Jason Heffernan, MD, regional medical director for TeamHealth in the Northwest, will never forget the moment he learned that a nursing center in Washington state had been identified as one of the country’s first COVID-19 hotspots. His thoughts immediately shifted to the residents of the more than 20 skilled nursing facilities (SNFs) under his purview in the Spokane area.

It was a safe bet that SNFs, communal facilities full of vulnerable residents, would suffer tremendous losses due to COVID-19. Not much was then known about the virus; what was clear was that the post-acute community needed to gear up quickly for a life-changing, and career-defining, battle.

Heffernan and his teams of clinicians mounted a massive campaign against an invisible foe. Their rapid implementation of new protocols, practices, and collaborations serves as a road map for reducing exposure and harm that other leaders and facilities may find helpful on the front lines of the pandemic.
Here are the key action items.

Clinical teams and facilities have to operate from a shared playbook.

Accurate information is critical when coping with any crisis. TeamHealth had the internal resources to investigate and explore innovative solutions and best practices quickly and thoroughly. Clinicians received near-daily briefings on the pandemic’s progress, proven ways to limit its spread, and the best medical strategies for treating patients. These resources helped create a clinician workforce with knowledge of the most up-to-date information available.

Heffernan knew to provide optimal care, the facilities he served needed access to the same set of facts. So he arranged for all of those resources to be made available to his facility partners, without limitation, for free. Doing so “made everything else that we needed to do that much easier, because both our clinicians and our facilities were operating from the same database of clinical information,” says Heffernan.

Facility disaster plans need to account for the new reality of COVID-19.

Heffernan connected with his facility partners to help create COVID-specific disaster plans that factored in the unique risks and scenarios brought forth by the pandemic. The facility medical directors in Spokane provided the medical expertise needed to rapidly develop comprehensive disaster plans. “We educated and encouraged facilities to create the strategies, staffing planning, and clinician resources they would need to put forth an effective response in the early days of pandemic,” Heffernan says.

Arrange clinician deployment to minimize exposures.

One of the earliest concerns about COVID was that asymptomatic clinicians would inadvertently spread the virus between facilities. Heffernan unilaterally decided to examine and, when necessary, adjust the facilities in which clinicians served.

For example, a clinician who had been working in five or six facilities might be re-assigned to just one or two: “We didn’t abandon any facilities, we simply redeployed clinicians so that each individual clinician’s schedule minimized the chance that they would spread the virus.”

New strategies around infection control are required.

It’s easy to think existing infection control procedures are adequate, but Heffernan didn’t go that route. The prevalence of COVID and its potential lethality to nursing center residents demanded an approach that considered family visitation, facility staff deployment, contact tracing, and resident and staff testing.

Nursing centers are communal settings that rely on resident activities and community relationships. Restrictions on resident and resident-family interactions needed to prevent the spread of COVID had significant negative impacts on resident well-being. Facilities needed support on how to create alternative activity and socialization techniques to minimize the impacts.

Partnerships with local hospitals are critical.

Heffernan knew limiting the spread of COVID would require close partnerships between SNFs and local hospitals. Two hospital groups and a large health plan in the region began collaborating to create a model in which nursing centers were partnered with hospitals.

Heffernan collaborated on best practices and what roles the acute and post-acute facilities needed to play for maximum impact. “When issues arose, each clinician or facility knew exactly who to reach out to at their assigned hospital partner in order to get the resources they needed,” he says. “I expect that the relationships we created as a result of COVID will continue to provide benefits, long after we move past the pandemic.”

Personal protective equipment must be a sure thing.

Almost immediately, the health care community needed to obtain significantly increased amounts of personal protective equipment (PPE). TeamHealth quickly committed to supply its clinicians with the PPE needed to augment facilities’ supplies, procuring approximately 600,000 masks, goggles, gowns, and face shields for distribution to clinicians across the country.

Heffernan also worked with his partner hospitals to ensure that PPE was in place where it was needed. Heffernan is pleased to report that none of his clinicians has tested positive for the virus, and “our clinician infection rate at TeamHealth is less than 1 percent, which is remarkably lower than the general population,” he says. “Obviously our success in this area has prevented many SNF residents from being infected by our clinicians.”

The broader SNF community in Washington state must work in partnership.

Heffernan is a board member of the Post Acute and Long Term Care Society of Washington State. The society has provided extensive COVID education. “The overall approach to COVID must reflect a concept that we’ve all come to understand from the pandemic: We’re all in this together,” says Heffernan. “Globally, we’re not going to have a good handle on COVID until everyone has access to a potential vaccine or to an effective treatment. Solving the problem in our country, our state, or even the particular facilities won’t solve the problem, since the solutions have to be population-based. In Washington state, we want all SNFs, hospitals, and associations to work collaboratively and effectively to contain the spread of the virus.”

Continued vigilance is crucial.

Heffernan is proud to report that, at press time, only one resident in all of the facilities in Spokane has tested positive for COVID. Continued vigilance is now crucial, as facilities and medical directors remain aware that “it just takes one or two mishandled scenarios to allow the virus to infiltrate our facilities,” he says.

“As states move to reopen, the challenges will become significantly more complex. But we’re confident that the measures and strategies that we’ve put in place will continue to serve us and the vulnerable residents we serve.”

Richard Juman, PsyD, is national director of psychological services at TeamHealth. A licensed clinical psychologist working in the field of behavioral health and substance use services for more than 25 years, he coordinates TeamHealth's psychological services in hundreds of contracted facilities in multiple states.

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