Any provider and administrator who has worked in a busy emergency department (ED) during flu season knows that when things get bad, leaders must be nimble and innovative with patient placement and clearing bottlenecks. Whether it’s boarding patients, implementing discharge lounges, or deploying rapid triage and treatment pathways for low-acuity patients, flexibility, prioritization, and capacity planning are paramount.
But with the advent of COVID-19, health systems are facing a potential capacity challenge for which very few organizations are prepared. One community hospital CEO shared that “we have already forgotten how we spent our time before COVID-19” when discussing how his management team is preparing for a potential coronavirus surge. Health system leaders need to dedicate time to careful planning right now, given the enormity of the challenge facing their hospitals. Consider the following:
- The Johns Hopkins Center for Health Security is projecting that an estimated 38 million people will require medical care related to COVID, with as many as 9.6 million requiring admission and 3.2 million requiring an ICU bed.
- Hospitals do not have enough beds to care for a surge of this magnitude. If these estimates materialize, there could be as many as 17 patients for every hospital bed in the US.
- With the projected additional influx of seriously ill patients, the nursing shortage in the US, already acute and growing, takes on added urgency. It is estimated that there is currently a shortage of about 1 million nurses in the US.
Preparation Begins Now
Below is a series of initial steps hospitals can take now to maximize inpatient capacity and prepare their teams for unprecedented demand.
- Ensure that only the highest-need patients wind up at the main hospital. This can mean using telehealth in conjunction with the ambulatory network to minimize low-acuity traffic to the ED. Consider ways to bolster efficiencies in urgent care and primary care offices for rapid triage and assessment, and make sure all locations understand the importance of appropriate safety measures.
- Keep your providers and personnel informed. Establish an incident command structure that increases the frequency and cadence of internal communication so that your associates understand the steps the organization is taking to protect them and their families as well as coordinated accountabilities.
- Create a triage area in the parking lot outside the ED to limit contact between hospital staff and potentially infected patients while clinicians assess them.
- Cohort admitted patients with suspected COVID-19 exposure on one unit or area of the hospital. Limit the number of providers and support staff involved in the care of this cohort of patients to reduce the potential incidence of exposure across your workforce.
- Likewise, cohort COVID-19 infected patients on an entirely separate unit to limit exposure to other patients and care providers. Create a negative pressure “ward” with its own dedicated air handling unit, dedicated bathroom exhaust systems, and plastic sheeting to ensure the entire space is properly sealed. Again, limit the number of providers and support staff involved in caring for these patients.
- Evaluate nursing staff schedules and resources. Centralize staffing functions so that leadership can make staffing decisions based on an understanding of the entire organization’s needs, rather than on a unit-by-unit basis.
- Expedite the evaluation of patients able to be discharged to create surge capacity.
- Utilize hallways on inpatient units to maintain patient and staff cohorting practices and to allow for additional capacity.
- Collaborate with human resources leadership to develop systems to support child care so that when schools are closed, care providers are still able to come to work. For example, if a provider has a scheduled day off, is it safe for the children of their three coworkers to come to their house for the day?
- Restrict visitors and screen all visitors for possible COVID-19 exposure and signs of illness prior to entering the facility.