The Santa Clara County Emergency Medical Services Agency is concerned about patient offload times at certain hospitals. The medical director is investigating new, creative workflows to help with some of the hardest hit hospitals, with a goal of getting 911 ambulances back into the system as quickly as possible.

CHA staff, RVP Jo Coffaro, and several hospital CEOs and government relations staff met with Assemblymember Evan Low (D-Campbell) on Nov. 23 and Assemblymember Marc Berman (D-Menlo Park) on Dec. 1 to provide an update on hospitals’ COVID-19 response and discuss key legislative issues for 2021.

On Nov. 16, the state moved Santa Clara County into the most restrictive purple tier and on Nov. 30, county officials issued revised and new mandatory directives, including requiring persons entering the county to quarantine for 14 days from travel of more than 150 miles.

In response to rising case rates and hospitalizations, the CEOs directed the formation of an ICU bed capacity work group to focus on volumes, constraints, and load balancing, and an emergency department (ED) surge capacity work group to focus on ED volumes, challenges, throughput, and ambulance patient offload concerns.

However, as inpatient hospitalizations rapidly increased, the hospitals decided to formalize a collaborative working relationship focused on the region by putting forth a framework to create a county-wide virtual bed management system, building upon each hospital’s commitment to the voluntary Hospital Mutual Aid System already in place in Santa Clara County.

• Daily COO Huddles — All hospitals participate in a daily huddle to share information and best practices, apprise each other of current issues/concerns, and identify immediate action items, including patient transfer and take-backs. Loading balancing and supply chain issues are standing agenda items. The county emergency operations center (EOC) is invited to receive an update at the end of the meeting.
• Weekly EOC Meetings — Each hospital holds a weekly 1:1 meeting with the EOC to review facility status.
• Weekly CEO Meetings with Public Health/EOC/EMS — The CEOs come together each week with county leaders to share information and apprise each other of significant issues/concerns.
• Transfer and Take-Back Agreements — The Hospital Council is working with hospitals on the status of these agreements and finding ways to streamline hospital-to-hospital transfers.
• Department-specific Meetings — The Hospital Council continues to convene department-specific groups and transfer center representatives.

There are several contributing factors to bed capacity issues, including COVID-19 outbreaks in congregate living facilities; behavioral health patients staying in EDs awaiting placements; limited stepdown options for some inpatients; and ED operations impacted by social distancing protocols and new cleaning regimes.