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From the Front Lines of COVID-19

· Tim Needham, Chief Commercial Officer

PATIENTSAFE CUSTOMERS SHARE THEIR LEARNINGS TO DATE

In an effort to facilitate information sharing across our customer base and to the healthcare industry at large, this post summarizes recent feedback gathered from multiple health system clients who are being significantly impacted by the COVID-19 pandemic. Thank you to those who took time out of their chaotic schedules to share their experiences, observations, and recommendations. Collectively, we hope this ongoing effort assists others as they prepare for and respond to the pandemic.

Operational Impacts and Recommendations

  • Establish a Formal Command Center structure and team as early as possible, preferably before caring for those who are COVID-positive or under investigation    
  • PPE Policies: Develop policies that will support 3x to 6x normal PPE usage run rates
    • Create a policy and process for PPE check-out
    • Outreach to your community early and often to request equipment donations
    • Specific to gowns: If you have re-usable gowns, this can be beneficial to supply sustainability. However, you will need a plan for nightly laundering. Identify a local business partner who can support you. Expect gown usage to be as high as 6-10 gowns per day per inpatient bed.
  • Staff Displacement and Redeployment: Most health systems are experiencing some degree of staff displacement due to the cancelling of elective procedures and minimization of non-essential services. These new or specialty roles were identified for staff redeployment:
    • Staff Screener: Dedicated personnel to interview staff at the start and end of shift, including recording temperatures and identifying symptoms
    • Supply Runner: Dedicated to each nursing unit, these runners fulfill the supply needs of each unit, typically at the direction of the Charge Nurse
    • PPE Nurse: Dedicated clinical staff who provide real-time staff education on use of PPE, including supervision and help as clinicians dress for isolation
    • Drive-Through Testing station personnel
    • Laundry Management (see above note on gowns)
    • Staff Health and Wellness oversight, including exposure notification management
    • COVID Hotline staff
    • Phone Support staff for patient training on Telemedicine/video visit tool use
  • Capacity Expansion:
    • Customers show wide utilization of external tents for both COVID screening (pre-ED), and for pre-admission to other clinical units
      • Note: Planning is required to validate connectivity (wireless or cellular) for external triage areas
    • The following inpatient unit re-allocation models are in use: COVID-Person Under Investigation (discharge immediately upon negative test result), COVID-Positive (stable) and COVID-Positive (ICU)
    • In Pediatric EDs, consider moving Peds patients directly onto the Peds units if asymptomatic in order to create additional adult ED capacity
      • Note on unit re-allocation: This is being accomplished through changes in the EMR and PatientTouch, typically through ADT modifications that our integration team is supporting with immediate urgency
    • Same day surgery/medical areas are being deployed as inpatient units – specifically COVID-PUI or non-COVID ICU
    • Non-COVID End-of-Life patients are candidates for expedited transfer to off-site hospice locations to expedite throughput and minimize visitor exposure
    • In some cases, consideration is being made for re-allocation of pediatric facility units to accommodate certain adult populations in support of the broader regional effort
  • Survey and Screen Employees:
    • Develop a plan to resource staff screening, either “screen in” only, or “screen in” and “screen out” for temperature and health status questions. Provide clarity as to which hospital staff are required to participate in the screening procedure.
    • Identify a methodology for tracking and reporting staff screening
  • Visitor Management: Establish dedicated entrances for all visitors who are still allowed in the hospital

Personnel Impacts and Recommendations

  • Prepare for non-clinical staff to move to a work-at-home model. Note that this is atypical for health systems, so new policies, best practice recommendations, and IT support should be in place prior to any announcement if possible.
  • Assume universal precautions: Clients are reporting very high stress levels across clinical staff, with the assumption that any patient entering the system with COVID-19 symptoms is being treated as presumptive positive prior to test results
  • Act now to increase staff: Clients are reporting the need for expanding their pool of available clinical staff early, based on isolation needs or personal impacts on the ability to work shifts (family, anxiety)
  • Engage Staff: Despite the need to make top-down decisions rapidly, continue to include frontline caregivers in the planning process to ensure clinical workflow is accounted for in process changes

Technology Impacts and Recommendations

  • Rapid Deployment of Video Use Cases: Clients report the value of widespread video use within hospital walls to limit the number of caregivers who need to go to the bedside. The goal is to minimize employee exposure and conserve PPE. Examples in use:
    • Care Teaming model in which one caregiver goes into the patient room while the other stays out and communicates via audio or video to elicit/manage/secure supply and specialist needs
    • Video communication with Intensivists who may be in isolation or supporting from a remote location
  • PatientTouch Expansion: Clients are rapidly expanding their user base through additional shared devices, mandated BYOD adoption, and/or access to Web Messenger to:
    • Improve patient care team awareness of changing patient conditions
    • Rapidly deploy mass notifications across the organization
    • Communicate with community physicians, non-clinical users, and outside support teams
    • Update ancillary staff (i.e., Dietary, Housekeeping) on patient status
  • Addition of COVID-Specific Roles Within PatientTouch: Most common new Care Roles:
    • Supply Runner dedicated to each nursing unit
    • PPE Nurse dedicated to each unit to support proper PPE usage
    • Staff Health Screener to support employee health tracking and documentation
  • Addition of COVID-Specific Teams Within PatientTouch: Clients are recommending setting up these Teams to facilitate group communication and to reduce the number of “All Staff” notifications:
    • Critical Care Operations, comprised of critical care leadership, intensivists, and respiratory therapists to support decisions on ventilator and resource deployment
    • COVID Command Center used for emergent notifications to this team
    • COVID Rapid Response Team for support of rapidly deteriorating patients
    • COVID Transport to identify transport needs with PPE required
    • COVID Supply Runners
    • COVID Infection Control to support potential family and/or caregiver exposure

We hope you find this information valuable. If you have additional feedback or ideas, please contact me at tneedham@patientsafesolutions.com so we can share with your peers in our next customer communication.

If there is anything that our team can do to help with any of the system changes identified above, including re-identification of nursing units, addition of user groups, addition of COVID groups, etc., please contact your Customer Success representative or email us at support@patientsafesolutions.com. We are prepared to help immediately.

For more information about emerging communication use cases, please visit our COVID-19 Resource Center and join our Innovation Community to collaborate on new solutions in the fight.

Our entire team is thankful for your ongoing work. You are in our thoughts.

Respectfully, Tim

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