Home Journals Inpatient Care of Patients with COVID-19: A Guide for Hospitalists

Inpatient Care of Patients with COVID-19: A Guide for Hospitalists

Highlights/Clinical Significance

  • Interventions to help a health system prepare for patients with COVID-19 include establishing a committee for logistic planning and information dissemination, creating a service dedicated to caring for patients with COVID-19, and building contingency plans for anticipated staffing needs.

  • Common findings of COVID-19 include fever, cough, dyspnea, lymphopenia, and normal procalcitonin.

  • Supportive care is the mainstay of therapy, though several medications including hydroxychloroquine and remdesivir are undergoing clinical trials.

Abstract

Since its emergence in December 2019, the virus known as severe acute respiratory syndrome coronavirus 2 has quickly caused a pandemic. This virus causes a disease now known as coronavirus disease 2019, or COVID-19. As an increasing proportion of the at-risk population becomes infected, and patients with severe illness are hospitalized, it is essential for hospitalists to remain current on how to best care for people with suspected or confirmed disease. Establishing a system for logistical planning, and accurate information sharing is strongly recommended. Infection control remains the ultimate goal. As such, healthcare workers should be educated on universal and isolation precautions, and the appropriate use of personal protective equipment. Social distancing should be encouraged to prevent the spread of infection, and creative and innovative ways to reduce contact may need to be considered. Moreover, it is imperative to prepare for contingencies as medical staff will inevitably get sick or become unavailable. Hospitalists have the difficult task of caring for patients, while also adapting to the many logistical and social elements of a pandemic.

Keywords

Introduction

Since its emergence in December 2019, the virus known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has quickly spread throughout the world. This virus is pathogenic in humans and causes what is now known as coronavirus disease 2019 (COVID-19). On March 11, 2020, the World Health Organization declared COVID-19 a pandemic. As of March 25, 2020, there have been 54,453 cases of COVID-19 in the United States and 414,179 cases worldwide. As an increasing proportion of the at-risk population becomes infected, and patients with severe illness are hospitalized, it is essential for hospitalists to remain current on how to best care for people with suspected or confirmed COVID-19.

Planning for COVID-19

As more and more of the population become infected, it will be necessary for health care systems and providers to plan and adapt to the rapidly evolving societal and healthcare landscape. New information, and misinformation, manifests daily, and it is important to establish a committee focused on logistical planning and accurate information sharing. It may also be useful to form a dedicated unit for patients with suspected or confirmed COVID-19. At least initially, the hope is that this will help centralize patient care and contribute to infection control. If an institution is equipped to use order sets or note templates specific to COVID-19 patients via their electronic medical record system, this may be helpful to streamline work, and to ensure consistent patient care.

On an individual provider level, the overwhelming goal is to limit exposure to the virus. To that end, hospitalists (and other healthcare workers) should be educated on universal precautions, isolation precautions, and the appropriate use personal protective equipment. Education and fit testing for respiratory protective equipment such as N95 masks, and powered air purifying respirators should be mandatory for anyone with direct patient contact.

Unnecessary contact should be avoided to prevent the spread of infection. For example, while hospital rounds are traditionally conducted as a team, contact should ideally be limited to the provider primarily responsible for the patient. Telemedicine resources, such as video chat services, can also be used by the healthcare staff when direct patient contact is not mandatory. A consideration can be made that some inpatient consultations may be performed entirely by chart review or with the use of video services. Moreover, policies that limit or prohibit hospital visitors should be strongly considered.

It is imperative to prepare for contingencies. Medical staff will inevitably get sick and should be educated on the signs of illness in order to appropriately triage for SARS-CoV-2 testing. Likewise, there should be contingency planning for instances when staff must leave for illness, family illness, or other similar circumstances. While quarantined, and if without symptomatic illness, hospitalists may find innovative ways to continue to work from home such as covering triage calls, providing telemedical care, and logistic planning. Providing different forms of family support, such as childcare, can enable hospitalists to minimize absences and continue to work. Much will be asked of health care staff during this outbreak.

When to suspect COVID-19

Understanding the signs, symptoms, clinical presentation, and risk factors associated with COVID-19 is essential in patient care, and infection control. The most common symptoms of COVID-19 are fever, cough, fatigue, or myalgias.

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