POST 157. April 25, 2021. CORONAVIRUS. Ohio hospitals; “We agreed in multiple conversations, there’s nothing in fighting a pandemic that creates a competitive advantage.”…

for links to POSTS 1-157 in chronological order, highlight and click on

https://doctordidyouwashyourhands.com/2021/05/coronavirus-tracking-links-to-posts-1-157/

“From March through May (2020), a group of Colorado health systems with hospitals spread mostly across the Front Range collaborated to care for 96% of Colorado’s hospitalized COVID-19 patients.

That coalition, which presented data Tuesday on its efforts to treat cases and curb the virus’ spread during that three-month period, includes Banner Health, UCHealth, Boulder Community Health, Centura Health, Denver Health, HCA Healthcare/HealthOne and SCL Health.

“In early March, we realized that this is bigger than one physician, one hospital or one health system,” SCL Health chief clinical officer Dr. J.P. Valin said during a virtual press conference Tuesday.

“Since that time, we’ve been meeting regularly — daily for the first seven weeks and now three to four times a week,” Valin said. “This close collaboration has allowed us to see broadly across the state to identify trends and act quickly in a unified way.”..

Together, the seven members of the collaborative cared for 4,903 confirmed positive COVID-19 hospital admissions.

Of those patients, more than 65.5% were released from the hospitals to their homes. Another 18.4% were discharged to another facility such as a rehabilitation center or hospice. The mortality rate for the seven-system collaborative was 14.3%…

Sharing data within the coalition helped doctors and nurses adapt as the outbreak progressed and develop best practices for care, hospital leaders said.

“As we have progressed collaboratively over the past three months, we’ve learned so much about how to appropriately care for patients,” Centura chief clinical officer Shauna Gulley said.

“One of the most important things we learned early on is that permissive hypoxemia — allowing oxygen levels to float a little lower than normal — made a big difference,” Gulley said. “It allowed us to avoid mechanical ventilation and overall improved outcomes.””  (A)

“In the spring (2020), as patients with COVID-19 poured into Massachusetts hospitals, an unusual, ad hoc collaboration kicked in. Boston Children’s Hospital took in kids from other institutions that needed more space for adults. Hospitals loaned ventilators and other equipment to competitors. And they handed over vials of scarce meds.

Now, with agreement from the Massachusetts Health and Hospital Association (MHA), the Baker administration is turning those informal arrangements into a formal, regional plan. Hospitals, grouped into five areas, will meet at least weekly to share updates about their bed capacity, staffing levels, PPE and other supplies, and ability to accept transfer patients.

Hospitals are divided by the regions outlined in this map from the Massachusetts Department of Public Health. For the purpose of resurgence planning, the metro area and the Boston area are combined. (Screenshot via Massachusetts Office of Preparedness and Emergency Management)

The goals are to avoid having any one hospital or region become overwhelmed by a spike in cases, to continue elective and non-urgent care, and to make sure patients in every part of the state have equal access to the best possible care.

Gov. Charlie Baker says he does not want to stop routine care for adults or children, which happened during the first surge, so that hospitals could reassign beds, equipment and staff to COVID patients.

“Those resources are finite,” Baker said Tuesday. “We don’t want to go back to the restrictions we put in place last spring.”” (B)

“Dr. Richard Lofgren remembered the meeting, early on as the crisis bore down, when the leaders of the Cincinnati area’s hospitals each presented plans for how each would address the novel coronavirus. They were solid plans, even elegant. They had plenty of plans.

Then Michael Fisher spoke. Words from the president of Cincinnati Children’s Hospital Medical Center always carried extra weight, but Fisher’s recommendation had not been done before. Break down walls, and unify, with one plan. Now.

“He asked us to do better. It was a fateful moment,” said Lofgren, president and chief executive officer of UC Health. “We needed to work together as collaborators.” 

That choice built an unprecedented network among fierce competitors amid crisis that could well have been the edge that kept the Cincinnati region from an even heavier burden from COVID-19. Federal officials come into town to see how the systems harnessed their teams with public health and other entities to pull together.

