Weighing the benefits and challenges of patient cohorting

Hospitals have taken many approaches on arranging care for COVID-19 patients in hospitals. Driven by the needs of the care team, the overall census and severity of COVID-19 patients, and the physical constraints of the hospital buildings, two major care approaches are to: 1) cohort COVID-19 patients in specific sections of the hospital building; or 2) to spread these patients throughout the care areas based on medical conditions and availability of patient rooms.

With the addition of elective services and the increase of patients presenting for medical care other than COVID-19 but testing positive for COVID-19 after presenting, the need to determine an appropriate arrangement is significantly increasing. The decision-making around any approach should be led by the infection prevention and care teams, and the following paragraphs describe pros and cons for each.

Benefits and challenges of cohorting 

Grouping COVID-19 patients together in a devoted area enables dedicated staff to focus on the specialized precautions and personal protective equipment (PPE) needed to care for COVID-19 symptoms. It reduces risk of cross-contamination to non-COVID-19 patients that would otherwise be in the area.  Hospital systems can be modified in a focused manner to provide the proper negative air environment.  It can also help to reduce the use of PPE by implementing usage strategies within the dedicated area; although, there is also the concern that the longer a worker is required to wear the same PPE, the risk that they will fidget with it increases. From a staffing perspective, staff can be trained on and regularly practice specific care protocols, however burnout is a concern. Another concern could be the focus on COVID-19 symptoms and not on other medical care that could be needed for other patient issues. Cohorting works best when there is a more limited population of critical care or med-surg patients, and sections or floors can easily be separated.

Benefits and challenges of not cohorting

Given universal approaches to masking and precautions during care, not cohorting enables the use of existing isolation rooms and specialized environments throughout the hospital to care for patients with COVID-19 symptoms. It enables staff to maintain skills related to caring for COVID-19 patients and allows for specialized care to be provided. Not cohorting also limits individual staff exposure, however it increases exposure to more staff overall and creates difficulty in rapidly disseminating changes regarding best practices. Not cohorting is a good approach when a hospital has a high COVID-19 census or patients with less aggressive COVID-19 symptoms, and must use all available beds for the care.

As stated, the decision to cohort or not should be led by infection prevention professionals and the care team, but facilities managers should be aware of the reasons why the decision is being made and be ready to respond to the demands as required to support the best care possible for the patients.

Onyeka Nwankwo, M.D. is chair of the infection prevention committee at Pennsylvania Hospital, and Jeffrey T. O’Neill, AIA, ACHA, CHFM is senior director of facilities at Pennsylvania Hospital.