As of noon Tuesday, a new statewide order took effect for hospitals, mandating hospitals transfer patients to where beds are available, according to the state health department’s COVID-19 plan.

The Mississippi State Department of Health has issued a statewide order making participation in the Mississippi COVID-19 System of Care Plan mandatory for all licensed hospitals. The order will remain in effect until Jan. 23, unless revoked prior to that time.

“Due to the current wave of COVID-19 and limited ICU availability, and the inability of ill patients in rural areas to access care, MSDH is activating this Limited System of Care Plan,” an MSDH statement read. “All Mississippi hospitals must participate in the plan to allow the most critically ill patients to be transferred for care while not overburdening any hospital.”

The stated vision of the Mississippi COVID-19 System of Care Plan is that the plan “when fully implemented throughout Mississippi will result in a more efficient use of all Mississippi hospitals’ inpatient hospital beds and other resources for COVID-19 patients who require admission during COVID-19 crisis to achieve the best possible outcomes in terms of patient care for COVID-19 patients.”

King’s Daughters Medical Center Chief Executive Officer Alvin Hoover said the mandate will make an impact on a situation that is already stressed.

“KDMC will be impacted as we pick up more ICU patients, and more ventilator patients. Our nurse staffing and nurse/patient ratios are already very stressed. We have a more limited infrastructure and less capacity due to the nursing shortage than we have had at any of the other pandemic surges. I am afraid the rotation of care will only add more work to already overworked nurses and physicians in our ER and ICU,” Hoover said.

According to MSDH, the System of Care Plan provides a process for bidirectional patient movement to the most appropriate level of care for the individual patient while adjudicating available hospital capacity and capability.

The Plan’s criteria for patient transfer and transport are as follows:

 

Patient escalation

Moving patients to higher-level centers for required services to effectively manage COVID-19.

• Utilized when lower-level centers lack clinical resources
• Higher-level centers must have consultant specialists available within 30 minutes of request.
• Patients in cardiac arrest or post-cardiac arrest should not be transferred without discussion.
• Consideration should be given to patient demographics and comorbid disease state.

 

Patient de-escalation

Moving patients from higher-level centers to lower-level centers in order to maximize available COVID-19 capacity and resources for the acutely ill.

• Ventilated patients with only respiratory failure (move to lower-level ICU)
• Patients with SpO2 ≥ 88% on ≤ 6L O2 with stable respiratory status (move to lower-level med/surg)
• Convalescing patients that are unable to perform ADL’s, (would need med/surg bed and resources, e.g., OT, PT, Social Work)
• Qualifying convalescing patients that are able to perform ADL’s are eligible to be discharged to the existing Convalescent Centers around Mississippi.
• Long term care patients, nursing home placement patients
• Hospice patients

 

Additional considerations for COVID-19 transfers.

• Patients with active malignancies
• Patients with devastating neurological events
• End of life discussions at the day of admission/transfer (e.g. POST Form)