STEPS THAT RURAL HOSPITALS CAN BE TAKING TO PREPARE FOR IMPACT OF THE COVID-19 PANDEMIC

MARCH 19, 2020

An early and recurrent commitment to limiting those who come to the hospital for care to those that NEED to come to the hospital.
1. Communication through every possible community vehicle regarding who needs to come in and be seen. (Note that this message may change as adequate testing becomes available in that we may begin to ask people who are symptomatic to come to be tested or to go to drive through sites for testing even as we then ask them to go home and provide self-care unless their symptoms become worse.)
  1. Part of sending someone home for “self-care” is knowing if they have any form of support system – someone to assure there is food, to check that daily needs are met, that chronic meds are available, etc. while maintaining quarantine protocols
  2. If we are sending people home, it would be ideal if there is some means of checking on them (especially the elderly or those who may not have support systems at home) to see if they are stable, improving or perhaps deteriorating. Continue to monitor your state’s updates on telehealth provisions as there have been changes in regard to payment and relaxation of HIPPA provisions to allow for popular applications to be used such as Skype or Apple FaceTime.
  3. Community paramedics or public health nursing would be ideal home follow up where available. Access to PPE has been a barrier to largescale roll out of this practice but there have been some changes in PPE requirements (droplet precautions are different than aerosol precautions) and the ability to re-use which may prolong available supplies.
2. Currently, we have no treatment that will slow the disease or change the course. Thus home care with over the counter remedies is as effective as being admitted to the hospital UNLESS someone has more severe symptoms. Symptoms that might precipitate either a visit or an admission include:
  1. Unable to “catch their breath” – short of breath, hypoxic – deteriorating lung condition
  2. Vomiting to a point that dehydration is a concern
  3. Deterioration from a previously stable condition
Assessment of current response capacity
1. How many of your licensed beds could you staff tomorrow if there were an influx of med/surge patients needing care at a level of acuity appropriate for your facility?
  1. If the number is less than your licensed capacity, what are the barriers to full census? Staff? Support like respiratory therapy? Equipment like IV pumps or ventilators?
  2. Can we/who can help you take steps to address the barriers so that you can step up in time of surge needs?
2. How is the emergency and community response process being managed (either need to coordinate with them or perhaps you are the manager of that)
  1. Cleaning of ambulances – should you identify some that only deal with possible corona virus patients and others that don’t respond to possible corona virus calls (limiting those that could potentially be contaminated)?
  2. Community paramedicine – can it help you keep more people at home and doing self-care? Have you provided adequate personal protective equipment for them?
3. Supplies and restocking – it seems that wherever someone is today, there are shortages of necessary equipment. However, working now with your suppliers, state health departments, and others to assure that you have a ready and repeated restocking process is important BEFORE you run out of necessary materials.
  1. There is a state level contact that allows hospitals to access the emergency stock piles. Do you have that contact information? Would you use it to meet current/anticipated needs if we provided state by state contacts? The CORH website will be posting regular updates and summaries and contacts for accessing emergency stock piles is available on the optimizingruralhealth.org
Planning to expand response capacity
1. Are there retired health care workers in your area – nurses, pharmacists, technicians – lab, respiratory, PT, etc., physicians – that might be willing to return to work should there be a crisis need
  1. If there are identified people, what can you do now to assure they are ready to be called upon?
    1. Confirm license status or whether there is a waiver for the pandemic period
    2. Need for brush up of knowledge/skills with regard to PPE, respiratory assessment/support, etc.
      1. Do you have or need continuing education in order to provide that brush up to either supplemental staff or to your regular staff?
2. Even as you are looking at ways to expand your capacity, consider the health status of your existing and possible recruited help. Many retired healthcare workers might be in high risk categories and attempting to use their assistance other than in direct line of COVID-19 care might be preferable.
  1. Using these individuals to support any telemedicine platform might keep them at a lower level of exposure.
3. How much do you rely upon staffing through contracts and are you at any risk as needs ramp up in larger hospitals that you might lose some level of staffing on which you rely for current needs? For ramp up needs?