A survey study, published by the Journal of Hospital Medicine on July 22, described how 51 hospital medicine groups at U.S. academic centers adapted to care for non-ICU COVID-19 patients. At the time of the survey (April 3 to 5), 30% reported having COVID-19 test results available in fewer than six hours. Half of the respondents with data on personal protective equipment (PPE) availability had stockpiles of two weeks or fewer. Nearly all sites had implemented respiratory isolation units (RIUs), which rarely incorporated residents and never students. Almost half of the respondents said that non-COVID-19 diagnoses had been initially unrecognized in patients admitted for COVID-19 and that COVID-19 diagnoses had been delayed in patients admitted for other reasons. The authors concluded that medical wards adapted to the crisis in a number of ways, including “implementation and rapid expansion of dedicated RIUs, greatly expanded use of inpatient telehealth for patient assessments and consultation, implementation of other approaches to minimize room entry (such as grouping in-room activities), and deployment of ethics consultation services to help manage issues around potential scarcity of life-saving measures such as ventilators.”
Another article, published by the American Journal of Respiratory and Critical Care Medicine on July 20, described how Michigan ICUs changed visitor policies, while one published by Health Affairs on July 16 explained how a New York health system provided emotional and psychological support to patients, families, and staff.
One hospital described its strategy for pooling nasopharyngeal samples from patients at low risk of SARS-CoV-2 infection into groups of three for testing in a brief report published by the Journal of Hospital Medicine on July 20. During three weeks of this strategy, 530 tests were run in 179 cartridges. Four positive test groups required the use of 11 additional cartridges. The overall positive rate was 0.8%, and the strategy saved 340 cartridges compared to running one sample at a time. “We believe this strategy conserved PPE, led to a marked reduction in staff and patient anxiety, and improved patient care. Our impression is that testing all admitted patients has also been reassuring to our community,” said the authors. They noted that strategy may be modified based on community prevalence of infection or availability of reagents. A JAMA viewpoint published July 22 urged hospitals to pool their research data. Noting that some randomized clinical trials of COVID-19 therapies around the U.S. currently risk failing to meet recruitment targets, they offered a practical approach for real-time pooling of individual patient data.
Finally, a perspective published by the Journal of Hospital Medicine on July 20 recommended additional support for female hospitalists during the pandemic. The recommendations included monitoring direct and indirect effects of COVID-19 on female hospitalists and identifying and meeting their needs; accounting for lack of academic productivity and recognizing and rewarding increased efforts in clinical or administrative duties; and advocating for diversity, inclusion, equity, and fair compensation for clinicians.