COVID Boarder Solutions?

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If your ED is like mine, it's filled with COVID boarders right now. We're doubling up rooms, moving to other parts of the hospital, and even seeing patients in the parking lot. Needless to say it's not ideal. Hospital admin is working on more inpatient beds, admit to inpatient ward hallway lip service, etc.

Any creative solutions for easing the boarder problem during this weird time?

 

[Angry Birds]

In the Walking Dead, the military took them to the parking lot and shot them all dead

Dunno if that's what you were looking for

 

[Mushdoc]

Get case management +/- hospitalist to set up home 02 from the ED with daily SP02 checks or phone calls

 

[RustedFox]

For every boarder in the ED, the C-suite forfeits one day of pay.
They're not doing their job, so they get punished.

Sound good?

 

[namethatsmell]

For every boarder in the ED, the C-suite forfeits one day of pay.
They're not doing their job, so they get punished.

Sound good?

And perhaps their suite becomes a covid overflow unit and they relocate their desks to the ER hallways?

 

[alpinism]

Start discharging patients with home oxygen and finger pulse oximeters.

 

[namethatsmell]

As much as I hate to say it, good admin seems to be one of the few common themes on if whatever ED I'm at is a dumpster fire or not.

One place I've stayed on at has a remarkably reasonable--and *gasp* helpful--group of admin from low level managers up to c-suite. The way they've conducted themselves and kept the hospital going since March has, frankly, been remarkable and about 2000% better than any other place I've heard of. I suspect this is because many of the higher level admins are actually physicians.

 

[Rekt]

Ours just board long enough to either code or decompensate past nippv and get tubed then they magically find a bed.

 

[Saddleshoes]

For every boarder in the ED, the C-suite forfeits one day of pay.
They're not doing their job, so they get punished.

Sound good?

Genius!!!

 

[WilcoWorld]

For every boarder in the ED, the C-suite forfeits one day of pay.
They're not doing their job, so they get punished.

Sound good?

I suspect that would solve the problem pretty quickly.

 

[WheezyBaby]

Get case management +/- hospitalist to set up home 02 from the ED with daily SP02 checks or phone calls

Out of curiosity are any of yall doing home o2 for COVID from ED? I've done this inpatient but I'd be leery to do this from the ED when you don't have a good sense of trajectory outside of dire need (recognizing this is the situation some places are in)

 

[GeneralVeers]

What's case management?

 

[thegenius]

If your ED is like mine, it's filled with COVID boarders right now. We're doubling up rooms, moving to other parts of the hospital, and even seeing patients in the parking lot. Needless to say it's not ideal. Hospital admin is working on more inpatient beds, admit to inpatient ward hallway lip service, etc.

Any creative solutions for easing the boarder problem during this weird time?

Discharge pt's with decadron, O2 and a portable pulse oximeter and tell them to come back if there O2 on 4L < 85%.

 

[turkeyjerky]

Out of curiosity are any of yall doing home o2 for COVID from ED? I've done this inpatient but I'd be leery to do this from the ED when you don't have a good sense of trajectory outside of dire need (recognizing this is the situation some places are in)

One of my medical directors keeps suggesting it in his weekly emails. It's logistically very difficult, and imho I think it's poor practice. The course of the illness is relatively unpredictable and I'm not aware of any validated predictive criteria that could help guide you that a certain patient isn't going to deteriorate. I've seen people go from 2-3 Lpm on NC in the morning to getting tubed in the evening. I'd feel a whole lot better about sending people home on 02 after a night in the hospital. I would hope that any place doing this has already cancelled elective surgeries, decreased nursing ratios and take other crisis measures.

 

[The Knife & Gun Club]

Out of curiosity are any of yall doing home o2 for COVID from ED? I've done this inpatient but I'd be leery to do this from the ED when you don't have a good sense of trajectory outside of dire need (recognizing this is the situation some places are in)

In addition to the decompensation risk mentioned above, there’s also a ton of patients who simply have 0 social support available for their ADLs.

The magic of Florida in winter is that the snowbirds arrive down here but their families and friends stay up north. These 65 year old stent x6, HTN, DM, s/p CABG people don’t even have a doctor in the state much less a responsible adult who can make sure they don’t syncopize if they get up to pee.

If you send these “stable” patients home you’re just farming AKIs and Subdurals for your next shift.

 

[RustedFox]

In addition to the decompensation risk mentioned above, there’s also a ton of patients who simply have 0 social support available for their ADLs.

The magic of Florida in winter is that the snowbirds arrive down here but their families and friends stay up north. These 65 year old stent x6, HTN, DM, s/p CABG people don’t even have a doctor in the state much less a responsible adult who can make sure they don’t syncopize if they get up to pee.

If you send these “stable” patients home you’re just farming AKIs and Subdurals for your next shift.

So, so true.

 

[WheezyBaby]

One of my medical directors keeps suggesting it in his weekly emails. It's logistically very difficult, and imho I think it's poor practice. The course of the illness is relatively unpredictable and I'm not aware of any validated predictive criteria that could help guide you that a certain patient isn't going to deteriorate. I've seen people go from 2-3 Lpm on NC in the morning to getting tubed in the evening. I'd feel a whole lot better about sending people home on 02 after a night in the hospital. I would hope that any place doing this has already cancelled elective surgeries, decreased nursing ratios and take other crisis measures.

