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Fear of Covid-19 in EDs—How Providence is using data to build trust

October 28, 2020

    Despite hospitals adding Covid-19 safety precautions, patients are still avoiding EDs due to the perceived infection risk. ED volumes are down 20% or more compared to 2019 volumes. To build back patient confidence, Providence St. Joseph Health is using research evidence to reassure clinicians and better target patient communications.

    How Covid-19 has changed consumer behavior and preferences

    Initial communications campaign helpful but insufficient

    Providence began to see noticeable decreases in heart attack, stroke, and other time-sensitive ED cases in early May. Physicians were also reporting patients who were dying in their home for fear of overwhelming the health care system or contracting Covid-19.

    To allay patient fears, Providence launched an aggressive campaign to communicate that it is safe to return to the hospital. It published a webpage describing its safety precautions, along with a Covid-19 landing page enumerating the ways patients can access care. It also partnered with several providers in the Los Angeles market to create a television and radio advertisement campaign emphasizing the importance of seeking necessary care.

    But while the strategies Providence took were a big step in gaining trust among patients, volumes were still lagging.

    Research study reassures clinicians

    With little improvement in ED volumes, clinical leaders began to question whether there was merit to patients' fears and if they needed to add additional safety protections or double down on their communications strategy. To get the answers they needed, they took a scientific approach: researchers conducted a retrospective case-control study examining 102 patients who visited an ED, were discharged, and subsequently tested positive for the new coronavirus one to three weeks later. They matched these cases with two control subjects who visited the same ED and tested negative for the virus one to three weeks later.

    Researchers found that neither the length of stay nor collocation with Covid-19 patients in the ED were associated with an increased risk of Covid-19. The factors that were correlated with test positivity were: age, ethnicity, and prevalence of infections in the community. Cases tended to be among patients who were younger, Hispanic, and lived in a ZIP code with greater than 14% Covid-19 test positivity.

    3 key priorities for future messages

    Now, with evidence that EDs do not pose undue risks to patients, Providence plans to build on the safety message that it started months ago—but this time, with added confidence among its clinical leadership that its EDs are safe for patients. Going forward, Providence's communications team will focus on three key priorities:

    1. Keeping tabs on shifting patient perceptions: At the peak of the country's coronavirus epidemic, Providence's marketing research team began sending biweekly pulse surveys to more than 20,000 consumers to better understand their current perceptions of hospitals and the virus. They have used this information to deliver targeted and personalized messaging to different patient segments who are more risk-averse, such as women and millennials.

    2. Leveraging the voice of physicians: Providence has found that patients view physicians as the most trusted and credible source for information. They have developed several physician videos to outline what safety precautions the organization is taking to protect employees and patients against Covid-19 and why patients shouldn't postpone emergency care. These clinical leaders have communicated powerful statements such as, "You shouldn't be asking if it's safe to go to the ED, you should be asking if it's safe for me not to."

    3. Building deeper relationships with patients through proactive, ongoing communications: Providence began sending out monthly Covid-19 newsletters to its over 2 million patients early in the epidemic, and found that these messages have excellent open, click-through, and opt-out rates. Now, Providence will attempt to shift from reactive to proactive communications by suggesting preventive health actions patients should take—such as receiving the annual flu vaccine—to its newly engaged patients.

    Providence's study gives clinical leadership and marketing and communications teams more assurance that patients can return to the ED without additional infection risk. Health systems can leverage that kind of evidence to develop a long-term communication strategy that builds trust and shifts consumer perceptions about the safety of health care settings. To start, explore our covid-19 survey results showing the types of messages patients find most reassuring:

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