Frontline Hospital Research Articles

Assessment of the effectiveness of hospital external disaster functional drills on health care receivers’ performance, using standardized patients and mass cards simulation: a pilot study from Saudi Arabia

BackgroundGiven the increasing frequency of disasters globally, it is critical that healthcare systems are prepared for these mass casualty events. The Saudi health system’s preparedness for mass casualty incidents needs to be more robust, potentially due to limited disaster drills and inadequate standardized patient (SP) simulation training. This study aims to (i) assess the performance of front-line hospital staff in Saudi Arabia through a functional drill and (ii) evaluate the drill’s effectiveness using SP and MAC-SIM cards, providing detailed insights into its design and execution.MethodsA functional drill was conducted at a government hospital in Riyadh, Saudi Arabia, on December 19, 2022, using a cross-sectional approach with two phases. 141 healthcare receivers served as subjects, while 23 volunteers acted as SPs. The scenario simulated a building collapse to assess the emergency department (ED) response, interdepartmental communication, and surge capacity. Data were collected through direct observation of healthcare practitioners’ interactions with the SPs, analysis of SP data, and participant feedback. Quantitative data were analyzed descriptively, while qualitative data were examined for patterns and themes related to simulation performance and effectiveness.ResultsThe hospital receivers’ performances demonstrated accurate triage categories. The ED team assessed most patients (67%) in less than 5 min. For patients requiring definitive care, such as intensive care unit, 95% spent less than 2.5 h in the ED. Most patients (65%) required ‘other treatments’. Communication was efficient in the triage zone and the yellow treatment area. Participants’ feedback on using MAC-SIM cards during the simulation was overwhelmingly positive with 82.61% reporting that MAC-SIM use helped them respond better. Experienced SPs (paramedics) with prior disaster knowledge and experience outperformed inexperienced SPs (nurses) in the functional exercise.ConclusionThis groundbreaking study is the first in the Arabic Gulf region to use SPs with MAC-SIM cards in functional drills. The findings highlight the potential of simulation exercises to improve hospital team knowledge and performance when responding to disasters. Multiple evaluation techniques can effectively identify participant strengths and weaknesses, informing future disaster improvement plans. This information is a valuable resource for Arabic and middle-income countries where disaster medicine is still developing.

Treating wartime injuries amidst attack: insights from a medical facility on the edge of combat

BackgroundProviding emergency care during conflict poses unique challenges for frontline hospitals. Barzilai Medical Center (BUMCA) in Ashkelon, Israel is a Level I trauma center located close to the Gaza border. During the November 2023 escalation of conflict, BUMCA experienced surging numbers of civilian and military trauma patients while also coming under rocket fire.MethodsWe conducted a retrospective review of BUMCA operational records and 827 de-identified patient records from October 7–14, 2023. Records provided data on daily patient volumes, injury patterns, resource constraints, and impacts of rocket attacks on hospital function. Basic demographic data was obtained including age, gender, injury severity scores, and disposition.ResultsOf the 827 patients brought to BUMCA, most (n = 812, 98.2%) presented through the emergency department. Tragically, 99 individuals were pronounced dead on arrival. Injury severity assessments found nearly half (47%) had minor injuries such as lacerations, contusions and sprains, while 25% exhibited moderate injuries like deep lacerations and fractures. 15% sustained severe or critical injuries including severe head injuries. The largest age group consisted of adults aged 19–60 years. No pediatric patients were admitted despite proximity to residential neighborhoods. The majority of cases (61%) involved complex polytrauma affecting multiple body regions. BUMCA served as both the primary treatment facility and a triage hub, coordinating secondary transports to other trauma centers as needed. Patient volumes fluctuated unpredictably from 30 to an overwhelming 125 daily, straining emergency services. Resources faced shortages of beds, medical staff, supplies and disruptions to power from nearby missile impacts further challenging care delivery.ConclusionDespite facing surging demand, unpredictable conditions and external threats, BUMCA demonstrated resilience in maintaining emergency trauma services through an adaptive triage approach and rapid surges in capacity. Their experience provides insights for improving frontline hospital preparedness and continuity of care during conflict through advance contingency planning and surge protocols. Analysis of patient outcomes found a mortality rate of 15% given the complex, multi-region injuries sustained by many patients. This study highlights the challenges faced and strengths exhibited by medical professionals operating under hazardous conditions in minimizing loss of life.Patient and public involvement in researchGiven that the study analyzed patient data from a hospital treating casualties of an ongoing armed conflict, directly engaging patients or the public during the sensitive research process could have posed risks. The volatile security situation and restrictions and protections in place amidst the crisis made it not feasible or appropriate to involve them in the study’s design, methods, reporting of results, or dissemination plans. Our aim was to conduct this retrospective analysis in a way that did not endanger those affected or compromise the hospital’s emergency response operations.

