From the Frontlines: 10 COVID-19 Learnings From New York

Accounting for just shy of half of the coronavirus cases in the United States, New York has emerged as the epicenter of the coronavirus outbreak, and its health systems are going to extremes to prepare and care for the influx of patients.

Some are instituting strict visitor restrictions. Others are allotting one N95 respirator mask per clinician per week.

If the measures seem excessive, two experts say, think again.

Supply chain experts Jeff Ashkenase of Nexera and Jay Fligstein of Acurity are on the frontlines with New York state hospitals. Because of the measures New York has had to undertake, the state is regarded as about 10-14 days ahead of most states, besides Washington state, in terms of its COVID-19 response.

Jeff and Jay shared their observations and guidance during our Weekly COVID-19 call, open to members and the industry, and their regular insights have helped inform Premier’s ongoing conversations with the federal government, group purchasing organizations and other key stakeholders. Premier is coordinating across the industry to help solve the supply chain challenges presented by COVID-19, partnering with providers, group purchasing organizations, distributors, manufacturers and the government.

Here is advice from supply chain experts in New York on what providers should be doing today.

Prioritize Personal Protective Equipment (PPE)

• Conserve, conserve, conserve. While 97 percent of hospitals have implemented at least one conservation protocol for PPE, providers’ conservation tactics could – nay, should – be more extreme. Premier recommends all providers follow the Centers for Disease Control and Prevention’s (CDC) recommended conservation protocols for PPE, including to extend the life of single-use PPE, and to be judicious in their use of supplies. The cancelation of elective surgeries and non-essential services should free up supplies, as would eliminating visitors from the hospital.
• Find new sources. An easy starting point are clinics that are no longer seeing patients or have significantly lower volumes, but out-of-industry suppliers could prove beneficial. Knock on the doors of university research labs to borrow their testing equipment and reagents. Restaurants temporarily shuddered could lend gloves. Gyms may have sanitizing wipes or spray, and the local drycleaner likely has a seamstress on site who could sew gowns and masks. Don’t be afraid to leverage local corporate relationships with industries like construction and real estate to collect their products, either.
• Avoid leakage. Take an initial inventory, and then centralize and lock down every mask, gown and critical item. Assign an appropriate department to count and report on-hand inventory levels to the c-suite on a regular basis, and determine who currently uses PPE and whether they meet appropriate-use guidelines. Educate all stakeholders to ensure that no one is using more PPE than is necessary.

Plan for Equipment Needs

Ventilators and inhalers are likely to be in short supply and on March 22, the Food and Drug Administration (FDA) issued guidance to increase availability of ventilators and respiratory devices. Recommendations include using emergency transport ventilators and anesthesia gas machines.

While tapping ambulatory surgery centers to donate equipment, consider engineering schools as a resource to help reconfigure machines. And don’t be restricted to thinking about current needs, either – plan ahead for other equipment that will be needed long-term such as pulse oximeters and proximity thermometers.

Prepare for Capacity Swells in Advance

On March 23, New York Governor Andrew Cuomo mandated that all hospitals in the state increase their capacity by 50 percent, but recommended that they increase it by 100 percent. Our supply chain experts concur. Begin strategic discussions around net new ICU units – churches, schools, community centers, and arenas are potential options – and planning for the space, staff and supplies needed.

Reassess Delivery Logistics

Delivery drivers will not want to come into the hospital, so providers should create a plan for getting supplies from dock to end user. Anticipate fewer days that delivery trucks come on-site and, accordingly, think through storage space for larger shipments. Blood and food are of particular concern, and may require the rental of refrigerated trucks.

Be Agile with Personnel

Evaluate the credentials and skill levels of all employees and determine which staff and nurses, including those in business operations and administrative roles, can be reassigned to patient care. Cross-train employees to work in the areas where the most help is needed. Be sensitive to burnout, physical and emotional strain. Finally, find new people to temporarily join the workforce—retirees, academics, and clinicians working in industry are potential sources.

Double-Down on Cyber Security

Times of crisis provide fertile ground for cyber criminals. Increase employees’ vigilance regarding phishing and malware, and be especially cognizant of offers touting in-demand items like gowns and gloves. What seems like a bid for masks may be an attempt to hack the system.

Set Expectations with Finance

Speed to action doesn’t just apply on the clinical side. Work with finance to create a workflow for quick approvals to purchase available products. Many options will require the wiring of payment upfront, and waiting for layers of approval may mean sacrificing product to another buyer. Likewise, level-set expectations with senior leaders that misses can occur, and take steps to prevent engaging in gray market activity including fraudulent goods and price gauging.

Expect More Change

Tomorrow, even these changes, which seem extreme today, may not be enough. An article by Frank Huyler, MD, an emergency medicine physician in New Mexico, sums it up best: “Hospitals need a call to arms, and specific, bold, unified plans for collective action on a military scale.” Our recommendation is run, don’t walk, to implement these initiatives.

Access a recording of the call to hear Jeff and Jay’s full presentation, slides and a one-page summary.

Unwavering Support and Partnership

During COVID-19, Premier continues to act as a trusted connection point for healthcare providers, suppliers and the government. We are working 24/7 to address challenges as they occur and help our alliance of more than 4,000 hospitals and health systems and 175,000 non-acute providers access the supplies they need to serve their communities. We are also partnering with the Administration and private sector to create both short-term and long-term solutions, and sharing our insights to help inform the public understanding.

Access our COVID-19 resources and tools.