大流行行动计划:第 3 阶段-实施中的经验教训。“我们学到了什么?”。

Pandemic Action Plan: Phase 3-Lessons Learned from Implementation. "What Did We Learn?".

机构信息

Telehealth Consultants, Worcester, Massachusetts, USA.

National Telehealth Technology Assessment Center, Anchorage, Alaska, USA.

出版信息

Telemed J E Health. 2024 Oct;30(10):2637-2646. doi: 10.1089/tmj.2023.0248. Epub 2024 Jul 4.

Abstract

The COVID-19 pandemic created critical challenges for hospitals and health care providers. Suddenly clinics were forced to close; elective procedures were delayed; scheduled visits were canceled; emergency rooms were overcrowded; hospital beds, equipment, and personal protective equipment (PPE) were in short supply; and staff were faced with rapidly changing circumstances, care protocols, trauma, and personal risk. To better address challenges of the ongoing COVID-19 pandemic and prepare for future pandemics, the National Telemedicine Technology Assessment Resource Center (TTAC) was asked to develop a Pandemic Response Action Plan that would allow its users to address critical issues with available telemedicine and related technologies. The project was constructed in 3 phases. Phase 1-Develop a Pandemic Response Action Plan and a Pandemic Response Action Plan Policy and Regulatory Summary, which identifies the regulatory challenges as well as policy recommendations. Phase 2-Publish the Action Plan and the Policy and Regulatory Summary. Phase 3-Look at health care providers who used the approaches, tools, and technology in the Pandemic Action Plan and document the results. This document represents Phase 3. This document is Phase 3. In this report we look back at health care providers who used the approaches in the Phase 1 as published in Phase 2. In this document we report on the challenges and results of implementing parts of the Pandemic Action Plan. It records the findings, conclusions, and recommendations resulting from the experience of health care providers and the professional experiences of the team and their organizations in implementing parts or all of the plan. The same multidisciplinary team that constructed Phase 1 and Phase 2 were engaged to develop this Phase 3 report. The members of the team represent leadership expertise and key stakeholders in health care delivery during a pandemic (administration, infection control, physicians, nurses, public health, contingency planning, disaster response, and information technology) as well as a facilitator. For Phase 3, the group used structured brainstorming to define the findings, issues, and results of their own organizations' digital health response to the pandemic. In addition, eight health care providers (hospitals) identified by the Telemedicine Resource Centers' (TRCs) organizations, who used the Pandemic response Plan (created in Phases 1 and 2), were interviewed. All interviews were conducted by the same facilitator with leaders (CEO, and leaders of the telemedicine programs) in each of the eight programs, using a standard questionnaire created by the team. Current literature references are included in this report to illustrate when findings are known to have broader applicability. The impact of the COVID-19 Pandemic was severe and identified multiple critical challenges and weaknesses. Applying the approaches, tools, and technology outlined in the proved to be effective in addressing critical provider challenges. However, implementing these tools during a crisis was difficult unless the organization had experience with the tools and necessary workflows in advance. Implementing these tools as part of standard workflows and everyday operations increased the capabilities and resilience of these organizations in the provision of care during this and for future pandemics.

摘要

新冠疫情给医院和医疗服务提供者带来了严峻的挑战。突然间,诊所被迫关闭;非紧急手术被推迟;预约被取消;急诊室人满为患;病床、设备和个人防护设备(PPE)短缺;员工面临着迅速变化的情况、护理协议、创伤和个人风险。为了更好地应对持续的新冠疫情挑战并为未来的大流行做好准备,国家远程医疗技术评估资源中心(TTAC)被要求制定一项大流行应对行动计划,使用户能够利用现有的远程医疗和相关技术来解决关键问题。该项目分三个阶段构建。第 1 阶段-制定大流行应对行动计划和大流行应对行动计划政策和监管摘要,确定监管挑战以及政策建议。第 2 阶段-发布行动计划和政策及监管摘要。第 3 阶段-观察使用大流行行动计划中方法、工具和技术的医疗保健提供者,并记录结果。这是第 3 阶段的文件。本文件是第 3 阶段。在本报告中,我们回顾了在第 2 阶段发布的第 1 阶段中使用这些方法的医疗保健提供者。在本文件中,我们报告了实施大流行行动计划部分内容所面临的挑战和结果。它记录了医疗保健提供者的经验以及团队及其组织在实施部分或全部计划方面的专业经验所产生的发现、结论和建议。参与构建第 1 阶段和第 2 阶段的相同多学科团队被聘请来编写本第 3 阶段报告。团队成员代表了大流行期间医疗保健提供方面的领导专业知识和主要利益相关者(行政管理、感染控制、医生、护士、公共卫生、应急规划、灾害应对和信息技术),以及一名协调人。对于第 3 阶段,该小组使用结构化头脑风暴来定义其组织对大流行的数字健康应对的发现、问题和结果。此外,由远程医疗资源中心(TRC)组织确定的 8 家医疗保健提供者(医院)使用了大流行应对计划(在第 1 阶段和第 2 阶段创建),对他们进行了采访。每个计划的领导者(首席执行官和远程医疗计划的领导者)都由同一位协调员使用团队创建的标准问卷对每个计划中的 8 个领导者进行了采访。本报告还包括当前的文献参考,以说明当发现具有更广泛的适用性时的情况。新冠疫情的影响是严重的,确定了多个关键挑战和弱点。应用第 1 阶段和第 2 阶段中概述的方法、工具和技术在解决关键提供商挑战方面被证明是有效的。然而,除非组织事先具有使用这些工具和必要工作流程的经验,否则在危机期间实施这些工具是很困难的。将这些工具作为标准工作流程和日常运营的一部分实施,提高了这些组织在提供护理方面的能力和弹性,无论是在当前疫情期间还是未来的大流行期间。

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