City Hospitals Cooperating to Save Lives
In normal times, health systems may compete with each other to attract patients. In times like this, competition is replaced – at least in Philadelphia – with an extraordinary cooperation transcending business boundaries and embodying the noble mission of medicine: working together to save lives.
In the face of COVID-19, the chief medical officers at the city’s major hospitals are in constant contact to help each other respond to the unprecedented issues and needs of the outbreak. Every day, there are a dozen or so text messages. Twice a week, there are conference calls. They are on a first-name basis.
Rohit Gulati, MD, Executive Vice President and Chief Medical Officer at Einstein Healthcare Network, is part of the joint effort with his counterparts at Philadelphia’s other major healthcare institutions to help each other respond to the crisis.
- Is it safe to reuse N95 masks in the face of severe shortages?
- How do we allocate ventilators if there are not enough for everyone?
- What’s best practice for treating behavioral health patients in this situation?
- What are you seeing in your hospitals? Is the volume high? Is the ICU full?
Those are a few of the questions Dr. Gulati addresses with clinical leaders at Thomas Jefferson University Hospital; Temple University Hospital; Penn Medicine; Children’s Hospital of Philadelphia; hospitals affiliated with Trinity Health, a not-for-profit Catholic health network; St. Christopher’s Hospital; Tower Health; plus officials from Independence Blue Cross and Philadelphia Health Commissioner Thomas Farley, MD.
“The city has really come together,” Dr. Gulati said. “There’s a sense of great collaboration.”
One of the grimmer situations resolved during the meetings was the need for refrigerated trucks to hold bodies overflowing the morgue; at one point, Einstein had 15 bodies with a morgue capacity for eight. The city stepped up and ordered the additional trucks.
In another case, an Einstein patient needed ECMO (extracorporeal membrane oxygenation) – a last-resort life support effort to save a patient’s life – and it was determined during the calls that Jefferson was better prepared to provide the care in this instance. The patient was subsequently transferred and treated.
The medical leaders help each other locate sources of badly needed personal protective equipment, share data and ensure the policies and procedures they’re adapting are safe, advisable and consistent across healthcare systems. Together, they toured the Liacouris Center at Temple, which has been allocated for the treatment of COVID-19 patients.
The collaboration has been comforting in a time of uncertainty. When N95 masks for medical staff became in short supply, for instance, Dr. Gulati wondered about the growing practice of reusing them as opposed to the standard practice of discarding them after a single use. He discussed it at length with his counterparts, who were grappling with the same issue, and they agreed that it was an acceptable, necessary step for all of them to take.
“It’s reassuring,” Dr. Gulati said.
The framework for collaboration came out of a local crisis: the closure of Hahnemann University Hospital. Dr. Farley, the city’s health commissioner, reached out to all the local health systems in 2019 when Hahnemann suddenly announced it was closing that September.
“All the Hahnemann patients had to be reallocated,” Dr. Gulati said. “There were inpatients in mid-treatment, patients in chemotherapy, patients in the last trimester of pregnancy ready to deliver. There was a scramble to move them.”
The city’s major hospitals marshaled their resources for Hahnemann’s patients and staff. “We said, we’ll pitch in. We’ll all help,” Dr. Gulati said. “All the hospitals were able to support the patients and make sure they were all taken care of. We all came together as a city-wide initiative.”
When the Hahnemann crisis was resolved, the group decided to continue their collaboration. “We said we work so well together, perhaps we should look at other city-wide issues,” Dr. Gulati said.
They discussed three possible topics: the social determinants of health, gun violence and the opioid epidemic. They began to tackle the opioid epidemic, specifically, to encourage medical staff to obtain the mandatory special licenses to dispense Suboxone, a drug used to treat opioid use disorder.
They were in the midst of the opioid response when the coronavirus derailed everything else. The structure and precedent enabled them to quickly join forces on COVID-19.
When the outbreak is contained, Dr. Gulati expects the collaboration to continue to bring expertise, consensus and commitment to address other city-wide issues. He said Dr. Farley, the city’s health commissioner, has been pivotal in bringing the city’s health systems together.
Meanwhile, the group exchanges professional information – and personal wishes for each other as allies and first-name colleagues. During the recent holiday celebrations of Passover, Easter, Ramadan and Raisakhi, Dr. Gulati sent the same message to his counterparts at other hospitals as he did to his medical staff:
“There is one commonality in all the above celebrations, and that is the message of hope. At the end of the day all we need is hope and strength. Hope that it will get better – which it will – and the strength to hold on till it does. Wishing you strength and hope.”