Public Health

Caring for our caregivers during COVID-19

Updated March 26, 2020

Resources for health care leadership

Amid the COVID-19 global outbreak, it's likely to be a stressful time for those who work on the front lines of health care. Now more than ever, it's important for health systems and health care organizations to create and ensure an infrastructure and resources to support physicians, nurses and care team members.

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The following lists provide practical strategies for health system leadership to consider in support of their physicians and care teams during COVID-19.

Some items in the list are suggestions, while others have already been implemented by health systems.

Workload redistribution

  • Physicians/APPs who are at home (on quarantine or for childcare) manage the inboxes and phone calls of those who are at work and provide telemedicine care. Organizations have the ability to redirect or create physician work (wRVU) credit for this work.

    • Atlantic Medical Group has shifted their ambulatory practice care model to telephonic and telemedicine and has reduced office visits significantly. They are considering splitting their offices into teams of staff and physicians and rotating the teams in/out of the office. Rotating shifts would reduce staffing in the office such that everyone isn't in the same very close spaces together. Clinicians not in the office can do phone visits, telemedicine, answer patient questions or be deployed to call centers and testing centers.

  • Retraining and/or enhancing the skills of who have not recently worked in the intensive care unit to increase workforce.
  • Set up triage hotline. Medical students at Washington University in St. Louis are providing extra staffing for the medical school call center. The purpose of this triage hotline is to provide students/staff/faculty who have traveled or have symptoms of COVID-19 with real-time information on protocol and next steps.
  • Allow medical assistants and nurses to make contributions according to their ability, with physician or APP oversight and discretion. This may include nurses or MAs taking verbal orders, performing computerized order entry, doing medication reconciliation or assisting further with visit note documentation. This will alleviate some of the workload on physicians and APPs.

Institutional policies

  • Ensure that paid time off and sick days remain unaffected for all employees for COVID-19 related illnesses.
  • Ensure no out-of-pocket expenses for employees with COVID-19 related illnesses.
  • CMS, Surgeon General, CDC, and American College of Surgeons have called for cancellation of all elective surgeries and the rescheduling all non-urgent outpatient visits.

Meals

  • SweetGreen will deliver free salads and bowls to hospitals in the cities they serve: DC, Philadelphia, Boston, New York City, San Francisco, Los Angeles, Chicago and Houston. To request free salads, please visit their site to order.
  • GrubHub and DoorDash are now offering contact-free deliveries. Both companies have reduced or eliminated commission fees for local restaurants to support restaurants that are mandated to only have carry-out/delivery only service.
  • Medical students at Washington University in St. Louis have volunteered to deliver supplies/meals and run errands on behalf of individuals in quarantine.
  • A Denver community has reported the development of “Lunches for Clinicians” in which clinicians can order meals from local restaurants for delivery during shifts. Community members are raising funds to help pay for these meals. Many communities across the country have launched similar efforts.

Childcare and pet care

  • Medical students in Minnesota, St. Louis (Washington University in St. Louis), and Chicago (Northwestern University) are offering childcare and pet care services for physicians and care teams. To facilitate logistics, both students and families register for services and students volunteer for shifts. Students are then matched with families based on need and availability. Students have reported that the need is overwhelming, with some systems reporting more than 100 families signed up for childcare or pet care services.
  • One system reported a program in which staff members who must stay home to care for their children are still paid their regular rate if they agree to care for children of two other staff members.

Personal protective equipment (PPE)

  • American Dental Association and state dental associations are encouraging dentists to donate their PPE to local hospitals.

Attention to emotional and mental well-being

  • Headspace is a meditation and sleep app that can have a positive impact on health professionals' personal and professional lives.
  • With the goals of ensuring physicians and advanced practitioners receive the psychological support they need and of paving the way for them to successfully access existing resources through their Physician Assistance Program, the Washington State Medical Association called on Employee Assistance Programs/Physician Assistance Programs with clients in the health care industry to consider the following actions: 
    • Change the pre-recorded greeting message on the 1-800 number to clearly communicate that all calls are confidential and HIPAA compliant.
    • Establish a triage system at entry that allows people to identify themselves as clinicians at the frontline of the COVID-19 response. Deploy your most highly trained and skilled staff to support this population, including the provision of cognitive behavioral therapy.
    • Develop custom communication materials targeted to clinicians at the frontline of the COVID-19 response that clearly explain that your mental health care professionals are equipped to help them navigate the COVID-19 crisis and that the services are completely confidential.
    • Work with each of your clients to provide just-in-time group and 1:1 sessions to frontline clinicians while protecting the health of your staff. For example, use telehealth technology to plant multiple virtual mental health professionals inside the most impacted hospitals and/or at health care provider quarantine facilities for easy on-demand access.
    • Ensure your organizations’ emergency response plan includes strategies to adequately handle a surge in requests for services.

