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. 2021 Mar;47(2):239-255.
doi: 10.1016/j.jen.2020.10.008. Epub 2020 Dec 11.

Use of the Donabedian Model as a Framework for COVID-19 Response at a Hospital in Suburban Westchester County, New York: A Facility-Level Case Report

Cairenn Binder, Rafael E Torres, Diana Elwell

Use of the Donabedian Model as a Framework for COVID-19 Response at a Hospital in Suburban Westchester County, New York: A Facility-Level Case Report

Cairenn Binder et al. J Emerg Nurs. 2021 Mar.

Abstract

The purpose of this facility-level case report was to describe our facility's leadership process of applying the Donabedian model to structure an early response to the coronavirus disease pandemic relative to emergency care. Using the Donabedian model as a guide, both structure and process changes were implemented to maintain high-quality clinical outcomes as well as ED staff safety and engagement. Rapid changes to the model of care, both architecturally and through the expansion of universal precautions through personal protective equipment, created the foundation for what was to follow. Clinical, service quality, and staff safety outcomes were evaluated to demonstrate that the collaborative changes that follow a known process improvement model can be used to address the coronavirus disease pandemic. Further study is needed to compare the outcomes of this facility-level case study with those of others to evaluate the success of the measures outlined.

Keywords: COVID-19; Donabedian Model; Emergency Department; Hospitals; Pandemics.

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Figures

Figure 1
Figure 1
Measures as described using the Donabedian model. COVID-19, coronavirus disease; PUI, person under investigation for COVID-19; UV, ultraviolet.
Figure 2
Figure 2
Coronavirus disease 2019 hotline call volume. COVID-19, coronavirus disease.
Figure 3
Figure 3
Percentage of ED volume tested for coronavirus disease 2019. COVID, coronavirus disease; ED, emergency department.
Figure 4
Figure 4
ED, emergency department; RN, registered nurse; NT, nursing technician.
Figure 5
Figure 5
Coronavirus disease 2019 screening performed in outdoor screening tent. COVID-19, coronavirus disease; EMS, emergency medical services; PPE, personal protective equipment; POC, point of care; RSV, respiratory syncytial virus; strep, group A streptococcal infection.
Figure 6
Figure 6
Departmental layout after structural changes. COVID-19, coronavirus disease; ED, emergency department.
Figure 7
Figure 7
Examples of personal protective equipment guidelines provided to staff. PPE, personal protective equipment; RN, registered nurse; NT, nursing technician; Rad, radiology; Resp, respiratory; COVID-19, coronavirus disease; PAPR, powered air-purifying respirators; MD, physician.
Figure 8
Figure 8
Admission criteria and clinical workflow. WPH, White Plains Hospital; COVID-19, coronavirus disease-19; ED, emergency department; PUI, Person Under Investigation for COVID-19; PCR, Polymerase Chain Reaction COVID-19 test; F/U, Follow Up; PCP, Primary Care Provider; RSV, Respiratory syncytial virus; CXR, Chest X-Ray; POC, Point-of-care; LUS, lung ultrasound; CT, Computed Tomography Scan; PSI, Pneumonia Severity Index; PORT, Pneumonia Patient Outcomes Research Team; MuLBSTA, (Score for Viral Pneumonia Mortality); CURB-65: (Score for Pneumonia Severity); PNA, Pneumonia; VS, Vital Signs; O2, oxygen; HR, Heart Rate; RR, Respiratory Rate; POX, Pulse Oximetry; NC, Nasal Cannula; WOB, work of breathing; HIV, human immunodeficiency virus; DM, diabetes mellitus.
Figure 9
Figure 9
COVID-19, coronavirus disease; C-CAT, COVID-19 Critical Airway Team; EM, Emergency Medicine Provider; ICU, intensive care unit.
See this image and copyright information in PMC

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