Hospitals facing a growing population of COVID-19 cases need a coordinated approach with a multidisciplinary team to increase efficiency, conserve personal protective equipment and protect staff.
In "Hospital Preparedness for COVID-19: A Practical Guide from a Critical Care Perspective" – published online in the American Journal of Respiratory and Critical Care Medicine – experts from Weill Cornell Medicine and NewYork-Presbyterian/Weill Cornell Medical Center share their road map for meeting challenges posed by the pandemic, including an influx of critically ill patients.
As one of the nation's largest academic medical centers, Weill Cornell Medicine and NewYork-Presbyterian/Weill Cornell Medical Center boasts an experienced team of specialists and an array of resources. Physicians there used early lessons from existing data to help plan for a surge.
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WHAT'S THE IMPACT?
More than anything, hospitals should plan early, said Dr. Lindsay Lief, lead author of the guide and medical director of the medical intensive care unit at NewYork-Presbyterian/Weill Cornell Medical Center and assistant professor of clinical medicine at Weill Cornell Medicine.
That means planning early for equipment, beds and people, and listening to epidemiologists about the kinds of numbers to expect. Hospitals should plan for daily remote communications platforms, and support front-line staff – with big things like mental health support, and small things such as food, scrubs and hand lotion.
The authors wrote, "Given rapidly evolving data on the infectiousness of COVID-19, including from asymptomatic or paucisymptomatic patients, initial highest priorities included obtaining an adequate supply of personal protective equipment (PPE) for the staff and evaluating/expanding intensive care unit and ventilator capacity, among numerous other measures."
Lief and her colleagues, with the support of medical center administrators, called upon a number of resources to care for COVID-19 patients. The usual protocols were amended to expedite training of clinical staff to care for patients with acute respiratory distress syndrome, a disorder characterized by a build-up of fluid in the air sacs of the lungs, which deprives the body's organs of oxygen. Physicians (including residents and fellows), nurses, respiratory therapists and essential non-clinical staff began sharing responsibilities.
Clinical care doctors needed help – and got it. For instance, there are occasionally not enough patients who are well enough to exercise, so the hospital collaborated with physical and occupational therapists to make a "proning team," using their expertise on body positioning to help with flipping patients onto their stomachs to increase their oxygen levels.
Ultimately, the staff learned that daily clear communication is critically important, given the rapidly changing environment. Communication about PPE, infection prevention and control, and state and CDC guidelines was effective in reducing staff anxiety, and daily phone conferences with front-line physicians kept care staff cognizant of the ideal care for respiratory failure in light of new research and findings about the disease.
THE LARGER TREND
It isn't just clinical care staff that needs a plan. CFOs are scrambling to maintain a semblance of financial stability during the outbreak, and many have been focusing on a rolling forecasting mode of doing business, a practice that could continue post-outbreak.
Since budgets are typically thrown out after a month or two in normal circumstances, hospital leaders are eyeing a shift to month-to-month and quarter-to-quarter forecasting – the better to stay on top of hospital finances during a shifting and unpredictable situation.