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Responding to COVID-19 Through Interhospital Resource Coordination: A Mixed-Methods Evaluation.
Michael G Usher1, Christopher J Tignanelli, Brian Hilliard1
1From the Section of Hospital Medicine, Division of General Internal Medicine, Department of Medicine.
Journal of Patient Safety
|September 27, 2021
Summary
Transferring COVID-19 patients to a dedicated hospital improved guideline adherence and care quality. This multihospital system approach demonstrated effective patient management during the pandemic, despite some electronic health record challenges.
Area of Science:
- Healthcare Management
- Infectious Disease Preparedness
- Hospital Operations
Background:
- The COVID-19 pandemic severely strained hospital resources and operations.
- There was a critical need for innovative strategies to manage increased demand and specialized care for COVID-19 patients.
- Maintaining access to essential hospital services and expertise was paramount during the crisis.
Purpose of the Study:
- To describe a novel hospital system strategy for managing the COVID-19 pandemic.
- To evaluate a multihospital coordination approach involving the transfer of COVID-19 patients to a single, dedicated facility.
- To assess the impact of this system on patient care, guideline adherence, and healthcare worker satisfaction.
Main Methods:
- A 12-hospital network including a dedicated COVID-19 hospital was established.
- Patients testing positive for SARS-CoV-2 were included in the study.
- Adherence to guidelines (risk stratification, anticoagulation, dexamethasone) was assessed using differences-in-differences analysis post-guideline dissemination.
- Barriers to safe transfer, including electronic health record interoperability, were evaluated.
Main Results:
- A total of 1209 patients were admitted, with 56.3% transferred via a physician-led System Operations Center.
- Transferred patients were older but had similar risk-adjusted mortality rates.
- Guideline adherence significantly improved post-dissemination for transferred patients: risk stratification (P < 0.001), anticoagulation (P < 0.001), and dexamethasone (P = 0.003).
- Interoperability issues between electronic health record systems were identified as barriers.
Conclusions:
- Standardized communication enables safe and effective interhospital transfers for cohorting COVID-19 patients.
- The transfer approach was positively received by healthcare providers.
- This strategy has the potential to enhance the quality of care during public health crises.
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