During the Coronavirus crisis, Kaufman Hall will be providing regular updates with a focus on efforts to combat the virus from hospitals in the U.S. and throughout the world.


Early innovations

The coronavirus pandemic is creating severe challenges for hospital operations, including a potential shortage of ventilators and hospital beds, exposure-related staff furloughs, and supply chain gaps, just to name a few. While there are no easy solutions, providers are already testing and scaling ways to safely test and care for the initial wave of patients.
 

Testing

In Italy, the scale of the coronavirus pandemic placed an extreme strain on hospital facilities and staff. U.S. Surgeon General Jerome Adams, MD, estimated Monday that the trajectory of the pandemic in the U.S. is roughly two weeks behind Italy. The first order of business for many hospitals will be rapidly developing testing options that relieve the burden on emergency departments while avoiding unnecessarily exposing staff and other patients.

Many hospitals, including Sutter Health, are directing patients to online symptom checkers and urging patients to call or contact a provider before visiting a facility. Some hospitals are increasing signage around their facilities to direct at-risk patients to appropriate locations. Northwell Health has begun an “ask and mask” screening policy for all walk-in patients at their entrances.

Providers are also ramping up virtual visit programs, and the federal government has loosened restrictions on providing video visits to Medicare patients. Some hospital executives believe that hospitals that build up their virtual visit capabilities now are unlikely to scale back after the pandemic. The quickened pace of digital adoption is also noticeable in other industries: many film studios have announced plans to allow customers to rent streaming versions of movies that were originally expected to begin with theatrical releases.

A number of providers, including Kaiser Permanente, have begun offering limited drive-through testing. For now, Kaiser is limiting the coronavirus tests to patients with symptoms and a doctor referral. Clinicians at the sites wear full protective gear. Abington-Hospital Jefferson Health in Philadelphia is testing patients in a parking lot across the street from the facility, and using a separate entrance for high-risk patients.
 

Care management

Once patients test positive for coronavirus, hospitals must find effective ways to provide care without unnecessarily exposing patients or other staff—which has necessitated staff furloughs in some instances. Carney Hospital in Boston, part of Steward Health Care, will have the nation's first dedicated care center for coronavirus patients; the system’s nine other Massachusetts-based hospitals continue regular operations, while offering drive-through testing for the virus. Steward Health Care plans to replicate the model in all of the eight states where it operates hospitals.

CommonSpirit Health has developed an EHR trigger to identify and isolate patients with coronavirus symptoms.  Providence St. Joseph Health --- the site of the first documented U.S. coronavirus case – have been using Vici, a robotic cart, to communicate with isolated patients.

Hospitals are also reassessing non-coronavirus operations in the wake of the pandemic. Numerous hospitals have announced plans to curb or postpone elective surgeries to prevent spread of the coronavirus and create more capacity.
After treatment, coronavirus patients may require a place to stay in isolation. Health systems and governmental bodies looking for solutions to underbedding will need to think creatively about other modalities for housing patients in the weeks and months to come.

King County in Washington State recently purchased an EconoLodge to house quarantined patients who no longer require active treatment but are still a risk to other high-risk individuals. The motel’s individual heating and cooling unit and no central hallways are well-equipped for keeping patients in isolation. 
 

In Brief