Revisiting the ‘Powder Keg’ of COVID’s First Days

The circumvention of institutional hierarchical structure to establish a teamwork atmosphere, and the training of staff in the proper use of personal protective equipment (PPE) helped a large tertiary urban hospital weather the early stages of the coronavirus disease 2019 (COVID-19) pandemic, according to a pre-print study in the American Journal of Infection Control.

Using a qualitative study that depended on in-person interviews with 55 healthcare professionals, investigators also found that the use of telehealth helped hospital staff connect with infectious disease physician specialists which in turn alleviated some fear. There was a lot of that, as well as confusion. One nurse interviewee described her apprehension as a “powder keg ready to kick off.”

As the quote indicates, the interviews, which were conducted from March 2020 to April 2020, offer insight into the frame of mind of those on the frontlines of the COVID-19 pandemic and how they were able to function despite the problems that healthcare professionals are by now all too familiar with such as changing guidance and a shortage of PPE.

“In an emergent time of uncertainty, the compression of formal hierarchies enables clinical staff to deliver care in an ‘all hands on deck’ approach to meet the demands for care,” the investigators concluded. “Evidence-based, robust approaches to public health emergency preparedness, with a focus on supporting the frontline clinical staff, can promote effective responses to both the current COVID-19 pandemic and future public health emergencies.”

Of the 55 healthcare professionals interviewed, 21 were registered nurses, 13 were patient care technicians, 12 were physicians, 5 were respiratory therapists, and 4 were pharmacists. The staff eventually started to lean heavily on telehealth to help them get through the pandemic.

The study states that “there was an expanded role of infectious disease MDs working with all care teams. One MD described the process as the following: ‘There’s an attending backup that is actively helping—not just waiting around for work—but actively helping with new COVID-19 e-consults. There’s a backup fellow that’s doing the same, and we’ve had to recruit medicine residents to help with the workload. So, right now, we probably have three more people—three or four more people—working actively than we would in a non-pandemic situation.’”

The interviewees said that communication was crucial to getting through the immediate crisis. The study states that “given the importance of workforce safety, there is a need for early education to enforce correct PPE use to alleviate personal risk concerns. This includes re-education of the donning and doffing of PPE to confirm staff are effectively protecting themselves. Data suggests substantial self-contamination risk occurs when doffing PPE, therefore re-education is critical.”

Telehealth might help in that regard, as well.

Investigators say that their findings “suggest a need to broaden telehealth technology to support remote patient monitoring, data management, facilitate public health mitigation strategies, and preserve staff. For instance, telehealth delivery offers less exposure to COVID-19. Hence, these clinical staff were available to go into the hospital and provide care should their colleagues fall ill from COVID-19. Other investigators have reported the use of telehealth among quarantined providers, allowing them to continue providing care. Further, tele-ICU models can be expanded for specialists to e-consults at multiple sites.”