Evidence Check - System capacity and evaluation

Infrastructure, hospital capacity, human resources, supplies, monitoring, surveillance, prediction, evaluation, post-pandemic

COVID-19 pandemic and wellbeing of critical care and other healthcare workers

Added: 18 Feb 2022

Evidence in brief on the impact of the COVID-19 pandemic on the wellbeing of critical care and other healthcare workers.
  • During the COVID-19 pandemic, critical care and other healthcare workers may be at increased risk of physical and mental stress, including depression, anxiety, exhaustion and burnout.
  • Managing the wellbeing of healthcare workers during the pandemic may include providing psychological support, assisting with basic needs and promoting self-care.
  • There is limited evidence on the effectiveness of different management strategies.

Hospital visitor policies

Added: 31 Jan 2022

What is the evidence for hospital visitor policies during and outside of the COVID-19 pandemic?
  • During the COVID-19 pandemic, hospital visitor policies were used to organise care, limit the spread of infection and reduce the use of personal protective equipment.
  • Hospital visitor policies may include restricting visitors, requiring visitor registration and screening, and limiting visitor movement.
  • Visitor restrictions may have a negative impact on the wellbeing of patients and family members and increase the workload of healthcare workers.

Incidental COVID-19

Added: 21 Jan 2022

How are incidental COVID-19 cases being reported internationally, and what is the proportional of incidental COVID-19 cases?
  • COVID-19 may be the direct cause for hospitalisation, have an indirect effect (on principal diagnosis and on delivery of care), or be incidental to the reason for hospitalisation.
  • The percentage of hospitalisations classified as incidental COVID-19 varies. Internationally, it has been reported as between 12% and 63%.
  • Internationally, reporting is often split by COVID-19 positive patients in hospitals or intensive care units admitted for COVID-19 and those admitted for other reasons.

Test, trace, isolate and quarantine

Added: 14 Oct 2021
Updated: 16 Nov 2021

What is the evidence for and jurisdictional policies on test, trace, isolate and quarantine strategies for COVID-19?
  • Modelling studies have found that test, trace, isolate and quarantine can prevent transmission, reduce the reproductive number, decease years of life lost and hospital bed use and reduce mortality.
  • The elements of these programs found to be effective include a strong test component. To be strong requires high testing rates, timely contact tracing, high quarantine compliance, timely self-isolation of symptomatic individuals and quarantine of their household contacts. It also means comprehensive case finding, repeated testing to minimise false diagnoses and pooled testing in resource-limited circumstances. Effective elements also include an extended quarantine period and the use of digital tools for contact tracing and self-isolation.
  • Internationally, many jurisdictions have implemented test, trace, isolate and quarantine (TTIQ)strategies. These can have differing lengths of time in isolation, testing requirements andexceptions for vaccinated people.

Public health measures and COVID-19 vaccine rollout

Added: 30 Sep 2021

Evidence in brief on public health measures and COVID-19 vaccine rollout
  • Modelling studies from different countries caution that even with a high vaccine coverage, some level of public health, travel and social measures may still be needed to minimise the risk of localised transmission and deaths.
  • The World Health Organization updated their interim guidance on considerations for implementing and adjusting public health and social measures in the context of COVID-19 in June 2021. They advise that some countries may consider relaxing some measures for individuals who are either vaccinated or have had a confirmed SARS-CoV-2 infection in the past six months. Depending on transmission level, measures that could be relaxed include waiving quarantine and/or allowing indoor congregation with other vaccinated or recovered people.
  • The Canadian Government have guidance on adjusting public health measures in the context of COVID-19 vaccination. They describe a risk-based approach at an individual and community level.

Workforce reconfiguration

Added: 4 Jun 2020
Updated: 29 Sep 2021

What is the evidence regarding temporary workforce reconfigurations such as splitting of teams and establishing social distancing protocols within teams to minimise staff exposure to COVID-19?
  • Workforce reconfigurations of split teams, or creating smaller ‘sub teams’ and establishing social distancing protocols within teams have been described for a range of specialties including general surgery, oncology, radiology, cardiology, emergency departments and dialysis units.
  • A modelling study describes a desynchronisation strategy with two medical teams working on alternate seven day periods. The findings of the strategy is that it’s associated with reduced infection rates among the healthcare workforce.
  • Different approaches tried in various settings have been described in the literature including the following. • An account from the University of Washington on the use of separate and sub-teams (inpatient care, operating care, and clinic care teams) to ensure continuity of care and minimise exposure of healthcare workers. • The University of Wisconsin has used a restructuring ‘team of teams’ framework that focuses on network of networks approach to enable communication, staffing redesign, synchronising work cycles and clinical and educational changes to minimise staff exposure to COVID-19. • Hospitals in Singapore have used sub-teams which function separately and do not come into contact with each other to ensure emergency surgery can continue if one team if quarantined or infected, and a fixed-team based strategy in the emergency department, where several nursing and doctor sub-teams were created, resulting in longer shift hours but longer rest periods between rostered days. • Many of the specialties have halted inter-hospital and cross-institutional rotations of medical staff to reduce interactions, where previously staff were scheduled to cover several hospitals within a hospital network.

Furloughing staff following exposure to COVID-19

Added: 17 Sep 2021

Evidence in brief on furloughing staff following exposure to COVID-19
  • Recommendations for quarantine have been made throughout the course of the pandemic for people who have COVID-19, have either been exposed or potentially exposed to COVID-19 and those who have travelled. Recommendations are generally based on a risk assessment which considers exposure type and, more recently, vaccination status.
  • Workforce reconfigurations, such as splitting teams, have been described for a range of specialties in order to minimise staff exposure.
  • This evidence brief focuses on furloughing (leave of absence from work) and self-isolation of healthcare workers following exposure to COVID-19 and the implications for staffing levels. It is based on small descriptive studies and recommendations from healthcare organisations.

Ethics and duties of treating COVID-19 patients

Added: 27 Aug 2021

There is general agreement that healthcare providers have a duty or obligation to provide care to patients, however the extent of this obligation is occasionally contested.
There is little practical guidance for healthcare institutions that are deciding whether or when to exclude healthcare staff from providing care or allow them to opt out from providing care in order to protect themselves.
  • Many perspective and opinion articles outline that healthcare professionals have a have a duty or obligation to provide care to patients due to the specialised skills obtained during their training.
  • The capacity for a health professional to protect themselves during a pandemic whilst caring for infected patients, depends on their ability to practise universal precautions.
  • While some authors assert that doctors cannot, with integrity, refuse to serve the victims of an infectious outbreak, there are instances where some argue that healthcare professionals may be excused from their duties.
  • If excused from some duties, healthcare professionals may still be expected to contribute in other nonclinical ways.
  • Specific specialties may need to help manage the surge of respiratory failure when required.
  • In the United Kingdom, parliament has introduced indemnity protection for nurses. There was a rapid deployment of returning nurses and student nurses to a range of traditional and novel roles, including retraining for nurses to work in intensive care settings.

Daily Evidence Digest

Rapid evidence checks are based on a simplified review method and may not be entirely exhaustive, but aim to provide a balanced assessment of what is already known about a specific problem or issue. This brief has not been peer-reviewed and should not be a substitute for individual clinical judgement, nor is it an endorsed position of NSW Health.

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