The Minnesota Medical Operations Coordination Center: A COVID-19 Statewide Response to Ensure Access to Critical Care and Medical-Surgical Beds.

Autor: Baum KD; Essentia Health, Duluth, MN; University of Minnesota, Minneapolis, MN., Vlaanderen L; M Health Fairview, Minneapolis, MN; Scope Anesthesia of North Carolina PLLC, Charlotte, NC., James W; Minnesota Department of Health, St. Paul, MN., Huppert MJ; M Health Fairview, Minneapolis, MN., Kettler P; M Health Fairview, Minneapolis, MN., Chell C; Metro Health & Medical Preparedness Coalition, Minneapolis, MN., Shadiow A; Arrowhead EMS Association, Duluth, MN., Strike H; Allina Health, Minneapolis, MN., Greenlee K; CentraCare, St. Cloud, MN., Brown D; Mayo Clinic, Rochester, MN., Hick JL; University of Minnesota, Minneapolis, MN; Hennepin Healthcare, Minneapolis, MN., Wolf JM; University of Minnesota, Minneapolis, MN., Fiecas MB; University of Minnesota, Minneapolis, MN., McLachlan E; Minnesota Department of Health, St. Paul, MN; Hennepin Healthcare, Minneapolis, MN., Seaberg J; Minnesota Department of Health, St. Paul, MN; Hennepin Healthcare, Minneapolis, MN., MacDonnell S; Minnesota Department of Health, St. Paul, MN; Hennepin Healthcare, Minneapolis, MN., Kesler S; University of Minnesota, Minneapolis, MN., Dichter JR; University of Minnesota, Minneapolis, MN. Electronic address: jdichter@umn.edu.
Jazyk: angličtina
Zdroj: Chest [Chest] 2024 Jan; Vol. 165 (1), pp. 95-109. Date of Electronic Publication: 2023 Aug 17.
DOI: 10.1016/j.chest.2023.08.016
Abstrakt: Background: COVID-19 led to unprecedented inpatient capacity challenges, particularly in ICUs, which spurred development of statewide or regional placement centers for coordinating transfer (load-balancing) of adult patients needing intensive care to hospitals with remaining capacity.
Research Question: Do Medical Operations Coordination Centers (MOCC) augment patient placement during times of severe capacity challenges?
Study Design and Methods: The Minnesota MOCC was established with a focus on transfer of adult ICU and medical-surgical patients; trauma, cardiac, stroke, burn, and extracorporeal membrane oxygenation cases were excluded. The center operated within one health care system's bed management center, using a dedicated 24/7 telephone number. Major health care systems statewide and two tertiary centers in a neighboring state participated, sharing information on system status, challenges, and strategies. Patient volumes and transfer data were tracked; client satisfaction was evaluated through an anonymous survey.
Results: From August 1, 2020, through March 31, 2022, a total of 5,307 requests were made, 2,008 beds identified, 1,316 requests canceled, and 1,981 requests were unable to be fulfilled. A total of 1,715 patients had COVID-19 (32.3%), and 2,473 were negative or low risk for COVID-19 (46.6%). COVID-19 status was unknown in 1,119 (21.1%). Overall, 760 were patients on ventilators (49.1% COVID-19 positive). The Minnesota Critical Care Coordination Center placed most patients during the fall 2020 surge with the Minnesota Governor's stay-at-home order during the peak. However, during the fall 2021 surge, only 30% of ICU patients and 39% of medical-surgical patients were placed. Indicators characterizing severe surge include the number of Critical Care Coordination Center requests, decreasing placements, longer placement times, and time series analysis showing significant request-acceptance differences.
Interpretation: Implementation of a large-scale Minnesota MOCC program was effective at placing patients during the first COVID-19 pandemic fall 2020 surge and was well regarded by hospitals and health systems. However, under worsening duress of limited resources during the fall 2021 surge, placement of ICU and medical-surgical patients was greatly decreased.
Competing Interests: Financial/Nonfinancial Disclosures None declared.
(Copyright © 2023 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE