July 29, 2020

We’ve recently completed six months of treating COVID patients in the United States, with the first known case occurring on January 20, in Everett, Washington.  In that time, we have seen remarkable changes in American healthcare and American society.  At the time of this writing, areas of the country that had been relatively cleared of the virus are now experiencing a dramatic rise in cases and the reported number of COVID-related deaths is hovering around 150,000.

In a lengthy article recently published by HealthcareDive, editor Shannon Muchmore provided her insights on what may be the short-term and long-term future for the U.S. hospital community as it continues to grapple with the stresses and strains, the ups and downs, of the ongoing pandemic.  This article will act to summarize some of her takeaways.

Remain at The Ready

According to a June survey of healthcare executives, 65 percent of respondents said the industry is prepared for a fall or winter reignition of the coronavirus, which is nearly a 180-degree departure from what an earlier survey had revealed.  However, with the prospect of a COVID “phase II” coming this fall added to the surge of cases now being felt in 40 states, hospitals are having to remain in a near state of emergency with no let-up in sight.

In one of the memorable scenes from an old war epic, a commanding officer says, “Alright, we’re going on alert.”  When the commander’s aide protested that the men were getting confused with so many alerts, the commander responded, “[Darn] it, un-confuse ‘em.”  Many hospital administrators and clinical directors might attest to seeing their own staffs being faced with that same type of confusion and fatigue, given the on- and off-again COVID conditions.

HealthcareDive observes:

Whether there is a clear nationwide second wave or smaller surges in various parts of the country at different times, hospitals will need to remain in an effective state of emergency that requires constant vigilance until there is a cure or vaccine.

That’s a tough pill for our currently stressed healthcare workers to swallow, as they have already sacrificed so much.  However, their resiliency thus far gives us reason to remain hopeful, regardless of how this all plays out.

A Time for Elections

For the most part, American hospitals that had previously shut down elective surgeries for a period of several weeks are showing a current reluctance to once again halt such surgeries, despite the new rise in cases. They argue that “the care is still necessary and can be done safely when the proper protections are in place.”  Nevertheless, there is still a concern that surgical volume will remain suppressed, perhaps for some time.

In addressing the future of elective surgeries in this current environment, one healthcare executive stated that, “While we think demand will come back, we’ve seen some flattening on demand in certain aspects that may be the new indicator of the new norm in terms of how people seek care.”

Transition to Telehealth

With the advent of the coronavirus, the federal government began the process of providing various waivers that had the effect of promoting the use of telehealth services.  Many commercial payers followed suit.  Since that time, virtual visits dramatically increased and may remain a preferred option for millions of healthcare consumers for the foreseeable future.

As stated in previous articles, we expect many of these temporary measures and waivers to be made permanent.  With many patients and providers becoming accustomed to this “care at a distance,” we can expect the trend to continue.  It is uncertain to what extent this will affect traditional services offered by hospitals, but it seems clear that certain types of services provided in the hospital setting will be transitioning away.  In support of this notion, HealthcareDive reports, “Multiple large health systems have established programs to provide hospital-level care at home and major employers have inked contracts to have primary care delivered to employees at on-site clinics.”

Supplies and Staff

Many hospitals in the U.S. did not have sufficient time to build up their supply of personal protective equipment (PPE) prior to the recent surge in cases in the several states.  One supply chain executive has stated, “conservation practices continue to be the key to this.” According to a recent hospital survey, over 50 percent of respondents said that N95s were heavily backordered, and nearly half reported backorders for isolation gowns and shoe covers, as well.  Unfortunately, the ability to restock these critical supplies is dependent upon the raw materials that go into their manufacture, which are also limited at this point.  This may indicate that some hospitals will have to wait months to receive a sufficient supply of PPE.

Staff shortages is another issue many facilities are facing during the continuing national health crisis.  We were already experiencing a growing doctor shortage prior to the COVID pandemic, but you add the enormous potential of burnout and the limited educational capabilities of medical schools during this current environment, and you’re looking at a potential crisis over the next several months.  One medical staffing expert put it this way:

“Those areas are concerning to our hospitals because our hospitals depend on a whole myriad of medical staff. Whether it’s physicians, nurses, technicians, housekeepers — that whole staff complement is what’s at the core of healthcare. You can have all the technology in the world but if you don’t have somebody to run it that whole system falls apart.”

In addition to this, many nurses are experiencing increasing stress due to poor working conditions connected to the coronavirus advent and response.  One RN this past weekend described a nightmare scenario at one of the top hospitals in her state, where the nurses were being overworked and the floors were consistently understaffed.

Tweaking Workflows

Hospitals will need to continue to demonstrate flexibility in their response to COVID.  One hospital in Salt Lake City presents a good case example of this ability to adjust.  According to HealthcareDive, the facility executed the following plan and processes:

• Triage.  The hospital developed a triage system to help evaluate what services are necessary based on what level of COVID-19 spread is present in the community and how many beds and workers are available to treat them.
• Designated Space and Resources.  Certain floors and employees were designated for COVID-19 treatment. Staff have been reallocated for certain needs like testing, and there are plans in place if doctors and surgeons need to be deployed to the ICU.
• Distancing and Screening.  As many outpatient visits as possible are being changed to virtual; but, in the building, patients are screened for symptoms and required to wear masks and follow distancing protocols.

Every hospital in the U.S. has a plan that they are following, but those plans need to be flexible enough to morph with every new circumstance presented by the virus, the government, and the patient-consumer.  No one knows with any degree of certainty what the next few months will look like, so hospitals will need to be ready for any contingency.  Quickness and agility in deploying or rearranging resources will remain the key.