“Being There for Each Other”: Hospital Nurses’ Struggle during the COVID-19 Pandemic

This study aims to explore the experiences of frontline hospital nurses over 18 months of struggle with the COVID-19 pandemic. The qualitative thematic analysis method was applied. Twenty-three nurses from nine tertiary hospitals in Israel were interviewed using semi-structured interviews via the ZOOM platform between August and September 2021. Interviews were video recorded and transcribed verbatim. Trustworthiness was assured by using qualitative criteria and the COREQ checklist. Results: Both negative and positive experiences were reported: threat and uncertainty along with awareness of their important mission; anxiety and helplessness alongside courage and heroism. Personal management strategies emerged: regulating overwhelming emotions and managing work–life balance. Team support emerged as the most meaningful source of nurses’ struggle with the pandemic. A sense of intimacy and solidarity enabled the processing of the shared traumatic experiences. Conclusions: A deeper understanding of nurses’ experiences through the pandemic was gained. Informal peer support has proven effective in struggling with the events. Formal interventions, such as affective–cognitive processing of traumatic events, need to be integrated into practice. Healthcare policymakers should promote better support for caregivers, which will contribute to their well-being and impact the quality of care they provide.

Stress, Depression, Anxiety and Willingness to Seek Help of Healthcare Workers in the COVID-19 Pandemic

Background and objective: Although the serious stage of the COVID-19 pandemic has passed, the consequences are not only socio-economic but also affect the mental health of many people, in which healthcare workers tolerate the fiercest and longest-lasting consequences compared to other social groups in the community. This study aims to explore the status of healthcare workers' mental health and evaluate their capacity to effectively manage mental health issues in the context of the COVID-19 pandemic. Particularly, it explores the relationship between depression, anxiety, and stress (DASS) scale and seeking help from healthcare workers.Methods: The study was conducted from April 2022 to August 2022, using an online survey of 638 healthcare workers working at two frontline hospitals in Ho Chi Minh City, Vietnam. It was undertaken at two hospitals in Ho Chi Minh City (i.e., Cho Ray Hospital and the COVID-19 Resuscitation Hospital), facilitated through the social work departments of these hospitals.Results: The result shows that the majority of medical staff faces various mental health problems from mild to severe, with different degrees of severity, depending on the individual's psychological characteristics, gender, education level, and work position. The study also revealed a correlation between help-seeking attitudes and symptoms of depression, anxiety, and stress. It shows that only a minority of healthcare workers have the attitude demonstrated a willingness to seek help and request assistance from psychologists when experiencing mental health issues.Conclusion: Policymakers should prioritize regular awareness campaigns during the initial phases of a pandemic to enhance motivation, knowledge, and preventative measures among healthcare workers. This approach can help identify mental health issues early and reduce the stigma of seeking support. Encouraging group psychotherapy and addressing cultural barriers in the medical field can increase trust in therapists and psychiatrists, improving overall mental well-being.

Impact of COVID-19 first wave on the mental health of healthcare workers in a Front-Line Spanish Tertiary Hospital: lessons learned.

