Repurposing Staff Using Education and Training in a Pandemic

This poster serves as complementary material to the rapid fire presentation “Responding to COVID-19: Multidisciplinary Leadership Creating New Care Models in the Face of a Pandemic” presented during session 213 of the 2021 AAACN Annual Conference.

The rapid spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), has impacted health care systems across the United States. Emergency departments (ED), intensive care units, hospital wards, and outpatient clinics have seen an unrelenting increase in patient care volumes due COVID-19. Many other factors of this new virus compound the impact of increased volumes including viral spread, safety, personal protective equipment (PPE), and the unknown. This led to a burgeoning need to transform the way we delivered care to patients who were either presenting to the ED with COVID symptoms, identified by serology testing as being COVID (+) and/or calling the health care system.

Under the guidance of the Centers for Disease Control and Prevention guidelines and internal infections disease physicians and nurses, a system-wide response was developed to manage COVID (+) patients safely, effectively, and efficiently while containing the spread of the virus to health care workers. A resource team was gathered, working collaboratively to respond to the need to ultimately provide safe care for our COVID (+) population. The team included an operational support staff, physician, clinical nurse, advance practice leader, and the ambulatory care educator and utilized the A3 methodology for improvement. The group focused on managing patients via outpatient methods to minimize unnecessary contact with health care workers and the general population as well as decrease ED visits.

Two separate care delivery models were created, one virtual and one for in-person encounters. Within the delivery model, key components included staff needed and skill set, training/education, technology requirements, patient access to the care system, care delivery process, personal protective equipment (PPE), and safety. Re-purposing physical space and workflow onsite to minimize COVID transmission was paramount, as well as requiring the virtual team to have a designated workspace with the requisite technology. A dedicated team of redeployed clinical staff worked were precepted in person and/or virtually. Infectious disease training and donning and doffing of PPE was provided by the ambulatory care educator and the infectious disease physician in person and also via on-line and virtual formats.

Analysis of the care delivery system included reconciling data from the scheduling platform and the organization’s data warehouse management reports to determine the number of calls, messages, patients, and number of encounters. A daily dashboard was provided that displayed the total numbers of patients that received care in person or virtually.

From March 27, 2020, and April 3, 2020, through June 15, 2020, the nascent virtual outpatient management clinic (VOMC) and the newly created onsite outpatient acute respiratory clinic (ARC) managed 6,215 calls/encounters and 604 outpatient visits, respectively.

Through multidisciplinary leadership, clinical innovation, and use of the best available evidence, the team created best practices for the transformation of the care delivery and management of primary care patients who were battling COVID-19. The approaches described can provide best practices for leaders in response to newly identified infectious disease and the care delivery models.