Hospital and Health System Management For COVID-19


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Managed Care

  1. Contact Managed Care companies to waive pre auth requirements for SNF's and Sub-Acute facilities

  2. Determine adjusted guidelines for reimbursement requirements

Nursing Homes/SNFs/Home Care/Hospice

  1. Confirm Nursing Home/SNFs return policy for established patients/residents

  2. Confirm Nursing Home/SNFs/Home Care acceptance protocol for ED patients who don’t meet criteria but require additional services

DME/External Transportation

  1. Ensure that auth process is confirmed and expedited

  2. Notify all DME companies of need for expedited ordering and delivery; verify company’s availability

Daily Touchpoint with Facilities

  1. Establish daily touchpoint with Nursing Home/SNF/Homecare/Hospice partners to clarify needs and discuss volumes projected today and planned DC’s for tomorrow – should focus on early DCs for pts identified for next day

  2. Notify all external Transportation vendors and DME suppliers of current capacity status and facility’s need for expedited services; verify company’s availability

  3. Clarify that this is temporary for capacity status “COVID-19 Crisis” (verify status name) so it can be distinguished from standard workflow and develop criteria to support policy

  4. Develop escalation tree – triggered by Hub/Command Center to notify hospital providers, leadership, ancillary support depts. (EVS, transport, therapies, dietary, etc.), and continuing care partners when status is in effect with key phone #s and emails for notification

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  1. Establish triage capabilities outside of the ED proper (screening and preliminary evaluation for capacity management)

  2. Clinical Leadership/Case Management to assess each patient to confirm medical necessity and admission criteria

  3. Clinical Leadership/Case Management to facilitate appropriate discharges from the ED

  4. Develop a “DC Response Team” (PA/Hospitalist, MCC, MSW, others?) to outline the hospital and/or community resources so this patient is not admitted

 
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Capacity Assessment/Bed Utilization

  1. Hold “safety” briefing meeting (minimally at start of each shift) with hospital leadership

  2. Complete capacity assessment (recommended every 6 hours minimally)

    • ED

    • Critical Care

    • General Medical

    • Surge (Outpatient/ Overflow/ PACU/ Diagnostic Holding)

  3. Determine potential and confirmed discharges for today and tomorrow

    • Engage medical leadership to prioritize the discharge assessment, order and documentation completion

    • Complete early unit-based multi-disciplinary huddles

    • Formalize afternoon discharge rounds

  4. Mobilize appropriate personnel (ex. EVS/Transport/Therapies/Diagnostics) to prioritize activities facilitating discharges

  5. Provide communication to all hospital personnel with ongoing and pertinent updates

  6. Review COVID-19 patient volume and placement opportunities (cohort where possible)

Resource Allocation

  1. Develop medical/clinical/ancillary personnel check-in protocol to establish human resource availability and determine allocation (ongoing)

  2. Hospital Leadership to complete inventory assessment and consider allocation protocol (recommended every 6 hours minimally)

    • Ventilator usage and inventory

    • Medical equipment inventory

    • PPE inventory

    • Other supply inventory