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New York City Council Oversight Hearing: New York City Hospitals’ Reopening Plans

Eric Wei, M.D., Senior Vice President and Chief Quality Officer
NYC HEALTH + HOSPITALS
Wednesday, June 24, 2020

Good morning Chairperson Rivera and members of the Committee on Hospitals. I am Dr. Eric Wei, Senior Vice President and Chief Quality Officer at NYC Health + Hospitals (Health + Hospitals). I am joined by Dr. Andrew Wallach, Chief Medical Officer of Ambulatory Care, and Dr. Shaw Natsui, Director of Emergency Medicine Innovation at Health + Hospitals. Thank you for the opportunity to testify before you today on Health + Hospitals’ reopening plans, which includes: 1) increasing capacity to perform a higher number of scheduled medically necessary surgeries for existing patients; 2) increasing the capacity of limited in-person ambulatory care visits across the health system, while maintaining our hugely successful telehealth apparatus; 3) changing the physical layout of our emergency departments to maximize distance between patients in waiting rooms and care areas, while creating new spaces for isolation and negative pressure rooms to protect spread of diseases such as COVID-19; and 4) continuing to test and trace positive cases for COVID-19.

Health + Hospitals is open and we’re safe. As the City prepares for Phases 2 and 3 of the reopening, we are urging all New Yorkers to seek the care they need and deserve, and we stand ready to care for all patients safely and effectively whether they are existing patients or new to the system who need ongoing, preventative or emergency care. Patients in need of in-person appointments or who are seeking emergency care, will experience a new, safer patient environment that includes:

  • Requiring all patients over the age of two and visitors to wear face masks, and encouraging the use of gloves, which will be offered;
  • Mandatory temperature and symptom check for all patients and visitors;
  • Prompt triage and isolation of any person presenting with fever for further evaluation;
  • Redesigned waiting rooms, floor decals, and updated signage to ensure social distancing;
  • Plexiglas sneeze guards that have been installed at all registration and welcome areas;
  • Clear signs that remind staff and patients of proper personal protective equipment (PPE) use depending on what patient care activities are taking place; and
  • Reserved early-morning appointments for elderly patients and those who are immunocompromised at some clinics.

Inpatient

As previously mentioned, there have been changes in our inpatient setting. As the COVID-19 patient census declined, Health + Hospitals entered the phase of recovery and resilience, and on June 14, in compliance with the New York State Department of Health’s (NYSDOH) directive, the surgical departments across the public health system’s 11 hospitals increased their capacity to perform all essential surgery with a prioritization of approximately 9,000 cases which had been postponed secondary to the Governor’s executive order. From March 16 through June 14, Health + Hospitals only performed emergent, urgent and otherwise essential surgical cases – the latter defined as surgical cases that should not be postponed any longer. Examples include surgery for cancer, increasingly symptomatic patients, etc.

During that time period of restricted surgical cases, several processes were implemented: system wide PPE protocols were developed, a governance structure was put in place at each facility to oversee the performance of scheduled procedures and ensure compliance with the Governor’s executive order. In preparation of reopening our operating rooms, a ‘’roadmap” was developed to facilitate the performance of the cases, which had been postponed.

Since the June 14 lifting of the NYSDOH’s restrictions on surgical procedures, the perioperative leads at each facility have been working diligently to bring back the procedural areas including ambulatory surgery units and the post anesthesia care units, which had been utilized as flex ICU spaces. Each patient is tested for COVID-19 prior to their date of scheduled surgery. Ambulatory care COVID-19 testing capacity was established to provide same day access. Specific operating rooms have been designated for patients who are COVID-19 positive. As of June 21, Health + Hospitals surgical productivity is 79% of what it was pre-COVID-19. In addition, we have 44% ICU capacity and 41% medical surgical capacity in case we are beset with a second COVID-19 surge.

As you know, Coney Island Hospital, Jacobi Medical Center, and North Central Bronx were three Health + Hospitals facilities selected to participate in the State’s 2-week hospital visitation pilot to allow family to visit patients in our hospitals, while taking all precautions to keep everyone safe. Effective today, Health + Hospitals will ease restrictions on visitations in all of its 11 hospitals for the first time since COVID-19 peak. Visits at each of the hospitals will be limited to just one visitor at a time per patient for four hours a day. Patients in all departments of the hospitals will be allowed visitors. Visitors will be advised to perform meticulous hand hygiene, be required to wear appropriate personal protective equipment (PPE), and undergo symptom and temperature checks upon entering the hospital. Restrictions on visitation were implemented during the COVID-19 surge across the State to reduce the transmission of the virus.

Ambulatory Care

Health + Hospitals ambulatory care clinics are also busy transforming to welcome back our patients into a safe environment. The reopening of our 11 hospital-based ambulatory care sites and over 30 Gotham Health community sites will be a phased-in approach to ensure the safety of our patients and staff. In early June, the goal of our outpatient clinics was to have 20 percent in-person visits, while continuing to conduct televisits, by telephone and video, for existing as well as new patients.
Offering primary care and over 90 specialty care services, all patients now have the option to access care from their home through a phone or tablet when it’s clinically safe to do so. Phone and video visits offer a safe alternative for many patients. We were able to quickly scale up telemedicine services, going from just 500 billable virtual visits in the month prior to the COVID-19 pandemic, up to nearly 57,000 in the first three weeks of the pandemic, and over 345,000 televisits through the middle of June. We will continue to provide televisits as an option for our patients seeking ambulatory care remotely.

