Health Crisis Management in Acute Care Hospitals : Lessons Learned From COVID-19 and Beyond

In the USA, the COVID-19 crisis came as an unpleasant surprise and a shock to many healthcare systems and hospitals, especially in the crisis epicenter, New York City. The Bronx was one of the hardest hit boroughs of New York City, with significant negative impact of the COVID-19 pandemic on its indigent population. SBH Health System (formerly known as St. Barnabas Hospital) is an integrated system of an acute care hospital, ambulatory care center, trauma center, dialysis center, stroke center and other services and facilities, serving the community of the Bronx. The story of SBH in preparing for and managing the rapidly escalating surge of severely ill patients is a treasure of lessons in health crisis preparedness and management at all levels: clinical, administrative, financial, etc. These lessons can be used for other acute care hospital settings and other potential health crises that may arise in the future. Within a short 3 weeks, SBH increased its in-patient capacity by 50%. However, during the same short time, it increased its critical care capacity by over 500%, providing critical care to severely ill patients on ventilators. This book chronicles the situation step by step and describes how this accomplishment was done. Accounts from the frontline health workers and from the clinical and administrative leaders describe important aspects of crisis management, such as team building, multi-departmental coordination, effective communications, dynamic decision-making in response to rapidly changing situations, keeping up the morale and caring for the healthcare workers and managing the supply chain. The uniqueness of the experience of SBH is enhanced by the fact that SBH is a low budget “safety net” hospital serving the poorest population in New York City. The worldwide trend is toward tighter healthcare budgets with demands for higher efficiency and productivity. There is a lot to be learned from the SBH health crisis management, including how efficient management, team building, management of limited resources and collaborative workplace culture make the foundation of success in the face of the crisis of the century. This unique text serves as a “how to” guide for implementing skills necessary for crisis management. Lessons from the success of SBH in tackling the dramatically fast unfolding crisis are utilized in a clear and concise manner. Such lessons may benefit other health systems and hospitals in planning and preparing for similar crises. Foreword Prologue Acknowledgments and Appreciations Contents Contributors Chapter 1: Background, the Hospital System, the Patient Community, and the Bronx The Bronx The SBH Patient Community During COVID-19 SBH Health System SBH During the Initial COVID-19 Surge: First Thoughts References Chapter 2: COVID-19 Crisis Timeline: The Warning and the Surge Defining the COVID-19 Pandemic Origins of COVID-19 Basics of SARS-CoV-2: The Coronavirus Symptoms Classification as a Pandemic COVID-19 Pandemic in the USA and Its Epicenter New York City: Timeline of the Crisis Timeline of the Response at SBH Health System Key Lessons Learned from the Surge at SBH References Chapter 3: Preparation, Planning, and the Command Center Preparation and Planning for Health Crisis Management The Hospital Incident Command System HICS Command Center and Communication During a Healthcare Crisis/Pandemic Expanding the Role of the Command Center During a Health Crisis Communication The Daily Safety Call Float Pool: Supporting the Care Teams Creating a Team to Coordinate Transfers to Alternative Care Sites and Partnering with Other Health Systems Emergency Operations Plan The Dashboard Case Study 1: Meaningful and Actionable Presentation of Data to Decision-Makers During a Crisis: The Case of SBH Health System During the 2020 COVID-19 Pandemic Leading Leaders and Creation of the Leadership Team Supporting the Clinical Leadership and Frontline Healthcare Workers Managing Clinical Volunteers – Medical Reserve Corps Case Study 2: The COVID-19 Pandemic, Expansion of Clinical Services, and Crisis Surge Management Summary and Conclusions References Chapter 4: Internal Medicine, Infection Control, and Occupational Health Services Internal Medicine and the Usual Role of the Internal Medicine Department Expanding the Role of Internal Medicine During the COVID-19 Crisis Beds Physician Staff Role of the Residents Critical Shortages of Specific Physicians Treatment Protocols Discharging Patients with COVID-19 Infection Control and Occupational Health Service Conclusion References Chapter 5: Critical Care Introduction: Critical Care as a Crucial Pillar in Health Crisis Management What Is Critical Care? Components of Critical Care The Patients Critical Care Health Workers Levels of Critical Care Expanding Critical Care During