This week a hospital Emergency Room essentially closed because it did not have enough staff. A patient with COVID-19 had recently been seen in the ER. Unfortunately, many frontline staff were not appropriately protected, resulting in exposure before the diagnosis. As a result, these individuals were quarantined at home, and the ER was left with inadequate staff. What services will be available for ER patients in the coming weeks?
“Nursing homes are incubators of epidemics,” said Dr. Betsy McCaughey, Chair of the Committee to Reduce Infection Deaths. “Every facility should be holding a boot camp to train health care workers.” If not, “hospitals and nursing homes will become the most dangerous places to be.”
A nursing home in Kirkland, WA, has had COVID-19 spread rapidly across residents, with at least seven now dead. While the elderly are especially vulnerable, multiple staff members and at least one visitor have been infected, too. Who will care for the currently quarantined patients? How much more isolated from their families will they be?
To compel training and compliance, CMS announced their plan today to focus heavily on infection control in hospital inspections.
“There are very detailed instructions and guidelines around infection control,” said CMS Administrator, Seema Verma earlier this week. “They are already in place. Dealing with infectious disease is not new to the health care system. We’re just calling health care providers to action and to double down on infection control.”
Therein lies the problem. Frontline healthcare workers are under tremendous duress. As our population has grown, patient volume has grown. Healthcare finances have pushed organizations to do more, with less. And medical procedures are accelerating at mind-blowing pace, both in volume and complexity. Frontline staff were already struggling to stay on top of everything well before COVID-19. And now increasing numbers are saying, “I will get coronavirus.”
To combat the COVID-19 outbreak, frontline staff must:
- Screen patients and visitors, and manage those possibly infected
- Quickly alert hospital leadership and county health agencies
- Protect other patients
- and Protect themselves and fellow staff
As a major county public health official recently shared, “Real-time, seamless access to current guidelines, protocols, information are vital to effective containment and mitigation strategies.”
Most institutions have no bandwidth to pull staff off the line for an intensive bootcamp. Furthermore, with rapid flux in practices, what is taught one day is obsolete the next.
And there is so much noise– from media, from peers. Overburdened frontline teams are struggling to stay up to speed. Institutions are responding by falling back on decades old strategies of blast emails and increasingly bloated websites. They have no idea who is listening, nor how well messages are understood.
The world is moving to small bites of information. Adults learn in context, pulling what they need, when they need it. Leadership needs an agile solution delivering relevant information filtered to specific workgroups, when they need it. And, consistent with adult needs, the information must be actionable– “microlearning.”
UCSF’s Emergency Department is in a hot zone for COVID-19. Their leadership understood the challenge and transformed hospital-specific practices into digestible decision guides, pictures, and short videos– all contextual to the ED, immediately updatable, and delivered in both desktop and mobile formats. Leadership can readily update information to a single point of truth, assign content to specific users, and track both engagement and frontline feedback. The result: patient care is safer, and staff are more secure.
Dr. Bruce Auerbach, former Chair of the Committee on Quality & Patient Safety at the American College of Emergency Physician says that this approach allows staff “to get the most up to date and accurate information for emerging diseases such as Coronavirus. With a large team working different shifts around the clock, leadership can now readily document staff review, audit staff learning, and collect staff questions and feedback.”
PBS News Hour recently filmed a story on the coronavirus outbreak in San Francisco. One focus was the excellent care at the UCSF ED, including video of staff wearing personal protective equipment to avoid disease spread. Their ED Chief shared the importance of their novel technology implementation to support frontline staff, and how it is being scaled to other EDs. Unfortunately, this clip fell to the cutting room floor. Supporting our frontline staff to do the right thing– our most critical role– needs to be our priority.