Hospitals need a contingency plan to meet COVID-19 surge in urban areas

The COVID-19 pandemic is resulting in an increased demand for hospitalization, which can in turn highlight logistical deficiencies that place additional stress on the U.S healthcare system. Because of that, hospitals and health systems need contingency plans to meet surges of hospitalizations in urban areas, and to minimize coronavirus exposure to care staff.

In "Mobilization and Preparation of a Large Urban Academic Center During the COVID-19 Pandemic," published online in the Annals of the American Thoracic Society, experts from Philadelphia's Temple University Hospital share their contingency plans, which they say can also ensure proper active and reserve staffing.

The authors hope to reduce COVID-19 mortality by ensuring that standards of care are maintained despite the increase in healthcare utilization. They emphasize early detection, isolation and triaging.

WHAT'S THE IMPACT?

The situation the team faced was especially challenging, as the medical center is located in a medically underserved area, and its ICU beds are typically at 80% to 90% of capacity during normal operations.

Staff training on safety measures was started immediately after the outbreak. An infection-control committee drafted personal protective equipment protocols, while simulation exercises were conducted on advanced cardiac life support and rapid response. All staff members were required to report symptoms online and have their temperature monitored before and after shifts.

Based on learnings from the COVID outbreak in Wuhan, China, the authors created a screening protocol to stratify patients based on their risk of virus transmission. Inpatients are monitored for COVID-19-related changes and screened. Patients requiring rapid responses or having cardiac arrest are immediately transferred to the COVID-19 unit if coronavirus is suspected.

At first, all tests for SARS-CoV-2 – the virus that causes COVID-19 – were sent to a third-party diagnostics company with a four-to-five-day turnaround. But that resulted in appropriate PPE usage and delayed discharges for non-COVID-19 patients. By developing in-house testing with a turnaround time of five to 10 hours, the team could more effectively triage and discharge patients.

They determined that three units were necessary: an isolation unit separate from the main hospital, a unit designated for patients with a low probability of COVID infection and a third unit that functioned as an outpatient COVID-19 screening unit.

Contingency planning included creating designated backup units; mobilizing ventilators from smaller satellite campuses; asking staff who were not performing essential inpatient services to remain at home on reserve for staffing shortages; the creation and enforcement of a strict no-visitor policy; and plans for conservation of PPE and disinfection of solid objects such as phones, glasses and pens.

WHAT ELSE YOU SHOULD KNOW

They also developed COVID-19-specific admission protocols. These covered isolation precautions, specimen collection, imaging and laboratory testing. Once admitted, patients are kept in airborne/droplet isolation and contact isolation until SARS-CoV-2 is ruled out. Patients are kept in various states of isolation if they are at varying levels of risk or have a confirmed COVID-19 diagnosis, while COVID-19-positive patients whose symptoms improve are discharged to home quarantine.

On discharge, close follow-up is done to help assure pandemic mitigation. Discharged COVID-19 positive patients are provided with an online portal, where they are required to log in daily to report their symptoms. They are asked to remain in mandatory quarantine for 14 days. Follow-up with these patients is continued for a month, and then again at three and six months. If they are symptomatic, additional tests are ordered.

The hospital's lung center converted all in-person outpatient appointments to telemedicine visits. All telemedicine patients are asked COVID-19-screening questions when their appointments are made.

The protocols are intended to provide a road map for other healthcare institutions in the U.S.

THE LARGER TREND

While the Temple University Hospital road map could prove useful from the standpoint of clinical care, healthcare finance teams are also rethinking their processes. Dan Michelson, CEO of Strata Decision Technology, said it's likely there will be a shift in how people do budgeting, with a new approach centered on rolling forecasting: driving improvements from month to month and quarter to quarter.

Another big shift will be in the area of telehealth. The most common usage for telehealth is for common cough-and-cold maladies, but with the relaxation of telehealth reimbursement restrictions from the federal government, usage will likely extend beyond coughs and colds – and many of these changes could be permanent.

Twitter: @JELagasse

Email the writer: jeff.lagasse@himssmedia.com