Becker's Hospital Review

42 CMO / CARE DELIVERY Where people go wrong with 'incidental' COVID-19 hospitalizations: It's time to refocus the conversation By Erica Carbajal T he current state of the COVID-19 pan- demic in the U.S. in many ways differs from earlier surges, with breakthrough infections now a norm and not the exception. With that has come a rise in what health ex- perts call incidental COVID-19 hospitaliza- tions, referring to patients who are primarily admitted for other ailments and test positive as part of routine screening. New York and Massachusetts have shied their reporting on COVID-19 hospitalizations, asking hos- pitals to distinguish between those who are admitted primarily because of the virus and incidental cases. And, as of Feb. 7, the Biden administration is looking to update data- reporting requirements for hospitals to distinguish between these cases as well. And while some may dismiss all incidental COVID-19 hospitalizations as a mere coin- cidence that surfaces when patients seek care for other ailments, and thus inconsequential relative to the 'real' COVID-19 hospitaliza- tion tally, health providers say that line of thinking is too simplistic. First, COVID-19 is a multisystem infection with variable presentation that can compli- cate care and worsen existing conditions, whether it's the primary reason for hospital admission or not. In a series of Jan. 4 tweets, Ashish Jha, MD, dean of the Brown Universi- ty School of Public Health in Providence, R.I., broke down a scenario involving an 86-year- old patient with kidney disease. "is 86 year-old had COVID a week ago with two days of fevers, sore throat," Dr. Jha wrote. "Two days of fever caused him to be- come dehydrated, go into acute kidney fail- ure. His COVID is 'better' but he's in the hos- pital with kidney failure. Was he admitted for COVID? No. With COVID? Yes." Additionally, all COVID-19-positive patients are isolated, and isolation rooms "are not plentiful," Dr. Jha said. Treating patients who incidentally tested positive for the virus can place the same demands on the system as a patient who was admitted primarily for the virus. For example, entering the room of any infected patient commands the same supply of personal protective equipment, he said. Across NewYork-Presbyterian hospitals, there are approximately 1,200 COVID-19-positive patients, Rahul Sharma, MD, emergency phy- sician-in-chief at NewYork-Presbyterian/Weill Cornell Medical Center in New York City, said during a Jan. 10 news conference. About 50 percent of patients were primarily admitted for treatment of their virus symptoms, such as difficulty breathing and pneumonia. e other half include patients primarily hospitalized for heart attack, stroke, abdominal pain and other infections who incidentally test positive. While the conversation on primary versus incidental COVID-19 hospitalizations is im- portant to shed light on the overall state of the pandemic and disease severity, the distinc- tion only goes so far, especially in the context of hospital capacity and labor shortages. For example, NewYork-Presbyterian is not chal- lenged by COVID-19 alone, Dr. Sharma said: Its emergency departments are seeing prepan- demic volumes — as opposed to the surge in 2020, when volume fell nearly 50 percent — and current staffing shortages are much more pronounced than earlier surges. n Why Billings Clinic is recruiting nurses from overseas By Kelly Gooch A mid a shortage of nurses at the health sytem, Billings (Mont.) Clinic is hiring international workers from multiple countries. The health system is bringing in the nurses through a partnership with Avant Healthcare Professionals, a Flor- ida-based company that provides international nurses to healthcare organizations in the U.S., spokesperson Zach Benoit told Becker's. As of December 2021, the health system had three nurses through its international nurse program, all from Thailand or the Philippines. Billings expects about 20 additional in- ternational nurses to arrive at the health system this year, from multiple countries such as the Philippines, Thailand, Kenya, Ghana and Nigeria. "The goal of this program is for these nurses to transition into permanent employees," Mr. Benoit said. "They're a part of our team from the moment they agree to come here, and we want them to make Billings Clinic their forever home." He said Billings is currently hiring for about 120 nursing positions and will continue to bring in international nurses as appropriate and, hopefully, have them transition in sev- eral years to permanent employee status. Billings is not the only health system to bring in interna- tional nurses. Detroit-based Henry Ford Health System, for example, in September 2021 revived its strategy of recruiting nurses from the Philippines. And the American Association of International Healthcare Recruitment re- ported in September that more than 5,000 international nurses were waiting on embassies and consulates to schedule processing interviews. n While some may dismiss all incidental COVID-19 hospitalizations as a mere coincidence ... health providers say that line of thinking is too simplistic.

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