While hospitals continue to grapple with staffing issues, visitor restrictions, and safety protocols required to treat COVID-19 patients, those responsible are planning for the future with the lessons learned during the pandemic.
Staff training, infection control measures, outpatient treatment options and regional cooperation are some of the areas in which long-term changes can be expected.
“There are some things that we have learned operationally that are positive and that help other conditions or scenarios,” said Andrew Rush, President of UPMC Somerset.
Conemaugh Health System’s chief medical officer said mitigation efforts that limit direct access to hospitals and doctor’s offices demonstrate the value of telemedicine, sometimes referred to as telemedicine.
“I don’t think there is a question that will be a long-term change that has been facilitated by the pandemic,” said Dr. Elizabeth Dunmore. “There is so much that can be done very well on a television.”
The definition of telemedicine in the Oxford language is “remote diagnosis and treatment of patients using telecommunications technology”. Over the past 11 months, doctors have increasingly relied on the growing resource by performing television exams with exams using smartphones.
The advanced technology includes apps that check pulses, blood oxygen levels and other vital signs. Hospitals also use telemedicine to connect with specialists in larger facilities and use telemetry to share vital health information.
For example, Conemaugh Health System and UPMC have Telestroke programs that allow patients with stroke symptoms to be screened in rural hospital emergency rooms in collaboration with experts in Johnstown or Pittsburgh.
“We saw how well telemedicine can work in a wider application,” said William Caldwell, market president of Conemaugh Health System and CEO of Conemaugh Memorial Medical Center. “Most of the patient feedback is pretty positive. There’s an ongoing place – an expanded place for telemedicine. “
Dunmore noted that there are fewer no-shows for television visits.
Virtually bring experts to local hospitals
In addition to its telestroke network, UPMC is expanding telemedicine options for kidney disease and critical care patients, said UPMC Somerset’s Rush.
“We’ve expanded telenephrology and our Pittsburgh-connected tele-intensive care unit, which was remarkable during the COVID,” said Rush. “It has given our doctors so much support in treating these patients, treating these patients, and not just COVID but other critically ill patients as well.”
The system works on telemedicine networks in more specialties and connects its 40 hospitals, Rush said.
For rural areas, UPMC Somerset Home Health is bringing more technology to patients’ homes.
“We’re going to improve our telemonitoring with home health,” said Rush. “Many patients are at home or need frequent visits. The home nurse goes in, sets up an iPad, and has that visit with a doctor right there.
“It will be critical to readmission and the overall quality of care for the patient, who may or may not have transportation.”
24-hour monitoring for patients at home
A new program through Chan Soon-Shiong Medical Center in Windber is telemonitoring at home and using telemetry to monitor chronically ill patients around the clock, said hospital president and CEO Tom Kurtz.
The remote palliative care program was launched in January 2020 with around 10 patients who had long-term, serious illnesses but were not at the level of hospice care. The aim is to increase the capacity of the program 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 goals of the rural health model is to design care in such a way that inpatient stays are reduced, said Kurtz.
“These people can be monitored in their homes with the same sophistication as in a hospital bed,” he said, adding that many patients who are admitted to hospitals stay longer so that they can be monitored. He intends to expand telemetry surveillance to nursing homes and reduce the number of hospital admissions from these facilities.
“I think that will be the answer to this whole thing once the dust settles,” said Kurtz.
Windber’s chief medical officer said home monitoring not only reduces hospital admissions and saves money, but it can also enable better health care.
“If a patient can be cared for at home, it really is best for the patient and the family,” said Dr. David Csikos. “Elderly patients can deteriorate mentally in a hospital.”
Honing and refreshing skills for clinical staff
The expansion of telemedicine wasn’t the only adjustment local hospitals made over the past year to improve care.
The November and December peak in COVID-19 cases not only brought a tsunami of admissions but also quarantined hospital workers after a positive test or possible exposure to sick patients, Caldwell said.
“We had to use clinical staff who hadn’t played a role as a patient – maybe computer science or case management,” he said. “So we’ve done a few things about quick skills and competency refresher training. That’s one thing I think we’ll probably try hard-wired just to give ourselves a bit more flexibility to meet increasing patient demands in the future. “
While it doesn’t take much to brush up on skills after a year or two out of bed, working with patients a few times a year offers other benefits.
“I think it ultimately keeps you grounded as to why we are here,” he said, “and that is to take care of patients, the community and their families.”
The security measures are reinforced by the precautionary measures of COVID-19
Sanitation has been anchored in hospital culture for decades, but COVID-19 precautions have taken it to a new level, Rush said.
“We’ve all learned that some safety precautions and infection control things remain in place, such as the frequency of cleaning,” Rush said. “With our cleaning we have improved the procedures in every department. I think all of this will continue. “
With hospitals and their intensive care units often at full capacity, with new treatment information being released almost daily, hospitals across the region have put aside differences and banded together against the virus.
Kurtz would love to see the spirit of collaboration continue after the worst of COVID-19 is over.
“It was nice to see the competition veil lifted,” he said. “We knew we were all there together. It was a good spirit. “