UF Health recalibrates everything to take on a global pandemic
Hundreds of faculty members suddenly began teaching their students online. Overnight, a huge workforce transitioned from busy offices to working from home. A new computer algorithm was designed to optimize the use of COVID-19 testing supplies. A quick pivot to telehealth enabled an unprecedented number of medical appointments to go forward. An agile hospital supply chain ramped up to assure that front-line workers had protective equipment. Researchers and clinicians came out of retirement to offer their skills, while colleagues around campus put their sewing skills to work crafting masks for use wherever needed around the health system. Zoom became a thing, a very important thing.
Across the University of Florida Health system, everyone faced a cascade of unprecedented challenges as the coronavirus pandemic arrived and settled in. Thousands of staffers, faculty members and health care workers responded with problem-solving bursts of creativity and resolve to keep the sprawling system humming and to support the front-line workers. These are some of their stories.
Resetting technology at warp speed
At the heart of UF Health’s nimble COVID-19 response is the UF Health Information Technology Services department. Its teams launched unique initiatives that kept virus testing on track, improved the flow of crucial patient information and enabled a surge in telehealth medical appointments. The IT staff also scaled computing resources and front-line support to enable a four-fold increase in the number of employees working remotely.
Gigi Lipori, M.T., M.B.A., senior vice president and the chief information officer for UF Health, credits those successes to a resolute staff.
“There were a lot of long days and late nights for many people,” she said.
For Lipori, one notable accomplishment was the implementation of a complex algorithm to optimize COVID-19 testing resources. In the pandemic’s early days, reagents — the main chemical ingredients for patient testing — were in short supply everywhere. There were other variables: A patient who was relatively healthy and staying at home likely didn’t need as rapid of a COVID-19 test response as one who was acutely ill in the emergency room.
The speed and capacity of testing equipment varies with its design. The algorithm, developed by UF Health clinical leadership to optimize lab routing to account for all those variables, resulted in likely the most complex order ever built into UF Health’s Epic electronic medical record system.
“The algorithm is a solution to make sure we have the right reagent and testing methodologies at the right time in order to maximize our testing capabilities,” Lipori said.
The IT staff also enhanced Bugsy, an infection control module used in Epic, by integrating the lab result and infection workflows. It now issues alerts and automatically sets infection statuses when a test is ordered or a new positive case is discovered. That gives the hospital’s infectious disease and infection control experts valuable and timely information, Lipori said.
The command center is also provided a real-time dashboard that includes data on laboratory testing volumes and results, as well as infection and isolation statuses for patients in the hospital and at external testing locations.
Outside the hospital environment, the IT teams were just as busy. They set up the technology backbone for “virtual clinics” — COVID-19 outpatient testing at sites in Jacksonville, The Villages® and Gainesville. As social distancing took hold, IT staff worked with physicians and administrators to rapidly boost UF Health’s telemedicine capacity. On March 12, UF Health Physicians providers in Gainesville conducted 20 telehealth visits. By April 16, the daily count was 1,497 visits — a 7,385% increase. Today, almost every UF Health outpatient practice has a telehealth component.
As UF Health Web Services devised a new public-facing COVID-19 information and resource site, one of the biggest challenges was obvious: managing the massive flow of information from multiple UF Health departments and colleges as well as other sources. It was decided early on that the site’s primary mission would be addressing immediate questions about COVID-19 and showing how UF Health’s response to the pandemic fit with its patient care and research missions, said Jeffrey Stevens, the assistant manager of UF Health Web Services.
To manage the inflow of material, Web Services quickly expanded its digital communications effort to include content and contributors from UF Health’s communications teams. The site, coronavirus.UFHealth.org, has had more than 174,000 page views since its March 17 launch. It was recognized recently by the well-respected digital agency Modern Tribe as one of the nation’s best crisis-response websites in higher education. The site was commended as a “clean and modern” exemplary resource and for the collaboration among communicators to provide timely updates across the three health campuses.