Healthcare workers (HCWs) were at high risk of experiencing psychological distress during COVID-19 pandemic. The objective of this study was to evaluate the impact on HCWs' mental health in a Spanish hospital. Cross-sectional study of HCW, active between May and June 2020. A web-based survey assessed probable current mental disorders (major depressive disorder [PHQ-8 ≥ 10], generalized anxiety disorder [GAD-7 ≥ 10], panic attacks, post-traumatic stress disorder [PTSD; PLC-5 ≥ 7], or substance use disorder [CAGE-AID ≥ 2]). The Sheehan Disability Scale (SDS) was used to assess severe impairment and items taken from the modified self-report version of the Columbia Suicide Severity Rating Scale (C-SSRS) assessed suicidal thoughts and behaviors. A total of 870 HCWs completed the survey. Most frequent probable mental disorders were major depressive disorder (33.6%), generalized anxiety disorder (25.5%), panic attacks (26.9%), PTSD (27.2%), and substance use disorder (5.0%). Being female, having aged 18-29years, being an auxiliary nurse, direct exposure to COVID-19-infected patients, and pre-pandemic lifetime mental disorders were positively associated with mental issues. Hospital HCWs presented a high prevalence of symptoms of mental disorders, especially depression, PTSD, panic attacks, and anxiety. Younger individuals and those with lifetime mental disorders have been more vulnerable to experiencing them.

The economics of deep and machine learning-based algorithms for COVID-19 prediction, detection, and diagnosis shaping the organizational management of hospitals

Research background: Deep and machine learning-based algorithms can assist in COVID-19 image-based medical diagnosis and symptom tracing, optimize intensive care unit admission, and use clinical data to determine patient prioritization and mortality risk, being pivotal in qualitative care provision, reducing medical errors, and increasing patient survival rates, thus diminishing the massive healthcare system burden in relation to severe COVID-19 inpatient stay duration, while increasing operational costs throughout the organizational management of hospitals. Data-driven financial and scenario-based contingency planning, predictive modelling tools, and risk pooling mechanisms should be deployed for additional medical equipment and unforeseen healthcare demand expenses. Purpose of the article: We show that deep and machine learning-based and clinical decision making systems can optimize patient survival likelihood and treatment outcomes with regard to susceptible, infected, and recovered individuals, performing accurate analyses by data modeling based on vital and clinical signs, surveillance data, and infection-related biomarkers, and furthering hospital facility optimization in terms of intensive care unit bed allocation. Methods: The review software systems employed for article screening and quality evaluation were: AMSTAR, AXIS, DistillerSR, Eppi-Reviewer, MMAT, PICO Portal, Rayyan, ROBIS, and SRDR. Findings & value added: Deep and machine learning-based clinical decision support tools can forecast COVID-19 spread, confirmed cases, and infection and mortality rates for data-driven appropriate treatment and resource allocations in effective therapeutic and diagnosis protocol development, by determining suitable measures and regulations and by using symptoms and comorbidities, vital signs, clinical and laboratory data and medical records across intensive care units, impacting the healthcare financing infrastructure. As a result of heightened use of personal protective equipment, hospital pharmacy and medication, outpatient treatment, and medical supplies, revenue loss and financial vulnerability occur, also due to expenses related to hiring additional staff and to critical resource expenditures. Hospital costs for COVID-19 medical care, screening, treatment capacity expansion, and personal protective equipment can lead to further financial losses while affecting COVID-19 frontline hospital workers and patients.

Exploring hospital resilience protective or risk factors: lessons for future disaster response efforts.

