Review of patient care at the TCF Center Alternative Care Facility during the COVID-19 pandemic
Klausner HA, Rockoff S, Beyer M, and Clayton P. Review of patient care at the TCF Center Alternative Care Facility during the COVID-19 pandemic. Academic Emergency Medicine 2021; 28(SUPPL 1):S393-S394.
Academic Emergency Medicine
Background and Objectives: The first confirmed case of COVID-19 in The U.S. was on January 19, 2020 and by the end of March, COVID-19 was in all 50 states. In Michigan, the first confirmed case was on March 10 and later that day a state of emergency was declared. Given the exponential growth of the pandemic, and with concern that hospital resources would be overwhelmed, local hospitals determined that the TCF Center (local convention center) in Detroit, MI would function as a site for an Alternative Care Facility.
Methods: Admission criteria included patients accepted as transfers from local hospitals, must be inpatient >48 hours, hemodynamically stable, >14 days from symptom onset (later reduced to 10 days) and requiring no more than 4L NC. The TCF Center was equipped to administer oxygen, IV fluids, perform ACLS, and send iSTAT and POC glucose labs, but there were no imaging capabilities, telemetry, consultants or critical care providers.
Results: 39 patients were admitted (one patient twice and another four times for total of 43 admissions). 23 were male and 16 were female, range of ages were 33-95 with an average of 66. The highest census was 21 patients. 14 patients required oxygen, and 25 did not. Length of stay (LOS) ranged from 1-19 days with an average LOS of 7.2 days. Of the 43 admissions, 13 were discharged to a private home, 1 to a homeless shelter, 14 to a nursing home, and 15 were sent back to the hospital. Of these 15 patients transferred back to a hospital reasons included fever (3) and chest pain (2) as the most common reasons. Other reasons include inability to take oral meds, dehydration, lethargy, atrial fibrillation, worsening dyspnea, falls, hyperkalemia, anemia and altered mental status.
Conclusion: The TCF Center had a capacity of 970 patients, but only admitted 39, much fewer than anticipated. At the time of design and construction of the facility, the COVID-19 pandemic was in an exponential growth phase and the facility was designed for a surge that never materialized. This may be due to difficulty of scientific models in predicting a novel pandemic course, the ability of hospitals to better care for a larger number of COVID-19 patients than anticipated due to an unprecedented decrease in routine hospital volume, and the beneficial effects of social distancing. Apart from the Javits Center in New York City, which saw 1,095 patients, other field hospitals throughout the country built in response to the COVID-19 pandemic saw equally few patients.