Your Covid-19 checklist to expand capacity

We will be keeping this resource updated on a rolling basis as new strategies and best practices are introduced. This checklist was last updated on April 23, 2020

By Taylor Hurst and Virginia Reid

Boosting capacity has never been more important as hospitals face an impending surge of Covid-19 cases across the coming weeks.

As our researchers engage with hospital and health system leaders in Covid-19 hotspots across the country, we’ve assembled an early checklist of table-stakes strategies your organization should implement now to proactively manage patient demand and staff and resource shortages.

1. Redirect patient demand

Postpone all elective procedures

    Delay elective surgeries to free up bed capacity, staff availability, and conserve PPE and other resources.

    • In line with social distancing practices, proactively postponing elective procedures will minimize the risk of transmission of Covid-19 between patients and providers.
    • Though delays will cause revenue loss in the short-term, it is seen as a no-regrets move to proactively conserve resources in anticipation of a surge of Covid-19 cases.
    • Consult this list for full details of state guidance on elective surgeries.

    Advisory Board resource: Covid-19 elective surgery cancellation impact estimator

Repurpose beds for additional ICU capacity

    Repurpose surgical beds (e.g., PACUs, ORs, ASCs) for additional ICU capacity.

    Set protocol for isolating different patient populations, including non-Covid patients, persons under investigation (PUIs), and patients who test positive for Covid-19 in your facilities.

    Transition a subset of essential, non-Covid inpatient services to ASCs (e.g., surgeries typically performed in hospital, labor and delivery.

Ramp up telehealth capabilities

    Shift existing non-Covid appointments to telehealth visits where possible.

    Proactively suggest virtual visits for patients with existing medical conditions. For patients with chronic illnesses, assess capacity for remote patient monitoring.

    Stand up a phone triage line or chatbot for patients who suspect they are ill. Direct patients who present with symptoms to a virtual visit for further consultation before scheduling an in-person visit.

    Develop standard guidelines for staff who are triaging patients that communicate clear referral pathways.

    Advisory Board resources:

Brainstorm alternative sites of care

    Create criteria for places that can be repurposed as sites of care for Covid-19 patients, including proximate hotels, dorm beds, or gyms.

    Partner with post-acute sites of care, including LTACHs, for additional bed space.

    Plan your organization’s approach to staffing alternative sites.

Re-envision discharge planning

    Collaborate with area home health agencies and home-based support services to discharge more patients directly home, faster.

    Use 1135 waivers to accelerate more acute patient discharges to post-acute facilities, starting with non-Covid patients.

2. Redeploy staff

Redeploy all available MDs across medical units

    Reallocate providers, especially surgeons and anesthesiologists no longer performing procedures, to serve in acute care settings.

    Flex providers working in outpatient sites of care to work in acute settings as non-Covid care moves from in-person to virtual options.

Upskill RNs to work in ICU

    Create a contingency plan for quickly getting RNs up to speed on acute care for Covid-19 patients.

    Tap other members of the care team to backfill RN roles in non-acute settings.

    Move any non-clinical staff at your organization who have clinical backgrounds into care roles.

Source childcare for clinical staff to reduce no-shows

    Organize small group or individual childcare for staff to align with social distancing recommendations

Ready your list of licensed clinical retirees and medical/nursing students to join the workforce

    Determine how you will leverage your state’s expedited license renewals and temporary emergency licenses to expand workforce capacity.

3. Locate all available supplies

Source PPE donations

    Publicize a list of the supplies your organization needs through press releases, social media, and other broad channels, along with contact information for how to donate.

    Reach out to the list of community businesses below to source PPE by donation:

    • Construction companies
    • Woodworking, painting, industrial coating companies
    • Welding suppliers
    • Marine suppliers
    • General industrial suppliers (such as Granger, Fastenal)
    • Automotive stores
    • Heavy equipment, worksite machinery rental companies (such as United Rentals)
    • Cleaning companies (especially fire, water and mold restoration franchises)
    • Agriculture companies

    Transition from single-use masks and gowns to alternatives that can be sanitized and used for multiple wears.

Reuse and create PPE to fill supply chain gaps

Access all available ventilators

    When facing shortages, follow FDA guidance that suggests use of supplemental alternative devices capable of delivering breaths including home or emergency transport ventilators, anesthesia gas machines, and sleep apnea machines.

    Consider extending use of ventilators past their shelf life, depending on availability.

    Identify alternatives to ventilators already on the market, including helmet ventilators and portable, non-invasive ventilators.

    Advisory Board resource: Cheat sheets: Your one-stop-shop for ventilator shortages

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