Out of Fisher’s March 2020 appeal, “We were able to go on offense, on short order, and it was impressive to watch,” said Mark Clement, president and CEO of TriHealth. “The community should feel really good at how their health care systems put the public health first. … We agreed in multiple conversations, there’s nothing in fighting a pandemic that creates a competitive advantage.”…

The pandemic opened with the CEOs collaborating on acquiring more personal protective equipment for the staff and community, at profiteering costs. “On the phone six hours a day trying to get PPE for a month straight, and we were not the only ones,” said Garren Colvin, president and CEO of St Elizabeth Healthcare, the major provider in Northern Kentucky. He paid $10 each for masks that once cost a dollar.

“The most important meeting of the day was the PPE meeting,” Colvin said, “to understand how much quantity was on site, how much you anticipated that day, that week.”

Dr. Richard Lofgren, president and CEO of UC Health, is among the key advisers to Gov. Mike DeWine through the pandemic. Lofgren said the Cincinnati region’s hospitals realized they had to pull as one to get the community through the pandemic.

A key revelation of the collaboration was that the region has a lot more hospital beds than anyone knew, even as the pandemic surged in the summer and more dangerously at year’s end. The region’s leaders scrapped early plans for the Duke Energy Convention Center as an auxiliary facility. The more than 20 hospitals in the region’s 14 counties realized they could expand again and again.” (C)

“Reflecting on the pandemic’s one-year anniversary during a news conference, leaders at New Mexico’s largest hospitals said the virus drastically changed hospitals’ approach to medical care — and opened up new ways of thinking that can be applied to future outbreaks and health care in general…

Forced by necessity, hospitals learned to collaborate more than they ever had, and not just with each other. There had always been some cooperation, officials said, but the deadly pandemic raging through the state drove it to a new level.

That teamwork culminated late last year, when a third COVID-19 wave hit a peak and put a record number of people into critical care, said Dr. Jason Mitchell, Presbyterian Health Services’ chief medical officer.

Hospitals were meeting regularly about lending each other ventilators, transferring patients to available beds and doing everything else possible to get people treated, he said.

“If we didn’t have the team approach across all of our health care systems … we would’ve exceeded capacity in some of our areas,” he said.

The crisis in late 2020 put the state on the verge of declaring “crisis care” standards — a scenario that terrified state officials for weeks as hospitalizations increased and ICU capacities dwindled. At one point, more than 900 people were hospitalized. On Thursday, that number had fallen to 130.” (D)

“As with most challenges in life, cooperation has been the key to many of the problems presented by the COVID-19 pandemic. Whether it is adjusting to working from home; figuring out how to manage distance learning; or working together as a community to slow the spread, teamwork has helped to make our new reality a little easier for everyone.

It is no different for those tasked with managing the health aspects of the pandemic: Collaboration is key. Fortunately for Nevada County communities, local leaders realized this early on, creating a system of cooperation that helped all of us, whether we know it or not, beginning in the early weeks of the pandemic.

“More than ever, there has been strong collaboration between the hospital, community providers and public health officials,” says Jill Fitzpatrick, MD, Family Medicine physician with Dignity Health Medical Group – Sierra Nevada. “Last spring, we created a weekly touch base so we could stay aligned and informed of the constant changes we were being faced with and how we were approaching it.”

That “touch base” evolved into a weekly call every Friday morning that continues today. Among the participants are officials with Nevada County Public Health, the area’s two federally qualified health care centers, Dignity Health Sierra Nevada Memorial Hospital, Dignity Health Medical Foundation and all of the community physician partners.

Dr. Fitzpatrick says the group immediately went to work, collaborating to find solutions to issues affecting their ability to care for the community. “We address issues such as testing availability and accuracy, PPE needs, staffing issues, treatment protocols, and much more.”

From the perspective of the community’s hospital, the meeting has proven incredibly valuable.

