By Jonathan M. Metsch
With coronavirus, the hospital to which you are admitted is most likely the hospital where you will stay.
We don’t have “emerging virus” hospital designations like we do for trauma centers, cardiac surgery and newborn nurseries.
As hospitals exceed their surge capacities, your ambulance could be diverted from one hospital to another. Perhaps from a regional center to a community hospital.
While hospitals are adding ICU beds, they might be staffed by redeployed nurses rather than ICU nurses, or “travel” nurses.
ICU nurses might each be taking care of more patients then “best practices” standards of care.
The ICU might not have a fulltime physician intensivist.
While there appears to be a sufficient number of ventilators, there is a shortage of respiratory therapists and infection protectionists (formerly infection control nurses).
While there are new therapeutics, the hospital’s supply chain might determine its availability.
The hospital might be part of a tertiary care network or affiliated with an academic medical center, where innovation moves quickly. Or it might not be.
The hospital might not be connected to a Coronavirus Recovery Center.
You might be transferred to a coronavirus field hospital.
You could be admitted to a children’s hospital. Can staff pivot to treating adults?
Some hospitals have stopped elective surgery, some have not. Does that make a difference?
Clinical staff might be working too many hours due to a full house and/or short staffing due to symptomatic coronavirus staff, or staff in quarantine due to community spread. Or internal hospital staff spread, for example in break rooms.
You might be treated by an asymptomatic tested-positive nursing staff “ordered” back to work in dedicated coronavirus unit.
There is an ongoing surge in hospitals of candida auris, a fungal infection highly resistant to antibiotics.
Since you don’t necessarily pick the hospital to which you are admitted or diverted, you may get cared for and billed by out-of-network physicians. If you are transferred by air ambulance due to lack of capacity, not for clinical reasons, that expense might not be covered by your insurance.
Bottom line is that where a coronavirus patient gets treated should not be a random event. Hospitals need to be designated for different levels of care, and patients, where necessary and appropriate, should be transferred to a hospital with the best capability for a successful outcome.
I am not a clinician! Clinicians should develop a continuum of hospital capabilities so patients are treated where they are most likely to recover. And health departments should develop capacity metrics to make sure hospitals do not overreach.
I am not a logistics expert! Just a retired hospital CEO tracking the pandemic with the expectation that others will jump in and develop a hierarchy of coronavirus hospitals.
So every hospital and system in Hudson County and New Jersey needs to monitor ever-changing “best practices,” identify its gaps and take steps to be up-to-date to maximize successful clinical results.
Gov. Murphy and Commissioner of Health Persichilli, national leaders in evidenced-based Coronavirus Rapid Response, should consider developing and sharing hospital coronavirus “report cards.”
Jonathan Metsch served as president and CEO of LibertyHealth/Jersey City Medical Center from 1989 to 2006 and writes the blog “Doctor, Did You Wash Your Hands?” (doctordidyouwashyourhands.com).
Send letters to the editor and guest columns for The Jersey Journal to [email protected]