3 steps hospitals need to take now to prepare for a surge of COVID-19 cases

The large outbreak of COVID-19 has already started to overwhelm hospitals in Washington state and New York. 

And experts say other hospitals need to get ready, now.

“Recall the worst day that you had in your hospital and assume it is going to be four times worse than that,” said Joanne Roberts, M.D., director of quality for Providence St. Joseph Health System, which has 51 hospitals. “That is the magnitude of what we are looking at.”

The first confirmed case of COVID-19 was detected at one of Providence’s urgent care centers back in January.

Since then, federal data have shown that more than 10,000 Americans have been diagnosed with COVID-19. Washington state has the most cases with 1,187, according to the latest data from the Centers for Disease Control and Prevention.

Roberts and other experts offer these tips for hospitals to prepare for a surge of COVID-19 cases:

Make an inventory 

Every facility needs to take stock of their supplies such as personal protective equipment, ventilators and beds.

It is “not a surprise that this is coming,” said Scott Newton, executive director of clinical operations at TeleTracking Technologies, which develops technology to manage patient flow in facilities. “We need to understand some basics: how many beds are in the hospital, how many are operational and how many are offline that we can quickly resolve.”

Roberts said that the hospital didn’t just look at the number of intensive care unit ventilators but also ventilators in their operating rooms, ambulatory surgical centers and any other organizations. A lack of ventilators, plus questions around the amount in a federal stockpile, has been a major concern for providers alongside whether there is enough personal protective equipment such as masks.

“We are always hours to days of running out of masks and gowns,” said Roberts. Hospitals also need to put together an inventory of staffing, including their vacancy rate and how that could be filled.

Ensure your staff is well-rested

This pandemic is going to be far different from shorter-term stress events such as a hurricane or natural disaster, said Newton, who previously was the head of nursing, emergency medicine and critical care at Johns Hopkins Hospital.

“One of the challenges that happens in an extended event is staff become fatigued, and when they become fatigued they are less focused, and that is when you start to see some breaches in protocol,” he said.

When a hospital responds to a shorter, detailed event they have A and B teams.

“The A team goes in and staffs facility during a hurricane or blizzard that may last 36-48 hours at most,” Newton said. The B team would come in after the acute phase ends and then cares for the next group of patients while the A team gets rest.

So what do you do when the event lasts for days and even weeks?  “Think of an A team, B team and C team,” he said. Hospitals also need to compensate for healthcare professionals contracting COVID-19 and putting them out of commission for 14 days.

Do you need an alternative care site or screening area?

Hospitals should start checking with their incident commanders or logistic section chiefs to start thinking about whether to activate alternative sites of care.

“If we do activate one of those sites, who will staff it and who are partners in the community we might work with and how will we supply that?” Newton said.

Some hospitals are already putting together drive-by screening or screening tents in their parking lots to triage patients.

“For those that have a probable COVID-19 diagnosis then where is the best place to treat them,” Newton said.