From the Section of Hospital Medicine, Division of General Internal Medicine, Department of Medicine.
Division of Critical Care, Department of Anesthesiology.
J Patient Saf. 2022 Jun 1;18(4):287-294. doi: 10.1097/PTS.0000000000000916. Epub 2021 Sep 27.
The COVID-19 pandemic stressed hospital operations, requiring rapid innovations to address rise in demand and specialized COVID-19 services while maintaining access to hospital-based care and facilitating expertise. We aimed to describe a novel hospital system approach to managing the COVID-19 pandemic, including multihospital coordination capability and transfer of COVID-19 patients to a single, dedicated hospital.
We included patients who tested positive for SARS-CoV-2 by polymerase chain reaction admitted to a 12-hospital network including a dedicated COVID-19 hospital. Our primary outcome was adherence to local guidelines, including admission risk stratification, anticoagulation, and dexamethasone treatment assessed by differences-in-differences analysis after guideline dissemination. We evaluated outcomes and health care worker satisfaction. Finally, we assessed barriers to safe transfer including transfer across different electronic health record systems.
During the study, the system admitted a total of 1209 patients. Of these, 56.3% underwent transfer, supported by a physician-led System Operations Center. Patients who were transferred were older (P = 0.001) and had similar risk-adjusted mortality rates. Guideline adherence after dissemination was higher among patients who underwent transfer: admission risk stratification (P < 0.001), anticoagulation (P < 0.001), and dexamethasone administration (P = 0.003). Transfer across electronic health record systems was a perceived barrier to safety and reduced quality. Providers positively viewed our transfer approach.
With standardized communication, interhospital transfers can be a safe and effective method of cohorting COVID-19 patients, are well received by health care providers, and have the potential to improve care quality.
COVID-19 大流行给医院运营带来了压力，需要迅速创新，以应对需求的增长和专门的 COVID-19 服务，同时保持对医院为基础的护理的可及性并促进专业知识的传播。我们旨在描述一种管理 COVID-19 大流行的新型医院系统方法，包括多医院协调能力和将 COVID-19 患者转移到一家专门的医院。
我们纳入了通过聚合酶链反应检测出 SARS-CoV-2 阳性并收入包括一家专门的 COVID-19 医院在内的 12 家医院网络的患者。我们的主要结局是评估对当地指南的遵循情况，包括入院风险分层、抗凝治疗和地塞米松治疗，这些指标通过指南发布后的差异分析来评估。我们评估了患者的预后和医护人员的满意度。最后，我们评估了安全转移的障碍，包括跨不同电子健康记录系统的转移。
在研究期间，该系统共收治了 1209 名患者。其中，56.3%的患者接受了转移，这得到了一个由医生领导的系统运营中心的支持。接受转移的患者年龄较大（P = 0.001），但风险调整后的死亡率相似。在指南发布后，接受转移的患者的指南遵循率更高：入院风险分层（P < 0.001）、抗凝治疗（P < 0.001）和地塞米松给药（P = 0.003）。跨电子健康记录系统的转移被认为是安全和质量降低的障碍。医护人员对我们的转移方法持积极态度。
通过标准化的沟通，医院间的转移可以是一种安全有效的 COVID-19 患者分类方法，受到医护人员的欢迎，并有可能提高护理质量。
