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COVID-19: Planning for the Worst, Hoping for the Best

Anticipating a spike in Northern California hospitalizations, Kaiser Permanente is getting creative to maximize space in its 21 hospitals. Pictured, triage structures outside the Kaiser Permanente Fremont Medical Center emergency room.

Kaiser Permanente has introduced triage structures outside Northern California emergency rooms and greatly increased the number of hospital beds in anticipation of a surge in COVID-19 infections.

Patients in beds at all hospitals averaged about 3,000 before the virus began its exponential expansion in communities across the region, said Vivian Reyes, MD, Kaiser Permanente regional medical director of Hospital Operations in Northern California. With the addition of COVID-19 patients, leaders are currently planning to accommodate 5,200 patients by April 14.

“We are confident we will meet the needs of our members if the surge we experience is consistent with our current calculations,” Dr. Reyes said.

“And we continue to work aggressively on larger patient scenarios. In order to do so, we are requesting facilities to find as much space as they can that can be converted to accommodate a larger surge.”

Kaiser Permanente is currently working on an assumption that about 20% of its 4.4 million Northern California members — 880,000 — could contract the virus, but only a tiny fraction would need to be hospitalized at any one time. It also is prepared to accommodate for a higher rate of infection and hospitalizations, Dr. Reyes said.

Finding Space

One of the most visible aspects of the surge planning is the arrival of a variety of portable structures of varying sizes erected outside emergency rooms to help separate COVID-19 patients from those with other emergent issues, said Mark Tortorich, vice president of Kaiser Permanente National Facilities Services in Northern California.

“We’re standing the structures up predominantly to decompress our emergency departments,” Tortorich said, adding that Kaiser Permanente hoped to have all of them in place by April 10. “That way we can make the emergency department space inside the hospitals available to COVID-19 surge patients, where it’s needed.”

In addition to the portable structures, hospitals have rescheduled elective surgeries to make room for COVID-19 patients and have found hospital bed space in alternative areas such as post-anesthesia care units, offices, hallways, conference rooms, and by adding beds to intensive care units and existing hospital rooms.

An added challenge factored into planning for the surge in patients is finding space for those who need a place to recover from COVID-19 after being discharged. Extra space in hospital conference rooms and cafeterias could be used for those patients, said Dr. Reyes.

“Primarily the surge space is for those who need hospitalization, but there are some who will need alternative sites after they are hospitalized,” Dr. Reyes said. “Maybe they have an immune-compromised family member who is at risk of infection, or they need skilled nursing.” Such patients might need to receive their post-acute care within the hospital.

Both Dr. Reyes and Tortorich emphasized the expected surge in patients is a moving target that will have to be continually reassessed.



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