What previous natural disasters and outbreaks can teach us about COVID-19 and care access
By Barry Dennis
I was the administrative director of emergency services at a hospital in Western Tennessee when the ultimate emergency occurred in 2008. Our region was struck by an EF-4 tornado, which is a rating just below the most damaging EF-5. A funnel cloud touched down on a college campus near our hospital and left a 35-mile path of destruction. Thankfully, no students were killed, although 26 other people died as a result of the multiple tornados that day that crossed our state and then moved into Southern Kentucky.
That was one of the most memorable natural disasters and public health crises I’ve experienced in my career. While very different than what my colleagues on the frontlines are now experiencing with COVID-19, there is a common denominator: The knowledge that patient care access can quickly switch from a convenience to a life-or-death issue.
That means the ability to maximize patient care access across the health system is now essential. To achieve this, health systems need standardized and centralized patient care orchestration processes and strong ties with community hospitals in their regions, even crossing state lines when needed. Health systems also need to embrace “systemness,” or systemwide visibility over facility capacity and physician schedules. Systemness is even more important under the extreme circumstances we are experiencing now to ensure patients receive the right level of care without delay.
All Hands on Deck
When the tornado hit, injured patients arrived at our ED in ambulances, on foot and in the back of pickup trucks, so there was little time to prepare for the rush. In such situations, we called in nearly every physician or nurse affiliated with our hospital to either be onsite or on call as patients arrived. All the clinicians were eager to help, showing up at the ED even before we called them. We saw a similar, but more sustained, “all hands on deck” strategy deployed in the early COVID-19 hotspots in the U.S., such as New York City and Louisiana.
In my frontline experience, our hospital’s ED served as the transfer center for our health system, so it contacted all providers and specialty centers to request assistance or arrange a consult or an admission for our patients. Today, however, transfer centers—or “access centers” as they’re increasingly being called at health systems across the country—have been extracted from the ED and are dedicated business units for managing all patient care orchestration.
During the COVID-19 crisis, these access centers are contacting physicians and other facilities to manage patients who are positive, or to transfer patients with other conditions or injuries away from facilities if they are isolating patients with the virus to a specific facility. An access center can alleviate the care orchestration burden from clinicians while ensuring patients are screened, their information is captured and available to the care team and are triaged to the most appropriate care facility.
As we’re discovering with COVID-19, the triaging process needs to emphasize non-healthcare locations, such as the patient’s home if they have mild symptoms of the virus. Even patients with non-virus conditions, if mild enough, should be urged to access telehealth or sign up for remote monitoring services where their mobile device can be used to collect data and communicate with providers. Avoiding unnecessary visits to a healthcare facility during infectious disease outbreaks is advisable, and an access center can support some of that diversion.
Likewise, another memorable incident during my career that illustrates the importance of seamless care access is a regional influenza outbreak that struck the State of Ohio a few years ago when I was leading a health system’s access center. Similar to COVID-19, the outbreak impacted regional hot spots across the state at various times, creating significant impact on resources resulting from high-acuity patients who required hospitalization. Unlike COVID-19, we had established influenza care pathways in place which typically resulted in predictable, successful outcomes. However, like COVID-19, the rapid demand for critical care forced us to leverage the access center to manage and orchestrate resources across Ohio to provide the best care for all patients.
With our local hospitals at capacity, we transferred patients to affiliated hospitals hundreds of miles away in Toledo, as well as across state lines to Kentucky. Having an access center at this institution was enormously helpful because we had the visibility into the other facilities’ capacities and could transfer patients typically with just one phone call. Referring physicians and consultants also spent less time on the phone and waiting for information and answers, which they appreciated.
Case Example: Arizona
Given the scope of COVID-19, states are looking at ways hospitals across an entire state—not just within one health system—can collaborate with each other. For example, in a first-in-the-nation public-private collaboration, the Arizona Department of Health Services has created the Arizona Surge Line to facilitate patient transfers and to address the issue of healthcare resource allocation and load balancing in light of the pandemic. This approach can ensure patients get the specialized care they need when they need it.
The Arizona Surge Line, which includes all of the health systems and community hospitals in the state, also ensures one hospital in the state isn’t overwhelmed while another has a low patient census.
The technology driving the Surge Line is a Microsoft Azure-based platform that integrates data from electronic health records (EHRs) and numerous other information systems used by all of Arizona’s healthcare provider organizations to enable real-time, statewide visibility into facility bed capacity, provider availability—and inventories of critical medical equipment such as ventilators. Based on that information, the clinicians running the Surge Line can make decisions about where patients should be transferred for load balancing and better, faster access to much-needed care. The technology also facilitates emergent transfers by ground or air when time to treatment is critical—as it often is in patients with COVID-19.
Whether a state is in the middle of its first wave of COVID-19 cases or preparing for its second, Arizona’s model could be followed by other states interested in similar public-private collaborations to load-balance healthcare resources and improve care access for their state’s patients.
This approach is central to the strategy of how both state and health system leaders need to prepare for these types of crises. Embracing the view that an entire health system—or even an entire state—is connected and that patients should be able to seamlessly flow between facilities depending on their care needs is a lesson that I learned when the flu outbreak hit our area. It has become even more clear during this pandemic.
Knowledge is Power
Bed and facility capacity changes constantly, especially during high-volume events such as natural disasters or infectious disease outbreaks. To arrive at a systemwide view of care access options, all facilities and physicians need to be connected to a centralized platform that offers real-time visibility of capacity, capability and resources.
Such visibility will help avoid the care delays which often result in poorer clinical outcomes. During less chaotic times, a systemwide ability to orchestrate care can help increase patient volume for specialty centers, improve the referring and accepting physicians’ experience, and ultimately optimize clinical outcomes for each patient. In the meantime, what health systems need most is the ability to align the right level of care with the right patient without delay, whether he or she has COVID-19 or another condition or injury.
As I learned during times of crisis at my hospitals and health systems, having such systemwide processes and capabilities in place beforehand was a lifesaver—literally.
About the author:
Barry Dennis is senior vice president of clinical operations for Central Logic, an industry innovator in enterprise visibility and tools to accelerate access to care.