For Healthcare Providers - MMS

Dear Healthcare Facilities, 

As the city starts to reopen, please know that the Convention Center Medical Monitoring Station (MMS) remains an open resource to you. Some important/helpful points about the MMS: 
We continue to accept Covid positive patients referred from Nursing Homes, Clinics, Urgent Cares, Emergency Departments, and the Inpatient Setting. 

  • We accept symptomatic Covid positive patients who require medical monitoring (see the attached document to review clinical criteria for acceptance). 
  • We accept asymptomatic Covid positive patients who need a place to self-isolate. 
    Our Public Housing Unit (PHU) for patients with PENDING tests has demobilized. We can no longer accept patients with PENDING tests. 
  • To organize the transfer of a patient to the Convention Center MMS, call the MMS transfer line at 504-323-1719.
  • Patients must be transferred with prescriptions. Please refer to the attached handout for prescription guidance, which varies based on clinical setting. 
  • Patients must be transferred with appropriate paperwork so we can provide the best and safest care possible. Please refer to the attached handout for required paperwork. 

Please disseminate this information to your staff so they have it on-hand for reference. Please don't hesitate to contact us with any questions. 

Thank you, 

The Convention Center MMS Medical Team 

MMS Healthcare Providers Information

In preparation for the surge of COVID-19 cases and the strain on hospitals in the New Orleans region, the State of Louisiana has opened a Medical Monitoring Station (MMS) in the Earnest N. Morial Convention Center to ease the burden on acute care hospitals. This document is to help healthcare providers understand which patients qualify for transfer to the MMS, the process to initiate transfer of these patients, and to provide answers frequently asked questions. 

As a Medical Monitoring Station, patient care capabilities are limited to providing basic medical services such as taking vital signs, providing over-the-counter medications, administering limited amounts of oxygen, and making an isolated environment available outside of the hospital setting.

April 17, 2020 update

As the MMS census continues to grow, we have identified the need to make a few changes, to ensure safe, quality care for all our patients. The changes include the following: 

  1. On Wednesday, April 15, 2020, the MMS temporarily reached capacity to care for non-ambulatory patients. For clarification, we define ambulatory as the ability to ambulate with a cane or walker with minimal assistance. Non-ambulatory patients typically require appropriately equipped hospital-grade beds and enough personnel to safely assist with turning, urination/defecation needs, and other activities of daily living. While the MMS team works to increase our supply of appropriate beds and personnel, the acceptance of non-ambulatory patients will, for the short term, be based on current bed availability. Please continue to refer patients as usual but please be aware of these temporary limitations. 
  2. Numerous patients have been sent to the MMS with wound care needs exceeding our capability specified by the admission criteria (once daily dressing changes). Several of these patients have come with extensive wounds requiring dressing changes four times daily, specialized beds to prevent wound progression, and wounds that require debridement and inpatient-level care. As a result, the admission criteria is being revised to specify that only stage one decubitus ulcers requiring once daily dressing changes can be accommodated. 
  3. There is a new “family line” that families and case managers can use to connect with MMS patients. The number is 504-356-2297. 
  4. A few modifications/clarifications have been made to our information handouts. Please disseminate these handouts to your staff to assist them with the MMS/PHU referral process. 

Thank you, 

The Convention Center MMS Medical Team 


TO QUALIFY FOR TRANSFER, PATIENTS MUST

  • Be referred by a physician, PA, or NP (e.g. working in a clinic, Urgent Care, ED, hospital)
  • Come from LDH Region 1, Region 3, or Region 9
  • Have a documented positive COVID test
    • Persons Under Investigation (PUIs) pending test results cannot be accepted. Please refer to the PHU Information Sheet for these patients.
  • Not meet any of the exclusion criteria described below.

EXCLUSION CRITERIA include the following:

  • Lacks a documented positive COVID-19 test 
  • Age < 18
  • Suicidal/ Homicidal/ Violent
  • Behavioral issue or disability requiring a 1:1 sitter
  • Altered mental status with delirium
  • Acute change in mental status
  • Alcohol dependence with possibility of progression to alcohol withdrawal
  • Decubitus wounds greater than stage 1
  • Wounds requiring more than once daily dressing changes
  • Requires suctioning
  • Requires aerosolizing interventions (nebulizers, CPAP, BIPAP, ventilator)
  • Needs continuous telemetry monitoring
  • Manifests critical or severe illness:
    • Altered mental status
    • Respiratory distress
    • Worsening respiratory status with
      • Respiratory rate > 24
      • Oxygen saturation < 91% on 3L NC (Note: a physician-to-physician discussion must occur for all patients with SaO2 92-93% on 3L NC)  
    • Mean arterial pressure (MAP) < 65 
    • Requires vasopressors
    • Unable to take PO medications or food (unless patient has a PEG tube) or has persistent vomiting
  • Hospice or palliative care patients with life expectancy < 14 days (Note: a physician-to-physician discussion must occur to accept any hospice or palliative care patient)


