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Reduction in Hospital Transfers at a US COVID-19 Alternate Care Site: Maintaining Surge Capacity Support in Imperial County, California

Published online by Cambridge University Press:  04 July 2022

Frank W. Zhang Open the ORCID record for Frank W. Zhang [Opens in a new window] ,
Colin A. Meghoo ,
Katherine L. Staats ,
Elizabeth Perkins Hayes ,
Mitch Metzner ,
Julia Sobel ,
Eric Hultquist ,
Erin E. Noste ,
Charles E. Wright  and
Asha Devereaux Open the ORCID record for Asha Devereaux [Opens in a new window]
...Show all authors
Frank W. Zhang*
Affiliation:
CAL-MAT, Rosemead, CA, USA
Colin A. Meghoo
Affiliation:
CAL-MAT, Daytona, FL, USA
Katherine L. Staats
Affiliation:
Imperial County EMS, CA, USA Stanford University, Stanford, CA, USA
Elizabeth Perkins Hayes
Affiliation:
Emergency Medicine, Vanderbilt Tullahoma-Harton Hospital, Tullahoma, TN, USA
Mitch Metzner
Affiliation:
Finance and Administration Section, CAL-MAT, CA, USA
Julia Sobel
Affiliation:
Department of Emergency Medicine, University of California San Diego, CA, USA
Eric Hultquist
Affiliation:
CAL-MAT, Pasadena, CA, USA
Erin E. Noste
Affiliation:
Department of Emergency Medicine, University of California San Diego, CA, USA
Charles E. Wright
Affiliation:
CAL-MAT, San Diego, CA, USA
Asha Devereaux
Affiliation:
CAL-MAT, Coronado, CA, USA
Howard Backer
Affiliation:
CAL-MAT, Rancho Cordova, CA, USA
*
Corresponding author: Frank W. Zhang, E-mail: Fwzhang10@gmail.com
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Abstract

Objective:

The transfer rate for patients from an Alternate Care Site (ACS) back to a hospital may serve as a metric of appropriate patient selection and the ability of an ACS to treat moderate to severely ill patients accepted from overwhelmed health-care systems. During the coronavirus infectious disease 2019 (COVID-19) pandemic, hospitals worldwide experienced acute surges of patients presenting with acute respiratory failure.

Methods:

An ACS in Imperial County, California was re-established in November 2020 to help decompress 2 local hospitals experiencing surges of COVID-19 cases. The patients treated often had multiple comorbid illnesses and required a median supplemental oxygen of 3 L/min (LPM) on admission. Numerous interventions were initiated during a 2-wk period to improve clinical care delivery.

Results:

The objectives of this retrospective observational study are to evaluate the impact of these clinical and staff interventions at an ACS on the transfer rate and to provide issues to consider for future ACS sites managing COVID-19 patients.

Conclusions:

The data suggest that continuous, real-time process-improvement interventions helped reduce the transfer rate back to hospitals from 36.7% to 14.5% and that an ACS is a viable option for managing symptomatic COVID-19 positive patients requiring hospital-level care when hospitals are overburdened.

Keywords

alternate care siteCOVID-19disaster managementmass casualtysurge
Type
Original Research
Information
Disaster Medicine and Public Health Preparedness , Volume 17 , 2023 , e231
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of Society for Disaster Medicine and Public Health, Inc.

