Clinical distancing of hospitalized patients with advanced heart failure and cardiac transplantation during COVID-19.

Our hospital system includes a central 825-bed, short-term, acute-care teaching facility where heart transplantation is performed under regulatory approval. Located 5.5 miles north of this main campus is a 107-bed cardiac specialty hospital, which operates on a single-bed concept that allows patients to remain in the same bed throughout their hospital stay. All rooms allow for the entire spectrum of care, including hemodynamic monitoring, peri-operative and intensive care, and complete cardiac and device management. At the onset of the expected surge of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), all elective cardiac surgeries and procedures were cancelled on both campuses. Because the central hospital was to be redesigned for the care of patients with COVID-19, we administratively decided to transfer all patients with advanced heart failure and cardiac transplant and services to the peripheral specialty hospital in an effort to protect immunosuppressed and vulnerable patients from exposure to SARS-CoV-2. The specialty hospital did not have a single case of COVID-19 at the time of this writing.

To accomplish this goal, on March 31, 2020, the United Network for Organ Sharing Membership and Professional Standards Committee's subcommittee granted our requested temporary change of geographic location for the cardiac transplantation program to the specialty hospital.

In addition to post-transplant patients, those transferred included 1 patient awaiting transplantation, 1 patient with severe rejection, and several other patients requiring intensive care unit care owing to recent implantation of ventricular assist device (VAD) or device complication of a previously implanted VAD. Cardiac transplant physicians and surgeons continued to care for patients on both campuses, with rotation adjustments to minimize exposure between the campuses. Experienced cardiac transplant critical care nurses accompanied patients on transfer and have continued to provide critical care support at the specialty hospital.

All patients were transferred without complication or worsening illness. Concurrently, we began admitting all post-transplant patients and patients with VAD with non–SARS-CoV-2 medical illness to the specialty hospital. Patients who have symptoms suggestive of SARS-CoV-2 infection and those under investigation continue to be admitted to the central hospital. Similarly, all patients with trauma or need for neurosurgical evaluation continue to be admitted to the central hospital as well. As of now, the 1 hospitalized listed patient underwent successful cardiac transplantation at the specialty hospital.

All employees of the specialty hospital were screened daily for self-reported symptoms through an online reporting system. Employees with symptoms suggestive of viral infection were tested at a testing center remote to the hospital and did not return to work unless symptoms resolved and testing was negative. Routine testing for asymptomatic carrier status has not been performed. Personal protective equipment has been widely available, and appropriate personal protective equipment has been used by all with patient contact (surgical mask for routine care and examination, N95 mask and face shield for invasive procedures such as bronchoscopy). The hospital has imposed a no-visitor policy.

As of now, our experience with this new paradigm has been successful and without significant complications. We propose that other multihospital systems with the option of transitioning advanced heart failure services to another institution consider this approach to preserve patient safety and outcomes. The success of such an initiative will require evaluation of outcomes once the threat of the pandemic settles down.