Tabletop exercises began as a response to the lessons learned during Hurricane Sandy, which hit the Caribbean, the Mid-Atlantic part of the country and the Northeastern U.S. in 2012.
“During that event, we were able to successfully evacuate the hospital, where not a single patient was harmed,” Fritz François, MD, executive vice president and vice dean and chief of hospital operations for NYU Langone, told Becker’s. “But we had to evacuate the entire facility. It was a defining moment for us because all our mission areas — meaning clinical research and education — were impacted. We had a completely empty facility as a result of that storm.”
Dr. François emphasized the importance of practicing scenarios for various emergencies. To enhance its preparation efforts, the organization began conducting up to two tabletop exercises per year. These exercises focused on potential scenarios such as an active shooter, blackout or snowstorm.
As NYU Langone conducted these exercises, the health system was also expanding. Dr. François, then chief medical officer and professor in the gastroenterology division, played a key role in the 2018 opening of the Kimmel Pavilion, which added more than 830,000 square feet. In 2016, NYU Langone completed a merger with Lutheran Medical Center, now known as NYU Langone Hospital-Brooklyn. Then, in 2019, NYU Langone completed a merger with Winthrop University Hospital, now known as NYU Langone Hospital-Long Island.
“During this period, a lot was happening. We were growing, opening new facilities, adding more people to the organization and using these tabletop exercises to ensure that everyone was on the same page,” Dr. François said. “We wanted to make sure there was one playbook for handling emergencies.”
In fall 2019, NYU Langone planned a tabletop exercise for Jan. 8, 2020, centered on the question: What if there was an outbreak of a respiratory virus?
During the exercise, Robert Grossman, MD, CEO of NYU Langone Health and dean of NYU Grossman School of Medicine, challenged leaders to consider the possibility of a hospital evacuation, drawing on lessons from Sandy in 2012.
“We had to evacuate the hospital [during Sandy], and that memory allowed him to bring it back and say, ‘OK, yes, you have a plan, but I don’t want you to forget there might come a time or a point where you need to do this, and you have to think about it,'” Dr. François said.
“…Can you evacuate a hospital in the setting of a respiratory viral outbreak? The team and I thought about this, and we realized it’s different. We would, for lack of a better term, have to ‘shelter in place’ and think about how to support patients [and] staff to get through this type of outbreak.”
By March 2020, several lessons from that Jan. 8 exercise proved invaluable during the COVID-19 crisis. Leaders recognized the need to plan for care coordination, ensure staff safety with adequate personal protective equipment, and secure necessary supplies. Additionally, Dr. François emphasized the importance of defining the overall processes to guide pandemic response.
“When I say that, I’m talking not just about one unit or one hospital but across the board,” he said. “This playbook becomes exceedingly important in how we ultimately function as an organization.”
The health system was able to use these lessons to further develop a systemwide collection of dashboards with more than 800 metrics tracking everything from the time it takes for a patient to be seen by a physician in the emergency department to resource availability.
“These dashboards were very important during the pandemic because we knew exactly how many patients were under investigation (meaning they hadn’t tested positive yet but were in the ED), how many were COVID positive, how many were in the ICU [and] how many required ventilation,” Dr. François said.
“This clarity of information allowed us, from an operational perspective, to make decisions such as when to open additional beds or how many ventilators we would need — not just today but tomorrow as well. It also helped us anticipate which patients might need more advanced treatments like [extracorporeal membrane oxygenation].”
All of this, he added, resulted in improved outcomes. For example, the health system found that Black patients, while they were more likely to have COVID, when they were admitted, their condition was less likely to deteriorate, and they were less likely to go to the ICU and less likely to die.
“In fact, there was a 30% reduction in death for those patients, which was quite remarkable,” Dr. François said. “And the reason I believe that we were able to achieve those results is because [of] how much we work as a team with one playbook, with effective communication, with effective planning.
“[And] even though we had one playbook, we also used evidence. During the pandemic, there were a lot of things that we did not know, and when new information came about, we made changes to our playbook based on the evidence. But those changes didn’t live in just one hospital. We communicated across the board, and so that very quickly impacted the entire system in a positive way.
“We also shared resources, meaning that it wasn’t the case where one hospital had PPE and another hospital did not. We had a centralized supply chain, ensuring balance of the supplies that were needed.”
Since the pandemic, the dashboards have continued to evolve. Specifically, Dr. François said the health system has focused on ensuring the dashboards leverage data adequately from NYU Langone’s unified medical record for inpatient and outpatient care.
Due to the medical record data, the health system has been able to closely track improvement in performance and set goals.
For example, previously, “Our performance was similar or no better than a national average, which is above 30 minutes to see a patient in the ED that comes into the ED,” Dr. François said. “That wasn’t good enough, so we set a goal that we wanted to be under 15 minutes. The dashboards then allowed us to see how we were improving over time. And today, I’m proud to say that across our emergency departments, we see patients — any patient who arrives in our ED — in under 15 minutes.”
The ability to measure and make goals around performance is only part of the evolution. Dr. François said the health system has also integrated AI into the dashboards to help identify patterns in the data related to outcomes. For example, in a unit with significant nurse turnover, there is an increase in a particular type of infection.
“Well, that might be something worth looking at because the point there might be that those new nurses are not used to the protocol,” he said.
NYU Langone has also continued the tabletop exercises, with the next one scheduled for later in January.
“We’re committed to it. It is a preoccupation — that notion of preoccupation for failure, the ‘what if,'” Dr. François said. “We don’t know if something’s going to happen, but we are willing to challenge ourselves. We don’t rest on our laurels. We stay ‘hungry’ … and we challenge ourselves to do better.”