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Egbe-Etu E. Etu Editorial Staff Writer ORMS Tomorrow Magazine |
Over the last few months, the 2019 Coronavirus (COVID-19) pandemic has put a strain on the healthcare system, sickened many hospital staff, and stretched hospital resources to their limits and beyond. As of June 5th, 2020, the estimated number of infected patients worldwide stands at 6.7 million, with a recorded death toll of 395,597 (WHO, 2020). According to the Center for Disease Control and Prevention, the United States has the highest death toll of 110,699, with 1.93 million people infected by the virus. The primary function of a hospital is to provide the general populace with complete health care service, but this has been challenging for these institutions during this pandemic. A shortage of resources and unlimited demand for service has hindered their ability to provide care to the numerous infected patients. You might be wondering, “What is health care resources?”. Ransom and Olson (2017) define health care resources as all the materials, personnel, facilities, and funds that can be used for providing medical services to patients. So, it includes the personal protective equipment (PPEs), ventilators, beds, triage rooms, hospital buildings, physicians, nurses, and paramedics that are put together to provide care to patients. For a long time, health care services have been inherently scarce: money for services is not unlimited, facilities for delivering services are finite, and medical professionals are limited in time, geography, skills, and capacity. The pandemic has only brought out some of the strengths and weaknesses we face in society and the healthcare system. This interview will focus on telling the story of some of the issues faced in the hospital emergency departments during the pandemic. How they were solved, lessons learned, and how research can be employed for improvement. We interview an experienced emergency physician to get some insights into what the hospital has done to cope with the limited resources.
The primary function of a hospital is to provide the general populace with complete health care service, but this has been challenging for these institutions during this pandemic. A shortage of resources and unlimited demand for service has hindered their ability to provide care to the numerous infected patients. You might be wondering, “What is health care resources?". Ransom and Olson (2017) define health care resources as all the materials, personnel, facilities, and funds that can be used for providing medical services to patients. So, it includes the personal protective equipment (PPEs), ventilators, beds, triage rooms, hospital buildings, physicians, nurses, and paramedics that are put together to provide care to patients.
For a long time, health care services have been inherently scarce: money for services is not unlimited, facilities for delivering services are finite, and medical professionals are limited in time, geography, skills, and capacity. The pandemic has only brought out some of the strengths and weaknesses we face in society and the healthcare system. This interview will focus on telling the story of some of the issues faced in the hospital emergency departments during the pandemic. How they were solved, lessons learned, and how research can be employed for improvement. We interview an experienced emergency physician to get some insights into what the hospital has done to cope with the limited resources.
Can you tell us briefly about the Henry Ford Health System and its emergency department?
“The Henry Ford Health System (HFHS) cares for a large proportion of patients in southeast Michigan. There are nine emergency departments total within the system and five hospitals, plus two additional psychiatric units. The main emergency department is a large-level one trauma center in the heart of Detroit, specifically in the midtown area. The system is integrated and has a unified medical group that cares for all the patients that call us their medical home.”
Health systems are facing so many issues with the COVID-19 pandemic. What are some of the resource shortages at Henry Ford Hospital?
“The main issues that we had with resource shortage, particularly during the first two months of the pandemic, were about PPE materials. We actually were doing okay on medications and I.V. fluids and other common resources for use. Still, just like many other health systems, we were in short supply. Our health system leadership had to be creative about resourcing proper PPEs and determining optimal use such that we conserved as much as possible for patients. Now, in theory, we could have had shortages of our mechanical ventilator supply. But fortunately, the hospital did not come close to the point of running out of ventilators. We still had plenty of ventilators throughout the entire pandemic. If the cases in Detroit had gone on for a longer period or had been more severe, we could have easily run out of those as well. The other resource that we were relatively short on was hospital beds. We did reach near-total hospital capacity. If the pandemic had gone on for a few more weeks in Detroit, we would have transferred a lot more patients to field hospitals. Another shortage that we ran across was a shortage of standard intensive care unit (ICU) beds. So, we did have to convert quite a few units that were not typically running as full ICU’s into ICU amid the pandemic. Another issue faced was with physician staffing. What happened was a lot of clinicians that don’t typically work in the inpatient ICU, or emergency department helped cover from other areas of the health system. Many nurses, physician assistants, faculty in other specialties came to assist the emergency department. This is great as it shows the teamwork, dedication, and willingness of the employees.”
What steps did the hospital take to address some of the resource shortage?
“The major steps had to do with sourcing PPE materials and operational changes. Converting units of the hospital from regular medical-surgical units to units dedicated to COVID-19 and including ICU’s dedicated to COVID-19. So, for instance, our entire surgical intensive care unit was converted into a COVID-19 unit that helps us manage the surge of patients with critical illness related to COVID.”
