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April 3, 2020

'Overrun' hospitals are looking beyond critical care doctors to treat Covid-19

Daily Briefing

    To help treat the influx of patients suffering from Covid-19, the disease caused by the new coronavirus, hospitals nationwide are being forced to improvise—and many have started turning to unexpected specialists such as cardiologists and anesthesiologists, Tara Bannow and Maria Castellucci report for Modern Healthcare.

    Your Covid-19 checklist to expand capacity

    Hospitals being 'overrun'

    In New York, the eight hospitals in Mount Sinai Health System are nearing capacity and are taking creative steps. Mount Sinai Morningside, for example, has converted its 26-bed cardiac ICU and 31-bed step-down unit into ICUs for Covid-19 patients, Bannow and Castellucci report.

    Daniel Katz—associate professor of anesthesiology, perioperative and pain medicine at Icahn School of Medicine at Mount Sinai—said, "We have just been overrun with the sheer number of critically ill patients. There just aren't enough critical care doctors to go around to take care of them. … We have had to get doctors from other areas who still have some critical care skills but might not be straight-up ICU doctors."

    Specialists being asked to help with Covid-19 patients

    As a result of the influx of patients, many hospitals have started asking specialists to step into new roles. According to Sanjay Saxena, a senior partner and managing director at the Boston Consulting Group, the most obvious specialists to ask are those who have backgrounds in critical care, such as anesthesiologists and critical care intensivists.

    After that, hospitals are looking to general surgeons, orthopedic surgeons, and subspecialists in internal medicine, such as cardiologists and oncologists, Saxena said, as these doctors have experience that easily translates to caring for critically ill patients.

    "While it feels like there is an element of chaos around it, there's also an element of thoughtfulness about it," Saxena said.

    David Ferraro, a pulmonologist and vice chair of fundamental disaster management at the Society of Critical Care Medicine, said specialists chosen to help should be done on a case-by-case basis to make sure patients are safe.

    "You can make arguments for and against groups of people," Ferraro said. "It really comes down to who is willing to step up, who feels comfortable managing sick patients and are they leaving their jobs and creating gaps that are going to be challenging to fill?"

    The heart team at Mount Sinai Morningside, which has been redeployed to treat Covid-19patients, is an example of one of these groups. John Puskas, the chair of cardiovascular surgery for the hospital, said, "It's a total transformation. We have literally transformed a heart team, a very sophisticated team of people which has been built up over years, to now provide a very different kind of care to a very different kind of patient in our ICU and our step-down ward."

    Meanwhile, Henry Ford Health System has developed a list of over 1,500 doctors within its system that shows what their specialties and training are, as well as their availability. Adnan Munkarah, chief clinical officer for Henry Ford, said that administrators can contact doctors to ask for help as needed.

    And at Providence St. Joseph Health, a volunteer pool consisting of the 10,000 doctors in the health system's medical groups has been created so doctors can sign up to help in hospitals experiencing a large number of Covid-19 patients.

    Spectrum Health also has brought in around 250 doctors of a variety of specialties to help triage patients over the phone who believe they may have the new coronavirus.

    Training to treat Covid-19 patients

    While many specialists may have relevant backgrounds to treat Covid-19 patients, they're still being trained by their health systems to an extent, Bannow and Castellucci report.

    For example, Puskas said as soon as it seemed that the heart team at Mount Sinai Morningside would be needed to help with Covid-19 patients, the team started shadowing doctors in the ICU. Then, days later, they started taking on their own Covid-19 patients with the help of infectious disease consultants who check in on the patients each day. The consultants make sure patients are getting the correct treatment, and hospital pharmacists assess the patients' medications, Pukas said.

    "There is a tiered structure built in," Katz said. "No one is being expected to do something with no experience and that is widely outside of their scope of practice."

    Similarly, the providers Spectrum tapped to help screen patients via telehealth have been trained on how to triage patients following state and federal guidelines—and since March 16, they've screened more than 20,000 patients.

    Ultimately, however, physicians aren't going to take on patients they aren't able to care for, Lowell Brown, a partner with the law firm Arent Fox, said.

    "You have to recognize your limits," Ferraro said. "Every individual physician and surgeon has to know what they can and can't do" (Bannow/Castellucci, Modern Healthcare, 3/30).

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