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March 26, 2020

Preparing for the surge: How Penn Med is bolstering capacity and staff to brace for COVID-19 cases

Daily Briefing

    On Tuesday, Steven Berkow, Advisory Board's VP of Provider Research, spoke with Patrick J. Brennan, MD CMO and Senior VP at Penn Medicine, about what steps his health system is taking to care for a surge in COVID-19 patients. Penn Medicine is a six-hospital health system, including the Hospital of the University of Pennsylvania in Philadelphia, and Brennan is board certified in infectious disease.

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    Question: PJ, thank you for joining me at a very intense time for you and your system. Can you give me a sense of where Penn Med is right now in terms of COVID-19 patients?

    Patrick Brennan: We think we're about two weeks behind New York in terms of COVID-19 cases. Across our six hospitals, we have 30 to 35 patients with confirmed cases in our beds. But we also have dozens of PUIs, persons under investigation, with suspected cases of the virus. We have enough supplies and capacity to care for these patients today as well as the patients we expect to get tomorrow. But it's a very day-to-day thing. We're projecting a doubling time of every two to three days. So things accelerate fast, and we're doing all we can to ready ourselves for supplies and capacity being drawn down very quickly.

    Q: Could you share more specific examples about what you're doing to ready for a patient surge?

    Brennan: Oh, absolutely! One of the first decisions we made was to postpone elective surgeries and all non-essential visits. This freed up beds and nurses and conserved PPE (personal protective equipment). Right now, I estimate we have at least 500 beds available across our health system. But we're still working on how to increase capacity.

    We're now thinking about capacity at essentially three levels. Level one surge is what I just described to you, drawing down our elective surgery and our non-essential visits and re-purposing freed up beds. We're also keeping people out of the hospital by doing things like evaluating patients with respiratory illness in tents outside the ED.

    Level two surge is a very thin layer of capacity that comes from clinical areas that are not currently in use. For instance, we have a long-term acute care hospital where one corridor has been closed. We just stood that up so it's fully stocked and ready to go, so we have a layer of about 54 beds after our inpatient capacity is filled.

    For level three surge, we're starting to look at nonclinical spaces such as lobbies and libraries. We've also accelerated construction on our new hospital pavilion. We hope to finish about 120 beds by mid-April. But, while challenging, space is less of the problem. Creating more space we can do, but having the people to cover all of it is going to be a bigger challenge.

    Q: So what solutions are you considering to address potential staffing shortages? And, with nearly 40,000 employees, do you have a sense of COVID-19's infection rate among clinicians yet?

    Brennan: I don't have a good handle on the clinician infection rate at this point. But what I can tell you is most of our exposures so far do not result from staff interacting with patients, but rather staff interacting with other staff who acquired COVID-19 from outside the hospital and travel. It seems that our staff are vigilant around patents but more prone to let down their guard when interacting with peers. As time goes on, I'm sure our exposures will have more to do with on-duty exposures, but for those at the outset of a surge, I'd encourage others to remind staff to keep their vigilance up with peers as well.

    Q: What else are you prioritizing to protect staff?

    Brennan: There's the more obvious stuff you’ve got to do, like making sure your wellness programming and other existing staff supports are ready for outsized need and creating new policies to address questions related to COVID exposure and coming back to work—and communicating this information out so that your people understand the organization's position on them.

    Those policies and communicating them effectively is particularly important to help quell fears among our more vulnerable staff populations, such as older physicians, pregnant staff, or those who have medical conditions and are concerned about being exposed and becoming seriously ill.

    Also, our HR department is trying to figure out good childcare options for staff with kids now home from school or working non-traditional hours. We had been searching for childcare sites, but most of our staff now, understandably, would prefer one-on-one childcare. So far, that’s been hard to find, though some of the medical students are stepping forward to provide this service.

    Q: Let's get back to the larger challenge you raised: staffing shortages. What solutions are you pursuing to expand staff capacity?

    Brennan: Right now, we're looking at how best to re-deploy staff from ambulatory sites, which aren't as busy, to inpatient units to support staff who need relief, are sick, or are spread too thin due to a surge in COVID patients. We're also lining up providers who can staff an ICU or an ED, such as surgeons who are not operating at present, and nurses who can work across multiple sites in our health system.

    Additionally, we're looking beyond our existing staff and are working with the state on the licensure and credentialing of new graduates and fellows. Like many, we're asking retired physicians to re-activate their licenses. We're also considering issues related to interstate practice. We want to be able to move our providers across our health system's hospitals in Pennsylvania and New Jersey. That has become a big concern for me: can we come to the aid of our hospital and practices in New Jersey where case surges are already taking place?

    Q: Before we run out of time, what about supplies? What challenges are you prioritizing on the supply front?

    Brennan: We have a lot negative pressure beds, but as cases surge, we likely will outstrip our negative pressure capabilities. But my biggest concern going forward is the PPE. For now, we have lots of powered air purifying respirators and a sufficient supply of N95 respirators. Again, we've got enough for today and enough for tomorrow, but what seems like a lot will dwindle fast as cases surge. We are still working to secure more CDC-approved products, but we are now collecting "make do" alternatives.

    There are lots of other products out there that pass FDA muster but don't have the preferred seals of approval. We're taking everything we can get our hands on that might work. Fortunately, area businesses have been reaching out to us with donations, and our engineering school just developed a face shield for us. We're hoping to have 10,000 of these manufactured in the near future.

    Q: I'd like to give you our last few minutes to share any wisdom you could impart to your peers, other CMOs across the country.

    Brennan: For those of us behind New York's case curve, it's evident that the exponential pace of growth can quickly catch you ill prepared. You percolate along with a few infections, then a few more infections, and then 100, and all of sudden 400 to 600. Pretty soon you are admitting people every hour and your ICUs are at capacity.

    My message is to prepare as fast as you can. We may be headed in the same direction as New York, so we have to think hard about surge capacity, and don't wait on cancelling elective surgeries because that will clear out a lot of beds. I expect we are going to need all of that and probably more.

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