Solid Preparation and a Spirit of Innovation: Upstate Medical University’s Response to COVID-19

By Jennifer Webster
Thursday, September 3, 2020

Even before the coronavirus arrived in the United States, forward-thinking physicians at Upstate Medical University saw the signs and got ready for action. Their quick response, paired with a culture of institutional preparedness and creativity, helped Upstate respond effectively to the crisis. Today, its hospitals and practices are open for business across all of its clinical areas, as the commitment to addressing COVID-19 continues.

As word of COVID-19 reached the U.S. in January, infectious disease specialists at Upstate, including Stephen Thomas, MD, Division Chief of Infectious Disease and Director of the Institute for Global Health and Translational Sciences, began tracking developments in China. These physicians communicated with Upstate’s leadership, who responded with alacrity. The promptness took some of their colleagues by surprise, but their forethought was soon lauded.

“In early January, Paul Suits, Director of Infection Control, convinced our Logistics Department to purchase a big shipment of N95 masks,” Dr. Thomas says. “Initially, they asked, ‘Why are we doing this?’”

Suits, Dr. Thomas and their colleagues pointed out that when the Ebola virus outbreak took place in West Africa, equipment was difficult to obtain worldwide because only a limited number of sources make medical-grade protective gear. If the coronavirus reached the U.S., it would be problematic.

Obtaining masks represented just one aspect of the preparedness Upstate demonstrated in the early days. Robert Corona, DO, MBA, Chief Executive Officer of Upstate University Hospital, knew that Upstate, and the entire Central New York region, could soon be facing some serious needs. When approached by Chris Dunham, Director of Emergency Management at Upstate, Dr. Corona activated the Incident Command structure, which stands ready to respond to crises.

University Hospital staff working with PPE

“Even before executive orders or recommendations were issued, we had a team of more than 70 people discussing our response to COVID-19,” Dr. Corona says. “This is the longest-serving Incident Command we have had.”

Formally convening in mid-March, Incident Command met twice daily, discussing needs that included rescheduling elective procedures, freeing hospital beds for potential COVID-19 patients, cleaning and decontaminating, and testing and communicating with the wider community. The meetings were held twice daily — weekends included — with more than 100 people on the Zoom calls to hear and act on the reports. Everyone wanted to play a part and learn as much as they could about how to keep patients safe.

“Facing a pandemic was such a complex challenge, and everybody was interconnected in some way,” Dr. Corona commented. “The structure we set in place also provided the necessary transition to our reopening, and now to full operations.”

In early spring, Upstate rapidly transitioned most outpatient visits in the majority of its 19 clinical departments to telemedicine and continues to offer the option for many types of visits. When patients do not need to be physically present, telemedicine provides a convenience and helps both patients and providers maintain social distance.

“Telemedicine has been something we have been readying ourselves to do for years at scale, and the crisis showed that this was viable,” Dr. Corona says.

Nursing Heroism

If science guided Upstate Medical University’s COVID-19 response, nursing care made up the backbone of that response. Nurses managed patients, communicated with families, and continuously donned and doffed protective equipment. Even though their jobs became exponentially harder, nurses found the resilience to do difficult work and even to travel to Long Island in downstate New York to render assistance in hard-hit hospitals.

Nancy Page, MSN, RN, NEA-BC, Chief Nursing Officer at Upstate University Hospital, oversaw that effort. One of the most important parts of a nurse’s role, before and especially during the pandemic, is teaching patients to advocate for themselves, she observes. Over and over, Page’s staff helped empower patients to ask providers and family members questions, such as if they’d washed their hands, and in other ways become active participants in their own care.

Observation skills also came into play.

Nancy Page, Chief Nursing Officer at Upstate University Hospital, with the team

“Nurses don’t diagnose, but we’re experts in looking at the whole person,” she says. “In COVID-19, nurses pioneered looking at people in the ICU and proning patients to improve their long-term function. Nurses and respiratory therapists were key to that intervention.”

