The disruption caused by the unprecedented events of the COVID-19 pandemic has impacted lives globally. Healthcare organizations across the nation have been challenged to adapt to changes in the delivery of care and operations, and Onslow Memorial Hospital is no exception. Support for our hospital from UNC Health, other Community Partners, and N.C. State and Federal resources has been unwavering. The safety of our patients, visitors, providers, and staff has and will continue to be at the center of all our actions. As the circumstances surrounding the pandemic rapidly change, a flexible phased recovery plan for a new operational norm is necessary.
The phased recovery plan, consisting of three phases, was developed by an interdisciplinary team of physicians and department leaders and was designed to look at bringing the hospital back to equilibrium. One prominent component concerns Surgical and Outpatient Services. The importance of reopening service lines cannot be overstated. By canceling and postponing the continual flow of patients and services, a massive backlog has occurred. Currently, April 30, 2020, financial reports show that total surgeries are down 86.7 percent (673 cases) for the month as compared to budget. Given that our priority is to be able to provide the best possible care to the community and to be a strong employer in the community, we need to ensure that Onslow is financially strong. As such, all efforts need to be focused on correcting the backlog. Communicating our plan is a key component to reassuring our community that we are ready to serve and take care of their needs, and most importantly ensure their safety, health, and security.
The phased recovery plan consists of a broad approach to hospital operations that considers implications of various changes to the many resources required to bring services live. With triggering metrics monitored daily, we are able to regulate and act quickly in real time, should events dictate such actions. Surgical services have continued to provide emergent and urgent surgeries throughout the pandemic. The phased recovery plan outlines a process for re-introducing surgeries beyond those that are emergent or urgent; beginning with surgeries determined to be a priority. The current definition of “priority” surgery is those cases in the physicians’ determination that must be performed within 1 – 4 weeks. This will change with the completion of Phase I to 1 – 8 weeks. Phase I for surgical services has resulted in an incremental increase of adding 20 percent to existing cases, Phase II would increase by at least 40 percent, and Phase III by at least 60 percent. Monitoring critical elements such as personal protective equipment (PPE), pre-op screening, COVID-19 testing, and staffing resources are included. Outpatient services must also open as they support surgical services and our providers in evaluating patients and delivery of care. Phase I for outpatient services involves an incremental increase to existing cases by at least 25 percent, Phase II by at least 50 percent, and Phase III by at least 75 percent. For surgeries and outpatient procedures our goal is to be “back to normal” by July 1. This will mean correcting the remaining backlog of cases in June.
Examples of monitored metrics include
- COVID (+) test confirmed OCHD cumulative
- COVID (-) test confirmed OCHD cumulative
- Percent (+) test / total test
- Total COVID (+) Inpatients (14-day average) (Compared to UNC Health forecast)
- Total COVID (+) Inpatients ICU (14-day average) (Compared to UNC Health forecast)
- Ventilator utilization
- PPE Burn rate
- Surgical/procedural cases (Compared to Phase goals)
Examples of Phase triggers include
- Decreasing number of positive (+) COVID test as a percent of total test last 14 day period
- Number of positive (+) I/P cases, average <1.0 over the last 14 day period
- Number of Person Under Investigation (PUI) I/P < 3.0 over the last 14 day period
- Critical PPE for surgical case > 15 days on hand, if <15 reassess scheduled cases
Flexibility is maintained by quickly adjusting the percentage for each phase to establish new operational goals. Leaders are able to evaluate metrics, which are out of step, and determine the risk and impact to the organization.
Our organization has experienced a negative financial impact due to the COVID-19 pandemic, as have many other healthcare systems nationwide. Great efforts in flattening the curve of the virus are apparent, however, and current forecasts indicate a peak of cases in September. The phased reopening plan attempts to minimize financial losses while caring for the entire community health needs.
In conclusion, it is imperative that we act in accordance with the daily changes due to the COVID-19 pandemic in the best interest of our community. Following the guidance of UNC Health and State and Federal resources will help us ensure we are acting in the best interest of the patients we serve in Eastern North Carolina.