New York hospitals were among the first in the nation to see emergency departments, hospital beds and intensive care unit beds flooded with COVID-19 patents. Medical leaders are now on the other side of the surge and have had time to reflect on lessons they learned from their pandemic experience.

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Three leaders shared their hard-earned knowledge in a recent panel discussion hosted by AMA Chief Experience Officer Todd Unger so that others can benefit from their experiences. The AMA is providing COVID-19 video updates featuring interviews with a wide range of physicians and experts from the AMA and elsewhere who provide real-time insight on the challenge of the pandemic.

“What I thought we didn’t expect was how rapidly this was going to go zero to 60 in terms of an event,” said Mark P. Jarrett, MD, senior vice president and chief quality officer, as well as deputy chief medical officer at Northwell Health in New York. “Our first patient was admitted in the first week of March and by the middle of April we had over 3,500 patients admitted to our hospitals with 800-plus on ventilators.”

One overarching theme of the discussion was the importance of working together in a hospital, in a hospital system and throughout the entire health care community to handle the deluge.

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We felt fortunate that we were able to level-load the surge across our facilities. And so, not only sending staff and equipment to where the most patients are coming in the front door, but actually moving patients around, so not allowing one facility to drown.

“If we could do this all over again in the next wave, if there is one, it would be for us to work together as a city, as a state, as a region,” said Eric Wei, MD, senior vice president and chief quality officer for NYC Health + Hospitals in New York.

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Ramon Rodriguez, president and CEO of Wyckoff Heights Medical Center in Brooklyn, N.Y., said they received help from the larger Northwell Health on how to adequately staff and look at data and use predictive models to predict as best as possible what a hospital may need for the next week, two weeks or month.

“And I can’t say enough about how helpful the state was, the city too was very helpful. … We never ran out of the most important aspects of our organization, the ventilators, etc. … And it caused us to be able to be responsive to, I think one of the hottest spots in the whole city of New York,” he said.

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Anticipating staffing needs

Rodriguez said in hindsight, staffing was the single most important problem they had during the surge and he wished they thought about it much earlier. Dr. Wei agreed staffing is “the hardest and often last component.”

“You can create a new surge ICU space and have the oxygen piped in and have the ventilators and all the equipment there, but without staff, you can’t bring patients in there,” he said. “And so that’s why we’re forever grateful for the Department of Defense bringing military health care personnel in to support our staff, the volunteers who came.”

Calculating supply needs

Dr. Jarrett said they and others created predictive models that others can now use to anticipate where they are going to be in terms of staff, beds, supplies including personal protective equipment and medical supplies, such as Foley catheters, in the days and weeks ahead during a surge.

“Things that you wouldn’t even think about all of a sudden they come in short supply, but that’s were predictive analysis and using your own data … is critical in maintaining yourself in an event like this,” he said.

Stay up to speed on the AMA’s COVID-19 advocacy efforts and track the fast-moving pandemic with the AMA's COVID-19 resource center, which offers a library of the most up-to-date resources from JAMA Network™, the Centers for Disease Control and Prevention, and the World Health Organization.

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