key: cord-0757345-xcv3ymjt
authors: Bansal, Aditya; Goldstein, Daniel; Schettle, Sarah; Pepitone, Stephen; Lima, Brian; Pham, Duc T.; Cowger, Jennifer; Schubert, Armin; Penney, Sean P.
title: Institutional preparedness strategies for heart failure patients during the COVID-19 pandemic
date: 2020-09-02
journal: J Thorac Cardiovasc Surg
DOI: 10.1016/j.jtcvs.2020.08.096
sha: 829d6f853c02f4c0c1a45ed864d2f742c8b63d77
doc_id: 757345
cord_uid: xcv3ymjt

[Figure: see text]

During the COVID-19 pandemic, patients with heart failure still required care. During the acute 10 phase of the pandemic, heart failure teams at 6 medical centers located in 4 infection hotspots-11 New York, New Orleans, Detroit, and Chicago-continued to care for heart failure and VAD-12 supported patients and served as resource centers for small hospitals and VAD centers. These 13 teams collaborated to coalesce their strategies for tackling the challenges of this pandemic to 14 help other institutions improve preparedness and potentially reduce mortality and suffering. 15

Each hospital already had emergency preparedness plans at the institutional level and also for 16 heart failure and VAD-supported patients that were developed prior to the pandemic. Despite 17 some differences, many strategies were similar, and we have categorized these best practices for 18 managing patients with heart failure during crisis situations as the 4Cs: Capacity, Cohort, Care, 19

and Collaboration (Figure) . 20

Triage is essential during critical times with limited resources. 1 Early identification of patients 22 who could be discharged helped protect them from exposure to the virus, decompressed the 23 hospital, and saved resources for the surge of patients with COVID-19. Using institutional and 24 schedule advanced surgical care for heart failure patients. 2 Organizations can limit workforce exposure by facilitating remote work. 8 Support functions in 50 many organizations-including finance, supply chain, communications, administration, office blocks to reduce potential for cross-contamination. 54

Rapid expansion of care team capacity for cohorting patients is difficult because of the delays 55 inherent in recruitment and sourcing of temporary workers. Just-in-time capacity expansion 56 relies on quickly creating new team structures. At one center, critical care and hospitalist 57 capacity was doubled (effectively adding 100 ICU beds) by assembling volunteer provider teams 58 and redeploying other care team members. Assembling these teams was facilitated by (1) 59 assuring access to expertise in critical and hospital medicine care through a professional transfer heart failure patients needing hospitalization to other regional VAD centers. Rapid 142 transfer can be lifesaving for patients needing urgent therapies. Family members must be 143 provided the contact information for the regional VAD center to prevent confusion and concern. 144 At most centers, weekly multi-institutional conference calls with the transplant/MCS programs-145 inclusive of MCS, ECMO, and critical care program directors-allowed for efficient patient co-146 management, as well as discussion of center-specific bed and ECMO capacities. Once transplant programs reopen, coordination with the local organ procurement organization is 207 critical, and efforts should be made for procurement and utilization of organs locally by in-state 208 centers to increase donor utilization and minimize long-distance travel for out-of-state 209 procurement teams. policies should be maintained until the incidence of infection in the community decreases or per 217 the recommendation of governmental agencies. Rapid screening of outpatients, social distancing 218 in waiting areas, and the use of PPE will help to minimize the risk of contagion. 219

Collaboration is critical during a global crisis. Cooperation with local, regional, and state 221 officials and with other hospitals in the region will enhance resource utilization. 16 At the 222 institutional level, departmental silos need to be unsealed to provide care for critically sick 223 patients across the multidisciplinary continuum. Collaboration with and learning from different 224 centers will prove helpful in compiling our collective experiences. During times of travel 225 restrictions, webinars can be used for rapid dissemination of information. Incorporating these 226 strategies to optimize patient care can help institutions with preparedness planning and 227 responsiveness to this pandemic. 228

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