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The coronavirus pandemic has led to disruptions in healthcare systems across the globe. Since March, hospitals in different areas of the country have had to address enormous challenges to their capacity, operating systems, and patient flow, among other issues. Although the situation has eased in some areas, the strain is now intense across broad swaths of the south and west.

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Amid the ongoing crisis, PCORI wants to ensure that health system leaders have access to a six-part webinar series, Confronting COVID-19: Finding Hospital Capacity and Improving Patient Flow. The webinars feature more than 20 leaders from hospitals and long-term care facilities, clinicians, and operations management experts discussing how they dealt with circumstances and sharing their knowledge with the wider healthcare community.

Although medical management of COVID-19 continues to improve, many of these fundamental operational challenges for health systems remain, said Susan Dentzer, senior policy fellow at the Duke-Margolis Center for Health Policy, who served as moderator of the webinar series.  “The lessons that our presenters shared from March through May remain highly relevant and can now help the parts of the country that are now hardest hit,” she said. 

Full recordings, along with summary reports of each installment of the webinar series, are available on each of the episodes hyperlinked below.

Reimagining Hospitals and Their Emergency Departments

The series began with hospital leaders in New York, Texas, and Virginia discussing incident command structures that they created early in the pandemic to coordinate their response to COVID-19, and how they managed those command structures. The leaders discussed ways to expand their organizational capacity to treat patients, through repurposing existing hospital space to accommodate patient flow, streamlining testing centers, creating a process to triage patients, canceling elective surgeries, and reallocating hospital staff.  

In Part 2, speakers from hospitals at the front of the crisis described their steps for managing demand in their Emergency Departments, and how they coordinated the flow of very sick patients to other parts of their hospitals. They also discussed ways to increase their capacity for inpatient care, increase staffing capacity, and minimize the spread of coronavirus within the Emergency Department. Issued explored included wearing personal protective equipment (PPE) consistently, managing ventilator use, and using technology—such as iPads—so that patients and doctors could communicate without being in close contact.

Addressing Non-COVID-19-Related Surgeries and Nurse Staffing

Part 3 explored hospitals’ strategies for managing urgent surgeries, including transplants and cancer surgeries, amid the widespread suspension of elective and nonessential surgeries.  As health systems looked to a future when they might restore elective and other surgeries, leaders also discussed criteria for resuming more surgeries, and methods for prioritizing urgent surgeries of all types.  They also described the use of telehealth as a complement to surgery, for example in conducting pre-surgery appointments.

In Part 4, nursing leaders reported on how they were addressing crucial nursing issues, including managing PPE and optimizing the performance of teams. In addition to PPE management, nurses had to address issues ranging from staffing capacity for intensive care unit beds, staff anxiety and overload, and much more. Reflecting the crucial role of nurses and the demands they continue to face on the frontlines of health care, this webinar on nursing has attracted the most views among all the sessions.

Recovered Patients and the Prospect of Telehealth

Part 5 focuses on the circumstances hospitals encountered in discharging patients recovering from COVID-19, from discerning when discharge was clinically appropriate to determining where these discharged patients can or should go. At the same time, post-acute facilities and home healthcare agencies faced their own challenges in accepting recovering patients and caring for them appropriately, including the immediate need to protect staff and other residents from infection.

In Part 6, clinicians in charge of two telehealth programs shared lessons learned and discussed prospects for ongoing use and growth of telehealth after the current public health emergency. Telehealth has grown dramatically during the pandemic as clinicians use various platforms to consult with a wide variety of patients—both those who may have COVID-19 as well as patients with many other conditions. Federal and state authorities have temporarily lifted many regulatory restrictions on telehealth, and public and private insurers, in many instances, have increased reimbursement. Yet the rapid shifts have posed challenges even for systems that had previously created robust telehealth programs.

PCORI's Ongoing Response

Immediately following this webinar series, PCORI posted funding announcements for COVID-19-related funding and launched a registry to monitor how the pandemic is affecting front line healthcare workers. We will continue to formulate ways to respond to the crisis in partnership with government, industry, and other funders.

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