Responding to COVID-19 Through Interhospital Resource Coordination: A Mixed-Methods Evaluation.

Autor:	Usher MG; From the Section of Hospital Medicine, Division of General Internal Medicine, Department of Medicine., Tignanelli CJ, Hilliard B; From the Section of Hospital Medicine, Division of General Internal Medicine, Department of Medicine., Kaltenborn ZP; From the Section of Hospital Medicine, Division of General Internal Medicine, Department of Medicine., Lupei MI; Division of Critical Care, Department of Anesthesiology., Simon G; Institute for Health Informatics, University of Minnesota., Shah S; Division of Hematology and Oncology, Department of Medicine., Kirsch JD; From the Section of Hospital Medicine, Division of General Internal Medicine, Department of Medicine., Melton GB, Ingraham NE; Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota Medical School, Minneapolis, Minnesota., Olson APJ; From the Section of Hospital Medicine, Division of General Internal Medicine, Department of Medicine., Baum KD; From the Section of Hospital Medicine, Division of General Internal Medicine, Department of Medicine.
Jazyk:	angličtina
Zdroj:	Journal of patient safety [J Patient Saf] 2022 Jun 01; Vol. 18 (4), pp. 287-294. Date of Electronic Publication: 2021 Sep 27.
DOI:	10.1097/PTS.0000000000000916
Abstrakt:	Objectives: The COVID-19 pandemic stressed hospital operations, requiring rapid innovations to address rise in demand and specialized COVID-19 services while maintaining access to hospital-based care and facilitating expertise. We aimed to describe a novel hospital system approach to managing the COVID-19 pandemic, including multihospital coordination capability and transfer of COVID-19 patients to a single, dedicated hospital. Methods: We included patients who tested positive for SARS-CoV-2 by polymerase chain reaction admitted to a 12-hospital network including a dedicated COVID-19 hospital. Our primary outcome was adherence to local guidelines, including admission risk stratification, anticoagulation, and dexamethasone treatment assessed by differences-in-differences analysis after guideline dissemination. We evaluated outcomes and health care worker satisfaction. Finally, we assessed barriers to safe transfer including transfer across different electronic health record systems. Results: During the study, the system admitted a total of 1209 patients. Of these, 56.3% underwent transfer, supported by a physician-led System Operations Center. Patients who were transferred were older (P = 0.001) and had similar risk-adjusted mortality rates. Guideline adherence after dissemination was higher among patients who underwent transfer: admission risk stratification (P < 0.001), anticoagulation (P < 0.001), and dexamethasone administration (P = 0.003). Transfer across electronic health record systems was a perceived barrier to safety and reduced quality. Providers positively viewed our transfer approach. Conclusions: With standardized communication, interhospital transfers can be a safe and effective method of cohorting COVID-19 patients, are well received by health care providers, and have the potential to improve care quality. Competing Interests: The authors disclose no conflict of interest. (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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