in sub-Saharan Africa. These countries face a real threat of health systems becoming overwhelmed, with dramatic increase in deaths from the outbreak and indirect deaths from vaccine-preventable and treatable conditions.
The document draws on new WHO guidelines and seeks to assist decision makers by highlighting urgent and priority actions. The key messages reflect views of expert health professionals responding to the COVID-19 pandemic in Ireland and Europe and with wide experience of health systems and managing epidemics in Africa.
Key WHO Guidance documents for health services response to COVID-19
Implementing a health service response to COVID-19 is just part of the wider national response to control the epidemic which involves a whole of government approach. The population measures are of utmost importance, including social/physical distancing measures, good hygiene practices and reducing transmission though testing and contacting tracing, where feasible.
Countries need to factor in the wider social and economic consequences of restrictive measures that affect people’s ability to move around and work. Public messaging should reach the whole population, emphasising hand washing, respiratory hygiene, physical distancing and the need to self-isolate if symptoms develop.
KEY MESSAGES for Health Service readiness and response
1. Health facility readiness
a) There are three objectives: to manage COVID-19 patients; to maintain essential health services; and to protect the welfare of health care workers.
b) All health facilities should assess their response capacity and establish a plan to deal with a surge of severely ill patients.
c) Consider how to mobilise additional staff for surge capacity
d) Have clear plans for infection prevention and control (IPC) including WaSH facilities, environmental cleaning & disinfection.
e) Communicate plans and actions widely, including signage and posters.
2. Segregation of COVID-19 patients
a) Separating COVID-19 patients from others is key. The ideal approach is to stream hospitals such that entire facilities are dedicated to COVID-19 (e.g. field hospitals); or else dedicate COVID-19 treatment areas within hospitals.
b) Establish effective patient flow at facilities including screening, triage and targeted referral of COVID-19 and non-COVID-19 cases.
c) Reduce transmission by isolating cases from other patients (or at least cohorting), and minimise the number of staff caring for each patient.
3. Care of COVID-19 patients
a) Initiate IPC at point of entry to hospital. Immediately screen and isolate COVID-10 suspects from other patients. If illness is mild, immediately discharge for self-isolation at home.
b) Assess whether patients will benefit from admission or transfer from other facilities. Consider not admitting patients with respiratory failure if the hospital is not equipped. This is equally efficacious, more humane for the patient, and reduces the risk of spread of infection to staff and other patients.
c) Establish guidance for handling deceased patients.
d) Minimise presence of visitors and non-essential staff.
4. Infection prevention and control (IPC)
a) The greatest risk of spread is by contact. Pay strict attention to hand hygiene, washing, respiratory etiquette and distancing measures. All staff should know about IPC and meticulously follow the WHO’s “5 Moments for Hand Hygiene”.
b) Ensure facilities have supplies of soap and running water.
c) Explore whether local ethanol producers (e.g. distilleries) could repurpose their facilities to make alcohol hand rubs following WHO formula.d. Manage supply and use of scarce PPE. Gloves, aprons and surgical masks mostly suffice. Don’t over-focus on PPE as adherence to other IPC measures mitigates most of the risk. Do not use PPE unless staff know how to use it properly, including putting on and taking off.
5. Maintain essential health services
a) Identify essential services to be prioritised for continuity (more people died from malaria than Ebola in west Africa in 2014).
b) Redistribute health workforce capacity to support ongoing services.c. Maintain availability of essential medicines, equipment and supplies.
Author: Dr David Weakliam, Global Health Programme Director, Health Service Executive
Originally published 30 March 2020 for the HSE National Quality Improvement Team. Republished with permission from the author.
ISQua's Brian Cahill, spoke with Dr Stephen Brennan, a GP based in Ireland, on how his General Practice has responded to the COVID-19 crisis; how the crisis has altered the patient journey in order to maintain good quality care, and how they are ensuring the safety of both staff and patients.
On 22 January 2020, a 65-year-old Chinese man with a history of hypertension, type 2 diabetes, coronary heart disease for which a stent had been implanted, and lung cancer was admitted to the emergency department of Cho Ray Hospital, the referral hospital in Ho Chi Minh City, Viet Nam, for low-grade fever and fatigue.
The coronavirus pandemic is challenging health systems and societies. The measures for restricting interpersonal contact that are being taken are aimed at flattening the COVID-19 infection curve, to prevent the health system from being overwhelmed by a sudden increase in the number of those infected and to continue to provide the best possible care for all patients.
As 1st April 2020 dawned in Australia, I realised it was April Fool’s day. But it wasn’t pranks from my children, friends or colleagues that I was immediately on alert about. It was what everyone does these days, in this era of the coronavirus.
In this very difficult moment, where we are trying our best to support our healthcare system, and especially the clinicians at the sharp end, we would like to share what we are experiencing and a bit of the knowledge related to the way we are facing this situation.