A Health System Response to COVID‐19 in Long‐Term Care and Post‐Acute Care: A Three‐Phase Approach

Abstract

BACKGROUND The Seattle, WA, area was ground zero for coronavirus disease 2019 (COVID‐19). Its initial emergence in a skilled nursing facility (SNF) not only highlighted the vulnerability of its patients and residents, but also the limited clinical support that led to national headlines. Furthermore, the coronavirus pandemic heightened the need for improved collaboration among healthcare organizations and local and state public health. METHODS The University of Washington Medicine's (UWM's) Post‐Acute Care (PAC) Network developed and implemented a three‐phase approach within its pre‐existing network of SNFs to help slow the spread of the disease, support local area SNFs from becoming overwhelmed when inundated with COVID‐19 cases or persons under investigation, and help decrease the burden on area hospitals, clinics, and emergency medical services. RESULTS Support of local area SNFs consisted of the following phases that were implemented at various times as COVID‐19 impacted each facility at different times. Initial Phase: This phase was designed to (1) optimize communication, (2) review infection control practices, and (3) create a centralized process to track and test the target population. Delayed Phase: The goals of the Delayed Phase were to slow the spread of the disease once it is present in the SNF by providing consistent education and reinforcing infection prevention and control practices to all staff. Surge Phase: This phase aimed to prepare facilities in response to an outbreak by deploying a "Drop Team" within 24 hours to the facility to expeditiously test patients and exposed employees, triage symptomatic patients, and coordinate care and supplies with local public health authorities. CONCLUSIONS The COVID‐19 Three‐Phase Response Plan provides a standardized model of care that may be implemented by other health systems and SNFs to help prepare and respond to COVID‐19. J Am Geriatr Soc 68:1155–1161, 2020.

Long-Term Acute Care Hospitals Extend ICU Capacity for COVID-19 Response and Recovery

“…Typically, health-care process improvements occur through redesigning, managing constraints and resources in parallel, eliminating redundant steps, and synchronizing tasks, 21 which was demonstrated by the University of Washington Medicine’s Post-Acute Care Network health system’s three-phased approach in response to the COVID-19 pandemic. 22 Many of the changes made in response to the pandemic may become standard practice. 23 With the urgency of a health system-wide COVID-19 response, institutions benefit from resilience engineering (RE), or the rapid development of processes specifically designed to respond to changes.…”

Post-COVID-19 global health strategies: the need for an interdisciplinary approach

“…Although a substantial body of studies on short-term outcomes of COVID-19 inpatients has already been produced, the literature is void of data on long-term outcomes of patients who survive the acute phase of the disease [3]. It may be assumed that the majority of survivors with a mildly symptomatic presentation (80%) will not be presenting longterm sequelae and will eventually fully recover.…”

System models for resilience in gerontology: application to the COVID-19 pandemic

“…For example, the initial COVID-19 outbreak in the US occurred in Seattle WA, where several LTC facilities experienced rapid spread of the disease. The University of Washington Medicine’s (UWM’s) Post-Acute Care (PAC) Network put in place a coordinated three-phase approach in response to the pandemic in LTCs [ 148 ]. During the first phase of low COVID-19 cases, emphasis was placed on communicating response plans with all facilities; developing a systematic strategy for tracking cases; and preparing for distribution of personal protective equipment.…”

“…The final third phase, during which time COVID-19 cases were spreading rapidly, a “drop-team” comprised of MDs, RNs and disease specialists was organized by the UWM and sent to targeted facilities. The drop team assessed and tested residents and staff; evaluated, triaged and organized transfer of patients to the Washington Disaster Medical Coordination Centre if needed; and notified local public health agencies [ 148 ]. Given the different socio-ecological contexts and resources across jurisdictions with different pandemic experiences, responses need to be retrofitted.…”