08/19/21
By: Conner Girdley
The COVID-19 pandemic has
taught us that success can be found in collaboration and partnership, not
isolation. Although effective alliances between hospitals and long-term care
can be challenging, even in non-pandemic times, skilled nursing facilities
(SNFs) have recently found that partnering with hospitals provided them a level
of defense against the pandemic that they never would have attained if working
on their own.
As the examples below
show, collaboration can be a mutually beneficial process. SNFs can benefit from
the access to equipment, staff, and expertise available to hospitals.
SNFs will find that
hospitals, even though constrained by their own resource limits, are equally
motivated to pursue these partnerships. Hospitals are driven by the desire to
control infection proactively; they are willing to provide meaningful support
to SNFs to prevent a major outbreak that would overwhelm their own emergency
rooms.
These collaboration
stories reveal a true partnership, with the hospitals empowering SNFs to do
what they do best: care for residents and patients. The hospitals provided
specific support, hands-on help, resources, and information as needed while
recognizing that the staff at the facilities ultimately know their residents
and how best to care for them.
Leadership Amid a Crisis
In many ways, the
COVID-19 pandemic did not catch University Hospitals (UH) in Cleveland by
surprise. Even before the pandemic, UH had created an emergency crisis plan that included
procedures for several disaster scenarios that could occur to prepare and
provide support to its community. UH was already actively monitoring COVID case
levels when the pandemic hit and was prepared to intervene proactively. In one
example, UH noticed a particularly troubling spike of COVID
infections at a SNF in the Midwest. UH quickly pulled together a team to decide
whether to transfer critically ill patients from the SNF to one of their
hospitals or take their resources directly to the SNF.
Ultimately, UH put
together an “intercept team,” a task force of UH healthcare leaders and acute
care practitioners with experience in emergency medicine that arrived at the SNF
to help. UH stepped in to immediately provide:
·
Workers to care for patient’s basic needs
·
Emergency clinical care for critical patients
·
Triage
·
Securing personal protective equipment (PPE) and testing
Using their prepared
playbook, UH quickly worked with the SNF staff to create a plan that empowered
them to work toward gaining control over the virus and its spread. With the
long-term goal of infection control, the intercept team kept a close eye on the
latest safety updates, monitoring the pandemic so that they could devise the
best strategy for infection control. Within four months of UH’s arrival, the
SNF achieved the desired goal of zero patients or staff infected with the
virus.
UH’s intercept approach
is unique. It pulls together a coalition strategy of local health systems,
facilities, and health departments to work on the front lines at the SNF with
an aggressive approach that directly brings resources to the patients while
minimizing risky transfers throughout the health system.
Cutting Out the Red Tape
One of the most
chronically prevailing challenges between hospitals and SNFs is the timely
transmission of medical records. SNFs often provide paper documents to
hospitals, which can get lost or misplaced. The onset of the pandemic further
complicated this paper system, pushing many staff and healthcare providers to
don PPE just to handle these records.
Duke University School of
Medicine’s accountable care organization established the Health
Optimization Program for Elders (HOPE) to support 25 SNFs. With
a focus on improving care transitions, HOPE created a system to safely,
quickly, and accurately transfer medical documents so that all staff can review
them.
The solution was to
install software that could convert SNF fax data into the
hospital’s electronic health record (EHR) system. This system required no new
equipment, training, or security, as hospitals and SNFs already use secure fax
to receive records. This simple but significant improvement of patient
transfers was effective and should continue to be utilized in a post-pandemic
world.
Providing Immediate Meaningful
Support
During the peak of the
pandemic, the Government of Ontario asked hospitals to create a specialized emergency response system by creating two
COVID-19 “SWAT” teams. One team focused on infection, prevention, and control
(IPAC), and the second one is dedicated to strengths, weaknesses, and threats
(SWOT). Again, the approach was to support individual facilities and partner
with them to create tailored assistance that lowers infection and the spread of
the virus. The results were impressive: facilities that received support from
the IPAC-SWAT team reported that the mean length of the outbreak was 10.7 days
shorter than in facilities that did not use the team’s resources.
The SWAT team’s approach
begins with “thoughtful listening” to ensure the hospital provides meaningful assistance.
At one nursing home, the team was able to build a tailored emergency response
plan within 72 hours that included:
1.
An inventory of clinical expertise, staffing, supplies, PPE, and
equipment needs
2.
Immediate infection prevention and control protocol
3.
Testing
4.
Establishing a team of senior hospital leadership, and facility
administrators, nurses, and clinicians
5.
Triage of patients for acute care
The second phase included
establishing virtual care, clinical triage of the remaining residents, and
palliative and medical care emergency provision. Ultimately, during the
maintenance phase, the situation was stabilizing with “no further
unanticipated resident deaths or transfers to the hospital.”
Build Relationships Now
Without an established
playbook in place and minus evidenced-based guidelines, the COVID-19 pandemic
forced the world to quickly create ad-hoc emergency systems based on
information that was labeled outdated hours later. Now that the healthcare
industry is armed with significantly more knowledge and wisdom, it has the
opportunity to improve systems and processes before the next storm arrives.
Building partnerships with hospitals now is crucial for SNFs to ensure that
patients and residents receive the very best care and attention.
Conner Girdley is a
director with Lument in Atlanta. He may be reached at conner.girdley@lument.com
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