Courtney A. Gidengil

Introduction Studies on the impacts of COVID-19 on patient safety are emerging. However, few studies have elicited the perspectives of front-line clinicians. Methods We interviewed clinicians from 16 US hospitals who worked in the emergency department, intensive care unit or inpatient unit during the COVID-19 pandemic. We asked about their experiences with both clinician well-being and patient care throughout the pandemic. We used a rigorous thematic analysis to code the interview transcripts. This study was part of a larger randomised control trial of an intervention to improve healthcare worker well-being during the COVID-19 pandemic; the findings described here draw from clinicians who spontaneously raised issues related to patient safety. Results 11 physicians and 16 nurses in our sample raised issues related to patient safety. We identified two primary themes: (1) compromised access to healthcare and (2) impaired care delivery. First, clinicians discussed how changes in access to healthcare early in the pandemic–including a shift to telehealth and deferred care–led to delays in accurate diagnosis and patients presenting later in their disease course. Second, clinicians discussed the effects of COVID-19 on care delivery related to staffing, equipment shortages and space constraints and how they deviated from the standard of care to manage these constraints. Clinicians noted how these issues led to patient safety events such as central line infections, patient falls and serious medication administration errors. Conclusions Several well-intentioned interventions implemented in the early weeks of the pandemic created a unique context that affected patient safety throughout the pandemic. Future pandemic preparedness should consider planning that incorporates a patient safety lens to mitigate further harm from occurring during a public health crisis.

Frontline healthcare workers (HCWs) have experienced increased levels of stress and burnout during and after the pandemic, resulting in healthcare worker shortages and diminished quality of care for patients. Originally piloted in combat environments, Stress First Aid (SFA) is an evidence-informed intervention that has shown promising results in helping mitigate stress reactions in other high-stress work environments. This article details the adaptation of an SFA intervention using a train-the-trainer model for use in hospitals and healthcare clinics for HCWs during the pandemic. The origins of the principles of SFA, how they were adapted for use with HCWs, and how barriers such as lack of time were addressed by further modifications during the intervention are discussed. These findings may help inform future SFA interventions in healthcare settings during public health crises.

COVID-19 hospitalizations among children younger than 5 years were 5 times higher during Omicron’s peak than Delta’s.¹ On June 17, 2022, the US Food and Drug Administration (FDA) extended the Emergency Use Authorizations for the BNT162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna) COVID-19 vaccines to children aged 6 months through 4 years.² Despite the long wait for this age group to become eligible for COVID-19 vaccination, there have been few peer-reviewed studies that have assessed intentions of parents of children younger than 5 years to get a COVID-19 vaccine for their child in this age group once they become eligible. However, these surveys were fielded in 2021 (February to March^3,4 and September to October⁵), and only 1 study³ examined parents of children younger than 5 years specifically, making their utility for anticipating factors associated with COVID-19 vaccine uptake among children in this age group less than ideal.

Gram-negative bacteremia historically has been treated with 10-14 days of parenteral antibiotics. However, data supporting this practice are lacking, and recent evidence shows equivalent outcomes for short-course (SC) therapy (7 days) and early (by day 5) conversion to highly bioavailable enteral (PO) antibiotics for Enterobacterales bacteremia. Under a QI framework, we used PDSA cycles to reduce treatment duration and increase use of PO levofloxacin or trimethoprim-sulfamethoxazole for uncomplicated Enterobacterales bacteremia among Infectious Diseases (ID) clinicians at a children’s hospital in Boston, MA. We conducted an education session on evidence to support these practices for ID faculty and fellows in October 2020. In December 2020, we implemented standardized recommendations for a 7-day duration and early PO transition for eligible patients (≥ 3-months-old, ≤ 2 days monomicrobial bacteremia, with source control and return to baseline clinical status) that could be inserted automatically into electronic consult notes. In February 2021, we reinforced this practice to ID providers. We collected data before and after these interventions on ID recommendations and on patients’ actual antibiotic management. From 11/01/20 to 05/31/21, mean recommended treatment decreased from 10.6 to 9.5 days; however, mean duration received was similar (11.2 vs 11.7 days) (Figure 1). The percentage of patients for whom ID recommended PO conversion and in whom transition to PO agents by day 5 occurred increased from 27% to 37.5%. Figure 1. Change in average duration of antibiotics recommended and received, in days Education and creation of automated standardized recommendations led to decreased recommended treatment durations and increased PO conversions for Enterobacterales bacteremia, but only modestly. This quality improvement initiative demonstrates the potential benefits of education and electronic documentation tools to facilitate evidence-based practice changes, but also highlights the difficulty in changing practice even amongst ID clinicians. Further PDSA cycles will be targeted at increasing more consistent awareness among a large ID division in addition to other stakeholders. Gabriella S. Lamb, MD, MPH, Nothing to disclose