'A lesson in agility': How providers in US hot spots are preparing for sharp increase in COVID-19 cases

Monitoring personal protective equipment supply, bed capacity and data are among the steps U.S. hospitals and health systems are taking to prepare for a potential second wave of the coronavirus.

Healthcare leaders said they have also learned lessons from their initial pandemic response and are adjusting operational processes accordingly. 

Here, seven hospital and health system leaders — including those in states where COVID-19 cases are spiking — discuss how they are preparing for a potential second wave. 

Note: Responses were lightly edited.

Erol Akdamar, president of Medical City Healthcare (Dallas): Medical City Healthcare hospitals have well-established protocols to care for patients with infectious diseases, including COVID-19. As part of HCA Healthcare, we have the resources to provide support and solutions to our patients, colleagues and communities. Our preparedness efforts and emergency planning are ongoing and have never ceased. As a result, we have the bed capacity, staffing, personal protective equipment and supplies to meet our community's healthcare needs. We are working in partnership with local and state health departments and the CDC and are monitoring all aspects of this evolving situation closely.

As our cities continue to reopen, we encourage our communities to remain vigilant and encourage social distancing, hand washing and wearing masks. These proven methods will help slow the spread of COVID-19.

Rob Deininger, president and CEO of AdventHealth Fish Memorial and leader of System Command Center for COVID-19 for AdventHealth (Altamonte Springs, Fla.): AdventHealth owns and operates hospitals in nine states. Our corporate headquarters and nearly 30 of our hospitals are in Florida where we are experiencing an all-time high number of COVID-19 cases.

We are diligently monitoring several key areas across our health system, such as PPE supply levels, bed capacity, employee health statistics, community prevalence analytics and regional guidance from public health officials. Our command centers have been active since March and the focused planning, redeployment of team members to areas where they are needed most, experience caring for COVID-19 patients, and implementation of new processes for remote patient monitoring and alternate sites of care to ensure we have as many inpatient beds as possible available have prepared us to care for a surge in COVID-19 cases, as well as all other patients who need care. 

We expect COVID-19 to be a part of our business for the foreseeable future and will manage it as we do other health service lines, continuously innovating new processes like touchless registration to enhance care. We are encouraging the communities we serve to stay vigilant, follow CDC guidelines and lower their risk of infection by wearing face coverings and keeping a safe distance from others.

Saad Ehtisham, president and COO of Novant Health Presbyterian Medical Center and greater Charlotte (N.C.) market: Since the onset of COVID-19 in Charlotte and surrounding counties, Novant Health's response has been guided by the dual purpose of caring for patients with COVID-19 while maintaining safe care for patients with other needs. Baked into our planning is the ability to balance surge readiness and COVID-19 recovery. Workflow efficiency is a priority and we're embedding COVID-19 order sets into our EMR, giving our clinical care teams tools they need to more rapidly respond. We are well-positioned to handle the COVID-19 spikes that we see now in the communities we serve, without having to dial back on nonessential surgeries or other services. Our success is due, in part, to our ability to share resources, personnel and equipment across the Novant Health footprint. We remain steadfast in ensuring that our team members feel supported emotionally and have the necessary resources to care for our community.

Mickey Foster, CEO of FirstHealth of the Carolinas (Pinehurst, N.C.): In many ways, we are still managing the first wave of COVID-19 in our service areas. FirstHealth of the Carolinas has been a leader in the mid-Carolinas in terms of testing for and treating the coronavirus, and we will continue to do that for as long as the pandemic lasts.

Internally, we have remained aggressive in procuring the personal protective equipment our front-line heroes need to help us care for the community and putting our system in a good spot to respond to an increase in cases.  The leadership team is monitoring employee morale and looking for signs of COVID fatigue. We know this pandemic will last until there is a vaccine, so it's vital we care for our employees, just like they are caring for our patients. Full transparency is the culture I want to build at FirstHealth.  With 5,400 employees, they need to know what we are facing and how we can work together and care for our co-workers who are undoubtedly feeling burned out. We've encouraged remote working for eligible employees, while ensuring that our "new normal" doesn't impact our ability to serve our communities.