a Health Crisis Planning ICU-Ready Areas Location Considerations: Advantages and Disadvantages Critical Care Crisis Team Building Integrated Tiered Critical Care Teams Cross-Training of Non-critical Care Physicians in Critical Care Multidisciplinary Critical Care Committee Mission, Goals, and Composition Meetings Agenda Minutes Timely Actions Transparency Bottle Necks and Service-Limiting Factors Creativity and Improvisation Utilization of Anesthesiologists in Critical Care Utilizing Dental Staff in Clinical Care Utilizing Other Staff Ventilator Sharing or Splitting Creative Solutions Staffing Crisis Management of Critical Care Facilities and Physical Spaces Clinical Practice Adaptation Supporting the Frontline Healthcare Workers Team Leadership Overwork, Long Hours, Intense Situations Support for Difficult Decision-Making Emotional and Psychological Support Material Support Daily Rounds Utilization of Critical Care Resources During an Overwhelming Health Crisis Managing the Flow of Critical Care Information, New Knowledge, and Clinical Practice Guidelines During a Crisis Continuation of Emergent and Urgent Services Neurocritical Care During a Health Crisis Stroke Care Neurotrauma Non-emergency Neurosurgery Neurosurgical Education Lessons Learned Case Study 1: Critical Care During a Health Crisis (SBH Health System in March, April, and May 2020) Contingency Planning and Management Patient Scoring Systems Networking and Information Sharing Overflow Planning (In the Hospital and Out) Case Study 2: The COVID-19 Pandemic and Critical Care at SBH Health System Repurposing Resources Expansion Units Summary and Takeaway Messages from Critical Care References Chapter 6: Emergency Medicine The Emergence of a Global Crisis Governance and Communication Departmental Reconfiguration of Space and Processes The ‘Tent Process’ Patient Transfers Diversion Status Visitation by Family Resources and Infrastructure Personal Protective Equipment (PPE) Ventilators Pharmacy Staffing Nursing Staff Physician Staff Staff Wellness Risk Awareness in Staff Resident Staffing Staff Sickness Easing of the Initial Crisis References Chapter 7: Nursing Introduction The Importance of Harmony and Coordination Between Hospital Nursing Leadership and Nursing Union Leadership During a Health Crisis The Importance of Morale-Boosting Huddles The Qualities That Differentiate the Nursing Department and Stepping Up to Help Others The Mandate to Expand Patient Capacity by 50% Processes Undertaken to Review Nursing Units and Their Capacity/Services Collaboration During a Healthcare Crisis Is Vital How Nursing Staff Were Impacted and What SBH Health System Did About It Changes in Nursing Staff Ratios and the Ethical Issues of “Price Gouging” When Obtaining Agency COVID-19 Crisis Workers Challenges Associated with Retraining Senior and Junior Nursing Staff Under a Pandemic The Critical Role of Nursing Leadership in Mentally Supporting Nursing Staff Education, Education, Education The Role of Hospital-Wide Nursing Education, Refresher Training, Retraining, and Adhering to CDC Guidelines Morale, Engagement, and Support The Importance of Keeping Morale Up and Nursing Staff Engaged and Committed During Difficult Times Reflection and Lessons Learned Case Study: Stepping up to Support the Whole Team Summary Chapter 8: Clinical Nutrition and Food Services Clinical Nutrition Services Clinical Nutrition Delivery Expanding Nutrition Services: Strategic Planning Aligning with the Challenges During the Evolving COVID-19 Crisis Staffing Critical Care Expansion and Room Revisions Supply Chain and Procurement Specific Nutrition Challenges in Managing COVID-19 Disease Nutritional Guidelines The Need for PPE The SBH Health System Nutritional Response Enteral Nutrition Provision Parenteral Nutrition Provision Additional Nutrient Requirements Lessons Learned References Chapter 9: Rehabilitation The Initial Response Inpatient Bed Management Inpatient Rehabilitation Outpatient Rehabilitation Protecting the Frontline Staff Rehabilitation of COVID-19 Survivors in Acute Care Prone Positioning of Patients Clinical Management Mobilization Comorbidities and Challenges Rehabilitation of COVID-19 Survivors Post-acute Care Adjusting to the “New Normal” and the Lessons Learned Conclusion References Chapter 10: Respiratory Therapy and Proning Respiratory Therapy Respiratory Therapy in the COVID-19 Crisis Challenges with Equipment Staffing Concerns Emotional and Psychological Impact Personal Protective Equipment (PPE) Challenges Proning The Proning Procedure Pre-proning Procedure Procedure While Proning Patient Post-proning Procedure and Maintenance Challenges Faced at SBH Training and Education of Staff Staffing Concerns Conclusions References Chapter 11: Pharmacy Pharmacy as an Integral Component of a Healthcare System Pharmacy: The Support Pillar of Health Crisis Management Outline of the Crisis