On December 8, the state will launch a program that aims to better equip Missouri’s rural hospitals to care for COVID-19 patients and avoid further strain on the largest hospitals. Some of the larger ones have had to stop accepting ambulances and patient transfers from rural areas for periods of time due to capacity problems.

Missouri Department of Health and Senior Services (DHSS) Director Dr. Randall Williams briefs Capitol reporters in Jefferson City on August 5, 2020 (photo courtesy of the governor’s Flickr page)

State Health and Senior Services Department Director Randall Williams tells Missourinet the program, called Project ECHO, stands for Extension for Community Healthcare Outcomes. ECHO will include specialists giving guidance to workers at smaller hospitals.

The University of Missouri is one of America’s pioneers of the program. Show-Me ECHO is a telehealth network that connects community providers with experts, building virtual learning and mentoring collaborative efforts to increase capacity for care.

Williams says the state’s program will allow human resource officers to offer ways to help maximize staffing, particularly among nurses.

“Where we find our rate-limiting staff is not beds. It’s not doctors. It tends to be nursing and ancillary personnel. Like 10% of those are affected by COVID. They can’t work because they either have COVID or they are quarantined,” says Dr. Williams.

He says the National Guard has helped hospitals during the pandemic, but he is not aware of soldiers helping with hospital staffing problems. The state is reviewing where it can get other nurses from, including other states and using LPNs and others to free up nurses.

Williams says the state is also converting ventilators to high-flow oxygen and making those available to smaller hospitals.

“There will also be a respiratory therapy component to that so that the respiratory therapists can know how to give high-flow oxygen, which is also something they don’t always do but is very much needed with COVID-19 patients,” says Williams.

Another element will involve long-term care facilities.

“One of the rate-limiting steps now is hospitals cannot discharge people who have recovered back to nursing homes. So, the ECHO covers both triage, I.E. referrals to tertiary care facilities. Reverse triage, which is getting people who have recovered back to smaller hospitals and getting patients out of all hospitals back into long-term care facilities. Listening to our clinicians, our intensivists and our hospitalists in both our large and small hospitals, they think all of those elements of patient care need to be addressed and that’s what the Echo will do.”

Will these efforts go far enough to prevent most transfers?

“That’s really a clinical decision that clinicians have to make. I probably wouldn’t speculate on that. I think what we’re very interested in is the whole chain of patient care,” he says.

According to Williams, Missouri also continues to review whether to temporarily waive regulations required of hospitals.

The program will launch on the heels of Missouri reporting today more than 2,900 new COVID-19 cases. Since the coronavirus came on the scene in March, the state has reported about 302,000 testing positive for the virus – more than 116,000 of those cases came in November alone. Missouri has had 4,006 people die as a result of COVID-19 and nearly 2,600 are in a hospital battling the virus.

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