Clinical

Lessons learned during the COVID-19 pandemic


 

Each day, we’re inundated with news about the COVID-19 pandemic and how it continues to strain our health care system and resources. With more than 1.15 million positive cases in the United States and over 67,000 deaths as of this writing, it has been a scary yet humbling experience for everyone. There is no doubt this pandemic will be a defining moment in health care for several reasons. From supply chain disruptions and personal protective equipment (PPE) and ventilator shortages to exhausted caregivers – both physically and mentally – this event has pushed the envelope on finding answers from federal and state authorities. Hospital administrations are working harder than ever to rise to the challenge and do what is best for their frontline staff and, more importantly, the patients and the communities they serve.

The provider experience during COVID-19

Dr. Jashanpreet Singh, chief of inpatient operations at Adena Health System in Chillicothe, Ohio, and president-elect of the Central Ohio Chapter of SHM

Dr. Jashanpreet Singh

Hospitalists are in a unique situation as frontline providers. Managing daily throughput of patients has always been a key role for the specialty. They also play an integral role in their own care teams alongside nurses, trainees, case managers, pharmacists, and others in cohorted COVID-19 units. Now more than ever, such a geographic placement of patients is quickly emerging as a must-have staffing model to reduce risk of cross-contamination and preserving critical PPE supplies. This heightened awareness, coupled with anxiety, sometimes leads to added stress and burnout risk for hospitalists.

Communication is critical in creating situational awareness and reducing anxiety within the teams. This is exactly where hospitalists can lead:

  • Active presence in hospital incident command centers and infection control boards
  • Close coordination with emergency medicine colleagues and bed placement navigators
  • Developing protocols for appropriate testing
  • Frequent daily huddles to discuss current state- and hospital-level testing guidelines
  • Close involvement in the hospital operations committee
  • Advocating for or securing more testing or supplies, especially PPE
  • Effective communication about changes in PPE requirements and conservation strategies as per the Centers for Disease Control and Prevention, State Department of Health, and the hospital infection control board
  • Crisis-driven changes, including development and review of triage and treatment protocols and elective procedure cancellations
  • Census numbers and capacity/staffing adjustments within the team to meet temporary dips and surges in on-service patient volumes
  • Frontline caregiver mental and physical health assessment

Daily huddles at key times (e.g., at shift start and end times) can help to identify these barriers. If operational issues arise, there should be a clear channel to escalate them to senior leadership.

Hospitalists could also use several strategies proven to improve staff morale and resilience. For instance, take this time to connect with friends and family virtually, unplug when off from work, explore one’s spiritual self through meditation and prayers, spend time with nature, exercise daily, seek humor, and develop or work on one’s hobby.

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