The COVID-19 pandemic demonstrated a significant impact on transportation. Closing of flights, shutdown of some shared car services and resistance to using mass transit drastically cut the ability to move people and goods. Slowdowns in logistics constrained supply deliveries on a global scale. It is critical to understand how these issues will affect the organization and workflow. It is then critical to find replacements for current options that may no longer exist or be practical for people, patients, supplies, treatment equipment, critical pharmaceuticals, etc.
Providing care through telemedicine and enabling telecommuting/remote work can significantly reduce the need to move people (patients, providers and staff).This is critical in a pandemic. The pandemic has also shown us that by putting these two options in place as part of an everyday strategy/workflow, organizations will then have the tools in place to scale/expand the use of them to reduce everyday transportation needs and costs. (Example: The University of Washington Medical Center has made telecommuting permanent. This will save $180,000 per month in office space costs.) Other organizations are looking at these potential savings an potential reuse of space[21].
Telemedicine can also be a method of delivering higher acuity services to facilities that do not have these in place such as capabilities of telestroke and teleICU (see Critical Issue #4).
Where physical transportation cannot be avoided, organizations will also need to have plans in place for cleaning and disinfection of vehicles transporting people. CDC guidance is available for this[22].
Maintaining and moving adequate supplies during a pandemic is a different issue. To some extent, this issue must be addressed with increased stocking of basic critical supplies (e.g., PPEs). However, especially for small and remote hospitals, addressing more on-demand items such as blood supplies and specialty pharmaceuticals will require more creative, out-of-the-box thinking. Be creative in your options. For example, Lyft and UBER have stayed in business through the COVID-19 pandemic for delivering both people and items. The University of Virginia and others have proven that drones can be an effective method of delivering limited but critical supplies remotely[23]. Volunteer flight services are also available and, in some cases, can be expanded[24].
Ideas:
- Assess your current transportation dependencies for patients, personnel and supplies (urgent and non-urgent).
- Have a contingency plan for each dependency.
- Avoid moving people.
- Use telemedicine to schedule appointments and deliver clinical expertise remotely reducing travel needs for both patients and staff.
- Enable the use of telemedicine for delivery of low to high acuity services where and when they are needed reducing travel needs for both patients and staff.
- Enable remote work.
- UBER / LIFT – set/monitor guidelines for shared car use.
- Set/monitor protocols for use of on-campus shuttles, trams or other transportation to move students/faculty on campuses during COVID-19.
- Set/monitor protocols for use of community vehicles (see CDC guidelines for community cabs/vehicles).
- Be creative and think about ways to Uberize local private pilots or flight services to address critical transportation needs (Examples: Veterans Airlift and Angel Flight) especially for urgent supplies.
- Consider the use of drones to deliver critical supplies
- Look to successful use cases (University of Virginia).