key: cord-0047991-ntap5ao0 authors: Kim, Christopher S.; Kritek, Patricia A.; Lynch, John B.; Cohen, Seth; Staiger, Thomas O.; Sayre, Cindy; Neme, Santiago; Nasenbeny, Keri; Goss, J. Richard; Dellit, Timothy H. title: All Hands on Deck: How UW Medicine Is Helping Its Staff Weather a Pandemic date: 2020-04-24 journal: NEJM Catal Innov Care Deliv DOI: 10.1056/cat.20.0113 sha: 5b69f4b7203b5002f85b25a4928b6e698c9f85ed doc_id: 47991 cord_uid: ntap5ao0 University of Washington Medicine took several concrete steps to fight clinician burnout and avert illness as it began to treat Covid-19 patients in significant numbers. In the following few weeks, we worked furiously around the clock to develop clinical protocols, guidelines, and policies. We tried to communicate as much information and as frequently as possible. Everyone was frantically working hard to resolve the next challenge. The burden of this disease on the health system has been incredible. In the month of March, we tested nearly 10,000 individuals for SARS-CoV-2, with 9% testing positive. The three hospitals that make up UW Medicine have admitted a total of 141 patients with confirmed Covid-19 as of early April, and 30 have died. As a snapshot, on April 6, the three hospitals had an inpatient census of 122 confirmed Covid-19 cases, with a third of them in the ICU. Prior to the Covid-19 days, our average daily census was more than 1,500. Currently, the number of hospitalized patients across our system is less than 1,200 (approximately 100 Covid-19), due to postponing elective and nonurgent admissions. Our hospitals so far have been fortunate not to face the shortages of critical supplies or staff that have been seen in other locations, though we have made contingency plans based on surge scenarios. As we rushed to mobilize to support the increasing numbers of patients with Covid-19, we learned that we needed to focus just as intently on the care of our colleagues who were struggling with the uncertainty and rapid change of this crisis. Clinicians share the same fear and concern as those outside health care, worrying about how this global pandemic will impact our health, families, and livelihood. Our colleagues are juggling work and family responsibilities with requests to cover extra hospital shifts while also homeschooling children, caring for loved ones, and maintaining physical distancing. As we have navigated this evolving crisis, we have made support of our health care team one of our guiding principles. We have reinforced existing practices and incorporated new ones. Specific domains we have prioritized include: helping employees determine their Covid-19 infection status, so employees can come to work confidently or appropriately stay home, communication that is effective and transparent, and strategies to build the sense of community across UW Medicine. UW Medicine has made its internally developed resources publicly available, and we invite the readers to some specific links within our general resource site (Table 1) . To do this, we have established a free employee drive-through Covid-19 testing clinic.4 As of March 31, we have tested nearly 2,800 symptomatic employees with 4.8% testing positive. Our initial rollout asked for classic history such as recent travel, contact with known Covid-19 patients, and new onset of fever, cough, or shortness of breath. As the virus became more prevalent in the community, we liberalized the history and symptom elements so that more of our employees could be free to ask for the test. Employees have tested positive for the virus at approximately half the rate of the general public. We believe the availability of drive-through testing has helped ease anxieties and reassure employees that they can safely care for their patients and return home to their families. For those who have tested positive, we have worked with them to identify when extra precautions and selfisolation practices are warranted, with specific guidance about when it would be safe to return to work. We are extremely fortunate in that our clinical virology lab proactively developed a test that was ready to deploy after FDA approval. 5 We were able to rapidly deploy it once we began to see local transmission of SARS-CoV-2 in our community. Even as the testing process was being ramped up, we made a commitment that our health care team members would have early access to this scarce resource. This has provided us with internal testing turnaround time of 8-12 hours while also providing testing resources to other health care organizations locally and across the country. Our clinical virology lab also remains a vital resource to the community, state, and country, as they now run 2,500 tests per day. While we're continuing to learn more about Covid-19 at a rapid pace, everyone still has numerous questions about risks to ourselves, our families, and our patients. We learned by many iterations of trial and error that timely communication of important information was critical to our providers and staff. We liberalized the history and symptom elements so that more of our employees could be free to ask for the test. Employees have tested positive for the virus at approximately half the rate of the general public." In that first week, everyone in the organization was searching for any information about what was going on and what we were doing. Blast emails from multiple leaders, all with good intentions to provide immediate updates, were perceived as disjointed and overwhelming. Town halls were held, but their frequency varied by hospital. One held them daily, another only once a week. In the ensuing weeks, we have standardized and streamlined the messaging within our community. We use various channels including daily community-wide emails from our Clinical Incident Commander (the infection-control clinician responsible for spearheading UW Medicine's Covid-19 response), posts to our dedicated Covid-19 information website, video messages, and town halls. We have learned that our staff and providers want to hear from our clinical leaders. A weekly 1-hour Zoom town hall on Friday afternoon has proven very effective. We bring together our systemwide Chief Medical Officer, the Chief Nursing and Medical Officers from all clinical sites, and our Clinical Incident Commander, to answer questions. We have a portal where members of the UW community can send in questions either in advance or during the town hall. Table 2 lists the top four themes of questions raised by our employees. Some of these topics have been readdressed at multiple town halls. Our format is one of conversation and response to questions as opposed to planned presentations. We begin by checking in with our leaders about their efforts to maintain well-being during this challenging time. Brief stories of cherishing those times at home with teenage twins, playing