Would you provide some detail about how your system is being organized, transparent, structured and how they are communicating?
To be clear, this isn't a place that has been hit hard, but I still find it impressive, especially given how hard it is for things to change under normal circumstances. These are some examples of whats happened:
As far as transparency, starting late Feb/early March the president, CMO and head epidemiologist were giving updates by email followed by video conferences with Q&A (in-person in small room, by email, and by real-time chat) by mid-March about most up-to-date info about the virus. Recommendations for updates to PPE use for conservation were relayed regularly. These have continued in a more organized way with daily emails that outline updates in system-wide protocols, the total number of COVID pts in house (adult and peds), number treated to date, percent of positive tests per day and running percentage, number of screening visits, etc. They have also continued the video updates at least twice a week.
In terms of organization, within what seemed like a matter of days (less than a week) in early/mid March, in coordination with the FM department they created a brand new telemedicine Influenza-like illness clinic (along with the associated infrastructure, software, and EPIC updates required) staffed primarily by FM and outpatient IM attendings and midlevels and then later by inpatient IM and peds attendings as well. All traffic and pre-screen for triage to the ED or acute care clinics were filtered to that clinic, and they started out seeing 150 visits a day which peaked to ~400 and is now steady around 150-250 daily. Only people truly experiencing significant SOB went to the ED.
They also simultaneously created a Respiratory clinic housed in the FM clinic, which is in building connected to the hospital, but with a separate entrance for testing as well as evaluation of patients deemed stable enough to not need ED visits, but needing further eval like CXR or lung exam and additional testing (flu, strep, etc.). This was again staffed primarily by FM and IM staff. Eventually that clinic became so busy that it took over the whole of the FM clinic space and the FM clinic was completely transitioned to an off-site clinic (one previously used by FM, IM, and med specialties, which were seeing reduced pt volumes). This transition was literally done within 2 days with surprisingly few bumps.
The ED volume as a result of the telemed clinic and distancing recommendations plummeted allowing for increased isolation of pts (no more hallway beds, etc.). Multiple consult services transitioned to doing video visits with iPads in the ED while COVID tests were pending to minimize exposure/preserve PPE. We all received these durable full face shields in early April.
From the psych department, they implemented telepsych almost right away. They made hard rules for the inpatient units. They developed a volunteer hotline for Healthcare staff in March with regards to stressor associated with the virus. When the hospital started implementing significant visitor restrictions they asked members of the psych department to volunteer around the clock for de-escalation services, which they did readily. These are still going on through at least the end of May (although scaled back due to decreased demand). They developed in coordination with palliative ICU/psych teams for pts/families.
They gave everyone with patient care duties a small extra stipend at the beginning of April. They have been very transparent with us about potential effects of the economy/lost revenue on paychecks, and are trying to create a graduated system (i.e. the people with the highest salaries get the biggest cuts and the people with the lowest including all residents with get very little if any cuts).
They developed and implemented in-house, followed by rapid testing relatively early on (within days of the first other big institutions doing the same).
Honestly it's all been very impressive. There have been hiccups just like anything, and I think we all know how bad and limited testing was early on, but I'm impressed that they've been able to do all that they've done in such a short time, and I'm impressed that they've actually thought of all the things that they did. Its all given me a greater appreciation for the institution. Now certainly, I have my complaints and I believe they could certainly treat house staff better, but that's honestly one area that I don't feel has been an issue in all of this. They've treated us residents better than I expected in the setting of all this.
