Strategies for communication, surge planning, clinical care, and staff wellness were published in NEJM Catalyst Innovations in Care Delivery. Strategies were based on the authors’ experiences in New York City, New York during its time as the epicenter of the coronavirus disease 2019 (COVID-19) pandemic.
The authors of this article were involved in caring for over 5000 hospitalized COVID-19 patients over 2 months at academic, private, affiliated public, and private hospitals. Despite differences in resources, affiliations, and patient populations, the authors state that ongoing collaboration and communication led to strategies that can be applied to a variety of medical centers.
The authors organized their findings into 6 domains of response: communication, surge capacity and expansion of beds, staffing, triage, clinical care, and staff wellness. For each domain, they describe the challenge, the strategy implemented, and advice on future steps. The following is a summary of those findings:
- Challenge: the volume of information and pace of change presented a need for leaders to coordinate plans within and between hospitals and to disseminate information.
- Strategy: they employed frequent and multiple modes of communication, including twice-daily intradepartmental operations calls, town halls, daily videoconferences, and emails to engage staff and alleviate concerns. Residents received nightly updates that consolidated information on patient volume, major system changes, and ongoing challenges.
- Future: further recommendations call for developing multimodal communication strategies and tailoring these to staff needs within and between facilities.
Surge Capacity, Expansion of Beds
- Challenge: hospitals needed sufficient intensive care unit (ICU) beds, negative-pressure rooms, and continuous oxygen saturation monitoring.
- Strategy: rooms were transformed to facilitate negative-pressure and continuous oxygen monitoring requirements, and previously closed units were revitalized. Staff also identified areas for potential conversion to flex-ICU spaces.
- Future: ensuring sufficient flex-ICU spaces are available continues in anticipation of future COVID-19 hospitalizations.
- Challenge: ensuring adequate staffing, especially ICU nurses, in the face of rapid patient surges and onboarding of staff new to the system or clinical area.
- Strategy: staffing pools were created for various areas, including ambulatory care physicians and nurses. Teams were constructed to ensure sufficient expertise was available in each team. Each site held weekly 60- to 90-minute orientations to the clinical service with a focus on the treatment of COVID-19.
- Future: the authors emphasized that the same sources of staffing pools may not be available in the next wave of the pandemic. Facilities will need to rely more on internal staff than on volunteers. They recommended early training of physicians and nurses for ICU care.
- Challenge: the need to separate respiratory and nonrespiratory patients at admission, and to develop a method to accommodate internal and external referrals.
- Strategy: emergency departments were organized into dedicated respiratory and nonrespiratory areas, with systems in place for identification and handoff of transfers.
- Future: continued planning for dedicated emergency department zones is recommended for the next wave of COVID-19.
- Challenge: there were many areas of uncertainty regarding care due to the novel nature of the disease and limited available evidence.
- Strategy: hospitals worked collaboratively to develop protocols in areas such as respiratory or renal failure, code teams, end-of-life care, and therapeutic management of COVID-19 patients.
- Future: this work continues and not only among affiliated hospitals. Improved clinical guidelines and protocols are being shared.
- Challenge: the strain was unprecedented for all healthcare staff.
- Strategy: access to mental health professionals and resources, including mediation, yoga, and sufficient time off were provided.
- Future: authors highlighted the need for ongoing staff wellness programs because the pandemic is a long-term challenge.
According to the article’s authors, “Collaboration within academic affiliations and, more globally, across the country will be beneficial to leadership, staff, and patients.” Hospital systems are either now facing or likely to face surges of COVID-19 patients, said authors, and this overview of strategies can be applied to COVID-19 and future disaster planning.
Schaye VE, Reich JA, Bosworth BP, et al. Collaborating across private, public, community, and federal hospital systems: lessons learned from the Covid-19 pandemic response in NYC. NEJM Catal Innov Care Deliv. Published online November 30, 2020. doi:10.1056/CAT.20.0343