A Hospital Partnership with a Nursing Home Experiencing a <scp>COVID</scp>‐19 Outbreak: Description of a <scp>Multiphase</scp> Emergency Response in Toronto, Canada

Stall, Nathan M.; Farquharson, Carolyn; Fan‐Lun, Chris; Wiesenfeld, Lesley; Loftus, Carla; Kain, Dylan; Johnstone, Jennie; McCreight, Liz; Goldman, Russell; Mahtani, Ramona

doi:10.1111/jgs.16625

Cited by 55 publications

(69 citation statements)

References 21 publications

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“…These measures include that all patients with fever and respiratory symptoms are referred to acute hospitals in order to rule out COVID-19, that all residents admitted with acute respiratory infections are isolated in negative pressure rooms and tested once for COVID-19 if the clinical suspicion is low, or twice prior to transfer to a general ward, and also include the cohorting of patients with respiratory infections when necessary [ 37 ]. Another experience in Toronto, Canada, presents a hospital-nursing home partnership that was characterized in several phases: 1) engagement, relationship and trust-building; 2) environmental scan, team-building and immediate response; 3) early phase response; and 4) stabilization and transition period [ 38 ]. Authors state that it is not too late for health systems to regroup and restructure to help homes survive the surge of COVID-19 outbreaks.…”

Section: Discussionmentioning

confidence: 99%

COVID-19 outbreak in long-term care facilities from Spain. Many lessons to learn

et al. 2020

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Background/Objectives To analyze mortality, costs, residents and personnel characteristics, in six long-term care facilities (LTCF) during the outbreak of COVID-19 in Spain. Design Epidemiological study. Setting Six open LTCFs in Albacete (Spain). Participants 198 residents and 190 workers from LTCF A were included, between 2020 March 6 and April 5. Epidemiological data were also collected from six LTCFs of Albacete for the same period of time, including 1,084 residents. Measurements Baseline demographic, clinical, functional, cognitive and nutritional variables were collected. 1-month and 3-month mortality was determined, excess mortality was calculated, and costs associated with the pandemics were analyzed. Results The pooled mortality rate for the first month and first three months of the outbreak were 15.3% and 28.0%, and the pooled excess mortality for these periods were 564% and 315% respectively. In facility A, the percentage of probable COVID-19 infected residents were 33.6%. Probable infected patients were older, frail, and with a worse functional situation than those without COVID-19. The most common symptoms were fever, cough and dyspnea. 25 residents were transferred to the emergency department, 21 were hospitalized, and 54 were moved to the facility medical unit. Mortality was higher upon male older residents, with worse functionality, and higher comorbidity. During the first month of the outbreak, 65 (24.6%) workers leaved, mainly with COVID-19 symptoms, and 69 new workers were contracted. The mean number of days of leave was 19.2. Costs associated with the COVID-19 in facility A were estimated at € 276,281/month, mostly caused by resident hospitalizations, leaves of workers, staff replacement, and interventions of healthcare professionals. Conclusion The COVID-19 pandemic posed residents at high mortality risk, mainly in those older, frail and with worse functional status. Personal and economic costs were high.

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Section: Discussionmentioning

confidence: 99%

COVID-19 outbreak in long-term care facilities from Spain. Many lessons to learn

et al. 2020

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“…There are examples of this type of collaboration in the United States as well as other countries. [60][61][62][63][64] Further development of units for viral-positive residents and those who require quarantine after hospitalization in wings of existing facilities, dedicated facilities, or repurposing existing locations in the community is essential. [65][66][67][68] Without this capacity, we may not be able to manage additional waves of COVID-19 that may occur (and are already occurring in some states), as well as for the surge in other respiratory illnesses that will add to the need during the upcoming fall and winter.…”

