Background: In April 2020, New York was the global epicenter of the COVID-19 pandemic. With as many as 12,000 new COVID-19 cases reported each day, many hospital beds and intensive care units were at capacity. As a part of Operation Gotham, the US Army Corps of Engineers transformed the Jacob K Javits Center in Manhattan into a 4,000-bed field hospital. This allowed nearby medical centers to transfer lower acuity patients to increase hospital capacity. To facilitate care of these transferred patients, four hospitalists from two tertiary care centers in the New York metropolitan area were redeployed to the Javits Center Medical Station.
Purpose: To create and utilize a model for hospitalists to provide safe and effective patient care at a field hospital during the COVID-19 pandemic.
Description: Four hospitalists from two New York metropolitan area hospitals were redeployed to the Javits Center Medical Station. Each hospitalist was assigned to a team consisting of three military physicians, and three advanced clinical providers. Military providers were trained in various medical and surgical specialties; only one military provider was a hospitalist. The patient census for each team varied but was generally about 30 patients. Shift duration was 12 hours and each team received one day off after four shifts. Hospitalists were redeployed for a period of two weeks at the peak of the pandemic in New York.Redeployed hospitalists assisted in the care of patients admitted to the Javits Center Medical Station. Nearly all patients were admitted with hypoxic respiratory failure and required supplemental oxygen. Hospitalists cared for these patients and identified those that were ready for discharge. Hospitalists also served as consultants to military providers and provided input on management. Diagnostic capabilities at the Javits New York Medical Station were limited to in-house basic metabolic panels and portable chest x-rays. All other laboratory testing was processed at an external laboratory with >24 hours processing time. Hospitalists screened incoming patients to ensure they could be safely treated given these resource limitations. Additionally, hospitalists were vital in identifying patients that developed complications that could not be safely treated at the medical station and required transfer to full-service medical centers.The majority of military providers were not from the New York area. Redeployed hospitalists provided insight on discharge planning issues unique to New York and worked closely with case managers and social workers. Hospitalists also utilized remote medical records access from their health system and professional contacts at local hospitals to obtain collateral medical information for admitted patients.
Conclusions: Field hospitals can offset the care of lower acuity hospitalized patients in medical centers that are at or near capacity. Hospitalists are uniquely positioned to identify patients that can be safely treated in these resource-limited settings. Additionally, hospitalists can provide effective patient care, serve as consultants to non-hospitalist team members, and utilize knowledge of regional nuances in healthcare to facilitate discharges.