Making transitions from nursing home to hospital safer during COVID-19 outbreak
Optimal care for nursing home patients during the COVID-19 pandemic requires an enhanced partnership between providers in both care settings. Here are 10 points summarized in the article for safe care transitions between nursing homes & the ER during the COVID-19 pandemic:
People residing in Nursing Homes (NHs) are at high risk for infection with COVID-19, as they live in close quarters with others and interact with multiple caregivers. Risk of mortality is subsequently increased given underlying medical conditions, advanced age and frailty.
NH providers and staff often treat infections in house, however, COVID-19 presents unique challenges given access to PPE, limited private rooms, and high patient to staff ratios.
While diagnostic testing and medical treatments can be provided in NHs, the turnaround time of several hours for “stat” labs or chest x-rays, and intensity of care differs from hospital settings. Delays in obtaining COVID-19 testing and results have placed additional stress on NHs.
NHs leaders are responding to the COVID-19 pandemic by enhancing their infection control policies and enacting screening and management protocols for persons suspected of, or diagnosed with, COVID-19.
The Center for Disease Control (CDC) and organizations such as AMDA-The Society of Post-Acute and Long-Term Care Medicine, American Health Care Association (AHCA) and National Center for Assisted Living (NACL) are regularly updating their COVID-19 guidelines specific to the care of persons residing in NHs and assisted living facilities.
Medically stable patients who are appropriately isolated should not be transferred to the emergency department (ED). Close and proactive communication with the ED, and the NH physician/APN provider can support NHs in providing care in place.
NH providers urgently need to address advance care planning with every patient and family in the context of COVID-19. Resources exist and are being adapted to support these efforts.
NH personnel should consider the risks and benefits of transferring residents with a febrile respiratory illness to an ED. This includes an evaluation of the patient’s current state of health, patient-centered goals, and an assessment of prognosis in the context of the COVID-19 illness.
NH providers should consider “forward triage” when considering patients for transitions of care. This involves assessing the resident’s level of acuity and where their care needs can most appropriately be met. This should involve a conversation with the ED physician who would otherwise be receiving the resident.
Warm hand-offs are critical – NH and ED providers need to communicate prior to a transfer and as medical decisions are being made, including the ability of the NH to safely accept a patient back. Emergency Departments should establish a process to accept and welcome calls from NH colleagues. NH providers need to make this bi-directional communication essential practice.
Full article here.