Are Hospitals Ready for a Second Wave of COVID?

By John Palmer

Editor’s note: The following Q&A resulted from a conversation PSQH had with Stacy Pur, vice president of product development at Minneapolis-based VigiLanz, a company that provides real-time clinical surveillance systems for hospitals.

With a potential second wave of COVID-19 on the horizon for the fall, combined with the regular flu season, real-time surveillance alerts may be the key to infection prevention as well as mitigating and controlling future on-premises infections.

PSQH: If clinical surveillance is so important, why do only 29% of surveyed hospitals use it? What would improve the rate of surveillance usage?

Stacy Pur: Clinical surveillance is a fairly new technology, developed about 10 years after EHRs [electronic health records]. Unfortunately, some of the early clinical surveillance solutions were fraught with issues, such as issuing alerts that weren’t relevant, meaningful, or appropriate, as well as tedious, inefficient workflows. These factors contributed to a slow initial adoption rate.

Over the past few years, clinical surveillance has significantly improved, and hospitals are taking notice. While the survey found that currently only one-third of hospitals are using clinical surveillance, about half of those who aren’t using it yet plan to do so by 2022. Hospitals are increasingly recognizing its value, particularly as the technology continues to grow in sophistication and efficiency.

PSQH: What will COVID-19 tell us about the status of patient safety in healthcare facilities? Will it improve some things? Make some things worse?

Pur: While hospitals have made significant patient safety gains over the past few years, and while they have responded to the pandemic with heroic efforts, COVID has exposed some critical patient safety challenges at hospitals across the country. For example, many hospitals struggled with delayed COVID-positive patient identification, PPE shortages, ventilator shortages, and lack of adequate capacity during the first surge of COVID patients.

The pandemic also highlighted how technology and communication gaps can jeopardize patient care and staff safety. For example, from an infection prevention standpoint, the faster that healthcare providers have information about a patient’s risk of currently being infected with a contagious illness like COVID, the sooner they can isolate that patient and contain the spread, initiate contact tracing, equip staff with PPE, and begin treating the patient appropriately.

In the early stages of the pandemic, positive test results took days to come back. Hospitals needed technology that looked beyond test results to identify probable infectious patients who not only needed to be isolated, but also needed to have their contacts assessed. Many hospitals were able to do this, as well as respond more proactively to the threat of drug shortages, by deploying clinical surveillance. For example, Sharp HealthCare in San Diego set up rules in its clinical surveillance platform to alert relevant providers in real time when patients have symptoms consistent with COVID, when COVID test results are ordered, what the results are, and when select medications are ordered inappropriately.

COVID has taught us that when healthcare systems are stressed, patient safety is vulnerable. It has also shown that tools that improve efficiency for healthcare workers and that improve the quality and timeliness of information provided to healthcare workers have immediate positive impacts to the safety of all concerned.

PSQH: COVID-19 has made it so only about 40% feel comfortable going to a hospital, the place everybody should feel comfortable about going to for help. Why is this, and what are some of the things that need to be done to improve customer confidence?

Pur: At the height of the first wave, many hospitals faced unprecedented patient demand that strained EDs and ICUs, and created critical supply shortages. Customers felt unsafe because many hospitals were not safe. Crowded EDs filled with infectious patients, and hospitals lacked basic protective measures, such as PPE. This was a recipe for disaster and resulted in the deaths of several healthcare workers.

Hospitals learned a lot from the first wave. They are acquiring additional PPE, increasing training on infection prevention protocols and procedures, implementing new technology such as clinical surveillance that can help them more rapidly identify and isolate COVID patients, and modifying their contingency plans to include overflow areas when cases increase.

The key for hospitals moving forward is effective communication with customers regarding how they will keep them safe. Then, hospitals must actively model the steps they are communicating. A sign in the ED that says everyone must wear a mask is meaningless unless healthcare workers wear masks at all times. If patients are still waiting in communal areas, hospitals should consider having them wait in their cars.