Caring for patients with COVID-19 can be emotionally and physically stressful. Nurses at Upstate clinical locations that did not have dedicated COVID-19 units proposed a “job swap” with nurses at locations with COVID-19 wards, at University Hospital and Upstate Community Hospital.

“A nurse could come into a non-COVID unit for two weeks and vice versa,” Page says. “Numerous nurses took advantage both ways. Some wanted experience caring for people with COVID-19, while others were glad to have a short break.”

Volunteerism went far beyond the Central New York region, as Upstate’s nurses traveled downstate to help their colleagues working in the most urgent of settings. The nurses traveled in three waves, along with a cadre of respiratory technicians. Each group served for a period of time at Stonybrook University Hospital on Long Island, a SUNY sister university to Upstate. In total, Page recalls, 46 nurses along with 11 other staff members traveled to help their colleagues get through the crisis.

“Each of our departments is focused on safely handing referrals, being in touch with referring physicians and seeing patients within their comfort zones. Every service at Upstate Medical University is open for referral.”
— Robert Corona, DO, MBA Chief Executive Officer of Upstate University Hospital

Resources of an academic medical center

From the start of the pandemic, Upstate took its position as an academic medical center seriously — caring for patients, pursuing research into COVID-19 and possible treatments, analyzing data, and advising the public about the crisis as it developed. In their public-facing role, Upstate leadership drew on data modeling from its own public health experts to predict the spread of the pandemic. Drs. Corona and Thomas, as well as others, became a reliable “voice of the pandemic” for Central New York.

Robert Corona, DO, MBA, Chief Executive Officer of Upstate University Hospital, and Stephen Thomas, MD, Division Chief of Infectious Disease and Director of the Institute for Global Health and Translational Sciences, became trusted voices of the pandemic for Central New York. Both doctors gave interviews to local media, including Channel 9 TV.

Some of the communication resulted from information gathered about the virus and the population’s influence on its spread, sharing that information with the public and, in turn, influencing the public’s response. For instance, Upstate public health experts discovered that cell phone data could help predict the virus’ spread. Areas where people were on the road more frequently experienced a surge in cases shortly thereafter.

Dr. Thomas, who was a frequent commentator in the media explains, “The data could be used as a ‘stick’ and ‘carrot.’ Based on what was happening in our community I could tell the public, ‘You’re out too much, and there’s a direct association with infections growing’ or ‘You’re doing a great job staying home, and infections are going down.’”

Upstate’s Department of Public Health and Preventive Medicine supplied much of the data and analyses that informed the public, government officials and countless areas within Upstate. As part of the College of Medicine, the department consists of epidemiologists, biostatisticians, data analysts, coordinators, community health and social scientists, who continue to provide ongoing reports and monitoring. Department Chair Christopher P. Morley, PhD, says the team is helping Upstate create a playbook that can be used for future waves of the coronavirus or another pandemic. For real time updates, faculty members Telisa Stewart, MPH, DrPH, public health, and Kathryn Anderson, MD, PhD, medicine and microbiology, immunology, helped to establish systems with a dedicated internal IMT team to collect, analyze and report infection data to Upstate leadership and Central New York.

“Being an academic medical center creates a huge advantage during this time,” Dr. Corona says. “We have experts to talk in public forums, answer media questions and meet with large groups, like manufacturing associations and other entities, to talk about how they can keep people safe. Now as more is known about the effects of COVID-19 on patients, we also have experts to address those varying aspects — from pulmonary to neurological to cardiovascular.”

Ingenuity in a Crisis

Teams at Upstate University Hospital leveraged technological savviness to protect staff and improve communications while keeping patients, providers and families in touch.

