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How hospitals hope to keep ‘worried well’ from flooding emergency rooms during coronavirus outbreak
General view of a hospital where health officers, wearing masks and special protective suits, take care of a patient infected by the coronavirus (COVID-19) at a hospital in Tehran, Iran on March 02, 2020.Fatemah Bahrami | Anadolu Agency | Getty ImagesSutter Health, a Northern California hospital chain, emailed its patients over the weekend of March…
General view of a hospital where health officers, wearing masks and special protective suits, take care of a patient infected by the coronavirus (COVID-19) at a hospital in Tehran, Iran on March 02, 2020.
Fatemah Bahrami | Anadolu Agency | Getty Images
Sutter Health, a Northern California hospital chain, emailed its patients over the weekend of March 7 to encourage them to use a new online tool if they have symptoms resembling the coronavirus.
The app works by leading patients through a set of questions to find out how they're feeling, how long they've experienced symptoms, their age and medical background, and whether they've traveled recently. Those who are concerned can opt to talk to a doctor via video chat.
Fearing that the virus would spread across the Bay Area in the coming weeks, Chan said he pulled together a meeting with infectious disease experts, some clinicians and a small team of web developers. The hospital had an existing capability for video visits, but knew it needed to quickly scale up. “We worked late into the night… over many evenings and the through the weekend,” said Chan.
It went live March 7, and the video service immediately started getting booked up quickly, with most slots taken by noon.
The tool is just one example of how hospitals across the United States are scrambling to prepare for a possible flood of COVID-19 coronavirus patients. Health system execs expect very soon to be managing far more patients than the usual volume and that they need to take extreme measures if they run low on supplies, according to half a dozen who spoke to CNBC. As of Thursday, there are more than 1,000 coronavirus cases across the United States and more than 120,000 worldwide.
Keeping people home if they're not too sick
“I fear we're just at the beginning,” said Rod Hochman, CEO of Providence St. Joseph Health.
Hochman runs hospitals in Seattle, one of the hardest hit regions, and says his hospital staff tunes in to meetings every morning at 7.30am to discuss the latest information about the coronavirus. It has also rolled out chatbot tools, in partnership with Microsoft, to keep patients out of the hospital who don't need to be there so its doctors can focus on the most critical cases. Providence is already seeing a “fivefold increase” in virtual visit services overall, according to Hochman.
“We're expecting volumes to spike, with thousands of patients using the virtual channels, not to mention thousands more in our emergency rooms and clinics,” he said.
Many hospital execs are turning to telemedicine and other virtual care offerings to stem the flood of patients. That strategy is in line with guidance from both hospital associations and public health organizations like the Centers for Disease Control and Prevention. Their advice to is to assess people who are worried about their symptoms remotely, then keep patients with mild symptoms at home, but monitor them closely via check-ins.
Providence is one of the first health systems to treat patients who are quarantined at home in Washington State, which is the epicenter of diagnosed cases in the U.S. so far. For Providence, the protocol is to send a thermometer and pulse oximeter to patients with mild symptoms, and have clinicians call throughout the day and see if their condition is changing.
For hospitals, it's a critical moment to test whether telemedicine technologies can be relied upon in moments of crisis. The technology has been around for decades. But it hasn't yet hit the mainstream because of a variety of obstacles, ranging from the lack of payment to complex state licensing requirements. As it stands today, doctors have to be licensed in that state to treat a patient. It can take months and thousands of dollars to get those licenses.
“I wish it was easier for hospitals to utilize telemedicine in a truly scalable way,” added Miri.
Dr. Hanson from Penn Medicine noted that virtual volume has doubled overall already for his hospital, whether it's the screening tools or video visits. One area of focus for him is to make sure that older patients understand how to use the virtual offerings, as seniors are among the groups at high risk. “There's a lot of education going on right now,” he said. “We've had to scale everything up quickly.”
Likewise, Chan sees an opportunity for telemedicine to have its moment as more people start to use it. “It's critical for hospitals like ours to load balance,” he said. “We need to figure out who needs to be tested and who needs to be seen, as we're going to be taking care of a lot of people.”
Ensuring supplies and communication
Smaller hospitals are scrambling to ensure that their doctors and nurses have sufficient supplies.
At Baptist Health in Kentucky, chief medical information officer Brett Oliver said the supply chain group is considering buying infant diapers in bulk because these could potentially be used as makeshift mask in an emergency. Some hospitals are already reporting that they're down their last month's supply of N95 respirator masks, with global supply deleted because of the outbreak in China.
Making matters worse, one of the Baptist Health warehouses that stores surgical supplies was recently hit by the tornado that tore through Nashville. “We're thinking of everything and being realistic,” said Oliver.
Most hospitals are concerned about dwindling supplies of protective gear for their own doctors and nurses. “The global supply has been absorbed rapidly by countries hit earlier than us by the virus,” said Penn Medicine's chief medical information officer Dr. C. Willam Hanson. “But we recognize that we have better purchasing power than some of the smaller hospitals.”
Digital communication tools are also key. Hospital executives are frequently communicating with each other via Google docs and video calls to share their best practices, said Aaron Miri, the chief information officer for UT Health in Austin. Others are working
“We want to prepare for this, but we also don't want to cause mass hysteria,” he said. “What I'm focusing on now is more digital solutions, so we can connect with patients in even the most rural parts of the state.”
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