Hospitals Adapt to the New COVID-19 Workflow
With COVID-19 forcing hospitals to rethink their procedures, they are developing new tools and methods to increase capacity and keep everyone safe – from the moment a patient arrives in the emergency room until post-discharge.
Hospitals are reinventing their workflows in critical areas:
- Triage outside of the hospital
- Telehealth using remote services
- Quarantining the infected to protect staff
- Rapid redeployment of equipment and technology
Remote Triage – Traditional triage occurs in the waiting area of the emergency department. Triage nurses ask questions, take vitals, and assign priority levels. With COVID-19, the triage process is changing to begin remotely – before the patient leaves home. Clinicians can now consult with patients via telemedicine to determine whether they need to come to the ER, or whether it’s safer to remain at home. Some hospitals have set up assessment tents in the hospital parking lot or the garage to allow for social distancing. COVID-19 testing also involves drive-through tents.
One Boston pediatric hospital set up an iPad on a four-legged robotic to allow staffers to evaluate young patients from a protected distance or even from a triage tent exterior.
Whether triage takes place in a tent, in the ER, or with a four-legged iPad, a battery-powered mobile EHR workstation makes triage documentation more efficient and flexible as hospital layouts and processes change.
Telehealth – “Remote rounds” have also emerged from COVID-19. In-room cameras and mobile telehealth carts allow care providers and loved ones to remain outside the room. Other members of the team can engage remotely for follow-up visits after a procedure. Virtual rounds reduce PPE use and help COVID-19 patients feel less isolated.
Enovate has developed telehealth mobile workstations to meet the growing demand for remote consultation. Both the Encore and Envoy EHR workstations have been outfitted with high-resolution PTZ cameras and diagnostic peripherals giving remote access for highly specialized physicians. A streamlined Encore Lite is also available for tablet-based video conferencing – for example, in primary care settings, frontline triage, and school clinics.
Redeployment of Resources
When the coronavirus hit New York City in March, Governor Cuomo ordered hospitals to increase capacity by 50%. When hospital executives asked where they would get staffing, beds, and protective gear to meet the demand, state officials told them to “do your best.”1 While most people remember the Jacob Javits Center in New York City converting into a 2,000-bed hospital, they may not realize that nearly every hospital had to reallocate beds and spaces.
Hospitals find ways to increase capacity. For example, endoscopy, catheterization, and other labs have the infrastructure to become intensive care units. Whether the hospital is converting a single suite or repurposing an entire building, the ability to reallocate and track resources is critical.
In 2012, when the Rush University Medical Center in Chicago built a new tower, they had the foresight to design spaces that could convert into negative-pressure wards to treat airborne diseases. Within hours, the hospital could increase its isolation-room capacity from 40 to 100. Rush also installed medical infrastructure into the pillars of its main lobby to handle a massive patient surge. In April, the lobby was converted to clinical use when it was redeployed to treat non-COVID patients.
Recently, the Cleveland Clinic converted its Health Education Campus (Case Western Reserve University) into a 1,000-bed surge hospital. This redeployment created 327 patient beds for low-severity COVID-19 patients. The Clinic has the option to return the space to educational use while keeping the medical infrastructure in place for another surge. The hospital can convert other areas, such as its recovery area, to serve as a temporary ICU.
In each instance, increasing capacity requires a quick redeployment of technology and clinical resources to adapt to change. Enovate’s MobiusPower PLUS helps hospitals manage quick deployments. Nurses can move their workstation to a new location without the need to reboot or park, plug, and wait for a recharge.
Protecting Staff – Hospitals are also leveraging technology to minimize bodily contact with patients. Today, robots are assisting with disinfection, and staff clinicians are distancing with video tools.
The Cleveland Clinic now uses virtual rounds where one doctor remains in the room while others connect via videoconference remotely. In the ICU, instead of positioning IV poles and patient monitors at the bedside, they are now placed outside the room to limit unnecessary exposure.
Enovate’s telehealth workstations allow hospitals to reduce opportunities for infectious exposure.
Flexible allocation is the new normal – In the pandemic era, hospitals need to reallocate resources with plug-and-play speed. Mobile workstations need to be remotely onboarded, tracked and maintained through a cloud-based management solution. Enovate’s Rhythm Mobile Device Management brings real-time visibility to large fleets of EHR workstations without straining the resources of the IT staff. RTLS location services, Uptime Ready Replacements™ workstations, and remote diagnostics make it easier to get the most out of limited resources and staff. What’s more, single sign-on and one-touch ergonomics allow nurses to grab a workstation and have it quickly become a personalized machine.
“A pandemic tests your ability to pivot,” says Kevin Bridges, Enovate’s VP of Marketing and Business Development. “We developed many of these solutions to control costs, but COVID-19 has revealed how they can be used to make clinical processes and workflows safer in the pandemic era.”
- Laura Landro, “Rethinking the Hospital for the Next Pandemic,” Wall Street Journal, June 8, 2020