COVID-19: Q&A on what providers should consider in the weeks ahead

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March 06, 2020

As providers try to prepare for potential cases of COVID-19, HRI talked with PwC Strategy& principal Igor Belokrinitsky and directors Dr. Grace Shao and Siddharth Doshi about what hospitals and health systems should consider in the weeks ahead. [Note, this information was last edited on March 6, 2020.]

PwC Health Research Institute (HRI):

What is the first thing providers should be thinking about?

Igor Belokrinitsky, Principal, PwC Strategy&

If I’m a hospital administrator right now, I’d be worried I’m going to get a case and we know the people who are most susceptible and most at risk are older people and people with comorbidities, which are my other patients.

The risk is not just the case I’m going to get, but also the risk to the rest of my patients, so I need to have the protocols in place, I need to have the checklist in place, I need to have the space designated and I need to be drilling every day on my process for when I get a case.

Dr. Grace Shao, Director, PwC Strategy&

We see similar practices in China, and one really useful tactic is to centralize those cases into certain facilities.

It’s difficult for health systems with multiple hospitals to implement these new processes and train staff at all the different locations. You want to train your front-gate staff, in the ER and in the clinics, to see these patients. Then you want to isolate the patients after they’re diagnosed and send them to a centralized place rather than keeping them at various facilities.

Siddharth Doshi, Director, PwC Strategy&

If you think of the hospital’s standing in the community, having a centralized unit and being able to communicate that may help signify that things are under control and the hospital has a plan.

It may also help to maintain the patient flow to other sites, putting up clear signage and helping address association risk where the community could associate the whole hospital with being infected or under quarantine.

The communication aspect to the staff, to the community and patients, and to the public health authorities makes it pretty vital to have dedicated resources and training as quickly as possible to ensure the flow of communication and the right messages.

HRI: How should hospitals and health systems approach planning with so much unknown about how many cases to anticipate?

Dr. Grace Shao: It would be helpful to prepare space and equipment to ratio. Based on the latest statistics and projections, if I get 100 cases, what is the likely case mix? What items do I need to prepare for?

There’s a ratio of drugs, equipment, beds, staff, and you proxy a low and max number. If there is a possibility that it’s going to exceed that, what’s my contingency plan? Where else could I source from to treat the critically ill? To keep my medical staff safe?

In China, in Wuhan and major cities, they stopped most hospital operations for some time just to prevent large flows to the hospitals. So if you have an elective procedure or it’s not serious, do it virtually, don’t come in.

Providers should think about how to reallocate their staff. The staff that are most related are internal medicine, ER, ICU and respiratory—they always run short.

Think about the other staff not treating that much volume who you can train to support others.

Medical staff with critical and intensive care experience are preferred and would be helpful treating severe cases with difficulty breathing and critical cases with respiratory failure, septic shock and/or multiple organ dysfunction or failure.

Preventing your frontline staff from getting sick and getting their families sick is important. What they did in Wuhan is they rented or used entire hotels so the medical staff would go to the hotel instead of going home and they monitored them closely, to prevent infections, but also to prevent infections to their families and friends.

Igor Belokrinitsky: Even having one case can create a sufficiently large disruption that you need to prepare for; even if it is just going to be one case, you need to look at areas of your vulnerability. Are there essential personnel that if that person becomes ill that brings things to a standstill? Are there medications that if your supply is interrupted for a week, because the supply chain has been disrupted, that’s going to bring you to a standstill?

If you do need to triage, and get as many people out of your facility as possible, do you have those triage protocols in place? Even planning for one case will really force you to face some of the areas where you are vulnerable or not sufficiently resilient.

Another thing really important is just triage, triage, triage. You need to drill for it, you can’t just assume or write a plan and put it on the shelf and assume it’s OK.

Siddharth Doshi: You can set up a small crisis team to do a lot of the things we’re talking about in addition to hospital operations, whether it’s people that think through how do you dynamically adjust flow, to resources and funding, to analytics and communications and partnerships. You can have a sole dedicated team that is empowered to allocate resources. 

HRI: How should hospitals and health systems approach planning with so much unknown about how many cases to anticipate?

Dr. Grace Shao: It would be helpful to prepare space and equipment to ratio. Based on the latest statistics and projections, if I get 100 cases, what is the likely case mix? What items do I need to prepare for?

There’s a ratio of drugs, equipment, beds, staff, and you proxy a low and max number. If there is a possibility that it’s going to exceed that, what’s my contingency plan? Where else could I source from to treat the critically ill? To keep my medical staff safe?

In China, in Wuhan and major cities, they stopped most hospital operations for some time just to prevent large flows to the hospitals. So if you have an elective procedure or it’s not serious, do it virtually, don’t come in.

Providers should think about how to reallocate their staff. The staff that are most related are internal medicine, ER, ICU and respiratory -- they always run short.

Think about the other staff not treating that much volume who you can train to support others.