The coronavirus pandemic has made telehealth an integral part of the care plan.
  • The chatbot, an AI addition to Upstate’s online presence, triaged COVID-19 questions, answering common ones and routing complex issues to live operators. The chatbot was designed to “speak” both English and Spanish. In five months, the chatbot supported 22,758 users.
  • iPads at the bedside helped patients safely chat with families. Providers, including physicians, nurses and dietitians, also hold consults through the more than 200 iPads now in place throughout the hospital. The tablets also function as a video call bell, saving PPE as some needs can be addressed without entering the patient’s room.
  • In-hall IV pumps and patient monitors allowed nurses to check the vital signs of patients with COVID-19 from outside patient rooms without having to don full protective gear.
  • Telemedicine expanded to include almost every service line, allowing patients to visit providers online from the safety of their homes. Continuing medical education also moved online.
  • In post-COVID recovery groups, patients obtain the support and specialized care they need. Physicians check in daily via telehealth visits, following patients until they are free of symptoms. As providers are discovering, COVID-19 can cause chronic symptoms in some people and Upstate has expertise across the areas patients need.

Recovery and Resilience

After more than two months of constant vigilance, Incident Command wound down and was replaced by a month in Recovery Mode, guiding the safe, full reopening of clinical services in late June. Upstate has now transitioned to a phase dubbed “Resilience” by the C-suite. The aim for Resilience is continue to improve by optimizing operations and rapidly adopting innovations using a Tiger Team model. Amy Tucker, MD, Chief Medical Officer at Upstate University Hospital, led the recovery effort, and is now spearheading its Tiger Teams initiative. She explains that these goal-oriented teams convene for a focused period to rapidly meet emerging needs. The process is tied to the hospital’s strategic pillars, with each member of the C-suite overseeing teams that relate to their areas.

“With our Tiger Teams we aim to streamline operations and to nimbly adopt innovation so that we serve patients and our colleagues even more effectively,” Dr. Tucker commented.

“Today, as we have been all year, we are finely attuned and responsive to the needs of the community,” Dr. Corona says. “We are committed to being a safe place for patients to come. And, we are committed to being a supportive partner to the physicians who refer their patients to us. We want the community to know that we are open and safe.”

Director of Transitional Care Diane Nanno, MS, CNS, RN, NE-BC, CCCTM, with the comfort care kit

As Upstate breathes a sigh of relief and resumes visits and scheduled procedures at every location, Dr. Thomas also notes that the pandemic has enhanced the mutual respect and solidarity between the academic medical center and Central New York’s community practices. It’s a dynamic he hopes will flourish into the future.

“Everybody who works in the medical environment stepped up to ensure hospitals had space to care for the sickest patients,” he says. “For that to happen, we had to have all hands on deck. Primary care providers and community subspecialists knew they would see people who might have COVID-19. We had multiple meetings with our medical community, and physicians told us, ‘We signed up for this. We understand the risks. If you provide the PPE, the training and the means to take samples, we will see these people in our offices.’ The community really came together, and it went well.”

A Response Undergirded by Science

Scientists and the physicians at Upstate University Medical Center took every opportunity to learn about the pandemic and to use that knowledge to help protect the community. Among the projects is participation in the National COVID-19 Convalescent Plasma Project, in which patients with COVID-19 receive blood plasma from survivors of the disease, and both groups are tracked.

Tim Endy, MD, MPH, Professor and Chair of Microbiology and professor of Preventive Medicine and Public Health was the lead on that project. Upstate’s Institute for Global Health and Translational Science worked with the Red Cross to get the project up and running.”

Under the direction of Matt Elkins, MD, PhD, Director of Hemapherisis, Director of Transfusion Medicine, Medical Director of Upstate Cord Blood Bank and Associate Professor of Pathology, Upstate created its own plasmapheresis unit in support of the Convalescent Plasma Project. More than 200 people volunteered and dozens have donated, with numerous patients benefitting from those plasma donations.

Other trials investigated the effectiveness of medical treatments, while the most prominent current trial is examining the effectiveness of a new COVID-19 vaccination. In conjunction with Pfizer, Upstate started vaccinating volunteers the last week of July.

“We’ve experienced an outpouring of interest,” says Stephen Thomas, MD, Director of the Institute for Global Health and Translational Sciences and principal investigator. “The investigators are tightly focused on enrolling a diverse group of participants, ages 18–85, especially focusing on people at high risk for infection or of having a bad outcome from an infection.”

He added, “This is why we have an academic medical university, so we can bring together education and care with treatment of patients and research.”

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