Mulcahy Symmons Sophie, Fox Robert, Mannion Marese, Joyce David, De Brún Aoife, Glynn Liam, Ryan Damien, Keane Niamh, McAuliffe Eilish
Centre for Interdisciplinary Research Education and Innovation in Health Systems (IRIS), School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, D04 V1W8, Ireland.
School of Medicine, University of Limerick, Limerick, V94 T9PX, Ireland.
HRB Open Res. 2021 May 12;4:16. doi: 10.12688/hrbopenres.13217.2. eCollection 2021.
Ireland's health system has been under significant strain due to staff shortages and inadequate capacity. Critical care bed capacity per capita in Ireland is among the lowest in Europe, thus, the coronavirus disease 2019 (COVID-19) pandemic has put additional strain on an over-stretched system. COVID-19 Community Assessment Hubs (CAHs) were established to mitigate unnecessary admission to acute hospitals, and reduce infection spread by supporting COVID-19 positive or suspected positive patients to isolate at home, or in isolation facilities. There is some evidence that similar assessment centres may be a successful triage strategy to reduce burden on hospital and acute care. The aim of this study is to evaluate the impact of COVID-19 Community Assessment Hubs on service delivery in two regions in Ireland during the pandemic. A mixed-methods approach will be used, incorporating co-design to engage stakeholders and ensure informed data capture and analysis. Online surveys will assess CAH patients' experiences of access to and quality of care. Clinical patient data from CAHs will be collected and analysed using multinomial logistic regression to check for association with patient demographics and COVID-19 symptoms, and CAH early warning scores and outcomes (Transfer to Emergency Department, Transfer to isolation unit, Sent home with care plan). Semi-structured interviews will be conducted with: patients to elicit an in-depth understanding of experiences and acceptability of attending CAHs; and staff to understand challenges, benefits, and effectiveness of CAHs. Interview data will be analysed using thematic analysis. : This study will provide valuable insights from both patient and staff perspectives on the operation of CAHs. We will evaluate the effectiveness and acceptability of CAHs and propose areas for improvement of the service. This will contribute to international literature on the use of community assessment centres during infectious disease pandemics.
由于人员短缺和能力不足，爱尔兰的医疗系统一直承受着巨大压力。爱尔兰的人均重症监护床位容量在欧洲处于最低水平之一，因此，2019年冠状病毒病（COVID-19）大流行给这个不堪重负的系统带来了额外压力。设立了COVID-19社区评估中心（CAHs），以减少不必要的急性医院入院，并通过支持COVID-19阳性或疑似阳性患者在家中或隔离设施中隔离来减少感染传播。有证据表明，类似的评估中心可能是减轻医院和急性护理负担的成功分诊策略。本研究的目的是评估COVID-19社区评估中心在大流行期间对爱尔兰两个地区服务提供的影响。将采用混合方法，包括共同设计，以使利益相关者参与并确保数据的有效收集和分析。在线调查将评估CAH患者获得护理的体验和护理质量。将收集CAHs的临床患者数据，并使用多项逻辑回归进行分析，以检查与患者人口统计学和COVID-19症状以及CAH早期预警评分和结果（转至急诊科、转至隔离病房、带着护理计划回家）之间的关联。将对以下人员进行半结构化访谈：患者，以深入了解他们前往CAHs的体验和可接受性；工作人员，以了解CAHs的挑战、益处和有效性。访谈数据将采用主题分析进行分析。本研究将从患者和工作人员的角度为CAHs的运作提供有价值的见解。我们将评估CAHs的有效性和可接受性，并提出服务改进的领域。这将为关于在传染病大流行期间使用社区评估中心的国际文献做出贡献。
