key: cord-0048034-nmtkh7es
authors: Forese, Laura L.; Corwin, Steven J.
title: Restarting with Covid-19: Seven Key Action Items
date: 2020-05-07
journal: NEJM Catal Innov Care Deliv
DOI: 10.1056/cat.20.0207
sha: 8f926076b8f876f51de1ffca5803ab990943ebb3
doc_id: 48034
cord_uid: nmtkh7es

As the first phase of the coronavirus pandemic slows, health care organizations need to get ready for the new normal. Leaders at NewYork-Presbyterian have created a Restart Coordination Committee to develop and execute a measured approach for the way forward.

2. Determine pre-procedure testing process and locations.

3. Create centralized 100% pre-visit completion process: scheduling, registration, insurance, questionnaires, and check-in pre-visit screening.

4. Develop process for lobby screening, moving patients directly to exam or procedure rooms, waiting rooms, and elevators with enhanced environmental services.

5. De-deploy the Covid staffing and develop new staffing plans.

6. Ensure adequate PPE and testing.

7. Develop marketing and communications plans (internal and external).

In this new normal, we have established new operating guidelines around testing, PPE, visitation, and infection prevention and control while continuing to put the safety of our patients and providers first. We will employ a broad and comprehensive testing strategy for the foreseeable future, evolving as new testing technologies and best practices develop. We will tirelessly protect patients and our employees; we will enforce a universal mask protocol for all employees, patients, and visitors. We will continue to have no visitors except for obstetrics and pediatric patients. Throughout the enterprise, we will maintain the highest standard of cleaning and disinfection protocols. And we will resume measuring our patient experience.

We must focus on two key questions: What will consumers and providers demand of their health system after Covid-19, and how do we instill in them a sense of confidence and trust?"

With more than 1,700 Covid-19-positive patients still in-house and 35% in the ICU as of April 28, we will need to open in a phased approach. The transition will begin in mid-May and continue through the fall, depending upon guidance from the New York state governor, ICU capacity, staffing including de-deployment, physician input on the urgency of the cases, and the certainty of sustainable levels of PPE. Over the long term, we will optimize and streamline the virtual front door to care including pre-visit work completion, enhance our ability to work remotely, and continue to increase use of telemedicine across the enterprise.

In our inpatient areas, we expect to continue to care for more critically ill patients. To do so, we will increase our pre-Covid ICU capacity by 50% by making medical/surgical beds ICU-capable. Additionally, we will cross-train more clinicians (e.g., hospitalists, intensivists, and med/surg and ICU nurses) and develop a critical care advanced practice provider training program. Where possible, we will care for more patients at home through increased remote monitoring and hospitalat-home programs.

The Procedure and Diagnostics Committee is creating a schedule detailing which procedures and locations will start on a return toward normal activity. Beyond emergent cases, each hospital will " prioritize cases into three categories: semi-urgent (May/June), less urgent (July/August), and least urgent (fall).

We will open all diagnostic and imaging locations 2 weeks prior to ambulatory procedures to allow adequate preparation time. We have cross-credentialed all of our physicians to allow them to practice at any of NewYork-Presbyterian's 10 campuses. As a result, we will have the flexibility of having our clinicians deliver care at any of our campuses depending on campus readiness factors such as space, materials, and staff.

The transition is going to be challenging -in many ways more difficult than it was to "pause" for this crisis -because none of us will be returning to business as usual."

For our physician practice offices, we will coordinate same-day patient visits across multiple providers and streamline diagnostic procedures (labs, imaging, etc.). We will use telemedicine as a first step to meet patient needs and register all patients before the visit or procedure. We will ensure appropriate spacing for patients depending on vulnerability, increase time between appointments, and provide free parking for all patients at all facilities. Overall, we will limit exposure to others in public areas (elevators, waiting rooms), provide prescreening stations upon entry, and staff will cover multiple roles in the practice setting where positions can be cross-trained in order to limit inperson interactions for patients.

The transition is going to be challenging -in many ways more difficult than it was to "pause" for this crisis -because none of us will be returning to business as usual. We are all facing tremendous economic uncertainty. The trajectory of this disease and the patient's response to expanded health care services are unknown. We expect business to rebound slowly, but if there is another surge, then we will need to be prepared both in number and appropriate training of our staff. As we manage our financial liquidity we must balance short-term lines of credit with the release of funds from the Coronavirus Aid Relief and Economic Security (CARES) Actand Federal Emergency Management Agency (FEMA), and contemplate longer-term financing solutions. Finally, we will need to revisit our long-term capital plan and reevaluate major projects while ensuring we meet routine capital needs and meet the demands that Covid-19 has placed on ICUs, EDs, and our supply chain.

In closing, we know we are stronger as an enterprise. And we know we must be resilient. We must continue to put patients first. We must address what the demographics of this disease reveals. We must address the persistent and pernicious inequality in this country. And, we must take great care of our health care workers. We must help them grieve, heal, and finally celebrate their individual and collective heroism. This must be a very measured restart.

Executive Vice President and Chief Operating Officer, NewYork-Presbyterian "

MD President and Chief Executive Officer, NewYork-Presbyterian Disclosures: Laura L. Forese and Steven J. Corwin have nothing to disclose