The COVID-19 pandemic has taught us that success can be found in collaboration and partnership, not isolation. Although effective alliances between hospitals and long-term care can be challenging, even in non-pandemic times, skilled nursing facilities (SNFs) have recently found that partnering with hospitals provided them a level of defense against the pandemic that they never would have attained if working on their own.
As the examples below show, collaboration can be a mutually beneficial process. SNFs can benefit from the access to equipment, staff, and expertise available to hospitals.
SNFs will find that hospitals, even though constrained by their own resource limits, are equally motivated to pursue these partnerships. Hospitals are driven by the desire to control infection proactively; they are willing to provide meaningful support to SNFs to prevent a major outbreak that would overwhelm their own emergency rooms.
These collaboration stories reveal a true partnership, with the hospitals empowering SNFs to do what they do best: care for residents and patients. The hospitals provided specific support, hands-on help, resources, and information as needed while recognizing that the staff at the facilities ultimately know their residents and how best to care for them.
Leadership Amid a Crisis
In many ways, the COVID-19 pandemic did not catch University Hospitals (UH) in Cleveland by surprise. Even before the pandemic, UH had created an emergency crisis plan that included procedures for several disaster scenarios that could occur to prepare and provide support to its community. UH was already actively monitoring COVID case levels when the pandemic hit and was prepared to intervene proactively. In one example, UH noticed a particularly troubling spike of COVID infections at a SNF in the Midwest. UH quickly pulled together a team to decide whether to transfer critically ill patients from the SNF to one of their hospitals or take their resources directly to the SNF.
Ultimately, UH put together an “intercept team,” a task force of UH healthcare leaders and acute care practitioners with experience in emergency medicine that arrived at the SNF to help. UH stepped in to immediately provide:
- Workers to care for patient’s basic needs
- Emergency clinical care for critical patients
- Triage
- Securing personal protective equipment (PPE) and testing
Using their prepared playbook, UH quickly worked with the SNF staff to create a plan that empowered them to work toward gaining control over the virus and its spread. With the long-term goal of infection control, the intercept team kept a close eye on the latest safety updates, monitoring the pandemic so that they could devise the best strategy for infection control. Within four months of UH’s arrival, the SNF achieved the desired goal of zero patients or staff infected with the virus.
UH’s intercept approach is unique. It pulls together a coalition strategy of local health systems, facilities, and health departments to work on the front lines at the SNF with an aggressive approach that directly brings resources to the patients while minimizing risky transfers throughout the health system.
Cutting Out the Red Tape
One of the most chronically prevailing challenges between hospitals and SNFs is the timely transmission of medical records. SNFs often provide paper documents to hospitals, which can get lost or misplaced. The onset of the pandemic further complicated this paper system, pushing many staff and healthcare providers to don PPE just to handle these records.
Duke University School of Medicine’s accountable care organization established the Health Optimization Program for Elders (HOPE) to support 25 SNFs. With a focus on improving care transitions, HOPE created a system to safely, quickly, and accurately transfer medical documents so that all staff can review them.
The solution was to install software that could convert SNF fax data into the hospital’s electronic health record (EHR) system. This system required no new equipment, training, or security, as hospitals and SNFs already use secure fax to receive records. This simple but significant improvement of patient transfers was effective and should continue to be utilized in a post-pandemic world.
Providing Immediate Meaningful Support
During the peak of the pandemic, the Government of Ontario asked hospitals to create a specialized emergency response system by creating two COVID-19 “SWAT” teams. One team focused on infection, prevention, and control (IPAC), and the second one is dedicated to strengths, weaknesses, and threats (SWOT). Again, the approach was to support individual facilities and partner with them to create tailored assistance that lowers infection and the spread of the virus. The results were impressive: facilities that received support from the IPAC-SWAT team reported that the mean length of the outbreak was 10.7 days shorter than in facilities that did not use the team’s resources.
The SWAT team’s approach begins with “thoughtful listening” to ensure the hospital provides meaningful assistance. At one nursing home, the team was able to build a tailored emergency response plan within 72 hours that included:
- An inventory of clinical expertise, staffing, supplies, PPE, and equipment needs
- Immediate infection prevention and control protocol
- Testing
- Establishing a team of senior hospital leadership, and facility administrators, nurses, and clinicians
- Triage of patients for acute care
The second phase included establishing virtual care, clinical triage of the remaining residents, and palliative and medical care emergency provision. Ultimately, during the maintenance phase, the situation was stabilizing with “no further unanticipated resident deaths or transfers to the hospital.”
Build Relationships Now
Without an established playbook in place and minus evidenced-based guidelines, the COVID-19 pandemic forced the world to quickly create ad-hoc emergency systems based on information that was labeled outdated hours later. Now that the healthcare industry is armed with significantly more knowledge and wisdom, it has the opportunity to improve systems and processes before the next storm arrives. Building partnerships with hospitals now is crucial for SNFs to ensure that patients and residents receive the very best care and attention.
Conner Girdley is a director with Lument in Atlanta. He may be reached at conner.girdley@lument.com
