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Analysis

Atlantic Health System CEO: 'This is All-Hands-on-Deck'

By Melanie Blackman  
   November 19, 2020

Brian Gragnolati shares how the health system is handling COVID cases through a combination of predictive modeling, in-hospital and at-home care models, and playbooks created from their learnings so far.

As of Thursday, the United States had over 4.4 million active COVID-19 cases, according to Worldometer, putting the domestic total at over 11.8 million total COVID cases. Six months prior, there were just over 1.5 million total cases.

Similar to the nation’s upward trajectory in cases, New Jersey currently has over 89,000 active COVID cases, putting the state's total at over 295,000 cases.

Atlantic Health System, a nonprofit health system based in the Garden State, is handling this coronavirus surge through a combination of predictive modeling, in-hospital and at-home care models, and playbooks created from their learnings so far.

CEO Brian Gragnolati recently spoke with HealthLeaders about how they're grappling with the latest challenges arising from the pandemic, and what other health systems can learn from their efforts heading into the winter.

This transcript has been edited for clarity and brevity.

HealthLeaders: What are some learnings that you and Atlantic Health System have held onto since the onset of the pandemic?

Brian Gragnolati: Everything. We were in the epicenter in the spring [phase] of this pandemic. At our peak, we had over 900 patients in our hospitals. We had stood up hospital-at-home programs and had another 150 patients there. We also opened another facility where we had on average 50 patients. So, taking care of 14,000 COVID patients, and at our peak, we were taking care of the equivalent of about 1,100 inpatient [cases].

Today, we're at 110 patients in our hospitals and another 30 in our at-home program. The numbers are quite different for us than they were back then but the good news is that we were able, over the period from May through September, to bring our teams together, codify our learning through that process, and create playbooks that are in use today as we're seeing our levels of activity increase again.

At one of our hospitals, we took a lot of the learnings on the innovation that was done by our biomedical engineers and our nursing teams to create a unit that is dedicated to COVID patients. It's a 30-bed unit at one of our hospitals, and it stays empty until we have COVID activity, which we do now.

Consequently, we're seeing a lot lower ICU usage, mortality rates are lower, we're seeing patients can get in and get out of the hospital setting more quickly with supportive care around them. And so, we're enthusiastic about what we've learned and how we're applying it. And we see it each day and all of our clinical sites.

HL: As COVID cases increase around the country, what steps has Atlantic Health System taken to prepare for this second wave?

Gragnolati: We do a lot of modeling to try to understand where our activity levels are going to be, and we did that in the spring because we got a pretty comprehensive data set of claims and clinical information. We modeled the flu migration, and we put it on top of some of the other models that the federal government and the state were using, and we were able to predict more accurately in our market circumstance where we were going to peak and what we expected.

We're using that modeling again. One of the things that we've learned in this process is that we do not expect to hit that level of volume that we had in New Jersey during this current course of the pandemic. We say that for several reasons.

Governor [Phil Murphy] has been aggressive in taking the steps needed to try to get people to wear masks, to socially distance, to wash their hands, and to use common sense when they're trying to go on with their lives. At the same time, he's worked hard to reopen the economy and make sure that in a healthcare setting, people don't have to put off care, that they can re-engage and get that care done that they need to prevent more difficult things from happening.

In New Jersey, we've had a lot of this in place, and I think that that has helped us in this current outbreak. When I look at our activity over the last month, we're going up maybe 7% a day with the level of admissions that we have. Back in the spring in March, we were doubling every two or three days. So, the interventions that the state continues with are important.

The side effect of [these policies] is that this could also curb a flu season. When we're looking at our modeling … we're not seeing the flu in the same way that we saw in previous years. We hope that this message of getting a flu vaccine, wearing masks, and washing your hands will have a complementary impact on keeping the normal flu season down.

It was scary in March and April, and into May. We saw numbers that would have overwhelmed the healthcare system and ultimately threaded that needle.

Hospitals are safe, and even during the COVID pandemic back in the spring, we were still caring for patients who needed urgent or emergent care, and we did quite well with that.

