Harnessing the Power of Hospitalists in Operational Disaster Planning: COVID-19

Abstract

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.

How the COVID-19 pandemic will change the future of critical care

“…However, this will not address shortages during a sudden surge. A more flexible solution is to have a pool of non-ICU staff (physicians and nurses) who can assist during surges; preferentially drawn from fields such as anesthesiology, emergency medicine, general medicine, and hospital medicine, where skill sets are not dissimilar to those required in the ICU [ 28 ]. These backup staff would receive structured training, possibly with simulation, through a course developed for this purpose (Table 2 ) [ 29 – 31 ].…”

COVID-19’s impact on faculty and staff at a School of Medicine in the US: what is the blueprint for the future?

“…In healthcare, COVID-19 has upended care delivery mechanisms, strained financial enterprises [4], and exposed the shortcomings of our emergency preparedness system [5]. In response, the medical workforce has had to adapt to extreme changes in the physical and structural norms of our work in order to provide necessary care to our communities [6][7][8][9]. Just as the pandemic exacerbated pre-existing racial, ethnic, and socioeconomic health disparities [10,11], it has also intensified existing tensions in work-life balance.…”

Physician Workforce Response to the COVID-19 Pandemic at an Academic Medical Center

“…While there is evidence that physician volunteerism rates in a prolonged medical disaster are low, 9,10 our plan supplemented physician altruism with a pragmatic and supportive approach. Geriatrics 14 13 3 7 0 0 0 3 1 Heme-Oncology 28 28 0 0 7 0 0 21 0 Hospital Medicine 35 35 0 0 34 1 0 0 0 Infectious Dis 7 7 0 0 4 0 0 3 0 Nephrology 26 23 0 0 10 0 0 13 3 Palliative Care 3 3 2 0 1 0 0 0 0 Pulmonary 21 18 4 1 4 1 1 7 3 Rheumatology 11 7 1 2 0 0 0 4 4 Total 536 476 68 69 72 5 3 258 60 1 All credentialed physicians, with and without admitting privileges 2 All credentialed physicians with admitting privileges, employed and independent 3 Employed physicians redeployed to acute and critical care (3 cardiologists, 2 pulmonologists) 4 Non-face-to-face care: occupational health telemedicine or Family Communication Service 5 Employed physicians excluded from redeployment: critical care, hematology-oncology, hospitalists, infectious disease, nephrology, pulmonary 6 Employed physicians who refused redeployment 7 Participants in the Supplemental Physician Workforce 8 Physicians with hospital credentials (for insurance purposes) without admitting privileges Dow...…”

“…1 To improve efficiency and quality, many US (United States) hospitals have employed physicians in inpatient and outpatient settings who practice alongside "independent" (or "voluntary") physicians. Although most physicians feel an obligation to provide urgent care during a disaster, 2 they may no longer simply volunteer as in the past, 3 as they often consider this responsibility of employed physicians, in addition medicolegal issues and clinical preparedness 4,5,6 concerns.…”