Prescription for Change

Q&A: How Trinity Health is tackling COVID-19, from tiered staffing to 'Kids Teaching Kids'

by Taylor Hurst and Rebecca Soistmann

Reginald Eadie, M.D., MBA, Trinity Health Of New England's CEO, and Syed Hussain, M.D., Trinity Health Of New England's Chief Clinical Officer and Senior VP, recently spoke with Advisory Board's Taylor Hurst about how their health system is thinking about capacity, exploring creative staffing solutions, and promoting social distancing in their community amid the COVID-19 pandemic.

Our take: Get ready for the COVID-19 staffing crisis

Question: Reggy and Syed, thank you for joining me during what I'm sure is a hectic time. I know many health systems on the East Coast have been on the front end of the rising COVID-19 cases. Can you tell us about steps Trinity Health Of New England is taking to expand critical care capacity in the system?

Reggy Eadie: One step we took was to petition the state to get access to a mobile field hospital. We learned through our petition that the state has access to three 25-bed units, and we were awarded one of them. We've also asked each hospital leadership team to decide what percentage of beds they could devote to COVID-19 patients based on what they're forecasting their capacity to be. We currently expect at least 50% of beds to be dedicated to those patients.

Another step we've taken is to have an 8 a.m. meeting every morning with key stakeholders to update our dashboard to see in real time how many ICU beds, ventilators, and spaces we have available to convert to acute or critical care, and how many COVID-19 positive and Persons Under Investigation (PUI) we currently have in-house. And we've worked with our parent organization to gain access to more ventilators and personal protective equipment (PPE) through the Strategic National Stockpile.

Syed Hussain: We've also implemented a tiered system for our staff. The first tier encompasses workers who can do all of their work responsibilities remotely from home, and we’ve sent them all home. The second tier involves staff whose core responsibilities can be done at home, but can't do all of their responsibilities remotely. We've divided the second tier into two cohorts—a purple cohort, which can stay at home two days a week, and a green cohort, which can stay at home for three days. The two groups switch off each week. The third tier involves colleagues who cannot fulfill any of their work responsibilities at home.

Q: It's great that your system was able to tackle that problem quickly and get staff who don't need to be in the hospital set up at home. We've seen a lot of questions related to remote work in an industry where teleworking isn't all that common.

While we're on the subject of staffing, how is your system thinking about potential staffing shortages as frontline staff interact with more COVID-19 patients?

Hussain: Preparing for surge also means that you're looking at your staffing and thinking outside the box. Part of the solution is enlisting other providers who aren't as busy in our current circumstances, such as surgeons and anesthesiologists.

We also plan to take advantage of Massachusetts' decision to shorten the state's long licensing process from about nine months to one day. Because we straddle both Massachusetts and Connecticut, we have to make sure we have adequate numbers of providers in both states. Separately, our CNO is making a list of people who have nursing licenses and can perform nursing responsibilities instead of their current  jobs, such as care managers. This will enable them to work at the top of their licenses and provide bedside care.

Eadie: We're also reaching out to doctors and asking them to apply for licenses in Massachusetts if they're based in Connecticut and vice versa. And we're looking to enlist residents and nursing students, particularly from schools where people do well on the licensing exams, prior to taking the license test. We hope to use them under supervision. I've also tapped Syed and our CNO to create a SWAT team with PAs, NPs, MDs, and RNs who can be mobilized between both states as needed.

That said, the bottom line is providers should not be getting sick if they're following CDC recommendations. We're holding calls with staff to keep them up-to-date on the latest guidance, our system’s expectations for providing safe care, their responsibilities, and the steps we're taking to reduce potential exposure.

Q: I'd like to shift back a bit to PPE. What steps is your system taking to source or conserve PPE?

Hussain: We have a daily tracking mechanism for PPE to see how many days we have with current usage. Our supply chain leader is part of our incident command center structure, so he does a daily update. We're also tracking where PPE has been misused. For example, we noticed a surge in eye protection being used and had to do a drill down. We mitigated the problem in real time and made sure staff understood what steps we are taking to conserve PPE, and what was needed per CDC recommendations. We're also cohorting patients to ensure N95 masks, for example, are only going to units with confirmed or suspected COVID-19 cases as those masks are precious right now!  In addition, we have started re-processing N95 masks so that they can be safely re-used. 

Q: If you had to offer advice to other hospitals and health systems who are about to see some of the surge you've already faced what would it be?

Eadie: Communication is key. It is important to have a responsive and available incident command center that can push information out and receive information from the bedside. We're also communicating with the community. For example, we're going to have a statewide webinar for Connecticut and Massachusetts called "Kids Teaching Kids about COVID-19." We've identified and trained four kids to lead the webinar because we think there's a population out there—school-age kids—who don't quite understand everything they might see on the news. Kids can enroll by visiting www.trinityhealthofne.org

Hussain: It is important to remember we cannot overprepare for this. We need to be ready, and that includes establishing multiple sub-layers like cohorting patients according to status, such as PUI, confirmed positive, confirmed negative, having a SWAT team and a surge plan that includes converting alternate spaces in the hospital into clinical areas.

Testing also continues to be critical. You need to erect the infrastructure because as testing ramps up, and I expect it to, we need to have the infrastructure to support that and expand hours at testing sites as necessary. We have already established multiple drive-thru test centers in our region. 

Leveraging telehealth under relaxed regulations and telephone visits is also crucial. We're looking to see how we can incorporate things like telephone visits into our EHR system.

 

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