New York hospital execs reflect on lessons learned

COVID-19 could dent hospital revenue by at least $53 billion in 2021, AHA says

Monday marked a full year since the city saw its first Covid-19 case. In the first weeks of the pandemic, health systems experienced a scramble to respond and streamline efforts. Today the city has seemingly turned a corner, working its way toward a robust vaccination push, and local health facilities have updated their playbooks for handling future crises.
The first confirmed positive Covid-19 case was a 39-year-old Manhattan woman who had traveled to Iran. The state kicked off a testing drive and was able to conduct up to 1,000 tests per day in the spring. By July the city had a capacity of processing about 50,000 tests per day, and it opened a dedicated laboratory in September that added an additional 20,000.
March and April were the most challenging and caught the entire health system off-guard, said Dr. Mitchell Katz, president and CEO of NYC Health + Hospitals, the city’s public health system. “But the city had done very well considering it didn’t have much of the necessary resources,” he said.
There was an initial rush to procure personal protective equipment, staffing and various medical equipment, such as ventilators. It was reported that the state could have a shortfall of more than 15,000 ventilators during the height of the pandemic.
“If there’s one thing for hospital managers to learn from this pandemic, it’s that we can’t always run hospitals the way many of us were taught,” Katz said. That means not buying supplies and equipment to just meet the needs of previous usage levels but to build caches, he said. “We are now maintaining large supplies of protective equipment and critical medication.” 
Managing internal patient and staffing flow was a challenge, said Dr. William Southern, division chief of hospital medicine at Montefiore Medical Center. For example, many providers were brought on from various specialties to tackle the first wave, but communicating the right protocols to them was complicated, he said.
Many health systems soon got a handle on their internal systems, but perhaps they could have done better communicating with each other too, said Dr. Fritz Francois, chief medical officer and patient safety officer at NYU Langone Medical Center.
“Today, a year later, our system has evolved so that patient movement and staff allocation can be performed seamlessly,” Southern said, noting that Montefiore has a daily reporting system between hospitals. NYU Langone has implemented a real-time dashboard that can be adapted for future crises, saving hours of information gathering, Francois said.
Health systems’ ability to surge their capacity and their personnel’s adaptability were key to handling each wave of cases, Katz said. However, looking back at some of the field hospital sites, including the Javits Center and the USNS Comfort, they were well intended but difficult to utilize, he said.
The Javits Center set up over 2,500 beds March 26, and the USNS Comfort, which arrived in the city March 30, had a configuration of 500 beds. The Javits Center site closed May 1, and the hospital ship left April 30. The two sites were reported to have treated about 1,100 and 182 patients, respectively.
“It was a right decision at the time, as projections had shown the city was bound for even higher numbers,” Katz said of setting up the sites. “However, a convention center is not a hospital.” The Javits Center couldn’t take in the very sick—the segment hospitals needed help with most—as it didn’t have the oxygen, medication or equipment to take in those patients. Moving the armed forces who assisted with the site to the city’s hospitals probably helped more as their skills were put to better use, he added.
Local academic institutions also forged ahead with studies and clinical trials that became guidance and protocols for the rest of the nation. Contributions included Montefiore’s work in steroid treatment and monoclonal antibodies, NYU Langone’s involvement with the vaccines and Mount Sinai’s work with plasma-related treatments.
With Johnson & Johnson’s vaccine granted emergency-use authorization last weekend, there is light at the end of the tunnel; three vaccines are now available. However, there will be health care workers who remain hesitant to accept them, and it is critical to listen to their concerns, hospital officials say.
“What we’re hearing are questions about how it was possible to develop the vaccine so quickly, and people are concerned about the process,” Francois said. 
Southern and Katz noted similar sentiments from workers in their health systems. 
“People will come around, and until then it’s about having open conversations with them,” Katz said.

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