Issue Summary

Hospitalizations are increasing steadily throughout Missouri due to widespread COVID-19 infections, higher acuity patients resulting from deferred care during 2020 and the onset of flu season. While most hospitals have the space and equipment to care for the current influx of patients, many face staffing issues as employees take leave for their own illnesses, to care for affected family members, or to supervise children who are unable to attend school or daycare. There are considerations for hospitals to keep current staff working.

Issue Spotlight

The Centers for Disease Control and Prevention urges health care personnel who test positive for COVID-19 to be excluded from work until they meet the agency’s Return to Work Criteria. The guidance also provides strategies for hospitals to plan and prepare for staffing deficiencies. Hospitals should employ all contingency plans to prevent allowing infected individuals to work, which may include canceling or deferring nonessential procedures and restricting discretionary time off work. However, the CDC recognizes that facilities facing extreme staff shortages with no other mitigation options may need infected individuals to work who are well enough and willing to do so.

Staffing shortages are a reality in many hospitals reaching crisis status. The CDC urges hospitals to use contingency capacity strategies to plan and prepare for mitigating this problem. The agency’s Strategies to Mitigate Healthcare Personnel Staffing Shortages offers considerations for hospitals developing and deploying a crisis staffing plan related to COVID-19.

The CDC’s guidance is predicated on health care personnel wearing a face mask for source control while at work. Given ongoing shortages of personal protective equipment, facilities should refer to and implement relevant Strategies for Optimizing the Supply of Facemasks.

Considerations

In the event of critical staff shortages, some hospitals may need to require employees who are confirmed with or exposed to COVID-19 to report for work. As a baseline, hospitals deploying a crisis staffing strategy already should have implemented contingent strategies, such as canceling elective procedures and visits, and working with local health care coalitions and federal, state and local public health authorities. Hospitals are advised to consider the following when contemplating crisis staffing and whether to allow infected individuals to work.

• the type of staff shortages to be addressed
• the worker’s stage of illness –contagion levels are believed to be higher earlier in the illness
• the types of symptoms the individual is experiencing (persistent fever versus a cough or fatigue, which may persist beyond the point of contagion)
• the degree of direct interaction with patients, visitors and staff
• the type of patients for which the individual cares (e.g., those at high risk for serious complications due to COVID-19 versus those currently infected with the virus)

The guidance further urges hospitals to develop plans to inform patients and coworkers when health care personnel infected with COVID-19 will be allowed to work, and the precautions that will be taken.

MHA developed a fact sheet for hospitals to consider when responding to surges.

MHA Subject Matter Experts

Sarah Willson, Vice President of Clinical and Regulatory Affairs
swillson@mhanet.com | 573-893-3700, ext. 1304

Jane Drummond, General Counsel and Vice President of Legal Affairs
jdrummond@mhanet.com | 573-893-3700, ext. 1328