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How cancer programs are protecting their patients from Covid-19

March 18, 2020

    Welcome to "Field Report," a new series where Advisory Board experts weigh in on what they are hearing from health care organizations across the county. In this edition, Deirdre Saulet explores how cancer programs across the country are responding to the COVID-19 outbreak.  

    COVID-19 is officially a global pandemic, and, in the United States, public health officials are focused on "flattening the curve." But not everyone can self-quarantine, especially those currently receiving cancer treatment. So it's especially important for cancer programs to ensure the safety of immunocompromised patients. While all health systems have emergency preparedness capabilities, such as command centers, we're seeing cancer centers develop their own working groups within those structures to focus specifically on oncology care and research. 

    Your top resources for coronavirus readiness

    Here, we've assembled information from published articles, conversations with oncology service line leaders, and online resources to help guide your cancer program's strategy during this time.  Please feel free to email me at sauletd@advisory.com to share what your organization is doing.  

    How are cancer programs mitigating patient and staff risk of exposure?

    • Screening patients before their appointments. The day before their scheduled appointments, staff are calling patients to ask if they are experiencing any COVID-19-related symptoms, including shortness of breath, cough, and/or fever.

    • Triage for rapid intervention. Using algorithms for patients with COVID-19-compatible symptoms to ensure swift interventions, especially if they have neutropenia or are receiving immunotherapy, to determine if they need to be directed to the system's 24/7 triage line or require urgent care or hospital admission.

    • Restricting entry. Most health systems are currently restricting access to the hospital and outpatient facilities to a small number of entry points where anyone entering, including patients, visitors, staff, and clinicians, are screened for symptoms and recent international travel.

    • Offering onsite "drive-thru" testing and testing tents. For example, all sites at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins have or will soon have testing tents and drive-through testing sites at all their cancer treatment sites.

    • Limiting visitors. Many organizations are restricting the number of visitors to one or two per patient—and a few are even saying no guests at all in their infusion centers. Visitors, like patients, are being screened for symptoms.

    • Rescheduling non-essential patient visits. Non-essential patient visits and invasive procedures, such as reconstructive surgeries or bone marrow transplants for sickle cell disorder, are being delayed whenever possible.

    • Fast-tracking injections. Setting up a separate "fast-track" area for patients receiving injections only in the infusion center. (Note: This is great to do under normal conditions as well to drive efficiency.)

    • Separating lab and infusion visits. Helping patients find labs close to home where they can get their blood work done one to two days before their infusion to minimize wait times—and make sure patients coming in are eligible to receive treatment.

    • Encouraging appointments during extended hours. Cancer centers that already offer evening and weekend hours are encouraging patients to take advantage of that availability to try to limit the number of patients in the center at any given time.

    • Deploying telehealth. Shifting follow-up visits for patients who have completed treatment to telephone or video visits.

    • Minimizing the number of "touches" a patient receives. For inpatient admissions, such as bone marrow transplants, limiting the number of individuals coming in and out of a patient room. For example, having a physician come in alone without the entire team or having unit staff deliver and take away food trays.

    • Cancelling in-person patient-facing events. Support groups, fundraisers, and the myriad of other non-treatment-related activities programs offer are being cancelled or rescheduled. Whenever possible, organizations should look to use virtual options to make sure patients still have the support they need.

    • Moving in-person administrative and clinical meetings virtual. Encouraging teams to use Skype, WebEx, and other virtual platforms for meetings, seminars, and grand rounds.

    • Reducing the number of staff onsite. Some organizations are encouraging work from home for non-essential staff, such as administrative and research staff.

    • Implementing policies for vendors. Currently, most vendors and contractors are being screened like all other hospital visitors, but a few organizations are working on vendor-specific policies and considering restricting vendor visits.

    • Restricting employee travel. While business travel is already restricted across nearly every organization at this point, some organizations are also asking employees to cancel any personal travel plans to areas with a Level 2 or 3 travel advisory based on federal guidelines. MD Anderson has set up a COVID-19 Travel Registry where employees can confidentially share any details of personal and family member travel to help curtail the introduction of the virus at any of their campuses.

    • Working to find sufficient supplies. Fortunately, drug shortages aren't a serious concern for the organizations we've spoken with (at least not yet). However, a recent report revealed that Memorial Sloan Kettering—like many other health systems in the United States—is challenged with shortages of personal protective equipment (PPE), such as masks and gowns. While we wait for manufacturing in China to rebound, it's critical for organizations to balance supply and demand for PPE, while ensuring clear communication to frontline staff and keeping them safe.

    How are cancer programs communicating these changes to patients and families?

    • Dedicated websites. A few cancer centers have built out dedicated webpages for all patient-facing communication and updated info. For inspiration, take a look at what these organizations have done:
    • Social media. Organizations with Twitter and Facebook accounts are sharing updates in the moment with patients through these channels. MD Anderson has also been posting short videos on its YouTube channel.

    • In-person signage. Notifying all patients and families of any changes in cancer center policies and processes. You can see UCSF's simple and eye-catching self-screening signs in multiple languages here.

    Other resources to help

    Check out the Advisory Board's top resources for coronavirus readiness, featuring upcoming events and available resources.

    The National Comprehensive Cancer Network has a COVID-19 resource page, including sample documents from member institutions.

    The American Society of Clinical Oncology has compiled general resources, as well as FAQs about the impact of COVID-19 on clinical practice.  

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