Teamwork at UH Helps Boost Patient Volumes Amid the Pandemic

Return to near-normal is not by chance

UH Clinical Update | August 2020

By Cliff Megerian, MD, FACS
President, University Hospitals

When the COVID-19 pandemic hit in early March, health systems braced for three to six months – possibly a year – of a significant decrease in patient volume.

But if you read Crain’s Cleveland Business last week, you saw that University Hospitals, unlike some others in the region, “is pretty much back to its budgeted patient levels.”

This is not by chance. It’s because early in the pandemic UH leaders were already beginning to plan how we could return patients for the care they need, as soon as the statewide ban on non-essential appointments, procedures, and surgeries was lifted.

Well before May 2, the day when all types of care were again permitted, we prepared to shift into overdrive: rescheduling appointments that may have been delayed or canceled, and helping coordinate needed care and services.

We knew patients would understandably have some concerns about exposure to the COVID-19 virus. So we provided details to assure them how UH would keep them safe:  all providers wear masks, frequently wash their hands, and practice physical distancing; we are doing extra cleaning and disinfecting; patients can wait in their cars instead of the waiting room, and have a ‘touchless’ experience in the office, even for paperwork; we also began testing all patients for the virus prior to surgery or other procedures.

In most cases, our providers contacted patients directly to reschedule and to answer any questions they may have about their clinical condition and medications. This helped us strengthen our connection to patients. We are grateful to our physicians and staff for working above and beyond.

All of this gave people in our communities a tremendous amount of confidence in UH, as did their knowing and recalling:

• UH was one of the first hospitals in the country granted a trial of the most effective therapeutic drug to date, remdesivir.
• We launched testing for the virus very fast and were soon able to do at least 1,500 tests a day, with quick turnaround of results
• We offered a “virtual visit” portal, so that during the ban, patients could have online appointments with their clinicians. (These jumped dramatically from about 1,000 appointments a month pre-COVID-19 to a peak of 10,000 a week.)

And our UH Marketing team developed campaigns to reschedule visits and encourage a focus on continued health. This effort kicked off with a public service announcement by Cathy Sila, MD, on behalf of UH, in which she first thanked our community for its diligence in “staying home and flattening the curve,” and conveyed that UH is following CDC guidelines to safely provide patients with the care they needed.

Sam Brown, UH Vice President of Operations and Logistics, notes that our virtual delivery model helped patients during the ban, and we continue to maintain 10 percent of our appointments as virtual. “We’ve seen people come back for clinical visits, but we’ve replaced some of that volume with patients who have concerns, so they can engage virtually,” he said. “That allows us to space out the patients who come in person.” In addition to ambulatory appointments, surgical volumes also have returned.

The one area in which volume remains lower is in our emergency departments – and this is a trend across the country. Why? Research is underway, but part of the answer is likely that many people remain fearful of contracting COVID-19 in an emergency department, while others may have lost their insurance along with their jobs and have concerns about incurring medical costs.  Many know costs are higher for emergency treatment. Also contributing is that there are new, convenient and affordable access points for those with COVID-19 concerns -- they can use one of our new “Fever Clinics” for testing rather than the ED; others realize an urgent care is a more appropriate and cost-effective place to be treated for many conditions. Volume at our urgent care centers remains strong.

However, the patients who come to our EDs are often more seriously ill. “Before COVID, about 16 percent of those patients would be admitted,” said Sam. “Now, it is about 25 percent. But they are very ill – perhaps because they were deferring care or were afraid to seek medical attention.”

As pointed out in the Crain’s article, in July UH discharges were at budget -- and outpatient levels, which were at about 30,000 per week in April, have also bounced back to budgeted levels of around 65,000 per week.

Eric Beck, DO, MPH, UH Chief Operating Officer, noted that the plans we made seem to have worked for the benefit of our patients and our health system. “As we got closer, all we had to do was pull the trigger,” he said. “UH was prepared -- we were first in the market to have a PSA, by Dr. Cathy Sila – and the first thing stated was, “Thank you for keeping us all safe, now let UH get back to taking care of you.”

The word “planning” barely covers what our team did, though. We prototyped the patient experience for returning to UH for care, Eric explained. This included staging a vacant office to test layout and design, to rehearse, and find even more ways to safely improve the patient’s visit. Our incident command structure had readied a special team to focus on this, including infectious disease experts, operations, as well as innovation and design experts to further refine our procedures.

Our intensely proactive and comprehensive approach – and the hard work of all our clinicians and caregivers – meant we readied and returned care for our community as quickly and efficiently as possible, exceeding our expectations.