How did HFHS source for PPEs, and did you benefit from any of the “Big Three” automotive companies in Michigan?
“Yes, we benefited from many different sources. For instance, Ford Motor Company donated PPEs. We had PPE materials donated from general donations, and we set up a kind of centralized donation process. The other thing to mention is that we were involved in the establishment of a field hospital. The field hospital was put up to increase the capacity to potentially manage a thousand patients. Yeah, the field hospital wasn’t needed for a short time but was there just in case the pandemic had become much worse. Eventually, I would say for residents in Detroit who obeyed the stay at home order; we were able to flatten the curve.”
With the limited resources diverted to treat critical patients, what happened to the other deferred patients (e.g., pregnant patients, patient with transplants, etc.)?
“So, a lot of health care was deferred. In some cases, new transplants were not performed in the middle of the pandemic. However, clinicians used their judgment to determine things that cannot be deferred. For example, pregnancy patients continue to deliver babies during the pandemic. It continued with special precautions to protect pregnant women and their babies. Next, patients with a serious illness, or perhaps with a history of transplants and complications, continued to receive either virtual or in-person care, as needed, for acute or chronic illnesses. The health system actually went from doing an estimate of 400 virtual visits a week to 4,000 virtual visits a week using telehealth visits or video visits. So, an exponential rise in virtual visits.”
Did the hospital dedicate any units to non-COVID related patients?
“Yes, essentially, we perform what we call ‘cohorting’, where special units were dedicated to COVID patients. Then there was a small number of units where we quarantine and designate as non-COVID. To protect the health of uninfected patients, but still had an acute illness or had pregnancy-related admissions.”
What are some possible research areas you think prospective students, researchers, or institutions can engage in to help improve the health care system during a pandemic?
“There’s so much research to do as a result of the pandemic. First, there is research in the area of predictive analytics for systems or regions to estimate the likelihood of a future outcome of the health system in terms of resources and capacity during a pandemic. Secondly, research on operational efficiency to develop methods by which systems can operationalize some of the changes that most health systems have implemented. But in a more data-driven approach rather than on the fly approach, which is what many systems were forced to do during the pandemic. Third, I think research related to how systems supply, allocate PPE, and other related medical resources amid a pandemic to protect employees the best. Fourth, research on telehealth to determine what scenarios and patients are best served purely through telehealth and virtual health rather than in-person encounters and how to best deploy the technology either during a pandemic or other aspect of care.”
Telehealth is an exciting research area for students to delve into. Any security or connection concerns?
“Yes, research has to be done in addressing the security and connection issues. Patient confidentiality, privacy, and data are important. I think there are telehealth systems and providers that have established a secure Health Insurance Portability and Accountability Act (HIPAA) compliant connection. Still, the issue has come up throughout the pandemic. Many clinicians that do not have access to some of these more robust information technology (I.T.) solutions made use of Zoom or other less secure virtual visit methods. This puts the patients at risk and raises security concerns.”
Lastly, as a medical professional, what practical lessons have you learned?
“A couple of things we’ve learned is that having good data can help guide and inform rapid changes. Having that in place for an operation before a pandemic can help you decide how best to use resources. The second lesson is that having a conservative and extensive use of PPE can help save a lot of medical professionals. I think a lot of us learned that early on, as a lot of providers, clinicians, and nurses became sick. With time, we had a better handle of things as we started to make more judicious use of PPEs, the number of ill medical personnel reduced. But I think if clinicians, nurses, physicians, everyone involved was more cautious at the beginning, they might have saved a lot of lost hours of work. Finally, we were uncertain about recycling and reusing medical equipment at the beginning. Now, we have much knowledge about it and how to handle it.”
| Dr. Joseph Miller, is an emergency care physician and a director for the combined internal medicine and emergency medicine residency program at Henry Ford Health System in Detroit, Michigan. He is a clinical associate professor at Wayne State University, Detroit. His research interests focus on emergency neurological conditions such as acute stroke, epilepsy, and traumatic brain injury. Also, he does research in hypertensive emergencies, the operations/systems of the emergency department, and he teaches research methodology within the health system. |
References:
World Health Organization (2020). “COVID-19 Report”. https://www.who.int/emergencies/diseases/novel-coronavirus-2019
Centers for Disease Control and Prevention (2020). “COVID-19 Cases in the US.” https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html
Ransom, H., & Olsson, J. M. (2017). Allocation of Health Care Resources: Principles for Decision-making. Pediatrics in review, 38(7), 320-329.