Hospital resilience is essential in responding to disasters, but current research focuses mainly on frameworks and models rather than the protection of resilience and analysis of risk factors during public health emergencies. This study aims to examine the development of resilience in Chinese frontline hospitals during the initial COVID-19 outbreak in 2020, providing insights for future disaster response efforts. We conducted interviews with 26 hospital staff members who were involved in the initial response to the COVID-19 outbreak in China. We used a semi-structured interview approach and employed purposive sampling and snowball sampling techniques. The interview outline was guided by the 'Action Framework' proposed by the World Health Organization (WHO) for responding to infectious disease emergencies. This framework includes dimensions such as command, surveillance, risk communication, medical response, and public health response. We analyzed the collected data using Colaizzi's seven-step data analysis method and the template analysis method. WHO's 'action framework' effectively highlights the factors that contribute to hospital resilience. While medical response, including the availability of materials and facilities, the use of information technology, and the capacity for infectious disease diagnosis and treatment, remains crucial, other important aspects include awareness and beliefs about infections, treatment experience, interdisciplinary collaboration, and more. Additionally, it is essential to establish an intelligent command system, foster trusting partnerships between teams, improve monitoring capabilities for infectious disease agents, enhance risk communication through information synchronization and transparency, strengthen infection control planning, and improve environmental disinfection capabilities for effective public health emergency response. These contradictions significantly impact the enhancement of hospital resilience in dealing with major infectious disease outbreaks. In responding to sudden major infectious diseases, hospitals play a vital role within the healthcare system. Enhancing hospital resilience involves more than just improving treatment capabilities. It also requires effective command coordination at the hospital level, infection control planning, and the deployment of intelligent equipment. Additionally, planning for effective communication and coordination between hospitals, communities, and the national healthcare system can further enhance hospital resilience.

Evaluating emergency response at a hospital near the Gaza border within 24 h of increased conflict

BackgroundFrontline hospitals near active hostilities face unique challenges in delivering emergency care amid threats to infrastructure and personnel safety. Existing literature focuses on individual aspects like mass casualty protocols or medical neutrality, with limited analysis of operating acute services directly under fire.ObjectivesTo describe the experience of a hospital situated meters from hostilities and analyze strategies implemented for triage, expanding surge capacity, and maintaining continuity of care during attacks with limited medical staff availability due to hazardous conditions. A focus will be placed on assessing how the hospital functioned and adapted care delivery models in the event of staffing limitations preventing all teams from arriving on site.MethodsA retrospective case study was conducted of patient records from Barzilai University Medical Center at Ashkelon (BUMCA) Medical Center in Israel within the first 24 h after escalated conflict began on October 7, 2023. Data on 232 admissions were analyzed regarding demographics, treatment protocols, time to disposition, and mortality. Missile alert data correlated patient surges to attacks. Statistical and geospatial analyses were performed.ResultsPatients predominantly male soldiers exhibited blast/multisystem trauma. Patient surges at the hospital were found to be correlated with the detection of incoming missile attacks from Gaza within 60 min of launch. While 131 (56%) patients were discharged and 55 (24%) transferred within 24 h, probabilities of survival declined over time reflecting injury severity limitations. 31 deaths occurred from severe presentation.ConclusionInsights gleaned provide a compelling case study on managing mass casualties at the true frontlines. By disseminating BUMCA's trauma response experience, strategies can strengthen frontline hospital protocols optimizing emergency care delivery during hazardous armed conflicts through dynamic surge capacity expansion, early intervention prioritization, and infrastructure/personnel protection measures informed by risks.

The 5 + 1 Practice Research Model in Health Social Work: The “Eye of the Storm”

Purpose: The 5 + 1 Collaboration is an initiative where five teaching hospitals and a leading Melbourne university collaborate to promote and strengthen research, clinical practice in health social work, teaching, and collaboration. This collaboration fosters greater connection between academics, practitioners, and social work students. The 5 + 1 Collaboration provides a unique platform for the advancement of effective practice, practice-driven research, and student field education placements. Method: In a prospective study (2020 through 2021), employing the 5 + 1 model, at the time of the COVID-19 pandemic, over 100 frontline hospital social workers from five Melbourne hospitals participated in this study to determine, in detail, how the pandemic had affected their work. Results: This provided at a granular level, significant insights relating to the impact of the pandemic on the provision of social work services in the acute hospital setting. Additionally, during the study period, academic social work student placements were made at the five participating hospitals, with the students actively participating as part of the research team and providing feedback about their own experiences. Discussion: The study documented the challenges to hospital social work practice because of the pandemic, how hospital social workers rose to the challenges, and, importantly, adapted their practice and acquired new skills. This information may inform future hospital social work practice. The study also demonstrated that effective on-line student placements were possible, even in the setting of a pandemic.

Preparing the Frontlines: Delivering Special Pathogen Training to Maryland Hospital Staff.

