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Evidence Check - System capacity and evaluation

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

The impact of COVID-19 on clinical education and training evidence check

Added: 18 Jun 2020
Updated: 19 Jun 2020

What has been the impact on the mode and content of clinical education*, and what has been trialled and/or recommended to address the impact?
How has the clinical training of postgraduate trainees† been affected?
  • Due to the COVID-19 pandemic, many medical education programs suspended onsite activities such as clinical rotations, clerkships, and in-person lectures and examinations.
  • Innovations and changes often relate to virtual distance-learning formats, such as videoconferencing, live streamed ward rounds, pre-recorded lectures, podcasts, and online surveys, and discussion forums.

Workforce reconfiguration evidence check

Added: 4 Jun 2020
Updated: 5 Jun 2020

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.

Guidance and underlying evidence about personal protective equipment (PPE) use during COVID-19 evidence check

Added: 20 May 2020
Updated: 21 May 2020

What is the current guidance on the use of PPE in COVID-19?
What is the evidence base for that guidance?
  • Personal protective equipment refers to specialised clothing or apparatus worn by an employee for protection against infectious materials or other hazards.
  • Occupational health and safety guidance asserts PPE should be considered in the context of broader, more effective hazard reduction approaches such as elimination, engineering and administrative controls
  • The core principles underpinning the use of PPE for infection control are: the safety of staff and patients is a priority at all times
  • PPE selection is informed by the anticipated contact with body substance or pathogens and the evidence base about transmission
  • a risk assessment approach is used to guide decisions about appropriate use.

Ventilation use for COVID-19 patients evidence check

Added: 12 Apr 2020
Updated: 28 Apr 2020

What proportion of COVID-19 cases in intensive care units (ICUs) require ventilation?
  • Across studies, the proportion of ICU cases requiring mechanical ventilation ranged from 47% to 88%.
  • In a French model, the proportion of ICU cases requiring mechanical ventilation was assumed to be 71%, based on data from Yang et al. In a New Zealand model, it was assumed that 45% of cases in ICU require ventilation, with variation by age group.

Thermal imaging for detection of fever evidence check

Added: 8 Apr 2020
Updated: 28 Apr 2020

Is mass thermal imaging an effective way of identifying people with COVID-19?
  • Infrared thermal detection systems have been used to quantify skin temperature and provide an assessment of internal body temperature, they have been shown to be accurate in identifying people with no fever but much less so in identifying people with fever.
  • Thermal detection systems have been used in border screening at airports for COVID-19 and in previous pandemics.
  • While fever is a common symptom of COVID-19, early estimates of asymptomatic infections are between 18-42% of patients.
  • According the World Health Organization (WHO), the virus can initially be detected in upper respiratory samples 1-2 days prior to symptom onset, suggesting potential pre-symptomatic transmission.
  • Completely asymptomatic subjects display viral loads similar to those of symptomatic patients.
  • A recent study of airport screening for COVID-19 estimated that using thermal screening, 46% of infected travellers would not be detected.

Temporary shared accommodation evidence check

Added: 24 Apr 2020

What guidance is available regarding temporary shared accommodation in response to COVID-19?
What recommendations are available for temporary shared accommodation and people experiencing homelessness during COVID-19?
Is temporary shared accommodation being closed in response to COVID-19? In brief
  • Guidance across countries in response to temporary and shared accommodation differs, with some countries closing hostels, campsites or boarding houses, while others allowing sites to remain open with conditions such as enforced social distancing.
  • There are inconsistencies across commercial accommodation providers and countries regarding closures, with some chains closing all or some of their hostels, and some remaining open (but with additional requirements around cleaning/social distancing or access).
  • Media coverage has focused on people in temporary accommodation, in particular backpacker accommodation, not adhering to social distancing directives. There are recent reports from Singapore that clusters of COVID-19 infections are occurring in dormitories for temporary and peripatetic workers. Universal testing in one USA shelter had a 36% positivity rate.

Testing before surgery evidence check

Added: 24 Apr 2020

What is the evidence for preoperative testing of COVID-19 for patients undergoing surgery?
  • COVID-19 testing before surgery is generally recommended for people undergoing surgeries perceived as high risk, including upper gastrointestinal, ear nose and throat, neurosurgery and interventional cardiac services.
  • Most of the guidance is from surgical specialty groups or from individual hospitals – generally these publications recommend preoperative testing, however there are some publications that say this is impractical.
  • The Royal Australasian College of Surgeons (RACS) recommends COVID-19 testing should be carried out where possible in line with current federal, state, and territory Department of Health guidelines.

Domestic and family violence and COVID-19 evidence check

Added: 23 Apr 2020

What evidence is available about increased risks associated of domestic and family and violence during COVID-19?
How can health systems mitigate the increased risks of domestic and family and violence during the COVID-19 pandemic?
  • NSW Police recorded crime data for March 2020 shows no evidence of an increase in domestic violence since social distancing was implemented in response to the COVID-19 pandemic.
  • Research in Australia and internationally shows increased domestic and family violence following disasters.
  • The World Health Organisation recommends the inclusion of domestic violence services in preparedness and response plans for COVID19. Services are to be accessible in the context of distancing measures. In some jurisdictions pharmacies and grocery stores have been used to provide access and support.

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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