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“This is like nothing you have drilled for”

Editor’s Note: This is the fifth blog post in a series in which Leigh Burchell shares the lessons learned from conversations with industry thought leaders during the Virtual ACE Conference Oct 6-8. View the slides from “Our First-hand Experience with COVID-19 and the Lessons Learned” here.

I’ve had two opportunities to speak with Northwell Health Chief Medical Information Officer Dr. Michael Oppenheim: About the health system’s first-hand experience with COVID-19 in March and April of this year, as well as the lessons they learned that could be beneficial to others experiencing or anticipating a possible surge environment. Northwell has 23 hospitals and more than 4,000 physicians in a fairly compact geography.

In the early days of the pandemic in mid-March, Northwell experienced a dramatic drop in non-COVID patients and their COVID census shot up, peaking in early April with an inpatient volume almost one-third above normal. Inpatient and ambulatory surgery dropped to virtually nothing, and sadly, while it’s clear that other acute health incidents, such as heart attacks and strokes, were still occurring, the population surrounding the Northwell hospitals also experienced an increase in non-COVID deaths as people refused EMS transport or even died in their homes.

As the Northwell system began to adjust to the emergent pandemic situation, it took several key steps maximizing their health IT and other technologies:

  1. Built a COVID-specific data mart to enable emergency operations at the facility and central levels and understand supply/demand for services, equipment and care space
  2. Converted non-clinical space (conference rooms) and pop-up facilities to expand the number of general and intensive care beds
  3. Streamlined hospital administrative and provider processes to focus on patient care
  4. Assessed workflows to minimize exposure for care providers
  5. Maintained patient engagement/monitoring through innovative approaches (chat bots, video surveillance, wearable sensors, telehealth) that respected the need for patient isolation and efficient use of difficult-to-find PPE
  6. Launched new clinical decision alerts and pre-built order sets to assure rapid delivery of latest treatment protocols
  7. Participated in clinical trials as soon as two weeks after the pandemic hit New York
  8. Launched operational dashboards to facilitate cross-location monitoring that allowed patient load to be addressed

Dr. Oppenheim described how his team developed special documentation and tools for severity-based longitudinal monitoring of not only inpatients but also outpatients, and they used machine-learning-based predictive modeling to identify patients who might soon be ready for discharge to allow for bed capacity planning. Conversely, they also used machine learning tools to monitor clinical indicators that signaled a patient who was likely to decline so their teams could conduct goal-of-care conversations amongst themselves and with the patient’s family. (Based on that experience, Northwell made available for any interested organization a Survival Calculator to help clinicians in assessing their patients, and they recently launched a publicly-available tool predicting COVID caseloads based on web search volumes.)

Another topic addressed were the challenges associated with staffing during the height of their pandemic surge. At one point, several of the Northwell hospitals saw 20% of their registered nurses on leave, either because of their own illness/exposure or because of family impact, which unsurprisingly directly impacted the health system’s ability to care for the synchronous high patient volumes.

Accordingly Northwell’s human resources (HR) team was a critical partner in the COVID-19 care delivery process, taking steps to reassign clinicians from hospital-to-hospital or ambulatory environment-to-hospital, secure volunteers from as far away as Utah to come provide assistance, recruit new staff members, and leverage staffing agencies. There were also significant efforts made to look after the morale and emotional well-being of all staff as much as was possible, including financial bonuses and extra week of paid time off.

When asked what advice he would give to hospitals or physician practices facing a possible surge, Dr. Oppenheim said the following, “We have weathered major emergency events successfully before, but I would say, this is like nothing you have drilled for. You are not ready for this. You need to think through every bit of your operation, and don’t neglect the small details. Think about space, including how you will surge if necessary and where you will add beds. Additionally, the kind of absenteeism you will face will be nothing like you see after a weather event. Have you thought about a situation in which your oxygen system is overwhelmed, with as much as 80% of your census on high-flow oxygen? Imagine what it’s like to have a hospital where your staff can’t come to work, oxygen and ventilators are all fully utilized, you don’t have enough beds, and your patients all need to be isolated from their family members. Plan for that as much as you can.”

View the slides from “Our First-hand Experience with COVID-19 and the Lessons Learned” here.

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