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References

Federal Healthcare Resilience Task Force. Alternate care site toolkit. Third edition. Accessed July 12, 2021. https://files.asprtracie.hhs.gov/documents/acs-toolkit-ed1-20200330-1022.pdf Google Scholar
Christensen, K, Metzner, M, Lovett-Floom, L, et al. Utilization of alternate care sites during COVID-19 surge and mass care: California 2020-2021. Disaster Med Public Health Prep. 2022;1-6. doi:10.1017/dmp.2022.93CrossRefGoogle Scholar
Breyre, AM, Sloane, B, Herring, C, et al. Establishment of an alternate care site (ACS) in Imperial County during COVID-19. West J Emerg Med. 2021;22(3):608-613. doi: 10.5811/westjem.2020.12.49237 CrossRefGoogle ScholarPubMed
Imperial County. Public Health Department (2015-2016). Imperial County health status report. Accessed July 16, 2022. www.icphd.org/media/managed/medicalproviderresources/HEALTH_STATUS_2015_2016_final.pdf Google Scholar
CAL-MAT. Alternate Care Site Field Guidance First Edition. Nov 2020. Accessed July 16, 2022. https://emsa.ca.gov/wp-content/uploads/sites/71/2020/12/CALMAT-Alternate-Care-Center-ACS-Field-Guide-Draft-11.24.20-v1-sje.pdf Google Scholar
Gandhi, RT, Lynch, JB, Del Rio, C. Mild or moderate COVID-19. N Engl J Med. 2020;383(18):1757-1766. doi: 10.1056/NEJMcp2009249 Google ScholarPubMed
COVID-19 Treatment Guidelines Panel. Coronavirus disease 2019 (COVID-19) treatment guidelines. National Institutes of Health. Accessed August 17, 2021. https://www.covid19treatmentguidelines.nih.gov/ Google Scholar
Kadri, SS, Sun, J, Lawandi, A, et al. Association between caseload surge and COVID-19 survival in 558 U.S. hospitals, March to August 2020. Ann Intern Med. Accessed July 30, 2021. https://www.acpjournals.org/doi/10.7326/M21-1213 Google Scholar
Devereaux, AV, Backer, H, Salami, A, et al. Oxygen and ventilator logistics during California’s COVID-19 surge-when oxygen becomes a scarce resource. Disaster Med Public Health Prep. 2021:1-7. doi:10.1017/dmp.2021.267Google Scholar
Sanyaolu, A, Okorie, C, Marinkovic, A, et al. Comorbidity and its impact on patients with COVID-19. SN Compr Clin Med. 2020;2:1069-1076. doi: 10.1007/s42399-020-00363-4 CrossRefGoogle ScholarPubMed
Seyller, H, Gottlieb, M, Colla, J. A breath of fresh air: the role of incentive spirometry in the treatment of COVID-19. Am J Emerg Med. 2021;48:369. doi: 10.1016/j.ajem.2021.01.084 CrossRefGoogle ScholarPubMed
Zhu, Y, Wang, Z, Zhou, Y, et al. Summary of respiratory rehabilitation and physical therapy guidelines for patients with COVID-19 based on recommendations of World Confederation for Physical Therapy and National Association of Physical Therapy. J Phys Ther Sci. 2020;32(8):545-549. doi: 10.1589/jpts.32.545 CrossRefGoogle ScholarPubMed
Morey, JC, Simon, R, Jay, GD, et al. Error reduction and performance improvement in the emergency department through formal teamwork training: evaluation results of the MedTeams project. Health Serv Res. 2002;37(6):1553-1581.Google ScholarPubMed
Risser, DT, Rice, MM, Salisbury, ML, et al. The potential for improved teamwork to reduce medical errors in the emergency department. The MedTeams Research Consortium. Ann Emerg Med. 1999;34(3):373-383.CrossRefGoogle ScholarPubMed
Kohli, A, Hande, PC, Chugh, S. Role of chest radiography in the management of COVID-19 pneumonia: an overview and correlation with pathophysiologic changes. Indian J Radiol Imaging. 2021;31(Suppl 1):S70-S79. doi: 10.4103/ijri.IJRI_967_20 Google ScholarPubMed
Mathews, K, Podlog, M, Greenstein, J, et al. Development and Implementation of an Alternate Care Site During the COVID-19 Pandemic. Cureus. 2020. doi: 10.7759/cureus.10799 CrossRefGoogle ScholarPubMed
Datta, SD, Talwar, A, Lee, JT. A proposed framework and timeline of the spectrum of disease due to SARS-CoV-2 infection. JAMA. 2020;324(22):2251-2252. doi: 10.1001/jama.2020.22717 CrossRefGoogle ScholarPubMed