During this COVID-19 epidemic, many hospitals are struggling to develop their “surge capacity,” (the ability of the community or health system to respond to a sudden increase in demand for services). The primary focus is typically on ensuring there is adequate staffing with front-line physicians and Advanced Practice Providers, such as those working in emergency medicine, or as hospitalists.
However, there are several issues and potential solutions that may be overlooked.
CONSIDER
- Protecting clinicians with increased risk factors for developing severe disease (increased age, underlying significant chronic diseases, etc.) also offsets initial total available physicians. How do we minimize their exposure and risk of developing an infection?
- Managing a limited pool of sub-specialists. Whether you are a large academic center, or a small community hospital, there are typically limited numbers of specialists available even on a good day. Consider the impact to a facility that has three neurologists, with one falling ill, the second being quarantined, and the third being overwhelmed from responding 24/7 to the needs of the hospital. Are there ways to proactively protect these limited resources?
- Increasing numbers of clinicians are becoming unavailable for direct patient care when they are quarantined due to exposure to COVID-19 or develop mild illness. Is there a way to utilize exposed clinicians to support direct patient care?
SOLUTIONS
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- Utilize Telemedicine Services for any physicians or APP, that do not require direct physical contact with patients. CMS has significantly loosened regulations and eased the process of developing telemedicine services. For more details, we provided a link below. Telemedicine allows for:
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- Primary Care Physicians screening of the “worried well,” and those with mild symptoms. This allows for decreased congregation at the PCP office, and decreased volumes of non emergent cases presenting to the emergency department.
- Remote consultation by sub-specialists, decreasing the unnecessary exposure of these clinicians.
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- Utilization of clinicians that are in quarantine due to exposure or active infection, decreasing the risk of spread from these clinicians to others
- Fewer direct interactions, leads to a decreased waste of personal protective equipment which is currently in short supply
- If the projected volume of cases exceeds the capacity of the system, novel solutions will be necessary. Consideration should be given for utilizing clinicians positive for COVID-19, but with mild/no symptoms, to provide direct patient care within areas of the hospital that are designated as “coronavirus only.” This increases the pool of available physicians and decreases unnecessary exposure to those who are not infected.
Other ISSUES that have been identified, include:
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- Potential shortage of ventilators for management of those with acute respiratory failure. One solution is for “cohorting” more than one patient on the same ventilator. There are several excellent videos available, showing step-by-step instructions.
- A limited number of negative pressure isolation rooms. Most hospitals have only a few of these rooms that are designed to ensure that air is pulled into the room, rather than pushed out (positive pressure). Negative pressure decreases the risk of airborne transmission of the coronavirus. Hospitals should talk with their environmental engineers, to determine what portions of the hospital can be converted to negative pressure units, increasing the total number of beds available for isolating those with COVID-19
RESOURCES: https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet
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