Objective

The Coronavirus disease (COVID-19) outbreak has evolved into a pandemic crisis, with King County in Washington State emerging as the early US epicenter. A literature review revealed few reports providing front-line clinical and research teams guidance related to multilevel, rapidly evolving COVID-19 directives.

Method

The Rapid Assessment Procedure Informed Clinical Ethnography (RAPICE) method was used to develop a clinical case series and conduct participant observation during an ongoing comparative effectiveness trial of peer-integrated, patient-centered interventions after traumatic injury. Participants were patients enrolled in the intervention arm of the ongoing trial, as well as front-line clinicians, patient peer interventionists, and clinical research team members implementing the trial. All participants were exposed to the Washington State COVID-19 outbreak.

Results

Primary and secondary COVID-19 prevention strategies were feasibly integrated into ongoing care coordination and behavioral interventions for at-risk patients. Beyond the compilation of case studies, as an iterative method, RAPICE data collection naturalistically evolved to include observations of intervention team activity occurring within the larger pandemic epicenter context. A daily clinical research team huddle that flexibly accommodated virtual participation was also feasibly implemented.

Conclusions

Primary and secondary COVID-19 prevention strategies can be feasibly integrated into ongoing clinical interventions during the pandemic. Routine, proactive clinical and research team communication that transparently addresses ethical tensions and health-sustaining activities may promote well-being for providers grappling with rapidly evolving pandemic directives. Proactive assessments of individual provider vulnerabilities for severe COVID-19 related respiratory illness may also be a crucial element of the health care system pandemic responses.

中文翻译：

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美国早期COVID-19震中的经验和见解：快速评估程序，告知临床人种学案例系列

目的

冠状病毒病（COVID-19）爆发已演变成一场大流行性危机，华盛顿州的金县成为美国早期的震中。文献综述显示，很少有报告为一线临床和研究团队提供与多级，快速发展的COVID-19指令相关的指导。

方法

快速评估程序知情临床人种志（RAPICE）方法用于制定临床病例系列，并在正在进行的以创伤为对象的以患者为中心的同伴综合干预的比较有效性试验中，对参与者进行观察。参加试验的患者包括正在进行的试验的干预小组，以及一线临床医生，患者同行干预者和实施试验的临床研究团队成员。所有参与者都暴露于华盛顿州COVID-19爆发。

结果

将初级和次级COVID-19预防策略切实可行地整合到了针对高危患者的持续护理协调和行为干预中。除了案例研究的汇编之外，作为一种迭代方法，RAPICE数据收集自然地发展为包括对在大流行性震中范围内发生的干预团队活动的观察。灵活实施虚拟参与的每日临床研究团队挤在一起也是可行的。

结论

大流行期间，可以将一级和二级COVID-19预防策略切实地纳入正在进行的临床干预措施中。定期，主动地与临床和研究团队进行沟通，以透明的方式解决道德压力和维持健康的活动，可以为努力应对快速发展的大流行指令的医务人员带来福祉。对个别提供者的严重COVID-19相关呼吸道疾病的脆弱性进行主动评估，也可能是卫生保健系统大流行应对中的关键要素。