Six employees of NYC Health + Hospitals published an article in Health Affairs July 16 detailing how the largest municipal health system in the country resolved numerous supply chain challenges during the height of New York's COVID-19 outbreak this spring.
The New York City health system, in one of the areas hardest hit by the COVID-19 pandemic, has a workforce of nearly 40,000 people, so procuring and keeping up with demand for personal protective equipment was "one of our most difficult challenges," the authors wrote.
In January, the health system began proactively placing orders of equipment and medical supplies, including PPE and ventilators, in anticipation of a surge.
"Despite our efforts to prepare, we were foiled by the global supply chain on which we relied: Orders placed became orders never filled. Supplies shipped became supplies never received. Bidding wars began with other systems and entities across the globe in competition for the same resource," they wrote.
The health system increased its acute care bed capacity by 50 percent and ICU bed capacity by about 75 percent, meaning the supply chain team had to quickly procure and deliver hundreds of medical beds, IV pumps, feeding tubes, critical care ventilators, dialysis units, cardiac monitors and all other general medical and surgical-related supplies.
But in January, most manufacturers and distributors said that after February, they wouldn't deliver more per month than they had on average over the previous three months, so supply volume was frozen.
By Feb. 27, NYC Health + Hospitals began advising staff to reuse N95 masks under specific circumstances, and it advised the same for other types of PPE on March 22.
When critical equipment ran out, clinical teams had to "creatively fashion replacements out of other available supplies and tools."
"This was tremendously labor-intensive work at a time when the strain on staff was already incredibly high. Their ingenuity and successful problem-solving in a time of crisis saved many lives," the authors wrote.
At one point, the health system's entire supply of IV pumps was gone, so they had to implement protocols to decrease the number of medications requiring an IV infusion pump.
The authors wrote that the health system's central supply chain office had to find products from nontraditional, noncontracted vendors by talking with colleagues, placing cold calls and following leads on potential sources. In total, the office placed 300 emergency purchase orders.
A PPE hotline was established at every facility to answer employee questions.
The authors said that because COVID-19 is still spreading, the health system must operate under the belief that the traditional supply chain processes will not return to normal anytime soon.
"Looking ahead, we will need to continue devoting significant time to acquiring PPE and associated supplies that remain in great demand: ventilators, dialysis machines, catheters, laboratory supplies and other procedures equipment. This work includes regularly reviewing current needs while also evaluating the equipment we acquired under emergency procedures to confirm that they can adequately meet our needs going forward," they wrote.
The article was authored by Syra Madad, senior director of the systemwide special pathogens program; Laura Iavicolli, MD, an emergency medicine physician with special expertise in emergency management; Paul Albertson, vice president of supply chain services; Danielle Dibari, PharmD, chief pharmacy officer; Priya Dhagat, assistant director of the systemwide special pathogens program; and Mary Fornek, system director of infection prevention.
Read the full article here.