What’s best for patients and for care team members: MUSC Health leaders confident in pandemic plan

July 17, 2020
exterior view of entrance to University Hospital in Charleston
MUSC Health leaders say they are focused on two principles: what's best for patients and what's best for care team members. Photo by Brennan Wesley

Like people across the country, leaders at MUSC Health are learning to live with ambiguity and uncertainty. It’s not something they necessarily like – “We're all desperate as physicians to know where things are going so we can prepare, but none of us know. No one knows,” said Eugene Hong, M.D., chief physician executive – nonetheless, they are confident that the health system’s preparations ensure it can provide excellent care to COVID and non-COVID patients alike as South Carolina faces its greatest challenge yet from the pandemic. 

“I am extremely confident,” said Tom Crawford, Ph.D., chief operating officer. His confidence stems from the hard work and planning that have been happening behind the scenes for months, focused on the three priorities of capacity, staffing and supplies.

“When this started occurring, even though there was a very low prevalence in South Carolina, we started behaving like it would be here on our doorstep within days. That started in March, so we were very, very well-prepared going forward,” Crawford said.

Pandemics have long been part of the system’s emergency management planning. Unlike hurricanes and tropical storms, which test the system on a near-annual basis, pandemics have been such a rarity that none of MUSC Health's leaders – nor any of the colleagues across the country that Hong has talked to – have had to deal with a public health crisis quite like this one.

From the beginning of this pandemic, Hong said, MUSC Health leaders have focused on two principles: “What's best for our patients and what’s best for our care team members?”

"We need to understand ‘How do we strive to provide perfect care in the COVID world?’ That's what we should always be aspiring to – perfect care – and now the world has changed."

Dr. David Zaas 
CEO, MUSC Health Charleston Division

That focus continues as MUSC Health has transitioned from emergency mode into modified operations for the foreseeable future. In other words, MUSC Health is committed to providing the safest care possible for all patients throughout this pandemic. That means testing every patient admitted to the hospital so that COVID-19-positive patients are cared for separately from other patients; it means reallocating spaces within the hospitals on the Charleston campus and adding COVID units as necessary; and it means making use of the telehealth infrastructure that MUSC has spent years building.

“This isn’t emergency management. This is just the world we live in,” said David Zaas, M.D., chief clinical officer and CEO of MUSC Health Charleston Division.

Zaas noted that MUSC Health is continuing to provide what are generally termed elective procedures, although he doesn’t like using that term.

“I don’t think anything we do in hospitals and academic medical centers is ‘elective.’ We do medically appropriate care for patients. If you’re in a lot of pain, spine surgery isn’t elective. If you have a breast mass or a colon mass, that surgery isn’t elective. That's medically necessary surgery,” he said.

Those types of surgeries can be put off for a couple days or weeks but not for the duration of a pandemic, he said.

“We need to understand ‘How do we strive to provide perfect care in the COVID world?’ That's what we should always be aspiring to – perfect care – and now the world has changed,” Zaas said.

One of the more visible recent changes has been the move to admit young adults to the MUSC Shawn Jenkins Children’s Hospital and Pearl Tourville Women’s Pavilion. That’s part of the reallocation of space across campus.

But it’s not unprecedented for the children’s hospital to care for young adults. The specialists there treat patients who survived heart disease or cancer in childhood, for example, and help transition patients with chronic conditions, like sickle cell disease or Type I diabetes, to adult care.

Mark Scheurer, M.D., chief of the Children’s and Women’s Integrated Center of Clinical Excellence, said the move is simply an extension of the children’s hospital’s mission as a member of the overall MUSC Health hospital system. He noted that not all young adults will be automatically admitted to the children’s hospital. A team of doctors and nurses meets daily to review patient records and determine who, if anyone, would be a good fit. It’s a plan that’s been under discussion since March, he said.

Leaders took advantage of the four-month head start on planning to craft a tiered bed capacity plan that details the triggers for opening new COVID units and where each COVID unit will go. The plan accounts for children and pregnant women who test positive as well as patients at the Institute of Psychiatry who test positive. MUSC Health also got lucky in that it had just vacated the old children’s hospital in February, not even a full month before South Carolina Gov. Henry McMaster ordered schools to close.

“We’re very fortunate to be in a situation where we do have physical capacity because we do have the old children’s hospital,” Hong said.

Leaders also developed contingency plans to provide care outside the hospital building – for example, in the MUSC Wellness Center – but, as long as the community does its part by wearing masks, washing their hands and physically distancing, those plans shouldn’t be needed.

“We need to plan for scenarios that will never happen,” Zaas said.

“We feel very strong about our ability to keep our patients safe and our care team members safe in the hospital and health care system, whether it's ambulatory or inpatient."

Dr. Eugene Hong
chief physician executive

MUSC Health also has a strong telehealth infrastructure. It’s been the headquarters for the South Carolina Telehealth Alliance since 2014 and a National Telehealth Center of Excellence since 2017. This meant that, in addition to offering virtual urgent care, MUSC Health’s doctors can see patients virtually when it makes sense to do so.

Besides capacity, leaders keep an eye, every day, on supplies and staffing levels. As the system deals with normal nursing shortages on top of temporary vacancies caused by staff members who must quarantine, some people who typically work in administrative or outpatient roles have returned to the bedside. Travel nurses are also being hired. It would be nice if he could snap his fingers to make more nurses and respiratory therapists magically appear, Hong admitted, but, barring that superpower, the system is managing its staffing issues. The pandemic has forced them to think about health care provider staffing in a holistic way and really tap into the deep well of expertise that exists at MUSC Health, he said.

Crawford agreed. “We know where we can pull from. We know what spaces we can utilize. And, we created alternative pathways for our supply chain,” he said.

Supplies have been a sore point nationally, especially early on, but Crawford said he has not felt that anyone at MUSC Health has been placed in an unsafe situation.

“Our supply chain has done a remarkable job – and I really mean a remarkable job – of not just capitalizing on our current supply chain pathways to get what we need but by creating new pathways to get supplies in,” he said.

Thanks to the work that so many people have been putting in, the health care system leaders feel good about MUSC Health’s ability to deal with whatever lies ahead, all while providing safe and quality care for patients no matter what their diagnosis.

“We feel very strong about our ability to keep our patients safe and our care team members safe in the hospital and health care system, whether it's ambulatory or inpatient,” Hong said.

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