Sarah M Kesler, Christina Bastin De Jong, Christine Chell, Debra DeBruin, Heidi L Erickson, Kimberly A Goodman, Walter James, Jason Kallestad, Tom Klemond, Erin McLachlan, Cheryl Petersen-Kroeber, James Risser, Erin S DeMartino, Alexandra T Waterman, Susan M Wolf, Joel Wu, Clara Zamorano, Karyn Baum, Daniel Brown, Joshua Cohen, Deanna Diebold, Jennifer A Fischer, Kay Greenlee, John Hick, Paul Kettler, Michele LeClaire, Jacob Lyons, Sean MacDonell, Kyle Mairose, Andrea Boehland, Joseph Martinelli, Elizabeth A Miller, David E Niccum, Ronald Reilkoff, Judy Seaberg, Nneka O Sederstrom, Adam Shadiow, Shawn Stoen, Helen Strike, Ken K Maslonka, Jack M Wolf, Jennifer Schoenecker, Jeffrey R Dichter
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引用次数: 0
Abstract
Background: At the request of the Statewide Healthcare Coordination Center, the Minnesota Critical Care Working Group (CCWG) and ethics subgroup (EWG), composed of interprofessional leaders from Minnesota's nine largest health systems were asked to plan and coordinate critical care operations during the COVID-19 pandemic, including the 2021 Fall surge.
Research question: Can a statewide Working Group collaboratively analyze real time evidence to identify crisis conditions and engage state leadership to implement care processes?
Study design and methods: CCWG/EWG met via video conferencing during the Fall 2021 severe surge to analyze evidence and plan for potential crisis care conditions. Five sources of evidence informed their actions including group consensus on operating conditions; Federal Tele-Tracking data; MOCC patient placement data; and two surveys created and distributed to hospitals and healthcare professionals. The group developed and recommended processes to mitigate the conditions and engaged statewide leadership for support.
Results: Evidence of crisis conditions included rising numbers of inpatient COVID-19 patients, tertiary care centers with difficulty accepting transfers (including emergencies), severe ED crowding, activation of ICU allocation teams, and low patient placement rate at the Minnesota MOCC. A statewide hospital survey demonstrated numerous staffing adaptations, expansion of telemedicine, and delay of non-emergent procedures. A survey of healthcare professionals revealed instances of poor patient outcomes, bedside rationing, implicit triage, and moral distress. Leadership engagement resulted in public messaging, though no change in how ICU care was allocated, or transfers managed.
Interpretation: CCWG collected and analyzed evidence demonstrating crisis conditions and healthcare professional moral distress during the Fall 2021 COVID-19 surge. However, the group had a limited impact on care processes. This paper analyzes the group's efforts. It includes recommendations for researchers and policy makers.
期刊介绍:
At CHEST, our mission is to revolutionize patient care through the collaboration of multidisciplinary clinicians in the fields of pulmonary, critical care, and sleep medicine. We achieve this by publishing cutting-edge clinical research that addresses current challenges and brings forth future advancements. To enhance understanding in a rapidly evolving field, CHEST also features review articles, commentaries, and facilitates discussions on emerging controversies. We place great emphasis on scientific rigor, employing a rigorous peer review process, and ensuring all accepted content is published online within two weeks.