RE-BOOTING HOSPITALS POST COVID-19 LOCKDOWN
By: Dr George Noel Fernandes
In the current scenario, hospitals are facing financial problems. Many hospitals had to close their facilities to the public as some of their staff were infected with COVID-19 while others took to limit their services in an attempt to prevent COVID-19 infection. The facilities are facing further financial strain due to a loss of revenue from the cancellation of elective procedures. The lack of revenue from such surgeries, in addition to low patient volume overall, has sparked a cash crisis for hospitals.
This crisis has further deepened with cross-infection of staff with COVID -19 infection within the hospital, employees contacting the infection from the community, staff not returning to work, increase cost of supplies, increased cash burden due to additional precautions and resources that hospitals need to implement to prevent and protect their employees and facility from COVID-19.
It is important to restart care that is currently being postponed, such as certain procedural care (surgeries and procedures), chronic disease care, and, ultimately, preventive care in a phased manner.
Action Points before start of facility:
1. Ministry of Health, State Medical Council and local municipality council guidelines to hospitals: Any decision to resume services will be up to local and state authorities. Please be update with the ever evolving guidelines and directives. They define what services are mandated, the reporting of staff to duty, action points for hospital authorities for their staff and patients etc.
2. Hospital Leadership: They need to define
- Their available working capital and available financial resources
- Preparing budgets taking into account that they with the need to still treat COVID-19 and non- COVID-19 patients with the complexity of having a large number of suspect cases.
- Ensure adequate human resources for all critical medical and non-medical departments to run at a pre-defined hospital capacity. Staff should also be routinely screened for COVID-19 and tested and quarantined. Also have a contingency plan for staffing levels to “remain adequate to cover a potential surge in COVID-19 cases.” The hospital needs to ensure they have enough protective equipment and staff to handle both COVID-19 cases and care for other patients before they resume procedures.
3. Hospital Planning:
- TRIAGE area for segregating and demarcating walk-in patients for COVID-19 (positive and suspect)
- Separate entrance for COVID-19 negative patients who are planned admissions with standard screening procedures.
- Separate entrance for employees if possible with standard screening procedures
- Separate entrance for vendors with standard screening procedures
- Demarcating hospitals into red, orange and green zones and corridors.
- Demarcating hospitals for COVID-19 positive in-patients, COVID-19 suspect in-patients (which will be largest number) and COVID1-19 negative in-patients. Similar key segregation/ processes will need to be made to treat patient in ER, ICUs and OTs.
- Environmental factors need to be addressed so as to ensure infection control- e.g- air conditioning, zoning, humidity and temperature, separate lifts if possible or/ and special procedures and protocols for various services to infected, suspected and non-infected areas. Within the facility, administrative and engineering controls should be established to facilitate social distancing. Visitors should be prohibited but if they are necessary for an aspect of patient care, they should be pre-screened in the same way as patients
4. Review all current policies, processes and protocols for ensuring specialized care for all patients and re-structuring of out-patient, emergency and in-patient services. A facility that decides to reopen procedures should also create areas to reduce the risk and exposure to COVID-19. Any patient who is coming in for a procedure must also be screened for potential symptoms of COVID-19. Facilitate social distancing by minimizing wait times, spacing chairs at least six feet apart and keep low patient volume. The hospital policy should require patients to wear a cloth face covering that can be bought or made at home if they don’t already have a surgical mask.
5. Have a robust supply management system.
6. Constant communication by senior leadership to the employees, patients, community and vendors etc to update on new guidelines by the government and any change in processes and policies by the hospital management. It is very important for leadership to provide the confidence and all support to their staff, patients, community and their vendors. Key is for the leadership to be proactive, listen and act fast with careful planning, making the right decisions at the right time, at the right place and for the right people.
7. Testing Capacity -All patients must be screened for potential symptoms of COVID-19 prior to entering the non- Covid Centre, and staff must be routinely screened for potential symptoms as noted above. When adequate testing capability is established, patients should be screened by laboratory testing before care, and staff working in these facilities should be regularly screened by laboratory test as well. All facilities should be prepared to cease non-essential procedures if there is a surge.
8. Non-COVID-19 care should be offered to patients as clinically appropriate. Careful planning is required to resume in-person care of patients requiring non-COVID-19 care, and all aspects of care must be considered — for example: adequate facilities, workforce, testing, and supplies, adequate workforce across phases of care (such as availability of clinicians, nurses, anesthesia, pharmacy, imaging, pathology support, and post-acute care). The priority should be to re-start clinically necessary care for patients with non COVID-19 needs or complex chronic disease management requirements. It is important to evaluate the necessity of the care based on clinical needs. Hospitals should prioritize surgical/procedural care and high-complexity chronic disease management; however, select preventive services may also be highly necessary.
9. Sanitation Protocols- Ensure that there is an established plan for thorough cleaning and disinfection prior to using spaces or facilities for patients with non-COVID-19 care needs. Ensure that equipment such as anesthesia machines used for COVID-19 (+) patients are thoroughly decontaminated, following CDC guidelines.
10. Adequate supplies of equipment, medication and supplies must be ensured, and not detract for the community ability to respond to a potential surge.
11. Maximum use of all telehealth modalities is strongly encouraged. Important to invest in date and information technology.