The healthcare field is facing an unprecedented situation. As the coronavirus upends virtually every aspect of modern life, the world is relying on healthcare professionals to simultaneously protect infected COVID-19 patients, protect themselves, prevent the spread of the virus to other patients and the community at large, and still maintain essential healthcare services for non-infected patients, all while medical resources become strained beyond anything we’ve experienced before.
It’s a tall order for any medical professional, and we respect and admire the long hours and the hard work that those in the healthcare field have put in in recent weeks.
We want case managers, nurses and patient discharge specialists to know that we’re here to assist you and answer any questions you may have. To that end, we’ve compiled some resources and insights you may find useful when assessing patient health and navigating their current workflow.
Discharge Criteria for Coronavirus Patients
There’s still a lot we don’t know about the coronavirus, and so much research is still in the early stages. Government agencies have, however, provided some guidelines and other information that case managers and discharge specialists will find worthwhile when deciding whether to send a patient home for self-quarantine or graduate them to the next level of care.
On March 4, the Centers for Medicare and Medicaid Services released guidance for infection control and prevention, and part of that document speaks specifically to the steps hospitals and their staff members can take to assess a patient’s condition for potential discharge and to successfully transport that patient while preventing infection to others. The entire document is worth a read for any healthcare professional, but I want to specifically turn your attention to the section on discharge:
“The decision to discharge a patient from the hospital should be made based on the clinical condition of the patient. If Transmission-Based Precautions must be continued in the subsequent setting, the receiving facility must be able to implement all recommended infection prevention and control recommendations.”
CMS also includes information on regulatory compliance that you should consider, particularly in regard to communication with your post-acute providers.
“Medicare’s Discharge Planning Regulations (which were updated in November 2019) requires that hospital assess the patient’s needs for post-hospital services, and the availability of such services. When a patient is discharged, all necessary medical information (including communicable diseases) must be provided to any post-acute service provider. For COVID-19 patients, this must be communicated to the receiving service provider prior to the discharge/transfer and to the healthcare transport personnel.”
One thing we want to emphasize in regards to this messaging: it’s imperative that discharge specialists provide the specifics of the disease not just to the post-acute provider, but to the healthcare transport personnel. Additional precautions are necessary to ensure that the NEMT or emergency medical transportation team members carrying the patient to the next level of care understand the patient’s condition and are equipped with the appropriate preventive measures.
Basically, every link in the chain must be notified and prepared to mitigate the risk of transmission while ensuring continued medical support of the patient.
Finally, in addition to the CMS information outlined above, the European Centre for Disease Prevention and Control has released a much more comprehensive and specific set of clinical criteria to consider and follow when treating patients and assessing their fitness for discharge. That resource can be found at this link or by clicking the button below.
But not all patients will be graduated to a post-acute facility. In fact, in order to ensure medical infrastructure isn’t strained past the breaking point, doctors may send home those patients whose recovery seems to be progressing apace and who are deemed low-risk for infection transmission or readmission.
Here’s what CMS suggests, from that same document linked above:
“Although COVID-19 patients with mild symptoms may be managed at home, the decision to discharge to home should consider the patient’s ability to adhere to isolation recommendations, as well as the potential risk of secondary transmission to household members with immunocompromising conditions.”
The Centers for Disease Control and Prevention have released a further guide on how to determine if it would be appropriate to send the affected patient home rather than to a post-acute care facility. Here are their suggested considerations:
- The patient is stable enough to receive care at home.
- Appropriate caregivers are available at home.
- There is a separate bedroom where the patient can recover without sharing immediate space with others.
- Resources for access to food and other necessities are available.
- The patient and other household members have access to appropriate, recommended personal protective equipment (at a minimum, gloves and facemask) and are capable of adhering to precautions recommended as part of home care or isolation (e.g., respiratory hygiene and cough etiquette, hand hygiene);
- There are household members who may be at increased risk of complications from COVID-19 infection (.e.g., people >65 years old, young children, pregnant women, people who are immunocompromised or who have chronic heart, lung, or kidney conditions).
A few things to note: there aren’t specifics about age limits or the vitals of patients. All individuals must be assessed on their own merits after careful consideration by the physician and the medical team. I also feel it’s important to point out that, at the time of this publication, this CDC document hasn’t been updated since February 12, and I think we can all agree that this entire situation has evolved dramatically since that time. I would encourage you, then, to continue consulting the websites of the CDC, CMS and other federal and world health organizations for the latest best practices.
Finally, when assessing a patient for discharge, either to an in-home or post-acute setting, it’s worth being aware of the increasing evidence that patients may test positive for the coronavirus weeks after treatment and the disappearance of symptoms. Experts are still unsure whether or not this means the patient is contagious during that time, but this is yet one more wrinkle to the pandemic that deserves ongoing attention from your clinical team on the latest developments.
I’ll leave you with one last recommendation: take care of yourself. Those of us in the healthcare field have a tendency to get so focused on protecting our patients and ensuring the wellbeing of the community that we move our own self-care far down the list of priorities.
These times are stressful, and I want you to remember to leave time for you, even if it’s just 15 or 30 minutes you can carve out over a break or at the end of the day. When you feel your best, you do your best work for patients. Even as we self-quarantine in the coming weeks, remember to make time for the hobbies you love, the people you care about and the mindfulness and relaxation techniques that center you.
Thank you to every healthcare worker who is dealing with this global crisis, and please don’t hesitate to reach out with any questions you have about discharge or provider communication.