And for the communities we serve, we continue to provide care in safe ways in person and virtually. Virtual and telephone visits are available for patients at most of our clinics, and our safety procedures at our facilities keep the public safe when they need in-person care. We have mandatory masking and temperature screenings at our facilities, along with ongoing visitation restrictions at our hospitals and clinics. We want the patients we serve to know they should not put off necessary care during the pandemic.

This pandemic has been a lesson in agility. As a health system, we were forced to make quick decisions in our initial response to COVID-19. We implemented new procedures and temporarily suspended non-time sensitive surgeries and procedures early on in our response to ensure we had the resources needed to respond to a potential surge in patients. While we have resumed non-time sensitive surgeries and procedures, we know we are not out of the woods, yet, and we continue to monitor trends and data in coordination with our state consortiums, local agencies and partners, and FirstHealth's infectious diseases experts to change course as needed to continue to respond to COVID-19.       

Stephen Mette, MD, CEO of University of Arkansas for Medical Sciences Medical Center and senior vice chancellor for UAMS Health (Little Rock): We have had a modest amount of COVID-19 here in Arkansas in comparison to many other parts of the country. However, for the last three to four weeks, there has been a rapid rise in COVID-19 cases and hospitalizations across the state. We are unfortunately predicting hospitals to be at capacity in Arkansas if our modeling is correct.

We are preparing by using what we have learned from our own experience and those of others over the past four months. We have had four months in which to get our operational process improved. We mobilized early in March creating capacity, creating a robust surge plan, creating our care processes, and having the ability to see how these succeeded in managing these complex and resource intensive patients. We have not had more than 26 [COVID-19] patients at a time, so we have been able to hone our skills and operational algorithms.

As we anticipate larger numbers of COVID-19 patients requiring hospitalization, we will know how to titrate down the care of non-COVID patients by decreasing our non-time-sensitive inpatient procedures and clinic visits to build capacity. We have built our ICU surge capacity three-fold. We have also created a total of 135 additional negative pressure rooms in anticipation of a larger surge.

We have changed our supply chain management out of necessity. UAMS now has procurement responsibility for PPE and other equipment for the State of Arkansas, which gives us much larger buying clout and capacity that will benefit all Arkansas hospitals. In addition, the six major hospitals here in Little Rock have been working together since March to build a collective and synchronized approach to the management of patients here in the city and Central Arkansas. Together, we have committed to a surge capacity of an additional 750 beds. This kind of cooperative approach should provide our region with the resources and preparedness as the pandemic continues. 

Lawrence Nycum, MD, senior vice president and chief clinical officer of Novant Health's greater Winston-Salem (N.C.) market: When the coronavirus first really started to hit our communities in mid-March, we made the careful decision to limit some services. During this time, which is also when a stay-at-home order was in place, we were able to greatly increase our capacity, by about 60 percent, and reinforce our supply chain. For about two months (since early May) we've been balancing our COVID-19 response while resuming those postponed services and continue to fine-tune our ability to toggle between our COVID-19 cases and tier 4 recovery patients. We don't see a scenario during a second wave, or surge, where we'd again have a need to put a pause on nonessential surgeries or appointments in large part because of our cohorting plan and preparedness planning over that time period. We continue to work on team member resiliency and prepare for the redeployment of our care teams should we need that additional workflow and support.

Jim Sheets, vice president of outreach services at Intermountain Healthcare (Salt Lake City): Intermountain Healthcare has created a surge plan to care for additional COVID patients in the event that cases increase in the community. This plan includes converting medical/surgical beds to ICUs in our larger tertiary hospitals and cross-training and redeploying staff from medical and surgical units to treat higher acuity patients. We have also established a COVID call line, symptom checking chat bot, and expanded our Connect Care virtual visit platform to triage patients and answer COVID related questions. We continue to utilize our expansive telehealth network to treat patients across the system that might not be able to travel into our clinics or hospitals.


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