Harnessing the Power of Hospitalists in Operational Disaster Planning: COVID-19
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Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA; 2University of Colorado School of Medicine, Aurora, CO, USA; 3Division of Pulmonary Sciences and Critical Care Medicine, Aurora, CO, USA.
Hospitalists are well poised to serve in key leadership roles and in frontline care in particular when facing a pandemic such as the SARS-CoV-2 (COVID-19) infection. Much of the disaster planning in hospitals around the country addresses overcrowded emergency departments and decompressing these locations; however, in the case of COVID-19, intensive care units, emergency departments, and medical wards ran the risk of being overwhelmed by a large influx of patients needing high-level medical care. In a matter of days, our Division of Hospital Medicine, in partnership with our hospital, health system, and academic institution, was able to modify and deploy existing disaster plans to quickly care for an influx of medically complex patients. We describe a scaled approach to managing hospitalist clinical operations during the COVID-19 pandemic. J Gen Intern Med DOI: 10.1007/s11606-020-05952-6 © Society of General Internal Medicine 2020
INTRODUCTION
On December 31, 2019, Chinese officials informed the World Health Organization of a “mysterious pneumonia” affecting 41 patients, all tied to the Huanan Wholesale Seafood Market.1, 2 Later identified as SARS-CoV-2 (COVID-19), COVID-19 would soon unfold into a pandemic impacting frontline responders across the world.3–5 Overburdened providers and healthcare systems would soon surface in China, Italy, and eventually the USA.6 Hospitalists have been at the forefront of the COVID-19 response, helping to lead frontline work, orchestrating complex and dynamic clinical operational plans, and partnering with clinicians and leaders from many different specialties.7–9 Much of the hospital disaster planning in the USA focuses on rapid intake of a large number of trauma patients in response to a time-limited event such as a natural disaster or a mass casualty incident. Prior pandemics such as the influenza H1N1 epidemic in 2009 directed attention to the importance of emergency preparedness for potentially large pandemics but failed to Received April 21, 2020 Accepted May 29, 2020
motivate sustained attention in the wake of a successful vaccine. In that context, COVID-19 was primed to overwhelm intensive care units, emergency departments, and medical wards. Starting with preparedness models outlined by Persoff et al.,10 Frank et al., 8 the CHEST consensus statement,11, 12 and our existing disaster plans, we developed a modified framework for hospital operations management and staffing, anticipating a massive influx of acutely ill, medically complex, and highly contagious patients with COVID-19.
THE FRAMEWORK: THE 4 C’S
Using best practices in disaster planning, we developed a working framework for the management of the COVID-19 pandemic (Fig. 1). Crucial to successfully addressing this challenge was collaboration: forming effective partnerships and informatio
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