Hospitals in New York and Washington states experiencing the first wave of US COVID-19 cases have confronted intense questions about how to free up inpatient beds, create more space to house patients, roll out triage centers to isolate suspected patients, obtain tests, conserve personal protective equipment, locate additional supplies and keep workers informed and healthy so they can keep coming in to work.
Hospitals, state government and local communities moved to expedite the discharge of patients, banned elective and non-urgent surgeries, and postponed routine visits to preserve diminishing supplies of personal protective equipment such as masks. They conducted screenings of anyone coming into the hospital, directing people with symptoms to call doctors or use virtual health services.
To keep potential patients with the virus isolated, some hospitals set up testing locations in parking garages, swabbing symptomatic employees in their cars and sending results 24 to 48 hours after.
Healthcare executives identified other medical personnel who could be pulled from other practice areas and specialties, and mobilized for COVID-19 treatment. States moved to ease restrictions so that licensed healthcare workers could work in their states without needing a new license.
With the importance of limiting contact and reducing the number of people coming into the hospital, telemedicine and virtual care have been identified as solutions, and The Wall Street Journal reported that hospital chief information officers have sprung into action to get those projects moving.
In the Seattle area, as cases started emerging, the total staffed hospital bed capacity was about 4,900, with 940 critical care beds and some hospitals operating at near 100% occupancy on normal days, according to a working paper from the Institute for Disease Modeling, the Bill & Melinda Gates Foundation and the Fred Hutchinson Cancer Research Institute.
Healthcare organizations moved to create more capacity by converting other areas of the hospital to COVID-19 wards or even buying a motel to prepare for housing patients. The report found interventions were needed to stave off staff absenteeism due to employees being sick or worried about the risk to themselves and their families.
Governors and mayors also took action to help providers. In New York, Gov. Andrew Cuomo’s emergency declaration allowed EMS personnel to transport patients to quarantine locations other than hospitals and allowed qualified personnel other than doctors and nurses to do testing. He also asked President Donald Trump to activate the Army Corps of Engineers to help retrofit buildings in New York as hospitals.
New York City officials started identifying unused or underused healthcare buildings, such as a recently built nursing home that was not yet occupied, dorms and hotels, and said they were looking for ways to activate retirees or students to help. The city emergency management team also acquired tents for medical use.
The lessons from these early states underscore that in this fast-moving environment, providers should develop plans to answer the crucial questions for how to accommodate the influx of patients, absorb the impact of canceling elective surgeries, communicate with high-risk patients to limit exposure, conserve and locate needed supplies, and create extra bed space.
Strategies to limit exposure for the elderly and those with chronic conditions are crucial, and healthcare organizations should consider what care they might deliver in the home or virtually to reduce their risk of illness. They also should look at ways to identify these high-risk patients and monitor their status. The American Society of Clinical Oncology and other groups have tried to address questions providers may have about protecting high-risk patients such as those on chemotherapy.
Providers should enact strong communication with employees to address their questions during the pandemic and consider who may be pulled from regular duties to provide critical COVID-19 care.
Telehealth has frequently been raised as a way to reduce the spread of the virus, but some organizations and states haven’t been ready to immediately pivot to it, needing changes in regulations and what payers cover for telehealth and having to persuade patients to use it.
HRI’s new report “COVID-19: Six things health organizations should be considering (but might not be)” shows that the American public has been slow to adopt telehealth, but usage does appear to be gradually ticking up. According to the American Hospital Association, the use of telehealth has grown from 35% of hospitals in 2010 to 76% reporting fully or partially implementing a telehealth system in 2017.