Reassessing Care During Covid-19

COVID-19 has affected almost every facet of life as we know it and will likely continue to impact our society for the foreseeable future. It is likely that as a hospitalist, you have seen quite a few changes in the last year that you weren’t expecting. From variations in hospital admissions, changes in protocols, and potential caregiver fatigue, challenges across the board have placed considerable burdens on health care organizations and personnel. On the other hand, COVID-19 has also forced hospitalists and health care workers to rethink the way they make decisions when it comes to routine care.

Routine care for an inpatient may include labs, imaging, vital signs, monitoring, and other recurrent procedures. Pre-COVID, health care workers likely didn’t have to worry as much about limited personal protective equipment, medication shortages, and overall personal health safety. But now, all visits with a patient must be thoroughly assessed to validate the reasoning for specific care. The questions, “how is this going to benefit my patient,” and “am I providing the best care with the most effective use of resources,” are what a hospitalist must answer prior to visiting a patient each time they enter a hospital room. Delivering this type of care has become a focal point with front line health care workers, especially now, during a time of such uncertainty.

Examples of post-COVID care include:

• Remote monitoring overnight
• Bundling lab work
• Reducing unnecessary tests, treatments, and procedures

Whereas examples of traditional care include:

• Routine overnight vitals – Checking vital signs every four hours throughout the night for low-risk patients can lead to sleep disruptions, which can contribute to higher perception of pain, sleep deprivation, and elevated blood glucose levels. Unless the patient specifically requires frequent monitoring, overnight vital checks may not be necessary.
• Routine lab work – In the case of a clinically stable patient, routine lab work may not be needed. It’s important to assess each patient to determine the benefit versus risk of conducting types of blood tests and how often they should be administered. It’s important to also note, if a patient does need to receive routine lab work, a clear routine should be set, so the blood draw is happening at the same time(s) every day.
• Imaging services – Sometimes a patient may not need the most comprehensive imaging service to diagnose a condition. Instead of wheeling a patient into get an MRI or CT scan, hospitalists should ask themselves, “would a portable x-ray be a better option to start with, so my patient isn’t put into a position of more distress?” If a less invasive imaging option is available and applicable for the condition at hand, it would be wise to start there.

With each of the above examples, clinicians are exposed to potential risk of infection more often. These are risks hospitalists are willing to take for the well-being of their patients, however, we do need to consider the safety and protection of our health care workers too. And, whether the interventions being performed are making a beneficial difference to patients.

Evidence-based care is all about safety, sustainability, and practicality. Clinicians all have the obligation and duty to uphold values that ensure patients receive the right care at the right time. Assessing the value of essential versus nonessential services can positively impact a patient’s outcome.

The future of medicine lies in the hands of our clinicians. By joining together in the effort to advance medical treatment, we can vastly improve the care our patients receive, and the safety of our care teams.

Contact Advanced Care Hospitalists to Learn More

ACH is a Lakeland-based hospitalist group providing comprehensive patient care in community hospitals across Central Florida. If you are interested in learning more about our programs, services, providers or becoming a partner facility, please call us at 863-816-5884 or fill out a contact form online.

*Facts and figures derived from the-hospitalist.org.