Health Systems and Strategies

This article by Panda et al. reports a qualitative study of health care worker (HCW) redeployment strategies based on interviews with hospital leaders from 9 hospitals in 8 health systems across 5 countries (USA, United Kingdom, New Zealand, Singapore, and South Korea). The study provides detailed, qualitative data on hospital leader approaches and concerns that can help guide planning and development of redeployment plans to address future emergencies.

• Most of the hospitals experienced a surge of critically ill COVID-19 patients, while the remaining hospitals anticipated but did not experience a surge. Of the 8 systems, 7 redeployed their health care workforce, and the other had a plan in place but did not redeploy.
• Human resources, including ensuring the availability of appropriately trained, supported, and healthy HCWs, posed a major challenge in responding to the pandemic, alongside other needs related to physical supplies (e.g., PPE) and the built environment e.g., spaces for delivering care).
• Redeployment involved redistributing HCWs to new or different roles to meet clinical demands created by COVID-19 surge, such as triage, testing, and ICU staffing.
• Major themes expressed by hospital leaders were process (e.g., identifying positions with similar skill sets or capabilities to guide placement), leadership (e.g., decentralization with point persons in each department rather than top-down approaches), and communication (e.g., maximizing transparency, including data and projections).
• The most salient concerns about redeploying personnel were fear of becoming infected, concerns regarding skills and patient safety, and concerns over professional loss such as loss of educational opportunities in chosen profession.

This report by Aron et al. describes COVID-related challenges and responses by a health network in rural upstate New York (Bassett Healthcare Network), providing insights into issues faced by rural health systems as distinguished from more urban entities.

• The report focuses on 4 strategies: 1) expansion of intensive care capacity; 2) workforce redeployment and retraining; 3) provision of information, testing, and follow-up for a geographically dispersed population; and 4) response coordination across a large, diverse organization.
• Bassett Healthcare Network (BHN) includes 5 hospitals (including 3 Critical Access Hospitals) and 24 outpatient clinics serving 8 rural counties in a primarily agricultural region. BHN also includes home health care services, short- and long-term rehabilitation facilities, school-based clinics, and a medical supply company.
• Strategies and solutions implemented by BHN included preparation of rooms specifically for COVID-19 patients, not transferring COVID-19 patients to skilled nursing facilities in order to protect residents, early adoption of PPE reuse policies and use of touchscreen tablets for communication with patients to limit room entries, establishment of a telephone triage line and expansion of telemedicine capacity, and offering at-home follow-up care for symptom management in conjunction with telehealth services.

Crisis Standards of Care

This article by Abbott et al. discusses palliative care and hospice crisis standards, focusing on planning initiatives in Colorado in response to COVID-19. The article notes that in a disaster or pandemic, as in normal times, some persons will prefer comfort-oriented care at home or in community residences to hospitalization and critical care interventions, and others may not be eligible for some critical care therapies.

• Palliative and hospice care represent important and distinct care approaches for patients and their families, and such systems were also strained by the COVID-19 pandemic.
• Because the goals and focus of care differ for palliative care and hospice care, the guiding principles for scarce resource allocation differ, as well. While allocation of ICU beds or ventilators, among other critical care resources, is often based on saving the most lives (or sometimes the most life-years), the principle of minimizing human suffering underlies palliative and hospice care.
• Most state crisis standards of care plans only briefly discuss palliative or hospice services and focus mainly on critical care treatment, leaving significant planning gaps.
• Identified gaps span all facets of emergency planning, including staffing and personnel, critical supplies and other resources, available facilities and equipment, and support and training. The article discusses specific key examples in relation to palliative and hospice care and explains necessary actions for addressing such gaps.