Lessons Learned from COVID-19: Specialization, Negative Air Flow, Community Education and Staff Support Key to Success
By Allison Scherer, Chair, CHEF Communications Committee
The song “Here Comes the Sun” by the Beatles has a deeper meaning at the NorthShore University HealthSystem’s Glenbrook Hospital in Chicago’s northern suburbs. When hospital staff hears the uplifting lyrics over the public address system, they know a COVID-19 patient is being successfully discharged from the hospital. This simple, unobtrusive notification method celebrates success and is one of many tactics Jesse Peterson Hall, president at the Glenview, Ill., hospital and his team use to support staff morale during the pandemic. Mr. Hall presented at the August 21 CHEF C-Suite Virtual Lunch Hour event sponsored by SCP Health, a leader in clinical practice management.
NorthShore University HealthSystem decided to consolidate COVID-19 patient care at Glenbrook Hospital as part of its overall plan to specialize care within its five-hospital system. Glenbrook Hospital also has the ability to change its airflow to use entirely outside air instead of its normal use of 20 percent outside air and 80 percent recirculated air. This prevents the spread of the virus through the ventilation system. The hospital successfully managed this negative pressure environment during the heat of summer and is working on plans to handle the bitter cold of winter. The emergency room became an extension of the 21-bed intensive care unit and has the ability to scale up to 60 beds in discreet compartments.
Seventy-five percent of the more than 800 COVID-19 patients treated at the hospital from March to mid-August were discharged home or to a community nursing facility. The hospital treated 155 COVID-19 patients at the peak during the first week in May. (Thirty additional patients were being treated for COVID-19 at Evanston Hospital that week. Most also were OB and Psych patients.)
As the number of COVID-19 patients began diminishing in June, the hospital began a 7-day deep cleaning of the COVID-19 compartments to return them to treating general medical patients. They cleaned four units over four weeks, keeping one unit for COVID-19 patients. On August 21, the hospital was down to 15 COVID-19 patients; 4 in ICU and 11 non-ICU. If the number of COVID-19 patients increases, the hospital can return those units to COVID-19 units.
While specialization created a reliable care process and efficiencies in COVID-19 patient care and conserved personal protective equipment, it also took a toll on staff morale, especially the nursing staff who had never seen that level of disease severity and mortality. To address fatigue and emotional wellbeing, the hospital focused on wellness programs, onsite counseling, and an onsite lounge for breaks. They provided respite therapies such as aromatherapy, acupuncture, massages and Reiki energy healing. Through the Employee Assistance Program, they provided a full range of services, and encouraged staff to go home and rest. The community sent food for the hospital staff and supplemented “thank you” signage near the hospital with signage throughout the community.
The hospital established a COVID-19 section of its intranet site to increase transparency of information regarding number of patients begin treated, testing and policies and procedures. While many non-medical employees worked from home, all administrative staff went into the office every day and on weekends. Instead of driving between hospitals, they conducted system-related meetings via videoconference. This enabled leaders to spend more time with staff within the hospital.
The hospital leaders also dedicated resources to educating the community about preventing spread of the disease, where to go for testing and what they need to know about COVID-19. The hospital had regular contact with community partners in the NorthShore University Health System coverage area, including 300 houses of worship, 50-60 school districts, and the fire departments, police departments and staff of villages and towns.
Heading into fall when COVID-19 and the flu are expected to overlap, Glenbrook Hospital is preparing its playbook for response with resources needed for each of its services based on a variety of scenarios (e.g., a little bit of COVID and a lot of flu, and vice versa). Mr. Hall recommends hospitals develop a thoughtful (but not voluminous) plan with actionable steps and triggers which move their teams down the path of the plan.