Last spring, COVID-19 changed how, when and where patients received medical care. Elective surgeries and treatments were postponed; appointments went virtual when possible. Staying home became its own type of good care.
Some patients didn’t have the option to delay care or go 100% virtual, however. At the Atrium Health Levine Children’s cancer and blood disorders program, in-person treatments remained life-saving care for some of our smallest patients. When COVID-19 swept across the country with no handbook and no precedent, the team of providers had to find ways to treat these patients safely – even amid a pandemic.
“Our patients need to get the care we give them,” says Ashley Hinson, MD, a specialist in pediatric hematology and oncology at Levine Children’s. “We had to move very quickly to make it safe for them and for our staff to continue that care.”
The team’s efforts exceeded expectations. About ten pediatric cancer patients came into the hospital with COVID-19, but none of them had any delay in their chemotherapy treatments and all are doing well today.
The plan that led to these incredible results began in March, when Dr. Hinson and the rest of the team began to create a phased approach to pare the Levine Children’s cancer and blood disorders department down to essentials. Which staff members had to remain at the hospital or outpatient center? Who could work remotely? How could they distance patients from each other? How – and when – could they introduce patients and staff back to the hospital? The plan began with questions, and it quickly filled with answers.
Phase 1: Reduced Capacity in the Hospital
At first, the team determined who had to be in the hospital, and who could go virtual. This applied to both staff and patients. At home, staff members supported the on-site team by offering virtual visits, taking notes and writing orders. The team reduced on-site capacity by 25% by shifting patients and staff to virtual treatments when possible, creating social distancing within the hospital and reducing the risk of COVID-19 exposures.
The effective teamwork across locations didn’t begin in March, however. The team already had a strong multidisciplinary approach that relied on technology and cooperation to share data in real time for seamless patient care. When COVID arrived, the close-knit team already had a strong foundation of high-tech collaboration that could bridge virtual and in-person treatments.
The reduced capacity allowed children who were COVID-positive to continue their chemotherapy or transfusions.
“The criteria for patients who had COVID or who even had any signs of COVID were – and still are – very strict,” Dr. Hinson says. “If they had any symptoms, they would go directly into a special room that allowed for isolation. We couldn’t take the chance for anyone getting sick.”
Phase 2: New Strategies for Care
The treatment plan for COVID-positive pediatric patients wasn’t born in a bubble. A multi-disciplinary team of experts from cancer and blood disorders, intensive care, infectious disease, rheumatology and more came together to create a strategy to continue care during the pandemic. They drew upon their fields of expertise, as well as the latest data about the virus.
“The situation was ever evolving. As we learned more about how COVID-19 affected children, we had to adapt,” Dr. Hinson says. “We needed expertise from across the board to support our patients.”
The team learned how to bring more patients back to the hospital safely through new policies that kept COVID-19 exposure risks down. They closed the waiting room; instead, patients checked in outside the door, and at their appointment time, staff brought them directly to the treatment room.
The team also found ways to minimize exposure risks through at-home care. Sometimes this meant virtual visits; other times, it was old-fashioned home visits. Paramedics could perform lab work by going to COVID-positive patients’ homes, for example, and providers could discuss results through virtual visits. The patient could complete the process without leaving home.
“We focused a lot of energy on how to do things for the patient at their home, which is huge for us,” Dr. Hinson says. “We now have options for care that we didn’t have before, and we’d love to continue these services as much as possible.”
What began as temporary measures to reduce hospital capacity became long-term improvements. By allowing patients to receive quality care at home, providers will be able to offer more convenient treatments in the future, especially to patients who live farther away or have mobility or transportation challenges.
‘Calm and Critical Thinking’
During a time when uncertainty was the only certainty, the team came together to create a plan for pediatric cancer and blood disorder patients – and change it, and change it again, as the situation and data progressed.
Some changes will eventually return to the old ways: the waiting room will reopen when it becomes safe, for one. But some changes will become new, better ways: the use of virtual care will only grow, for example.
“We are all challenged on a daily basis, but how we respond to challenge is our power,” Dr. Hinson says. “We can face it with calm and critical thinking or respond with stress and a negative attitude, which is never helpful. We all have to collectively agree on the best plan for the day and that may change tomorrow!”
Learn more about the pediatric cancer and blood disorders care offered by Atrium Health’s Levine Children’s.