Connecting with others

  • Several organizations, including Methodist Hospital and UCSF, are using video conferencing tools to set up peer support “connection groups” in which physicians and care teams can support one another and discuss ongoing challenges. UCSF’s anesthesia department provides virtual support sessions via Zoom for faculty and trainees. These sessions are held once per week—one for faculty and one for trainees. Discussion questions for these sessions includes: What worries you? How are you feeling and what are you experiencing now? How are you processing all of this? Here are some Zoom and moderator tips provided by UCSF.
  • Virtual session tips:
    • Have everyone turn on their cameras (if possible)
      • Open Zoom chat function so participants can bring up items and moderators can discuss with the group
      • If more than 15 people consider using Zoom breakout rooms
      • Acknowledge each person as they join the Zoom meeting
  • Moderator tips:
    • Psychological safety is key
    • It may take time for participants to open up, resist the urge to “fill the silence” if there are lulls
    • Let conversations unfold naturally
    • Try to focus more on emotions vs. clinical details or how to fix the problem
  • A new Slack channel, “Medical Students vs. COVID-19,” allows medical students from across the country to connect and share helpful strategies for how students can continue to support physicians and care teams. Join the Slack channel.

Resources specifically for COVID-19

  1. Supporting the health care workforce through the COVID-19 global epidemic

    1. This JAMA ViewPoint offers practical ideas for optimizing safety for our health care workforce amid COVID-19.
    2. Source: JAMA
  2. Sustaining the well-being of health care personnel during coronavirus

    1. This document provides a list of strategies for sustaining health care personnel well-being during the COVID-19 outbreak.
    2. Source: Uniformed Services University Center for the Study of Traumatic Stress
  3. UW Medicine COVID-19 support

    1. This resource provides examples for ways in which health systems can set up peer support “drop in” hours via virtual meetings as well as ways in which UW is providing childcare and elder care for employees.
    2. Source: UW Medicine
  4. Briefing note on addressing mental health and psychosocial aspects of COVID-19

    1. This briefing note summarizes key mental health and psychosocial support (MHPSS) considerations in relation to the 2019 novel coronavirus (COVID-19) outbreak (key activities that should be implemented, page 10, and specific messages that can be used by health care leaders with care teams working on the COVID-19 response, page 15).
    2. Source: Inter-Agency Standing Committee Reference Group for Mental Health and Psychological Support in Emergency Settings
  5. Managing health care workers stress associated with the COVID-19 outbreak

    1. This resource provides an overview of specific sources of stress for health care workers treating patients with COVID-19.
    2. Source: Department of Veterans Affairs
  6. Emergency responders: Tips for taking care of yourself (CDC)

    1. This resource provides tips for emergency workers to care for themselves in preparation for an emergency response, during an emergency response and immediately following an emergency response.
    2. Source: Centers for Disease Control and Prevention
  7. StepsForward™

    1. This website provides several online modules to help care teams and health system leaders build and maintain team cohesion and prevent physician burnout. Relevant modules include: (1) Physician well-being (2)  Team cohesion and engagement (3) Hospitalist well-being
    2. Source: American Medical Association
  8. Keeping the coronavirus from infecting health-care workers

    1. Drawing on lessons learned from Hong Kong and Singapore, physician and author Atul Gawande describes key tactics for protecting health care workers from contracting COVID-19 while caring for patients.  
    2. Source: The New Yorker

Contact us

How is or could your organization care for clinicians during the COVID 19 crisis?

Share your ideas and experiences with the AMA by emailing us. The AMA remains committed to ensuring quick dissemination of ongoing strategies to support physicians and care teams. Your learning and experiences will help other organizations better support their care teams during this time.

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Disclaimer: The information and guidance provided in this document is believed to be current and accurate at the time of posting, but it is not intended as, and should not be construed to be, legal, financial, medical, or consulting advice.  Physicians and other qualified health care practitioners should exercise their professional judgment in connection with the provision of services and should seek legal advice regarding any legal questions.  References and links to third parties do not constitute an endorsement or warranty by the AMA and AMA hereby disclaims all express and implied warranties of any kind.