Section: Resourcesmentioning

confidence: 99%

COVID‐19 in Nursing Homes: Calming the Perfect Storm

Ouslander

Grabowski

2020

J American Geriatrics Society

265

269

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The pandemic of viral infection with the severe acute respiratory syndrome coronavirus-2 that causes COVID-19 disease has put the nursing home industry in crisis. The combination of a vulnerable population that manifests nonspecific and atypical presentations of COVID-19, staffing shortages due to viral infection, inadequate resources for and availability of rapid, accurate testing and personal protective equipment, and lack of effective treatments for COVID-19 among nursing home residents have created a "perfect storm" in our countryʼs nursing homes. This perfect storm will continue as society begins to reopen, resulting in more infections among nursing home staff and clinicians who acquire the virus outside of work, remain asymptomatic, and unknowingly perpetuate the spread of the virus in their workplaces. Because of the elements of the perfect storm, nursing homes are like a tinderbox, and it only takes one person to start a fire that could cause many deaths in a single facility. Several public health interventions and health policy strategies, adequate resources, and focused clinical quality improvement initiatives can help calm the storm. The saddest part of this perfect storm is that many years of inaction on the part of policy makers contributed to its impact. We now have an opportunity to improve nursing homes to protect residents and their caregivers ahead of the next storm. It is time to reimagine how we pay for and regulate nursing home care to achieve this goal.

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“…These support platforms have been shown to be helpful for LTCFs in organizing IPC measures, especially repeated facility-wide RT-PCR testing and reporting of test results. The hotline can be useful for responding to the information requirements of the LTCF staff regarding care procedures, in connection with other specialized units, (emergency, intensive care, palliative care, pulmonary medicine, infectious diseases and hygiene units), possibly by telemedicine [ 39 ].…”

Section: Second Interim Eugms Guidance To Prepare European Long-termmentioning

confidence: 99%

August 2020 Interim EuGMS guidance to prepare European Long-Term Care Facilities for COVID-19

et al. 2020

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Purpose The European Geriatric Medicine Society (EuGMS) is launching a second interim guidance whose aim is to prevent the entrance and spread of COVID-19 into long-term care facilities (LTCFs). Methods The EuGMS gathered experts to propose a guide of measures to prevent COVID-19 outbreaks in LTCFs. It is based on the specific features of SARS-CoV-2 transmission in LTCFs, residents’ needs, and on experiences conducted in the field. Results Asymptomatic COVID-19 residents and staff members contribute substantially to the dissemination of COVID-19 infection in LTCFs. An infection prevention and control focal point should be set up in every LTCF for (1) supervising infection prevention and control measures aimed at keeping COVID-19 out of LTCFs, (2) RT-PCR testing of residents, staff members, and visitors with COVID-19 symptoms, even atypical, and (3) isolating subjects either infected or in contact with infected subjects. When a first LCTF resident or staff member is infected, a facility-wide RT-PCR test–retest strategy should be implemented for detecting all SARS-CoV-2 carriers. Testing should continue until no new COVID-19 cases are identified. The isolation of residents should be limited as much as possible and associated with measures aiming at limiting its negative effects on their mental and somatic health status. Conclusions An early recognition of symptoms compatible with COVID-19 may help to diagnose COVID-19 residents and staff more promptly. Subsequently, an earlier testing for SARS-CoV-2 symptomatic and asymptomatic LTCF staff and residents will enable the implementation of appropriate infection prevention and control. The negative effects of social isolation in residents should be limited as much as possible.

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A Hospital Partnership with a Nursing Home Experiencing a COVID‐19 Outbreak: Description of a Multiphase Emergency Response in Toronto, Canada

Cited by 55 publications

References 21 publications

COVID-19 outbreak in long-term care facilities from Spain. Many lessons to learn

COVID-19 outbreak in long-term care facilities from Spain. Many lessons to learn

COVID‐19 in Nursing Homes: Calming the Perfect Storm

August 2020 Interim EuGMS guidance to prepare European Long-Term Care Facilities for COVID-19

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