The Impact of the COVID-19 Pandemic on Nursing FacilitiesThe article "Nursing Homes are Ground Zero for COVID-19 Pandemic" is the first to describe a major outbreak of SARS-CoV-2 infection in a U.S. nursing facility (NF) in Kirkland, Washington (1). Almost simultaneously, the world began learning about the large number of deaths in NFs throughout Italy and Spain (2). Close living quarters, the high incidence of cognitive impairment, the need for frequent daily caregiver interactions, and the advanced age and high comorbidity burden of NF residents, are some of the factors that have led to unmitigated disease spread. The high risk of this infection in older adults, especially those in congregate living settings, is well recognized (3,4). Although reporting of COVID-19 positive rates is now required in U.S. NFs, testing and reporting of positive rates has thus far been sporadic. Some reports now suggest that deaths of NF residents and workers may account for 35% or more of all COVID-19 deaths in the U.S. (5). New clusters of infection among NF residents could contribute to further spread outside the facility by staff, as well as potentially by visitors if visitor restrictions are relaxed.
Evidence for Testing in Nursing FacilitiesAggressive testing has been a hallmark and best practice for countries to "flatten the curve" of this pandemic (6). Taking the same approach in NFs, as well as in other congregate settings such as assisted living facilities, seems essential because of the susceptibility of the population. A number of reports document the prevalence of NF outbreaks (7). Examining the characteristics of these outbreaks may provide approaches to containment and mitigation of this epidemic (8). "Unrecognized asymptomatic and pre-symptomatic infections might contribute to transmission in these settings," concluded an MMWR published on March 27 2020 (9). The article went on to state that "as testing availability improves, consideration might be given to test-based strategies for identifying (nursing
A modest financial incentive resulted in a marked improvement in the time-to-discharge summary dictation by medicine residents. Pay-for-performance programs may be an effective strategy for improving the quality and efficiency of patient care in academic medical centers.
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