Each wave of the COVID-19 pandemic has brought a diverse set of challenges to health care systems everywhere, and this third wave has been no exception. With the rapid spread of the Omicron variant across Massachusetts, the Brigham has faced enormous staffing challenges.
However, this surge has differed from previous ones because most non-COVID-related care continued at pre-surge levels. In addition, due to its highly contagious nature and widespread community infection rates, Omicron has affected more staff than previous variants. In tandem with staffing shortages, an increase in patients with complex medical needs has put additional stress on hospital providers working tirelessly to provide high-quality care around-the-clock.
“In this third wave, we saw a rapid and significant increase in our COVID-19 census, and it became beyond what the Department of Medicine could manage alone due to staffing challenges,” said Mallika Mendu, MD, MBA, executive medical director of Clinical Operations. “But unlike previous surges, where we could leverage staff from other departments to help virtually, with documentation or even stand up additional COVID-19 specific teams, very little was shut down. We’ve been constantly pivoting and developing alternative strategies to support our frontline teams.”
Seeing this predicament, Mendu and the inpatient operations team had an idea. They approached departments outside of the Department of Medicine to discuss whether they could care for COVID-19 patients on their existing teams.
Since the pandemic’s beginning, the Department of Medicine has cared for all primary COVID-19 patients. Primary COVID-19 patients are those admitted to the hospital due to health issues directly caused by COVID-19. Many departments care for secondary COVID-19 patients, who are admitted to the hospital for a reason other than COVID-19, but who test positive for the virus. With this initiative, Mendu and the inpatient operations team identified teams willing to take on primary COVID-19 patients onto their existing teams.
Many departments across the hospital, including the Department of Surgery, Neurology, Neurosurgery, Orthopaedic Surgery and Obstetrics and Gynecology, were more than willing to help.
While eager to assist their colleagues, these health care providers required training and assistance to care for COVID-19 patients outside their typical caseload. Laura Smith, MD, medical director of inpatient operations and a hospitalist in the Division of General Internal Medicine & Primary Care, led educational initiatives for this effort.
“We created structured guidelines that determined which patients were appropriate for which teams and when patients might need to go back to the Department of Medicine should their condition necessitate more advanced medical care,” said Smith. “We also compiled training resources for teams to access virtually, and held training sessions to introduce clinicians to the new process.”
To create space for providers to receive clinical guidance, the Department of Medicine also initiated an enhanced medicine consultation service to support departments caring for primary COVID-19 patients.
Rising to the Occasion
After training and holding numerous meetings with the departments involved to establish workflow, the new process was implemented. By the height of surge, eighteen patients were managed across five departments that had capacity to receive patients. Mendu emphasized that while this number may appear small, other areas supporting this care was immensely helpful to the Department of Medicine when they were at capacity.
This effort did not come without challenges. Many providers were working with primary COVID-19 patients for the first time. Thanks to the help of the consultation team, however, staff adapted quickly to their new line of work.
Jamie Maguire, MD, a physician in the Division of Infectious Disease, acted as a consultant to the orthopaedic surgery team, providing COVID-19 expertise as needed.
“This team stepped into a new role and rose to the occasion with eagerness and enthusiasm,” said Maguire. “And I think that speaks to how bright, hardworking and highly motivated these physicians are.”
Moving Out of the Comfort Zone
Care teams met twice a day to review patient plans and connect with consultation services throughout this process. Internal medicine consultants fielded clinical questions and reviewed cases for these providers, ensuring that all patients received the best care possible.
Several providers on the frontlines of these efforts reflected on their colleagues’ enthusiasm to participate in this difficult yet impactful endeavor.
“Everyone was so willing to move out of their comfort zone to help our colleagues in internal medicine, which was amazing to see,” said Matthew O’Connor, a physician assistant in the Department of Neurosurgery. “Considering that we’re from surgical services and are not used to treating primary COVID patients, I was impressed by everyone’s wiliness to dive in, learn and do all they could to help.”
James Kang, MD, chair of the Department of Orthopaedic Surgery, spoke to how proud he was of his team for stepping up to this challenge.
“This was a valuable learning experience for all of us,” said Kang. “I’m proud of my team’s efforts to support one another and our patients.”
Several residents also expressed how beneficial this experience was to their medical training.
“It was a privilege to be asked to work alongside the medicine teams in caring for the COVID-19 patients during this surge,” said Harry Lightsey, MD; Brendan Striano, MD; and Michael Gustin, MD. “We could not be more thankful for the support of our talented team, including our orthopaedic attendings, the medicine liaison staff and, in particular, Dr. Jamie Maguire. “This collaborative effort instilled the confidence in us to safely and effectively take care of these patients.”
While the Brigham has since discontinued this effort due to a decline in COVID-19 cases, Mendu and her colleagues recognize this initiative’s positive impact on the Brigham community and the care Brigham patients received.
“I want to thank everyone for their flexibility, trust and support for each other and the hospital,” said Mendu. “This effort exemplifies the very best of who we are at the Brigham and that we truly are stronger together.”