Abstract
Background:UC San Diego Health System (UCSDHS) is an academic medical center and integrated care network in the US-Mexico border area of California contiguous to the Mexican Northern Baja region. The COVID-19 pandemic deeply influenced UCSDHS activities as new public health challenges increasingly related to high population density, cross-border traffic, economic disparities, and interconnectedness between cross-border communities, which accelerated development of clinical collaborations between UCSDHS and several border community hospitals – one in the US, two in Mexico – as high volumes of severely ill patients overwhelmed hospitals.Objective:We describe the development, implementation, feasibility, and acceptance of a novel critical care support program in three community hospitals along the US-Mexico border.Methods:We created and instituted a hybrid critical care program involving: 1) in-person activities to perform needs assessments of equipment and supplies and hands-on training and education, and 2) creation of a telemedicine-based (Tele-ICU) service for direct patient management and/or consultative, education-based experiences. We collected performance metrics surrounding adherence to evidence-based practices and staff perceptions of critical care delivery.Findings:In-person intervention phase identified and filled gaps in equipment and supplies, and Tele-ICU program promoted adherence to evidence-based practices and improved staff confidence in caring for critically ill COVID-19 patients at each hospital.Conclusion:A collaborative, hybrid critical care program across academic and community centers is feasible and effective to address cross-cultural public health emergencies.
Highlights
The UCSD Health System (UCSDHS) is an academic medical center with an integrated care network located at one of the most populous sections of the US-Mexico border area
The public health importance of this border area is well recognized given its population density and social, economic, and political importance [1]. The interdependence of these cross-border regions is characterized by high traffic across the US-Mexico border, at the San Ysidro Land Port of Entry [2], as US citizens and legal residents reside in Mexico for lower costs of living but maintain employment in the US
The Tele-ICU service began on June 22, 2020 with 12 sessions through Aug 1, 2020, with one patient case discussion per session alternating with review of a peer-reviewed journal articles regarding COVID-19 management
Summary
The UCSD Health System (UCSDHS) is an academic medical center with an integrated care network located at one of the most populous sections of the US-Mexico border area. Legal border crossings at the San Ysidro and Otay Mesa border normally exceed 130,000 daily and initially decreased to 40,000 daily with governmental COVID-19 travel restrictions in March 2020 but eventually returned to 80,000 daily by June 2020 [3]. During this time, more than 90% of crossings were by US citizens or legal permanent residents of the US. The COVID-19 pandemic deeply influenced UCSDHS activities as new public health challenges increasingly related to high population density, cross-border traffic, economic disparities, and interconnectedness between cross-border communities, which accelerated development of clinical collaborations between UCSDHS and several border community hospitals – one in the US, two in Mexico – as high volumes of severely ill patients overwhelmed hospitals
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