As the number of COVID-19 cases rises in the United States, a growing number of health systems are preparing for, or already experiencing, an influx of patients visiting their EDs and other facilities.
March 26 webinar: COVID-19: What you need to know in 45 minutes
Current projections vary, but most models indicate that without immediate action to curb the spread of the new coronavirus hospitals will soon be overrun with patients.
Advisory Board experts recently spoke with members of Leo A Daly's health care team to identify unique ways hospitals can safely free up hospital bed capacity to treat COVID-19 patients. Leo A Daly is the architecture firm that helped build the biohazard containment units used to treat Ebola patients at University of Nebraska Medical Center.
Below we outline some steps systems can take to prepare themselves for the potential torrent of patients with confirmed and suspected cases of COVID-19.
6 ways to increase capacity (quickly)
Free up as many patient beds as possible: One of the first steps a health system can take is to ensure all their inpatients actually need to be in the hospital. Hospital staff should be taking a close look at patients' status and care and identify cases in which it makes sense to discharge patients to free up space for those with confirmed or suspected cases of COVID-19. This has the added benefit of reducing the risk that inpatients will be exposed to COVID-19 patients coming in the door. As COVID-19 cases begin to rise, hospitals can consider reducing the number of barriers for patients to be discharged from the hospital and set up a triage process at their EDs.
Rethink how to use patient rooms: If health systems have acuity adjustable rooms, now is the time to consider when and how to shift them from general beds to ICU beds. These rooms should already be set up to handle the additional electrical, med gas, and care needs of an ICU bed. But hospitals that do this must also ensure that staff assigned to these rooms receive the proper coaching and cross-training needed to treat patients with higher acuity.
Go bigger and rethink how to use entire floors or units: Under current CDC guidance, providers should care for patients with suspected or confirmed cases of COVID-19 in a single-person room with a door and bathroom, while reserving ICU and higher acuity beds for those patients that need intense care. To limit the spread of the novel coronavirus and conserve personal protective equipment (PPE), health systems can designate an entire wing or unit of a hospital for patients with COVID-19.
Some health systems also are considering adding an anteroom to the entrance of a dedicated wing or unit for patients with COVID-19. This ensures that providers only enter and exit the wing from one direction, isolating the wing from the rest of the facility. Creating this isolated wing can help staff preserve PPE and allows staff to properly discard waste without tracking it through the whole facility.
Reactivate shuttered facilities. Some health systems have been considering whether to reactive closed facilities to respond to an influx in patients with COVID-19. Hospital leaders should look to their own shuttered hospitals and rehabilitation facilities to see they are viable options for patients. However, reopening buildings is not without its challenges—health systems will need to find staff and supplies to get these facilities operating. And depending on the length of time of closure, the facilities could need maintenance. For those closed facilities not currently owned by the health system, health system leaders will have to work with the building owner to navigate a reopening. Even with these roadblocks, the empty facilities with available space are there—and at least worth considering.
Repurpose ambulatory surgical centers (ASCs): Another way health systems could increase capacity for patients with COVID-19 is by repurposing their owned or jointly owned ASCs. As more health systems seek to limit elective surgical procedures, ASCs could play a pivotal role in increasing capacity to treat patients with the disease because ASCs already have emergency power, gases, and other capabilities to treat patients with COVID-19.
But there is one potential problem. Some ASCs lack private rooms and are constructed with only curtains separating patients. These ASCs might be less primed to isolate COVID-19 from non-diagnosed patients. However, these facilities might be helpful if health systems decide to keep patients with COVID-19 together and separate them from patients without the disease—much like China did.
Think outside the health care facility box: While now may not be the best time to launch a new construction projection, there are a multitude of non-health care facilities—such as hotels, recreation centers, and university dorms—that could be readily transformed into treatment facilities for patients with COVID-19. Some facilities are better suited than others to house patients—such as hotels, which have a door and private bathroom—but they also present their own challenges. For example, health systems would need to determine whether hotels have the electrical capacity for medical equipment and appropriate ventilation systems to prevent the spread of disease. One challenge that health system leaders likely won't face when taking this approach is certificate of need (CON) laws. In North Carolina and other states, officials have suspended CON laws to remove regulatory barriers for hospitals to open new beds, regardless of the facility.