Healthcare workers (HCWs) at community hospitals, also known as frontline hospitals (FLHs), may encounter patients with possible infectious diseases, including those caused by high-consequence pathogens such as Zaire ebolavirus. We created and piloted a 1-day, in-person, didactic and skills training program to determine the feasibility and acceptability of implementing an educational program to enhance the knowledge and skills needed to respond when a patient with a potential high-consequence pathogen presents to an FLH. The Maryland Department of Health queried all 104 state FLHs to identify their interest in participating in the pilot training program. HCWs from 12 (75%) of the 16 interested FLHs participated in the program before it was interrupted by the COVID-19 pandemic. In addition to pathogen-specific training based on the Identify, Isolate, and Inform framework, we provided skills training in the proper use of personal protective equipment, spill cleanup, and removal of an incapacitated HCW from an isolation area. We conducted a paired pretraining and posttraining knowledge assessment and measured a significant learning gain among 135 participants (2-tailed t test, P<.05). Over 95% of the participants reported that the training was relevant to their daily work and the clinical simulations and reference material were useful and appropriate for their learning level. Findings from this pilot program demonstrated the feasibility and acceptability of a 1-day combined didactic and skills training program focused on high-consequence pathogens. We plan to reengage the original FLHs and add regional FLHs in an updated training effort based on our findings.

Barriers in Reporting Administration, Transcribing and Dispensing Errors Among Clinical Nurses in A Tertiary Health Care Facility in Saudi Arabia

Background: Medication errors significantly affect patient safety. Medical error reporting is sharing potential or actual medication errors occurring in the workplace by healthcare professionals. Reporting medication errors enhance safe practices. Despite the availability of an excellent user-friendly reporting system and a heightened awareness among healthcare professionals about the importance of reporting, some nurses still need help to report medication errors due to specific barriers that require identification. The current study explores barriers to medication error reporting perceived by frontline hospital staff in a tertiary healthcare facility in Saudi Arabia. Methods: A cross-sectional study was conducted from June 2022 until March 2023. Data was collected using a structured questionnaire and analyzed using SPSS 25 (AMOS) and MS-ECD 10. Results: The number of nurses who participated in the study was 309. Barriers concerning fears were ranked the highest on the barriers scale, such as fear of disciplinary action, being blamed, losing the respect of co-workers, a non-anonymous reporting system, and fear of liability or lawsuits. Another barrier related to practicality is the extra time involved in documenting a medication error. Almost half, 45.63%, of nurses reported fear of liability or lawsuits (3.28 ± 1.27), 42.71 % reported a fear of disciplinary action (3.19 ± 1.24) and 42.72 % fear of being blamed (3.11 ± 1.25). The least significant reason for nurses not reporting medication errors was the lack of information on how to report a medication error. Conclusions: Nurses play an essential role in patient safety. Most of the participating nurses reported barriers related to fear. Reporting failure might potentially impact practice safety. Accordingly, we support and recommend empowering and encouraging nurses to report medication errors and create a safe climate in the healthcare setting.

CO-DESIGNING A STAGE 1B FEASIBILITY STUDY OF INPATIENT PALLIATIVE COMMUNITY HEALTH WORKER SUPPORT

Abstract Persons living with dementia (PLWD) are 2-3 times more likely than their non-dementia peers to be hospitalized annually and experience burdensome care transitions and treatments at the late stage of dementia. Minoritized PLWDs are significantly more likely to be hospitalized and experience frequent transitions between care settings, and also less likely to access palliative care. There is a pressing need to develop better models of care transition support for PLWDs and their family caregivers. Proactive palliative care can reduce unnecessary hospitalization and improve outcomes for PLWDs and family caregivers. Community health workers (CHW) can effectively bridge cultural gaps between vulnerable patients/families and formal care systems, and provide care navigation and coaching support. We are currently conducting a single-site randomized controlled pilot trial study to co-design with key stakeholders (Stage 1a), implement and assess (Stage 1b) the acceptability and feasibility of a palliative CHW support for hospitalized PLWDs and caregivers. To date, we have conducted a needs assessment with 34 PLWD/caregiver dyads, key informant interviews with 4 palliative care providers and 2 CHW and social care experts, and multiple stakeholder meetings with hospital frontline providers and CHW groups to develop intervention components and research implementation plans that address language and cultural barriers and healthcare provider and system level barriers experienced by PLWD and caregivers from minoritized and financially vulnerable backgrounds. In this presentation, we will describe stakeholder engagement and co-design process outcomes and preliminary findings on intervention fidelity, participant recruitment and retention, and PLWD/caregiver outcomes.