INSTRUCTIONS FOR INITIATING PATIENT TRANSFER: 

Call (504) 323-1719. This is an Acadian Ambulance Call Center that is working directly with the Convention Center MMS. They will verify the patient meets criteria, and if so, accept the patient for admission to the MMS and coordinate their transport. All patients must be transported by Acadian Ambulance. This transport is free of charge to the patient.

Physician-to-physician discussions must occur for any patients with SaO2 92-93% on 3L NC and for any hospice or palliative care patient before they will be accepted. This will be coordinated by the Acadian Ambulance Call Center during the transfer discussion.

THE CALLER WILL ALSO BE ASKED THE FOLLOWING QUESTIONS AT THE TIME OF TRANSFER REQUEST: 

  • Patient Name
  • Patient DOB/ Age
  • Is this a bariatric patient?
  • Does the patient have mobility issues?
  • Does the patient have an oxygen requirement?
  • Is the patient a diabetic on insulin? 
  • Is the patient in custody/currently incarcerated?
  • Is the patient DNR/DNI? 

ALL HOSPITALS ARE REQUIRED TO PROVIDE THE FOLLOWING FOR ANY PATIENT TRANSFERRED TO THE CONVENTION CENTER MMS: 

  • Medications:
    • Patients transferred from the inpatient hospital setting must be sent with a 14-day supply of all medications and medical supplies.
    • Patients referred by an ED, urgent care, or clinic must have 14 days’ worth of all medications and medical supplies e-prescribed, phoned in to, or faxed to CVS.
    • Patients referred by a nursing home must be sent with all of their on-hand
      home medications and 14 days-worth of all medical supplies.
    • For all non-emergent prescriptions, please use the CVS at 800 Canal Street, New Orleans, LA 70112. Phone: 504-528-7099, Fax: 504-528-7871. 
      • Specify “MMS patient” in the sig line
      • Rx’s received 8AM-3PM will be delivered the same day.
      • Rx’s received after 3PM will be delivered the next day by 11AM.
      • Medications that must be obtained more urgently after normal hours can be e-prescribed, phoned in to, or faxed to the CVS at 4950 W Esplanade Ave, Metairie, LA 70006. Phone: 504-888-9000. Fax: 504-888-7601.
    • Name and phone number of referring physician/PA/NP
    • Patient face sheet
    • Documentation of a positive COVID-19 test result
    • If coming from the inpatient or ED setting:
      • Discharge summary
      • Code status paperwork
      • Walker or cane as needed for mobility
      • Hospital arm band left on patient (please do not cut it off)
      • Notify the patient’s family of their transfer to the MMS

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MMS FREQUENTLY ASKED QUESTIONS (FAQ) FOR HOSPITALS

What types of services are provided at the Convention Center MMS? 

  • An isolated environment for COVID-19 positive patients
  • Twice daily vitals signs monitoring
  • Blood glucose monitoring for diabetic patients
  • Oxygen and titration up to 3L via nasal cannula for oxygen saturation >91% 
  • Food services and other feeding needs as provided with the patient
  • Bedside care—assistance with feeding, toileting, and ambulation 
  • Administration of medication provided
  • Refills of medications through outpatient pharmacy delivery
  • Refills of medical supplies through outpatient pharmacy delivery 
  • Limited in-house over-the-counter medications
  • IV fluid intervention, if needed (bolus only)
  • Limited emergency IV medications
  • Dialysis transportation for patients with already-established dialysis regimens 
  • Onsite paramedics to initiate care and transport of decompensating patients 
  • Limited nursing, nurse practitioners, physicians, and EMTs
  • Temporary housing

What types of services are NOT provided at the Convention Center MMS? 

  • Labs (blood, urinalysis, etc.)
  • Diagnostic imaging 
  • Physical therapy
  • Occupational therapy 
  • Suctioning (i.e. for patients with tracheostomies) 
  • Chemical/ physical restraint
  • Ventilator support
  • On-site pharmacy
  • On-site medical supplies
  • End-of-life care

WHO CAN REFER a patient? 

