Co-authored by Bryan Dickerson and Shawn Melvin
We recently sat down for a roundtable discussion with Hospital IQ experts and thought leaders to examine what conditions will be like on the ground inside a hospital before, during, and after a regional peak COVID-19 surge. The full discussion can be heard in the podcast below; this is a condensed and edited version of the conversation.
When you know a massive surge in patient demand is coming, whether in 1, 2, 3 weeks or more, what steps are people taking within a hospital or health system?
Shawn Sefton, VP of Client Operations & CNO: Disaster preparation itself isn’t new, we actually train for this. And over 25-30 years, I’ve seen these preparation efforts grow. Hospitals anticipating a COVID-19 surge right now are setting up command centers, triage areas, and honing general readiness.
But the scope of this pandemic is unprecedented. Additionally, we’ve never worried about available equipment and supplies before.
Shawn Melvin, Director of Product Management: There are a couple of levels of response right now. There’s the normal natural disaster response like when a hurricane is bearing down, and the extraordinary response.
One example of a normal response is canceling elective surgeries to open up space in the hospital, although that carries a significant revenue hit. There are a lot of discharges happening, but those are also being pinched by skilled nursing facilities and rehab facilities being reluctant to take patients that don’t have confirmed negative COVID-19 tests. The Centers for Medicare and Medicaid Services has relaxed their 3-day rule for inpatients to qualify for skilled nursing care for the first time in 50 years to help with that effort.
The extraordinary measures include things like converting all available internal, and even some external, spaces into overflow areas. Anywhere that can house a bed is being changed to inpatient care.
Bryan Dickerson, Senior Director, Healthcare Workforce Solutions: Patient census is actually low right now in regions where the surges haven’t hit. Beyond elective procedures being cancelled, people are avoiding hospitals unless totally necessary. Staff members are being sent home and rested ahead of the surge.
At the same time, administrators are formulating plans to augment critical care staffing with nurses from other units. They’ll create a buddy system in which trained and certified ICU nurses handle the critical patient activities that they are trained to perform and their buddy nurse, who doesn’t have the same level of training, handles the rest. Regulations are being relaxed here as well.
A couple decades of mergers and acquisitions have created a system in which 2, 3, or maybe 4 competing health systems cover entire regions. Do you expect these competitors to begin collaborating as they work through this pandemic?
BD: We’re already seeing some collaboration and collecting of information about resource availability in various regions. This may become more important depending on how COVID-19 spreads.
SM: In the past, there have been levels of collaboration in natural disasters as incident response teams spin up and local and state government coordinate their efforts. Sharing information and data is key right now, as everybody needs to understand what is available at all times. For example, beds, ventilators, PAPR suits, masks, and other supplies.
Let’s jump ahead and assume a region is right in the middle of their peak curve. What does it look like inside the hospital now?
SS: It’s a really, really tough situation. The big fear is that this won’t be just one or two days, but that it will be a sustained surge for several weeks. Even over-surge. Frankly, I don’t know what they are going to do. This is something that challenges us like never before.
Our solutions are focused on improving processes; eliminating time consuming manual processes and giving hospitals the gift of time. During this time of extreme duress, do you see hospitals and health systems abandoning processes, reverting to manual work, and just finding whatever works for a period of time?
BD: There will be extra work needed to find where there are nurses who can work outside their home unit despite their qualification level. Ironically, there are a lot of existing processes that are well defined due to current rules, but with those rules relaxed it’s now taking more time to arrive at decisions because of the ambiguity that has been added, so a conversation must be had.
SM: I think the system is going to change in a lot of positive ways. Telemedicine should ramp way up and stick after that. It could change how we look at inpatient and outpatient permanently. We should also expect a greater desire for the unification of information. People need to know the entire state of the entire hospital in a unified manner. Lastly, I expect a renewed focus on operational readiness and situational awareness.
Unlike a hurricane or other natural disaster, there won’t be an end, per se, to this pandemic. Cases won’t suddenly drop to zero. Post-surge, what does “normal” look like inside the hospital?
SM: Hospitals will want to manage length of stay so other patients don’t contract COVID-19 while in the hospitals. The average length of stay for COVID-19 itself is higher than the general average and that needs to be carefully managed as well. It’s very possible that 110% or 120% of capacity is the new normal for a while.
SS: We will see 24/7 operations. Elective cases will come back fast because the revenue they create will be desperately needed. And patients that have been delaying care will still need it. In some cases, more than they had needed it before. A huge question for me is, will supplies be available when hospitals are ready to resume normal operations?