March 24, 2020 Advisory Board's take: 2 principles to keep in mind while developing COVID-19 staffing strategy

Hundreds of U.S. health care workers have been sent home from work due potential exposure to the new coronavirus and dozens of others have gotten sick with COVID-19, the disease the virus causes—and health experts are concerned the growing number of cases could leave hospitals short-staffed.

Health care workers are getting sick with COVID-19

Health care workers on the frontlines treating patients are always at heightened risk of infection during a pandemic, and the new coronavirus is turning out to be no exception.

Andra Blomkalns, chair of emergency medicine at Stanford University, said she believes the 80 physicians in her ED likely have all been exposed to the new coronavirus. One physician in her ED who was confirmed to have COVID-19 got severely ill, and at least a dozen other physicians had coronavirus test results pending, the Wall Street Journal reported Saturday.

Across the country, a children's hospital in Philadelphia closed its ICU and trauma unit to new patients after a physician tested positive for COVID-19, the Philadelphia Inquirer reports. Patch.com, reported last Thursday that 10 of the 44 cases of COVID-19 in the city at that time were among health care workers.

According to health experts, a lack of testing could exacerbate these numbers by allowing the virus to spread. One firefighter and EMT in Santa Cruz, California, said he was denied a test in the beginning of March because he didn't meet government criteria for testing. He later tested positive for COVID-19.

Meanwhile, health care workers around the country are concerned about shortages of personal protective equipment.

One nurse in Michigan said at her hospital, nurses have been given one N-95 respirator mask apiece and were told to reuse them. She also said nurses on her floor have struggled to get as many sanitizing wipes as they need.

"I don't feel like my hospital is failing us," she said. "It's the whole system that's failing us."

Hospitals work to make do with less staff

But as the number of COVID-19 cases increase and health care workers continue to be taken out of work, health care experts are concerned the response could leave hospitals short-staffed.

"If you take all those people off the front lines, you don't have a workforce," Blomkalns said. Her hospital is in the San Francisco Bay area, which has been hit particularly harshly with COVID-19. She added, "I feel like a monster having to make some of these really tough decisions and how they affect people’s lives."

Former CDC director Tom Frieden said, "If there are large numbers of health care workers exposed, how do we manage that and keep them out of health care facilities?" Staffing reductions "eliminate your ability to respond," he said.

April Hansen, EVP of workforce solutions and clinical services at health care staffing company Aya Healthcare, said the rise of COVID-19 cases overall has meant the company is fielding an increased number of requests for health care staff.

"We are now posting more than 1,000 crisis jobs for health systems across the nation and orders continue to come in rapidly," she said. According to Leslie Snavely, chief strategy officer at CHG Healthcare, demand for ED doctors, hospitalists, and infectious disease specialists has been increasing for weeks, especially in New York and Washington (Mettler et al., Washington Post, 3/5; Bernstein, et al., Washington Post, 3/17; McKenna, Wired, 3/13; Kacik/Meyer, Modern Healthcare, 3/16; Gantz/Whelan, Philadelphia Inquirer, 3/15; Adamy, Wall Street Journal, 3/21; Bennet, Patch.com, 3/19).

Advisory Board's take

2 principles to keep in mind while developing COVID-19 staffing strategy

Lauren Rewers, Senior Analyst

There are many shortages to come as the nation ramps up to care for a surge of COVID-19 patients—and yes, a shortage of staff equipped to care for highly acute patients is among them. Over time, the staff shortage will only become more severe as staff inevitably fall ill and become patients themselves.

Clinical leaders across the country are rising to meet this challenge with a bevy of creative staffing solutions. I’ve heard dozens of ideas in the past week alone that would have been unthinkable a month ago.

What solution set is right for you will depend on your organization’s unique market and needs. But there's two principles I recommend all clinical leaders to keep in mind while developing their COVID-19 staffing strategy.

First, relax your definition of "top of license" care. Under normal circumstances, it's a win-win for cost and quality to encourage staff to work at the top of their license. But as the supply of different types of clinicians drastically changes day by day, sticking to strict boundaries can do more harm than good.

In other words, our ultimate goal shouldn't be to ensure each clinician is working as efficiently as possible within their license. But instead, to ensure we are able to deploy the total number of clinicians we have against the total volume of care we need to deliver.

Other than relaxing the strict roles within the multidisciplinary team, this also means redeploying staff across specialties and sites of care. For example, many organizations are redeploying staff from cancelled elective surgeries or other non-emergent procedures to triage and COVID-19 testing.

The one exception to this rule: make sure that clinical staff are not tasked with anything that could be covered by a non-clinical member of the team. Non-clinical staff may also be in short supply, as volunteers at high risk of contracting the virus practice social distancing. But organizations have more flexibility to recruit new volunteers or redeploy administrative staff than they do to recruit clinicians.

Second, think of your clinical staffing pool at the community level, not at the organization level. This approach ensures that organizations addressing the epidemic within the same community aren’t inadvertently competing for staff. It can also open up staffing pools previously unutilized by hospitals.

It’s not lost on anyone that these options require additional legal or regulatory steps. But I encourage organizations to explore what options are open to you before a staffing shortage becomes truly debilitating.

Consider the following ideas as a starting point:

  • As a community, decide on as few screening and triage points as possible to reduce transmission of the virus. Consolidate staffing at those locations.

  • Several states have loosened licensing and credentialing restrictions for recently retired clinicians. Organizations should consider now what steps to take to re-introduce retirees to practice. Similarly, with the cancellation of most clinical rotations, medical and nursing students are available to support providers in a more limited fashion.

  • Consider deploying any clinical team members that serve businesses or industries that are currently shut down. For example, RNs who work at schools and universities may now be available to assist with COVID-19 care.

My team and I will be working throughout the next few weeks to profile creative ways organizations have increased their staffing capacity. If you have done so at your organization, please email us directly at RewersL@advisory.com so we can continue to share emerging strategies.

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