Author:
Auerbach Andrew,O'Leary Kevin J,Greysen S Ryan,Harrison James D,Kripalani Sunil,Ruhnke Gregory W,Vasilevskis Eduard E,Maselli Judith,Fang Margaret C,Herzig Shoshana J,Lee Tiffany,Schnipper Jeffrey
Abstract
IMPORTANCE: Although intensive care unit (ICU)
adaptations to the coronavirus disease of 2019 (COVID-19)
pandemic have received substantial attention , most
patients hospitalized with COVID-19 have been in general
medical units.
OBJECTIVE: To characterize inpatient adaptations to care
for non-ICU COVID-19 patients.
DESIGN: Cross-sectional survey.
SETTING: A network of 72 hospital medicine groups at US
academic centers.
MAIN OUTCOME MEASURES: COVID-19 testing,
approaches to personal protective equipment (PPE), and
features of respiratory isolation units (RIUs).
RESULTS: Fifty-one of 72 sites responded (71%) between
April 3 and April 5, 2020. At the time of our survey, only 15
(30%) reported COVID-19 test results being available in less
than 6 hours. Half of sites with PPE data available reported
PPE stockpiles of 2 weeks or less. Nearly all sites (90%)
reported implementation of RIUs. RIUs primarily utilized
attending physicians, with few incorporating residents and
none incorporating students. Isolation and room-entry
policies focused on grouping care activities and utilizing
technology (such as video visits) to communicate with
and evaluate patients. The vast majority of sites reported
decreases in frequency of in-room encounters across
provider or team types. Forty-six percent of respondents
reported initially unrecognized non–COVID-19 diagnoses
in patients admitted for COVID-19 evaluation; a similar
number reported delayed identification of COVID-19 in
patients admitted for other reasons.
CONCLUSION: The COVID-19 pandemic has required
medical wards to rapidly adapt with expanding use of RIUs
and use of technology emerging as critical approaches.
Reports of unrecognized or delayed diagnoses highlight
how such adaptations may produce potential adverse
effects on care. Journal of Hospital Medicine 2020;15:XXXXXX.
© 2020 Society of Hospital Medicine
Subject
Assessment and Diagnosis,Care Planning,Health Policy,Fundamentals and skills,General Medicine,Leadership and Management
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