It is no accident that so many hospitals and health systems performed at their best under the worst pandemic conditions.
Lessons learned years earlier enabled organizations to excel under the stress of the pandemic. Knowledge developed about rapid problem-solving, process improvement, optimizing critical care team efficiency and hospital flow steeled teams for this crisis. Some high-performing organizations recently provided insights on how they met these difficult challenges.
Go with the Flow
Long Island Jewish (LIJ) Medical Center, part of Northwell Health, was among the hardest hit regions by COVID-19 patient surges in early 2020. It went from treating 500 to 600 inpatients on a typical day before the pandemic to more than 1,000 after COVID-19, notes James Rudy, senior director of integrated operations at Northwell, in a recent Institute for Healthcare Improvement (IHI) report.
Building on what was learned in a 2018 IHI hospital-flow development program, Rudy along with physician, nursing, process improvement leads and system executives soon began focusing on load balancing across Northwell’s 20-plus hospitals. The program, led by experts and hospital executives with demonstrated success in improving patient flow outcomes, provided a framework for the Northwell team to explore potential solutions.
The team would go on to address staff redeployment, clinical pathways and personal protective equipment (PPE) usage before the pandemic and continued to refine systems once hit COVID-19. The combined efforts enabled LIJ and Northwell to respond effectively during peak surges.
Key Takeaways from Northwell’s Hospital-Flow Experience
- Develop a learning system.
Rudy and the team shared with senior Northwell leaders what they learned from the IHI program and provided ideas for a learning system that could be used to analyze and solve challenges. Excitement built and rapid progress followed before COVID-19 surfaced, giving leaders confidence in ways to address surges.
- Don’t let perfect be the enemy of good.
COVID-19 forced the team to look at data and analytics differently in a crisis. Even though available data may not be perfect, the question became whether they offered leaders sufficient insights to make solid decisions. As long as quality and safety weren’t being sacrificed, information was used to guide decision-making. One solution included using simulation software to help identify anticipated bed, staffing and PPE needs.
- Focus on continuous, collaborative learning among hospitals.
Northwell uses a similar approach to collaborative learning in other areas of operations. It now has five hospitals working on processes related to interdisciplinary rounds. The teams meet monthly to learn, share, collaborate and innovate together. In the past, much of this work was siloed, Rudy says, adding that participants are building off each other’s incremental progress.
Optimizing Critical Care Resources
Electronic intensive care units (eICUs) have been around for nearly two decades, but deploying this virtual care approach on a large scale had never been stress tested in a prolonged crisis. Mayo Clinic and Advocate Aurora Health leaders credit their e-ICU programs with being a major factor in enabling them to support large numbers of severely ill patients despite shrinking resources and financial pressures during the pandemic.
Mayo Clinic Health System began its Enhanced Critical Care program in 2013, but during the pandemic quickly stood up connections to support ICUs across its 16 hospitals that were reaching capacity, Prathibha Varkey, president of the health system, told mHealth Intelligence.
The program provides 24/7 access to a Rochester, Minn.-based team of specialized care physicians, advanced practice providers and registered nurses. An integrated medical record and specialized software enables the Enhanced Critical Care team to identify the most acute patients while high-fidelity audiovisual equipment is used for real-time interactions with patients, their families and bedside care teams, Varkey notes.
Advocate Aurora Health, a pioneer in eICU development back in 2003, used mobile carts to offer critical care in other units during coronavirus spikes. The health system deployed eICU carts to emergency departments and had its telecritical care team consult and care for patients while waiting for beds to open. The team estimates that about 25% of patients improved without needing ICU beds.
The health system also virtually connected respiratory therapists to support rounding on patients who were on ventilators, thereby alleviating on-site respiratory therapists. This helped the system decrease patient length of stay and days spent on ventilators, resulting in cost savings and fewer adverse events.