Our electronic patient portal – MyChart – will allow our patients to save time at their next visit by preparing for their visit online. A few days before their visit, patients can login and complete “eCheck-In” where they can update their contact information, insurance, preferred pharmacy, and other clinical information. Patients will still need to present at the front desk for their visit. MyChart is a free and secure way for patients to manage their health from home 24/7, request medication refills, message their care team, and more. FastCheck visits will offer patients a fast and safe way to have their vitals checked or lab-work done on a day prior to or after a telehealth visit. Patients will be instructed on when and which clinic they should report to for their in-person visit. These FastCheck visits will take approximately 15 minutes and will avoid any prolonged possible exposure to COVID-19.

By September, every New Yorker in the hardest-hit communities will have access to guaranteed health care through the expansion of NYC Care to the remaining boroughs of Queens and Manhattan. This includes hiring 26 providers to ensure a new primary care appointment within two weeks, patient education materials, financial counseling services, and expanded pharmacy hours. Health + Hospitals will also release a Requests for Proposals this summer to engage community-based providers for community outreach and enrollment. The program has already launched in the Bronx, Brooklyn, and Staten Island as part of the Mayor’s Guaranteed Care commitment, offering quality health care services at low or no-cost to New Yorkers who do not qualify for or cannot afford health insurance based on federal guidelines. To date, 22,705 New Yorkers have enrolled in NYC Care.

Emergency Department

Health + Hospitals is reengineering its emergency departments and is working on short-term and long-term solutions to refine spaces, improve patient flow, expand telemedicine and ensure workplace safety. We are reducing the number of entrances to have checkpoints where all patients and visitors will be given masks, a temperature check and the latest NYSDOH guidelines on COVID-19 testing and how to isolate. It’s important to note that visitors with a fever will not be allowed in the hospital; however, patients with a fever will not be denied care. Once inside, all patients and visitors will be required to keep masks on for their stay. At a minimum, emergency department staff will have N95 masks and eye protection even while treating patients in cold zones.

New, easy to clean plexi-glass partitions will be installed near nurse stations, information and registration desks, and triage areas where greeters, clerks, hospital police, and other staff work. Floor markers will indicate where to stand for appropriate distancing in waiting areas and registration lines. Facilities will also have predetermined paths for patients based on their symptoms and likelihood of having COVID-19. There will be separate waiting rooms for patients suspected of having COVID-19 and those who are not. In both areas, chairs will be adjusted and blocked so that patients are not sitting shoulder-to shoulder.

Another strategy to reduce volume within the Emergency Department (ED) is to help patients find a more appropriate place for treatment, like ExpressCare, Labor & Delivery, and other walk-in clinics. This builds upon patient flow changes implemented during the peak of the first surge where providers were placed in front of the EDs to perform medical screening exams and direct patients to the most appropriate care areas including tents, Express Care, or the EDs.

While we continue to expand access to telemedicine visits for patients who do not need urgent, in-person care, the health system is also considering ways to adopt telemedicine technology to serve patients who enter the ED. For example, video conferencing can be adopted to offer virtual encounters and protect health care workers who don’t need to physically examine patients. An ante room, an area between hot and cold zones, allow staff to put on and take off PPE while transitioning from one area to another. During COVID-19 response, the entire ED was transformed into a hot zone and without an ante room, PPE was often worn crossing over from hot to cold zones. While it is difficult to find space to build these rooms in our EDs, the ED teams are looking for creative options, including leveraging existing rooms or sealing off entrances to build temporary walls for ante rooms. Pairing this process with more Provider in Triage (PIT) workflows, which allows low acuity patients to be quickly evaluated and discharged without ever having to step foot into the ED pods behind triage, reduces the number of patients in the physical space of the ED. This makes social distancing more feasible

Test and Trace

Lastly, the ability to test and trace positive COVID-19 cases is key to the reopening of New York City. We now have the capacity for up to 30,000 tests per day in New York City, which will increase to 50,000 per day by August. At Health + Hospitals we offer free, walk in testing at our hospitals, health centers, and new pop-up locations across the five boroughs. There are now more than 200 testing locations throughout New York City, including those run by our public health system. For anyone who is positive, we have hired over 3,000 tracers, more than 50 percent of whom are from the hardest hit communities in New York City, to contact cases and asked them with whom they’ve been in close contact. To date, we’ve been able to reach 97% of people in New York newly diagnosed with COVID-19. Among New Yorkers that have successfully completed the tracing interview, 74% have provided names of those they have been in close contact with and we’re now in the process of contacting those people. Since the beginning of the program, there are 650 contacts who told us they were symptomatic or likely contagious and we were able to instruct them to isolate at home, or provided them with hotel isolation services. We have now prevented a possible 2,000 new cases of COVID-19 across New York City.

While there’s still a lot of work to be done, we are making significant inroads in bringing New Yorkers to our health system for the care that they need. Thank you for the opportunity to testify this morning and we look forward to answering your questions.