The Impact of the Covid-19 Pandemic on the Mental Health of Healthcare Professionals and Paramedical Staff Working in Peshawar, KP

Background: COVID-19 has a considerable impact on the psychological wellbeing of front-line hospital staff. Therefore, it is extremely important to identify the healthcare workers who are at increased risk of psychological stress.Objectives: To determine mental health issues due to COVID-19 among health care workers during the pandemic. To determine the factors behind mental health issues among healthcare workers during COVID-19Material and Methods: A cross-sectional study, carried out at two major tertiary hospitals in Peshawar Khyber teaching hospital (KTH) and Hayatabad Medical Complex (HMC). The participants included house officers, trainees, consultants and nurses. Data was collected through questionnaires. Survey tools such as Patient Health questionnaire -9 (PHQ-9) scale for depression and Generalized anxiety disorder (GAD-7) scale for anxiety were used. Chi -square test was applied to find association between mental health issues and COVID-19.Results: About 230 HCWs participated having equal number of males and females. Most of the participants were in age group 25-30 and were composed of trainee medical officers. We found that 61.2% of the participants screened positive for depression while 52.6% of the participants screened positive for anxiety and it was due to dissatisfaction towards facilities provided by their respective hospitals. Conclusion: Anxiety and depression were prevalent among the health care workers especially younger and un married individuals during COVID -19. To foster supportive work environment effective strategies are needed.Keywords: Anxiety, Covid -19, Depression, Pandemic

'I became the nurse I dreamed to be': Posttraumatic growth of hospital nurses during COVID-19

Abstract Background The unexpected COVID-19 pandemic outbreak has shaken the personal and professional lives of people worldwide. Nurses, as the largest healthcare workforce and in the closest proximity to patients, are at high risk of being infected, facing life-threatening situations while being exposed to secondary traumatic stress from direct care of others who are also experiencing traumatic events. Aim To explore the lived experiences of frontline hospital nurses as direct caregivers of COVID-19 patients, during four waves of the pandemic. Methods The grounded theory approach was employed to generate a theory of nurses’ lived experiences during four waves of the pandemic using the constant comparative method of analysis. Semi-structured interviews were conducted with 23 nurses from nine tertiary hospitals in Israel, between August and September 2021. Interviews were video recorded and transcribed verbatim. Criteria for establishing trustworthiness were applied. Results Nurses experienced the COVID-19 pandemic as (1) A direct and secondary threatening event; unexpected, uncertain with poor conditions and resources; (2) Paradoxical negative and positive changes were experienced such as threats to life vs. valuing life; social distancing vs. improved relations; and professional challenges vs. growth; (3) Nurses gained meaningful professional growth such as awareness of their professional strengths and limitations; choosing the optimal career path, and restructuring their nursing identity and image. Conclusions This study shed some light on nurses’ positive experiences during their struggle during the COVID-19 pandemic without neglecting the impact of adverse experiences on nurses. The phenomenon of secondary traumatization in nursing is still undervalued and needs to be explored and addressed. The pandemic provided nurses with a rare opportunity to redefine the meaning of being a nurse and experience professional growth. Key messages • Nursing leadership should consider nurses’ emotional needs and include affective-cognitive processing of traumatic events as part of the professional curricula in nursing education and at workplace. • Public recognition of the added value of nurses strengthened nurses’ professional identity and image. This process of developing the future state of the nursing image must be continued internationally.

