Photo by Markus Spiske | Unsplash
Editor’s note: IHI acknowledges that some of the information below may not seem timely for all readers because of how quickly responses to the COVID-19 pandemic are evolving. However, we present this account of a recent IHI Leadership Alliance call because we believe it will be helpful to others. As the science advances, IHI is committed to continuous learning and improvement. We are working hard to determine how we can best help everyone in the global health and health care community.
On Thursday, March 12, IHI convened a special webinar focused entirely on COVID-19 and the stresses it is creating for our health systems. Panelists from the IHI Leadership Alliance included clinical leaders from two health systems operating within one of the epicenters of the coronavirus outbreak in the US. (We are maintaining the confidentiality of who said exactly what as this was a ground rule for the call.) More than 150 people dialed in for the webinar, representing health systems from across the US.
One of the first revelations from the clinical leaders on the panel was that the health system that treated one of the very first patients in the US with COVID-19 had recently conducted a drill for responding to a potential Ebola outbreak in its special pathogens unit. It’s hard to imagine a stronger demonstration of the importance of effective scenario planning and drilling. This kind of preparation and disaster preparedness, while usually unseen by the public, is a hallmark of effective health systems.
In addition to diligent preparation, the panelists extolled the virtues of rapid-cycle, real-time learning. They are using frequent structured huddles to share data, challenges, and ideas to improve. This kind of daily, iterative learning has been indispensable during the rapidly evolving crisis.
The delay in expanding access to testing was a major topic of the webinar. Shortages of the actual test kits and the restrictive rules about their administration severely compressed capacity as more patients needed to be isolated as they waited for results. The panelists did note that testing was starting to ramp up, but capacity remains stressed.
A surge in the “worried well” is accompanying the increase in people sickened by the virus, and further stressing systems. This is contributing to dangerous shortages, and not only in tests. Facilities are running out of personal protective equipment (PPE) for their staff, ventilators for their patients, and even general supplies.
These unprecedented circumstances have been met with ingenuity and innovation:
Floors are being opened and converted to increase surge capacity.
Short-term triage stands have been set up outside emergency departments to deal with the steadily increasing number of patients needing care.
Telehealth has proven effective in helping those at home who do not need face-to-face care. The panelists from one health system described how their telehealth department used an online retailer to get an oxygen saturation monitor and a thermometer to the homes of high-risk patients. Self-monitoring was complemented by frequent and regular check-ins from telehealth nurses. Clinicians can monitor patients at home, and the patients feel well-supported.
A key theme expressed by the panelists was that this is a community issue, not just a health care issue. Collaboration and coordination across health systems, local health departments, and state, and federal government have never been more crucial. Dealing with this pandemic requires transparent sharing of data – about patient load and capacity, about levels of supplies, and about the effectiveness of new models of care. Local networks also need to collaborate to use their collective voice to reach out to government when needed.
The final topic of the webinar was the workforce. The panelists described in detail the sobering challenges facing their workers. Many health care workers have contracted the virus or have been exposed to someone with the virus and are therefore quarantined and unavailable. Many others have been sickened. The cascade of school closings means parents with children need to be home to care for them, further reducing available staff. And the safety of the workforce is at risk as well, due to compressed capacity, shortages of PPE and other equipment, slow and at times conflicting information, and of course, the rapid spread of the virus itself. These burdens and risks are faced not only by clinicians, but by staff at every level and in every department.
Not surprisingly, the panelists on this special webinar painted a grim picture. What was surprising was the tone of their remarks – calm, confident, competent, hopeful. Health professionals and first responders are often celebrated in our society. Crises like this one are a powerful reminder of why.
You may also be interested in:
COVID-19 Clinical Practice Guidance and Resources
PPE’s for Health Care Workers: Act Now to Protect Those Caring for Us All