Pandemic Care Through Collaboration: Lessons From a COVID-19 Field Hospital

Abstract

During the surge of Coronavirus Disease 2019 (COVID-19) infections in March and April 2020, many skilled-nursing facilities in the Boston area closed to COVID-19 post-acute admissions because of infection control concerns and staffing shortages. Local government and health care leaders collaborated to establish a 1000-bed field hospital for patients with COVID-19, with 500 respite beds for the undomiciled and 500 post-acute care (PAC) beds within 9 days. The PAC hospital provided care for 394 patients over 7 weeks, from April 10 to June 2, 2020. In this report, we describe our implementation strategy, including organization structure, admissions criteria, and clinical services. Partnership with government, military, and local health care organizations was essential for logistical and medical support. In addition, dynamic workflows necessitated clear communication pathways, clinical operations expertise, and highly adaptable staff.

Keywords: Boston Hope; Coronavirus (COVID-19); alternative care site (ACS); field hospital; post-acute care.

Fig. 1

Photograph of the field hospital in the final stages of construction. A downloadable PDF of this form is available at www.sciencedirect.com.

Fig. 2

Clinical care and operations organization chart. APP, advanced practice practitioner; LICSW, licensed independent clinical social worker; MD, physician; OT, occupational therapist; PCA, patient care attendant; PT, physical therapist; PsyD, psychologist; RN, registered nurse; RT, respiratory therapy; SLP, speech-language pathologist; UC, unit coordinator. A downloadable PDF of this form is available at www.sciencedirect.com.

Fig. 3

Admission inclusion and exclusion criteria. BiPAP, bilevel positive airway pressure; c-diff, Clostridium difficile; CPAP, continuous positive airway pressure; ED, emergency department; ESRD, end-stage renal disease; IM, intramuscular; IV, intravenous; NG, nasogastric; NJ, nasojejunal; SQ, subcutaneous; TPN, total parenteral nutrition. A downloadable PDF of this form is available at www.sciencedirect.com.