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Accepted manuscript

Reduction in Hospital Transfers at a US COVID-19 Alternate Care Site: Maintaining Surge Capacity Support in Imperial County, California

Published online by Cambridge University Press:  04 July 2022

Frank W. Zhang
Affiliation:
CAL-MAT Physician 2658 La Presa Ave RosemeadCA 91770 Fwzhang10@gmail.com
Colin A. Meghoo
Affiliation:
colmeg@yahoo.com
Katherine L. Staats
Affiliation:
Imperial County EMS Medical Director Assistant Professor, Stanford Universitykatherinestaats@co.imperial.ca.us
Elizabeth Perkins Hayes
Affiliation:
Emergency Medicine, Vanderbilt Tullahoma-Harton Hospital lizhayespa@gmail.com
Mitch Metzner
Affiliation:
Finance and Administration Section Chief California Medical Assistance Team mitchmetzner@gmail.com
Julia Sobel
Affiliation:
Department of Emergency Medicine, University of California San Diegojdsobel@health.ucsd.edu
Eric Hultquist
Affiliation:
eric.m.hultquist@gmail.com
Erin E. Noste
Affiliation:
Associate Professor Department of Emergency Medicine, University of California San Diegoenoste@health.ucsd.edu
Charles E. Wright
Affiliation:
CAL-MAT Physician intldoc1@aim.com
Asha Devereaux
Affiliation:
CAL-MAT Physician Coronado, CAdoctor@drashadevereaux.com
Howard Backer
Affiliation:
CAL-MAT Medical Director Rancho Cordova, CAHoward.backer@emsa.ca.gov

Abstract

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 healthcare 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 two local hospitals experiencing surges of COVID-19 cases. The patients treated often had multiple comorbid illnesses and required a median supplemental oxygen of three liters per minute (LPM) on admission. Numerous interventions were initiated during a two-week 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.

Type
Original Research
Copyright
© 2022 Society for Disaster Medicine and Public Health, Inc.

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