Having shed light on several weaknesses of the U.S. health care system, the COVID-19 pandemic has also presented an opportunity to optimize and alter fundamental aspects that have been challenging for years. One such weakness is communication – both between clinician and patient as well as among team-based care models. One silver lining of this crisis is it has pushed facilities and providers to make disruptive changes, and quickly, that have improved the frequency and flow of vital communications.
The spread of COVID-19 is rapidly changing the landscape of healthcare consumerism, with patients and providers starting to engage one another in unprecedented ways. They are educating patients about what precautions to take to stay healthy and safe, updating them about clinic policies and screening procedures, introducing new telehealth services, and explaining other changes that impact patients’ ability to access care.
The Phone Lines are Open.
In late March, the Federal Communications Commission issued a ruling which qualified the COVID-19 pandemic as an “emergency” under the Telephone Consumer Protection Act. This gave hospitals and providers the freedom to make automated calls and send text messages with information about COVID-19. Recent data shows that many facilities and healthcare providers took advantage of the opportunity. As the number of COVID-19 cases in the U.S. spiked dramatically, healthcare providers broadcasted messages to patients at unprecedented volumes to quickly and effectively reach large portions of their patient population.
In fact, California, one of the states hit early and hard by COVID-19, increased patient communications more than 91X over, with 206,000 messages broadcast between late January and March. New York saw a 16X increase over the same period. In another report, 74% of primary care providers report that their phone lines have become flooded with calls from patients.
Many facilities have started identifying and screening patients who are most at risk of contracting COVID-19 and using simple text messages to deliver automated surveys and digitize screenings. Many others are pulling information directly from the electronic health record to identify their high-risk patients and digitize screening efforts. It seems clear that while Americans grapple with the spread of the pandemic, they are reaching out to and communicating with their providers during this critical time.
The use of the telephone isn’t just being used to disseminate information and communicate with patients outside of the facility, it is also being utilized in the inpatient setting. For example, at the Cleveland Clinic, nurses and care managers have started communicating with patients via telephone. Caregivers call patients from outside patient rooms to tell them they will be entering their room and asking the patient what their needs are so the nurse can be prepared to respond upon entry.
The phone calls help minimize the number of times caregivers enter patient rooms, reduce the risk of infection, and improve care efficiency. Care managers are also calling patients to determine their patient discharge needs and completing post-discharge services electronically. According to Cleveland Clinic, the patient phone calls have unveiled unexpected increases in both efficiency and productivity of nursing care. Nurses making the COVID-19 phone calls are often doing so remotely, avoiding commute times, and are on average achieving at least three more patient touches per day per nurse.
Communication Boosted by Telehealth.
For the first time in more than 20 years, government officials, providers, health plans and employers are recommending telehealth as the first choice for care, as opposed to an alternative – due to the coronavirus (COVID-19) pandemic. Before the pandemic, only 1 in 10 patients in the U.S. used telehealth, according to a J.D. Power survey. Now, health systems and private telehealth companies are seeing a dramatic increase in the use of telehealth – to the tune of digital visits climbing from 750% to 1,000% since the coronavirus became widespread.
Hospitals and facilities across the healthcare sector have realized that the need for an easy-to-use telehealth solution in now a must have. The benefits being realized from this widespread move to telehealth are many, including maintaining access to care, the ability to refill schedule openings caused by cancellations, and increasing patient touches, among others.
Beyond the adoption of telehealth by providers, consumer opinions are changing as well. Almost three-quarters of patients polled for one recent survey said they’d consider using telehealth to be remotely screened for COVID-19 and two-thirds said the pandemic has increased their willingness to try virtual care.
Optimizing Team Coordination and Communications.
In the pre-COVID-19 environment, team-based care has been challenging, despite the clear benefits of patient outcomes. This is due, in part, to a sense of power hierarchies – real or perceived – that often existed among many care teams with some less experienced providers hesitant to correct or weigh in on an issue with more seasoned clinicians. The existence of this situation along with incidences of workplace bullying has been well documented as putting strains on interprofessional collaboration.
However, it appears the global pandemic may have changed all that. With such an unprecedented crisis, few providers had experience navigating such a widespread and devastating health emergency. In a recent article, Jessica Dudley, MD, Chief Clinical Officer at Press Ganey, stated, “Psychological safety is happening now more than we’ve ever seen. Part of that is nobody has ever seen this before, so nobody knows the right way. So, that, in some sense, is leveling the playing field. It’s making everybody recognize that they have to step up and share what they’re seeing and learning. I’m seeing this across the country with physicians and nurses.”
As physicians, nurses, advance practice professionals, and others on the frontline are now working together as a team for the betterment of the patient, there is no room for power hierarchies, just collaboration and collective efforts to deliver care and flatten the curve.
Communication among teams has also been altered during this unique event. Traditional methods of sharing information such as, daily huddles or emails, are less effective when clinicians are working around the clock and having little time. This has ushered in new, emerging ways to communicate and coordinate care across teams, including using Zoom meetings, virtual chat rooms, or other collaboration tools.
Advancing Communications for the Future.
When the country emerges on the other side of this pandemic crisis, healthcare organizations will no doubt be analyzing the changes that were made during this time, what worked well, and what should stay changed for the future. When it comes to communications and coordination of care, the health system will likely continue to embrace telehealth and other forms of virtual care. Further, consumers may take a much more active role in managing health and participating in a health system that is re-created.