Cohorting patients with COVID-19 is probably quite obvious, but it is probably a bit more nuanced that most folks think.  What is the best practice for unspecified viral respiratory illnesses, influenza, low risk COVID patients?  How is it best to staff these patients.

At first, people may think that it is best to share the wealth – that is, distribute these patients throughout the hospital so that there is not one group of nurses that is asked to care for COVID risk patients.  You may have in mind a “we’ll do that when we have 20 COVID-19 patients but right now we only have 50 cases in the state.”  The same may be said for hospitalists, where patient with viral respiratory illness are equally or just randomly distributed among different admitting and rounding hospitalists.  Taking this strategy will, unfortunately, put the adequacy of your workforce at risk –  doctors, PAs, nurses, PCA, etc.

The time to cohort patients on a physical unit is when a case of COVID-19 in reported in your community (anywhere in your primary or even secondary service area).  At that point, cohorting patients with viral respiratory illnesses on a single unit will help ensure an early COVID-19 positive patients are not exposed to multiple nurses on multiple units.  Similarly, hospitalists should be assigned to such a unit, and they should be assigned all patients on that unit with a viral respiratory illness, confirmed influenza, and COVID-risk as well as COVID-confirmed patients.  Those hospitalists should not rotate on other units, given possible transmission to other staff, and be sure to have in place tight social distancing capabilities when you do this.

Hospitalists should all get their turn on these units on which patients are cohorted, and be sure to consider the schedule carefully as you think about the current week and future weeks so that there is some equity in how these weeks are distributed.  Obviously, this may become irrelevant if COVID-19 volume grows considerably, but hopefully with social distancing, that will be blunted.  Your hospital should also be certain to have in place a clear surge plan, where COVID-19 units are identified, in sequential order, such that as volume grows the next unit for cohorting patients can be activated.   At that time, additional hospitalists will need to be assigned to that unit.