长期护理和急性后期护理中 COVID-19 的卫生系统应对措施：三阶段方法。
A Health System Response to COVID-19 in Long-Term Care and Post-Acute Care: A Three-Phase Approach.
机构信息
Division of Gerontology and Geriatrics, Department of Medicine, University of Washington, Seattle, Washington.
Office of the President, University of Washington, Seattle, Washington.
出版信息
J Am Geriatr Soc. 2020 Jun;68(6):1155-1161. doi: 10.1111/jgs.16513. Epub 2020 May 30.
BACKGROUND
The Seattle, WA, area was ground zero for coronavirus disease 2019 (COVID-19). Its initial emergence in a skilled nursing facility (SNF) not only highlighted the vulnerability of its patients and residents, but also the limited clinical support that led to national headlines. Furthermore, the coronavirus pandemic heightened the need for improved collaboration among healthcare organizations and local and state public health.
METHODS
The University of Washington Medicine's (UWM's) Post-Acute Care (PAC) Network developed and implemented a three-phase approach within its pre-existing network of SNFs to help slow the spread of the disease, support local area SNFs from becoming overwhelmed when inundated with COVID-19 cases or persons under investigation, and help decrease the burden on area hospitals, clinics, and emergency medical services.
RESULTS
Support of local area SNFs consisted of the following phases that were implemented at various times as COVID-19 impacted each facility at different times. Initial Phase: This phase was designed to (1) optimize communication, (2) review infection control practices, and (3) create a centralized process to track and test the target population. Delayed Phase: The goals of the Delayed Phase were to slow the spread of the disease once it is present in the SNF by providing consistent education and reinforcing infection prevention and control practices to all staff. Surge Phase: This phase aimed to prepare facilities in response to an outbreak by deploying a "Drop Team" within 24 hours to the facility to expeditiously test patients and exposed employees, triage symptomatic patients, and coordinate care and supplies with local public health authorities.
CONCLUSIONS
The COVID-19 Three-Phase Response Plan provides a standardized model of care that may be implemented by other health systems and SNFs to help prepare and respond to COVID-19. J Am Geriatr Soc 68:1155-1161, 2020.
背景
西雅图地区是 2019 年冠状病毒病（COVID-19）的震中。其最初在一家熟练护理设施（SNF）中的出现不仅突显了其患者和居民的脆弱性，还突显了导致全国头条新闻的有限临床支持。此外，冠状病毒大流行加剧了医疗机构和当地及州公共卫生部门之间改善协作的必要性。
方法
华盛顿大学医学部（UWM）的后期护理（PAC）网络在其现有的 SNF 网络内制定并实施了一个三阶段方法，以帮助减缓疾病的传播，在 SNF 因 COVID-19 病例或疑似病例而不堪重负时支持当地 SNF，并帮助减轻地区医院、诊所和急诊医疗服务的负担。
结果
对当地 SNF 的支持包括以下各阶段，这些阶段在不同时间实施，因为 COVID-19 以不同的时间影响每个设施。初始阶段：本阶段旨在（1）优化沟通，（2）审查感染控制措施，以及（3）创建一个集中的流程来跟踪和测试目标人群。延迟阶段：延迟阶段的目标是一旦疾病在 SNF 中出现，通过向所有员工提供一致的教育和加强感染预防和控制措施来减缓疾病的传播。激增阶段：本阶段旨在通过在 24 小时内将“降落小组”部署到该设施，迅速对患者和接触过的员工进行测试，对有症状的患者进行分诊，并与当地公共卫生部门协调护理和供应，从而使设施为疫情爆发做好准备。
结论
COVID-19 三阶段应对计划提供了一种标准化的护理模式，其他卫生系统和 SNF 可以实施该模式，以帮助准备和应对 COVID-19。J Am Geriatr Soc 68：1155-1161，2020。
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