To cohort, or not to cohort? That is the question many hospitals have grappled with throughout the pandemic. As COVID-19 cases continue to be reported, hospital leaders are deciding whether to group COVID patients in one unit or to spread them out wherever beds are available. For Pennsylvania Hospital’s Jeffrey T. O’Neill, AIA, ACHA, senior director of Facilities, and Onyeka Nwankwo, MD, chair of the Infection Prevention Committee, there is no single best practice that all hospitals should follow. What is essential, though, is for facilities management and infection prevention teams to partner up to make these decisions.
“The COVID-19 situation calls for a team-based approach,” O’Neill said. “Because we were aware of what the surge plan needs were and what the infection prevention team required for effective patient care, we were able to problem solve the facility-related aspects and respond to those needs.”
This summer, O’Neill and Nwankwo wrote an article for Health Facility Management magazine laying out the benefits and challenges of cohorting vs. not cohorting. They noted that grouping coronavirus patients together in an area with their own dedicated care team reduces the risk of exposure both to other patients and staff, and it can be ideal when floors can easily be separated. But while this is the model PAH chose, opting not to cohort can also work well as patients return to the hospital after delaying their care. Patients coming in for surgery, for example, may test positive for COVID-19; not cohorting allows staff to use existing isolation rooms across units, rather than restricting COVID patients to one floor. Ultimately, hospitals must choose the approach that best fits their census and physical spaces, and that decision must be led by the infection prevention team and supported by facilities management.
“It’s important to remember that a decision made in the beginning of the pandemic doesn’t need to be continuous,” Nwankwo said. “As COVID-19 volumes change, hospitals should maintain an open conversation between all stakeholders to decide whether they should switch strategies. A partnership between facilities and infection prevention brings both areas of expertise to the table to make a decision that is best for patients and staff.”