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While Battling the Pandemic, Health System Prepares for Vaccine Rollout

Analysis  |  By Julie Auton  
   December 17, 2020

UNC REX Healthcare's CMO shares how the organization is planning for administering the COVID vaccine.

As the vaccine for COVID-19 is deployed to healthcare systems this week, HealthLeaders talked with Linda Butler, MD, vice president, medical affairs, and chief medical officer at UNC REX Healthcare in Raleigh, North Carolina, about their approach to the pandemic and what’s involved in vaccinating their workforce.

HealthLeaders: How has the community been responding to the pandemic?

Butler: It’s kind of interesting here. The state capital is in Wake County, so mass compliance is pretty good for the most part. In the more rural counties, you definitely see that mask use is optional. We’re at the point right now where it has impacted our numbers, in which we have more COVID patients in house and more staff either positive or quarantined because of community spread, than we did back during our previous peak. In July, we'd have maybe 45 COVID patients in house, and now we've got a little over 60, and our numbers of other procedures and patients have been really high. We hit an all-time high of 550 patients in the hospital last week and we're licensed to have 433 inpatient beds. So that tells you how full we are, and that people are just tired.

We’re continually asking people to wear a mask, social distance, wash your hands. Now, most of the media focus has been on the vaccine, and we're preparing for that. We're anticipating we'll get the vaccine on Dec. 17th, and will be getting 2,900 doses.

HL: What sort of planning has been required for administering the vaccine?

Butler: We have multiple calls each day across the system. Because we have a system central pharmacy, they're coordinating the supply chain. We have the ultra freezer here, so we don't have to worry about replenishing dry ice in storage containers.

We have a standing order that the system developed that we're getting approved at all of our entities. They’re helping us with adapting Epic, so that we have a standard workflow. We do a quick reg for our coworkers. We're a closed site; we're not immunizing people in the community, so that makes it a bit simpler. Before our interview, I was down in the auditorium where we're setting up our vaccination clinic, and we're going to try and have 10 stations to move people through. We’ll be immunizing on our very first day, taking it slowly and doing about 150 people, and then, ramping up pretty quickly to hit as many as 600 a day, so that we can get through our 2,900 doses. And then prepare for the second dose, which will happen in 21 days after the first one.

HL: That's an enormous effort. How are you going to do that and still conduct operations as usual with this added to your plate?

Butler: We have a great team and a lot of people have stepped up. We’ve asked people from our critical care transport--the EMTs and paramedics are able to vaccinate—and nurses from urgent care, so when they're off, they're going to be working a shift in the vaccine clinic. We’ve had to upload a lot of different files to the state because DHHS (Department of Health and Human Services) is having us log everything in through a portal. So we've all had to get portal access. It’s an amazing amount of work that's being done in a short amount of time, but it's going to be so worth it because this vaccine is really the light at the end of the tunnel. This is a way we can protect our coworkers, and eventually our patients, so that we don’t have to deal with COVID, since there's really no cure. If you can avoid the illness altogether, it's definitely the way to go.

HL: We’ve heard a lot about physician burnout. How are they holding up throughout the pandemic?

Butler: The physicians have been great. They've really stepped up and gone outside their traditional roles. When we first were dealing with COVID, there was a great sense of teamwork, everybody pulling together. We're looking to the physicians as leaders, as they get vaccinated to inspire their staff who may be worried about taking the vaccine. The docs also have had to cope with their own potential for exposure and make sure they're setting the example of wearing PPE appropriately. I can't say enough about how the team has pulled together. However, they are getting tired and don't have as much of a bench as the nursing staff. We're trying our best to make sure that we can get those at high risk vaccinated as quickly as possible.

COVID has really been sort of a burning platform. You have to adapt quickly. The standing joke was whatever we say today is probably going to change two weeks from now, and getting physicians comfortable with the fact that as the CDC guidance changes, that's how we change our process. One of our resilience webinars said that the waves are going to keep coming, so you might as well learn to surf, and our docs have definitely learned how to surf.

HL: What would you say to people who are afraid of getting vaccinated?

Butler: I will always take my chances with the vaccine--having a few side effects--rather than take my chances with the illness that can kill you. I have not heard of anything [severe side-effects]--a couple of allergic reactions, but I'll take my chances with that rather than dying.

HL: You started out in engineering and then shifted into medicine. Was that your intended goal or did something prompt you to move in the direction of healthcare?

Butler: I wasn’t one of those people growing up, thinking I am going to be a physician. My father had an illness while I was in college, and it interested me to help him go through that. I thought, I can probably do what the doctors are doing. So while I was in college, I did a lot of pre-med undergrad classes as my electives and finished off the engineering degree because I thought it might be useful. And I ended up completing that degree and then getting a master’s in medical physics. My undergrad was nuclear engineering.

It's really helped me more now being the CMO, because hospitals are very process-driven. The lessons learned in nuclear engineering, in which you want to be a high reliability organization, have made their way into healthcare. So I've come full circle. I started the performance improvement department at REX. We’re doing a lot of PI, and that department has helped with our quality objectives and goals. It’s been good to have been able to apply my engineering background to healthcare.

HL: What do you foresee for 2021?

Butler: I think getting back to a more normal state would be great. And making sure we take advantage of the lessons learned from this pandemic--that we need to have more things produced within the U.S., so we're not that depend on a foreign supply chain. And we don't forget that hand hygiene is good, no matter what infectious disease you're facing. Being able to accelerate certain processes to get a vaccine out in under a year is amazing. And hopefully we can accelerate other vaccines the same way.

Julie Auton is the leadership programs editor for HealthLeaders.

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