Last fall and winter, hospitals took a number of steps to handle what for many was an unprecedented demand for care amid a simultaneous surge of respiratory syncytial virus, flu and COVID-19.
Regardless of whether the upcoming virus season will be as severe as the "tripledemic" hospitals were up against last season, any level of surge is sure to exacerbate existing capacity strain and staffing challenges. Setting up discharge lounges and emergency room fast tracks to treat lower-acuity patients and ramping up coordination with other regional hospitals were some of the actions taken to handle the demand for care last season.
As fall approaches, Becker's asked three physician leaders what clinical workflows or process changes were most useful during the tripledemic that their hospitals plan to put into action again in the face of similar trends later this year. Their responses have been lightly edited for length and clarity and are listed in alphabetical order.
Aimee Becker, MD. Chief Clinical Officer at UW Health in Madison, Wis.: Like many health systems across the country, we saw an unprecedented demand for emergency care and inpatient admissions during the fall of 2022’s respiratory virus surge. At UW Health, we implemented and sustained two specific innovative improvements during the surge to enhance patient care and throughput. Each approach augments patient throughput from a different direction, one on the front end of admission and one on the back end of discharge.
On the front end, our emergency medicine team worked with our hospital medicine team to develop a standard process, including a communication pathway and EMR tool for the inpatient admitting team to coordinate with the ED team to advance the care of patients boarding in the ED. This standard process has been extended to all clinical services and serves as an important pathway for advancing the care of ED inpatients boarding in the ED.
On the back end, our nursing team led the charge to set up a discharge lounge for qualified patients who are medically cleared but have a nonmedical barrier to discharge (e.g., waiting for a ride). The internal lounge allows us to open beds for incoming patients while patients who are medically ready for discharge complete the sometimes lengthy process of physically leaving the hospital. We expect the use of these innovative improvements to be key levers in the setting of a repeat fall respiratory virus surge.
Ruth McDonald, MD. Vice President, Associate Chief Medical Officer and Chief Medical Operations Officer at Seattle Children's:
Seattle Children's has a complex medical population that is especially hard hit by acute viruses, and many pediatric centers in the western region were similarly over capacity with admissions. Throughout the viral surge, Seattle Children's worked extensively with the regional healthcare network to develop a pediatric medical coordination center for pediatric placement statewide to ensure that the patients most in need of specialized services were triaged to pediatric hospitals.
Seattle Children's healthcare emergency preparedness teams collaborated extensively to develop solutions and identify resources to help address the pediatric surge. Seattle Children's improved a direct admit process and outpatient urgent appointments to avoid ED visits, transformed acute care beds into ICU beds, which expanded care for the sickest patients in the region, in acute care utilized treatment rooms and converted single-patient rooms into double-bedded rooms to increase capacity, created additional mental health spaces for patients, and helped develop a treatment algorithm so hospitals without pediatric specialists could properly treat patients until they were stable enough to discharge or transfer to definitive care.
Looking ahead to the next viral season, Seattle Children's will continue to utilize a coordinated, multilevel response and is now a hub site for the Pediatric Pandemic Network that is working to improve pediatric care every day and in crises, and additionally are supporting the development of a Western Regional Alliance for Pediatric Emergency Management Pediatric Surge Playbook, which will serve as an important reference tool during or in anticipation of another surge incident in the region.
Stephen Weber, MD. Executive Vice President of Clinical Effectiveness and Chief Medical Officer at the University of Chicago Medicine: The lessons learned last year and throughout the pandemic provide essential insights for our management of severe respiratory viruses. While we have suspended many of those interventions for now, we are prepared to step up to meet the needs of our patients and community by again deploying practices such as intensive surveillance, targeted masking and, if necessary, restrictions to our campus. However, we will also apply the lessons learned to limit the burdens and disruptions for our patients, families and team members.