How a Transitional Care Leader’s Organization Survived the Pandemic Chaos
In this Q&A, Hospital Case Management asked Vera Usinowicz, APN-C, supervisor of The Center for Comprehensive Heart Failure Care at The Valley Hospital in Ridgewood, NJ, to discuss how her transitional care unit kept heart failure patients out of the emergency department and hospital during the COVID-19 pandemic.
HCM: What kind of changes did the center make during the early days of COVID-19?
Usinowicz: We moved from the hospital to an offsite location during the pandemic. We moved twice in 2020 in an effort to keep our patients safe and to minimize the viral exposure to patients at our current location in the hospital.
We moved again in 2021, and that was very stressful for staff as well as for patients. But we continued to provide our services by using our mobile intensive care unit (MICU), allowing them to dispatch registered nurses and paramedics who work in collaboration with the heart failure program to bridge a gap that would be evident in heart failure care services. The RN paramedic staff take direction from the advanced practice nurses in the heart failure program to provide individualized care and medication infusions in the patient’s home. This reduces risk of heart failure hospitalization.
HCM: What tactics helped with transitional care?
Usinowicz: We used telehealth medicine with success. We had some patients who were immobile and were having symptoms of heart failure, including elderly, frail patients with limited mobility. We didn’t have the staff or ability to see all of them. When we moved offsite for COVID in early 2020, we could only see two patients at a time.
At first, they were using our hospital space for COVID patients. Moving offsite was a big stress. We used telehealth management to make sure our patients stayed out of the hospital. It was successful because our readmission rate did not go up. Our mindset is that if we can prevent patients from coming to the hospital with heart failure symptoms, this opens up beds that are needed for COVID patients.
In the long run, this prevents exposing a heart failure patient to the hospital during the COVID pandemic. This was a priority goal for our program, despite not having the office availability to see a full complement of patients.
Since patients can be vaccinated for COVID-19, there are many who are eagerly wanting to come back for face-to-face visits. It makes them feel safe, comfortable, and they know that any emergent or urgent needs can be met with a visit to the heart failure care center.
HCM: Many hospitals and case management programs reported staffing problems from December 2021 through January 2022. Did your program also experience these issues?
Usinowicz: Unfortunately, we have had staff out for extended periods because they contracted COVID. This cuts down on our staff resources and ability to see patients. But we have employed our mobile health and dispatch health services and telehealth medicine in place of seeing patients due to staffing resource issues.
[Many] patients can be remotely monitored because they have implanted devices that allow us to read their fluid volume status. We have the capability of monitoring patients’ volume status through either a pulmonary artery sensor implant or through their pacemaker or defibrillator device. We have employed these practices in our program, and they continue to grow. All the devices are FDA approved and are covered by third-party payers and Medicare.
Our nursing staff is trained to review the remote monitoring of the implants daily, or as needed. It helps us manage their diuretic therapy without actually seeing the patient and doing a physical exam. It’s pretty cool stuff that we didn’t have at our disposal seven or eight years ago.
HCM: How do you use case management with these patients?
Usinowicz: We use case management especially when we see the patient for the first time, to identify any further needs for ongoing home care, blood draws in the home, support with medication management, or to help identify other home resources patients may need to reduce risk for heart failure readmission.
By employing these strategies with remote monitoring and MICU visits, we were able to meet the goals of patients’ care, even during the pandemic.
HCM: How have you maximized capacity and maintained staffing levels in trying conditions?
Usinowicz: Due to circumstances, sometimes we needed to be creative to maintain our staffing levels, especially when staff were redeployed to other units or departments. We also needed to help staff de-stress and develop resilience.
As supervisors, we were told we could offer staff additional resources to help manage their stress levels and deliver care during the pandemic. The resilience classes provided lessons on self-care, including telling us how to de-stress, decompress, and acknowledging patients are going through the same things in a different arena. We’re the care providers, but the stress level due to COVID could be equal amongst patients and care providers.
Staff were offered resources online, such as the NJ Hopeline for confidential counseling. There also was Nurse2Nurse, a peer support line staffed by nurses trained in mental health to speak to other nurses.
We had resilience lounges that allowed staff a space to disconnect during breaks without being interrupted. We had our spiritual care department go to staff meetings at managers’ requests to offer support, regardless of faith background.
To support my staff, I made sure they received encouragement and recognition of their outstanding care.
It’s all about trying to maintain a positive atmosphere despite what was going on, and letting them know they could come to us if they needed to discuss anything. We have an open-door policy.
HCM: Were any staff redeployed? Did any staff quit during the past two years?
Usinowicz: We had no staffing turnover. We’re a small group, but nobody is looking to leave. They’re passionate about what we do.
We were all redeployed during 2020 and 2021. We had staff give monoclonal therapy to COVID patients. We had staff redeployed to COVID units. We had our nurse practitioner staff redeployed to critical care. In 2020, I worked 12-hour night shifts in a pop-up critical care unit because of COVID overflow.
During those times when we were moved out of the hospital and our 10-chair area to an offsite area, we had the ability to see four or five patients a day instead of 16 per day, and we had a skeleton crew.
We stayed in touch by email. The goal was to make sure none of us felt out of touch with each other and felt isolated. It was very hard. I tried to keep them together so they knew they would come back to the program, and nobody decided to walk away.
With omicron, we were not redeployed, so we’ve been back at the hospital since the second redeployment in April 2021.
Keeping the program going during the COVID-19 pandemic is a testament to healthcare workers, nurses, doctors, and to everyone who has an impact on patient care during an unprecedented pandemic.
As leaders, utilizing all specialties and all support — including case management — provides us with the armament to continue to give high-quality care for heart failure patients during this unique time.In this Q&A, Hospital Case Management asked Vera Usinowicz, APN-C, supervisor of The Center for Comprehensive Heart Failure Care at The Valley Hospital in Ridgewood, NJ, to discuss how her transitional care unit kept heart failure patients out of the emergency department and hospital during the COVID-19 pandemic.
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