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CASE Study: COVID-19 Post-Discharge
Patient Care Coordination Success
July 1, 2020 was not a good day for a local retired physi-
cian, who exemplifies the challenges of this second wave of
infections. He was hospitalized after four days of fatigue,
body aches, poor appetite, and a climbing temperature. Med-
ical training was not necessary to decipher that his symptoms
were inevitably linked to COVID-19. Arriving at the hospital,
he was quickly diagnosed with COVID-19 pneumonia and
acute hypoxic respiratory failure. During a hospital stay man-
aged by doctors from Texas Intensivists, Pulmonary and
Sleep Medicine (TIPS), he made notable improvements after
the administration of convalescent plasma and initiation of
Remdesivir. The inpatient team determined he was well
enough to go home, but being discharged on a holiday week-
end made follow-up care even more critical.
The continued rampant nature of the virus combined with
the patient’s history of sleep apnea, along with multiple other
cardiopulmonary issues, complicated his discharge. Once
home, an assigned care coordination nurse became con-
cerned about the patient’s continued severe shortness of
breath with hypoxia and confusion; however, the patient re-
fused to return to the ER. After the patient was unable to
be seen by his pulmonologist due to his COVID status, his
daughter called and requested help, fearing her father was
going to “pass away in his sleep.” Following his initial visit, Thank You,
the patient was seen for a curbside COVID swab on July 15 San Antonio Area
and is now utilizing remote monitoring devices for daily
monitoring of BP, pulse, oxygen levels and temperature. He Foundation!
is now asymptomatic and stable on home oxygen.
The Bexar County Medical Library Association (BCMLA)
The patient and his family have expressed their gratitude
wants to thank the San Antonio Area Foundation COVID-19
and believe that rapid access to care enabled the patient to Response Fund for providing a grant to help fund the ongoing
continue to improve at home. His caregiving daughter could Personal Protective Equipment (PPE) Project.
now return to her own home and work with peace-of-mind The COVID-19 Response Fund is a community fund jointly
knowing that her father was being monitored and supported. managed by the San Antonio Area Foundation and the United
Way of San Antonio. The fund is comprised of nearly 30 caring
The COVID-19 discharge clinic has received more than
businesses, donor advised funds, philanthropic foundations,
1000 referrals and successfully navigated the majority of and government entities. For a complete list of the donors to
these patients from discharge to recovery. The program has the COVID-19 Response Fund visit the San Antonio Area
worked so well that it will be handling additional diagnoses Foundation website https://saafdn.org/nonprofits/grants/covid-
19-response-fund/.
in the near future. Even more important than this possible
With the assistance of SAFER Texas (Strategic Alliance for
expansion, the clinical data gathered through monitoring Emergency Response), the BCMLA PPE Project has been
programs and survey data is a source of growing insight into able to serve over 15,000 medical professionals with upwards
COVID-19 and how it affects patients once they have passed of 300,000 pieces of PPE from March through September. The
the acute stage of the virus. project is ongoing and continues to fulfill orders from medical
practices every day.
If a medical practice is having trouble acquiring PPE, visit
Jairo Melo, MD is the Chief Medical Officer of Wellvana the BCMS COVID-19 Resources page on the BCMS website
and is a member of the Bexar County Medical Society. www.bcms.org and click on the Request PPE button on the
left-hand side of the COVID-19 Resources page.

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