Editor’s Note: The following article is part of an ongoing series offering our strategic advice and expertise on what hospitals, healthcare workers, providers, and caregivers 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.
As the spread of COVID-19 accelerates, health systems have been preparing for major stresses on their delivery systems. Many are entering crisis mode planning. Given that the rate of spread for COVID-19 is much faster than past epidemics, health systems may be impacted for a longer duration. Hence, much more rigorous and thoughtful planning is required - now. Below, we outline key issues hospitals and health systems need to consider in preparation.
Hope for the Best But Prepare for the Worst
Although much is uncertain, COVID-19 has the potential to create unprecedented demand for hospital beds - and particularly intensive care unit (ICU) capacity. At most hospitals, ICU capacity is in short supply on a normal day.
The implication is simple: hospital capacity will be tested like never before. Right now, hospitals must establish plans that will allow them to convert portions of their systems to deal with a surge of COVID-19 patients.
Front-Load Elective Cases While Still Possible
If COVID-19 patients end up consuming the bulk of your region’s hospital beds, systems would be wise to look ahead at planned elective procedures and front-load volume while they still have the capacity. This volume shift should be based on a mix of clinical, operational, and financial considerations, aiming to serve the patients most urgently requiring care before this capacity is otherwise consumed. If needed, some scheduling rules will need to be relaxed to allow for a surge of elective cases. Management should keep a close eye on COVID-19 volumes and be ready to quickly adjust elective volume as infection rates rise.
Evaluate and Develop Free-Standing Triage and Testing Sites
Developing locations where potentially ill patients can go for assessment and testing is essential. Early feedback suggests this may be more efficient and effective for both patients and providers. Further, by doing the testing in another location, hospitals and reduce the risk of contamination and patient queues at the hospital. This means providers have a better chance to care for those with heightened needs.
With COVID-19 consuming leadership’s attention, elements of strategic and transformation agendas will need to be put on hold.
Prepare and Redeploy Physical Assets and Human Resources to Create Crisis Capacity
Hospitals need to increase emergency department (ED), ICU, and medical bed capacity. Some alternatives to consider include:
Identifying and prioritizing dischargeable patients: This includes certain postoperative surgical patients and medical patients with infections treatable with outpatient antibiotic therapy. This will require setting up the processes and capability to follow-up with them at home, via remote monitoring and home health.
Developing alternatives to the typical hospital stay: Wherever feasible, avoid all but the most critical of admissions. It will be essential to leverage the capabilities of homecare services, incorporating remote monitoring and technology solutions to support continuity of care.
Creating extra capacity to cover for exposed front-line clinicians: This will require very deliberate and thoughtful capacity planning to avoid and/or limit exposure for back up staff. Plans should consider 20 percent of the workforce being unavailable and higher demand than usual for hospital care.
Testing and strengthening the supply chain and facility services: This includes stocking up on consumables, testing the local power plant, ensuring an adequate supply of food and water, and preparing security for peak demand times at the ED. For more information, see our COVID-19 considerations for healthcare providers.
Refreshing and testing existing ED triage protocols: ED triage will also need to be revamped, with clear signage and separation between symptomatic and other patients arriving and being care for at the ED.
Engaging With and Beginning to Manage High-Risk Populations Remotely
Since the population over 60 and with underlying medical conditions are at greatest risk of high severity and mortality, it’s imperative to reach out and care for them remotely. Many health systems know their high-risk population well. A prudent strategy is for the clinicians or care managers to reach out and educate them on steps to take to reduce their risk (such as stocking up on medications, food, and necessities, or reaching out for care via phone or virtual channels). Enabling this population with resources, alternative access options, and answers to their most frequently asked questions is key to maintain their health and help manage hospital capacity. (For more information on this, see our COVID-19 executive playbook for health systems.)
Enabling Medical Group Offices with Telehealth and Remote Care
Symptomatic and at-risk patients should be made aware of how to access care without putting themselves or others at risk. This is a prime time to use telehealth solution alternatives and phone triage. In case telehealth is not offered by the health system, ensure patients check their insurance coverage. Most large US employers today offer a telehealth service to their employees.
Reducing Workforce Exposure Through Flexibility
With numerous workplaces curtailing travel or office commuting, now is the time to test the workforce’s eligibility to work from home. Beyond the basic communication infrastructure required, Human Resource leaders must establish a clear view regarding which employees can work from home under different scenarios. For example, when schools close or self-quarantine is required, how will absenteeism rates impact care delivery? In past pandemics, some large health systems developed creative solutions for their workforce such as on-site daycare and hoteling. Now is also the time to identify clinicians currently filling back-office, training, and leadership roles. And then define if, and when, they will need to return to the front-lines.
Planning for Additional Temporary Capacity
It very well may be necessary to engage back-up capacity while preparing for increased volumes. It is very likely hospitals will not have enough ED or ICU capacity (specifically ventilators) to care for these patients. While health systems are planning for asset and staff redeployment, another group needs to think about alternative capacity, including partnership with other local providers, as well as creating temporary hospital-like settings through repurposing assets in the market. For example, with low-occupancy lodging or tent-based facilities.
Considering Longer-Term Implications
With COVID-19 consuming leadership’s attention, elements of strategic and transformation agendas will need to be put on hold. Systems should review their in-flight initiatives and re-prioritize to create bandwidth that can be redeployed. While priority is given to patient care, in-year fiscal projections will need to be updated, given the significant shift in patient mix and reimbursement driven by COVID-19 patients. A worst-case scenario will create a lift in demand that crowds out higher-margin service and patients, likely to detrimental effect. Start cost controls now on discretionary spending and consider a pause on major investments for a few months or more. Chief Financial Officers (CFOs) should consider their long-term financial sustainability and prepare to use their balance sheets strategically.
In the face of uncertainty, it’s prudent hospital and system leadership be proactive and take ownership of scenario planning. The clinicians and front-line staff will be heads down, focused on what they have in front of them. Those systems that think both strategically and tactically through this episode can better serve their communities and potentially emerge in a better, more capable position.