A study of anti-SARS-CoV-2 antibodies among healthcare personnel and the general population

Bulgaria, like many other countries, has experienced the far-reaching consequences of the Coronavirus disease 2019 (COVID-19) pandemic. Seroprevalence studies serve as a crucial method for assessing the exposure and immunity levels within a population. In this serosurvey, which is the first of this kind conducted in Bulgaria, we enrolled 104 healthcare workers (HCWs) from one front-line Bulgarian hospital and 237 individuals from the general population. Serum samples were collected in December 2021 from the general population and in February 2023 from HCWs and the general population. The presence of four anti-SARS-CoV-2 antibodies was evaluated: anti-Spike 1-IgG, anti-Nucleoprotein-IgG, anti-Spike1-IgA and anti-Recombinant binding domain neutralizing antibodies. Our results showed high percentages of seropositivity in both the HCWs and the general population (99% and 78%, respectively) in February 2023. HCWs had significantly higher mean IgA and mean anti-S1-IgG antibody levels compared to the general population. The seropositivity in the general population in December 2021 was 79%. The mean levels of IgA and anti-NCP-IgG were significantly higher, whereas the mean anti-S1-IgG levels were significantly lower in February 2023 compared to December 2021. We found a strong correlation between neutralizing antibodies and anti-S1-IgA and anti-S1-IgG antibodies for all tested groups. It is necessary to perform large-scale serosurveys to provide analysis of the seroprevalence in a larger population and its dynamics over time and to facilitate evidence-based strategies that will safeguard the health and well-being of the Bulgarian population and contribute to the global efforts in combating the COVID-19 pandemic.

Impact of individual factors and personality trait on psychological problems of family members living with staff of a COVID-19 frontline hospital: A cross-sectional self-administered anonymous questionnaire survey.

This study aims to evaluate the association between individual factors/personality traits and depression and anxiety in family members living with staff working on the frontline of COVID-19 care. The subjects were family members over the age of 15 years living with staff members of a COVID-19 frontline hospital. Between March 27 and April 11, 2021, 204 self-administered anonymous questionnaires were distributed, and 149 responses were received. Symptoms of depression and anxiety were assessed using the Hospital Anxiety and Depression Scale (HADS). Personality trait was assessed using the Big Five personality traits, and fear of COVID-19 was assessed using the Fear of COVID-19 Scale. We examined associations between HADS depression or anxiety scores with individual background factors, scores of Big Five personality traits, and Fear of COVID-19 Scale. The participants with anxiety had significantly higher scores for neuroticism and for the Fear of COVID-19 Scale. The participants with depression had significantly lower scores for extraversion and higher scores for the Fear of COVID-19 Scale. No individual background factors were significantly associated with HADS depression or anxiety scores. Among family members of staff of a COVID-19 frontline hospital, lower extraversion, higher neuroticism, and fear of COVID-19 were associated with anxiety and depression. This questionnaire survey was conducted before wide-spread rollout of COVID-19 vaccination, so the findings of this study are expected to be applicable to other future novel infectious outbreaks.

The Relationship between Service Response Time and Waiting Time for Transfer of IGD Patients to Inpatients with Patient Satisfaction

The front line hospital services are the Emergency Room where the services provided are immediate, fast, precise and accurate. The services provided will affect patient satisfaction. One that is closely related to patient satisfaction in the emergency room is service response time and waiting time for patient transfer to inpatient care. This study aims to determine the relationship between service response time and patient transfer time to inpatient care with patient satisfaction at RSUD dr. Abdul Rivai in 2022. The design of this study was an analytic observational Cross Sectional design with a quantitative non-experimental approach to research methods with relationship analysis using the chi-square test. Based on the results of the bivariate test, it was found that P-Value = 0.016 on the relationship between service response time and patient satisfaction, and P-Value = 0.002 on the relationship between transfer time and patient satisfaction. There is a significant relationship between service response time and waiting time for patient transfer to the inpatient room with patient satisfaction.

Psychological Profile of Front Line versus Non- Front Line Hospital Waste Disposal Workers during the Outbreak of COVID-19

Psychological Profile of Front Line versus Non- Front Line Hospital Waste Disposal Workers during the Outbreak of COVID-19

Vaccination and Factors Related to the Clinical Outcome of COVID-19 in Healthcare Workers-A Romanian Front-Line Hospital's Experience.

