Most healthcare providers are not fully prepared to resume deferred care, citing a lack of COVID-19 testing supplies and personal protective equipment, according to a new survey.
Around 60% of 364 frontline healthcare workers surveyed said they are not prepared or only somewhat prepared to take on more non-COVID-19 patients, according to a new poll from Bain & Co. conducted in late April. Around half said they don't have enough tests for caregivers and patients while about a quarter said they don't have enough masks, gloves, face shields, gowns and other PPE.
In addition to supply constraints, prioritizing care presents operational hurdles, said Joshua Weisbrod, a partner at Bain & Co. who leads its U.S. healthcare practice.
"Having the testing in place and PPE in place is crucial," he said. "There's also identifying which patients are lower risk in terms of the COVID-19 care transition."
Many health systems are close to resuming delayed procedures, while some have just started. But so-called "elective procedures" encompass a wide range of treatments like cancer care and heart valve replacements, where urgency depends on patient characteristics.
This compounds the restart process. Meanwhile, hospitals are grappling with a 50% to 60% revenue decline resulting from delayed elective procedures, fear of COVID-19 that has caused people to avoid care, limited supplies and staffs that are stretched, increasing burnout levels, among other impacts.
"You have massive pressure on operations because you have to put more patients through the system in a shorter span of time," said Dennis Kogan, co-founder and CEO of caresyntax, a healthcare data analytics company.
Providers will face bottlenecks and burnouts in certain areas, he said. Anesthesiologists in hard-hit states like New York have been tasked with COVID-19 care and will have to pick up regular surgeries as well.
Mental health and burnout were the top concerns among 16% of New York frontline healthcare workers, which more than doubled since Bain. & Co.'s first survey in late March. Around 40% of clinicians expect additional pay cuts over the next three months, which was up from around a quarter of clinicians surveyed in mid-April, exacerbating any mental health issues.
Some providers have responded by ramping up resources to help workers cope.
Providence's St. Joseph Hospital in Orange, Calif., for instance, has been facilitating discussions with its workers and the broader community on how to recognize stress and manage it through strategies like reflective listening, said Glenn Raup, executive director of behavioral health, emergency and observational health at St. Joseph.
"A second curve of this pandemic could be related to mental health," he said. "A post-wartime approach to how we think about things and process them is a big focus now and for the long term."
On the testing front, medical professionals at Santa Clara (Calif.) Valley Medical Center have developed a risk stratification formula that they hope will help direct testing and resources as well as determine the least vulnerable individuals as the country eases social distancing, said Dr. Sanjay Kurani, medical director of inpatient medicine at the hospital.
"We have more testing capability, but the operational components and resources involved to test people can be very challenging, so we have to be mindful," he said.
Providers will have to decide whether they test all patients and workers and where those tests will be administered. That requires greater visibility into testing and processing capacity, said Ashley Ford, managing director at Advisory Board.
"How long it takes to get results will have a dramatic impact on when you can schedule that surgery," Ford said during a webinar Friday, adding that the appointment should be close to when they were tested so they don't get infected in the meantime. "Providers are going to need to have different types of testing options, they are going to need to have a surveillance process, they're going to need to have to connect to public health—all this points to pretty strong capacity challenges, but more importantly, supply chain challenges."
Testing capacity and efficiency largely relies on a flexible supply chain, which currently is anything but, said Brandi Greenberg, vice president at Advisory Board. Just-in-time inventory, sole-source contracting and clustering manufacturing and raw material sources have handcuffed the supply chain in times like these, she said.
"We have a supply chain that has been fundamentally designed for maximum efficiency, in doing that it loses resiliency," Greenberg said during the webinar, adding that a lack of transparency also hinders flexibility. "That is something that we as a national and global health community have to address."