Integrated Network Health System Gains Advantages During Pandemic

Sutter Health capitalized on functioning as an integrated network and effectively increased critical care capacity by more than 200%.

Sutter Health—an integrated network of hospitals and physician practices in Northern California—has successfully navigated several challenges during the coronavirus pandemic.

The pandemic is the greatest public health crisis in the United States in more than a century. As of July 20, there had been more than 35 million reported coronavirus cases in the country, with more than 625,000 deaths, according to worldometer.

Sutter Health, which features 24 hospitals and more than 12,000 employed physicians, has posted impressive performance metrics during the pandemic.

• Acquired more than 35 million pieces of critical personal protective equipment, including masks, isolation gowns, and face shields for patients and healthcare providers
   
• Increased systemwide critical care capacity by 200%–300% to care for patients during coronavirus surges
   
• Doubled the capacity of the health system's electronic ICU program—providing all patients access to an ICU team regardless of hospital location
   
• Rapidly expanded telehealth—conducting 1 million video visits in 2020
   
• Reduced hospital length of stay for COVID-19 patients by 12 days—from 20 days at the start of the pandemic to eight days by the end of 2020
   
• Provided COVID-19 testing with the capacity to test thousands of patients per day during surges—performing 700,000 tests in 2020

Integrated network advantages

In the Sacramento, California–based health system's response to the pandemic, functioning as an integrated network generated several advantages, says William Isenberg, MD, PhD, chief quality and safety officer.

"We have had the capability through integration to move around material resources such as personal protective equipment, ventilators, and reagents as well as the capability to move around patients. If one hospital was overrun with severely sick patients and another one had available beds and ICU capability, that gave us a lot of latitude. We were able to load-balance on both the support material as well as the patients. That gave us a lot more capability than a single hospital would have," he says.

Functioning as an integrated network generated supply chain benefits, Isenberg says.

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"We have a supply chain that is coordinated across the enterprise. So, this enables us to benefit from bulk purchase pricing—we do not have individual purchasing managers at every hospital. It is all managed through a centralized strategic sourcing supply chain group. Through their contacts that they have established through years of relationships and preferred customer pricing, they were able to get us things that we needed well in advance," he says.

The scale of Sutter Health's integrated network was an advantage in sourcing personal protective equipment during the pandemic, Isenberg says. "When you are a big, bulk buyer, you are considered a preferred customer at places such as 3M that make masks. We had an edge on individual hospitals that might make a purchase of one or two cases of masks every three months—that is nothing like getting a truckload of masks every other week like we do."

Integration played a key role in reducing hospital length of stay for COVID-19 patients, he says.

"Imagine an individual hospital with 100 beds. If I am a doctor at this hospital and read an article that remdesivir is a good drug to use with COVID patients, I can try remdesivir on one or two patients, but I have not amassed any data to understand whether the drug is safe or effective or understand the best treatment regimen. Because we are an integrated health system, we were able to combine data from across several hospitals. So, the doctors down in Modesto who were seeing a lot of COVID patients could share their experience with a smaller facility that had not seen many patients, and they could say, 'Stay away from hydroxychloroquine. We have already tried it and got no good results from it. But dexamethasone with remdesivir lowers the length of stay.'"

Sutter Health was able to achieve a dramatic reduction in length of stay for COVID-19 patients, Isenberg says. "The first COVID patients we saw in our hospitals were with us for about 20 days. Three months into the pandemic, we had that length of stay down to about seven or eight days. We achieved that through the sharing of information as well as the constant commentary and discussion among our various sites."

Increasing critical care capacity

To prepare for potential COVID-19 patient surges, Sutter Health assessed the health system's critical care capacity early in the pandemic, Isenberg says.

"Early on, we started working with our analytics team at modeling what would happen if the New York experience came to California. They looked at our resources such as how many ICU beds we had and what it would look like if the New York experience happened here. In looking at the models they created, they realized that to be successful we would need about three or four times the capacity of critical care beds that we currently had. We had about 300 critical care beds and needed to boost that up to about 1,200," he says.

To meet the potential need for more critical care beds, Sutter Health focused on supply chain and staffing.

"We immediately contacted our supply chain and put in orders for 900 more ventilators. Fortunately, as we continually monitored what was going on, we never got to a point where we needed that many ventilators. So, we were able to back off from those orders, which is a nice thing about having established relationships with vendors. We were able to throttle our purchasing and delivery for things such as ventilators as we needed them," Isenberg says.

The health system took two primary approaches to increasing critical care staffing.

"One, we flexed nurses from various areas. The governor had suspended elective surgery, and we have many ambulatory surgery centers that have critical care–capable nurses. We uptrained them so they could function in the role of an ICU nurse. Two, my office credentialled all of our ICU doctors and other physicians who were capable of managing ICU patients. These doctors were credentialled at all of our hospitals. So, I could call Davis and have a physician go down to Modesto to work for a week as an ICU doctor," he says.

Another important aspect of increasing critical care staffing was boosting the number of electronic ICU-capable beds, Isenberg says.

"We have hubs—one in Sacramento and one in San Francisco—where we have 24/7 ICU capability with ICU doctors who monitor patients. We have cameras in the ICU rooms so they can see the patients. There are microphones so ICU doctors can talk with the nurses and the patients. That gave the doctors who were physically in the ICU the capability of having ICU-trained physicians monitoring patients 24/7," he says.

Related: Coronavirus: Northwell's 10-Step Recipe for Addressing Patient Surges