A centerpiece of the response plan is a rapid expansion of telehealth. Like many health systems, Guthrie Clinic has limited the number of in-person clinic visits. With the recent approval for telehealth expansion by the Centers for Medicare and Medicaid Services, Guthrie Clinic saw its number of providers participating in telehealth soar from 12 before the COVID-19 outbreak to 252 providers performing remote office visits and 450 having access to the platform after the outbreak began.

The telehealth system works despite the limits of Internet access in rural areas, explained coauthor Burt Cagir, MD, FACS, a general surgeon. Most outpatient clinics within the system have telehealth kiosks, and the system is flexible to fit each patient's needs. "We allow all of our patients to communicate with any and every modality available to them, such as cellphones so they're able to do video conferencing," he said. Landline telephone calls are also handled and documented in patient records. The system now has the capability to do 1,000 video visits daily, he said.

Another important element of the response plan is what Dr. Cagir called "the patient safety huddle" first introduced in 2016. Senior leadership staff meets for a half hour each weekday morning to review patient safety issues. By 2018 a second huddle was added to identify trends from the previous day or week and to extrapolate forecasts for the next day or week. "We converted our forecasting and trend huddle to a COVID-19 huddle immediately in February, and the patient safety huddle system became the patient safety and personnel safety huddle," Dr. Cagir said. Huddles were added for Saturday and Sunday.

Dr. Miner explained the huddle works on four staffing levels: front-line, department, hospital, and systemwide.

Joseph Scopelliti, MD, a gastroenterologist and president of Guthrie Clinic, explained that for the huddles to work effectively, they must be blame-free zones. "It means that everybody has to expose their challenges, so the second series of huddles we have every day is the patient safety huddle," he said. "Think of it as the huddle where you have to answer the question, 'What is impeding you from doing your job today?'"

Dr. Cagir explained that the processes the Guthrie Clinic adopted were developed using the Lean Six Sigma and the PDCA cycle (for plan, do, check, act) principles that industry has used to improve efficiency and quality.

"Without a doubt this approach is scalable to every urban and rural center," Dr. Miner said. "Frequent communication has been key." She noted that staff gets a daily e-mail with that day's news, trends and expectations and that there are multiple ways staff can exchange ideas, including a Workplace from Facebook portal.

U.S. Healthcare Homepage