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Mary McGinn, BSN, RN, senior administrative director, patient logistics at Northwell Health's Lenox Hill Hospital on Manhattan's Upper East Side, has been through her fair share of catastrophes. In 2001, the veteran nurse was a month into a brand-new position managing patient throughput at St. Vincent's Hospital, the closest trauma center to the World Trade Center, when the 9/11 terrorist attacks occurred.
A decade later at Lenox Hill, she was part of the LHH emergency management team in its implementation of the hospital's response to Hurricane Sandy. There, she played a key role in the ED during the triaging and immediate placement of nearly a hundred patients from New York University Langone Medical Center after its backup generator failed and the hospital had to be evacuated.
But the COVID-19 pandemic is like nothing McGinn has experienced in her 45-year nursing career.
Below are four areas where the pandemic has changed the nursing profession, and what nurse leaders are doing about them within this new environment.
Nursing burnout, compassion fatigue, and moral distress have been perpetual issues in nursing for at least the past decade. But nurse leaders like Tari Dilks, RN, DNP, APRN, PMHNP-BC, FAANP, president of the American Psychiatric Nurses Association and professor at McNeese State University in Lake Charles, Louisiana, are concerned that the scale, intensity, and pervasiveness of the COVID-19 pandemic will intensify these issues.
As the senior administrative director, patient logistics, Lenox Hill's McGinn is responsible for the overall patient flow strategy, including the internal movements of all admitted patients from numerous portals of entry, the transitions of care within the hospital, and the facilitation and timely acceptance of external patient transfer requests.
McGinn says she believes patient safety, outcomes, and experience are all driven by the patient being in the right place at the right time. She also says nursing experience is extremely valuable in the role that she holds. Patient throughput, while operational in nature, really is a bridge between the clinical and ancillary departments of a hospital.
McGinn says she needed to utilize her previous experience, current skills, and numerous tools from her toolbox, including the enterprise TeleTracking system, when Lenox Hill's surge plan was developed with senior leadership and its ICU capacity grew from 48 beds to 123 beds. The expansion was accomplished by converting all the step-down units to ICU units, and physically moving the outpatient infusion center to Lenox Hill's ambulatory Manhattan Eye/Ear/Throat (MEETH) location, which added another 24-bed flexible-acuity unit.
"We knew we were going to need a lot of vacant beds to handle the surge volume. There are only two ways of getting beds that I know of: discharging patients, and by reclaiming and standing up closed units that were repurposed over the years. However, at some point, you finally run out of real estate, and you have to figure out what else from your surge plan you can implement," she says.
Having the support and resources of the Northwell Health system, McGinn says Lenox Hill was able to create and open a 35-bed nursing unit in the same building as the stand-alone Lenox Hill Greenwich Village ED. This was accomplished by utilizing the ambulatory PACU space of a closed surgical site. The unit's population was composed of patients who were clinically ready for discharge, but for various nonclinical reasons—such as needing a required number of negative COVID-19 tests—were screened and selected by a transition-in-care team who clinically approved the patients for lateral transfer after patient and family consent.
The unit was staffed with redeployed advanced practice clinicians, Greenwich Village team members, and a Northwell Health physician who volunteered to be the physician in charge. The transfer process was facilitated by the patient throughput team in collaboration with both the sending and receiving clinical teams to an off-main-campus nursing unit site. The Northwell Health IT team built the unit during surge planning, and the movement of these patients from one location to another was possible because of the technology platform that was in place.
In addition to discharging and relocating patients, McGinn says she was very concerned for the "load-balanced transfers" Lenox Hill admitted from several of their sister hospitals that were at the center of the epidemic.
"The last thing I wanted was for the nurses and the physicians who were already working their tails off to be running from rapid response to rapid response because we were transferring patients that were too acute to be at their level of care," she says.
McGinn called a meeting with the Lenox Hill ED leadership and advocated for triaging incoming patients through the ED, similar to what had been done during Hurricane Sandy, and the group agreed.
"I believe by transferring patients in this way, we prevented numerous rapid responses from occurring on the units," McGinn says.
One of the accomplishments Lenox Hill Hospital achieved throughout the COVID-19 surge was the timely movement of all patients to their beds, including ICU patients. There were "no boarding" issues in the ED, "which was a testament to everyone who worked tirelessly throughout this period," according to McGinn.
"We were able to get people out of the ED and up into a bed quickly. We had the ability to get them up to where the appropriate care was," she says.
The fact that McGinn is part of the emergency management team highlights the value of patient logistics.
"I go to those meetings and I participate, and I think, 'It really shows the level that people believe that throughput is valuable, and they need to have us at the table with them,' " she says.
Going forward, says McGinn, the patient throughput group will continue some of the duties it took on during the crisis.
For example, after consulting with teammates in epidemiology, the patient logistics team updated information to indicate when patients are being tested for COVID-19, whether a patient tests positive for COVID-19, and whether the patient was intubated.
"We are now taking that on permanently for all indicators," McGinn says. "That's a change in process. The throughput coordinators are utilizing Microsoft Teams®, having partnered with the epidemiology team, so they're constantly chatting with each other about who's a rule-out COVID low suspicion, high suspicion precautions, or who has a 'banner' from a previous admission. They have a clinical conversation, the outcome of the conversation is relayed, the banners are changed, and attributes in the system are removed if needed. This ensures that patients are going to the correct location the first time, thus reducing nursing handoffs."
This work will continue as McGinn's team continues to partner with the clinical teams, patient care management, and the ancillary department testing teams to identify, prioritize, and transport anticipated discharge-ready patients who require one last test before leaving.
"Those are things that we're doing to help facilitate earlier discharges," McGinn says.