COVID-19: For hospitals, emergency preparedness is a year-round activity

While COVID 19 is new, preparing for responses to disasters is not new to hospitals.  Emergency preparedness training is a year-round activity that is done within each facility, system and region. Hospitals treat patients with a variety of infectious diseases daily. These patients are isolated and treated in appropriate spaces by trained staff using specialized equipment. 

When there is a threat of a disease that could cause a surge of patients, each individual hospital steps up its preparedness and coordination activities. Hospitals share information and best practices, but also deploy the specific strategies that will work best in their facilities and in response to the changing situation. 

NMHA and hospitals are working closely with agencies and updating daily

The New Mexico Hospital Association and its hospital members around the state are working closely with the Centers for Disease Control, the New Mexico Department of Health and local public health agencies to address COVID-19.  Hospitals are refining their responses regularly based on new information. From what we know now, most people who become infected with COVID-19 will not become seriously ill and will therefore not need hospitalization. However, those with serious illness may need hospital care, including respiratory support. 

Hospital capacity limited, and will be as flexible as possible

Most hospitals in the state are not holding beds open for possible COVID-19 patients. However, this is not a static situation and hospital space can and will be made quickly available in an emergency or with a surge of critically ill patients. Hospitals have demonstrated this in several instances, including the H1N1 flu outbreak.

For now, most hospitals are operating normally with planned procedures happening as scheduled. Hospitals need to provide planned care to people who need cancer surgery, hernia repair and many other issues. Hospitals also need to provide urgent and emergency care to people experiencing a heart attack, stroke or serious accident. If beds are reserved before there is a need, it would mean delays in care for people who need services now. As COVID-19 cases present, hospitals will coordinate with public health officials to meet the need.

Hospital strategies to meet patient needs

Below are examples of common strategies that hospitals are prepared to use to meet the need to care for a large number of COVID-19 patients. The three areas where there could be shortages are:  space to care for patients, the supplies or “stuff” needed to care for patients and staff. This is just a short list of possible options; not all of them will be necessary, and other tactics may be more effective.  

Hospitals communicate and coordinate directly and regularly with each other to help accomplish these goals.

Space (NMHA hospitals provide 4434 licensed beds statewide):

    • Expanding number of available beds by using temporary beds in clinical units
    • Expanding inpatient care into non-inpatient spaces
    • Referring patients who do not need emergency or hospital level care to clinics or urgent care
    • Transferring stable patients to non-impacted facilities
    • Discharging patients home (with appropriate home or follow-up care plans) 
    • Expanding hours of outpatient care facilities
    • Leveraging telemedicine and nurse triage call lines to reduce the number of patients being seen within a facility
Staff: 
    • Adjusting staffing schedules/extending shifts
    • Call on PRN “as needed” employees. (Most hospitals, in addition to full- and part-time staff, also have PRN staff.) 
    • Adapting staffing levels to best meet patient needs
    • Re-purposing non-essential staff
    • Reducing frequency or scope of nonessential documentation
    • Expanding scope of certain providers to do the most within their licensure
Stuff (Supplies):
    • Sourcing supplies including Personal Protective Equipment (PPE, gowns, masks, gloves, etc) from alternate vendors. The state is currently contacting hospitals once a week to assist in ensuring hospitals have enough supplies.
    • Providing mutual aid between health care organizations or other business partners
    • Implementing conservation strategies to effectively manage the limited supplies 
    • Carefully allocating critical resources

Supplies are currently the biggest concern for hospitals. There are significant demands on the national supply, particularly of personal protective equipment, and local supplies are also pinched. Hospitals have strategies to help control inventory, but with international shipping and manufacturing affected, this is a very concerning situation.

How Elected Officials, Healthcare Providers and the Public Can Help

While we are seeing an increasing number of COVID 19 cases in New Mexico, we don’t know how this will grow. The response could be small or very large, depending on the need and severity of patients. Hospitals need help from the state and local governments as well as the media to prepare. Specifically:

Healthcare Providers 
    • There are hospital beds currently occupied by patients who have completed their hospital care and do not need to be there any longer. These patients should be appropriately discharged.  The state could help place dischargeable patients in community facilities such as adult family homes, long term care centers or with home health.
    • Primary care providers should appropriately triage patients so that only those who absolutely must go to the hospital go to the hospital. 
    • Individual hospitals should share specific resources for their local communities such as nurse triage lines.
Public

The public should understand that most cases of COVID-19 will not mean hospitalization, or even a trip to an emergency room. Hospital care is a precious resource that needs to be reserved for those with the most serious symptoms. The state will be developing a plan for greater use of urgent care as well as home testing/home monitoring and patient education about when to seek care. 
In the event of a surge in demand, public health needs to give hospitals flexibility in how care is delivered. 

CDC Fact Sheets
Use CDC’s fact sheets  if you are a:
    • Patient who suspects you have COVID-19 symptoms.
    • Healthcare professional determining next, most appropriate steps for a patient.
    • Hospital or other healthcare facility.
    • Contractor to a healthcare facility.
    • Employer, community and group leader who wants to prevent employee and public illness.