As part of the incident command structure at Northwell Health, surge plans are in place from level 1 through level 10 at each of the health system’s 23 hospitals. As of March 31, most facilities were at level 6 or 7; by late April, those numbers were just starting to decline.

“That [would involve] the use of every alternate site possible,” explained Mark Jarrett, MD, MBA, senior vice president, chief quality officer, and deputy chief medical officer at Northwell Health, headquartered in Manhattan. Jarrett spoke during a briefing sponsored by the Patient-Centered Outcomes Research Institute (PCORI) on March 31.

Northwell has turned to alternative locations such as ambulatory care sites as the demand for care has escalated and strained traditional facilities and departments. The health system also is working with predictive modeling to anticipate care needs each day and predict what will be happening by the end of each week.

“What you have to do is plan for the worst,” Jarrett advised. That means determining where both beds and staff will come from under the direst circumstances. “You just have to map out scenarios and say if this happened, what would we do? If it got worse, what would we do?” The same types of exercises are ongoing at Stony Brook University Hospital in Stony Brook, NY, explained Carol Gomes, chief executive officer and chief operating officer.

“It’s really about flexibility and adaptability,” said Gomes, who also spoke during the PCORI briefing. “We have emergency credentialing processes in place so physicians who are not typically ICU physicians will have privileges to take care of patient populations they haven’t taken care of before or haven’t taken care of in recent times.” In addition to emergency credentialing, Stony Brook has identified recently retired individuals, including nurses, physicians, and allied healthcare personnel, in the region.

“We have sent notifications to them, and we are obtaining lists of volunteers who are willing to come back and participate in our workforce,” Gomes reported. “These are some of the creative things we are doing, but most certainly we have a heightened sense [of concern]. Every day we think it is the worst that we have ever seen before, but then the next day seems to be even worse.”

For hospitals still awaiting a crush of COVID-19 patients to arrive, the time to map out precisely how to manage such a surge is now, Jarrett advised. “It is always hard. As they say in the Army, your strategy always works until the first bullet is fired ... but you really need to plan as much as possible.”