Management Plan at SBH Health System Mitigation Phase Preparedness Response Phase Recovery Phase Expansion of Pharmacy Services and Operations During the Crisis Distressed Supply Chains Secured Access to Medication and Automated Dispensing Cabinets Increase in Orders Received and Processed Staffing Concerns During the Crisis Pharmacy Clinical Services Health Information Systems Health Workforce Case Study: The SBH Pharmacy Response to COVID-19 and Expansion of Pharmacy Services Expansion of Critical Care Patient Care Units Gaining Access to Essential Medications Maintaining Adequate Staffing Levels Successes Realized by the SBH Pharmacy Department Key Lessons Learned Conclusion References Chapter 12: Laboratory Laboratory’s Role, Response, and Continuity Plan During a Healthcare Crisis Conducting a Comprehensive Risk Assessment and Identification of Disruption in Services Developing a Laboratory Crisis and Continuity Management Plan Expanding and Prioritizing Laboratory Services During a Healthcare Crisis Setting Up Dedicated Laboratory Team and Capacity Building Setting Up and/or Coordination with an Incident Command Center Mobilization of Staff During Healthcare Crisis Resource Management Developing a Communication and Reporting Plan Networking, Linkage Development, and Identifying Sources of Information and Help Emergency Succession Plan Emergency Succession Plan in Case of Temporary Disruption of Laboratory Services Emergency Succession Plan in Case of Partial Shutdown of Laboratory Services Phlebotomy and Specimen Receiving Areas Anatomic Pathology Blood Bank Core Laboratory: Chemistry, Hematology, and Immunology or Others Microbiology Point-of-Care Testing Emergency Succession Plan in Case of Full Shutdown of Laboratory Services Recovery Processes Mass Fatality Management Request and Preparation of Body Collection Points Managing the Body Collection Points Handling and Transport of the Human Remains Staffing in Morgue/BCP Management Infection Control Procedures Storage of Bodies in the Body Collection Point Temperature Monitoring Fuel Management Security Personal Effects Morgue Census Case Management/Tracking Family Management Release Cases to Funeral Homes Retrieval of the Body Collection Point Summary References Chapter 13: Radiology A Radiologist’s Reflection on the Start of the Pandemic The History of Medical Imaging Organization of a Modern-Day Radiology Department The Initial Response: Psyche Shift, Protect, and Plan Paradigm Shift to Accept the New Pandemic Reality Protecting Staff and Patients Early on Early Testing and Isolation/Quarantine Anxiety, Assurance, and Recognition Considerations for Managing the COVID-19 Crisis Dynamic Reorganization of Resources and Processes Communication How to Organize When Facing the Unknown Psychiatric Support What Worked Well and What Didn’t: A Reflective Practice References Chapter 14: Supply Chain, Material Management, and Finance The SBH Health System Supply Shain The Pandemic Begins Daily Meetings Surveys and Meetings The Group Purchasing Organization Sourcing Under Pressure Managing a Shortage of Supplies Allocations and Back Orders Allocations Back Orders The Ongoing Challenges in Obtaining Resources to Cope with Increasing Patient Volume The Importance of the Chief Financial Officer and International Sourcing The CFO Securing Resources, International Sourcing, and the Importance of Relationships Additional Storage Space Reflection on Lessons Learned During the COVID-19 Pandemic Conclusions References Chapter 15: Information Technology, Healthcare Data and Analytics, and Clinical Engineering Information Technology at the Epicenter of a Crisis Virtual Command Center in a Crisis Technology and Communication Infrastructure Expanding IT Applications and Devices During a Pandemic Electronic Health Records Data Reporting and Analytics Communication and Collaboration Tools Virtual Care Platform IT Infrastructure for Rapid Cycle Quality Assurance and Performance Improvement During a Health Crisis Enhanced Information Security Clinical Engineering: Patient Care Monitoring Solutions IT Customer and Technical Support Contingency Plan for EHR Downtime Reflection and Key Lessons Learned from Adaptation to the COVID-19 Crisis What Would Be Done Differently Next Time? How and Why? Summary and Conclusions References Chapter 16: Medical Students and the Medical School Educational Setting Curricular Changes and Innovations in Response to COVID-19 Teaching Environment Service Learning Clinical Curriculum Graduation and Residency Wellness Needs Research and Community Service Activities New Research Synthesis COVID-19 Patient Chart Reviews Community Service Conclusions: Long-Term Impact and Reflections References Chapter 17: Dynamic Decision-Making and Effective Communications The Lead Up to the Crisis at SBH Health System Strategic Decisions Made Early on in the Pandemic Readiness