By Christopher Cheney
By multiple measures, COVID-19 has challenged healthcare providers more than any other public health crisis since the 1918 influenza pandemic. As the coronavirus pandemic enters its second year, many health systems, hospitals, and physician practices remain in crisis mode.
A pair of physician leaders at Cincinnati-based UC Health recently spoke with HealthLeaders to discuss how the health system has grappled with COVID-19. Following are four primary lessons learned from the coronavirus pandemic.
1. Strain on healthcare workforce
Healthcare workers have risen to the challenge, says Dustin Calhoun, MD, medical director of emergency management at UC Health.
“In emergency management, there is a concept that in a major disaster such as this pandemic only 50% to 60% of your healthcare workers will show up for work. In the face of personal danger to themselves and their families, a significant number of healthcare workers would stay home. We had always planned based on that concept, but that turned out to be very much not true,” he says.
Particularly at the start of the pandemic, UC Health’s workforce faced daunting uncertainty, Calhoun says. “The amount of willingness of healthcare workers to put themselves in danger has been remarkable. Our personal protective equipment practices are excellent now and our supplies are excellent now, but we did not know that in the beginning.”
“When the pandemic started, we did not know a lot about the virus. In the first few months, there were educated guesses at best. Yet, healthcare workers took those educated guesses, put the PPE on, and took care of the patients. For most healthcare workers, this is probably the first time in their career that doing their job put them at significantly more risk than they anticipated when they went into the field. We all knew there were risks in healthcare such as needle sticks. But in the beginning of the pandemic, the perceived risk of personal danger was high,” he says.
Huddles have played a pivotal role in supporting healthcare workers during the pandemic, says Jennifer Forrester, MD, associate chief medical officer and an infectious disease specialist at UC Health.
“We started having huddles before work shifts prior to the pandemic and that was one of the things that was helpful for the staff over the past year. Instead of coming to work, getting your assignment, and doing your job, you come to work, and everybody meets before the shift begins. Some of the people from the prior shift meet with the people from the new shift,” she says.
“During these huddles, you not only talk about patients but also talk about what is going on in the bigger picture. You discuss what everybody needs for their shift. And the huddles are not limited to the micro level of a clinic or a unit. We made a system that allows concerns raised in the huddles to escalate to the executives, including employee well-being, which is one of the things stressed in the huddles,” Forrester says.
The health system’s employee assistance program (EAP) has also been critically important to supporting healthcare workers, Calhoun says.
“The employee assistance program pushed out their availability. We know that among healthcare workers and the entire population that psychiatric illness from the very mild to the more severe has certainly been more pronounced during the pandemic. The EAP made sure that there were programs available for employees who were experiencing the effects of serious stressors,” he says.
2. Unconventional treatment modalities and new ways of providing care
Adoption of telehealth has been a transformative change at UC Health, Forrester says.
“Probably the biggest new way of providing care has been the use of telehealth. It was up and coming at the beginning of the pandemic—mostly used by primary care physicians, but most of us in specialty care were not using it routinely. The pandemic skyrocketed the use of telehealth, which is great for patients. Telehealth is excellent for patients in rural areas, especially for accessing subspecialists at an academic center. It can be a two-hour drive for a visit, which is a lot to ask of patients,” she says.
Proning of seriously ill coronavirus patients is a great example of unconventional treatment techniques utilized during the coronavirus pandemic, Calhoun says.
“When I went through medical school, ventilatory proning—the idea of venting a patient while they were laying on their stomach—was an extraordinary technique that we only used with super sick patients in the ICU. It was found out early in the pandemic that the pathology that occurs in the lungs due to COVID is responsive to the proning technique of ventilating. We began invasively proning patients in the emergency department as well as proning patients who were still breathing spontaneously and not on a ventilator. We just positioned them in ways that made it easier for their lungs to function,” he says.
Proning was initiated early in the pandemic, Calhoun says. “We started proning in mid-March of last year. Our intensivists, our pulmonologists, and our infectious disease doctors were very aggressive at recognizing that this was a useful procedure.”
3. Improving communication
Effective communication strategies have been pivotal during the pandemic, Calhoun says.
“We have learned a tremendous amount about the most efficient methods of communicating with our clinical staff, our employees, and our patients as well as communicating with the community in general. We have utilized trusted partners in the community to communicate with particular groups. Even though we like to think of ourselves as being very trusted by the community because we are healthcare workers and our purpose is to help the community, there are barriers sometimes. Standing beside another trusted partner significantly improves our ability to communicate with particular groups,” he says.
For internal communications, UC Health has ramped up utilization of an online resource that was in place before the pandemic, Calhoun says.
“An internal communications tool called The Link has had a major impact during the pandemic. It is essentially an internal communication online tool that is intended to be the source of truth for UC Health’s healthcare workers. The amount of use of The Link now is tremendous. Early in the pandemic, our marketing and communications team very adeptly put The Link at the center of our pandemic communications. We put our protocols on The Link—it became where you looked for answers,” he says.
Email also has been an effective internal communication strategy, Forrester says.
“We set up dedicated email addresses to answer questions about certain things. Employees can just send an email to a COVID-19 address and ask questions. For example, employees can ask questions about personal protective equipment. When the vaccines became available for our employees, we set up a dedicated email for the vaccines; so, if staff had questions about vaccination scheduling or side effects, they could get reliable information. These dedicated email addresses link our employees to the right people,” she says.
Externally, taking a multi-faceted approach to communication has been successful, Forrester says.
“From a community standpoint, the multipronged approach of meeting people where they are was critical, whether it be on television, social media, or our website. The different ways to communicate have been expanded during the pandemic. Particularly with the vaccine, we want to reach as many people as possible, and we will do that in any way possible. In this area, working with our community groups and leaders has been very important,” she says.
4. Honing emergency preparedness
Improving emergency preparedness at UC Health has been one of the silver linings of the pandemic, Calhoun says.
“Unlike the 2014 Ebola outbreak, which was relatively short-lived, the prolonged nature of the coronavirus pandemic has taught us what really is and is not important. We have made emergency management part of our daily plan. There are few times in my career when I have seen emergency management become part of daily healthcare operations. That is when emergency management works really well—when it is truly integrated into operations. The duration of the pandemic has forced that integration,” he says.
The coronavirus pandemic also has impacted a major emergency department renovation at UC Health, Calhoun says.
“We are renovating a very old emergency department. After seeing what we went through with Ebola and seeing what we have been going through with the pandemic, we saw the need for integration of capabilities. For example, we have taken a second look at how many negative pressure rooms we are going to have and how much ‘blow out’ space we need to expand capacity when necessary. The pandemic demonstrated the importance of integrating those kinds of things into the design of this new emergency department. The timing of the pandemic in this remodeling process will benefit the community significantly,” he says.
Christopher Cheney is the senior clinical care editor at HealthLeaders.