Strategies for communication, surge planning, clinical care, and employee wellbeing have been published in NEJM Catalyst Innovations in Care Delivery. The strategies were based on the authors’ experiences in New York City, New York, during its time as the epicenter of the 2019 coronavirus disease (COVID-19) pandemic.
The authors of this article have been involved in the care of over 5000 COVID-19 patients in hospital for 2 months in academic, private, affiliated public and private hospitals. Despite different resources, affiliations, and patient groups, the authors state that ongoing collaboration and communication has resulted in strategies that can be applied to a wide variety of medical centers.
The authors organized their results into 6 response areas: communication, bed capacity and expansion, staff, triage, clinical care and staff wellbeing. For each domain they describe the challenge, the implemented strategy and advice for future steps. The following is a summary of these results:
- Challenge: The volume of information and the pace of change required executives to coordinate plans within and between hospitals and to disseminate information.
- Strategy: You used common and varied communication methods, including twice-daily inter-departmental visits, town halls, daily video conferencing, and email, to engage employees and address concerns. Residents received nightly updates that consolidated information about patient volume, key system changes, and ongoing challenges.
- Future: Further recommendations require the development of multimodal communication strategies and their adaptation to the needs of employees within and between the facilities.
Surge protection, extension of beds
- Challenge: Hospitals need sufficient beds in intensive care units, negative pressure rooms and continuous monitoring of oxygen saturation.
- Strategy: The rooms have been remodeled to facilitate negative pressure and continuous oxygen monitoring requirements and previously closed units have been revitalized. The staff also identified areas for a possible switch to Flex ICU rooms.
- Future: In anticipation of future COVID-19 hospital stays, it will continue to be ensured that sufficient space is available in the intensive care unit.
- Challenge: Ensuring adequate staffing, especially of intensive care nurses, in view of rapid patient fluctuations and the inclusion of staff who are new to the system or in the clinical area.
- Strategy: Personnel pools have been created for various areas, including outpatient doctors and nurses. Teams have been put together to ensure that sufficient expertise is available in each team. Each location conducted 60- to 90-minute clinical service orientations weekly, with a focus on treating COVID-19.
- Future: The authors emphasized that the same sources of personnel pools may not be available in the next wave of the pandemic. Institutions have to rely more on in-house staff than on volunteers. They recommended early training of doctors and nurses for intensive care.
- Challenge: the need to separate respiratory and non-respiratory patients on admission and develop a method to accommodate internal and external referrals.
- Strategy: The emergency rooms were divided into specific airway and airway areas, with systems in place to identify and hand over transfers.
- Future: For the next wave of COVID-19, continued planning for special emergency rooms is recommended.
- Challenge: Due to the novel nature of the disease and the limited evidence available, there have been many areas of uncertainty surrounding care.
- Strategy: Hospitals worked together to develop protocols in areas such as respiratory or kidney failure, code teams, end-of-life treatment, and therapeutic management of COVID-19 patients.
- Future: This work continues and not just among affiliated hospitals. Improved clinical guidelines and protocols are shared.
- Challenge: The exposure was unprecedented for all healthcare workers.
- Strategy: Access to mental health professionals and resources, including mediation, yoga, and adequate free time, was provided.
- Future: The authors emphasized the need for ongoing wellness programs for staff as the pandemic is a long-term challenge.
According to the authors of the article, “Collaboration within academic affiliations and more globally across the country will benefit leaders, employees and patients.” According to the authors, hospital systems are either now or likely to face a surge in COVID-19 patients, and this overview of strategies can be applied to COVID-19 and future disaster planning.
Schaye VE, Reich JA, Bosworth BP et al. Collaboration Between Private, Public, Municipal, and Federal Hospital Systems: Lessons Learned from NYC Response to the Covid-19 Pandemic. NEJM Catal Innov Care Deliv. Published online November 30, 2020. doi: 10.1056 / CAT.20.0343
This article originally appeared on Infectious Disease Advisor