Last week, we outlined why supporting post-acute partners is critical to hospitals' Covid-19 strategy. Hospitals struggling to adapt to increased Covid-19 demand need to be able to rely on post-acute providers as partners to accelerate throughput. At the same time, the high rate of outbreaks in skilled nursing facilities (SNFs) and other long-term care facilities mean hospitals should have a vested interest in supporting these providers to prevent additional hospitalizations.

7 lessons on discharge planning during Covid-19 from UW Medicine

Hospitals can meet both of these goals by helping nursing homes address their most pressing need: infection control. Below, we outline three ways hospitals can help their post-acute partners with infection control, while keeping their own resource constraints in mind.

1. Help SNFs establish separate isolation units

In accordance with both CDC and American Health Care Association guidelines, SNFs are creating special units within their facilities to separate positive Covid-19 patients; patients who have tested negative; and new admissions from the hospital, who are presumed to have been exposed. Without these units, the SNF could risk mixing exposed or confirmed-positive Covid-19 patients with residents and staff.

But while hospitals are well versed in patient cohorting, this is a new challenge for most SNFs. That's why some hospitals are sharing their expertise in infection control and facility design to reduce infection risk:

• Spaulding Hospital Cambridge, a member of the Spaulding Rehabilitation Network and Partners HealthCare, established a Covid-19 unit in one of its owned Long-term Acute Care Hospitals. The hospital decided to share its experience with other local providers interested in building their own Covid-19 units. It invited nursing and infection control leadership from other organizations to visit and learn how they designed the unit to minimize potential infection transmission. In addition, the Partners team has hosted conference calls to help answer follow-up questions from the organizations and guide them through the process of creating their own unit.
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• UW Medicine's post-acute medical director and advanced registered nurse practitioner traveled to partner SNFs and met with leaders at each facility to walk through the logistics of creating an isolation unit based on the facility's layout. The UW Medicine team helped identify separate entry points, build modified staffing plans, and place equipment and hand sanitizer to minimize the risk of infection spread.

2. Connect SNFs to local PPE sources and expertise

Although PPE shortages are a challenge for all health care providers, SNFs face unique challenges in accessing adequate supplies. Prior to the Covid-19 pandemic, highly infectious SNF patients would typically be transferred back to the hospital, which reduced the need for facilities to keep large stockpiles of PPE. But today, they're being called on to keep and care for these patients so hospitals can focus on more severe cases.

Whenever possible, hospitals should support SNFs in accessing and conserving PPE. For example:

• Sparrow Health System shares information about possible sources of PPE with their SNF partners. The system's Population Health Analyst connects SNF leaders with sources ranging from local businesses making masks to university programs seeking volunteers for research on disinfecting used PPE.
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• UW Medicine adapted its hospital PPE conservation guidelines for SNF and long-term care providers. The health system shared the protocols directly with their partners, and made them publicly available so other providers can easily access the guidelines.

3. Provide testing support to partner facilities

To reduce the likelihood of an outbreak, most SNFs that do not have current Covid-19 cases will only accept patients who have tested negative for Covid-19 at least once, which can significantly delay transitions out of the hospital. Hospitals that are able to extend testing support to SNFs can equip them to both mitigate cross-contamination risks and take on new admissions. For example:

• Michigan Medicine's faculty medical directors worked with the University of Michigan's pathology and microbiology departments to provide testing for all patients at three of their partner SNFs. This testing revealed that some of the SNF patients were Covid-19 positive, leading the SNFs to set up isolation units so they could separate negative patients from positive patients. Once these facilities realized they already had Covid-19 in their facilities and established appropriate safety measures, they became more comfortable admitting patients from the hospital without first seeing two negative Covid-19 tests.
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• Hartford Healthcare Corporation found that most SNFs in the area were not accepting patients without one or two negative tests, depending on risk level. Because testing centers were taking an average of six days to return tests, Hartford extended its lab's 24-hour testing capabilities to eight SNFs accepting Covid-19-positive patients. Once patients in these SNFs met the negative-testing criteria to be admitted to non-Covid-19 SNFs, they were moved out, clearing space for more incoming patients. This system has allowed the hospital to safely accelerate discharge of patients to SNFs, improving hospital length of stay and throughput.

Additional support for acute/post-acute partnership strategy during Covid-19

Helping post-acute partners safely care for patients is vital for hospitals seeking to improve throughput and mitigate the spread of Covid-19 in their communities. In the coming weeks, the Post-Acute Care Collaborative will be publishing further articles answering key questions for hospitals about post-acute strategy during Covid-19, including:  

1. How hospitals can utilize owned post-acute assets as a space for Covid-19 positive patients or suspected cases.
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3. How hospitals can discharge more patients directly home with support, bypassing the need for additional facility-based care.

To read more of our current work on the topic, review:

• 7 lessons on discharge planning during Covid-19 from UW Medicine
• The missing piece of your Covid-19 capacity strategy: Post-acute care