Talking Points on COVID-19 Hospital Preparedness

Hospital Preparedness

THA is actively involved in Tennessee’s response to the COVID-19 response with Tennessee in coordination with Tennessee hospitals and state and federal officials.

Every day in Tennessee, physicians, nurses, support staff and other healthcare providers go to work in our hospitals, to care for patients with a variety of health needs. This practice of medicine occurs 24 hours a day, seven days a week, 365 days a year because health needs and issues don’t take holidays.

One of the hallmarks of our healthcare system is the ability for patients to visit emergency departments and provider practices to seek care whenever they need it. These needs are met by the dedicated individuals who serve our communities as front line heroes to ensure the health and safety of all Tennesseans.

During the COVID-19 pandemic, these healthcare providers, hospitals and many other sites of care are still open and providing the same compassionate care as always.

Hospitals constantly work to prepare for crisis situations, and COVID-19 is no exception. While the ultimate scale and impact remains unknown, hospitals are hard at work on the front lines of this fight to care for the people of Tennessee.

While COVID 19 is a new virus, preparing for responses to disasters is not new to hospitals. Emergency preparedness training is a year-round activity that is done within each facility, system and region.

Hospitals treat patients with a variety of infectious diseases on a daily basis. These patients are isolated and treated in appropriate spaces by trained staff using specialized equipment. For example, hospitals have implemented no visitor or limited visitation restriction policies in an effort to reduce the likelihood of disease transmission.

When there is a threat of a disease that could cause a surge of patients, each individual hospital steps up its preparedness and coordination activities. Hospitals share information and best practices, but also deploy the specific strategies that will work best in their facilities and in response to the changing situation.

Hospitals around the state are working closely with the Centers for Disease Control and Prevention (CDC), Tennessee Department of Health (TDH) and local public health departments to prepare and care for COVID-19. In times of large-scale disasters, they work with one of the emergency preparedness healthcare organizations in Tennessee.

Testing

While testing capacity has increased since the virus was first detected in the state and remote assessment centers now are available across the state, Tennesseans should first call their usual source of care. If an assessment cannot be done in that location, individuals should call the assessment site prior to showing up at an assessment site. Most locations do a phone assessment to determine if an in-person assessment or test is needed. Most individuals, particularly those with mild or no symptoms may not need a test.

The public should understand that most cases of COVID-19 will not mean hospitalization, or even a trip to an emergency room. Hospital care is a precious resource that needs to be reserved for those with the most serious symptoms.

PPE

Supplies of personal protective equipment (in particular masks and gowns) are dangerously low in some hospitals. Hospitals are taking action to try to conserve these resources by canceling non-essential surgeries and procedures and adhering to new recommendations regarding the use of personal protective equipment.

Of course it is best for hospitals and healthcare workers have approved commercial PPE to protect those on the front lines of this pandemic and THA continues to advocate that all options are pursued to procure PPE. THA is working with state and federal officials as they address this issue from multiple fronts. However, there is a nationwide shortage and alternate PPE options may be needed.

The CDC has released guidance on strategies to optimize the supply of PPE. Hospitals and healthcare workers should employ those strategies and request resources from TEMA or their local emergency management operations.

Unfortunately, hospitals must prepare for the possibility they will exhaust all commercial PPE options. In that event, the CDC has released guidance on how to make or sew cloth masks. If individuals are interested in making these to help their community, they should reach out to their local hospital to see if they are accepting these types of masks and if so, their preference on mask type.  THA and Tennessee hospitals appreciate the outpouring of support we’ve seen from Tennesseans during this challenging time.

Hospital Bed Capacity

Most hospitals in the state to do not have extra capacity and are not holding beds open for possible COVID-19 patients. However, this is an evolving situation and hospital space can and will be made quickly available in an emergency or with a surge of critically ill patients.

If beds are reserved before there is a need, it would mean delays in care for people who need services now. As COVID-19 cases present, hospitals will coordinate with public health officials to meet the need.

The state is focused on developing Alternative Care Sites in major metropolitan areas that will care for low acuity COVID-19 patients. This will allow hospitals to redirect less ill patients, as needed, in order to focus on patients with the greatest needs. THA and and Tennessee hospitals are actively engaged in these efforts.

Routine Care

Hospitals need to provide planned care to people who need knee replacements, cancer surgery, hernia repair and many other issues. Hospitals also need to provide urgent and emergency care to people experiencing a heart attack, stroke or serious accident.

Hospital Strategies

Below are some examples of common strategies that hospitals are prepared to use to care for a large number of COVID-19 patients should be need arise. The three areas where there could be shortages are: space to care for patients, supplies needed to care for patients and staff. This is just a short list of possible options; not all of them will be necessary, and other tactics may be more effective.

Space

  • Using temporary beds in clinical units
  • Expanding inpatient care into non-inpatient spaces
  • Referring patients who do not need emergency or hospital level care to clinics or urgent care
  • Transferring stable patients to non-impacted facilities
  • Discharging patients to go home (with appropriate home or follow-up care plans)
  • Expanding hours of outpatient care facilities
  • Leveraging telemedicine and nurse triage call lines to reduce the number of patients being seen within a facility

Staff

  • Adjusting staffing schedules/extending shifts
  • Adapting staffing levels to best meet patient needs
  • Repurposing non-essential staff
  • Using volunteers
  • Reducing frequency or scope of documentation
  • Expanding scope of certain providers to do more

Supplies

  • Sourcing supplies from alternate vendors than those normally used
  • Providing mutual aid between healthcare organizations or other business partners
  • Implementing conservation strategies to effectively manage the limited supplies
  • Careful allocation of critical lifesaving resources

Supplies currently are the biggest concern for hospitals. There are significant demands on the national supply, particularly personal protective equipment, and local supplies also are in demand. Hospitals have strategies to help control inventory, but with international shipping and manufacturing affected, this is a very concerning situation.