Response Plan for COVID-19 Draws on Lessons from Initial SNF Outbreak in Washington State

A group of researchers developed a plan for health systems to support skilled nursing facilities throughout the COVID-19 pandemic, a plan that drew on lessons learned from the first major outbreak in the U.S. — which also happened to occur inside a skilled nursing facility.

The three-phase approach was published in the Journal of the American Geriatrics Society, and was developed and implemented by the University of Washington Medicine’s Post-Acute Care Network, within its pre-existing SNF network.

The goal was to slow the spread of COVID-19, support local SNFs when they were “inundated with COVID‐19 cases or persons under investigation,” and to reduce burden for local clinics, hospitals and emergency medical services (EMS), according to the article.


“Having an established relationship with partnering SNFs undoubtedly provided a level of trust that allowed for effective coordination and delivery of services,” the authors noted. “By sharing the Three‐Phase Response as well as lessons learned while implementing this plan throughout the UWM PAC Network facilities, we believe this model will help other SNFs and health systems decrease spread of this communicable disease as a public health service and decrease the burden on local acute care hospitals, area clinics, and EMSs.”

The approach includes an initial phase, a delayed phase and a surge phase. The first addresses situations where a SNF has no cases of COVID-19 and focuses on communication, tracking and preparing personal protective equipment (PPE); the delayed phase focuses on situations where COVID-19 is confirmed at a SNF and zeroes in on education, testing and isolation.

The surge phase calls for the activation of a so-called “drop team,” in the event of an increase of COVID-19 cases and individuals under investigation for the disease.


The researchers noted that even in the initial phase, testing and tracking are crucial.

“Rapid turnaround times for testing are critical to allow for cohorting of patients and conservation of PPE,” they wrote. “UWM has not historically performed laboratory testing on SNF patients unless it occurs on UWM campuses. However, SNFs had limited access to COVID‐19 testing, and turnaround time from SNF site vendors varied between 5 and 7 days. Thus, a system was created allowing SNF sites to test all symptomatic patients and employees regardless of them belonging to the UWM Health System.”

This included setting up a centralized registry of patients in the population being examined, which allowed for facilities to get test results within 24 hours, a key step, given the fact that multiple medical groups and providers can be in one facility, according to the article.

In an accompanying editorial, Dr. Kathleen Unroe of the Indiana University School of Medicine and Indiana University Richard M. Fairbanks School of Public Health argued that the plan provides a road map for building on existing relationships between health systems and SNFs, as well as creating new ones.

“Too often transitions and communications across settings of care are characterized by fragmentation,” they wrote. “We cannot tolerate such risks to the safety of residents or healthcare workers in the era of COVID‐19.”

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