Texas Health Resources was in the process of rolling out its well-received new app for nursing rounds this year when, as every hospital system experienced this year, everything changed quickly in response to the COVID-19 pandemic.
Rollout of the app – which is provided by CipherHealth Software and is used to better track patient and staff needs, and to improve communication – was frozen as Texas Health dealt with more pressing concerns. But even amid the new safety protocols around hospital visitors and ways to treat COVID-19 patients without putting staff in danger, the app ended up being a useful tool in the fight at the five sites where it was already deployed, Texas Health staffers say.
“I think we just had to get creative with how we were rounding,” said Yolanda Blaine, who helped pilot the app at Texas Health Presbyterian Hospital Dallas. “We’re rounding through the phone because we’re trying to decrease the amount of exposure to our COVID-19 patients. We’re not decreasing the amount of time we’re spending with patients, we’re just decreasing how we’re rounding them.”
Texas Health acquired more iPads to use with the app and is utilizing technologies such as videoconferencing to keep patients in touch with families. So-called “virtual visits” have gotten positive feedback and may end up being incorporated permanently into the hospital system’s offerings, officials at Texas Health said. Michele Kennedy, patient experience consultant says that tools like the rounds app and practices like using videoconferencing have had to evolve quickly to meet the needs of staff and patients during the COVID crisis. “The bigger picture is we are looking at ways to conserve PPE as much as possible,” she said.
Bianca Radney, vice president of patient and family experience, says that tools like the rounds app and practices like using videoconferencing have had to evolve quickly to meet the needs of staff and patients during the COVID crisis, “We’re redefining our existing rounding practices to still make sure we include patients and families as much as we can in a virtual format. We are conserving our resources and being as efficient as possible.”
Creatively Managing Resources in a Pandemic
The question of how hospitals can continue to innovate and to move forward amid the financial burden of dealing with a pandemic is one that Stephen Bowerman, senior video president and chief financial officer at Midland Health, says every hospital is dealing with right now.
“I think the hospital’s in a pretty good position, but we’re constantly hustling to stay that way from a PPE perspective,” Bowerman said. The hospital has taken on a new line of credit as it has frozen elective procedures and applied for COVID-specific Medicare funding from the U.S. government.
Like many other hospitals, Midland Health has had to deal with dramatically rising costs for items such as N-95 masks, which Bowerman said went from about 45 cents per mask to “the price of gold,” nearly $8 per item. “But we made the decision that we want to continue to invest in the safety of our employees and our community. And we need to do whatever it takes to make sure we have enough of that product available.”
Some of the solutions borne out of necessity have included asking staff to use N-95 masks for four days at a time and to use other kinds of masks in areas where there are not COVID-19 positive patients or persons under investigation.
Midland Health has been using a UV light room, hanging up items such as N-95 masks for disinfecting, a practice the hospital wasn’t engaging in until the COVID-19 pandemic.
Bowerman said the hospital has 44 high-end ventilators and 37 disposable ones in preparation for a possible surge in COVID-19 cases and has so far not had layoffs or furloughs of employees. Many of the big challenges, he says, have more to do with managing staff and resources, and widening the use of telemedicine tools such as Basin MD, a virtual urgent-care app.
But new tools still can’t replace all practices in relation to COVID-19 patients, he said. “Staff have to put hands on the patient. They have to do what they have to do to make sure the patient is getting the care they need. So it’s not a lot of telehealth specific to those patients, but definitely in a lot of other ways across our hospital and our organization and community, in how they‘re taking on health care compared to the way they were just a month ago in March.”
‘Mind-boggling’ Solutions to COVID-19 Problems
Dr. Faisal Masud, medical director of critical care at Houston Methodist Hospital, says that the burn rate of PPE has been top-of-mind in dealing with COVID-19. But aside from implementing different kinds of protective wear for different parts of the hospital, Dr. Masud said his team has been able to find other creative ways to limit viral exposure.
One of those projects has been the creation of three iterations of the Houston Methodist Aerosol Container, which allows for more protection of a hospital worker during intubation of patients. It looks like a glass box and includes 15-centimeter wide arm holes. “That saves a lot of PPE for this patient,” Dr. Masud said, “A nurse walks in and doesn’t have to wear an N-95 mask and can still interact with the patient and check on things, and then come out.”
The design was created in a more rudimentary form in Taiwan and was adapted and improved upon by hospital staff in a few days. The third version of the HMAC now includes HEPA filtration, he said. Twenty of the units have been deployed and the designs have been posted publicly for other medical systems to adopt. “We want everybody to learn and be safe,” Dr. Masud said.
Masud said the hospital has tried to be creative financially as well, redeploying team members and nurses to work as ICU support in lieu of layoffs or furloughs.
Like many other hospitals, Houston Methodist has found a lot of value in video and virtual medicine during this time. Dr. Masud said the hospital has been working on a virtual ICU feature for four years and was able to launch it earlier this year. “I think it was destiny,” he said; the tool has helped keep staffers safer by keeping ventilator monitors outside of the actual ICU and by creating a link for patients to interact with family.
“The virtual ICU is not device-specific, family members immediately open up a link and see their loved one. People cry because they’ve not seen their mom or other family member,” he said.
The virtual ICU began in one location and is being deployed at all five of the ICUs at Houston Methodist’s main campus. “We had to jump start it at a very fast pace,” Dr. Masud said, “we put a lot more manpower there so we could provide 24/7 care. And that has been a gamechanger.”
The work, he says, has shown that even in the toughest times, hospitals can still tackle new challenges in creative ways. “I’m blown away by the ingenuity of people,” he said, “people are coming up with solutions that are mind-boggling.”
The medical director said that all hospitals are going to be financially hit, and hit hard, by the COVID-19 pandemic, and that despite all the work and innovation that’s happening, they will still need help in the end.
“We are really fighting on behalf of all of you. We are not sparing any expense, but that’s not a sustainable model,” Dr. Masud said, “If you want us to deliver this kind of level of care, society and the government has to help us.”