Division of Pulmonary, Critical Care, and Sleep Medicine, UC San Diego Health, La Jolla, CA, US.
Department of Family Medicine and Public Health, UC San Diego Health, La Jolla, CA, US.
Ann Glob Health. 2021 Jan 4;87(1):1. doi: 10.5334/aogh.3108.
UC San Diego Health System (UCSDHS) is an academic medical center and integrated care network in the US-Mexico border area of California contiguous to the Mexican Northern Baja region. The COVID-19 pandemic deeply influenced UCSDHS activities as new public health challenges increasingly related to high population density, cross-border traffic, economic disparities, and interconnectedness between cross-border communities, which accelerated development of clinical collaborations between UCSDHS and several border community hospitals - one in the US, two in Mexico - as high volumes of severely ill patients overwhelmed hospitals.
We describe the development, implementation, feasibility, and acceptance of a novel critical care support program in three community hospitals along the US-Mexico border.
We created and instituted a hybrid critical care program involving: 1) in-person activities to perform needs assessments of equipment and supplies and hands-on training and education, and 2) creation of a telemedicine-based (Tele-ICU) service for direct patient management and/or consultative, education-based experiences. We collected performance metrics surrounding adherence to evidence-based practices and staff perceptions of critical care delivery.
In-person intervention phase identified and filled gaps in equipment and supplies, and Tele-ICU program promoted adherence to evidence-based practices and improved staff confidence in caring for critically ill COVID-19 patients at each hospital.
A collaborative, hybrid critical care program across academic and community centers is feasible and effective to address cross-cultural public health emergencies.
加州美墨边境的圣地亚哥大学健康系统（UCSDHS）是一个集学术医学中心和综合护理网络为一体的机构，与墨西哥北部下加利福尼亚地区接壤。COVID-19 大流行深刻影响了 UCSDHS 的活动，因为新的公共卫生挑战越来越与人口密度高、跨境交通、经济差距以及跨境社区之间的相互联系有关，这加速了 UCSDHS 与几个边境社区医院之间的临床合作的发展——其中一家在美国，两家在墨西哥——因为大量重症患者使医院不堪重负。
我们描述了在美墨边境的三家社区医院中发展、实施、可行性和接受一种新的重症监护支持计划。
我们创建并实施了一个混合重症监护计划，包括：1）进行设备和用品需求评估以及实操培训和教育的实地活动，2）创建基于远程医疗的（Tele-ICU）服务，用于直接患者管理和/或咨询、基于教育的体验。我们收集了与循证实践的依从性和工作人员对重症护理的看法相关的绩效指标。
实地干预阶段确定并填补了设备和用品的空白，Tele-ICU 计划促进了循证实践的遵守，并提高了每家医院工作人员对护理 COVID-19 重症患者的信心。
跨学术和社区中心的协作混合重症监护计划是可行且有效的，可以应对跨文化的公共卫生紧急情况。
