Keywords
Graduate Medical Education - COVID-19 pandemic - trainee wellness
Introduction
Ascension Providence Hospital (APH), Michigan, United States, is a 654-bed teaching complex located in the Metro Detroit Area. Graduate Medical Education (GME) in APH is well established with a total of 205 trainees across 18 specialties approved by the Accreditation Council for Graduate Medical Education (ACGME). To address the pandemic, we formed an incident command team consisted of APH leaders in collaboration with the Ascension Michigan State Incident Command Center. The critical need was in three main fronts: (1) emergency services, (2) intensive care units (ICUs), and (3) nonintensive care medical units.
To address the needs, we requested Pandemic Stage 3 emergency status from ACGME,[1] which allowed the reassignment of residents to support these critical services under supervision. Fellows were divided into two groups: (1) eligible for appointment to emergency hospitalist and (2) noneligible who supported the “surge plan” under supervision. Trainees with higher risk (e.g., pregnancy or chronic illness) were assigned to telehealth ambulatory rotations.
The Development of Cohort Teams
As the number of coronavirus disease 2019 (COVID-19) admissions increased while the number of other admissions steadily declined, patients with and without COVID-19 were interspersed throughout the hospital. This was accelerated once the Centers for Disease Control and Prevention (CDC) changed its recommendation to allow placing COVID-19 patients in regular hospital rooms with droplet precautions.[2]
To care for these patients using “conventional capacity” standard infection control practices, the use of personal protective equipment (PPE) was expanding and the supply was limited. APH initiated the “crisis capacity surge plan” with implementation of COVID-19 cohort units. Under this plan, all COVID-19 patients were assigned to closed-units and were staffed by a predetermined group of caregivers: physicians, fellows, residents, and advanced practice providers. This accomplished three important needs: preservation of PPE by adapting prolonged use protocol per the CDC,[2] standardization of care, and decrease risk of infection among health care workers.
Our experience was unique and the success of this model was due to: (1) immediate collaboration between GME and hospital to form incident command team; (2) forming closed-cohort units with predetermined team coverage; (3) multidisciplinary approach provided by physicians, nurses, respiratory therapists, social workers, and led by trainees; and (4) following the up-to-date guidelines on treatment of COVID-19 patients provided by APH and remaining on the units from 7 a.m. to 7 p.m. allowed standardization of care, prompt medical management of patients, and reduction in stress for other members of the team.
To ensure strict implementation of this model we had scheduled and organized rounds twice daily on every unit and direct communication with closed-cohort unit teams. All their concerns and feedback were documented and reported to the command center and adjustments were implemented immediately. This success was reflected by the positive feedback received from trainees participating in the model.