In addition to the decompensation risk mentioned above, there’s also a ton of patients who simply have 0 social support available for their ADLs.

The magic of Florida in winter is that the snowbirds arrive down here but their families and friends stay up north. These 65 year old stent x6, HTN, DM, s/p CABG people don’t even have a doctor in the state much less a responsible adult who can make sure they don’t syncopize if they get up to pee.

If you send these “stable” patients home you’re just farming AKIs and Subdurals for your next shift.

Very much agree with this perspective, but seems like it's happening! Certainly couldn't see myself doing it outside of dire system strain

 

[GeneralVeers]

I'm still curious about why we didn't expand capacity during the lockdown in March-June. The purported reason was to allow hospitals to respond. It's now almost a year later and we have the same hospital capacity that we had previously but even more COVID cases. Worse still, many of our nurses and midlevels have left to go to higher paying jobs in NY doing COVID swab clinics. We nuked our economy, and subsequently government and hospital admin failed us at every level.

 

[dadaddadaBATMAN]

Get case management +/- hospitalist to set up home 02 from the ED with daily SP02 checks or phone calls

Don’t forget to ask for an address to send flowers to.

 

[GeneralVeers]

Don’t forget to ask for an address to send flowers to.

Yes I would never take the liability from doing this. I never take system problems or other people's problems and make them my own. If that hypoxic COVID patient has to board in the hallway it's not my problem.

 

[bravotwozero]

I'm still curious about why we didn't expand capacity during the lockdown in March-June. The purported reason was to allow hospitals to respond. It's now almost a year later and we have the same hospital capacity that we had previously but even more COVID cases. Worse still, many of our nurses and midlevels have left to go to higher paying jobs in NY doing COVID swab clinics. We nuked our economy, and subsequently government and hospital admin failed us at every level.

My hospital had put up a tent outside the hospital to screen and manage additional covid patients. Because the anticipated surge at that time didn't happen during the stay at home order, they decided in their infinite wisdom to take it down 'because it doesn't look nice'. NRG stadium was also supposed to become a field hospital, but none of that is happening now. Short sighted stupidity when you know this pandemic is not going anywhere anytime soon.

 

[Mushdoc]

No I agree, only for system overload crisis situation - which it sounds like he is almost at - seeing patient in parking lot, doubling up rooms etc.

One way to modify the risk, is to have the ED doc be able to identify patients likely able to go home after a midnight in the hospital and have case management start working on home 02 from the ED so that the hospitalist can discharge the next day

 

[namethatsmell]

Yes I would never take the liability from doing this. I never take system problems or other people's problems and make them my own. If that hypoxic COVID patient has to board in the hallway it's not my problem.

I'm also risk-averse and think attempts to try to make us responsible for system issues well outside our control are ridiculous.

Which is why I pretty much always give preference to gigs that self-insure their docs and have their backs. It's actully a way the system can make our lives a bit better.

 

[VA Hopeful Dr]

I'm still curious about why we didn't expand capacity during the lockdown in March-June. The purported reason was to allow hospitals to respond. It's now almost a year later and we have the same hospital capacity that we had previously but even more COVID cases. Worse still, many of our nurses and midlevels have left to go to higher paying jobs in NY doing COVID swab clinics. We nuked our economy, and subsequently government and hospital admin failed us at every level.

I do wonder if hospitals used that time to at least get more supplies (PPE, vents). I know my office went to part time for a month or so because we didn't have enough masks for staff at first.

I'd like to say they also used that time to come up with contingency plans, but it seems clear from this thread that wasn't done.

 

[RoyBasch]

I'm still curious about why we didn't expand capacity during the lockdown in March-June. The purported reason was to allow hospitals to respond. It's now almost a year later and we have the same hospital capacity that we had previously but even more COVID cases.

I assume this is rhetorical, because you seem like the kind of person who already knows the answer:

The pandemic will be over someday in the not too distant future, and at that point the hospital will not expect an adequate financial return on the money they spent on heavy capital investment to expand capacity to meet an immediate need during the pandemic that will not continue indefinitely into the future.

It's the same reason the toilet paper companies decided to weather the storm and have people freak out for a few months rather than ramp up the physical plant to increase production capacity.

 

[BAM!]

My hospital had put up a tent outside the hospital to screen and manage additional covid patients. Because the anticipated surge at that time didn't happen during the stay at home order, they decided in their infinite wisdom to take it down 'because it doesn't look nice'. NRG stadium was also supposed to become a field hospital, but none of that is happening now. Short sighted stupidity when you know this pandemic is not going anywhere anytime soon.

Yeah, but then they needed the field for football. 🙂. In a selfish way, I am sort of glad they played football there instead of filled it with COVID patients.

Don't worry, we all feel left out. We got a big white military boat for a month that ended up getting its own covid out-break and then peaced out before seeing any covid patients. 🙁