Many COVID-19 cases are geographically localized and can overwhelm local healthcare facilities. Healthcare systems typically have uneven distribution of COVID-19 cases with some regional healthcare systems experiencing patient surges while others have excess capacity for patient care. When healthcare facilities reach or exceed patient capacity “Crisis Standards of Care” are often implemented. Healthcare systems entering Crisis Standards of Care are faced with the tremendous challenge of providing high-quality care while allocating scarce resources. Thus “Relief Healthcare Facilities” are introduced in states to address the crisis with the primary goals of:
- Providing the appropriate level of medical care
- Protecting healthcare personnel and non-COVID-19 patients from infection
- Preparing for a potential surge in patients with respiratory infection
- Preparing for shortages of personal protective equipment (PPE) and staffing
Elements Needed for Use of Relief Healthcare Facilities
Relief Healthcare Facility Resources and Capacity
- Ensure that RHFs have all legal documentation and infrastructural requirements needed to rapidly re-open, if closed.
- Ensure that RHFs have an adequate number of trained healthcare professionals, sufficient space to accommodate additional patients, appropriate PPE, and other equipment and supplies to care for these patients.
- RHFs must be able to accept transfers from highly impacted hospitals and other healthcare facilities without compromising their ability to respond to surges in their own communities.
- Relief skilled nursing homes should declare their willingness to accept both patients with and without COVID-19 and their willingness to accept stable patients requiring long-term mechanical ventilation and considered appropriate for long-term care.
- Ensure RHFs use strategies to ensure workers’ safety and support, including healthcare personnel monitoring and operational planning
- Consider if cohorting patients and healthcare personnel may be feasible or useful (i.e., entire facilities or units for patients with COVID-19 or non-COVID-19); including post-discharge planning for patients who are going from hospitals to long-term care or other types of healthcare facilities.
- Ensure all RHFs are prepared to safely triage and manage patients with respiratory illness, including COVID-19. Ensure they become familiar with infection prevention and control guidance for managing patients with COVID-19 and preparation steps.
- Ensure RHFs plan to optimize the supply of PPE in the event of shortages and identify flexible mechanisms to procure additional supplies when needed.
Interfacility and Patient Communication
- All planning efforts for RHFs should adhere to regulations and standards for informed consent regarding patient transfers between facilities.
- Consider whether and what legal documentation may be necessary to facilitate patient transfers.
- Ensure communication between healthcare professionals at the transferring and receiving facilities with an accurate clinical description of the patients and with clear acceptance by the RHF.
- Telehealth consults with the RHSs should be considered, as needed, for patient management.
- The receiving facility’s policies regarding visitors should be communicated to family members and healthcare powers of attorney.
Relief Healthcare Facilities (RHFs):
Established, licensed healthcare facilities (i.e., hospitals, long-term care hospitals, long-term care facilities and other licensed inpatient health care facilities) that accept patient transfers or share extra resources to extend conventional standards of care to as many people as possible during a crisis and therefore minimize the use of crisis standards of care.
Crisis Standards of Care:
Standards of care that reflect a substantial change in usual healthcare operations and the level of care that healthcare providers are capable of delivering during a crisis. When a state government formally declares the need for crisis standards of care, this formal declaration enables specific legal/regulatory powers and protections for healthcare providers as they perform the necessary tasks of allocating and using scarce medical resources and adopting alternate healthcare operations during a crisis.
Medical Operations Coordination Cell (MOCC):
A cell (a group of medical operations experts) within emergency operations centers (EOCs) at the sub-state regional, state-wide, and federal regional levels that can assist in the transferring of patients between healthcare facilities. A MOCC makes data-and stakeholder-informed decisions to balance patient load and ensure high-quality care. MOCC decisions direct the movement of patients and resources from one facility to another or re-direct referrals of patients who would usually go to an overwhelmed facility or system to one that has the capacity to care for those patients.