07/12/2020 | Press release | Distributed by Public on 07/12/2020 11:35
Relief Healthcare Facilities (RHFs): Established licensed healthcare facilities (e.g., hospitals, long-term acute care hospitals, long-term care facilities, and other licensed inpatient healthcare facilities) that accept patient transfers or share extra resources to extend conventional standards of care to as many people as possible during a crisis and therefore minimize the use of crisis standards of care.
Crisis Standards of Care: Standards of care that reflect a substantial change in usual healthcare operations and the level of care that healthcare providers are capable of delivering during a crisis. When a state government formally declares the need for crisis standards of care, this formal declaration enables specific legal/regulatory powers and protections for healthcare providers as they perform the necessary tasks of allocating and using scarce medical resources and adopting alternate healthcare operations during a crisis.
Medical Operations Coordination Cell (MOCC): A cell (group of medical operations experts) within emergency operations centers (EOCs) at the sub-state regional, state-wide, and federal regional levels that can assist in the transferring of patients between healthcare facilities. A MOCC makes data-and stakeholder-informed decisions to balance patient load and ensure high-quality care. MOCC decisions direct the movement of patients and resources from one facility to another or re-direct referrals of patients who would usually go to an overwhelmed facility or system to one that has the capacity to care for those patients.
Why This Guidance Is Needed
Many COVID-19 cases are geographically localized and can overwhelm local healthcare facilities. This means that healthcare systems typically have uneven distribution of COVID-19 cases, with some regions' healthcare systems experiencing patient surges while others have excess capacity for patient care. When healthcare facilities reach or exceed patient capacity, crisis standards of careexternal icon are often implemented. Healthcare systems entering crisis standards of care are faced with the tremendous challenge of providing high-quality care while allocating scarce resources.
Who This Guidance Is For
This guidance is for state and local emergency medical planners and all healthcare facilities, especially facilities in rural areas. This guidance outlines considerations around the transfer of patients, staff, and supplies between healthcare facilities to optimize patient care, balance resources, and minimize use of crisis care standards. One strategy is to identify relief healthcare facilities and either establish a federal, state, or regional Medical Operation Coordination Cell (MOCC) or coordinate with an existing MOCC. This guidance offers considerations for jurisdictions around patient safety and relief healthcare facility operations. Specific guidance related to the implementation of the elements highlighted in this guidance can be found in the Federal MOCC Toolkitpdf icon external icon .
Key Considerations for States
Many states and regions have drawn upon years of experience responding to past public health emergencies as they coordinate healthcare, public health, and emergency medical systems in response to COVID-19. One advantage of a coordinated approach is monitoring for resource-straining surges of patients and identifying facilities with available beds, staff, and supplies.
To optimize care for patients, some states designate facilities with available beds and staff as relief healthcare facilities (RHFs). RHFs are established licensed healthcare facilities (e.g., hospitals, long-term acute care hospitals, long-term care facilities, and other licensed inpatient healthcare facilities) that accept patient transfers or share extra resources to extend conventional standards of care to as many people as possible during a crisis and therefore minimize the use of crisis standards of care.
The Federal Medical Operations Coordination Cells (MOCCs) Toolkitpdf icon external icon offers flexible guidance to help regional, state, local, tribal, and territorial governments improve surge capacity and resource allocation across the healthcare delivery system during the COVID-19 pandemic.1,2> The toolkit provides a framework for states or local jurisdictions to establish RHFs. The primary goals for states identifying RHFs are:
Elements Needed for Use of Relief Healthcare Facilities
The following guidance is for state and local emergency medical planners and all healthcare facilities, especially facilities in rural areas, planning to identify RHFs, establish a MOCC, or coordinate with an existing MOCC. Guidance, tools, and resources for many of these factors can be found in the MOCC toolkitpdf icon external icon .
Relief Healthcare Facility Resources and Capacity
Interfacility and Patient Communication
SPOTLIGHT: Texas implements a Regional Medical Operations Coordinating Center
Texas used the existing regional trauma system as a stable framework for responding to the COVID-19 pandemic. Texas further strengthened this framework and response efforts by linking existing public health, acute healthcare, and disaster management systems to MOCCs. The state's experience demonstrates the benefits of having established systems for public health and disaster response.
Texas's system enabled and facilitated timely action by:
Building on this existing response framework, Texas implemented performance improvement processes to adapt the system to the response and achieve the best patient outcomes.
The Role of Regional MOCCs
The Regional MOCC bolstered the framework created by Texas's trauma system by:
SPOTLIGHT: Michigan's response to extreme surge in southeast regions
In mid-March, Michigan began to experience a significant spread of COVID-19 in the southeast region and metropolitan Detroit area - with peak hospitalizations of greater than 4,400. The Michigan Healthcare Preparedness Program quickly put into place a surge strategy that optimized the use of healthcare resources to save lives. A key piece of this strategy was using relief hospitals to extend healthcare to residents in need. Although Michigan encountered staff recruitment challenges for hospitals in minimally impacted regions, willingness of these hospitals to accept patients improved following requests from senior state leadership to hospital chief executive officers. The state's experience demonstrates the importance of monitoring statewide hospital status and facilitating direct connections between hospitals.
Extending Conventional Standards of Care
Michigan was able to implement the relief hospital concept using the following effective strategies:
During a 20-day period (April 1-20, 2020), nearly 1,000 patients were transferred between hospitals. About 85% of these patients were transferred through direct interhospital contact, and about 30% were transferred within healthcare systems.
The Role of Regional and State MOCCs
Michigan prioritized a facilitative role by establishing and supporting:
2HHS's Office of the Assistant Secretary for Preparedness and Response (ASPR) Hospital Preparedness Program (HPP) annual cooperative agreement recipients (62 states, select localities, territories, and freely associated states) and subrecipients (e.g., healthcare coalitions) may utilize this funding to operationalize a MOCC.external icon