During the initial wave of the epidemic, most hospitals diverted its resources from routine inpatient critical care to meet the surge in demand. Due to resource constraints and fear of infection, non-urgent visits, evaluations, diagnostics were deferred. Doctors noticed a dramatic drop in health emergencies during the early part of the epidemic.
These postponements may have helped in reducing the load on the hospitals at this point in time but the requirement has been deferred which could strain the hospital resources later.
We must manage these patients also simultaneously with the epidemic affected patients proactively. This is important not only to sustain life and health but to preserve future hospital capacity. Drawing upon principles of operation management, the following four strategies can be considered to treat normal patients even as hospitals are stretched to cater to epidemic patients.
Innovate outpatient management
Outpatient clinicians should expand their proactive management by directing critical patients directly to emergency departments to reduce serious complications later.
many clinicians have adopted some form of telemedicine, they will need to increase their digital engagement with patients in a more targeted fashion. Clinicians should evaluate their patient records and initiate telemedicine visits, rather than wait for patients to initiate contact.
High-risk patients vary by specialty and to facilitate remote monitoring clinicians may send telehealth kits tailored to patient requirements. To effectively use telemedicine, clinicians should promote inter-disciplinary collaboration across technicians, specialists, social workers, and patients.
Combine essential non-COVID inpatient across hospitals
To balance demand across hospitals, health officials should apply location-pooling strategy, combining the demands of multiple locations. rather than providing multiple redundant full suites of services each of these services should be located at one location. this is difficult to do now as hospitals are organized as independent units and compete with one another. But sharing the data across hospitals is required for successful implementation.
Location pooling eliminates variability in service-specific demand faced by each hospital. as demand falls for specific cases they can close those series and repurpose the hospital for another use. Location pooling draws demands from across hospitals, allowing it to maintain sufficient numbers to remain viable.
The centrally coordinated regional organization is necessary to ensure each essential service remains operational while adapting to the region's dynamic capacity.
Group patients with infections by their existing conditions
Hospitals should place patients with infections with other patients of the same condition. In each such wards redeployed clinical staff from relevant specialty service, can provide essential care along with clinicians addressing infection specific treatments.
Discharge patients into post-acute care based on infection status.
Nursing homes, rehabilitation hospitals, etc. should collaborate to set up regional specialized care facilities for Infected and other patients which will facilitate discharge planning, patient flow out of the hospital. This will ease the strain on the hospitals and help them maintain quality.
There are challenges to this model in terms of ensuring timely access to infected patients and rapid testing to guide the patient. Hospitals need to implement rapid tests and facilities should designate quarantine areas while the patient awaits test results.
These ideas will be challenging to implement. But it is time to rethink the health care delivery model and adopt operations management strategies that are most promising. This will help us be better prepared for future infections.
How Hospitals Can Meet the Needs of
Non-COVID Patients During the Pandemic
by Hummy Song, Ghideon Ezaz, S. Ryan Greysen, Scott D. Halpern and Rachel Kohn HBR July 14, 2020
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