NewYork-Presbyterian's CXO: A dispatch from the front line of the COVID-19 emergency

As I write this, I am sitting in my office in Manhattan, part of an amazing team of people at NewYork-Presbyterian Hospital taking the COVID-19 emergency head on. This morning, we have over 2,000 COVID-19 inpatients in our hospitals in Manhattan, Queens, Brooklyn and Westchester. In the corridors I walk through, in the ED just down the hall, and on the floors above me, we are taking care of COVID-19 patients. We are at the center of the storm.  

I have never been more exhausted, and never been more proud — especially of our front line — doctors, nurses, EVS workers, security guards, social workers, chaplains, transporters and more. People say these are "healthcare heroes." And, they are. I don't think anyone outside of a hospital could ever fully understand how true this is.

We have weeks ahead of us still to go, and we are determined to make it through. For us, that means serving every patient who comes through our doors. It means fighting to get our teams everything they need to treat patients and maintain their own safety. It means supporting each other through the greatest marathon we will probably ever run. We have our heads down, and we are waiting for the day when the curve begins to bend downward.

This is New York right now. Empty streets and stores. Hospitals looking deceptively quiet on the outside but bursting with activity within. We struggle and strive to meet the need even as spring blooms all around us.  

But, the truth is that the virus will spread. It will move inland and in all directions. And every community and hospital needs to be ready.  

The needs for PPE, ICU capacity, ventilators, surge-level staffing and other key resources have already been well-documented and thoroughly communicated. I won't address that further here. But, we are learning other lessons in New York — patient-centered ones. I want to share them in the hopes that we can help other communities be ready for what may be coming.

First — I am already seeing how, in this crisis, patient centeredness takes on a whole new form. Being patient centered now first and foremost means keeping people safe from infection. It means acting to protect patient safety and staff safety. In this pandemic, we are all in the same boat — all facing the same risk. We need our healthcare workers to get through this so they can take care of the next patient. And, we also need to prevent this very contagious virus from spreading among patients and visitors.  

What has this meant for us? It has meant imposing strident restrictions on visitation. Restricting access between patients and their loved ones goes against every fiber of our being. But, we have done it. The virus is everywhere and many are asymptomatic. We have to keep people safe. Hospital leaders who are not yet at the brunt of this should think about this and prepare now. Look carefully at the websites of hospitals in hard hit areas like New York and Washington state. Think about how you would restructure your access. Write your policies and protocols now, and prepare your staff for implementation.

This crisis also gives us a chance to be creative in providing access. The media have reported many stories about how telemedicine is exploding in this emergency. Virtual connection can be ramped up so that patients and families can see each other. Stock up on tablets. Make sure you can rapidly credential (IDs and passwords) people on services like Facetime and Zoom so people can stay connected. Focus less on what you are restricting and more on what connection you can provide.

Think about how you will shift from in-person to virtual visits quickly. Prepare now. Think about how your workforce can be redeployed to support this access. It keeps people safe. It helps to conserve scarce resources. It empowers patients in a time when we are being asked to "physically distance" from each other.

Feed people's souls. Our staff are pouring themselves into this work and standing in the breach. They need support, honesty and resources. Now is a time, more than ever, for transparency and empathy. We've instituted a daily live broadcast from our COO and Executive Vice President Dr. Laura Forese. Every day, seven days a week, she is in front of all our teams with updates, answers to questions and encouragement. These briefings have been viewed hundreds of thousands of times in recent weeks.  It has served as an effective counter to misinformation that may be circulating. And, it's a way to maintain the bond between leadership and the front line.  

We've also found creative ways to encourage our teams. Yesterday, I walked into our hospital over sidewalk chalk art done by our Child Life Teams with encouraging messages. We've created videos with brief reflections from our chaplains reflecting the many faith traditions in our community. Child care and other services have been provided to help people get through. And we are reminding people of wellness resources.  

Finally, food doesn't hurt either. We've tapped our generous donors and worked with our local restaurants to keep our teams fed. We had to figure all of these things out on the fly. Other communities can prepare now and be ready when the time comes.    

I'm sure there will be more lessons to share. We are in a war — against a virus. But, it's a war. We need to share what we are learning to help us all get to the other side. As I said, this is the biggest challenge many of us have ever faced. But, it will also be our finest hour.   



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