Medical staff with critical and intensive care experience are preferred and would be helpful treating severe cases with difficulty breathing and critical cases with respiratory failure, septic shock and/or multiple organ dysfunction or failure.

Preventing your frontline staff from getting sick and getting their families sick is important. What they do in Wuhan is they rented or used entire hotels so the medical staff would go to the hotel instead of going home and they monitored them closely, to prevent infections, but also to prevent infections to their families and friends.

Igor Belokrinitsky: Even having one case can create a sufficiently large disruption that you need to prepare for; even if it is just going to be one case, you need to look at areas of your vulnerability. Are there essential personnel that if that person becomes ill that brings things to a standstill? Are there medications that if your supply is interrupted for a week, because the supply chain has been disrupted, that’s going to bring you to a standstill?

If you do need to triage, and get as many people out of your facility as possible, do you have those triage protocols in place? Even planning for one case will really force you to face some of the areas where you are vulnerable or not sufficiently resilient.

Another thing really important is just triage, triage, triage. You need to drill for it, you can’t just assume or write a plan and put it on the shelf and assume it’s OK.

Siddharth Doshi: You can set up a small crisis team to do a lot of the things we’re talking about in addition to hospital operations, whether it’s people that think through how do you dynamically adjust flow, to resources and funding, to analytics and communications and partnerships. You can have a sole dedicated team that is empowered to allocate resources. 

HRI: How should hospitals and health systems approach planning with so much unknown about how many cases to anticipate?

Dr. Grace Shao: It would be helpful to prepare space and equipment to ratio. Based on the latest statistics and projections, if I get 100 cases, what is the likely case mix? What items do I need to prepare for?

There’s a ratio of drugs, equipment, beds, staff, and you proxy a low and max number. If there is a possibility that it’s going to exceed that, what’s my contingency plan? Where else could I source from to treat the critically ill? To keep my medical staff safe?

In China, in Wuhan and major cities, they stopped most hospital operations for some time just to prevent large flows to the hospitals. So if you have an elective procedure or it’s not serious, do it virtually, don’t come in.

Providers should think about how to reallocate their staff. The staff that are most related are internal medicine, ER, ICU and respiratory -- they always run short.

Think about the other staff not treating that much volume who you can train to support others.

Medical staff with critical and intensive care experience are preferred and would be helpful treating severe cases with difficulty breathing and critical cases with respiratory failure, septic shock and/or multiple organ dysfunction or failure.

Preventing your frontline staff from getting sick and getting their families sick is important. What they do in Wuhan is they rented or used entire hotels so the medical staff would go to the hotel instead of going home and they monitored them closely, to prevent infections, but also to prevent infections to their families and friends.

Igor Belokrinitsky: Even having one case can create a sufficiently large disruption that you need to prepare for; even if it is just going to be one case, you need to look at areas of your vulnerability. Are there essential personnel that if that person becomes ill that brings things to a standstill? Are there medications that if your supply is interrupted for a week, because the supply chain has been disrupted, that’s going to bring you to a standstill?

If you do need to triage, and get as many people out of your facility as possible, do you have those triage protocols in place? Even planning for one case will really force you to face some of the areas where you are vulnerable or not sufficiently resilient.

Another thing really important is just triage, triage, triage. You need to drill for it, you can’t just assume or write a plan and put it on the shelf and assume it’s OK.

Siddharth Doshi: You can set up a small crisis team to do a lot of the things we’re talking about in addition to hospital operations, whether it’s people that think through how do you dynamically adjust flow, to resources and funding, to analytics and communications and partnerships. You can have a sole dedicated team that is empowered to allocate resources. 

Another thing really important is just triage, triage, triage. You need to drill for it, you can’t just assume or write a plan and put it on the shelf and assume it’s OK.

HRI: Today, we see retail health clinics and urgent care centers on nearly every corner. We also have virtual health and telehealth. Are these additional access points helpful in responding to a potential epidemic/pandemic?

Igor Belokrinitsky: It doesn’t help directly until we have an easy test, and an easy treatment, which we may never get. What it allows you to do is offload some volume that is not coronavirus-related, so as your facility refocuses and retools on your COVID cases, some of the other volume can be pushed out to other modalities for the time being. You’re going to try to minimize your risk and move as much low-acuity care to those low-acuity settings, particularly digital settings that avoid physical human contact to minimize the risk.

Siddharth Doshi: It’s hard to see an outpatient testing center unless there’s more volume of these tests available or a vaccine. Currently it seems unlikely they will be treated in the outpatient setting, they’ll be treated at home or in the hospital.

The challenge will be if a lot of these retail locations are through partnerships, do you have the right resources in place to manage these partnerships, and do they have the resources in place to manage this? I see these access points more as an opportunity for your business planning versus a threat of some sort.

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Igor Belokrinitsky

Principal, PwC US

Siddharth Doshi

Director, PwC US

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