COVID-19 has made Rush University Medical Center in Chicago, Illinois, face challenges typical at large, academic hospitals situated in urban areas: a changing inpatient experience due to visitation policies, fragmented care transitions, lack of community education, and reduced employee safety and well-being.

THE PROBLEM

Additionally, without a central agency coordinating patient transfers in Chicago, the medical center stepped up to lead the region’s COVID-19 response. Between April and May, it received more than 600 patient transfers from surrounding safety net hospitals. Some 70% of those patients were COVID-positive, and one-third did not have insurance or were on Medicaid.

More specifically, Rush saw an immediate need to both engage staff to improve staff safety and well-being during this challenging time, and strategically communicate with its most vulnerable patient populations.

PROPOSAL

Rush University Medical Center found that CipherHealth, a patient engagement platform vendor, had a staff rounding capability as part of the company’s CipherRounds tool, which would be critical for Rush to round on staff. Using this tool would allow the medical center to analyze and report on the responses it received from staff and note any trends over time.

"Using digital patient engagement tools that allow you the flexibility to customize your interactions based on the specific and unique needs of each of your constituencies is critical."

Kathleen Egan, Rush University Medical Center

“Regarding communicating with our vulnerable patient populations, CipherHealth recently launched longitudinal monitoring as part of their automated communication tool, CipherOutreach,” said Kathleen Egan, director of care transitions at Rush University Medical Center. “Longitudinal monitoring would allow us to follow up with patients post-COVID-19 testing, assisting us in monitoring both COVID-positive and COVID-negative patients. This technology would allow us to scale our communication efforts, and triage patients appropriately to speak to a nurse if they needed assistance.”

MARKETPLACE

There is a variety of patient engagement systems on the health IT market today. Some of the vendors of these technologies include Casetabs, CipherHealth, Demandforce, Medici, OhMD, Patient Trak, PerfectServe, Revenue Well Systems and Solutionreach.

MEETING THE CHALLENGE

Rush University Medical Center is an anchor within the community it serves, one of the top hospitals. So when the first wave of COVID-19 hit the hospital, staff members knew they needed to respond like a community leader. The only way they could do that was by taking a cross-functional, data-driven approach to managing an all-hands response to COVID-19 while not losing contact with other patients who depend on Rush for critical and chronic care, Egan said.

“We relied on CipherHealth’s digital engagement solutions to continuously monitor the changing needs of our patients, our own staff, and the broader community,” she explained. “Rush leaders and frontline staff used both the rounding and outreach tools to keep pace with the pandemic and the rapidly evolving demands it put on patients and caregivers alike.”

The real-time data staff were aggregating through the rounding tool (for staff engagement efforts). The outreach tool (for communicating with patient populations) allowed staff to make data-based decisions quickly on how to pivot practices to deal with the COVID-19 crush and better manage the care of all patients, she added.

With the help of the vendor’s digital engagement platform, Rush instituted a comprehensive plan comprising seven concurrent initiatives:

• ICU Flex: Just-in-time expansion of ICU capacity allowed Rush to maintain consistent, unlimited access to services for critical COVID-19 patients.
• Source of Truth: Collecting and analyzing data from many sources allowed Rush to rapidly deploy, manage and optimize resources as organizational needs evolved.
• Virtual Care Triad: Widespread distribution of communication devices to admitted COVID-19 patients’ family members facilitated patient-to-family communication and alleviated some of the patients’ loneliness.
• Community Extension: Extensive collaboration with external organizations to offer community-based services, such as food and prescription-medication deliveries and home visits from volunteers, addressed social determinants of health.
• Critical Staff Support: Ongoing commitment to supporting staff safety, well-being, and resilience – including working with Chicago city resources to secure temporary housing for staff in proximity to the hospital and hosting town halls – helped workers and their families feel safe while allowing them to remain vital contributors to patient care and hospital operations.
• Longitudinal Monitoring: Proactive assessments through longitudinal outreach programs by Rush’s team of “Cipher Nurses” and widespread expansion of telemedicine to evaluate clinical trajectory, determine necessary treatment options, and avoid adverse outcomes ensured continuity of care regardless of where patients are.
• Care Anticipation: Real-time data insights allowed Rush leaders to predict needs, pivot quickly to deploy new services, and prioritize limited resources where they could achieve the most favorable patient outcomes.

RESULTS

Rush was able to achieve two key results since the start of COVID-19 around staff engagement and vulnerable patient population outreach.

“Regarding staff engagement, through technology-enabled staff rounding, we built a culture of resilience to sustain frontline teams,” Egan reported. “It was important to develop support services and bring these resources directly to staff where they work. We gained direct insight into staff concerns and how they evolved over time, which allowed our team to rapidly implement programs that addressed morale and turnover. From the start of the staff rounding program launch in April to the month of June, we were able to increase the total number of rounds performed on staff by 247%.”

And vulnerable patient population outreach was one area that required immediate attention – namely, patients with congestive heart failure, cancer and those testing positive for COVID-19. Rush wanted to maintain continuity of care for its congestive heart failure patients, since staff noticed they were communicating with care teams less frequently.

“We discovered patients were misinformed about their plan of care, prescriptions and availability of telehealth options,” Egan revealed. “We reached more than three-quarters of our patients and triaged those who expressed concerns to our dedicated nursing team for further consultation, symptom management and patient education – thereby reducing the strain of avoidable readmissions and ED recidivism during a period when our resources were already at capacity.”

ADVICE FOR OTHERS

“We all know that patient engagement is vital to improving patient outcomes,” Egan stated. “This means tracking and understanding their needs both as admitted and as discharged patients. We are able to begin our technology-facilitated communication with newly admitted patients. And then we can maintain our digital communications with discharged patients, both COVID-19 and otherwise, all through our existing patient engagement solutions. This sustained contact helps our patients continue their recovery at home while reducing our readmission rates.”

What Rush didn’t anticipate, however, was how crucial it was to be taking a parallel approach to its own staff – both clinical and essential nonclinical – so that the medical center could understand and address their needs and concerns through that first COVID-19 surge, she added. Rush used its patient engagement solutions to guide care for staff like it cared for patients.

“Using digital patient engagement tools that allow you the flexibility to customize your interactions based on the specific and unique needs of each of your constituencies is critical,” she advised. “You need a technology partner that takes a systems approach to patient engagement so that you will have the agility you need to stay ahead of the pandemic as it evolves and continues to circulate through our communities.”

Twitter: @SiwickiHealthIT
Email the writer: bill.siwicki@himss.org
Healthcare IT News is a HIMSS Media publication.