PERSPECTIVE

COVID-19 Surge Preparedness for Fall/Winter 2021

Gregg Miller , MD

Chief Medical Officer

Published September 28, 2021

COVID-19 Surge Preparedness for Fall/Winter 2021

Healthcare workers ready to treat patients during COVID-19 pandemic

When it comes to pandemic preparedness, your clinical team is your most crucial resource. Simply having beds and providers is not enough. You also need the right expertise. At Vituity, our physicians play an integral role in helping hospitals prepare for and manage surges. As the delta variant brings new challenges, Chief Medical Officer Gregg Miller, MD, shares tips for planning and response.

After a brief reprieve in spring 2021, COVID-19 cases have spiked again. The highly contagious delta variant is spreading rapidly among unvaccinated individuals and overwhelming hospitals across the country. While this news is bad enough, we must prepare for the situation to worsen if delta overlaps with a harsh flu season.

At this stage of the pandemic, hospitals are grappling with a new challenge: staffing shortages. Nurses, techs, and other team members are moving out of acute care medicine, retiring early, or simply quitting. As a result, many hospitals now have beds that they just can’t staff.

So how can healthcare leaders prepare for a potentially difficult winter? Here are three lessons we’ve learned at Vituity—from our own practices and at disaster relief sites across the country.

1. Assemble Your Clinical Team and Physician Leadership

As we prepare for the coming months, hospitals and health systems need to be ready to manage a surge of patients driven by COVID-19 variants and/or a severe flu season.

To fortify your clinical team, it’s critical to develop strategies to retain staff and recruit traveler/locum staff. Consider using flexible scheduling, increased benefits, and staff extenders such as scribes. Compassionate messaging is also important to relay the importance you place on clinician and staff mental health, which can be a real differentiator during this challenging period.

To successfully manage during surge times, consider mobilizing clinicians from all areas of your system, including those with no critical care experience. In the worst-case scenario, you may also need to bring in relief providers who are unfamiliar with your facility and procedures.

With so many moving parts potentially in play, as well as the risk of critical workforce shortages, it’s crucial to map out a clinical command structure that defines everyone’s roles and responsibilities:

Incident commanders: Your in-house emergency physician, hospitalist, or intensivist leaders should liaise with the hospital administration and serve as top-level clinical consultants.
Team leaders: Physicians with critical care experience (e.g., emergency physicians, intensivists) should manage each clinical unit.
Front-line providers: Clinicians delivering hands-on care can be divided into teams of attendings and advanced providers.
Additionally, you may need to create special teams dedicated to consulting (e.g., cardiology) and procedures (e.g., proning).

Consider also how you will integrate relief clinicians, per diems, and travelers. Each outside provider who joins your organization carries an administrative burden in terms of credentialing, scheduling, training, and orientation. For this reason, it’s most efficient to work with one or two organizations that can supply the team members you need and also assist with logistics.

2. Build Your Pandemic Processes in Advance

Overlapping flu and COVID-19 surges will play out differently at each hospital. For this reason, it’s important to have a solid plan in place while remaining open-minded and responsive. Some key areas to cover in your planning:

Where will you treat COVID-19 patients if you exceed your current ICU capacity? And where will you treat all other inpatients? Could you leverage a program like hospital at home to free up clinical space?
What care protocols should clinicians follow in treating COVID-19? If you haven’t already, now is an excellent time to update your care standards with the latest evidence (e.g., use of monoclonal antibodies).
How could you leverage telehealth to force multiply your providers and protect patients? For example, one of our Vituity EDs funneled patients with COVID-19 symptoms to an outdoor fast-track trailer equipped with telehealth bays. This allowed a pair of advanced providers inside the hospital to safely and efficiently disposition these patients without exposing anyone to the virus.
How can you leverage telehealth to force multiply your nursing staff? Much has been said about telehealth physician visits, but telehealth has been underutilized for nursing. For example, teletriage or telehealth discharge instructions are feasible processes for nurses who are working from home or covering multiple low-volume facilities.
How will you handle variable ICU and ED volumes—both within your hospital and across the system? One solution is to create an infrastructure that allows clinicians to pitch in virtually. For example, an emergency physician at a quiet site could perform virtual medical screening exams for a busy ED.

3. Plan for Mental Health Impacts on Healthcare Providers

As the pandemic grinds on with no end in sight, it’s taking a toll on healthcare providers. While we no longer fear for our lives thanks to vaccines, we are now mired in a crisis that’s largely preventable. At the same time, harassment toward healthcare workers is on the rise—often triggered by requests to mask or comply with safety rules.

To rein in further workforce attrition, hospitals must find ways to reward those loyal team members who stick with them. Over the long term, investing in your in-house medical and nursing staff will pay greater dividends than bonuses to per diems and travelers. Start by ensuring that your workers are safe and well resourced and that concerns are quickly addressed. From there, consider ways to boost quality of life, such as flexible scheduling and advancement opportunities. Most of all, take time to show appreciation for your clinicians’ hard work and personal sacrifice.

There’s Still Time to Vaccinate against COVID-19

If the delta wave overlaps with a tough flu season, surge preparedness will help to give every patient the best chance for survival. However, we could prevent this scenario altogether and save lives by raising vaccination rates. To this end, encourage your physicians, advanced providers, and nurses to discuss vaccination with patients (and to offer the shots directly when feasible). This is the only way to end the pandemic for good so we can all return to our normal lives.

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