Indian Health Service Use of Critical Care Response Teams Has Helped To Meet Facility Needs During the COVID-19 Pandemic

WHY WE DID THIS STUDY

Coronavirus disease 2019 (COVID-19) is a highly contagious, sometimes fatal, disease that has disproportionately affected American Indians and Alaska Natives (AI/ANs). IHS and Tribal health care facilities are the main health care providers for the AI/AN population. Prior OIG work found that IHS facilities often lacked sufficient staff and had limited access to clinical specialists, as well as finding other quality-of-care concerns. One recent IHS effort to address staffing and quality concerns is its development of Critical Care Response Teams (CCRTs) to support IHS and Tribal facilities in caring for critically ill COVID-19 patients. This study examines IHS's first five deployments of the CCRTs, which provided services to six IHS facilities and three Tribal facilities from June through September 2020.

HOW WE DID THIS STUDY

We based our findings on document reviews and interviews with 74 key officials and staff at IHS headquarters, IHS Area Offices, IHS-operated facilities, and tribally operated facilities, as well as with contracted providers who served on the CCRTs. We conducted data collection in December 2020 and January 2021. We reviewed contracts and other documents related to IHS's deployment of the CCRTs. Topics for the interviews included processes for deploying the teams; roles and expectations; and strategies used to address any challenges encountered during the deployments.

WHAT WE FOUND

IHS designed and launched the CCRT program within a few months of COVID-19's reaching the United States. IHS awarded a contract in May 2020 to pilot the program and began receiving facility requests for CCRT deployments shortly thereafter. IHS expedited the credentialing and onboarding process, and the first team arrived onsite at a tribally operated facility in June 2020. CCRT teams consisted of a critical care physician, one or two critical care nurses, and a respiratory therapist, all deployed on short notice. At the time of our review, IHS had fulfilled all requests for CCRTs in a timely manner. While onsite, the CCRTs provided hands-on training to strengthen staff skills and capacity to handle surges of COVID-19 patients. Facility administrators found the deployments, which typically lasted 2 weeks, valuable. In interviews, IHS officials and staff credited the CCRT training with saving lives and stated that the teams' presence boosted staff's confidence and skills. Although the CCRTs focused mostly on training staff, the teams also provided direct patient care, particularly during patient surges. Throughout each CCRT deployment, facilities provided close oversight and communicated frequently with IHS headquarters and Area Offices about CCRT activities. In January 2021, IHS awarded two contracts to extend the program through the pandemic. Although none of the facilities in our sample planned to request another CCRT deployment, all facilities reported a need for similar resources to assist with non-COVID-19-related care.

WHAT WE RECOMMEND

To further leverage the successes of the CCRT model in support of IHS's broader care improvement efforts, we recommend that IHS (1) solicit feedback from CCRTs regarding their observations of potential need for broader IHS-wide improvements beyond COVID-19-related care; (2) share the CCRTs' recommendations across all IHS and Tribal facilities; and (3) assess whether IHS could use the CCRT model to provide support and training for non-COVID-19-related care. IHS concurred with our recommendations.