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Responding to COVID-19 Through Interhospital Resource Coordination: A Mixed-Methods Evaluation.
Usher, Michael G; Tignanelli, Christopher J; Hilliard, Brian; Kaltenborn, Zachary P; Lupei, Monica I; Simon, Gyorgy; Shah, Surbhi; Kirsch, Jonathan D; Melton, Genevieve B; Ingraham, Nicholas E; Olson, Andrew P J; Baum, Karyn D.
  • Usher MG; From the Section of Hospital Medicine, Division of General Internal Medicine, Department of Medicine.
  • Hilliard B; From the Section of Hospital Medicine, Division of General Internal Medicine, Department of Medicine.
  • Kaltenborn ZP; From the Section of Hospital Medicine, Division of General Internal Medicine, Department of Medicine.
  • Lupei MI; Division of Critical Care, Department of Anesthesiology.
  • Simon G; Institute for Health Informatics, University of Minnesota.
  • Shah S; Division of Hematology and Oncology, Department of Medicine.
  • Kirsch JD; From the Section of Hospital Medicine, Division of General Internal Medicine, Department of Medicine.
  • Ingraham NE; Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota Medical School, Minneapolis, Minnesota.
  • Olson APJ; From the Section of Hospital Medicine, Division of General Internal Medicine, Department of Medicine.
  • Baum KD; From the Section of Hospital Medicine, Division of General Internal Medicine, Department of Medicine.
J Patient Saf ; 18(4): 287-294, 2022 06 01.
Article in English | MEDLINE | ID: covidwho-1440697
ABSTRACT

OBJECTIVES:

The 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.

METHODS:

We 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.

RESULTS:

During 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.

CONCLUSIONS:

With 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.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study Limits: Humans Language: English Journal: J Patient Saf Journal subject: Health Services Year: 2022 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study Limits: Humans Language: English Journal: J Patient Saf Journal subject: Health Services Year: 2022 Document Type: Article