Equitable and timely access to outpatient COVID-19 treatment: A review of centralized workflow implementation at an integrated health system.

BACKGROUND: During the evolution of the COVID-19 pandemic, health care entities had to adapt to rapidly changing research and best practices in disease prevention and treatment to maintain the delivery of high-quality patient care. Prompt interdisciplinary efforts amongst physician, pharmacist, nursing, and information technology teammates are needed to develop robust centralized strategies to allocate and administer COVID-19 therapies in the ambulatory setting. OBJECTIVE: The objective of this analysis is to demonstrate the impact of a system-wide, centralized workflow on referral times and treatment outcomes for COVID-19 infected patients in the ambulatory setting. METHODS: Upon release of monoclonal antibodies for the treatment of COVID-19, a centralized approach for patient treatment referrals to the University of North Carolina Health Virtual Practice team was developed due to the limited supply. Collaboration with infectious disease colleagues played a pivotal role in the rapid application of therapeutic guidance and creation of treatment prioritization levels. RESULTS: From November 2020 through February 2022, the centralized workflow team facilitated the administration of over 17,000 COVID-19 treatment infusions. The median time from treatment referral to infusion was 2 days from a positive COVID-19 test result. From January through February 2022, 514 oral COVID-19 treatment courses were dispensed from the health system's outpatient pharmacies. The median time from referral to treatment was 1 day from diagnosis. CONCLUSION: Given the ongoing strain and demand of COVID-19 on the health care system, a centralized, multidisciplinary team of experts allowed for efficient delivery of COVID-19 therapies through one provider touchpoint. The collaboration between outpatient pharmacies, infusion sites, and Virtual Practice culminated in a sustainable, centralized treatment approach that supported widespread reach, and equitable dose distribution, to the most vulnerable patient populations.

Evidence-based smoking cessation interventions for patients with acute respiratory disorders.

Worldwide, tobacco use continues to be the most significant preventable cause of death and hospital admissions, particularly related to respiratory diseases. Acute respiratory illnesses requiring hospitalization provide an opportunity for nurses to intervene and help smokers quit. Of the three top hospital admissions related to respiratory diseases, chronic obstructive pulmonary disease (COPD) is the one that continues to have increased mortality whereas community acquired pneumonia and asthma have decreased over the past 5 years. The course of all three can be caused or exacerbated by continued smoking. This review describes the state of the science of nursing research focused on tobacco cessation interventions for hospitalized patients with COPD, asthma, or community acquired pneumonia. Additionally, we describe two evidence-based, nurse-driven, hospital protocols to treat tobacco dependence that can serve as models of care. Recommendations are made as to how to effectively promote nursing interventions for tobacco cessation in the acute care setting.

Evidence-based approach to an inpatient tobacco cessation protocol.

Tobacco use contributes to USD53 to USD73 billion per year in healthcare expenditures and causes nearly 440,000 deaths per year. Given the strong cause-effect relationship between smoking and poor health outcomes, it is critical that smokers are identified early and advised about smoking cessation. Furthermore, the Joint Commission now mandates that tobacco cessation advice be given to patients admitted with heart failure, pneumonia, and acute myocardial infarction. As such, an interdisciplinary group at an urban academic medical center developed and implemented a tobacco cessation protocol with the goal of identifying and targeting inpatient smokers through evidence-based education and counseling. The protocol focused on admission assessment, education, and provision of standing orders for medication treatment for nicotine withdrawal and/or tobacco cessation therapy during the inpatient encounter and referral for outpatient counseling at discharge.