Background: Rhode Island was hard hit by the COVID pandemic due to a particularly toxic combination of demographic factors. It is a densely populated state, with a large immigrant population. The populace is older, poorer, and less educated than the rest of New England. At Kent Hospital, in Warwick, Rhode Island, the first case in Rhode Island was diagnosed in February 2020 after a patient returned from a trip to Italy. As the pandemic progressed, Rhode Island and Kent Hospital quickly became inundated with COVID positive patients. Prior to the pandemic, the hospital’s capacity was typically one hundred eighty patients daily, with forty discharges daily and one hundred and seventy emergency visits. During the pandemic, these numbers dramatically shifted, with the hospital straining with two hundred twenty patients daily and about one hundred emergency visits daily. Approximately fifty percent of these patients were COVID positive. Like many hospitals across the nation, Kent Hospital struggled with the discharge disposition of the COVID-positive patients. Many patients had persistently positive COVID tests despite no longer being symptomatic. Nursing homes were hesitant to admit these patients into their general population, and, after severe illness patients were unable to return home leading to a backlog of patients.

Methods: Kent used a multifaceted approach to improve hospital through-put, communication with patients and quality. Measures included innovative staffing, with development of specialized communication teams, additional training of staff with the use of team meetings at Gemba boards; and new communication tools, including white boards and use of I-pads. With these tools, Kent Hospital was able to improve its patient satisfaction, hospital throughput and quality metrics. In addition, Kent Hospital established a Field Hospital to assist in the care of COVID -19 patients and it provided a safety valve for Kent Hospital. Although the more debilitated patients were not appropriate candidates for the Field Hospital, the medically stable patients on 6 liters of oxygen or less were able to be discharged to the Field Hospital for further care. This allowed the main hospital to focus on critically ill patients and the care managers could focus their efforts on discharge planning, setting up oxygen, and arranging home services.

Results: Using the Press Ganey Results, communication with nurses and physicians both increased despite restricted visiting hours and mandatory masking. Overall, patient satisfaction scores jumped from 59.3 to 64.6, an 8.9% increase from 2018. During the peak capacity period when the Field Hospital was open, the difference between ALOS and ELOS decreased by 0.5 days. The Hospital was able to maintain its surgical and endoscopic volumes. In April of 2020, both service lines decreased to less than twenty five percent of their normal volume. With the opening of the Field Hospital, Endoscopy maintained approximately ninety percent of its volume, while surgical services were operating at nearly a normal scheduled volume.Concurrently, Kent Hospital improved its Quality ratings, with an improvement in the Leapfrog score from C to B and its CMS rating from 2 to 3 stars.

Conclusions: The COVID -19 pandemic has been a challenging time to Hospitals across the world. Using innovative staffing, team training and with the opening a Field Hospital, Kent Hospital was able to meet to improve have improved communication with patients and families, improved patient satisfaction and maintain throughput.

IMAGE 1: During the surge, the Field Hospital allowed endoscopy, surgery and ED to maintain volumes.

IMAGE 2: LOS, Patient Satisfaction and Communication improvements