Problem: During the COVID-19 surge of winter 2020, Cedars Sinai Medical Center experienced an unprecedented shortage of hospital beds exacerbated by the widespread lack of supplies such as portable oxygen. To reduce bed compression, a pilot was implemented to improve clinical efficiency across the care continuum via a multi-pronged approach.
Measurement: We kept routine records of program participants and services rendered. A nurse case manager supervisor and a nurse practitioner collectively determined estimated bed days saved as well as recorded ED visits and hospitalizations. Patient satisfaction was collected via patient self-report and surveys.
Analysis: Descriptive analyses were performed on the data collected. Twenty unique patients with 1 re-enrollment participated in the pilot. 81% of patient episodes required durable medical equipment –- mostly COVID-related oxygen needs, 62% of patient episodes received home health, and 19% of patient episodes were administered intravenous remdesivir at home.
Implementation: A multi-disciplinary team that included hospital and physician leadership, care management, and pharmacy worked together to offer a wide range of services such as durable medical equipment, medications like intravenous remdesivir, close ambulatory case-management follow-up, caregivers, and virtual visits with physicians. In addition, Cedars-Sinai became the guarantor for payment.
Results/Discussion: An average of seven bed days were saved per patient episode, and there were no program-related adverse outcomes within 30 days of hospital discharge. It is unclear if the pilot can be applied to other contexts, but the pilot demonstrated the possibilities that can arise from multi-disciplinary collaboration.