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I wrote this piece at the peak of the pandemic. It's paywalled, so here's a thread about it https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2020.00810
Also, you can listen to a recording for free here:
https://www.healthaffairs.org/do/10.1377/hp20200806.201262/full/
https://www.healthaffairs.org/do/10.1377/hp20200806.201262/full/
In global health, we talk a lot about the "four S's" for healthcare: staff, space, stuff, systems, each of which is crucial to providing high quality care. 3/n
There was a lot of talk about a potential lack of ventilators - because it was clear running out of "stuff" would be dangerous, but there was and is still not enough discussion about the other three. In our case, staff and systems were the biggest bottlenecks. 4/n
We went to surge staffing, using staff "extenders" as guidelines would recommend in a pandemic. But while we deployed these emergency measures, other hospitals only a few miles away did not, including those within our health system. 5/n
Yet data are clear that thinly stretched staff and high patient to nurse ratios can lead to worse outcomes. And it took too long to smooth out the process to transfer patients from our hospital to those that were less overwhelmed. 6/n
Hospitals in NYC are built for competition, not cooperation. Systems matter. 7/n
How much this contributed to disproportionate mortality Blacks and Latinxs in NYC experienced isn't clear, but in addition to SDoH it's something researchers should be looking at. 8/n
So what are the solutions? First, setting up better systems in advance. Pandemic planning. More data transparency in real time to allow transferring either staff or patients as soon as staff ratios become unsafe. 9/n
But we need systems change as well. We need to end the disparity between public and private systems - separate but "equal" healthcare that reinforces racial and socioeconomic divides in the guise of a market-based system. 10/n
And we need to make hospitals more responsive to - and responsible for - the communities they serve. The ACA tried to do this, but hasn't gone far enough. 11/n
Since I wrote this piece, other great articles have raised similar questions about whether hospital-specific factors like staffing or critical care expertise could be an organizational determinant of mortality. 12/n https://www.nytimes.com/2020/07/01/nyregion/Coronavirus-hospitals.html
‘If I Hadn’t Been Transferred, I Would Have Died’ by @danielalamasmd 13/n https://www.nytimes.com/2020/08/04/opinion/covid-rural-hospitals.html
Thanks to @jebylander and Health Affairs for great editing and helping get the word out about these important issues. There unfortunately wasn't room for references, but here are some links for further reading (14/n):
System-level planning, coordination, and communication: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement https://www.sciencedirect.com/science/article/abs/pii/S0012369215519922
Surge capacity logistics: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement. https://www.sciencedirect.com/science/article/abs/pii/S0012369215519880
Critical Care Nursing: A History by Julie Fairman, Joan E. Lynaugh https://books.google.com/books/about/Critical_Care_Nursing.html?id=gQE69t0cbrMC
The double burden on safety net providers: placing health disparities in the context of the privatization of health care in the US by Sarah Horton at U Colorado Denver https://www.sciencedirect.com/science/article/pii/S0277953606003534
Are high nurse workload/staffing ratios associated with decreased survival in critically ill patients? A cohort study. https://link.springer.com/article/10.1186/s13613-017-0269-2
Impact of nurse staffing mandates on safety-net hospitals: lessons from California https://onlinelibrary.wiley.com/doi/full/10.1111/j.1468-0009.2011.00658.x
Nurse staffing and patient outcomes in critical care: a concise review.
https://journals.lww.com/ccmjournal/Fulltext/2010/07000/Effects_of_levosimendan_on_acute_pulmonary.2.aspx
https://journals.lww.com/ccmjournal/Fulltext/2010/07000/Effects_of_levosimendan_on_acute_pulmonary.2.aspx
