AN INNOVATIVE PROVIDER REDEPLOYMENT STRATEGY DURING THE COVID-19 PANDEMIC IN NEW YORK CITY

The rapidly evolving COVID-19 pandemic required the NewYork-Presbyterian/Weill Cornell Medicine Department of Emergency Medicine to seek innovative solutions and review steps to meet patient care demands while maintaining quality and safety in the face of increased patient volumes, insufficient staff, and an evolving understanding of a highly infectious pathogen. Examples from a combination of actual disaster events and exercises include alternate site surge facilities, mobile field hospital deployment, federal resource activation, modified triage algorithms, load-sharing with regional systems, and conversion of nontraditional spaces.4 All of these strategies were implemented by our enterprise in the pandemic response, though provider redeployment from specialties outside of EM into the ED during a pandemic disaster was a unique opportunity without a blueprint. With government officials urging social isolation and a substantial increase in the number of patients electing to receive care by telemedicine, our virtual urgent care service was also identified as an area that required additional support. To ensure patients would continue to receive the highest quality medical care, the ED leadership developed a comprehensive orientation and onboarding process and operationalized the training, scheduling, shadow shifts, quality review, and feedback process for redeployed staff from neurosurgery, ophthalmology, neurology, physical medicine and rehabilitation, dermatology, internal medicine, colorectal surgery, gastroenterology, psychiatry, and others (see Table 1).

Crisis clinical pathway for COVID-19.

The pandemic of COVID-19 has been particularly severe in the New York City area, which has had one of the highest concentrations of cases in the USA. In March 2020, the EDs of New York-Presbyterian Hospital, a 10-hospital health system in the region, began to experience a rapid surge in patients with COVID-19 symptoms. Emergency physicians were faced with a disease that they knew little about that quickly overwhelmed resources. A significant amount of attention has been placed on the problem of limited supply of ventilators and intensive care beds for critically ill patients in the setting of the ongoing global pandemic. Relatively less has been given to the issue that precedes it: the demand on resources posed by patients who are not yet critically ill but are unwell enough to seek care in the ED. We describe here how at one institution, a cross-campus ED physician working group produced a care pathway to guide clinicians and ensure the fair and effective allocation of resources in the setting of the developing public health crisis. This 'crisis clinical pathway' focused on using clinical evaluation for medical decision making and maximising benefit to patients throughout the system.