Any physician, PA, or NP working in a clinic, urgent care, ED, or hospital can refer a patient for acceptance/transfer. The patient MUST have a documented positive COVID-19 test to be accepted.

WHO DO I CALL to transfer a patient? 

Exclusively the Acadian Ambulance Call Center at (504) 323-1719 will coordinate all patient transfer acceptances and dispatch of units. 

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Can patients drive themselves to the MMS or be dropped off?

No. All patients must be transported by Acadian Ambulance, which is free of charge to the patient. 

What are the HOURS of patient admission/ transfer acceptance? 

Transfers are accepted 24/7. 

Who is the ACCEPTING PHYSICIAN?

Dr Wright Hartsell, MD is the accepting physician for all patients transferred to the MMS. 

How is NURSING REPORT given?

No nursing report will be required. A paper copy of the discharge summary should be included with the patient on transfer to include any information needed by the receiving team. 

Are patients with PENDING COVID-19 TESTS accepted?

No. All patients admitted to the facility must be confirmed positive for COVID-19 to reduce the risk that a COVID-19-naive patient is infected through nosocomial infection. At this time, the requirement is met only by a positive rtPCR test result for the patient.

Can a patient be sent to the MMS for the sole purpose of self-isolation?

Yes. Patients with mild illness who are COVID-19 positive and have a need for assistance with self-isolation can be referred to the MMS. 

How will MEDICATIONS AND MEDICAL SUPPLIES be supplied for patients?  

Patients transferred from the inpatient hospital setting must be sent with a 14-day supply of all medications and medical supplies.

Patients referred by an ED must have 24 hours’ worth of all medications and medical supplies, as well as 14 days’ worth of all medications and medical supplies e-prescribed, phoned in to, or faxed to CVS.

Patients referred by an ED, urgent care, or clinic must have 14 days’ worth of all medications and medical supplies e-prescribed, phoned in to, or faxed to CVS.

Patients referred by a nursing home must be sent with all of their on-hand home medications and 14 days’ worth of all medical supplies.

For all non-emergent prescriptions, please use the CVS at 800 Canal Street, New Orleans, LA 70112. Phone: 504-528-7099, Fax: 504-528-7871.

  • Specify “MMS patient” in the sig line
  • Rx’s received 8AM-3PM will be delivered the same day.
  • Rx’s received after 3PM will be delivered the next day by 11AM.
  • Medications that must be obtained more urgently after normal hours can be e-prescribed, phoned in to, or faxed to the CVS at 4950 W Esplanade Ave, Metairie, LA 70006. Phone: 504-888-9000. Fax: 504-888-7601.

 

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Are hospitals expected to send oxygen-dependent patients with a supply of oxygen? 

No. Oxygen is supplied by the Convention Center MMS. 

How are patients with OXYGEN REQUIREMENTS cared for?

Patients will have oxygen saturation measured twice daily and oxygen will be weaned based on protocol. We do not have continuous oxygen pulse oximeter monitoring. If the oxygen need increases to more than 3 LPM by nasal cannula, the patient will be transferred to a hospital. We are not able to provide oxygen by other delivery methods or give any nebulized treatments. 

Are patients with TRACHEOSTOMY accepted?

We have no capacity for suctioning in the facility, and we are not equipped to contain aerosolized infectious particles. Therefore, we are unable to care for patients with tracheostomies. 

Are you able to accept DIALYSIS patients? 

Fresenius, Davita, and DCI have agreed to provide dialysis for COVID-19 patients. All attempts should be made to coordinate dialysis services at one of these companies for a patient discharged with new dialysis needs. We have the ability to transport patients needing dialysis to COVID-19 dialysis clinics near the Convention Center, provided that the patients are ambulatory or can be transported in a wheelchair. We do not have the capability of drawing labs within the facility or weighing patients daily. The staffing ratio will be one LPN or medic per 15 patients, and active management of patients is beyond the capacity of this location. 

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Is WOUND CARE provided?

Basic, once-daily dressing changes can be performed by an LPN, medic, or medical professional school student. Complex wound care such as wound vac cannot be performed. A wound care team will not be available. If a wound progresses, the patient will be transferred to a higher level of care. 

Can HEART FAILURE PATIENTS be cared for?

The MMS does not have the capacity to perform labs, imaging, or active medical management of patients. The MMS can accommodate medication refills and monitoring for clinical deterioration necessitating transfer to a hospital. The MMS not have the capability of measuring daily weights or urine output.

Does the MMS care for FOLEY/CATH-DEPENDENT patients?

