Several hospitals are now permanently implementing pandemic-era safety precautions, a move that will likely improve safety and quality for many patients, Lisa Gillespie writes for Modern Healthcare.
At the start of the pandemic, hospitals had to quickly develop new measures to keep their workers and patients safe and reduce the spread of the coronavirus. Now, many hospitals say they will keep some of these measures in place even after the pandemic since they have helped improve safety and quality.
"[The pandemic] has so changed the delivery of healthcare in many, many ways that there are some components that there's just no going back," said Charleen Tachibana, SVP and chief quality, safety and patient experience officer at Virginia Mason Franciscan Health in Seattle.
According to Gillespie, here are five hospital safety practices that were first implemented during the pandemic and are likely here to stay.
1. A centralized monitoring system
During the pandemic, Virginia Mason Franciscan created a nurse observer and monitor role that was critical as the organization faced higher acuity patients and a labor shortage.
The organization now uses its centralized mission control system to remotely monitor patients' vital signs and consult with other hospitals in its network. In addition, the system is also used to virtually supervise bedside nurses to ensure that tasks are completed correctly.
"You would have a centralized nurse somewhere who could come in by camera remotely, and do that check with you," Tachibana said. "There's now another level of care oversight layered on top of a burdened and stretched workforce that's providing monitoring."
2. Daily meetings to pinpoint safety and quality concerns
To reduce the risks of patient harm during the pandemic, Bassett Healthcare Network in New York implemented daily escalation huddles to identify potential safety and quality issues.
In the morning, front-line staff on each unit met to voice any concerns about safety and quality. Then, managers would report these concerns at a director-level meeting. Issues were handled on the spot and communicated to senior executives, Gillespie writes.
"The executive leadership team really wanted to know the day-to-day concerns and that's key because traditionally, executive staff don't want to be bothered with the small stuff," said Russell Grant, Bassett's director of infection control and prevention. "That was a real shift, and I think a very positive shift for the organization. The plan is to continue these long after the Covid-19 pandemic."
3. Reducing the number of times workers enter patients' rooms
A major concern for hospitals early in the pandemic was how to reduce front-line workers' exposure to Covid-19 patients, Gillespie writes. Many hospitals achieved this through "clustering," which reduced the number of times a worker had to enter a patient area during a shift.
To do this, NYC Health + Hospitals adjusted its EHR and other technology to improve its patient monitoring so workers would not have to physically check in as often. In addition, they adjusted their alerts for routine tasks, such as taking blood and lab tests, so they would only go off every six hours a patient was awake instead of every two hours. Spreading out alerts like this also meant that patients were given more time to rest and recover.
"Or if a call bell goes off, we are able to check in through video," and then bring a patient what they need, said Eric Wei, SVP and chief quality officer at NYC Health + Hospitals. "[We had to] improve the monitoring of patients while decreasing the number of times that people had to go into inpatient rooms."
4. Guides for respiratory treatments to reduce the spread of disease
Another concern for hospitals was how to handle respiratory procedures, such as CPR or nebulizer treatments for asthma patients, Gillespie writes, which would expose health workers to patients' breath and potentially increase viral spread.
Novant Health helped mitigate this issue by implementing specific guides for certain respiratory procedures. Staff are now required to wear respirators during these procedures, and signs are posted on doors where these procedures are being done to warn others not to enter until it has been vacant for a certain amount of time.
"Before when people were having respiratory treatment, we would walk in and out without even a mask on—it just wasn't something that we thought about," said Daria Kring, Novant's VP of clinical and patient education. "I can imagine where we won't think of them as benign events for a very long time."
5. Safety precautions for visitors
Outside of measures for their staff, many hospitals have also implemented safety measures for visitors to protect staff and patients from potential infection, Gillespie writes.
"Now, visitors are just expected to wash their hands, wear a mask and they have certain responsibilities to protect against family and other patients from infection," said Leah Binder, president and CEO of the Leapfrog Group.
Overall, "[t]he legacy of Covid-19 safety procedures will be lasting, and includes innovations that arguably should've been in place all along and lessons for the entire industry about what does and doesn't work," Gillespie writes. "[T]he next pandemic could look very different." (Gillespie, Modern Healthcare, 12/14)
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