Editor’s Note: The following article is part of an ongoing series offering our strategic advice and expertise on what healthcare industry stakeholders should do immediately in response to the rapidly evolving novel coronavirus (COVID-19) pandemic. What follows are strategies and tactics that we hope will help hospitals and health systems prepare for and contend with the coronavirus pandemic.
Hospitals and health systems nationwide recently began reporting on the heroic acts of healthcare workers battling the COVID-19 pandemic. For example, one health system posted a list of shifts needing additional staffing. Within mere hours, their teams rallied together to sign up and help. At another academic medical center, doctors are signing up to work in labs to speed up COVID-19 testing. Retired doctors, nurses, pharmacists, and others have raised their hands to help too, and are now dusting off their stethoscopes. This is all happening because of a growing and very real concern for the healthcare workforce’s safety.
The demand for healthcare services, and hospital care specifically, is very quickly outstripping routine capacity across some facilities. Attention has already been given to the physical capacity of beds and equipment like ventilators and masks. However, we must now recognize the workforce constraints health systems and hospitals will face when attempting to care for an influx of hospitalized patients. Our learnings from prior outbreaks tell us these constraints will be exacerbated as clinicians are exposed to COVID-19 and need to self-quarantine.
The Chinese Center for Disease Control and Prevention’s recent statistics reveal that 3.8 percent of healthcare workers were infected in mainland China through February 11. Last week alone, 50 nurses in one Massachusetts hospital were quarantined after exposure to five COVID-19 patients. But quarantine is only one cause of a workforce shortage. As Oliver Wyman suggested earlier this month, some members of your workforce may also need to take sudden absence from work due to personal reasons, like the need to care for young children when schools close. Others may choose not to come into work out of fear of becoming infected and infecting others around them.
Healthcare is an industry in which the workforce largely cannot work from home during a pandemic. Although telehealth, widespread electronic health record adoption, texting, and the like mean we’re perhaps better prepared to manage a pandemic compared to five or so years back, doctors, nurses, pharmacists, respiratory therapists, and others are all greatly needed to decrease a patient surge. Yet, these healthcare workers also face the greatest risk of becoming infected with COVID-19.
Below, we illuminate six strategies hospitals should pursue to protect and best use their clinical workforce.
1. Isolate and distance your COVID-19 screening and testing areas from your main medical facilities.
Given COVID-19’s contagious nature, caring for symptomatic patients using standard workflows will put employees at risk. It’s no longer an option to cohort patients with either suspected or known exposure in the common waiting area of a clinic or emergency room. Consider alternative options, like how tents and drive-through testing have started popping-up outside hospital campuses – areas where only a handful of well-protected employees are testing and triaging patients. Also consider how leveraging your call center capability and ramping up virtual visits will greatly reduce your healthcare workers’ exposure incidents.
COVID-19 patients should only be admitted to a main facility (where non-COVID-19 patients are also receiving care) when they require hospitalization. And, your COVID-19 patients must remain in isolation from other, non-COVID-related staff and patients.
2. Specialize a designated COVID-19 staff to manage the front lines.
Healthcare workers’ risk of contracting COVID-19 can be mitigated by having only a designated portion of the workforce care for COVID-19 patients. This strategy will protect large parts of the workforce. And it will increase the competency of those repeatedly handling COVID-19 exposure (while also protecting other, non-COVID-19 patient populations). It’s also absolutely critical that those healthcare workers in your organization at high risk of developing health complications if diagnosed with COVID-19 are not in the designated caregiver group whenever possible.
3. Refresh your employees’ pandemic training.
Separate from how patient care staff has already been trained in the use of personal protective equipment, those staff members meeting COVID-19 patients should re-train regarding the procedures of donning and removing protective wear. All employees must be educated on what COVID-19 signs and symptoms they should monitor (like coughing, shortness of breath, fever, and others), and continue to monitor, in themselves. They should also be educated on the best protocol for seeking help if they suspect inadvertent exposure or infection.
4. Expect an uneven demand for labor.
COVID-19 patients exhibit similar symptoms and therefore require similar care pathways. As a result, some hospital roles will be in extremely high demand (like nurses) while others may appear idle (like surgeons). Last Sunday, the United States Surgeon General advised, for instance, that hospitals cancel elective surgeries. Hospitalists, pulmonologists, those working bedside, critical care nurses, respiratory therapists, imaging and lab technicians, and others will all be greatly needed in times like these.
5. Prepare for all hands on deck.
Given uneven labor demand across hospitals, there is now an opportunity to leverage clinicians’ capabilities in a different setting to support COVID-19 patient care. If, for example, elective surgical volume becomes significantly curtailed or canceled, surgeons, anesthesiologists, and operating room nursing staff can use their critical care training and be deployed in Intensive Care Units (ICUs). Similarly, Post Anesthesia Care Unit (PACU) nurses and others trained in Advanced Cardiovascular Life Support (ACLS) should be re-deployed to critical care areas if PACUs have not already been converted to ICUs.
For medical office employees, given non-acute ambulatory care is deferred and triage is occurring away from the medical clinic, some clinical staff from outpatient facilities – such as Registered Nurses (RNs), medical assistants (MAs), and patient care technicians – can return to inpatient duties for non-isolated patients. Others can help monitor mild to moderate symptomatic patients who don’t require hospitalization.
Physical and speech therapist roles are likely to be in low demand at this time. However, these individuals are already competent in vital sign assessment, screening, patient transport. Therefore, these individuals can perhaps help support these functions in times of staff shortage.
Some clinicians may be only employed as a partial Full-Time Equivalent (FTE). Leadership should identify these individuals and proactively seek to increase their availability to as close as a 1.0 FTE as possible. Now is the time to also identify what training refresher these individuals may need in advance.
6. Direct clinicians’ capacity to care for patients.
There are multiple pockets of clinical capacity across health systems that can be diverted to patient care.
In administration, for example, consider that every health system uses clinicians in roles other than patient care. Quality, Training, Information Technology (IT), and Administration are just some examples. Those clinicians, although vital for day-to-day routine operations, are already returning to the clinical setting to rejoin their colleagues in caring for patients. It’s essential to identify and tier which roles should be diverted to patient care to balance immediate needs with longer-term, infrastructure, and management requirements.
Just last Thursday, The Dean of the University of Washington School of Medicine asked its graduate students to pause current research and consider volunteering to help run COVID-19 lab tests. (These students will undergo training and will work under supervision.)
In research and medical schools, academic medical centers and systems can similarly leverage meaningful clinical talent across research, faculty, and student body to support patient care needs in medicine, nursing, and other roles. Similarly, bench researchers, trained in laboratory methods, should suspend current research activities to meet high testing demands.
In all instances, clinicians should receive concrete and clear assignments for a defined time period (for example, two weeks) prior to re-assessment and extension of duties as needed.
COVID-19 will put hospital staffing levels to the test, as it has in many parts of the world. These opportunities will hopefully leverage current staffing support of different patient care needs if thoughtfully considered before the peak patient surge arrives.