In the United States, healthcare providers have been forced to change their normal operations around preventative care delivery and elective procedures to meet the needs of COVID-19 patients. Where I practice, for example, in New York City, hospitals have converted pediatric oncology floors into COVID-19 wards.
As a physician seeing HIV patients remotely in New York City during this pandemic, I have connected with other clinicians on the front lines and learned from the lessons they shared. Any efforts to help our front-line staff manage COVID-19 patients must first come from understanding their needs, both in the short- and long-term. In my opinion, this can be categorized as acute management of COVID-19 patients and redirecting usual practice operations.
From there, providers should be thinking through how to ascertain which early treatments are most effective, capture the results of clinical trials and lead through innovation.
Acute management of COVID-19 patients: fewer peer-reviewed abstracts, more sharing insights over social media
As a novel disease with no known cure and few well-proven treatment modalities, COVID-19 has clinical staff in most hospital systems learning how to care for its patients on the fly. New treatments like prone positions or compassionate use of agents like remdesivir are being trialed in the absence of well-established remedies. The normal channels of peer-reviewed abstracts, conferences and medical journals may not be enough to share real-time knowledge, and we are seeing clinicians devise new ways of sharing insights, from posts on Facebook and Twitter to weekly webinars and recorded grand rounds.
Much has been written about the challenges with testing and acquiring enough personal protective equipment (PPE) to deal with a surge. A recent Premier survey of U.S. hospitals indicated a three- to 17-fold increase in demand for critical products such as N95 respirators, surgical masks, face shields, isolation gowns and viral swabs related to patient surge. These shortages are posing a tremendous strain on the U.S. healthcare system, and require facilities to ultimately identify alternative ways to provide patient care. As the economy comes back and health systems ramp up elective surgeries, facilities will once again be tasked with ensuring they stock enough of these products.
Redirecting and rethinking usual practice operations
Many preventative and elective services, such as primary and specialty care, and non-emergency procedures were placed on indefinite hold. In those settings, providers had to create ways to stay close to patients who continued to need care for their chronic illnesses; to assist patients needing acute medical, but non-emergent, care; and in some cases, to assist with medical conditions that could not wait, such as cancer treatment or palliative/hospice care.
By and large, telemedicine has become the modality of choice, especially as regulations governing its use have made it more accessible. In cases where providers have to be physically present in clinics to provide care, new approaches remove the use of waiting rooms, alter clinic flow to allow for efficient use of PPE by streamlining patient touchpoints, and redirect and retrain clinicians to change the way they deliver care in these new settings. As with the need for acute treatment insights for COVID-19 patients, there are numerous lessons to be learned about how best to provide remote or redesigned preventive care for non-COVID-19 patients. Health systems in hotspots like New York, New Jersey and New Orleans that have undergone these transformations rapidly may be a source of insight for those who have yet to see a COVID-19 surge.
It is clear that, in addition to treatments and vaccines for management of COVID-19, health systems desperately need mechanisms to rapidly share the best practices and recommendations for redirecting preventative care management.
Meeting health systems’ needs in the face of an evolving pandemic
If health systems’ needs fall into the two categories of (1) a requirement for up-to-date information for management of COVID-19 patients and (2) assistance with redeploying health resources to be COVID-19-facing, the most supportive response lies in providing information on COVID-19 patients as well as offering platforms to share best practices. Premier has devised ways to do both. Here’s how:
- Using the Premier Healthcare Database, which is one of the largest chargemaster databases in the U.S. with information on 45 percent of nationwide hospital discharges, Premier is collecting vital data on COVID-19 patients, including clinical course, diagnostic and treatment plans, disposition and demographic differences. The insights gleaned from this database can help health systems to understand risk factors for high-risk patients, as well as devise early insights into which treatment plans (including imaging or medication) may be most efficacious.
- Premier is working to ensure that the treatment and vaccine clinical trials that will offer key insights for disease management are shared with our health systems. We have created a COVID-19 Research Network of interested sites and are actively partnering with contract research organizations (CROs) and life science partners, as well as academic and public health bodies, to ensure our health systems are engaged.
- Premier’s prospective research offerings, such as our expert input forums, quality improvement studies and observational trials, will allow us to explore and analyze best practices from multiple health systems. Those results will then be shared across multiple networks.
Referring to these times as “unprecedented” is cliché at this point. But it’s true. The way we deliver – and receive – care will fundamentally change, as will the ways in which we share information and best practices. But we as clinicians are trained to roll with the punches and make decisions based on limited information. I am confident that we will adapt and find new workarounds for the challenges our new reality presents.