Zhang Frank W, Meghoo Colin A, Staats Katherine L, Hayes Elizabeth Perkins, Metzner Mitch, Sobel Julia, Hultquist Eric, Noste Erin E, Wright Charles E, Devereaux Asha, Backer Howard
CAL-MAT, Rosemead, CA, USA.
CAL-MAT, Daytona, FL, USA.
Disaster Med Public Health Prep. 2022 Jul 4;17:e231. doi: 10.1017/dmp.2022.166.
The transfer rate for patients from an Alternate Care Site (ACS) back to a hospital may serve as a metric of appropriate patient selection and the ability of an ACS to treat moderate to severely ill patients accepted from overwhelmed health-care systems. During the coronavirus infectious disease 2019 (COVID-19) pandemic, hospitals worldwide experienced acute surges of patients presenting with acute respiratory failure.
An ACS in Imperial County, California was re-established in November 2020 to help decompress 2 local hospitals experiencing surges of COVID-19 cases. The patients treated often had multiple comorbid illnesses and required a median supplemental oxygen of 3 L/min (LPM) on admission. Numerous interventions were initiated during a 2-wk period to improve clinical care delivery.
The objectives of this retrospective observational study are to evaluate the impact of these clinical and staff interventions at an ACS on the transfer rate and to provide issues to consider for future ACS sites managing COVID-19 patients.
The data suggest that continuous, real-time process-improvement interventions helped reduce the transfer rate back to hospitals from 36.7% to 14.5% and that an ACS is a viable option for managing symptomatic COVID-19 positive patients requiring hospital-level care when hospitals are overburdened.
患者从替代护理场所（ACS）转回医院的比率可作为适当患者选择以及ACS治疗从不堪重负的医疗系统接收的中度至重度患者能力的一项指标。在2019年冠状病毒病（COVID-19）大流行期间，全球医院都经历了急性呼吸衰竭患者的急剧激增。
加利福尼亚州帝国县的一个ACS于2020年11月重新设立，以帮助缓解两家当地医院COVID-19病例激增的压力。接受治疗的患者通常患有多种合并症，入院时所需的中位补充氧气量为3升/分钟（LPM）。在两周内启动了多项干预措施以改善临床护理服务。
这项回顾性观察研究的目的是评估ACS的这些临床和人员干预措施对转回率的影响，并为未来管理COVID-19患者的ACS场所提供需要考虑的问题。
数据表明，持续的实时流程改进干预措施有助于将转回医院的比率从36.7%降至14.5%，并且当医院负担过重时，ACS是管理需要医院级护理的有症状COVID-19阳性患者的可行选择。
