A Providence executive offers lessons for U.S. hospitals on coping with the new coronavirus

• Providence, the largest healthcare provider in Washington state, is treating the first U.S. patients diagnosed with COVID-19, the disease caused by the novel coronavirus.
• Developing a communications strategy is an essential first step for every system.
• Remote monitoring by telehealth may allow some COVID-19 patients to be treated at home.

Amy Compton-Phillips, MD, is executive vice president and chief clinical officer at Providence, a 51-hospital system that serves seven states. Providence is the largest healthcare provider in Washington state, site of the first and, to date, largest COVID-19 outbreak in the country. As of March 17, 787 cases of the disease caused by the novel coronavirus had been diagnosed in the state, and 48 patients had died.

During a HIMSS webinar on March 12, Compton-Phillips urged hospital leaders to act quickly to prepare for what’s coming.

“If the trajectory does not change, this is going to be in communities all across the U.S. before we have vaccines and treatments available,” she said. “So it’s better to be prepared than to be panicked when the time comes.”

Takeaways from the Providence experience to date include:

Develop a communications strategy

Providence initially used “tiered communication huddles” — group telephone calls to exchange information — for physicians and nurses only. As more COVID-19 patients entered the system, the health system created a “virtual emergency operations center” (EOC) responsible for systematically gathering, distilling and distributing information throughout the organization.

“The EOC doesn’t just have clinicians on it anymore,” Compton-Phillips said. “Supply chain is critical. Government affairs is critical. Finance is critical — how are we going to pay for all this? So we have a much broader array of people participating in our EOC calls.”

Consider remote monitoring via telehealth

Based on the experience seen in China and European countries, Providence expects that about 80% of patients with COVID-19 will be able to recover at home, 15% will qualify for hospitalization and about 5% will need respirator support in intensive care units.

Providence is using “hospital at home” protocols to limit the number of COVID-19 inpatients.  When appropriate, patients diagnosed in an emergency department are sent home with a thermometer and a pulse oximeter and are monitored via telehealth. Patients with COVID-19 can do well for a while and then decompensate rapidly, Compton-Phillips said, so close monitoring is essential.

“Having this capacity has made our clinicians much more comfortable treating patients at home rather than admitting them for observation into our acute care facilities,” she said.

Anticipate near-term critical needs

As of mid-March, 10 skilled nursing facilities in Seattle had COVID-19 patients. “We are expecting that, in the next couple of weeks, we might have a great need for ventilators, so we are deploying ventilators [from other hospitals] up here to be ready just in case,” Compton-Phillips said. “We also are very rapidly creating additional ICU bed capacity by creating negative pressure rooms out of standard rooms.”

Plan for disruption

Patients scheduled for elective procedures may need to be rescheduled or redirected to a different facility. “Because of the ventilator need at one of our facilities, we are diverting much of that volume to a sister facility,” Compton-Phillips said. “And we are very much thinking about how we ‘load balance’ to accommodate where things are happening.”

In China, for example, “fever hospitals” have been designated to treat patients with fevers and infections, while other patients are sent to facilities in which no one has COVID-19 symptoms.  Providence is considering that approach, Compton-Phillips said. “People still have MIs [myocardial infarctions] and break their hips and do all those other things that we need to provide care for.”