Long-Term Acute Hospitals Play Vital Role in Pandemic Response

A recent feature published in Chest outlined the successful role played by long-term acute care hospitals (LTACHs) in the response to managing the COVID-19 pandemic.

According to Anthony M Grigonis, PhD, Select Medical, Mechanicsburg, PA, and coresearchers, when managed and modified correctly, LTACHs can manage acutely ill patients with more severe clinical manifestations of SARS-CoV-2 alongside less severe COVID-positive patients, and even those without COVID-19 due to their facilities already being equipped to handle patients directly from the ICU.

Dr Grigonis and colleagues examined a network of 94 LTACHs across 27 states with similar operating models managed by a parent organization. These facilities typically provide intensive, prolonged hospital-level care, including 24-hour nursing and respiratory therapy services, staffing ratios commensurate with patient acuity, and ancillary services such as physical, occupational, and speech-language rehabilitation.

Upon the incursion of the COVID-19 pandemic, these facilities implemented new pathways and workflows like under what they called a Resilient Work System. Key components of this system included proactive indictors, prevention strategy, adaptations to stressors, and maintaining stability.

The researchers outline their process for modifications as follows:

• transforming LTACHs into a COVID-19 treatment center;
• preparing LTACHs to admit and treat COVID-19 recovery patients; and
• preparing LTACHs to treat non-COVID-19 ICU overflow patients.

“Many of these additional processes were similar to those developed by traditional hospitals in response to the pandemic but required personalization and further adaptation to fit into the LTACH workflow,” noted Dr Grigonis and colleagues. LTACHs offer a unique solution due to their source of high-acuity beds and well-experienced critical care staff to help support hospitals during this pandemic.

During March through May 2020, 992 COVID-19 positive adults, average age 18 years or older, were admitted to the 94 LTACHs. Facilities were able to implement enhanced infection precautions to minimize transmission. Recovering patients had access to multiple support programs, such as physical therapy, occupational therapy, and respiratory therapy that were all modified for COVID-19 patients. Modifications included changes to frequency and duration.

“More than 20% of COVID-19 patients recovered sufficiently to be discharged home (n=212), whereas others required ongoing treatment at a lower-level-of-care facility (n=524; 53%),” explained researchers.

Other modifications included developing new patient-family services to address the new void caused by social distancing. This program included outpatient clinic staff deployed from the parent organization to navigate family and surrogate communication.

“LTACHs have a critical role to play in caring for patients during COVID-19 pandemic and future crises that overwhelm our health-care system,” concluded researchers.

—Edan Stanley

Reference:

Grigonis A, Mathews K, Benka-Coker W, Dawson A, Hammerman S. Long-Term Acute Care Hospitals Extend ICU Capacity for COVID-19 Response and Recovery. Chest. 2021;159(5):1894-1901. doi:10.1016/j.chest.2020.12.001