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A Review of Brooke Army Medical Center Chaplaincy Service During the SARS-COV2 Pandemic: Implications for Service Structure and Patient Needs
Military Medicine ( IF 1.2 ) Pub Date : 2021-08-28 , DOI: 10.1093/milmed/usab353
Zaith Bauer 1 , Joseph Sherwin 2 , Stanley Smith 2 , Jason Radowsky 3
Affiliation  

Introduction We aimed to evaluate the effect of the SARS-COV2 pandemic on chaplain utilization at Brooke Army Medical Center. Our hypothesis was that multiple pandemic-related factors led to a care environment with increased mental and spiritual stress for patients and their families, leading to an increased need for adjunct services such as chaplaincy. Materials and Methods This was a single-institution retrospective chart review study that evaluated the records of 10,698 patients admitted between July 1, 2019, and January 31, 2020, or between July 1, 2020, and January 31, 2021. Our primary study outcomes included the number of chaplain consultations, the number of visits per consultation, and the time of visits between the two study cohorts. Secondary outcomes included inpatient mortality and the number of end-of-life visits. We also isolated a subgroup of patients admitted with COVID-19 and compared their outcomes with the two larger cohorts. Statistical analysis included t-test or chi-squared test, based on the variable. This study was reviewed and approved by the Brooke Army Medical Center Institutional Review Board (IRB ID C.2021.010e). Results Fewer consults were performed during the study period affected by the SARS-COV2 pandemic (4814 vs. 5884, P-value <.01). There were fewer individual visits per consult during the study period affected by the SARS-COV2 pandemic (1.44 vs. 1.64, P-value <.01), which led to fewer overall time spent per consult (37.41 vs. 41.19 minutes, P-value <.01). The 2020 cohort (without COVID-19 cases) demonstrated a higher mortality rate than the 2019 cohort (2.8% vs. 1.9%, P-value <.01). The COVID-19 diagnosis cohort demonstrated a much higher mortality rate compared to other patients in the 2020 cohort (19.3% vs. 2.8%, P-value <.01). We demonstrated the relative need for EOL consults by presenting the ratio of EOL consults to inpatient deaths. This ratio was highest for the COVID-19 diagnosis cohort (0.76) compared to the 2020 cohort (0.50) and the 2019 cohort (0.60). Conclusions This study demonstrates that factors related to the SARS-COV2 pandemic resulted in fewer chaplaincy consults in our inpatient setting. We did not find other reports of a change in the rate of chaplaincy consultation, but available reports suggest that many centers have had difficulty balancing the spiritual needs of patients with local exposure guidelines. Although fewer individual chaplain consults occurred during the SARS-COV2 pandemic, our chaplain service innovated by utilizing various phone, video, and web-based platforms to deliver spiritual support to our community. Our study also suggests that the patients most greatly affected by the pandemic have an increased need for spiritual support, especially at the end of life. Future studies in this subject should examine the effect of various types of chaplain services as they relate to the health and well-being of hospitalized patients.

中文翻译:

SARS-COV2 大流行期间布鲁克陆军医疗中心牧师服务回顾:对服务结构和患者需求的影响

简介 我们旨在评估 SARS-COV2 大流行对布鲁克陆军医疗中心牧师利用率的影响。我们的假设是,多种与大流行相关的因素导致护理环境增加了患者及其家人的精神和精神压力,导致对牧师等辅助服务的需求增加。材料和方法 这是一项单机构回顾性图表审查研究,评估了 2019 年 7 月 1 日至 2020 年 1 月 31 日或 2020 年 7 月 1 日至 2021 年 1 月 31 日期间入院的 10,698 名患者的记录。我们的主要研究结果包括牧师咨询的次数、每次咨询的访问次数以及两个研究队列之间的访问时间。次要结果包括住院患者死亡率和临终就诊次数。我们还分离了一部分因 COVID-19 入院的患者,并将他们的结果与两个较大的队列进行了比较。统计分析包括基于变量的 t 检验或卡方检验。本研究由布鲁克陆军医疗中心机构审查委员会 (IRB ID C.2021.010e) 审查和批准。结果 在受 SARS-COV2 大流行影响的研究期间进行的咨询较少(4814 对 5884,P 值 <.01)。在受 SARS-COV2 大流行影响的研究期间,每次咨询的个人就诊次数较少(1.44 对 1.64,P 值 <.01),这导致每次咨询花费的总时间较少(37.41 对 41.19 分钟,P -值 <.01)。2020 年队列(没有 COVID-19 病例)的死亡率高于 2019 年队列(2.8% 对 1.9%,P 值 <.01)。与 2020 年队列中的其他患者相比,COVID-19 诊断队列的死亡率要高得多(19.3% 对 2.8%,P 值 <.01)。我们通过显示 EOL 咨询与住院患者死亡的比率来证明 EOL 咨询的相对需求。与 2020 年队列 (0.50) 和 2019 年队列 (0.60) 相比,该比率在 COVID-19 诊断队列中最高 (0.76)。结论 这项研究表明,与 SARS-COV2 大流行相关的因素导致我们住院病人的牧师咨询次数减少。我们没有发现其他关于牧师咨询率发生变化的报告,但现有报告表明,许多中心难以平衡患者的精神需求与当地接触指南。尽管在 SARS-COV2 大流行期间个别牧师会诊较少,我们的牧师服务通过利用各种电话、视频和网络平台进行创新,为我们的社区提供精神支持。我们的研究还表明,受大流行影响最严重的患者对精神支持的需求增加,尤其是在生命的尽头。该主题的未来研究应检查各种类型的牧师服务的效果,因为它们与住院患者的健康和福祉有关。
更新日期:2021-08-28
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