Regardless of the procedures in place, some infection of staff must be expected and plans must be in place to mitigate the impact on staffing and care. There is a critical need to plan for shortages to occur as demand for specific specialties and for intensive care resources increase. Telemedicine offers advantages to reduce exposure of providers, to share resources and to access resources outside of current operations.
Ideas:
- Establish infrastructure to engage available replacement and surge staff in advance. Establish a program to identify and engage workers that are retired or underutilized who have the capability and willingness to serve in a “reserve” capacity. These should include: public healthcare professionals, nurses, physicians, support staff and management staff. Like all reserves, arrange for training on a regular basis or have crash training available and tested to bring personnel up to speed on current platforms and processes at the facility. Use telemedicine and tele-commuting wherever possible to accomplish this.
- Be prepared to use virtual pools (UBER model) available through telemedicine providers.
- A pandemic may not affect hospitals evenly. Hot spots may result if over demand and need more resources. Other areas may have less demand and excess resources. It would be beneficial to have mutual aid agreements in place and a method of demand contraction surplus. An UBER model works well for this and shared resources software and APPs are available. Most on-demand telemedicine platforms can deliver this capability.
- On-demand telemedicine and panel services are widely available and can act as resources to augment capacity. These services can provide on-demand primary care, behavioral health, second opinion and specialty consultations to relieve your staff. There are dozens of companies that provide these services on-demand
- (See TTAC tool kit: On-Demand/Direct to-Consumer Telemedicine https://telehealthtechnology.org/toolkit/direct-to-consumer/ )
- Make management decisions and protocol regarding whether COVID-19 positive nurses can treat COVID-19 patients without infecting other staff and set protocols.
- Have testing in place for all staff (clinical and nonclinical) and continuously screen staff too.
- TeleICU can provide remote intensivists and intensive care nurses to support and enhance your current ICU operations. These services can also support the ability to convert additional beds to ICU beds and expand your ICU capacity. Planning is required and organizations should engage these services in advance on a contingent basis or integrate them into current, day-to-day ICU operations. Facilities should have the communications and video capability in place with basic equipment staged and ready.
- Telestroke can provide timely access to remote stroke neurologists to support or enhance your current ED/neurology operations. Like teleICU, advanced planning and preparation is required, communications and video capabilities must be in place, basic equipment should be staged and ready for use and specialist services should be engaged in advance on a contingent basis or integrate them into your current, day-to-day ED operations.
- Use telemedicine to support other demands for specialists. As in ICU and Stroke above, access to expert consultation via telemedicine is widely available in almost every other clinical specialty area. These resources can fill in for or augment your specialty providers.
- Allow and enable staff to work from home whenever possible reducing their exposure and the risk of staff carrying infection into the hospital. This will also allow staff that have been exposed to COVID-19, or are infected but not seriously ill, to continue to fill at least a portion of their operational role.
- Enable training for providers and coders and ensure guidelines/compliance rules are in place for providers furnishing and billing telehealth services from home (e.g., coding, documentation, privacy, security, etc.) (See Critical Need #9 )