Among the many shortage concerns raised by the COVID-19 pandemic is whether there will be enough personnel to handle the surges — particularly as healthcare workers begin to get sick themselves.
As healthcare organizations across the U.S. scramble to keep ahead, they are going to have to rethink how to best use their workforces to maximize capacity, experts said in a virtual panel discussion hosted by the Alliance for Health Policy this week.
"If you look at the models of what a surge might look like — even with optimal mitigation strategies on the public health sector side — we’re going to need to be able to increase hospital capacity by two or three or more times to be able to provide the care," said Stephen Parodi, M.D., executive vice president of external affairs, communications, and brand for The Permanente Federation and associate executive director of The Permanente Medical Group during the chat.
Among the ideas:
Expanding scope of practice and licensure
State legislatures should be looking at licensure and expanding the scope of practice right now.
"To some extent, the public has been aware of the expansion of scope of practice for advance practice nurses," said Polly Pittman, professor of health policy and management and director at the George Washington University Milken Institute School of Public Health. "But there are also really important expansions available for pharmacists and for respiratory therapists, and for clinical laboratory people, for paramedics, for LPNs, for CNAs, all of those kinds of members of the team can potentially do more when they are trained up. So having that authorization for healthcare organizations to be able to use personnel in that way is a really important lever."
A second important area is expedited licensing.
Some have floated the idea of relicensing retired healthcare personnel. But with the virus more likely to cause serious illness among older individuals, that idea wouldn't be advisable, Pittman said.
"But certainly there are a lot of health professionals who do not work in patient care who could be mobilized," Polly said. "That may be renewing licenses, it may be issuing licenses across states in a temporary manner. There are also opportunities to use international professionals who may not be licensed in this country that could receive emergency licenses."
Beyond that, there is an "army" of nursing students graduating this year, she said "There are all kinds of opportunities to mobilize that workforce with temporary licenses as well. You could have, for example, nursing students who haven’t graduated could be operating as LPNs. LPNs that haven’t graduated could be operating as CNAs, et cetera. There’s a lot of room for creativity there and it involves leadership on the part of the licensure bodies, in coordination in response to the needs healthcare organizations have."
A found workforce
There are also staff members who could be repurposed within health systems who could be provided "in-time training" before the surge occurs.
"If you think about it, what we’re finding with the telemedicine work on the outpatient side is we’re going to have a found workforce," Parodi said. "Before even moving to the retired workforce, taking your existing workforce that is, right now, in the moment, they have the training, they have the licensure and then moving them to alternative settings that they might not have been doing before is going to be critically important."
For instance, Kaiser Permanente is actively developing plans knowing there will be a need for more critical care, said Stephen. The idea is to repurpose critical care physicians so they can provide consultation on a telemedicine basis to multiple hospitalists.
"They are going to be repurposed as essentially, think of them as residents that are doing critical care," Stephen said. "And then repurposing other subspecialists to backfill the hospitalists and having the adult family medicine physicians then backfilling the emergency department. So actually thinking through, 'What does that look like? What do the ratios look like for a doubling or tripling of what would be a normal hospital census and working in these different conditions?
Rethinking the worksite
This is not just a hospital-centric strategy, Parodi said.
"We've got to be thinking about skilled nursing facilities and what immediately comes to mind is the initial experience in Kings County up in Washington State where a lot of the morbidity and mortality was centered around a particular skilled nursing facility," Parodi said. "So repurposing either the skilled nursing facilities so we can provide the care there with the appropriate PPE and training or actually using alternative sites like hotels to provide skilled care there, or post-discharge care out of a hospital is going to be critically important."