Wellness group, redirection of patients to other services aided COVID-19 response
Group meetings and individual coaching helped hospitalists at one facility deal with COVID-19 stress, a study showed, while another described how redirecting some common medicine diagnoses to admission by other services reduced the pressure of pandemic patient surges.
Two recent studies reported on strategies individual hospitals adopted in response to the pandemic.
One study, published by the Journal of General Internal Medicine on Feb. 10, assessed a program to prevent burnout among hospitalists during the pandemic. In the yearlong intervention, three hospitalists at an intervention hospital were designated as wellness warriors and led weekly group meetings that provided COVID-19 information, including infection rates, treatments, and workflow changes, and discussion of topics such as coping strategies, vaccine hesitancy, and difficult cases. Individual coaching was also offered, and the group sessions were recorded for asynchronous access. Surveys about burnout and job satisfaction were given to internal medicine hospitalists at the intervention hospital (58 physicians and 6 nurse practitioners [NPs]) and at a control hospital in the same system (59 physicians and 6 NPs).
Surveyed before the intervention, in October 2020, the two sites didn't show significant differences in burnout or job satisfaction. A year later, the intervention group had a burnout rate of 32% while for controls it was 56% (P=0.024). High wellness support was reported by 48% of the intervention group and 0% of the controls. The intervention group showed significantly lower emotional exhaustion and higher job satisfaction and reported more feelings of appreciation, manageable work hours, and organizational value alignment compared to controls. Almost all intervention respondents had attended at least one group meeting, and 72% attended at least half. The authors concluded that the intervention reduced burnout and would be feasible for most hospitals and clinics. “Anecdotally, one of the biggest shifts that we observed was increased clarity about the locus of control within the intervention group. … We had no control over how many COVID patients were in the hospital or availability of PPE, but we did have control over work flows and communication,” the authors wrote. They noted that providing paid, protected time for the wellness warriors to run the program was critical to its success.
The other study, published by the Journal of Hospital Medicine on Feb. 14, described a solution to the surge of patients admitted to a general medicine service due to COVID-19. The retrospective study at a large teaching hospital reported on an intervention implemented during two surge periods (January and February 2021 and 2022). During the surges, standard procedure changed so that patients with six common medical diagnoses—cellulitis, choledocholithiasis/cholangitis, diverticulitis, GI bleed, pancreatitis, and urinary tract infection/pyelonephritis—were admitted by other services. Outcomes during the surge periods were compared to those during a matched number of days preceding the intervention.
The control period included 365 admissions for the six diagnoses (81.9% admitted to general medicine), and the intervention period included 384 admissions (24.5% admitted to medicine). The average census of these patients on the general medicine service decreased from 17.9 and 21.5 during the control periods to 5.5 and 8.5 during intervention periods. An interrupted time-series analysis confirmed the decrease in daily admissions and average daily hospital census for the medicine service. There were no significant differences in length of stay (5.9 vs. 5.9 days; P=0.059) or adverse outcomes (14.5% vs. 16.4%; P=0.482) between the intervention and control patients, although the study authors noted the relatively low rate of adverse events and the retrospective case-controlled study design limited their ability to make definitive conclusions. They concluded that their system of admission redistribution based on diagnosis “is a safe lever to reduce capacity strain.” They noted that the policy did still allow frontline clinicians to admit patients with the targeted diagnoses to medicine when they felt it was best and that the program required trust and collaboration among the leaders of the various services, which might limit its generalizability.
