Abstract
BackgroundHospital systems have rapidly adapted to manage the influx of patients with COVID-19 and hospitalists, specialists in inpatient care, have been at the forefront of this response, rapidly adapting to serve the ever-changing needs of the community and hospital system. Institutional leaders, including clinical care team members and administrators, deployed many different strategies (i.e. adaptations) to manage the influx of patients. While many different strategies were utilized in hospitals across the United States, it is unclear how frontline care teams experienced these strategies and multifaceted changes. As these surge adaptations likely directly impact clinical care teams, we aimed to understand the perceptions and impact of these clinical care and staffing adaptations on hospitalists and care team members in order to optimize future surge plans.MethodsQualitative, semi-structured interviews and focus groups with hospitalist physicians, advanced practice providers (APPs), and hospital nursing and care management staff at a quaternary academic medical center. Interviews focused on the impact of COVID-19 surge practices on the following areas: (1) the experience of clinical care teams with the adaptations used to manage the surge (2) the perception and experience with the communication strategies utilized (3) the personal experience with the adaptations (i.e. how they impacted the individual) and (4) if participants had recommendations on strategies for future surges. We utilized rapid qualitative analysis methods to explore themes and subthemes.ResultsWe conducted five focus groups and 21 interviews. Three themes emerged from the work including (1) dynamic clinical experience with a lot of uncertainty, (2) the importance of visible leadership with a focus on sense-making, and (3) the significant emotional toll on care team members. Subthemes included sufficient workforce, role delineation and training, information sharing, the unique dichotomy between the need for flexibility and the need for structure, the importance of communication, and the emotional toll not only on the provider but their families. Several recommendations came from this work.ConclusionsCOVID-19 surge practices have had direct impact on hospitalists and care team members. Several tactics were identified to help mitigate the many negative effects of COVID-19 on frontline hospitalist providers and care teams.
Highlights
Hospital systems have rapidly adapted to manage the influx of patients with COVID-19 and hospitalists, specialists in inpatient care, have been at the forefront of this response, rapidly adapting to serve the ever-changing needs of the community and hospital system
While previous disaster planning efforts have focused on large-scale disasters [5], the COVID-19 pandemic represents a longer-term challenge with intermittent but large fluctuations in patients with COVID-19 [1]
We recruited providers and care team members including hospitalist physicians, advanced practice providers (APPs), social workers, case managers, and nurses as many of the adaptations deployed by our hospitalist team had wide reaching impact
Summary
Hospital systems have rapidly adapted to manage the influx of patients with COVID-19 and hospitalists, specialists in inpatient care, have been at the forefront of this response, rapidly adapting to serve the ever-changing needs of the community and hospital system. Examples of the adaptations included hospitalist providers (physicians and advanced practice providers such as physician assistants and nurse practitioners) increasingly caring for critically ill patients, outpatient providers moving from the outpatient setting to the inpatient clinical setting to help manage the large influx of patients, and streamlining of communication strategies in response to the sheer quantity and dynamism of the situation. One early example during the pandemic was that patients who needed ongoing rehabilitation care did not have facilities that they could go to because of the highly infectious nature of COVID-19 and the lack of information at the time around safety of transferring patients to these types of facilities These are just a few examples of how frontline care teams were impacted
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