CHICAGO (April 10, 2020): Major metropolitan areas such as New York, Seattle, and Detroit have dominated news of the COVID-19 outbreak, but rural hospitals and health care systems must also prepare for a surge of coronavirus patients. Surgeons at one rural health care system on both sides of the New York-Pennsylvania border have reported on their preparedness response plan for dealing with the COVID-19 surge in an "article in press" appearing on the website of the Journal of the American College of Surgeons ahead of print. This rural surgery plan takes into account challenges unique to a rural population and geography, and it includes greater utilization of telehealth and coordination of resources and communications at affiliated centers spread over a large geographic area.
"We have an older patient population, and they have more comorbid conditions than what you might find in an urban area," said Jean Miner, MD, MHA, MMEL, FACS, a general surgeon at Guthrie Clinic/Robert Packer Hospital in Sayre, Pa., and article coauthor. "Our population is also very spread out, with about 77 people per square mile, and some of the research shows that up to 35 percent of the people in rural areas don't have Internet access. Some of our staff doesn't even have Internet access." By comparison, New York City has about 27,500 people per square mile.
Robert Packer Hospital is a 267-bed tertiary care teaching hospital in Sayre, a town of about 5,400 people, 270 miles northwest of New York City. It is the primary institution of the Guthrie Clinic, a nonprofit system of five hospitals that serves an area of about 770,000 people in 12 counties in northern Pennsylvania and the southern tier of New York State.
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"Our older patients are at risk of not only complications from COVID-19 and the higher mortality rates, but also have chronic diseases that we must also take care of to try to keep them out of the hospital at this time," Dr. Miner said.
Key components of the preparedness plan include:
Implementation of a screening process for visitors and employees (which began in early February) and tightening that process as more information about the coronavirus became available
Having nonessential staff work at home before such a mandate was in place from governors in either state
Conserving personal protective equipment (PPE)
Postponing elective procedures
Having a contingency plan to redeploy a pool of volunteer physicians and advanced practitioners to cover areas where they're needed during a surge of COVID-19 patients