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Looking for ideas? OIG report outlines hospital strategies on COVID challenges

Hospital Safety Insider, April 9, 2020

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By A.J. Plunkett

If you are still preparing for a major onslaught of suspected COVID-19 patients, review your plans against the strategies hospitals already have employed to deal with supply and personnel challenges, as outlined in an HHS Office of Inspector General (OIG) report released Monday.

In a National Pulse Survey conducted with hospital administrators nationwide the last full week of March, hospitals confirmed the much-reported challenges obtaining adequate supplies of personal protective equipment (PPE), ventilators, and other medical supplies, as well as timely results in COVID-19 testing.

Hospital administrators also reported:
 

• Being unable to maintain adequate staffing and support, especially with specialized providers, and concerns that fear and uncertainty was taking a toll on staff.
• Bed space and capacity was being pushed beyond limits, especially if post-acute-care facilities refused to take patients no longer needing advanced care unless they tested negative for COVID-19.
• Besides PPE and ventilators, hospitals were also seeing shortages in such items as IV poles, medical gas, linens, toilet paper, and food. Isolated and smaller hospitals faced special challenges, according to the report, maintaining supplies and restocking quickly when supplies ran out.
• Increased costs and decreased revenue were impacting cash reserves.
• Inconsistent and changing guidance from federal, state, and local authorities sowed confusion at hospitals and contributed to public misinformation, with patients showing up unnecessarily.

To cope, hospitals employed various strategies, including conserving and reusing PPE and other supplies normally thought of as disposable, and turning to non-traditional supplies such as N95 masks designed for construction personnel or handmade masks and gowns.

As ventilators grew scarce, some hospitals tried renting ventilators, buying single-use emergency transport ventilator equipment, and converting other equipment, such as anesthesia machines into ventilators.

Other strategies, according to the report, include:
 

• Collaborating with other industries in their region to find supplies and create solutions.
• Training anesthesiologists, hospitalists, and nursing staff to help care for respiratory patients on ventilators.
• Managing patient flow and hospital capacity by providing ambulatory care for patients with less severe symptoms, offering telehealth services where possible, and looking to alternate facilities such as college dorms, fairgrounds and closed correctional facilities.
• Providing childcare, laundry, and grocery services to support overworked and stressed out staff members, as well as offering hotel rooms to “promote separation from elderly family members.”

The report also has a five-page appendix of specific strategies used by hospitals to meet the variety of challenges, but HHS notes that “these strategies are self-reported by the hospitals and OIG has not validated their effectiveness or safety.”

Find the specific strategies expanding bed capacity, restricting access, and supporting staff and morale here.

A.J. Plunkett is editor of  Inside Accreditation and Quality, a Simplify Compliance brand.

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