Even as hospitals continue to deal with staffing issues, visitor restrictions and safety protocols required for treating COVID-19 patients, leaders are planning for the future with lessons learned during the pandemic.
Staff training, infection control measures, outpatient treatment options and regional collaborations are among the areas where long-term changes are expected.
“There are some things that we have learned through this, operationally, that are positive and will help other conditions or scenarios,” said Andrew Rush, president of UPMC Somerset.
The chief medical officer at Conemaugh Health System said mitigation efforts limiting direct access to hospitals and doctors’ offices demonstrated the value of telemedicine, sometimes called telehealth.
“I don’t think there’s any question that’s going to be a long-term change that was facilitated by the pandemic,” Dr. Elizabeth Dunmore said. “There is so much that can be done very well over a televisit.”
The Oxford Language definition of telemedicine is “the remote diagnosis and treatment of patients by means of telecommunications technology.” Over the past 11 months, doctors have increasingly relied on the growing resource by holding televisits with examinations using smartphones.
Advancing technology includes apps that check pulses, blood oxygen levels and more vital signs. Hospitals also use telemedicine to connect to specialists in larger institutions, using telemetry to share critical health information.
For example, Conemaugh Health System and UPMC have telestroke programs that allow patients exhibiting symptoms of stroke in rural hospital emergency rooms to be examined in collaboration with experts in Johnstown or Pittsburgh.
“We’ve seen how well telehealth can work in a broader application,” said William Caldwell, Conemaugh Health System market president and Conemaugh Memorial Medical Center CEO. “Most of the patient feedback is pretty positive. There is an ongoing place – expanded place for telehealth.”
Dunmore noted that there are fewer no-shows for televisits.
Bringing experts to local hospitals, virtually
In addition to its telestroke network, UPMC is expanding telehealth options for kidney disease and intensive care patients, Rush said from UPMC Somerset.
“We have expanded telenephrology and our tele-ICU, connected to Pittsburgh, which has been remarkable during COVID,” Rush said. “It provided our doctors with so much assistance with treating those patients, managing those patients, and not only COVID, but other seriously ill patients.”
The system is working on telemedicine networks in more specialties, connecting its 40 hospitals, Rush said.
For rural areas, UPMC Somerset Home Health is bringing more technology into patients’ homes.
“We are going to be enhancing our telemonitoring with home health,” Rush said. “A lot of patients are home-bound, or they need frequent visits. The home health nurse is going in, settting up an iPad and having that visit right there with a physician.
“It’s going to be instrumental in readmissions and just overall quality of care for that patient, who may or may not have transportation available.”
24-hour monitoring for at-home patients
A new program through Chan Soon-Shiong Medical Center at Windber takes in-home telemonitoring another step with around-the-clock monitoring of chronically ill patients with telemetry, hospital President and CEO Tom Kurtz said.
The remote palliative care program was launched in January 2020 with about 10 patients who had long-term, serious illnesses, but who were not at the level of hospice care. The goal is to increase the program’s capacity to 25 patients.
It was developed as a demonstration project through Windber’s participation in the Pennsylvania Rural Health Model program, which is itself a demonstration project for the Center for Medicare and Medicaid Innovation. One of the Rural Health Model’s goals is to provide care in a way that reduces inpatient stays, Kurtz said.
“These people can be monitored in their homes with the same sophistication as they can in a hospital bed,” he said, adding that many patients admitted to hospitals remain longer so they can be monitored. He envisions expanding the telemetry monitoring to nursing homes, reducing the number of hospital admissions from those facilities.
“I think that’s going to be the answer to this whole thing once the dust settles,” Kurtz said.
Windber’s chief medical officer said the in-home monitoring not only reduces hospital admissions, saving money, but also can be better health care.
“When a patient can be cared for at home, that is really what is best for the patient and the family,” Dr. David Csikos said. “Elderly patients may deteriorate mentally in a hospital setting.”
Honing and refreshing skills for clinical staff
Expanding telemedicine was not the only adjustment local hospitals made to improve care in the past year.
The November and December peak in COVID-19 cases not only brought a tsunami of admissions, but also sent hospital staff members home to quarantine after testing positive or having potential exposure to ill patients, Caldwell said.
“We had to use clinical staff that hadn’t been in patient-facing roles – maybe informatics or case management,” he said. “So we did some things in terms of rapid-skills-competency refresher training. That’s one thing I think we will probably try to hardwire, just to give us a little bit more flexibility in terms of meeting spikes in patient demand in the future.”
Although it doesn’t take much to refresh skills after a year or two away from the bedside, Caldwell said working with patients a few times a year provides other benefits.
“I think it does keep you grounded in, ultimately, why we are here,” he said, “and that’s to take care of patients, the community and their families.”
Safety measures intensify with COVID-19 precautions
Sanitation has been ingrained with hospital culture for decades, but COVID-19 precautions brought it to new levels, Rush said.
“We have all learned that there are some safety precautions and infection control things that are going to stay, such as frequency of cleaning,” Rush said. “We have enhanced procedures in every department with our cleaning. I think all those will continue.”
With hospitals and their ICUs frequently near capacity and new treatment information coming out almost daily, hospitals throughout the region put aside differences and joined together against the virus.
Kurtz would like to see that spirit of cooperation continue after the worst of COVID-19 is in the over.
“It was nice to see the competitive veil lifted,” he said. “We knew we were all in this together. It was a good spirit.”