Healthcare providers today have found themselves in the midst of an unprecedented public health emergency requiring the combined efforts of the entire workforce. In times like these, clear and effective guidance is a necessity. To assist clinicians with navigating this challenging landscape, the Centers for Disease Control and Prevention have released interim guidelines outlining preparation strategies for healthcare facilities anticipating community spread of the novel coronavirus (COVID-19) and those which may be experiencing it currently.
As the situation is unfolding dynamically it is impossible to predict the course of the outbreak and the medical workforce’s preparedness is vital to improving patient outcomes. The CDC stresses the importance of continual care for all patients, despite a surge in demand at healthcare facilities, and the need for concentrated efforts aimed at mobilizing all aspects of the system to reduce the spread of COVID-19 while decreasing its burden. As the situation continues to evolve, public health guidelines will likely change; clinicians and healthcare facilities should remain aware of the latest updates on local and state public health recommendations as they become available.
Preventative Actions to Take Now
At this time, the primary goals for the U.S. healthcare system are to reduce morbidity and mortality rates, minimize COVID-19 transmission, protect medical personnel, and preserve healthcare system functioning. To do so, the CDC recommends several preventative solutions to prepare healthcare facilities for potential outbreak spread.
In communities yet unaffected by the virus, the CDC urges healthcare facilities to take time to educate staff on COVID-19 preparations and protocols. This includes informing them about transmission mechanisms, the clinical management of COVID-19 patients, as well as infection prevention and control recommendations outlined by the agency.
Additionally, providers are urged to minimize the amount of face-to-face contact with patients by encouraging patients to use advice hotlines, patient portals, online assessment tools, and to call medical professionals directly. Implementing or expanding an existing telehealth program can prove vital at this time, helping clinicians provide safe and effective care remotely.
Personal protective equipment is lacking all over the country, however, providers should plan to optimize their facility’s supply before they reach a dire need. Identifying flexible mechanisms of procuring additional supplies when needed and organizing local drives for equipment donations can help prepare for future shortages.
It is also essential for healthcare facilities to prepare to safely triage and manage patients with COVID-19, which includes implementing visual alerts, instruction on hygiene and prevention etiquette, ensuring supplies are available, and offering facemasks to patients with respiratory symptoms. In addition, an area should be created to spatially separate patients with such symptoms, ideally allowing for at least 6 feet of space between individuals. It is also important to ensure patients with symptoms are aware of healthcare facility protocols – such as the need to call before arriving in person to allow care teams to prepare.
Handling COVID-19 Community Spread
In communities currently experiencing community spread of the virus, healthcare facilities are urged to work with local and state public health organizations, healthcare coalitions, and other local partners to minimize disease spread. Designated staff – trained on the CDCs’ infection prevention and control guidelines – should be responsible for caring for COVID-19 patients; these providers should also be monitored closely for symptoms.
Facilities experiencing widespread transmission may opt to screen staff members for fever or respiratory symptoms and prepare for increased absenteeism by extending hours, cross-training current employees, and hiring additional staff. Further, it is essential for staff to be aware of sick leave policies, recommended work restrictions, staff monitoring procedures, and be given the opportunity to stay home if they present symptoms of illness.
Medical professionals are encouraged to manage mild cases of COVID-19 remotely; if patients are able to engage in home monitoring safely, then telehealth is preferred. Caregivers and patients should be aware of home care instructions and be able to access the healthcare facilities for urgent care. Working with local public health authorities and community organizations can help affected communities offer support services for COVID-19 patients recovering at home – including food, medication, and other necessity delivery.
Considerations for Outpatient Care
The CDC urges facilities with outpatient services to reschedule non-urgent outpatient visits as necessary. Providers should consider reaching out to patients deemed at high risk of COVID-19 complications – including the elderly and those with underlying health conditions – to ensure they adhere to current treatment plans, confirm they have sufficient medication refills, and provide instructions on how to notify their providers if they begin to experience symptoms. Additionally, it may be helpful to accelerate the timing of high priority screening and interventions in anticipation of an upcoming influx of COVID-19 patients. To support optimal hospital capacity, the CDC also recommends eliminating patient penalties for cancellations and missed appointments in cases of respiratory symptoms.
Considerations for Inpatient Care
Based on the latest guidance, facilities should reschedule elective surgeries as necessary at this time. When feasible, providers are urged to shift elective urgent inpatient diagnostic and surgical procedures to outpatient settings to further preserve hospital capacity. In planning for a forthcoming influx of COVID-19 patients, inpatient facilities should identify additional or alternate space in the ER, ICUs, and other patient care areas along with dedicated staff to care for known or suspected COVID-19 patients. Visitors of COVID-19 patients should be limited as well.
Considerations for Long Term Care Facilities
Long term care facilities are recommended to limit visitors, post visual alerts with hygiene instructions, ensure adequate supply availability, and employ targeted efforts toward preventing COVID-19 patients from exposing other patients. This can be achieved by limiting the movement of COVID-19 patients, designating staff members responsible for care of these patients, and observing incoming patients and staff for respiratory symptoms.
Although times are uncertain and it is not possible to determine if, how, and when the COVID-19 outbreak will affect your community, it is essential for healthcare providers and facilities across the nation to be prepared for potential emergency situations. These may include surges in incoming patients seeking care, potential staff shortages, closures related to social distancing, and a rising need for telehealth programs. Shifts in the healthcare model as a result of the outbreak are complex and expected to continue evolving as more information about the virus becomes available; clinicians are encouraged to communicate with their local public health officials to stay up to date with the latest guidance.