At the beginning of the COVID-19 crisis, we started From the Frontlines, a nationwide gathering of clinicians to discuss topics at the forefront of medicine, to facilitate connections between clinicians across the country. Every day, we learn more about the Novel-Coronavirus (COVID-19) and confront new challenges associated with the virus. The voices of our clinicians and clinical support teams have never been more valuable. Clinicians are on the frontlines of our national response to this virus — they are called upon to develop immediate strategies and solutions to keep our communities and colleagues healthy and safe.

Dean Dalili, MD, President of Hospital Medicine, and Adam Brown, MD, MBA, FACEP, President of Emergency Medicine, spoke with three Envision hospital medicine leaders about the unique COVID-19 challenges in their regions. Each of these clinicians found that communication and crisis management were crucial to their success. As our national response and the virus continue to evolve, we will continue to share information, resources and best practices to prepare for what is next.

Dolly Abraham, MD
Regional Medical Director, Hospital Medicine — Livingston, New Jersey

On the Challenges of Discharging COVID-19 Patients: As our number of patients grew, we realized a significant barrier to them returning home was access to oxygen. Patients were getting better, but they still required oxygen to go home.

We found that local oxygen suppliers would not supply oxygen for COVID-19 patients without underlying conditions, so we searched for alternatives. We were able to buy oxygen concentrators to keep in our command centers and created a new protocol to send patients home if they required two liters or less of oxygen to remain stable. Ultimately, we were able to send about 20 percent of our patients home on oxygen — this protocol was lifesaving for those who needed intense critical care support.

Dolly Abraham, MD “It's important for a leader to be by the side of physicians on the frontlines and remain calm and composed as an anchor for your team.”

– Dolly Abraham, MD

Marc Demyun, MD
Regional Medical Director — Denison, Texas

On Preparing for the Uncertainties of the Virus: At the time, I was reading about what was happening in other parts of the country, and we were not seeing many COVID-19 patients in my region, so we prepared. I actually called Dr. Abraham to discuss what I should prepare for based on her experience.

We set up virtual health solutions and cordoned off an area in the intensive care unit for COVID-19 patients. We established a multidisciplinary team of clinicians to care for COVID-19 patients and emergency scheduling protocols.

Lastly, we set up daily communications on how many patients we tested and how many were positive. I was transparent with my team so we could support each other when we needed to.

Marc Demyun, MD “Being open and transparent with our people has helped with the fear and uncertainty. People do better when they understand not just the decisions that are made but also why they are made.”

– Marc Demyun, MD

Alain Folefack, MD
Regional Medical Director — Arlington, Texas

On Teamwork and Training for COVID-19: I'm a firm believer in teamwork. As long as we are there for each other, we will be successful. Envision leaders have been there for us, hospitals have been there for us and nurses have been there for us, which has made us successful.

Envision provided the training and resources needed to handle the emotional aspects of the crisis. As physicians, we all lead teams of practitioners. Whether its nurses, nurse’s aides or techs — all those people look to the physician as the leader of the team. On every level of that clinical team, there were challenges. Still, everyone appreciated that we could provide them with some tools to manage the stress and anxiety and potential conflict surrounding the crisis.

Alain Folefack, MD “We stayed informed thanks to the Envision COVID-19 website. Thankfully we had those resources to help limit the amount of time we spent on research.”
 
– Alain Folefack, MD

Hosted by Adam Brown, MD, MBA, FACEP, President, Emergency Medicine, Co-Chair, National COVID-19 Task Force, From the Frontlines is a bi-weekly teleconference panel of multispecialty clinicians nationwide who speak from the frontlines and discuss the evolving best practices as they address the COVID-19 pandemic. Visit www.evhc.net/coronavirus to watch past webinars and learn more about our work on the frontlines of the COVID-19 pandemic.

As a leading national medical group, Envision brings clinicians together to offer transformative patient care and hospital practices. Our strength is in the shared expertise of thousands of clinicians across the country, each with a unique story and thoughtful understanding of medical practices.