Examining adaptive models of care implemented in hospital ICUs during the COVID-19 pandemic: a qualitative study
Background The emergence of the COVID-19 pandemic led to an increased demand for hospital beds, which in turn led to unique changes to both the organisation and delivery of patient care, including the adoption of adaptive models of care. Our objective was to understand staff perspectives on adaptive...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2023-11-01
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| Series: | BMJ Open Quality |
| Online Access: | https://bmjopenquality.bmj.com/content/12/4/e002353.full |
| _version_ | 1797365987665772544 |
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| author | Jane Merkley Linda Johnston Ru Taggar Linda McGillis Hall Vanessa Reali Sonya Canzian Carol Hatcher Kathryn Hayward-Murray Mikki Layton Joy Richards Susan Woollard |
| author_facet | Jane Merkley Linda Johnston Ru Taggar Linda McGillis Hall Vanessa Reali Sonya Canzian Carol Hatcher Kathryn Hayward-Murray Mikki Layton Joy Richards Susan Woollard |
| author_sort | Jane Merkley |
| collection | DOAJ |
| description | Background The emergence of the COVID-19 pandemic led to an increased demand for hospital beds, which in turn led to unique changes to both the organisation and delivery of patient care, including the adoption of adaptive models of care. Our objective was to understand staff perspectives on adaptive models of care employed in intensive care units (ICUs) during the pandemic.Methods We interviewed 77 participants representing direct care staff (registered nurses) and members of the nursing management team (nurse managers, clinical educators and nurse practitioners) from 12 different ICUs. Thematic analysis was used to code and analyse the data.Results Our findings highlight effective elements of adaptive models of care, including appreciation for redeployed staff, organising aspects of team-based models and ICU culture. Challenges experienced with the pandemic models of care were heightened workload, the influence of experience, the disparity between model and practice and missed care. Finally, debriefing, advanced planning and preparation, the redeployment process and management support and communication were important areas to consider in implementing future adaptive care models.Conclusion The implementation of adaptive models of care in ICUs during the COVID-19 pandemic provided a rapid solution for staffing during the surge in critical care patients. Findings from this study highlight some of the challenges of implementing redeployment as a staffing strategy, including how role clarity and accountability can influence the adoption of care delivery models, lead to workarounds and contribute to adverse patient and nurse outcomes. |
| first_indexed | 2024-03-08T16:56:49Z |
| format | Article |
| id | doaj.art-5d31119c421e467b9ae92267cb4a8b9e |
| institution | Directory Open Access Journal |
| issn | 2399-6641 |
| language | English |
| last_indexed | 2024-03-08T16:56:49Z |
| publishDate | 2023-11-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Quality |
| spelling | doaj.art-5d31119c421e467b9ae92267cb4a8b9e2024-01-04T22:30:07ZengBMJ Publishing GroupBMJ Open Quality2399-66412023-11-0112410.1136/bmjoq-2023-002353Examining adaptive models of care implemented in hospital ICUs during the COVID-19 pandemic: a qualitative studyJane Merkley0Linda Johnston1Ru Taggar2Linda McGillis Hall3Vanessa Reali4Sonya Canzian5Carol Hatcher6Kathryn Hayward-Murray7Mikki Layton8Joy Richards9Susan Woollard109 Lunenfeld-Tananbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada6 Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, CanadaSunnybrook Health Sciences Centre, Toronto, Ontario, CanadaNursing, University of Toronto, Toronto, Ontario, CanadaNursing, University of Toronto, Toronto, Ontario, CanadaUnity Health Toronto, Toronto, Ontario, CanadaHumber River Hospital, Toronto, Ontario, CanadaTrillium Health Partners, Mississauga, Ontario, CanadaToronto East Health Network Michael Garron Hospital, Toronto, Ontario, CanadaUniversity Health Network, Toronto, Ontario, CanadaNorth York General Hospital, Toronto, Ontario, CanadaBackground The emergence of the COVID-19 pandemic led to an increased demand for hospital beds, which in turn led to unique changes to both the organisation and delivery of patient care, including the adoption of adaptive models of care. Our objective was to understand staff perspectives on adaptive models of care employed in intensive care units (ICUs) during the pandemic.Methods We interviewed 77 participants representing direct care staff (registered nurses) and members of the nursing management team (nurse managers, clinical educators and nurse practitioners) from 12 different ICUs. Thematic analysis was used to code and analyse the data.Results Our findings highlight effective elements of adaptive models of care, including appreciation for redeployed staff, organising aspects of team-based models and ICU culture. Challenges experienced with the pandemic models of care were heightened workload, the influence of experience, the disparity between model and practice and missed care. Finally, debriefing, advanced planning and preparation, the redeployment process and management support and communication were important areas to consider in implementing future adaptive care models.Conclusion The implementation of adaptive models of care in ICUs during the COVID-19 pandemic provided a rapid solution for staffing during the surge in critical care patients. Findings from this study highlight some of the challenges of implementing redeployment as a staffing strategy, including how role clarity and accountability can influence the adoption of care delivery models, lead to workarounds and contribute to adverse patient and nurse outcomes.https://bmjopenquality.bmj.com/content/12/4/e002353.full |
| spellingShingle | Jane Merkley Linda Johnston Ru Taggar Linda McGillis Hall Vanessa Reali Sonya Canzian Carol Hatcher Kathryn Hayward-Murray Mikki Layton Joy Richards Susan Woollard Examining adaptive models of care implemented in hospital ICUs during the COVID-19 pandemic: a qualitative study BMJ Open Quality |
| title | Examining adaptive models of care implemented in hospital ICUs during the COVID-19 pandemic: a qualitative study |
| title_full | Examining adaptive models of care implemented in hospital ICUs during the COVID-19 pandemic: a qualitative study |
| title_fullStr | Examining adaptive models of care implemented in hospital ICUs during the COVID-19 pandemic: a qualitative study |
| title_full_unstemmed | Examining adaptive models of care implemented in hospital ICUs during the COVID-19 pandemic: a qualitative study |
| title_short | Examining adaptive models of care implemented in hospital ICUs during the COVID-19 pandemic: a qualitative study |
| title_sort | examining adaptive models of care implemented in hospital icus during the covid 19 pandemic a qualitative study |
| url | https://bmjopenquality.bmj.com/content/12/4/e002353.full |
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