The number of diagnosed COVID-19 cases in the United States is climbing each day. While hospitals prepare to manage the potential surge of contagious patients, healthcare leaders work diligently to implement changes to guidelines by quickly developing protocols to minimize the exposure to hospital staff and vulnerable patients. NES Health’s physician leadership and front-line clinicians are in rapid-response mode to address preparedness for this global pandemic. With over 35 Emergency Departments under NES management throughout the country, we are focused on education, infection control, supply and resource management, and communication with public health authorities.
Last week, NES leadership initiated daily COVID-19 meetings. These meetings with all physician leadership will provide department updates, share best practices, and answer questions with other NES Health clinicians across the country via conference call. In addition to provider focused meetings, NES Health’s executive and clinical leadership team are meeting with hospital CEO’s on a weekly basis to address challenges, provide updates and answer questions. While each hospital and provider’s circumstances are unique, NES’ recommended best practices are as follows:
NES Health’s current recommendations for COVID-19:
- When possible, keep patients from entering into the hospital Emergency Department.
- See patients in alternative treatment locations such as outside tents, on in their cars curbside.
- For hospitals that cannot achieve an outside protocol, patients should be seen in isolated areas away from the general Emergency Department.
- Patients that are unstable or more clinically ill, should be placed in a negative pressure room.
- All entry ways to the hospital should be closed.
- Ensure a strict policy on visitors into the hospital. If you allow visitors, keep to a ONE visitor per patient maximum assuming they are not symptomatic.
- All patients brought to the ED by EMS should be screened outside of the hospital.
- Recommended PPE: N95 mask, gloves, blue gown and eye shields/goggles. N95 masks can be reused if removed properly and not soiled. NES recommendation is to wear a surgical mask on top of the N95 mask to keep it from getting soiled. Currently there is a national N95shortage.
- In the case of having to intubate a patient, a PAPR with positive pressure ventilation should be worn with the blue gown and gloves.
- Arrive at work with a change of clothing to change into at the end of your shift. Clothing should be immediately bagged and washed separately from other laundry.
- Shower before leaving the hospital.
- Remove all facial hair; PAPR’s are limited.
- Deep nasopharyngeal swabbing up both nares is the recommended approach to testing.
- Steroids should NOT be used in this patient population.
- NSAIDS are safe in this patient population. If nebulized treatments are needed, this should be done in a negative pressure room. The use of NIPPV or high flow oxygen should be done in a negative pressure room.
- It is an expectation that ED Site Medical Directors meet with hospital leadership to coordinate the flow, treatment, and hospital visitation policies. SMDs should provide names and contact information for all community based physicians that could back-fill the ED in the event of a complete staffing crisis.
- Consider working with state and local agencies to influence the acceptance of healthcare professionals licensed in other states.
- Ensure emergency credentialing is available, and everyone required to participate in that process is accessible to expedite requests.
- When not working in the ED or hospital, we advise all clinicians to get as much rest as possible, focus on healthy nutrition, and exercise in order to keep your mind and body healthy.
COVID-19 response and protocols are evolving rapidly and recommendations will most likely change. To remain updated, please refer to CDC guidance for our healthcare professionals.
We are exceptionally proud of our providers who risk their own personal health and the health of their loved ones to care for all patients that present in our Emergency Departments. We are doing our best to keep them safe.
Transforming Patient Care, Together.