How an Upstate New York Hospital System Responded to COVID-19

APP Leadership Team Prepared, Mobilized, and Adapted

July 9, 2020

By Taylor J. Indivero, PA-C

Last March, as COVID-19 surged in New York City, advanced practice provider (APP) leaders at Rochester Regional Health (RRH) in Rochester, New York, faced the enormous task of effectively coordinating a system-wide provider redeployment that included MDs, DOs, DDs, PAs, and APRNs. RRH is a five-hospital system with over 19,000 employees and a medical staff of over 2,700. RRH serves families in the communities of western New York and the Finger Lakes region.

I practice in orthopaedics at Whitbeck Spinal Associates within Rochester Regional Health and  was redeployed to the ICU during COVID-19 after undergoing in-person training. During the crisis, I split my time between the ICU and telemedicine responsibilities. As a PA within RRH, I am proud to share the story of of my colleagues’ hard work responding to COVID-19.

APP leadership team strategizes redeployment
Our APP leadership team was organized at the onset of the pandemic into a system-wide multidisciplinary clinical and organizational crisis response team. A multidisciplinary team was redeployed to staff drive-up screening tents and a provider-supported call center which reported COVID-19 test results and provided phone support and triage to infected patients. Additionally, highly-trained PAs and APRNs were redeployed to staff a newly-created closed-door respiratory care unit.

Simultaneously, the APP leadership team helped to maximize hospital and ICU beds while expanding provider support – not only for RRH’s five-hospital system, but for an additional surge hospital and a potential county field hospital. New and creative strategies were implemented to maximize provider skillsets, safety, quality, and efficiency, including dedicated medication reconciliation teams and discharge teams made up of APPs from other inpatient areas. We coordinated plans to further decompress the emergency department with triage to specialist care, using specialty APPs and physicians from hospital and ambulatory specialty service lines.

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Socially distanced in-person training
Responding to the pandemic required our health system to rapidly organize, prepare, mobilize, and adapt so we could treat COVID-19 patients while continuing to provide the comprehensive medical care we pride ourselves on. Our team developed and implemented a system-wide provider survey which allowed us to organize up-training based on provider-reported clinical competencies. We immediately coordinated a full-day conference to prepare providers with in-person critical care education in accordance with social distancing guidelines. These providers received in-person training on central line placement, ventilator support, PPE application, end-of-life conversations, and hemodynamics management of the critically-ill patient. The conference content was extended to an expanded provider audience utilizing video and e-learning modules. Furthermore, our team designed and developed department-specific education modules for “just-in-time” training and a comprehensive manual for high-need areas including the emergency department, intensive care unit, COVID-19 testing tents, and hospital medicine units.

Matching providers to high-need areas
The APP leadership team was able to effectively mobilize and match over 200 providers to high-need areas based on their skill sets. Our workforce mobilization timeline was based on specific department needs, in coordination with department chiefs so that small groups of providers could be trained “just-in-time” and to limit the use of PPE. By leveraging up-training ambulatory PAs and APRNs, they were able to safely plan staffing for an additional 800 beds. The RRH APP leadership team also hired an additional 60 providers from across the nation for our COVID-19 relief workforce. The crisis brought out the best in our team as PAs and APRNs across the system assumed various roles and provided excellent patient care.

A challenging time
Our APP leaders worked collaboratively across the operational leadership structure, human resources, medical staffs, and executive leadership. They were an effective crisis management team during this time while the eyes of the company were on them to deliver competent providers to meet the COVID-19 surge. Despite the challenges our company faced due to significant financial losses during the COVID-19 surge, our APP leadership team was able to effectively advocate for keeping all 950 APP employees, thus avoiding furloughs and layoffs of this integral workforce.

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Throughout the entire process, resource availability, PPE availability, and ICU ventilator capacity and capability were constantly assessed and managed appropriately within the entire system. This planning would ultimately allow our system to successfully care for our community during COVID-19. As our team continues to lead through this crisis, we can’t understate the importance of effective communication, or the resilience of our entire workforce including PAs and APRNs.

As we navigate this pandemic, I am confident in our leadership. From a PA perspective, this task would not have been possible without AAPA and New York State Society of PAs advocating for New York Governor Cuomo’s executive order that temporarily waived the physician supervision or collaborative requirements needed for clinical practice. Our commitment to our community has never wavered and continues to be our passion.

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