Preventive Care During an Emergency Requires Effective Care Coordination

By Melinda Young

The COVID-19 pandemic disrupted standard health system practices in a way that allowed healthcare researchers and professionals to learn how to improve their preparedness for emergencies and disasters.

“The pandemic provided this amazing global natural experiment,” says Sylvia J. Hysong, PhD, director of the Houston Evidence-based Rapid Measurement and Evaluation Center and lead research health scientist at the Center for Innovations in Quality Effectiveness and Safety at Michael E. DeBakey Veterans Affairs (VA) Medical Center in Houston. “The pandemic dramatically changed the way we work in healthcare. We were funded to look at screening processes and say, ‘Given the next time we have a public health emergency, what kind of things can we do?’”¹

Public health emergencies include localized epidemics, natural disasters, and other crises. Health systems and staff need to prepare for those crises as much as they need to be ready for the next big one.

The goal is to learn how to tweak processes to make it easier to continue care when the day-to-day operations are interrupted. “What are things we can do to make sure we build resilience into our system so we can adapt and adjust when something like this happens again?” Hysong asks.

Case management leaders and others in health systems need to think about their workflow and how it was disrupted during the early months of the pandemic, as well as later in the crisis. “You can think about what kinds of things we can do to adjust workflow so that we can turn the ship in whatever direction is needed,” Hysong explains. For example, some case managers were unable to see patients at their bedside because of infection control measures. But they could visit patients via video.

Healthcare professionals also learned that they could do some types of screening and chronic care management via technology and remote healthcare. Even things like screening people for colon cancer could be performed with a mailed-in fecal test during a period when elective procedures, including colonoscopies, were on hold. “How do you adapt, and what can you do differently in your workflow?” Hysong asks.

Another example involves mental health screening. “Most of it is conducted by asking patients questions, but one of the unintended consequences during the COVID pandemic was that the very measures health officials were taking to keep people safe from COVID — physical distancing — were having the unintended consequence of affecting their mental health,” Hysong says. “The volume of mental health problems shot up.”

Healthcare providers need to see what they can do differently, and which processes they can tweak to handle that increased volume. Some facilities did well in adjusting to the pandemic. Others were not doing well with the pandemic’s disruption, and still others did better.

“The pandemic served as a catalyst to some facilities to get them to implement improvements, and their numbers improved with the pandemic,” Hysong explains. “We’re reaching out to facilities of all these different profiles so we can see how facilities with different circumstances were able to adapt and adjust.”

Hysong and colleagues created a process map they are taking to facilities, asking them what their processes looked like pre-pandemic and how they changed.

“What kind of things helped? What kind of things were barriers? If you had to do it over again, what would you do differently?” Hysong says. “We’re collecting that data now.” The goal is to learn more about healthcare facilities’ workflow and coordination between teams and patients.

During each patient encounter, several information handoffs occur between various healthcare providers and team members. Tests may be ordered, tissue collected and sent to a lab, results entered in the record, and follow-up consults on the results. “The provider needs to be alerted that the results are ready, and they interpret the results and communicate that to the patient, who then makes a decision,” Hysong says. “All of those little steps are where improvements could be made.”

According to Hysong, these are the questions to ask when preparing for a disaster or emergency:

• “Are there ways to modify that so you need fewer handoffs?”
• “Can you modify that process so it is not sequential?”
• “Could it happen in parallel?”
• “How is the provider alerted?”
• “When and how are results reported?”
• “How do clinicians and providers communicate with specialty care?”

“These are the building blocks of communication, coordination, and workflow,” Hysong says.

As case management and other health system leaders focus on improving their disaster and emergency preparedness, they should keep in mind that the single most important part to focus on after a disaster is communication.

“If you ask anyone who deals with disaster or emergency management, one of the first things they focus on is establishing communication,” Hysong says. “Like with hurricanes, which we frequently have in Houston, the first thing they want to get up and running is all of the cell towers so people can establish a chain of command and know who is responsible for what.”

Information exchange is critical in the care of people with chronic illnesses. “You do not have just the team, but a multi-team system. You’re speaking to maybe one person, a provider, who is in charge of the patient’s care management, but you may have to send the patient to different specialists, therapists, and procedures,” Hysong says.

The challenge is to figure out how to exchange information among all parties during an emergency. The information needs to be sent accurately, efficiently, and promptly.

“This is where facilities and organizations can start to think about how they can improve or bulletproof their systems in case of a large emergency,” Hysong says. “Make sure everyone has the information they need at the time they need without duplication.”

The VA’s data system has a great advantage over most health systems because it is a national electronic system that also is integrated. If someone receives care in Puerto Rico and is moved to Texas during a hurricane emergency, the Texas VA will have all the patient’s charts and up-to-date tests and results. All the patients’ records will be available at any VA nationwide, so the patient does not have to explain to providers what the situation is and which medications are needed.

When Hurricane Katrina struck New Orleans, many people were moved to Houston for continued medical care, Hysong notes. “The records were there and waiting for them,” she says. “That’s one of the very important and underappreciated services of the VA system — that ability to be national.”

REFERENCE

1. Hysong SJ, Giardina TD, Freytag J, et al. Study protocol: Maintaining preventive care during public health emergencies through effective coordination. Implement Sci Commun 2023;4:150.