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DCU Field Hospital Concept of Operations 

Process for transferring patients, please call TrAC at (508-334-4111).

Who is an appropriate patient for triage to the DCU Field Hospital?

· A patient with a low burden (<=5) of chronic conditions

· A patient with a lower (<=5L) oxygen requirement and few signs of respiratory distress

· A patient free from a significant and active cardiovascular or pulmonary condition

· A patient observed in an inpatient or emergency environment according to the above guidelines.

·A patient on low-dose steroids or a patient with HIV with normal CD4 counts is appropriate for triage

Who is not an appropriate triage for the DCU Field Hospital?

· In general, patients with evidence of ongoing respiratory distress are not appropriate for triage to the DCU field hospital.

· Similarly, patients with evidence of delirium or significant psychiatric comorbidity.

· Patients with active cardiovascular conditions, such as atrial fibrillation with rapid ventricular response, acutely decompensated heart failure, or acute myocardial infarction are not appropriate.

· Pregnant patients and breastfeeding patients are not appropriate for triage.

· Patients with prior organ transplant or undergoing chemotherapy.

· Patients who weigh > 227kg (500 lbs)

Five Units 40-50 beds each

Each unit can be stood up independently and in pods of 25 patients at a time to accommodate growing need for surge space. Will accept 25 patients the first week and stagger expansion after that. 

1 “rapid response” team staffed by RN resource/1 attending provider

BLS/ACLS code response provided by 911 services through Worcester EMS who will be on-site 24/7

Admission Criteria:

Lab confirmed COVID-19 + (by NAAT or PCR)

Resting O2 sat 94% or greater on no more than 5L NC O2

Resting HR less 120

Respiratory Rate <= 25/min

No hemodynamic instability

Risk Stratification Scores

DECOMP-Alert: Alert is calculated every time new vitals or laboratory data is entered in EPIC, refreshes every 15 minutes (Categorized as Green (0), Yellow (1), or Red (2))

The recommendations are based on probability below 5% of respiratory failure requiring mechanical ventilation throughout the hospitalization

  1. Patients with DECOMP-Triage score of 0-3 can be considered for DCU on day 0
  2. Patients with DECOMP-Triage score of 4-5 can be considered for DCU after 24 hours if DECOMP-Alert is Green or Yellow
  3. Patients with DECOMP-Triage score 6 or 7 can be considered for DCU after 72 hours if DECOMP-Alert is Green or Yellow

* Patients with DECOMP-Triage score of 8 or higher or DECOMP-Alert of Red should not be considered for DCU as their probability of respiratory failure is > 50%

Included Patients:

Up to two-person level of assist for mobility and ADLs

Patients with some cognitive or behavioral comorbidities requiring safety sitters

Patients requiring some mobility assistance including help getting to the restroom

Patients who require hemodialysis and who are stable for transfer to an outpatient dialysis center to obtain this treatment

Patients with chronic cardiovascular conditions such as persistent atrial fibrillation, stable coronary disease or congestive heart failure are eligible for transfer to the DCU Field Hospital.

Patients who may be treated with COVID Convalescent Plasma (CCP)

Patients who may be treated with Remdesivir

Patients who lack capacity as long as an HCP or Guardian is invoked.

Exclusion criteria:

Pediatrics

Pregnancy

Major Behavioral health comorbidities (i.e., schizoaffective disorders, aggressive behavioral disorders)

Total care needs

Anticipated need for rapid escalation of care

Patients with acute or unstable coronary syndrome, poorly controlled atrial fibrillation, or acutely decompensated heart failure are not eligible for transfer to the DCU Field Hospital.

Confirmed or high clinical suspicion of C. Diff.

Patients who lack capacity and are pending HCP affirmation or are pending guardianship

Disposition:

After treatment, plan to discharge to home or post-acute care treatment facility.

Capabilities as expected upon patient admission:

Lab

Glucose monitoring for point of care

Onsite iStat Chem 8 and VBG/lactate

Send out capability for CBC with diff, LFTs, others as required, ie UA/C+S/Sputum C+S

Radiology

Onsite chest X-ray

EKG

Continuous (Q1 minute) Pulse Ox monitoring

Vital signs every 4 hours

O2 up to 5 L/min

Intravenous access

Administration of inhalers

Administration of nebulized medications

Limited availability of telemetry monitoring

Close Observation

Patients with DECOMP-Alert of Red will be relocated in a pre-specified area within the DCU field hospital to facilitate frequent surveillance by the care team and prompt response for escalation of care if patient decompensates.

Resuscitation Bay

Ability to manage a patient requiring a higher level of care for up to 2 hours while awaiting transport via ALS or CCT to an appropriate patient care location.

On-site or easily available ALS and CCT transfer capability for decompensation patient via Worcester EMS and UMass Life Flight ground operations.

Staffing model is flexible based on the availability of staff can modified by medical director as needed.

Triage recommendations regarding outside transfer requests and observation period

No period of observation at an outside hospital is required before accepting COVID patients who have < 2 L oxygen requirement and mild dyspnea.

A period of observation of at least 6 hours without escalating O2 requirements is required before accepting patients who have 3 L or greater O2 requirement and mild dyspnea.

A period of at least 12 hours of observation is recommended for patients requiring oxygen support > 4L or moderate dyspnea at the time of transfer request.

All patients requiring a period of respiratory status observation should be placed in an inpatient or observation admission as clinically appropriate. The period of respiratory status observation should not result in the patient remaining in an ED status.

Anticipated common comorbidities

  1. Diabetes Mellitus
  2. Hypertension
  3. Coronary artery disease/prior myocardial infarction
  4. Chronic kidney disease I-III
  5. Congestive heart failure
  6. Ischemic stroke
  7. Chronic pulmonary disease (COPD/emphysema)
  8. Reactive airway disease/asthma
  9. Tobacco smoking
  10. Malignancy (solid tumor or CLL)
  11. Osteoporosis
  12. Dyslipidemia
  13. Peripheral arterial disease
  14. Atrial fibrillation
  15. Depression
  16. Anxiety
  17. Visual impairment
  18. Hearing impairment
  19. Osteoarthritis
  20. AIDS