I’m one of two hospitalists at a critical access hospital in the U.S. We have 25 beds, no ICU, 1 negative pressure room (NPR) on the Med surg floor and 2 in the ER (both ER NPRs are the trauma bays). The ER has 8 beds. We serve an increasingly elderly population (average age of admission is >70) with multiple poorly controlled comorbidities. We have 4 short acting MDIs (due to logistics of a critical access hospital, we cannot stock more than a certain amount)…. yes FOUR. We have sufficient nebulizers.
We have no functioning medical director and our infection control nurse of 10 years is quitting next week (yup). So I’m kind of it in terms of planning – everyone is looking to me for direction.
I have essentially been functioning as the de facto director / infection control and trying to come up with strategies for the community and the hospital based on CDC guidelines to help offload the ER when shit hits the fan in our community.
I’m reaching out to all the local PMDs (they’re all single private practice) with a consolidated easy to read CDC summary for management, testing indications, and discontinuation of isolation guidelines to prevent them from sending patients to the ER unnecessarily.
We are setting up a COVID triage phone line dedicated to people calling about COVID issues with a protocol to guide them on whether they need testing or not (at this point), need an ER visit, or if they should just monitor at home.
We are planning on distributing information through the school system (they’re sending fliers to all the homes in the area with COVID information so we can just add to it).
We have been reaching out to local pharmacies to boost our MDI quantity and have been quantifying our sepsis medications, intubation Meds, and PPE supplies. We are preparing for the possibility of needing to house and manage ventilated patients in the event that we cannot transfer to a tertiary hospital due to tertiary care overload.
One of my issues is: with the lack of NPRs and lack of MDI with the possibility of not being able to get anyone transferred if this turns into a massive cluster, how do I appropriate the rooms for COVID19 patients? (Also, our county does not yet have testing, labs nearby are limited and not offering testing…). The nearest tertiary care centers are only testing their own samples and not yet willing to handle ours.
I’ve proposed using the NPR room for treatments and aerosol generating procedures given that, for the most part, COVID19 can be managed as droplet precaution. This way patients can be dropped off at an NPR, get their neb treatment (since we only have 4 MDIs) and be shuttled back to their own room, and the next patient who needs a neb can go in. I know this isn’t ideal – but with only 1NPR on the floor and 2NPR which are trauma bays, I don’t see any other option.
There’s a lot more I’m working on but this seems to summarize what I’ve come up with so far.
Truth be told, I have not felt this uneasy in a long time. I would appreciate any advice this Reddit Community has. You have always been a great source if information for me and have helped me to get this far.
Godspeed to all our physicians, nurses, and other hospital staff on the front lines throughout the world. We will prevail. My thoughts are with you.
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