By Tara Gibson - June 23, 2020
Although hospitals have to plan for outbreaks of Emerging Infectious Diseases, few were prepared for the scale of hospitalizations when the COVID-19 pandemic reached its peak in April. This is how two hospitals adopted innovative response strategies to combat the COVID-19 pandemic.
Despite it having been a busier-than-average flu season, many hospitals will have believed they were adequately prepared for an outbreak of an Emerging Infectious Disease (EID) when the Trump administration declared a COVID-19 public health emergency in January. Some had recently conducted Ebola emergency drills in response to the Centers for Medicare & Medicaid Services (CMS) updating its Emergency Preparedness Rule to include guidelines for EIDs; and - at the time - federal health officials were claiming the risk of contracting COVID-19 in the U.S. was low.
Fast forward a little more than two months and, by the beginning of April, hospitals were starting to be overwhelmed by the scale of hospitalizations. To exacerbate the situation, many hospitals were experiencing staff shortages due to healthcare workers also contracting the disease.
Hospitals coped in different ways during the peak of the pandemic. Many supplemented existing coronavirus emergency preparedness plans with innovative response strategies to combat the COVID-19 pandemic - most of which revolved around technology.
Undoubtedly, the technology with the most significant impact was video conferencing. Changes to CMS policies enabled healthcare organizations to expand remote telemedicine consultations in order that fewer patients with non-emergency conditions had to attend hospitals to receive medical advice.
Where video conferencing systems could not be used because patients did not have the necessary tools, emergency notification solutions with two-way communication capabilities were called into action. These also proved useful for alerting staff, patients, and families to confirmed cases. As more people signed up to receive emergency notifications, many hospitals and public health authorities took advantage of the growing database of subscribers in order to crowdsource coronavirus awareness, promote coronavirus best practices, and advertise coronavirus resources.
One health system that has taken full advantage of the available technology was Yale New Haven Health. The Connecticut-based health system was selected as an example of communication best practices by the American Hospital Association for developing a regularly updated web portal containing COVID-19 clinical resources for employees and an 833-ASK-YNHH call center for the community.
However, where Yale New Haven Health was most active was in the development of a patient portal and encouraging patients to use it via multiple communication channels. Through the portal, patients could request a physical appointment at any of the health system Urgent Care Centers, organize a video consultation on demand, view test results, and request prescription refills.
The health system also organizes COVID-19 webinars on Facebook Live in which members of the public can ask questions, and encourages people to prepare Medical History Information Forms in advance if they do not already use the MyChart system - a system similar to Smart911, but unfortunately only accessible to authorized personnel within the Yale New Haven Health system and not first responders.
The outcome of Yale New Haven Health's innovative strategies is that it coped much better during the peak of the COVID-19 pandemic than some surrounding health systems, and has already resumed non-emergency in-person appointments. According to a report in the CT Mirror, at the peak of the pandemic the system had “adequate supplies” of PPE, ICU capacity, and nearly half its ventilators still available.
Further east, the Boston-based Cambridge Health Alliance (CHAlliance) made wholesale changes to procedures in order to combat the COVID-19 pandemic. Adopting a community management strategy, the health system addressed a potential shortage of healthcare workers, PPE, and hospital beds by first identifying individuals most susceptible to COVID-19 and referring them to a telephone triage center.
The telephone triage center sorted individuals suspected to have COVID-19 into two groups - those with mild symptoms and those whose symptoms were more severe. The mild group was monitored by video conferencing every three days, while those with severe symptoms were referred to a dedicated respiratory clinic which provided medication to manage the symptoms and treat concurrent illnesses.
The hospital system has also arranged free COVID-19 testing across its coverage area, set up a multilingual resources platform for the community, and extended its CHA-Connect service to support residents experiencing issues with housing, obtaining food, mental health, and domestic abuse. These services are still ongoing and available to all community members regardless of insurance status.
The outcome of this strategy was that, of 1,100 individuals identified with severe symptoms, 92% were managed by the respiratory clinic team and only 8% were admitted to hospital - reducing the risk to healthcare workers, reducing the demand for PPE, and saving hundreds of hospital bed days. As a result, the CHAlliance hospital system has now also resumed non-emergency in-person appointments.
While the peak of the first COVID-19 pandemic may have passed, hospitals have to remain prepared for localized outbreaks and an anticipated second COVID-19 wave in the fall. There are also concerns that the fear of contracting COVID-19 dissuaded individuals with health conditions from seeking medical attention during the peak of the pandemic, and their conditions might have deteriorated since.
This is concerning because, according to COVID-NET, approximately 90% of hospitalized patients had one or more underlying conditions - the most common being obesity, hypertension, chronic lung disease, diabetes, and cardiovascular disease. If the condition of other individuals with these diseases has deteriorated due to not seeking medical attention - and the second wave of COVID-19 coincides with another busier-than-average flu season - the consequences for hospitals could be devastating.
Hospitals that found themselves overwhelmed during the peak of the pandemic in April could collapse under the demand for healthcare in the fall, while healthcare systems that adopted innovative response strategies to combat the COVID-19 pandemic may have to up their game again - adopting more technology and healthcare communication solutions in order to collaborate with public health agencies, engage members of the community, and manage staff during wholesale changes to procedures.
Tara is a Marketing Coordinator on the Rave Mobile Safety marketing team. She loves writing about all things K-12 education, and manages the Rave social media channels. When she's not working, she's taking care of her smiley, shoe eating, Instagram-famous fur baby, Enzo!
As the summer months warm up and states relax some of the strict social distancing and stay-at-home protocols first...