The study aims to describe the frequency of COVID-19 in healthcare workers (HCWs) in a designated hospital for COVID-19 treatment in Bucharest, Romania, and to explore COVID-19 vaccination and other factors associated with the clinical outcome. We actively surveyed all HCWs from 26 February 2020 to 31 December 2021. Cases were laboratory-confirmed with RT-PCR or rapid test antigen. Epidemiological, demographic, clinical outcomes, vaccination status, and co-morbidities data were collected. Data were analyzed using Microsoft Excel, SPSS, and MedCalc. A total of 490 cases of COVID-19 in HCWs were diagnosed. The comparison groups were related to the severity of the clinical outcome: the non-severe group (279, 64.65%) included mild and asymptomatic cases, and the potentially severe group included moderate and severe cases. Significant differences between groups were registered for high-risk departments (p = 0.0003), exposure to COVID-19 patients (p = 0.0003, vaccination (p = 0.0003), and the presence of co-morbidities (p < 0.0001). Age, obesity, anemia, and exposure to COVID-19 patients predicted the severity of the clinical outcomes (χ2 (4, n = 425) = 65.69, p < 0.001). The strongest predictors were anemia and obesity (OR 5.82 and 4.94, respectively). In HCWs, mild COVID-19 cases were more frequent than severe cases. Vaccination history, exposure, and individual risk influenced the clinical outcome suggesting that measures to protect HCWs and occupational medicine are important for pandemic preparedness.

Mental Health Issues for Frontline Hospital Staff During Height of Covid Pandemic 2020

AbstractIntroductionWhen the SARS-Cov2 virus hit the New York and New Jersey metropolitan area in Spring 2020, hospitals and hospital workers were hit hard with a new unknown pathogen that either killed people or made them very ill. There were large numbers of severely ill patients that strained resources. Hospital workers had extraordinary stress with multiple additional patients, the need to use personal protective equipment (PPE) in short supply, and faced with a pathogen that had no treatments beyond care and support initially.MethodsWe surveyed our hospital workers in late Spring 2020 to identify the main stressors and find out what measures were helpful. An online anonymous survey included questionnaires about sleep, mood, outside stressors, helpful measures, and how they coped generally. All levels of hospital workers were surveyed. Resources were provided to all respondents.ResultsOver 240 individuals responded to the survey; most respondents were women (76%). ‘Workplace stressors’ topped the chart for 98 of our respondents. The worst workplace stressor that was cited was ‘irritable workforce,’ but ‘lack of ‘protocols’ and ‘shortage of PPE’ were also cited as stressors. ‘Other’ (not described) and ‘taking care of an ill relative’ were rated highly. Those who had ‘symptoms everyday:’ Anhedonia (loss of pleasure or interest), 13%; feeling down and hopeless, 12%; sleep disturbance, 41%; low energy, feeling tired, 29%; appetite disturbance, 26%; poor concentration and attention, 15%. Respondents told us what resources they used and what was most helpful; exercise was most frequently cited as helpful.Lessons Learned and DiscussionVarious resources for formal and informal mental health support were provided to all respondents at the time of survey. Our hospital mounted its own response with support services, as did our medical school and university. A "warm line" was available through the Department of Psychiatry from late March 2020; tip sheets and online groups were widely circulated; State Department of Health provided resources. There were formal peer support sessions and workers helped each other. Medical students provided child care, shopping, and transport. We learned that extra support for workers and more frequent rest and recharge time are important. A weekly "town hall" was instituted and a weekly update about the hospital and support in healthy activities are widely circulated to employees. Those with active PTSD (some were very disturbed by the number of deceased patients) were referred to professional providers. Hospitals need to be ready to deal with epidemics and pandemics more effectively in order to mitigate stress and support workers. Being prepared, not just with equipment, but with protocols in how to proceed should another pandemic come. We learned that listening to workers is important. Workers also need to know how valued they are.FundingDepartment of Psychiatry, New Jersey Medical School