Hospital for Special Surgery in New York City is most renowned for orthopedic surgery and rheumatology. When the COVID-19 pandemic hit last March, HSS moved quickly to reinvent itself and support its community. Within 72 hours, the academic medical center transformed into a multispecialty hospital, implementing new quality and safety measures to treat critically ill patients regardless of their COVID status.
Orthopedic operating rooms and a post-anesthesia care unit were converted into critical-care units, expanding the number of beds for ventilator-dependent patients. Caregivers were reassigned, with surgeons, nurses and other clinicians providing specialized care at the bedside. Leadership teams met to ensure staffing was adjusted to meet the round-the-clock needs.
Nurses quickly adapted to new technologies, integrating telemetry alerts to smartphones. HSS projected live views of bedside monitors outside patient rooms, and enhanced storyboards to ensure that all caregivers knew about individual patient COVID-19 status throughout the episodes of care.
COVID-19 units were a short-term solution to address the immediacy of the pandemic, but HSS has every intention of keeping the enhanced safety protocols in place as it continues to encounter patients suffering from the virus’ long-term effects.
“COVID provided a catalyst for us,” said Jamie Nelson, senior vice president, chief information officer at HSS. “The collaboration between the teams and the rapid pace of implementing new clinical practices and the supporting technologies to care for critically ill patients was really remarkable.”
For as quickly as health systems reacted though, quality and safety experts have cautioned that the incredible pace of change has opened to door to potential vulnerabilities. For instance, with many infectious-disease specialists being reassigned to respond to COVID-19, concerns have been raised that usual infection surveillance has lessened. Also, CMS postponed routine hospital inspections during the first few months of the pandemic, although some of that decline is related to the pausing of elective procedures and declines in hospital volumes. And then there’s the issue front-line staff being overworked and exhausted.
Nonetheless, by scrutinizing their techniques, many health systems discovered weaknesses in old protocols, and found new ways to improve care and infrastructure with lasting impacts beyond the pandemic.
“Our response to COVID has made us a much more data-driven, integrated health system,” said Matt Siegler, senior vice president of managed care and patient growth at NYC Health + Hospitals, which upgraded its data collection and transportation systems to streamline patient care during the pandemic. Spanning 11 hospitals, 60-plus community-based health clinics, and five skilled-nursing facilities, the public health system now has the capacity to look at data across acute, ambulatory, post-acute, and emergency settings, to target needs areas and provide support at different locations, Siegler said.
Similar to HSS, NYC Health + Hospitals took steps to reassign staff during a second wave of COVID to support increasing demands for dialysis treatment and ICU needs. Critical-care physicians received continuous renal replacement therapy credentialing and nurses received competency training in CRRT, a form of dialysis. Ambulatory-care nurses were trained in med-surg competencies and med-surg nurses were trained in ICU competencies. The health system also offers basic and advanced ventilator trainings to hospitalists and emergency doctors, respectively.
The training will likely stay in place indefinitely, said Dr. Laura Iavicoli, director of emergency management at NYC Health + Hospitals.
“With emergency management you have to be ever changing and evolving. As long as you look at your processes and keep up with innovations, you’re one step ahead. I definitely think we’re on that path,” she said.