Planning has been underway at the Brigham since the summer to ensure that we are prepared to respond to a second surge. In this new series, we will provide insights into our plans in a question-and-answer format. This week’s focus is inpatient planning and preparedness.

Over the last three months, teams across Mass General Brigham (MGB) and the Brigham have been planning to ensure we can effectively and safely care for patients during a surge. Plans address how we will adjust our operations when patient levels reach 25 percent, 50 percent or 100 percent of our peak patient level during the initial surge, which reached 197 inpatients at the Brigham.

This week, Kathryn Britton, MD, MPH, associate chief medical officer and vice president of Medical Affairs, Maddy Pearson, DNP, RN, NEA-BC, chief nursing officer and senior vice president of Clinical Services, and Tom Walsh, vice president of Analytics, Planning, Strategy and Improvement, share details about our inpatient care plans.

What are you anticipating will be the key challenges for our inpatient care teams if we get a second surge?

From left: Kathryn Britton, Maddy Pearson and Tom Walsh

Pearson: Let me start by saying that a second surge will be different from the first in a few key ways. We understand more about the virus now, and we’re planning to keep our operating rooms, procedural areas and ambulatory clinics open unless we have to close them by government mandate. So, challenge number one will be balancing the needs of our COVID and non-COVID patients while ensuring safety for everyone in our community.

Britton: In addition to supporting our COVID and non-COVID patients, as Maddy highlighted, supporting the wellness of our caregivers and other staff is our highest priority. Given how the surge is progressing, we believe we’ll have fewer COVID patients in the ICU than during the prior surge. But at high COVID census levels, we’ll be challenged to ensure we have sufficient staff in a few key areas.

What are the key lessons we learned during the initial surge that have influenced our planning for a second surge?

Walsh: Our key lessons were about the virus itself and the resources and behaviors that are critical to safely and effectively care for our patients. From an infection control perspective, we have a better understanding of the virus now. We know which supplies are critical and what additional safety measures are needed. We understand how important masking and eye protection, hand hygiene and distancing are for us to keep our environment safe. We can predict where we might see staffing challenges, and we’re able to better understand what our patients are experiencing and how we can help them. Our plan reflects all these learnings.

What is most important for Brigham staff to know about the second surge plan for inpatients?

Pearson: We have developed detailed plans for all levels of a potential second COVID surge with input and help from many of our colleagues throughout the organization. Our plans address all aspects of how we would respond, from where patients would be cared for and how we would care for them.

Britton: To ensure we can provide the best care for our patients wherever they are, we have proactively increased our staffing levels (where possible) and will refine our models to ensure we can adapt our staffing appropriately as our needs evolve. At the same time, our staffing plan strives to better balance patient care needs with provider wellness and our educational mission.

Walsh: And, of course, we are partnering with colleagues across MGB to ensure our system has a coordinated response to meeting the needs of patients who require ICU care.