THE MMS does accept patients with urinary catheters and need for catheterization. The patient should be sent with 14 days’ worth of supplies to enable sufficient time to obtain replacements as needed. These supplies will be ordered as would normally be done for outpatients and not supplied by the facility itself. 

Can INCARCERATED patients be accommodated?

Yes, however, there is no additional security for these patients. Incarcerated patients must arrive with a security team and handcuffs/restraints, which must be provided for the duration of their stay. Please communicate this information to the patient’s security staff/jail for any incarcerated patient being transferred. 

Can SPECIAL DIETS be accommodated?

The contractor providing meals to patients is able to prepare special diets needed for patients.  

Are CHAPLAIN SERVICES provided at the MMS? 

Yes, a chaplain will be available to provide these services at the MMS. 

Does the MMS provide COUNSELING SERVICES? 

THE MMS does not have capacity to provide counseling in person or by telehealth. 

What can be done for HOMELESS PATIENTS?

Patients without secure housing can be sheltered at the facility and case management will help to coordinate a self-discharge.

Does the MMS provide HOSPICE/PALLIATIVE CARE services?

The MMS has limited capacity for active medical management of patients in need variable pain control during disease progression. Staffing ratios will be one LPN or medic per 15 patients. The MMS does not have in-house hospice or palliative care specialists. The MMS is unable to allow visitors in the facility. For this reason, the MMS does not allow any hospice or palliative care patients with a life expectancy less than fourteen days. A physician-to-physician discussion will be coordinated by the Acadian Ambulance Call Center to discuss the potential transfer of all hospice and palliative care patients to ensure adequate care for accepted patients can be provided. 

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What are the CHARTING CAPABILITIES of the MMS?

Only limited paper charting is available at the MMS using forms adapted from those used in emergency shelters during disaster response. The MMS does not have access to remote electronic records at other facilities. 

Can the MMS provide TELEHEALTH SERVICES?

The MMS does not have the capacity to perform telehealth visits. 

Will hospitals or primary care physicians be NOTIFIED OF PATIENT DISCHARGE from the MMS?

The MMS does not have a process for notifying hospital systems of discharge from the facility. The MMS is actively developing systems to notify primary care providers of discharge to facilitate this transition of care. 

How will it be determined WHICH HOSPITAL A PATIENT WILL RETURN TO if such transfer is indicated?

Critical patients are taken to the nearest appropriate hospital to meet their clinical needs. Non-critical patients in need of hospitalization can be sent to the hospital of discharge unless that hospital lacks a COVID-19 bed or services needed by the patient (e.g. COVID-19 ventilator, hemodialysis etc.)

What PAPERWORK will be provided to the patient UPON DISCHARGE? 

The MMS uses paper charts. In addition to the hospital discharge paperwork provided by the referring hospital, a brief, hand-written summary of care provided is be sent home with the patient. 

Do you have a WEBSITE?

Please visit http://ldh.la.gov/COVID-19Response for more information and updates on the MMS.

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Transfer Checklist:

  • Ensure patient qualifies for transfer to the MMS per inclusion and exclusion criteria 
  • Call the Acadian transfer center at (504) 323-1719
  • Address medication needs:
    • Patients transferred from the inpatient hospital setting must be sent with a 14-day supply of all medications and medical supplies.
    • Patients referred by an ED must have 24 hours’ worth of all medications and medical supplies, as well as 14 days’ worth of all medications and medical supplies e-prescribed, phoned in to, or faxed to CVS.
    • Patients referred by an ED, urgent care, or clinic must have 14 days’ worth of all medications and medical supplies e-prescribed, phoned in to, or faxed to CVS.
    • Patients referred by a nursing home must be sent with all of their on-hand home medications and 14 days-worth of all medical supplies.
  • For all non-emergent prescriptions, please use the CVS at 800 Canal Street, New Orleans, LA 70112. Phone: 504-528-7099, Fax: 504-528-7871.
  • Specify “MMS patient” in the sig line
  • Rx’s received 8AM-3PM will be delivered the same day.
  • Rx’s received after 3PM will be delivered the next day by 11AM.
  • Medications that must be obtained more urgently after normal hours can be e-prescribed, phoned in to, or faxed to the CVS at 4950 W Esplanade Ave, Metairie, LA 70006. Phone: 504-888-9000. Fax: 504-888-7601.
  • Provide patient face sheet
  • Provide documentation of a positive Covid-19 test
  • If coming from the inpatient or Emergency Department setting:
  • Discharge summary
  • Code status paperwork 
  • Walker or cane as needed for mobility
  • Hospital arm band left on patient 
  • Notify the patient’s family of their transfer to the MMS

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