in a Crisis Dynamic Decision-Making During a Crisis Macromanagement Versus Micromanagement: Where Is the Balance? Effective Communication of the Decisions Conclusion References Chapter 18: Collaborative Culture and Lean Daily Management Introduction Workplace Values and Culture in an Acute Care Hospital The COVID-19 Experience at SBH and How Culture Influenced the Successes The Constitution of SBH Health System Staff and Patients Building a Culture The Journey to Patient-Centered Excellence: Creating a Pathway Lean Daily Management What Is LDM? Case Study: LDM, SBH Health System, and the COVID-19 Health Crisis LDM for Planning and Preparation for a Future Health Crisis Summary References Chapter 19: Soft Skills, Emotional and Social Intelligence, and Resilience The Psychological Burden of COVID-19 on Healthcare Workers Coping with the Crisis Resilience Emotional and Social Intelligence Strategies to Address Stress and Trauma During the COVID-19 “Peak” Weeks Week 1 Week 2 Week 3 Week 4 Beyond the Peak Weeks Reflecting on HCW Well-being at the SBH Health System During the Initial Surge of the COVID-19 Crisis References Chapter 20: Recovery From Crisis Introduction Impact of COVID-19 on Health Systems Impact on Health Service Delivery Impact on the Health Workforce Impact on Finance Impact on Leadership and Governance Impact on Access to Treatment Lessons Learned from the COVID-19 Pandemic Establishing a Disaster Plan Supply Chains and Stocks Improving Web-Based Primary Healthcare Infrastructural Alterations Social Inequalities Considerations for the ‘Recovery’ of Healthcare Systems Well-being of the Health Workforce Should Be of Paramount Importance Clarity of Thought, Vision and Communication by Leadership Reassessing Priorities, Optimising Performance and Management of Backlogs Preparation for Future Emergencies Recovery of SBH Health System from the Initial Surge Recovery Is Multifactorial Recovery from Infectious Disease Is Unique Recovery of Clinical Services Timeline for Recovery Recovering to a ‘New Normal’ Establishing New Operations Testing for COVID-19 Vaccination Program Novel Treatments for COVID-19 Managing Employee Health Patient Visitation Learning from Clinical Outcomes Reflections, Learned Lessons and Formulation of an Improvement Plan Implementation of the Improvement Plan Conclusion References Index The COVID-19 crisis came as an unpleasant surprise and a shock to many healthcaresystems and hospitals especially in the crisis epicenter of New York City. TheBronx was one of the hardest-hit boroughs of New York City with significant negativeimpact of the COVID-19 pandemic on its indigent population. SBH HealthSystem (formerly known as St. Barnabas Hospital) is an integrated system of anacute-care hospital, ambulatory care center, trauma center, dialysis center, strokecenter, and other services and facilities serving the community of the Bronx. Thestory of SBH in preparing for and managing the rapidly escalating surge of severelyill patients at the onset of the COVID-19 crisis is a treasure of lessons in health crisispreparedness and management at all levels, clinical, administrative, and financial.This book draws lessons from the success of SBH Health System in tackling thedramatically fast unfolding pandemic from the perspective of the system as a wholeand from each of the specific departments which all played a significant role inmanaging the local crisis of the largest threat to human health the world has seen inrecent years. Such lessons may benefit us and other health systems and hospitalselsewhere in planning and preparing for similar crises in the future. Accounts from the frontline health workers and from the clinical and administrative leaders describe important aspects of crisis management, such as team building, multi-departmental coordination, effective communications, dynamic decision-making in response to rapidly changing situations, keeping up the morale and caring for the healthcare workers and managing the supply chain. The uniqueness of the experience of Saint Barnabas Hospital is enhanced by the fact that SBH is a low budget "safety net" hospital serving the poorest population in New York City. The worldwide trend is toward tighter healthcare budgets with demands for higher efficiency and productivity. There is a lot to be learned from the SBH health crisis management, including how efficient management, team building, management of limited resources and collaborative workplace culture make the foundation of success in the face of the crisis of the century. This unique text serves as a "how to" guide for implementing skills necessary for crisis management. Lessons from the success of SBH in tackling the dramatically fast unfolding crisis are utilized in a clear and concise manner. Such lessons may benefit other health systems and hospitals in planning and preparing for similar crises