The novel coronavirus that causes COVID-19, unlike previously described coronaviruses, causes a wide spectrum of illnesses, from asymptomatic carriage, to common cold symptoms, to viral pneumonia, to disseminated sepsis with organ damage.
Early in the epidemic, pneumonia with low oxygen levels was treated with early intubation, with resultant problems of ventilator weaning and mortality rates approaching 80% in high risk individuals. Dr. Lauren Westafer of Baystate Emergency Medicine, in collaboration with BMC intensivists, helped adopt and disseminate an approach relying on high flow non-invasive ventilation with prone (stomach down) positioning, which helped avoid long Intensive Care Unit (ICU) stays and improved survival. The Respiratory team played a crucial role in treating COVID-19 patients who experienced the symptoms of difficulty breathing or gasping for breath. The team's skills in patient assessment and critical thinking were crucial when caring for COVID patients.
BH physicians began using the antiviral drug remdesivir early in the epidemic, and they participated in the Mayo Clinic protocol focused on plasma from patients who had recovered from the disease, which contained antiviral antibodies. Some weeks later, the discovery of the effectiveness of the steroid dexamethasone in modulating the immune response in serious illness, also helped improve survival. BH has been designated as a distribution center for monoclonal antibody therapy for high risk individuals early in disease.
In all, the clinical faculty of BH initiated or participated in 11 clinical research studies related to COVID-19.
By the end of 2020, over 2,000 patients have required hospital admission at BH hospitals, and over 350 have died. The great majority of deaths occurred early in the pandemic; 80% occurred in elderly individuals who had advance directives to limit care in case of serious illness.
The experience of being a patient with COVID-19 was made more difficult by the need to curtail visitors in most circumstances. A team from TechSpring, Informatics &Technology (I&T), and Patient Experience developed a Family Video Chat program which allowed communication between worried family members, patients and their caregivers. An innovation at BH that went viral across the country was the institution of the “Code Rocky” ceremony that began with some early successful discharges at BMC.
With the theme music from “Rocky” playing overhead, patients were met by dozens of applauding BH team members in the lobby as they left.
The original video for Code Rocky reached 1.2M views on social media, a BH record, and was picked up by national news organizations. Eventually there would be 600 such celebrations over a four-month span.
As personal protective equipment (PPE) became scarce, I&T developed a video app called "QuickConnect" and deployed it across Baystate's Emergency Departments. Using Apple's Facetime technology, iPads in patient rooms, and iTouches, clinicians were able to interview and continue to engage with patients who were under investigation (PUIs) without expending full PPE, and to the satisfaction of patients.
In the ambulatory space, care transformed dramatically as well. With the Governor’s Order to discontinue elective admissions came the expectation that routine follow-up care would also be suspended. Patients with respiratory symptoms suggestive of COVID-19 were initially evaluated over the phone and instructed on how to keep their close contacts safe. Those with serious symptoms were referred for triage to an Emergency Department (ED). The Facilities Team at BMC constructed a 45-bay triage area under the ED portico for rapid evaluation and testing of suspected COVID cases. The unit had processed over 3,000 patients with respiratory symptoms by the end of September. Community hospital EDs redesigned their work flow as well.
Telehealth underwent explosive growth in just a few weeks. From a baseline of 450 encounters per week, telehealth visits rose to more than 9,000, a twentyfold increase.
Nearly all eligible specialties adopted telehealth approaches and these visits came to comprise over 60% of all outpatient visits.
Even with the resumption of face-to-face encounters in the early summer, telehealth approaches remained at the 30% level based on patient preference and physician acceptance. Some specialists, such as psychiatrists, noted improvements in the quality of interactions with patients using technology which enhanced their ability to attend scheduled appointments. Since the pandemic started in March, our providers have conducted over 250,000 telehealth visits.
For those encounters that still had to occur in person, team members from TechSpring, I&T, and Patient Experience established a digital initiative for laboratory services called “Peri-visit” which included an app that allowed patients to start their visit from home as well as “self-arrive” using the MyBaystate patient portal. Patients could select where to wait, see their place in the queue, and receive a text message when they needed to come in. The app premiered in the laboratory services area of the Tolosky Center and has spread to other practices since then, with very favorable reviews. For those convalescing at home, an app from our GetWellNetwork® allowed self-monitoring of symptoms and provided information on what to expect.