Facilities vary greatly in terms of floor plan, layout, and equipment. The safest arrangement will vary according to facility and resources.
There are several non-negotiable rules:
- Patients that are COVID negative or not PUIs should never be co-housed in the same room or ward with confirmed positives or PUIs.
- Separate known positives from suspect cases/PUIs, higher-risk PUIs from lower-risk PUIs, and all of the above from negative patients see likelihood categories/ case definitions.
These are suggested principles:
- Seek to optimize patient safety and monitoring capacity.
- Seek to optimize protection of non-COVID patients, low risk suspect cases/ PUIs, healthcare workers, and surrounding communities.
- Consulting with nursing team members and analyzing the bedside caregiving workflow will yield the best results, in combination with systematic inventory of resources.
- Utilize space, technology, and staff in non-traditional ways to achieve best effect.
- Do not stop striving to optimize systems and equipment to increase safety. Adapting to an emergency system does not release institutions from the financial or functional responsibilities of quality improvement.
Healthcare workers and administrators around the world have already been responding to the crisis with various innovations and solutions. Imagining alternate scenarios can spark ideas and drive quality improvement.
Scenario A: Very small hospital has a single open ward, with no options for creating new wards Hospital has only a few oximetry devices and has traditionally treated inpatients with diverse health concerns.
Solution: Work with local organizations and authorities to designate the hospital for inpatient treatment of high-risk COVID patients only. Establish a separate small field hospital for housing low-risk PUIs and shift non-COVID care to other locations. Implement a rigorous spot-checking schedule for patients at risk of hypoxia.
Scenario B: Small hospital has exactly two open wards (one for men and one for women), limited equipment, and there are no other options for housing inpatients in the area.
Solution: If culturally possible, designate one ward for COVID care and one ward for non-COVID care. Divide the COVID-care ward into two sides, with positive patients on one side and PUIs on the other. Erect an improvised barrier between the two sides. Designate separate equipment for each of the three hospital areas. (and follow guidelines re. Disinfection, space between beds, etc.)
Scenario C: Larger hospital has several open wards and a few closed rooms traditionally used for housing TB patients. Hospital has no oxygen monitoring equipment that can wirelessly transmit data, but a collection of bedside monitors with large screens.
Solution: Combine two wards that can safely be combined. In the empty space, create a ward for lower-risk PUI patients. Implement an oxygen spot-checking regimen in the PUI ward. Cohort two confirmed positive patients in each private room and assign them oxygen monitors with large screens. Use commercial baby cameras to transmit visual data from monitor screens. Designate and train additional staff to safely monitor the data.
Scenario D: Hospital has 24 private rooms for housing COVID positive patients, but no large-screen monitors, wireless monitoring capacity for only 12 patients, and very limited PPE.
Solution: Assign wireless monitoring devices to the 12 COVID-positive patients with the highest risk for respiratory failure and the lowest capacity for self-care and communication with staff. Give standard pulse oximeters to 12 patients who are more stable and independent. Designate a staff member with the sole responsibility of remotely spot checking these patients on a continuous schedule via telephone. During hours when patients are sleeping, provide physical spot checking and utilize more PPE.