May 6, 2020

As systems consider offering scheduled procedures, their path to constructing a "new normal" for care delivery is anything but clear. One of the top priorities for leaders is preventing patients and staff from introducing Covid-19 to the care environment.

Q&A: Why Providence Health wants you to use its Covid-19 triage chatbot

To learn how one system is using technology to screen staff, we spoke with Aaron Neinstein, MD, Director of Clinical Informatics at the UCSF Center for Digital Health Innovation.

Read on to see how UCSF Health is using Covid-19 screening apps to monitor staff's physical and mental health in real time—and early thoughts on how their approach will evolve.

Launching the Covid-19 Employee Digital Health Screener

On March 13, the San Francisco Department of Health issued a mandate requiring all health care facilities to screen staff for Covid-19 before their shift. Like many organizations, UCSF first manually screened staff at facility entrances—which led to long wait times that made social distancing difficult and hampered managers' ability to adjust staffing if someone was sent home at the last minute. To more efficiently screen staff, leaders at UCSF partnered with their virtual health platform, Conversa Health, to develop a chat-bot based pre-screening platform. Within seven days, they had a system-wide app up and running.

Staff receive an automated text a few hours before their shift prompting them to complete the screening questions. If they are cleared for work, employees receive an Entry Pass via text message to show to staff stationed at each entrance. If the app recommends they stay home, the employee is connected with UCSF's occupational health department for follow up.

Screening questions are based on UCSF's occupational health guidelines and current WHO and CDC criteria for health care employees and updated regularly as guidance changes. For example, at first the questions focused on recent travel, while today they screen for Covid-19-specific clinical indicators such as fever and cough. Clinicians that interact with immunocompromised populations, such as cancer or transplant patients, have to meet more stringent criteria defined by internal leaders.

In addition to screening physical health, UCSF has also partnered with Conversa to expand the platform to measure and support staff well-being through a mental health screening tool. If clinicians screen positive for signs of burnout, the app will proactively direct them to the system's wellness or mental health resources, and if needed, it can also connect staff to on-demand emergency mental health care.

Monitoring staff wellbeing

Beyond allowing UCSF to protect individual staff and patients, digital screening also allows leaders to have real-time information about the health of the workforce. Conversa created a dashboard for leaders to display system-wide data on the well-being of hospital and ambulatory staff, including:

  • Number of staff screened for Covid-19;
  • Number of staff referred to occupational health for Covid-19 symptoms;
  • Number of staff screened for mental health needs;
  • Number of staff showing signs of burnout; and
  • Number of staff recommended for mental health care services.

Leaders use this data to modify the technology to better meet staff needs and to assess overall trends in staff health and wellness.

"It keeps a pulse on the physical and emotional well-being of our workforce in a way that we never had before," Neinstein said.

Lessons learned from UCSF's experience

For organizations interested in implementing a similar screening technology, Neinstein offered three key takeaways for success:

  • Don’t limit screenings to physical indicators. Employee mental health is a growing concern for health care leaders, as staff risk their personal safety to deliver Covid-19 care. Screening for signs of burnout or PTSD gives leaders a holistic view of staff well-being.

  • Proactively share screening technology with local health care facilities. Organizations investing in screening technology should consider making it available to local facilities not within the system, such as affiliated ASCs or post-acute partners.

  • Take steps to mitigate risk for asymptomatic spread. Of course, symptom-based screening technologies won’t identify asymptomatic carriers, who have been estimated to make up between 25% and 50% of Covid-19 carriers. Over time, organizations will increasingly be able to leverage Covid-19 testing, antibody testing, and contact tracing to monitor cases and prevent spread. In the interim, leaders need to stratify the risk of different types of in-person care delivery to strike the right balance between safety and feasibility. For example, high-risk procedures like surgeries will likely require a negative Covid-19 test from all patients.

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