What happens now, as we've worked through the summer, is we built that level of activity back up and patients have returned to the healthcare environment to get their needed care. Some areas have still not caught up yet, like the emergency department, [and] that's a national thing. Generally, surgeries have come back, and we continue to deliver a lot of babies.

What we've been able to do in our playbooks, whereas during the spring we had to on-the-fly create more ICU capacity, is have a plan on how to do that. We have trigger points on when we open certain areas for care, and how we went through that.

HL: What medical innovations are in place to care for those who get sick during this current surge?

Gragnolati: When this novel virus presented itself, we didn't know exactly how to care for these patients. What we had to do was treat the patients in ways that we treated other patients with similar problems and we had to do it aggressively.

We used the ICU a lot. We also used ventilators a lot because we felt that the lungs needed to be given a rest. It turns out that that earlier use of ventilators is not as effective as using things like proning patients, putting them on their belly, and giving them high concentrations of oxygen. That practice pattern was one of the early changes that were made and continue today. So, you're seeing fewer patients going on ventilators, which means you don't have all of the complications associated with long-term ventilator use.

The other thing that's happened over this period is that the drug industry continued to innovate. While there have been several candidate drugs that are being worked on as antivirals, the real innovation has come from how do we use other drugs that either were already here in place for other things or have been developed to deal with particular phases of the virus in certain types of patients.

We did have some promising news this week to vaccine candidates. The Pfizer vaccine, as Dr. [Anthony] Fauci said, is promising. I've had an opportunity to sit on the Professional Advisory Council here in New Jersey and we're working on the vaccine plan that was submitted to the federal government a few weeks ago.

The vaccine is not something that's going to impact our country or our world overnight. People are wary about taking a vaccine, and this vaccine in particular, because of a lot of political rhetoric around it has shaken the confidence of a lot of people.

The most important thing that's still a problem for us is testing because we will need a convenient test for the next couple of years at least, not unlike a pregnancy test. If we're going to completely reopen the economy, it's not just vaccines being available, it's got to be vaccines that are deployed and used. If we can continue to innovate around testing, that's going to allow us to move forward as a country.

HL: What advice do you have for hospitals and health systems that are experiencing an increase in COVID cases?

Gragnolati: The most important thing that you need to do is you need to have an all organization effort. This is all-hands-on-deck, particularly when you see the dramatic increases that we saw in the spring, and that many communities are seeing right now.

You need to trust your team, because the innovations and the things that got us through this were expert clinicians using their best judgment and ability to network with others, to try to figure out how to navigate this.

[And] don't underestimate the emotional impact on your team members. This concept of social distancing and isolation is a different way of practicing medicine. It has an emotional consequence on our team members. One of the most important things that we did early on, and continue to do, is to provide support for our team members because this is unlike anything that they've ever done.

We're used to taking care of sick people, but you can't compartmentalize this virus, because it's not just the work you're doing, it's in your communities, it's maybe in your home, and it's going to change your life. I don't know about you, but my Thanksgiving plans a different this year than they ever have been, and that's an emotional issue. It's one that we need to help our team members work through.

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Related: New approaches to coronavirus care have helped lower mortality rate, Atlantic Health System CEO says

“The innovations … that got us through this were expert clinicians using their best judgment and their ability to network with others to try to figure out how to navigate [the pandemic]. ”

Melanie Blackman is the strategy editor at HealthLeaders, a Simplify Compliance brand.

Photo credit: Hackettstown Medical Center located in Hackettstown, NJ. (Photo courtesy of Atlantic Health System)


KEY TAKEAWAYS

Through predictive modeling and utilizing playbooks, Atlantic Health System can successfully care for patients both in hospitals and at home.

CEO Brian Gragnolati says steps such as mask-wearing, social distancing, and handwashing, as well as state intervention, have helped curb COVID mortality rates and ICU usage in New Jersey.

Trust and an all-hands-on-deck attitude will help health systems during the current increase of COVID cases.


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