“You’re sitting too close together.”
We were gathered in a hospital lobby on a Saturday morning in February to discuss our response to COVID-19 when the medical director of infection control joined us and pulled her chair six feet away from us, encouraging us to do the same.
This, along with data projecting an inevitable global pandemic, were markers for the drastic steps to come.
Before mid-March, UW Health, was operating a Level 1 Hospital Incident Command System (HICS), the most comprehensive and serious emergency response for a health system. But HICS is designed for “incidents,” or short-term crises. How do you address a long-term emergency?
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Shutting down normal
Our best available data showed we needed to open our beds for a potential surge in COVID-19 patients, establish physical distancing, restructure our facilities and preserve our personal protective equipment (PPE). As a result, we decided to postpone all nonessential procedures and appointments. Regardless of some skepticism and the financial consequences, we needed fewer people in our buildings and more people at home.
Redeployment
With thousands of appointments postponed, including 6,000 surgeries, and COVID-19 accelerating, hundreds of specialists needed to be redeployed. Anesthesiologists were taken off surgeries and put on airway strike teams. Nurses staffed the COVID-19 hotline and testing facilities. PPE fit testing took place 24 hours a day. Every staff member prepared for the possibility of a new role and an unknown workload.
Flipping a hospital upside down
In addition to staff changes, healthcare facilities and operations—including security, sanitation, HVAC and construction—needed to be altered.
We doubled our ICU capacity. We reversed airflow to increase isolation options with negative pressure rooms. We stopped permitting visitors. We intensified sanitation, including using UV lights to disinfect patient rooms.
Literally thousands of protocols and operations changed across our system in a matter of weeks.
DIY supply chain
Hospitals all over the country have struggled to maintain critical supplies like PPE.
As we planned for the worst-case scenario and watched traditional supplies dwindle, we had to get creative with conservation and acquisition, often looking to our partners at the university and in our community. We’ve been sterilizing used N95 masks in case we ever need them. We are part of a laundry co-op that washes and sterilizes tens of thousands of gowns a week.
When we started to run out of hand sanitizer, we worked with the university’s School of Pharmacy to homebrew it.
The university’s School of Engineering worked alongside local manufacturers to design and 3D print face shields. They also helped us create adapters when the national stockpile provided PAPR hoods that were incompatible with our PAPR hoses. This ingenuity and collaboration will need to continue throughout the crisis.
What now?
So much is still unknown. Our health system remains poised to manage an influx of COVID-19 patients, but we’ve also started welcoming back other patients.
When we confirmed our first COVID-19 patient, we braced for the surge that did not emerge. Now we’re watching cases climb and we’re looking at the long haul. “A chronic smolder,” our medical director of infection control calls it. To maintain the health of our business and patients, we are settling into an extended emergency response.
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Some might say our actions were all for nothing. We postponed important care. Many of the plans and dreams for growth we had have been deferred. The financial impact to our system was upwards of $400 million.
No, we have not yet seen an immense surge. And we may never know the impact of our actions. But health systems across the country need to remain prepared. Because cases are rising and this is our new reality. We need to care for our patients and be able to pivot to a COVID-19 surge within days or hours then pivot back. We cannot go back to the way it was, because flexibility and resilience will continue to be tested.
That isn’t a bad thing. In some ways, this pandemic has moved the industry forward years in a few short months. Health systems are the cornerstone of community health and wellness, so we have no choice but to rise to this challenge and create a safe, agile, new normal.
Alan Kaplan, M.D., is CEO of UW Health. Elizabeth Bolt is COO and Pete Newcomer, M.D., is chief clinical officer at UW Health, the health system associated with the University of Wisconsin School of Medicine and Public Health.