Strategies to manage of a surge of patients at hospitals during a pandemic include establishing a crisis command center and transforming infrastructure.
As coronavirus disease 2019 (COVID-19) patients are surging across the country, there are five strategies health systems and hospitals should implement, a new BDO report says.
New York is expected to experience the country's first peak of COVID-19 patients in the next week or two, followed closely by other hotspot states such as Louisiana, New Jersey, and Michigan. The surge of patients is straining hospital capacity, healthcare worker staffing, and supplies of personal protective equipment (PPE) and ventilators.
Deb Sheehan, managing director at the BDO Center for Healthcare Excellence & Innovation, told HealthLeaders that she is cautiously optimistic that U.S. health systems and hospitals will be able to manage the surge of COVID-19 patients.
"Managing challenges around the patient surge during this pandemic will require Herculean effort; but if our healthcare workers have shown anything over the last few months, it's that they are committed to the task. In New York State, as example, there is a significant difference between resource demand in New York City verses the upstate regions. As a result, healthcare providers in Upstate New York and from across the country, where demand is not as high, are now heading to New York City to help care for patients," she said.
The new BDO report features five strategies to cope with COVID-19 patient surges.
1. Establishing crisis command center and setting crisis manager roles
- Create a situation room staffed with the health system or hospital's most senior operational leaders. The situation room should focus on the most significant short-term and long-term questions, make key decisions, and communicate regularly with the C-Suite and/or board of directors. Examples of questions the situation room should address include how the organization can help care continuum partners and whether emergency credentialing processes are in place to boost the healthcare workforce.
- Create a war room staffed with multidisciplinary leaders from areas such as communications, finance, human resources, and supply chain. The war room staff helps the situation room find answers to questions.
- Create a press room led by senior communications and public relations staff to disseminate situation room decisions to internal and external audiences.
- Conduct a daily crisis command center huddle to help coordinate the efforts of the situation room, war room, and press room.
2. Transforming infrastructure
- Find unused or underused local facilities that would be fit for testing stations, triage areas, and isolation rooms. Assess hospital units that can be converted into private rooms for COVID-19 patients.
- Manage patient flow, "including separating the worried well patients from your worried symptomatic ones." For example, worried well patients should be directed away from hospitals to get guidance and at-risk patients such as the elderly should get care in quarantined areas.
- Assess elective and non-urgent procedures for postponement to increase capacity for COVID-19 patients. Guidance is available from the Centers for Medicare & Medicaid Services (CMS) and the American College of Surgeons.
- Work with public sector and private sector organizations to find unused facilities in your community that are suitable for hospital beds.
3. Streamlining processes
- Work with local primary care practices to set protocols for when it is appropriate to send patients with COVID-19 symptoms to a hospital.
- Contact your post-acute care partners about providing care to elderly patients and patients with underlying health conditions after discharge for COVID-19 critical care. Help post-acute care partners to have capacity to take these patients and expedite discharge to home.
- Assess the COVID-19 care activities such as diagnostic testing at local retail clinics and other outpatient sites. When appropriate, encourage patients to utilize these resources.
- Manage inventory of PPE such as communicating with existing suppliers and contacting nontraditional suppliers such as construction businesses.
4. Addressing workforce impacts
- Communicate clearly and effectively with frontline clinicians and other healthcare workers about important issues such as availability of PPE.
- Manage communication channels such as designating modes of communication for sensitive information.
- Adjust staffing with health and safety considerations such as moving administrative staff to evening shifts to lower exposure risks for the entire workforce. Consult with your staff about these changes, including the financial impact on workers.
- Increase remote work in departments such as finance, human resources, and information technology.
- Support staff with on-site services such as food and mental health counseling as well as provide supportive accommodations such as resting areas and shower facilities.
- Increase cleaning of campus surfaces and promote hand washing.
- Enlist local nursing and medical school students to perform functions such as patient communication, patient flow management, and care coordination.
- Recruit retired physicians and nurses to help address healthcare worker shortages.
5. Embracing telemedicine
- Encourage patients to utilize telehealth services.
- Learn about temporary telehealth rule changes such as CMS reimbursing telemedicine visits on par with in-person visits.
- Assess available telehealth equipment and review modifications of Health Insurance Portability and Accountability Act rules for telemedicine during the pandemic.
- Find opportunities for rapid adoption of telehealth capabilities such as video conferencing and bots that can help patients assess COVID-19 symptoms and answer basic coronavirus questions.
- Assess the performance and cybersecurity capabilities of telehealth technology. Performance levels impact patient experience, and telehealth technology should be vetted for cybersecurity requirements.
- Learn about temporary changes to the federal cost-sharing waiver, including the option to reduce or waive cost-sharing for telehealth services.
Christopher Cheney is the senior clinical care editor at HealthLeaders.
New York is experiencing a surge of hospitalized COVID-19 patients, with several other states expecting surges by the end of the month.
Several processes can be streamlined to address patient surges such as working with local primary care practices to stem the flow of patients to hospitals.
Opportunities to use telehealth services to ease the flow of patients to hospitals include bots that help patients determine whether they are at risk of coronavirus infection.