Hospitals are taking extraordinary measures to improve safety and have learned some valuable lessons. They should continue to apply these lessons even after the pandemic begins to wane.

PSQH: What types of clinical surveillance tools would work best for most hospitals looking to improve patient safety in general? With less than 40% using technology to detect problems such as opioid problems and viral outbreaks, it seems there is a lot of work to do.

Pur: When hospitals first began implementing EHRs, many healthcare workers hoped the technology would make providing patient care much easier. Instead, in many cases, they are tied to screens responding to large numbers of alerts that are little more than white noise, performing redundant documentation, and struggling to find answers to the most basic questions. For new technologies to be successfully adopted and implemented, they must introduce meaningful efficiencies and naturally fit into providers’ everyday workflows. If it’s not easy for healthcare providers to use, and if it doesn’t communicate with established tools such as EHRs, meaningful data won’t be extracted, and providers won’t have the time to use it. Hospitals looking to implement clinical surveillance must prioritize solutions that have the sophistication to provide highly targeted alerts and offer seamless integration and easy implementation.

In addition, as we have seen with recent events, healthcare needs can change on a dime. Clinical surveillance technology needs to be nimble and responsive; able to adapt to the new needs of practitioners within hours, not weeks. For example, if a hospital’s top priority is reducing acute kidney injury, the clinical surveillance provider should be able to provide support that aligns with current industry gold standards, but that also can address the unique challenges specific to that institution’s patient population.

Key clinical surveillance attributes that hospitals should look for in a solution platform include the ability to do the following:

• Provide targeted real-time identification of patients requiring active interventions
• Identify and manage safety events in patients, employees, and visitors
• Provide ongoing, behind-the-scenes analytics detecting disease clustering, medication usage patterns, outbreaks, and other unusual trends of value to safety-driven cultures
• Identify complex medication errors or adverse events
• Identify opportunities to optimize care
• Identify opportunities to mitigate risk, such as opioid use

PSQH: With a possible second wave of COVID on the horizon, what are some of the biggest things that hospitals and healthcare workers need to be vigilant about? How will we know if a second wave is here?

Pur: The “second wave” is irrelevant, in my opinion. The reality is that COVID is here. Cases will wax and wane until an effective vaccine is developed and a large percent of the world population has been immunized or developed immunity. This will likely take years. Healthcare organizations must implement new strategies to rapidly recognize infectious individuals, screen employees, communicate shortages, assist stressed and/or infected healthcare workers, adapt to disease surges, implement telemedicine more broadly, and assure active and effective employee and public communication. These strategies should also remain in place permanently.

Most importantly, the science must continue to be actively monitored. Just recently, a new strain of influenza was detected, the G4 EA H1N1 influenza virus, which has acquired increased human infectivity. This is certainly not an immediate concern. However, COVID was “not an immediate concern” for months—until it was.

As healthcare organizations monitor the scientific findings that are helping improve COVID outcomes, vigilance around the next new concerns—whether they be infectious, economic, supply chain, environmental, or worker related—must be ongoing. Clinical surveillance tools that quietly monitor while supporting the science, and that alert healthcare providers when action is indicated, will be invaluable as we move into the new norms around the pandemic and challenges to healthcare in general.

PSQH: What should hospitals be doing right now to be ready for a second wave?

Pur: They should debrief on what has gone well and what hasn’t. They should consider not only implementing their best ideas permanently, but also sharing them more broadly with their peers. For areas where they were challenged, they should analyze and, if possible, test and implement new approaches.

If not yet in place, they should explore new technologies and solutions, such as clinical surveillance, cleaning solutions, and telehealth.

They should also assess their surge plans to ensure they have adequate PPE and other supplies and evaluate their overflow plans.

John Palmer is a freelance writer who has covered healthcare safety for numerous publications. Palmer can be reached at johnpalmer@palmereditorial.com.