This article is part of a series on what the healthcare industry looks like one year after the novel coronavirus was declared a pandemic and life in the United States began to drastically change.
Business as usual for the health sector was upended last spring when the novel coronavirus bore down on the U.S. and its hospitals.
COVID-19 cases were beginning to mount, stoking concerns about adequate supplies and hospital resources such as bed capacity and ventilators. Providers were forced to shutter some services and cancel elective procedures as a means to preserve precious resources, personal protective equipment among them.
Initially, New York City was hit hardest by a rising tide of cases that overwhelmed hospitals and clinicians. As spring wore on and infections quickly multiplied, it wasn't long before the virus escaped to other regions, jumping from one hot spot to the next.
It's been a full year since the U.S. shut down. While much has changed, life for many has yet to return to normal despite the hope the rollout of vaccines brings.
For some health systems, returning to pre-pandemic operations won't happen; the crisis has forced them to rethink how they operate. Healthcare Dive talked to physician leaders across the country about the biggest lessons they learned and the lingering concerns they have as a nation attempts to return to normal.
Leaning on big data
Every physician leader Healthcare Dive interviewed — from New York to South Dakota — said harnessing data was a game changer in combating the novel coronavirus.
In New York, patients flooded NYC Health + Hospitals facilities, particularly Elmhurst, by early spring.
At the time, there was no tool that allowed physician leaders to see real-time metrics of operations such as capacity levels within each hospital, or even in the ICUs. That required text messages and calls to individual hospital leaders, an inefficient process.
Now, there is a dashboard of information at the fingertips of those who need to make timely decisions. It's referred to as the "COVID intelligence," Eric Wei, chief quality officer at NYC Health + Hospitals, said. Many health systems have adopted similar dashboards.
"Now, we have dozens of dashboards with every kind of sliced and diced piece of data that we could possibly want to make decisions," said Wei, who is also a physician.
For example, the dashboard illustrates overall hospital strain and is color coded; green and yellow is good, red is bad. This dashboard enables decision makers to immediately see ICU capacity across hospitals so they can better allocate resources.
"So we know that these three hospitals are going to have to send patients out. Where can we find the capacity to receive?" Wei added: "Even before we get on the phone with all the CEOs, we have an idea of what direction we're going in."
For Sanford Health in South Dakota, the biggest lesson was learning how it could leverage the "huge repository" of patient data, Jeremy Cauwels, chief physician, said. Doctors across the system are now devising their own projects to see how they can utilize the data to improve patient care beyond COVID-19.
Cauwels explained that Sanford set up a registry of sorts with the information of the 95,000 COVID-19 patients it has treated. The analytics team then mined the data for trends and insights.
From its registry, Sanford has learned which patients are most likely to end up in the hospital, need a ventilator, or, in the best case scenario, sail through without complications, Cauwels said.
One of the most compelling uses of the data is turning it into actionable information and automating it.
For example, the moment someone tests positive for COVID-19 and they've also been identified in the system as high-risk, they're called within 24 hours of the positive test to receive an antibody infusion to help ward off more serious symptoms. Reaching these high-risk patients quickly is critical, Cauwels said, as studies have showed that if given the antibodies within 10 days it is more likely to prevent severe illness.
Using big data in this way likely prevented 400 days of hospitalizations in the past three months, prevented more than 40 admissions and avoided "probably at least four or five deaths," Cauwels said.
"One of the things that we'll walk away from the COVID years with is to really understand how we can use that for other things," Cauwels said of the data.
Rethinking old ways
The pandemic has forced hospital leaders to rethink the way they operate in all sorts of ways from the mundane to more critical elements.
As the virus took hold in the U.S., hospitals were quickly exhausting PPE supplies, a critical resource to keep front-line workers safe.
Continued shortages and supply chain issues led Advocate Aurora Health to invest in a domestic manufacturer of masks. Last May, Advocate Aurora partnered with group purchasing organization Premier to acquire a minority stake in Prestige Ameritech, the largest domestic manufacturer of PPE, including face masks, surgical masks and N95 respirators.
"We don't want to be caught off guard again," Gary Stuck, chief medical officer for Advocate Aurora, said. It's not something his organization would have likely considered but for the pandemic, Stuck said.
The onslaught of the virus also has forced hospitals to rethink the most basic elements of how they operate: how patients flow through a hospital.
Now, the goal is to immediately move any patient who is admitted up to a bed instead of waiting in the ER. The practice first started at Bellevue hospital as leaders wanted to keep the "deck clear" for any COVID-19 patients who may come in, Wei explained.
It's not uncommon for patients to have to wait for a bed once admitted. Numerous factors influence the trend; for example, Mondays can be a difficult day as surgeons want to schedule surgeries and patients tend to wait to come into the ER until after the weekend.
"The whole culture has shifted," Wei said. It's now a practice they're trying to roll out to the entire system.
The pandemic also reshaped work life for many employees not on the front lines.
The rising tide of cases forced many employers to send employees home to work remotely, hoping the seclusion away from bustling offices would help slow the spread of the virus.
As administrative employees remained productive at home, the Midwest regional giant Advocate Aurora learned they don't need everyone in an office every day of the work week.
It will cut down on their costs to trim its real estate footprint, but it also creates a more nimble and efficient organization, Stuck said.
But the rethinking goes beyond just office space and to the doctor's offices, too.
It's easier now than it was before to monitor chronic patients remotely. So instead of waiting for the patient to come to the next visit, their doctor can continuously monitor their vitals to intervene sooner to prevent a hospitalization.
"We learned this year that we really can provide great care virtually, and then [we] sort of have to figure out what's the necessity of a doctor's office and the bricks and mortar?"
Burden on frontline caregivers
When Wei returns home from work, what keeps him up at night is the emotional and mental toll this pandemic has had on his doctors and nurses.
"We're just scratching the surface of the long-lasting effects of being on the frontlines of this pandemic," Wei said. "Are we doing enough to support our staff? What more can we do?" Are all questions he keeps turning in his mind.
More than 2,900 healthcare workers have died since the start of the pandemic, according to an analysis by Kaiser Health News and The Guardian. On top of that, healthcare workers had to watch an unfathomable number of their patients die without family members nearby, but over video calls.
The pandemic has claimed the lives of more than 528,000 Americans and more than 2.6 million around the globe, according to Johns Hopkins Coronavirus Resource Center.
The call to duty never seemed to reach a lull. For many months, nurses and other clinicians worked extended hours as the surge of cases stretched resources.
Nurses were in such high demand that hospitals were willing to pay significantly more to bring in additional traveling nurses.
Hospital leaders everywhere seem to be grappling with how to adequately address the needs of coworkers.
"The emotional burden that our nurses have had to shoulder during all of this ... has really been incredible," Cauwels said.