When COVID-19 precautions emptied some UF Health offices, IT answered the call yet again by boosting the capacity for faculty and staff accessing email and work resources remotely. In Gainesville, IT managed volumes going from about 700 to an unprecedented 2,700 concurrent users; and in Jacksonville, from about 75 to 875 concurrent users.
“We have never had that many people attached to a network at the same time,” Lipori said.
Bringing vital COVID-19 tests to the community
In late March, UF Health experts and their collaborators completed more than 2,000 COVID-19 tests in The Villages®. Overall, there have been more than 16,000 COVID-19 tests conducted for medical and research purposes at UF Health sites in Gainesville, Jacksonville, Cedar Key and The Villages®. See related story elsewhere in The POST.
The nexus of news and decision-making
As the pandemic intensified, UF Health opened its COVID-19 information hub on March 10. By early April, it had evolved into the COVID-19 Command Center. The 24-hour site is the nerve center for gathering and distributing crucial information to health care workers, UF Health staff and the public. It typically includes a cadre of nurses, infectious disease physicians, hospital operations staff and an infection control specialist, among others.
That diversity of disciplines and expertise has been exceptionally valuable, hospital operations leaders said.
“It has allowed us to have someone in the room who can take on any question, regardless of its nature,” said Anna Michelle Brandt, vice president and hospital chief of staff for UF Health Shands.
The Command Center has allowed for potentially cumbersome or time-consuming COVID-19 issues to be handled efficiently and effectively, said Traci Spray d’Auguste, UF Health Shands chief operating officer. Typically, the Command Center fields a variety of calls, including questions about the proper use of personal protective equipment, outpatient COVID-19 testing and patient algorithm updates.
The Command Center has also streamlined the process of contact tracing — identifying workers who interacted with a newly diagnosed COVID-19 patient.
“We immediately identify staff who have had contact with that patient so we can follow up and have them tested as needed to ensure the utmost in employee safety,” d’Auguste said.
While UF Health Shands has a plan for biohazard events, COVID-19 posed some unique challenges. Brandt said Command Center leaders adapted quickly to account for the unique nature of the virus, patients’ isolation needs and guidance from federal disease-control experts. Even the hospital’s plan to deal with a surge of patients needed a revision. Hospitals typically plan and train for a sudden spike in patients due to mass-casualty incidents. The opposite has been true with COVID-19.
“Having a Command Center open this long with the potential for a slow, prolonged swell of patients was something new for us. We adapted our surge plan and updated it for key areas,” d’Auguste said.
Each day, the Command Center staff huddles three times for meetings. Once a day, there is a Zoom meeting with department chairs. All of that keeps information flowing in a timely manner.
“The key in our Command Center setup is having a group of people aware of situations and items that need clarification, attention or discussion,” d’Auguste said. “Ultimately, that gives our physicians one central source of truth.”
Keeping the supply chain on track
As other hospitals competed for a dwindling amount of personal protective equipment, UF Health was able to maintain a steady supply. Tedd Comerford, the associate vice president of supply chain services for UF Health Shands, credits that to a combination of timely action, reliable vendors and crucial donations.
At the beginning of the COVID-19 crisis, Supply Chain Services took inventory and determined which supplies were most at risk. At the time, masks and eye protection were potential trouble spots. Comerford’s team went to work, seeking help from state and county emergency management. Alachua County Emergency Management immediately provided crucial N-95 masks as well as face shields and reusable rubber masks.
UF Health supplies were also bolstered by having a very early, reliable U.S. wholesale source for procedural masks. Within seven days, 200,000 of the masks were on hand. That gave Comerford and his team crucial time to focus on other short- and long-term supply needs.
UF Health also benefits from having a dedicated supply distribution center, a 78,000-square-foot facility near the Gainesville Regional Airport. The site prevents competition with other hospitals that are also seeking supplies and helps UF Health procure products in short order, according to Comerford.
Donations of masks, gloves, face shields and other protective equipment from the local community and distant places such as Illinois and China were critical during the early days of the COVID-19 outbreak. See related story elsewhere in The POST.
“Anyone who needed an N-95 mask got one,” Brandt said. “We have been in a better situation than many of our colleagues at other medical facilities.”