“This weekly meeting has been a tremendous exchange of information and collaboration,” explains Jeffrey Rosenburg, MD, SNMH Chief Medical Officer. “We will continue it after the pandemic.””  (E)

“This article focuses on our experiences — caring for more than 5,000 hospitalized patients with Covid-19 over 2 months — in the Department of Medicine at New York University (NYU) Grossman School of Medicine, through NYC locations across four hospital sites: NYC Health + Hospitals/Bellevue Hospital (BH), NYU Langone Health–Tisch/Kimmel Hospital (NYU-Tisch), NYU Langone Hospital–Brooklyn (NYU-Brooklyn), and the Veterans Affairs New York Harbor Healthcare System (VA). The relationship of these NYU-affiliated hospitals offers a unique perspective on the pandemic. These hospitals participate in the educational programs of the internal medicine residents, medical students, and subspecialty fellows, in addition to sharing many clinical protocols across sites. However, these four hospitals have different funding mechanisms, organizational hierarchies, and supply chains. In this article, we highlight the coordinated response and the nuanced challenges that each hospital faced during the Covid-19 pandemic. We focus on four core domains based on challenges faced: communication strategies, development of surge capacity (expansion of beds, staffing, and patient triage), clinical care, and staff wellness ….” (F)

“By the middle of April 2020, New Jersey’s 72-acute care facilities were facing an unprecedented wave of hospitalizations, with more than 8,000 COVID-19 patients receiving care, according to state data. Nearly 2,000 of these patients were in intensive care, where three in four were attached to ventilators to help them to breathe. A year later, there are fewer than 2,000 COVID-19 patients hospitalized across the state…

“All of a sudden, not just in New Jersey, but all our sister states, the country, globally, we were all fighting to get our hands on PPE” [or personal protective equipment, the masks gowns and other items needed to keep staff and patients safe], Bennett said. “We had PPE on hand — we always keep a supply on hand — but certainly nothing for a novel virus like this.”

To accommodate the surge in patients, Bennett said hospital teams worked tirelessly to identify new space — in cafeterias, empty hallways, medical offices — to set up new beds as the federal government created field medical stations to reduce the pressure on acute care sites. The state created four health care regions; and hospitals, emergency responders, public health officials and other leaders all came together to collaborate on the response, she said.

Bennett would like to leverage these partnerships to do more to address underlying social factors — like poverty and housing — that have an outsize impact on an individual’s and community’s health. “What really played out for us in the pandemic, and I think this is a good lesson learned,” she said, “is that public health, together with clinical health, together with the government and the private sector, we all need to come together because this is a team sport.”

“No one entity is going to drive this forward alone,” she added.” (G)

AMERICAN HOSPITAL ASSOCIATION (H)

During the COVID-19 pandemic, hospitals and health systems are challenged with a limited supply of screening/testing kits as well as a lack of personal protective equipment (PPE) for staff, ventilators, respirators, space, etc. Hospitals cannot adequately respond to these challenges alone. You will need to collaborate, and quickly, with stakeholders in the health care field and beyond to leverage your collective resources, nd expertise.

This three-step guide provides strategskills aic considerations to form partnerships during the COVID-19 pandemic. In less than an hour, think through what you should be collaborating on, who your partners should be, and how you can work together to combat COVID-19.

STEP 1 | Understand your goals, assets and gaps. (10 minutes)

Assemble a diverse team from across your hospital to discuss your goals and assets, as well as what gaps will need to be filled. Partnerships should be informed by a clear understanding of your hospital’s goals and challenges. Consider:

• What do we want to accomplish during the COVID-19 pandemic?

• What are our strengths, assets and weaknesses at this time?

• What assets are available in our community to support our goals?

• What resources are we lacking (e.g., health care workforce, equipment, financial resources, medical supplies, PPE, etc.)?

• What do we have today that might not be accessible tomorrow?

• What do we need to prepare for? How is that going to impact our assets?

• How are we communicating with our existing partners and the public health department?

View page 26 of A Playbook for Fostering Hospital-Community Partnerships to gain a better understanding of developing goals.

