Responding to COVID-19 Through Interhospital Resource Coordination: A Mixed-Methods Evaluation

Abstract

ObjectivesThe COVID-19 pandemic stressed hospital operations, requiring rapid innovations to address rise in demand and specialized COVID-19 services while maintaining access to hospital-based care and facilitating expertise. We aimed to describe a novel hospital system approach to managing the COVID-19 pandemic, including multihospital coordination capability and transfer of COVID-19 patients to a single, dedicated hospital.MethodsWe included patients who tested positive for SARS-CoV-2 by polymerase chain reaction admitted to a 12-hospital network including a dedicated COVID-19 hospital. Our primary outcome was adherence to local guidelines, including admission risk stratification, anticoagulation, and dexamethasone treatment assessed by differences-in-differences analysis after guideline dissemination. We evaluated outcomes and health care worker satisfaction. Finally, we assessed barriers to safe transfer including transfer across different electronic health record systems.ResultsDuring the study, the system admitted a total of 1209 patients. Of these, 56.3% underwent transfer, supported by a physician-led System Operations Center. Patients who were transferred were older (P = 0.001) and had similar risk-adjusted mortality rates. Guideline adherence after dissemination was higher among patients who underwent transfer: admission risk stratification (P < 0.001), anticoagulation (P < 0.001), and dexamethasone administration (P = 0.003). Transfer across electronic health record systems was a perceived barrier to safety and reduced quality. Providers positively viewed our transfer approach.ConclusionsWith standardized communication, interhospital transfers can be a safe and effective method of cohorting COVID-19 patients, are well received by health care providers, and have the potential to improve care quality.

Comparison of Outcomes and Process of Care for Patients Treated at Hospitals Dedicated for COVID-19 Care vs Other Hospitals

“…Other previously undescribed factors may also play a role, such as decreased health care professional cognitive load when using personal protective equipment for all patients, decreased anxiety from universal personal protective equipment use, increased health care professional well-being from the COVID-19–dedicated hospitals’ unique camaraderie, and other factors. In addition, the creation of COVID-19–specific hospitals provided the benefit of isolating patients with infection to decrease potential in-hospital spread, as proven by the low rate of transmission from patient-to-clinicians at both sites …”

“…4,11,12 There has also been a report on the use of interhospital transfer to the COVID-19-dedicated hospitals, the association between use of these hospitals and quality care measures, and health care professional satisfaction within the M Health Fairview system. 13 However, to our knowledge, there…”

“…In addition, the creation of COVID-19-specific hospitals provided the benefit of isolating patients with infection to decrease potential in-hospital spread, as proven by the low rate of transmission from patient-to-clinicians at both sites. 13…”

“…There have been a few brief reports published describing the process that similar health care systems worldwide have used to establish COVID-19–dedicated hospitals . There has also been a report on the use of interhospital transfer to the COVID-19–dedicated hospitals, the association between use of these hospitals and quality care measures, and health care professional satisfaction within the M Health Fairview system . However, to our knowledge, there has not been a large-scale evaluation of the outcomes of this practice.…”

Period of hospitalization and mortality in transferred versus non-transferred COVID-19 patients: Results from Germany

“…With the widespread SARS-Cov-2 infections in the beginning of 2020, COVID-19 appeared as an outstanding challenge for health-care worldwide, which was particularly re ected in the numbers of hospitalized patients and mortality attributed to the SARS-CoV-2 infection [1,2]. COVID-19 exerted considerable stress on medical capacity (e.g., hospital beds and medical staff [3,4], requiring a sophisticated patient management that included optimal allocation to the available hospital capacity and capability [5]. In Germany, as in other countries, this led to a high number of inter-hospital transfers [5][6][7][8][9], particularly regarding intensive care treatment, raising the question whether the transfers had an impact on patient outcomes.…”