Care 2.0

Nearly a year after Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2 for short), the novel coronavirus that causes COVID-19, first emerged, “normal” feels like a fleeting memory. Many have died, many more have become ill and virtually everyone has been affected by a pandemic that continues to disrupt so many facets of everyday life.

Some things haven’t changed, though, including Cleveland Clinic’s Patients First commitment.

Cleveland Clinic opened in 1921, amid the aftermath of an influenza pandemic that left at least 50 million dead worldwide and spurred healthcare innovations, particularly in the realm of public health. A century later, the coronavirus pandemic is rewriting the playbook yet again.

“This is going to have a lasting effect on society,” says James Merlino, MD, Cleveland Clinic’s Chief Clinical Transformation Officer. “It’s hard to put a positive spin on a pandemic, but I’m optimistic about the good things happening in healthcare now. We’re learning how to deliver care differently, we’re innovating more quickly and we’re raising the bar on safety.”

To keep patients, caregivers and others safe during the pandemic, Cleveland Clinic has put numerous measures in place across its health system. Visitors are limited, and everyone entering a Cleveland Clinic facility has their temperature checked via thermal scanner or  thermal imaging system. They’re also screened for potential COVID-19 symptoms at safety stations, staffed by caregivers from throughout the organization who have stepped up during the crisis. Other safeguards include signs and interior configurations that promote social distancing; expanded testing capabilities; frequent cleaning and disinfection of surfaces; and requiring masks in most settings (as well as eye protection for caregivers in clinical areas).

Above and beyond these universal precautions, specific areas within Cleveland Clinic continue to keep Patients First by innovating and finding new ways to provide the best care possible.

"No one is immune," Dr. Merlino says, "so every part of what we do has been affected."

For the average young person, interacting via screens and electronic devices is second nature. So perhaps it comes as no surprise that Cleveland Clinic Children’s Hospital for Rehabilitation has enjoyed great success integrating telehealth platforms during the pandemic.

“Like our colleagues elsewhere, we’ve been thrust into an environment where we’ve had to find new ways to make things work,” says Michelle Marks, DO, FAAP, SHFM, Medical Director of the hospital.

Speech therapy. Gathering family history for autism or ADHD evaluations. Equipment assessments. Those are just a few examples of the kinds of patient care that increasingly have been accomplished remotely.

“Obviously, some things we can’t do virtually,” says physiatrist Lainie Holman, MD, MFA. “There will always be a lot of value in being able to do an actual hands-on physical examination for a well visit, where many things get discovered. At the same time, there are other things that we can do remotely and still provide good care. If a patient has outgrown the seating on their wheelchair, I don’t necessarily need to see them in person. I can see them well enough with a virtual visit to make recommendations and sign off on the paperwork, without exposing anyone to germs.”

Over the summer, the Children’s Hospital for Rehabilitation temporarily shifted to a hybrid on-site/virtual format for its Pediatric Pain Rehabilitation Program, which takes an interdisciplinary approach to caring for children and families coping with chronic pain. In the morning, patients were on-site for occupational therapy and physical therapy, among other sessions. In the afternoon, they took part in virtual group meetings from their homes. The program has since pivoted to a three-week inpatient format.

Other recent innovations at the hospital could be here to stay, including virtual rounding. Prior to the pandemic, rounding was conducted by a small army of caregivers, with representatives from speech therapy, recreational therapy, occupational therapy, physical therapy, social work, psychology, nutrition, nursing, medicine and other areas often crowding into patient rooms. To limit unnecessary contact, a much smaller group of caregivers now makes rounds in person, with the rest of the team joining in virtually via a tablet.

Virtual rounding likely will stick around long after COVID-19 is in the rearview mirror, predicts Dr. Holman. “It’s faster, it’s more efficient and it gives kids and their families the ability to touch base with the team every day,” she says.

The data paints a sobering picture. During the pandemic, new cancer diagnoses have decreased 45%. Reports of heart attacks and strokes are down, too — 38% and 30%, respectively. It’s not like the population at large suddenly got healthier. Rather, the numbers underscore the fact that many patients have delayed or even avoided seeking care during the pandemic, even after Cleveland Clinic and other health systems resumed elective procedures that had been put on hold in the spring to focus on the coronavirus.

“We’ve seen many patients presenting late for life-threatening conditions,” says cardiac surgeon Aaron Weiss, MD, of Cleveland Clinic’s Sydell and Arnold Miller Family Heart, Vascular & Thoracic Institute. “What’s even more worrisome to me are the patients who aren’t presenting at all — the ones we don’t know about, the ones for whom the reason they didn’t come in ultimately was their demise. More people are dying at home today than a year ago, and you start to get an idea that it’s because they’re not seeking medical attention. So we’re making every effort to demonstrate the safety of our hospital, so patients feel like they can come here without being exposed to COVID-19.”

Virtually nothing has changed in the operating room, where wearing masks and face shields and practicing sound sterile techniques have been par for the course all along. For Dr. Weiss, precautions implemented in other areas of the patient experience have taken some getting used to.

“I like being very personal with my patients,” he says. “Part of that always had been a handshake or even a hug, if the patient offers to give you one. You want them to feel safe. They’re trusting you with their lives, and we take that trust with the utmost respect. Developing that rapport with a patient may not be as easy now — it just takes time. As important as handshaking was, it’s much more important to practice safe hygiene.”

Remaining vigilant and continuing to rise to unforeseen challenges creatively and compassionately are the keys to coexisting with COVID-19 and weathering this crisis, according to Dr. Weiss.

“As much as we all want this pandemic to end, the reality is we have a new normal,” he says. “We have to adjust and to figure out new ways to deliver the same level of care. We’re in this for the long haul.”