STEP 2 | Identify partners and establish roles. (10 minutes)

Based on the goals and gaps identified in Step 1, you may need to expand the scope of your partnerships to include some non-traditional partners. Based on the need, potential partners could include:

• Community-based organizations – social service organizations, food banks, unions

• Educational organizations – early childhood care centers, primary schools, colleges and universities

• Faith-based organizations – churches, temples, mosques

• Housing and community development organizations – homeless shelters, supportive housing

• Government – local, state or national

• Local business – chambers of commerce, grocery stores, restaurants, manufacturers

• Public health departments – county and state

• Service organizations – United Way, YMCA, Rotary International

• Other health care organizations – FQHCs, physician practices, ambulatory centers, other hospitals

• Philanthropy – local or national foundations

Which of these organizations do you already have a relationship with? Given the urgent need to address COVID-19, start by leveraging resources from existing partners. For example, if you are already partnering with your state hospital association or state health department, determine if they are working with external parties to acquire resources such as funding, supplies, etc. to support hospitals.

Which of these organizations could help you achieve your goals and help fill in your gaps? Explore how other community stakeholders can be deployed to combat COVID-19. What functions do they fulfill with their assets and resources? How can they address your identified needs? Asset mapping, both internally and externally, can help your organization hone in on the resources you need to achieve your goals and fulfill any gaps. View pages 12-17 of the A Playbook for Fostering Hospital-Community Partnerships to learn more. Once you have determined who you would like to pursue a partnership with, reach out to them to set up an action planning call.

STEP 3 | Create and implement an action plan. (30 minutes)

To bring the partnership to life, hold a 30-minute virtual action planning call with your potential partner. Come prepared to explain your goals, challenges and gaps and why you think your organizations should collaborate to address COVID-19. Discuss the following as seen in Figure 10 of A Playbook for Fostering Hospital-Community Partnerships:

• Your goals and current challenges;

• Propose a partnership goal, of what you want to accomplish and the resources you need to be successful;

• Finalize your common goal;

• Define roles and tasks of partners to maximize your efforts within the limited time you have; and

• Settle on frequent check-ins to quickly update partners on progress and challenges.

• A.Front Range hospital officials discuss collaboration on COVID-19 care, by LUCAS HIGH, https://www.reporterherald.com/2020/06/23/front-range-hospital-officials-discuss-collaboration-on-covid-19-care/
• B.Mass. Plan Swaps Hospital Competition For Collaboration As COVID-19 Surges A Second Time, by Martha Bebinger, https://www.wbur.org/commonhealth/2020/11/11/massachusetts-hospital-plan-collaboration-covid19-second-surge
• C.Hospitals post-pandemic: Collaboration, from the C-suite to the ICU, carried the region, by Anne Saker, https://www.cincinnati.com/story/news/2021/04/17/covid-19-cincinnati-childrens-hospital-uc-health-health-collaborative-nursing-pandemic/7187459002/
• D.Top New Mexico hospital officials say collaboration key in year of virus battle, By Scott Wyland,  https://www.santafenewmexican.com/news/coronavirus/top-new-mexico-hospital-officials-say-collaboration-key-in-year-of-virus-battle/article_780c6b2a-8285-11eb-a276-8793ab81bd97.html
• E.Collaboration is Key to Managing COVID-19, by Mary Beth TeSelle, https://www.theunion.com/lifestyles/health/collaboration-is-key-to-managing-covid-19/
• F.Collaborating Across Private, Public, Community, and Federal Hospital Systems: Lessons Learned from the Covid-19 Pandemic Response in NYC, by ByVerity E. Schaye, MD, MHPE, Jenna A. Reich, Brian P. Bosworth, MD, David T. Stern, MD, PhD, Frank Volpicelli, MD, Neil M. Shapiro, MD, Kevin D. Hauck, MD, Ian M. Fagan, MD, Seagram M. Villagomez, MD, Amit Uppal, MD, et al., https://catalyst.nejm.org/doi/full/10.1056/CAT.20.0343
• G.COVID-19 surge, NJ hospitals learned lesson on cooperation, LILO H. STAINTON, https://www.njspotlight.com/2021/04/nj-hospitals-unique-collaboration-covid-19-usually-fierce-competitors-cathy-bennett-njha-building-lessons-long-term-public-health-benefits/
• H.Partnering to Address COVID-19, https://www.aha.org/system/files/media/file/2020/04/Partnering-to-address-COVID-19.pdf
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