Estimated read time: 5 minutes
As COVID-19 spreads across New York City and northern New Jersey, unprecedented numbers of patients are seeking care at St. Joseph’s Health in Paterson, New Jersey.
In this Q&A, Linda Reed, RN, FCHIME, LCHIME, vice president, information technology and chief information officer, St. Joseph’s Health, shares how her organization is adapting to care for a growing volume of patients testing positive for COVID-19, and what other health systems can do as they prepare for the increase in cases to affect their own communities.
Q: What is the current state of the pandemic at St. Joseph’s Health?
A: St. Joseph’s Health is a mission hospital system sponsored by the Sisters of Charity of Saint Elizabeth. We serve patients in northern New Jersey, just outside New York City. Like many other providers in our region, we have seen a very large surge in patients testing positive for COVID-19. As of April 3, the five counties surrounding Paterson have more than 11,600 confirmed cases, with more than 29,000 across the state. We are working hard to ensure we have sufficient medical equipment — including ventilators and protective equipment — to support care delivery. COVID-19 has impacted us personally, with our own director of emergency preparedness now on the road to recovery from this terrible illness after time in the ICU. Several other members of our own clinical team are currently in quarantine.
"We have tents outside both of our EDs, equipped from an IT perspective with workstations, connectivity and prescription printers. We’re performing a significant volume of the screening and swabbing in these tents in an effort to offload the more limited space available in our EDs." - Linda Reed
Q: How are you handling the patient surge?
A: A big issue early on was the delay in getting test results. Some results took almost five days to get back. St. Joseph’s Health was one of the first organizations in New Jersey to get Becton Dickinson’s new test, which allowed us to perform testing in-house and get results back in 45 minutes to an hour.
One of our big challenges now is moving outside normal nursing units. We’ve opened new COVID-19 units in our same-day surgery center and interventional radiology area. We’re working to offer a substantial number of additional acute beds at the former Barnert Hospital, which closed in 2008.
Our emergency department (ED) is a major focus. Under normal circumstances, we operate the nation’s third-busiest ED, and the surge of COVID-19 patients has greatly added to this level of activity. We’re thinking about the large volume of patients waiting for testing and care, and how we can keep them safe. Like many other hospitals around us, we have to manage a significant number of patients who are admitted and waiting for beds. We are caring for patients in holding, waiting on space and pending tests.
We have tents outside both of our EDs, equipped from an IT perspective with workstations, connectivity and prescription printers. We’re performing a significant volume of the screening and swabbing in these tents in an effort to offload the more limited space available in our EDs.
Everybody is working hard and getting creative to secure supplies.
"We got scheduled and on-demand telehealth (video visits) live in less than a week. Now, we’re working with our clinicians and patients to drive adoption. There’s been a lot of communication from our clinical leadership, getting the message out to doctors and promoting adoption." -Linda Reed
Q: How are you helping limit staff and patient exposure to the virus?
A: We can’t thank Cerner enough — we got scheduled and on-demand telehealth (video visits) live in less than a week. Now, we’re working with our clinicians and patients to drive adoption. There’s been a lot of communication from our clinical leadership, getting the message out to doctors and promoting adoption.
In addition, our doctors and nurses are trying to limit the number of times they go into a patient room, leveraging the use of technology like iPads to facilitate communication between care providers and our patients.
Q: With things changing so rapidly, how are you keeping up?
A: We set up a command center in early March when our patient volumes started to grow. Our Command Center includes different members of our executive team, spanning directors, vice presidents and other leadership. They act as our “air traffic control” team, with lines of communication to teams spanning our entire health care system. The Command Center team reviews comprehensive reporting focused on COVID-19 patient volumes and testing, which we’ve worked with Cerner to develop. We get daily updates on supplies and what we’ve been able to source. We troubleshoot any issues that come in and report what’s going on to the rest of the health system.
Q: What kind of reporting are you doing?
A: Reporting has been one of our biggest challenges. We initially kept manual statistics, which required a significant amount of work to build, validate and maintain. I have to thank the folks at Cerner because they’ve been helping us rapidly develop new reports tracking everything we need.
We’re focused on how many people we’ve tested and whether the results are back. We’re watching pending results too because those tell us where our capacity is going to flex in the coming days. We’re looking at patients’ diagnosis codes, in addition, to test numbers, because some patients aren’t being tested, but instead are initially diagnosed based on symptoms and other results apart from labs.
Our reports track COVID-19 patients’ demographic and encounter information, including age, sex, home state and ZIP code, current location, and the status of their encounters and orders, including the status of a ventilator order, if one is in place.
We’re also keeping a record of which providers have been in contact with COVID-19-positive patients, including what kind of service was provided and when.
Q: What advice would you share with other health systems preparing for a COVID-19 surge?
A: Start now. Establish your command center and get automated reporting in place so you don’t have to start with manual reports. Know how your patient testing process is going to work.
Also, look at what others are doing and anticipate new equipment and staffing needs. We put together a new labor pool — a spreadsheet filled out every day to show whether each department has people available to flex to other areas. Take inventory of your staff and determine whether they can work in other areas because, invariably, somebody’s going to get sick and you’re going to need people to fill in.
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