with the new puppy, and reviving that joy of reading are moments that can resonate with others. We then have a system update from the Chief Medical Officer of UW Medicine. The remainder of the time is focused on response to questions. One member of our team reviews questions in real time, prioritizing themes and forwarding them to the moderator via text. We work to avoid "planned" responses and make the discussion organic. We also find this is a way to humanize the leadership team, particularly as we all struggle with hard decisions. These town hall sessions have been attended with great interest. Our first town hall had the capacity for only 300 participants and it was filled within 20 seconds. We increased our capacity for the second one and had more than 1,200 live viewers and thousands of views of our posted video. Status of personal protective equipment (PPE) supplies and decisions on the approach to PPE (e.g., use of universal masking) Access to testing for patients, turnaround time, and the system's approach to testing (e.g., testing for patients undergoing surgery or in labor) Risk to the health care provider's family and strategies to mitigate that risk Surge planning and workforce issues Most common themes of questions submitted for a series of town hall meetings at UW Medicine related to supporting our providers and staff in the wake of the Covid-19 pandemic. Some of these topics have been readdressed in multiple venues as evidence and information surrounding the topic evolves as we live through this pandemic. Source: Authors " We make recordings of our virtual town halls available through our public Covid-19 website. In an effort to reach as many people as possible, we have added closed captioning to the videos and are working on translated transcriptions. We encourage our community to share the videos with friends and families to help answer their questions. After each town hall, we add common questions and their answers to the "Frequently Asked Questions" portion of our Covid-19 website. Our UW Medicine town hall approach has led to smaller town halls focused on specific cohorts including our residents and fellows, our medical students, nursing units, and the partners/spouses of members of our workforce. We have found these are helpful for addressing unique aspects of the common themes as well as allowing for more focused answers on topics relevant to these unique groups. It is our hope that by hearing the top concerns in the minds of our health care team and addressing them transparently -both real-time through virtual town halls and in follow-up communicationsthat our teams will feel more supported, empowered, and a part of our community. Our employees require both emotional and practical assistance during this crisis. We know that each of us, at different times, has had increased anxiety and times of grief.6 Our first approach was to highlight and reinforce our traditional forms of emotional support such as our Employee Assistance Program, but we rapidly realized that the program was not designed for the amount and type of support our community was going to need most at this time. By a lucky coincidence, we had recently launched a peer support program for our faculty and staff. This cohort of about 100 trained volunteers rallied to provide additional supportive listening as the crisis progressed. To date, we have been able to offer more than 100 peer-to-peer support sessions to our colleagues who have formally requested this type of connection through an online form or an e-mail to one of the program coordinators. Many more encounters have likely taken place informally. Our next layer of support came from our Department of Psychiatry and Behavioral Sciences. The faculty of this department volunteered to connect with faculty and staff in need, by phone or Zoom, for free. This new support program has garnered great demand early on and had more than 55 requests in just the first 2 weeks of its launch. Psychiatry and Behavioral Sciences faculty members have had 63 encounters as part of this program as of April 23. Our employees require both emotional and practical assistance during this crisis." We have also worked to relieve some of the additional stressors on our team by coordinating volunteers to provide childcare, school tutoring, dog-walking, and other services for which the pandemic has either created or increased the need. This coordination is done primarily through " the UW Medicine Care and Share website, an interactive platform set up specifically for this crisis period that connects seekers with offers for these types of supports. Originating within the School of Medicine to support its faculty and residents/fellows, the plan blossomed to include the entire UW Medicine system to create the broadest community within which to share resources. Individuals can post a new offer, and requesters can filter and search by keyword for types of offers and connect with the specific services offered or needed. Volunteer coordinators monitor the posts to make sure they are appropriate for the site. In less than 2 weeks, more than 130 offers and 100 requests for support were posted. As of March 28, 42 requests have been fulfilled. Projection models suggest that we will see a peak in hospital resource use sometime in mid-to late April, with a gradual decline as we head into the summer months,7 but we don't know with certainty when this pandemic will end. What we do know is that the only way we will get through this is by working together. Our employees are our most valuable asset. We need to support them now and through the coming months as we prepare for a marathon, not a sprint. If change is opportunity, then this moment will likely transform how we come together as a workforce. We have been inspired by how our employees have risen up to support each other and their patients. It is our job, as leaders of the health care system, to consistently, creatively, and effectively support them. First case of 2019 novel coronavirus in the United States Report First Covid-19 death Epidemiology of Covid-19 in a long-term care facility in King County UW Medicine News Release. Drive-Through COVID-19 Tests for UW Medicine Employees How Intrepid Lab Sleuths Ramped Up Tests As Coronavirus Closed In. Kaiser Family Foundation That Discomfort You're Feeling Is Grief Forecasting Covid-19 impact on hospital bed-days, ICU-days, ventilator-days and deaths by US state in the next 4 months The authors would like to thank the entire UW Medicine community for everything you are doing to support each other and providing the best care we can in these times. We also acknowledge Helene Starks, PhD, MPH for her editorial support. Kritek, John Lynch, Seth Cohen, Thomas Staiger, Cindy Sayre, Santiago Neme, Keri Nasenbeny, J. Richard Goss, and Timothy Dellit have nothing to disclose.