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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.
In recognition of the safety risks involved in caring for patients requiring any level of sedation, the Joint Commission, in the USA, has set specific standards around credentialing, competency assessment, and education. The six general competencies identified by the Accreditation Council for Graduate Medical Education and the American Board of Medical Specialties are cited by the Joint Commission as a framework for credentialing and ongoing competency assessment. The intent of procedural sedation education is to develop and validate knowledge, skills, and behavioral competency in the management of patients requiring pharmacologic intervention during procedures. Significant advances in technology over the past few decades have created opportunity for organizations to meet the challenges of competency development and validation for healthcare practitioners. Simulation-based education is an emerging learning and assessment modality that educates, provides practice experience, and validates the competencies required to manage procedural sedation.
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