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Hospital Ward Adaptation During the COVID-19 Pandemic: A National Survey of Academic Medical Centers.

Abstract：

IMPORTANCE:Although intensive care unit (ICU) adaptations to the coronavirus disease of 2019 (COVID-19) pandemic have received substantial attention , most patients hospitalized with COVID-19 have been in general medical units. OBJECTIVE:To characterize inpatient adaptations to care for non-ICU COVID-19 patients. DESIGN:Cross-sectional survey. SETTING:A network of 72 hospital medicine groups at US academic centers. MAIN OUTCOME MEASURES:COVID-19 testing, approaches to personal protective equipment (PPE), and features of respiratory isolation units (RIUs). RESULTS:Fifty-one of 72 sites responded (71%) between April 3 and April 5, 2020. At the time of our survey, only 15 (30%) reported COVID-19 test results being available in less than 6 hours. Half of sites with PPE data available reported PPE stockpiles of 2 weeks or less. Nearly all sites (90%) reported implementation of RIUs. RIUs primarily utilized attending physicians, with few incorporating residents and none incorporating students. Isolation and room-entry policies focused on grouping care activities and utilizing technology (such as video visits) to communicate with and evaluate patients. The vast majority of sites reported decreases in frequency of in-room encounters across provider or team types. Forty-six percent of respondents reported initially unrecognized non-COVID-19 diagnoses in patients admitted for COVID-19 evaluation; a similar number reported delayed identification of COVID-19 in patients admitted for other reasons. CONCLUSION:The COVID-19 pandemic has required medical wards to rapidly adapt with expanding use of RIUs and use of technology emerging as critical approaches. Reports of unrecognized or delayed diagnoses highlight how such adaptations may produce potential adverse effects on care.

journal_name

J Hosp Med

journal_title

Journal of hospital medicine

authors

Auerbach A,O'Leary KJ,Greysen SR,Harrison JD,Kripalani S,Ruhnke GW,Vasilevskis EE,Maselli J,Fang MC,Herzig SJ,Lee T,HOMERuN COVID-19 Collaborative Group.

doi

10.12788/jhm.3476

subject

Has Abstract

pub_date

2020-08-01 00:00:00

pages

483-488

issue

eissn

1553-5592

issn

1553-5606

pii

jhm.3476

journal_volume

pub_type

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Hospital Ward Adaptation During the COVID-19 Pandemic: A National Survey of Academic Medical Centers.