An Israel hospital's military COVID-19 response: 5 takeaways for US hospitals

Sheba Medical Center's COVID-19 response has been carried out with military precision from day one. 

Yoel Har-Even, director of the Israeli hospital's international division and resource development, said that's because he and several  leaders, physicians, nurses and other hospital personnel served in the Israel Defense Forces, and responding to crises is second nature to them. 

"Those who have served in the Israel Defense Forces — approximately two-thirds of Israeli citizens — learn a common language, a common set of procedures and a common understanding of what it takes to prevail in difficult situations," Mr. Har-Even wrote in an opinion piece published by the Jewish Telegraphic Agency. "These tactics have been central to Israel's fight against the novel coronavirus."

Sheba sits on a 200-acre campus in Ramat Gan near Tel Aviv and treats about 1.6 million Israelis annually. Key to its approach has been evaluating responses while planning next steps, Mr. Har-Even told Becker's Hospital Review during a recent interview. 

For example, as Sheba  prepared to treat Israel's first COVID-19 patients at the beginning of the pandemic, it created a remote, isolated compound for treating mild and moderate cases that largely relied on innovative telemedicine technology to minimize virus spread among  patients and medical staff, he said.

Shortly thereafter, as the numbers of COVID-19 cases in Israel increased, the hospital identified an urgent need to treat severe COVID-19 cases. Within 72 hours, Sheba converted a parking garage under the hospital into a fully equipped, 100-bed coronavirus critical care unit for high-risk cases.

The hospital's other efforts have included converting hospital wards into isolated COVID-19 units, opening a psychiatry COVID-19 unit, which houses patients who have trouble understanding the concept of social distancing, including a locked ward.

Sheba also set up a 300-bed general COVID-19 hospital, including designated wards for pediatrics, OB-GYN, surgery, hemodialysis and rehabilitation.

But this planning would not have been possible without ensuring employees were prepared for large-scale triage scenarios and that they had an effective information flow, said Mr. Har-Even. 

"At Sheba, efficient and timely data collection is an instrumental key to our success," he said. "We have experts that are trained to rapidly analyze, assess and implement immediate solutions across our day-to-day operations based on the constant data aggregated from our dashboards. We evaluate medical supplies, patient loads, availability of beds and equipment and various other data that guide our strategy." 

Being prepared during the pandemic also means developing moonshot technologies and innovating cures and treatments, Mr. Har-Even said. For example, Sheba partnered in April with the U.S.National Institutes of Health to pursue COVID-19 treatments and a vaccine. On May 26, the hospital unveiled its futuristic patient room with technologies that could be standard by 2030. And Mr. Har-Even said the hospital has invested in the Israel Centre for Medical Simulation, which is run by an Israeli Air Force veteran and develops technology that allows physicians to practice intubations and other procedures. 

"Being prepared means always being five steps ahead," said Mr. Har-Even. "Sheba relies on this military strategy of preparedness during regular times, and even more so during times of crisis, such as the COVID-19 global pandemic. We've had our exit strategy planned almost since the beginning of the coronavirus outbreak —   preparing incremental transitional phases out of crisis mode, and planning for the potential anticipated return waves of the virus. It's precisely this high degree of preparedness that allows us to best treat our patients and best protect our medical personnel." 

What US hospitals can learn

Based on Sheba's pandemic response, Mr. Har-Even recommended that U.S. hospitals:

1. Consistently measure and evaluate needs and operations daily. 

"At Sheba we have daily briefings without fault in order to constantly reassess our developing and changing needs," said Mr. Har-Even. "We react to the reality of the existing situation daily, and this, of course, includes evaluating our critical medical supplies and staff resources." 

"We also evaluate and understand the spirit of our essential troopers — our medical personnel. Having enough supplies is meaningless if a hospital is not also ensuring that its medical staff have what they need in terms of spirit and motivation, not just material equipment," he said.

Evaluating daily needs also involves constantly analyzing data and figures of operations and comparing those numbers against surrounding hospitals, and also with similar countries, or even U.S. states, he said. For example, Sheba can compare Israel and New Jersey since they have similar age demographics and population sizes. 

2. React to what they see and find in the hospital. 

"Don't wait for other authorities outside of your hospital to give direction," suggests Mr. Har-Even. "You know best the intricate and immediate needs of your own hospital. I also encourage hospitals to share and impart their knowledge with other nearby hospitals. We are all in the same boat confronting similar problems. We can all learn from each other's experiences and we should never feel uncomfortable about changing course in mid-route if needed."

3. Adjust operations to treat COVID-19 patients in isolated areas.

Adjusting operations in this way "will enable hospitals to continue to provide routine services to non-COVID-19 patients without spread of the virus," Mr. Har-Even said. "This initiative also allows hospitals to increase its degree of reliability to the surrounding communities of populations that they serve." 

4. Protect employees and allow them to work remotely as much as possible. 

"At Sheba, we rely heavily on the use of telemedicine technology and robotics within the hospital as much as possible to protect our staff by minimizing the risk of contagion," said Har-Even. 

5. Plan ahead. 

"Sheba is constantly planning for the next few hours, for the next few days, for the next few months and years. These plans are created in cycles and visions for short-term and long-term," said Mr. Har-Even. 

He said U.S. hospitals should also have an exit strategy from COVID-19 crisis mode and should plan how they will transition in phases.

 

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COVID-19 challenges healthcare's status quo: 3 things to know

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