Business plan summary
Although the Covid-19 pandemic is a public health crisis, the Covid-19 pandemic is also a crisis management, procurement, and operation in our health system. At Elmhurst Hospital in Queens, New York, the leadership and hospital teams have responded with creative solutions while working in bureaucracies that are not known to be lean, interactive or agile. Despite the gloomy prospects – at the time of this writing, the possibility of Covid-19 patients reaching more than 80% of the emergency department – Elmhurst Hospital took decisive initial action to quickly turn itself into a Covid-19 treatment center. This important lesson, implemented quickly, included stemming the wave of relatively healthy Covid patients, overcoming traffic jams, and empowering the right leadership team.
Elmhurst Hospital, in Queens, New York, is a city hospital with 545 beds that serves as a safety net for the population of working class immigrants. The new Coronavirus has quickly spread through this vulnerable community, and hospitals are currently operating at more than 100% capacity. In an effort to free up a valuable bed, dozens of cases unrelated to Covid are being moved to another facility. The inpatient ward is overwhelmed with those who, under different circumstances, will be included in the intensive care unit. This is “epicenter inside the epicenter“The Covid-19 crisis in New York City. It’s also a place, as a resident emergency doctor, I spend most of my days.
Although a pandemic is a public health crisis, a pandemic is also a crisis management, procurement, and operations in our health system. A month ago, Elmhurst did not confirm Covid-19 cases. Now, the possibility of Covid-19 patients reaches more than 80% of the emergency department. When the waves have hit Elmhurst Hospital, leadership and his team have responded with creative solutions while working in a bureaucracy that is not known to be lean, interactive, or agile.
Despite its gloominess, Elmhurst Hospital took initial and decisive action to quickly turn itself into a Covid-19 treatment center. This important lesson – carried out directly at Elmhurst – included stemming the wave of relatively healthy Covid patients, overcoming inherent congestion, and empowering the right leadership team. This is how we manage.
Stemming the Tide
In Italy, doctors observed that the emergency department was not the right place for most low-risk patients who looked healthy but had flu-like symptoms. The majority of them are treated with over-the-counter medicines and often hydrate at home. Health officials acknowledge that patients who do not have the virus are far more likely to be infected in the emergency department than in the relative isolation from their own homes.
After this observation, doctors at Elmhurst Hospital set up a tent – one of the first in New York – outside the emergency department. It blocks the waves in three ways: First, it keeps non-critical patients out of the emergency room and away from risks. Second, it allows us to assign doctors who normally work in outpatient clinics to tents, freeing ER doctors for more critical cases. Finally, in the face of unprecedented demand, New York City hospitals have limited supplies that need to be managed wisely for high-risk patients. Keeping the critical out of the sick helps us allocate resources appropriately.
No matter how your community handles it, reducing pressure on your emergency department will allow staff to focus on the impending waves of critically ill patients. Other hospitals have been able to reduce ER volumes quickly to offer telemedicine. Your hospital may have other creative solutions.
Clear Traffic Jam
At Elmhurst, we have experienced three major obstacles to providing ideal care:
1. Clinic Staff
The last thing we want is for most healthy people to sit next to someone who is critically ill with Covid-19 in the emergency department. In the early days of the crisis, this is what actually happened. The obstacle in this case is staffing: Nurse Triage who usually divides patients based on sharpness is in a short time. Without this important staff, patients languish in the waiting room, sharing space with other seriously ill patients.
Setting up tents and separating patients is part of the solution. The other side of it is quickly updating policies that bring as many staff to the hospital as possible. We bring back nurses who do not need to be quarantined and also use advanced practice providers, such as assistant physicians (PA) and nurse practitioners (NP), as “super-triagers”: staff who can quickly evaluate and exclude healthy patients.
2. Personal Protective Equipment (PPE)
That national shortage dresses, masks, gloves and other materials that keep medical staff safe have created obstacles and forced us to find creative ways to save. For example, Elmhurst already contains patients suspected of Covid in a separate hospital area negative pressure, which helps prevent cross-contamination between rooms. Providers who work in the Covid section of the hospital may be able to wear an N95 mask and face shield during shifts, while still protecting themselves from infection. Although not an ideal long-term solution, Elmhurst is permitted to continue to see and receive new patients at a reasonable pace while slowing down the rate of valuable PPE burns.
Already, on several occasions, doctors at Elmhurst have rushed to find ventilators for critically ill Covid-19 patients. We nervously anticipate a day that we won’t have. “Make more ventilators” is an obvious solution, but ventilators are complicated machines, difficult to produce quickly, and they have experienced a surge in global demand. We need it immediately – not next month or next week.
In response, we have released the ventilator in the operating room and obtained another from a hospital that is less affected in our health system. This is only possible because elective surgical cases are being held, but also offers a national model for finding urgent supplies in a forgotten place. Many outpatient surgery centers, for example, are equipped with ventilators and must be changed ICU emergency.
Empower the Right Leadership Team
The most important aspect of the Elmhurst Hospital response to the coronavirus pandemic is the willingness to constantly adapt – because the waves are stronger and the congestion is getting narrower – to impossible pressures. By its nature, a hospital is a bureaucratic structure with many layers of management. The key is to empower the leadership team that is closest to clinical reality. While working around the clock, Elmhurst’s emergency department leadership has the freedom and insight to quickly rethink workflows, create areas of negative pressure that did not exist before, and coordinate flexible admission protocols that can be adjusted when patient burdens increase. .
Will it be enough?
My front-line colleagues constantly go up and out to treat critical patients with innovative strategies. So far, Elmhurst has been able to fight one step ahead, but a more difficult decision – unproven treatment, allotment ventilator, and more – will likely come.
While the ingenuity of our doctors and leaders has led us so far, I fear Elmhurst is reaching the limit of what one hospital can do. So my final lesson from the front line of Covid-19 is this: This is a time for coordinated rapid efforts between our local, state and national institutions to free ventilator movement, increase production and distribution of PPE, and create an urgently need ICU from resources which exists. We do our best at Elmhurst, but unless we all work together, that won’t be enough.
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